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A study of 25 nonprofit and 87 for-profit nursing homes showed both types likely to offer education on advance care planning. However, nonprofits were more likely to have ongoing discussions that covered more than life support decisions and to have ethics committees to support advance care planning. (SK)

If used properly, the lactational amenorrhea method (LAM) can be a valuable family planning tool, particularly in low-income countries; however, the degree to which LAM is used correctly and characteristics associated with its use have not been well documented. We therefore sought to use nationally representative data from Niger, where fertility rates are high and women may have limited access to alternative contraceptive methods, to describe the proportion of women who use LAM correctly and the characteristics associated with LAM use. We utilized cross-sectional data from the 2006 Niger Demographic Health Survey. Our sample included all sexually active, non-pregnant, breastfeeding women using some form of contraception (N = 673, unweighted). We used weighted frequencies to describe the correct use of LAM and logistic regression models to describe women who chose LAM for contraception. Among our sample, 52 % reported LAM as their primary method of contraception, but only 21 % of the women who reported using LAM used it correctly. Women who reported using LAM were more likely to live in certain regions of the country, to have no formal education, and to have delivered their most recent baby at home. They were also less likely to have discussed family planning at a health facility or with their husband/ partner in the past year. Results indicated that few women in Niger who reported using LAM used it correctly. Our findings reinforce the need to address this knowledge gap, especially given Niger's high fertility rate, and may inform efforts to improve family planning in Niger and in other low-income countries. Keywords Lactational amenorrhea method * Family planning * Contraception, Introduction Unintended pregnancies, those that are either unwanted or mistimed, may lead to unsafe abortions which can increase the risk for morbidity and mortality among women. Unintended pregnancies may also [...]

Objective To conduct a cross-national comparative study of the prevalence and correlates of female genital cutting (FGC) practices and beliefs in western Africa. Methods Data from women who responded to the Multiple Indicator Cluster Surveys between 2005 and 2007 were used to estimate the frequencies of ever having been circumcised, having had a daughter circumcised, and believing that FGC practices should continue. Weighted logistic regression using data for each country was performed to determine the independent correlates of each outcome. Findings The prevalence of FGC was high overall but varied substantially across countries in western Africa. In Sierra Leone, Gambia, Burkina Faso and Mauritania, the prevalence of FGC was 94%, 79%, 74% and 72%, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6%. Older age and being Muslim were generally associated with increased odds of FGC, and higher education was associated with lower odds of FGC. The association between FGC and wealth varied considerably. Burkina Faso was the only country in our study that experienced a dramatic reduction in FGC prevalence from women (74%) to their daughters (25%); only 14.2% of the women surveyed in that country said that they believe the practice should continue. Conclusion The prevalence of FGC in western Africa remains high overall but varies substantially across countries. Given the broad range of experiences, successful strategies from countries where FGC is declining may provide useful examples for high-prevalence countries seeking to reduce their own FGC practices. [TEXT NOT REPRODUCIBLE IN ASCII.] Mutilations genitales feminines: pratiques et croyances actuelles en Afrique de l'Ouest Objectif Realiser une etude comparative transnationale de la prevalence et des indicateurs des pratiques et croyances en matiere de mutilations genitales feminines (MGF) en Afrique de l'Ouest. Methodes Les donnees fournies par des femmes ayant repondu aux enquetes en grappes a indicateurs multiples entre 2005 et 2007 ont servi a estimer la frequence avec laquelle elles avaient ete excisees, avaient fait exciser une ou plusieurs de leurs filles et pensaient que les pratiques de MGF devaient se poursuivre. Une regression logistique ponderee a ete realisee afin de determiner les indicateurs autonomes de chaque resultat. Resultats La prevalence des MGF etait generalement elevee mais variait de maniere significative d'un pays d'Afrique de l'Ouest a l'autre. En Sierra Leone, Gambie, Burkina Faso et Mauritanie, la prevalence des MGF etait de 94%, 79%, 74% et 72%, respectivement, alors qu'au Ghana, Niger et Togo, cette prevalence etait inferieure a 6%. Un age plus avance et le fait d'etre musulmane constituaient des facteurs generalement associes a des risques accrus de MGF et un degre d'education plus eleve etait associe a des risques plus faibles. L'association entre MGF et aisance financiere variait considerablement. Le Burkina Faso etait le seul pays de notre etude a avoir note une diminution spectaculaire des MGF des femmes (74%) a leurs filles (25%); seules 14,2% des femmes interrogees dans ce pays ont declare penser que cette pratique devait se poursuivre. Conclusion La prevalence des MGF en Afrique de l'Ouest reste generalement elevee mais varie de maniere significative d'un pays a l'autre. Compte tenu du large eventail d'experiences, des strategies reussies dans des pays ou les MGF sont en baisse peuvent fournir des exemples utiles a des pays a forte prevalence desireux de diminuer leurs propres pratiques de MGF. [TEXT NOT REPRODUCIBLE IN ASCII.] Mutilacion genital femenina: practicas actuales y creencias en Africa occidental Objetivo Llevar a cabo un estudio comparativo entre paises de artica occidental sobre la prevalencia y correlacion de las practicas de mutilacion genital femenina (MGF) y las creencias relacionadas. Metodos Se emplearon los datos procedentes de las mujeres que respondieron a las Encuestas de Indicadores Multiples por Conglomerados entre 2005 y 2007 para calcular el porcentaje de mujeres que habian sido sometidas a una ablacion, el de hijas de dichas mujeres que habian sido sometidas a una ablacion y la creencia de que las practicas de MGF deberian mantenerse. Se realizo una regresion logistica ponderada empleando los datos procedentes de cada pais para determinar las correlaciones independientes de cada resultado. Resultados La prevalencia de la MGF fue alta en general, si bien variaba de manera sustancial en los diversos paises de africa occidental. En Sierra Leona, Gambia, Burkina Faso y Mauritania, la prevalencia de la MGF fue de un 94%, 79%, 74% y 72%, respectivamente, mientras que en Ghana, Niger y Togo la prevalencia fue inferior al 6%. Una edad mas avanzada y la condicion de musulmana se asociaron generalmente a una mayor probabilidad de haber sufrido una MGF, mientras que se asocio una educacion superior a una menor probabilidad de MGF. La asociacion entre MGF y riqueza variaba ostensiblemente. Burkina Faso fue el unico pais dentro del estudio que experimento una reduccion drastica en la prevalencia de la MGF entre las madres (74%) y las hijas (25%). Solo el 14,2% de las mujeres encuestadas en dicho pais afirmaron considerar que debia continuarse con dicha practica. Conclusion La prevalencia de la MGF en affica occidental sigue siendo elevada en general, si bien varia sustancialmente entre los diversos paises. Teniendo en consideracion la amplia variedad de experiencias, las estrategias fructiferas en paises donde la MGF esta descendiendo podrian servir de ejemplo util a los paises con una mayor prevalencia que deseen reducir sus practicas de MGF., Introduction More than 100 million girls and women have undergone female genital cutting (FGC, also known as 'female circumcision'), and more than 3 million female infants and children are at [...]

Conducting qualitative interviews with seriously ill individuals about end-of-life issues is challenging for interviewers seeking to understand the problems, processes, and experiences individuals undergo when faced with death and dying. Although all qualitative interviewers face issues of building trust and obtaining answers to their research questions, these issues are exacerbated for interviewers of end-of-life issues due to the challenges of debilitated participants, sensitive subject matter, and heightened emotionalism. The purpose of this article is to offer field-tested techniques to tailor basic interviewing practices for discussions of end-of-life issues with seriously ill individuals. Use of tailored techniques facilitates the comfort of both interviewer and participant and enhances the probability of obtaining complete and accurate data, which in turn can improve the effectiveness of subsequent programs, policies, and clinical practice based on research findings. doi: 10.2190/OM.60.1.e

The primary percutaneous coronary intervention (PCI) is a reperfusion therapy, which improves the chances of survival of a patient by reestablishing blood flow in the infracted artery.

One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence concerning the effectiveness of fall-prevention services, describe barriers for clinicians and for payers in promoting these services, and suggest strategies to encourage greater use of these services. The challenges are substantial, but strategies for incremental change are available while more broad-based changes in health care financing and clinical practice evolve to better manage the multiple chronic health conditions, including falls, experienced by older Americans. Key Words: Falls interventions, Falls prevention, Fall-risk evaluation, Medicare, Preventive approaches

A study is conducted to examine different hospital strategies associated with a faster door-to-balloon time during primary percutaneous coronary intervention. Results show that many specific hospital strategies are associated with a significant reduction in the door-to-balloon time during treatment.

Objectives. The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. Methods. Analyzing data from the first four waves (1992-1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1-Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. Results. Among individuals with below median net worth, Wave 1-Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. Discussion. Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health.