Throughout West African societies, at times of social crises, postmenopausal women — the Mothers — make a ritual appeal to their innate moral authority. The seat of this power is the female ...genitalia. Wielding branches or pestles, they strip naked and slap their genitals and bare breasts to curse and expel the forces of evil. In An Intimate Rebuke Laura S. Grillo draws on fieldwork in Côte d’Ivoire that spans three decades to illustrate how these rituals of Female Genital Power (FGP) constitute religious and political responses to abuses of power. When deployed in secret FGP operates as spiritual warfare against witchcraft; in public it serves as a political activism. During Côte d’Ivoire’s civil wars FGP challenged the immoral forces of both rebels and the state. Grillo shows how the ritual potency of the Mothers’ nudity and the conjuration of their sex embodies a moral power that has been foundational to West African civilization.
Aim
To explore the barriers and facilitators to sexual discussions in primary care according to a sample of women aged 50 and older living with Type 2 diabetes.
Design
A qualitative, interpretative ...phenomenological analysis study.
Methods
Ten women aged 50–83 years living with Type 2 diabetes were interviewed between August 2016 ‐March 2017. Data were analysed using interpretative phenomenological analysis.
Results
The participants reported changes to their sexual health and well‐being, which they attributed to diabetes, menopause, ageing and changes in intimate relationships. Not all changes were considered problematic, but those that were, tended not to be discussed with healthcare professionals. The women assumed that the topic of sex was not broached by professionals due to embarrassment (both their own and that of the healthcare professional), ageism and social taboos around older women's sexual pleasure. The place that sexual health and well‐being held in the women's lives also influenced primary care discussions.
Conclusion
These findings demonstrate that social taboos around gender, ageing and sex influenced the barriers to sexual health and well‐being discussions in primary care. Facilitators to overcoming these barriers were professional–patient rapport, consulting with a female healthcare professional and instigation of the conversation by healthcare professionals.
Impact
Type 2 diabetes can have a negative impact on women's sexual health and well‐being. Prior to this study, little evidence existed of the barriers that older women with Type 2 diabetes faced with regard to sexual health care. This study shows that midlife‐older women with Type 2 diabetes can experience sexual health and well‐being problems which are neglected in primary care. It also shows that women want their healthcare professionals to explore these problems. Raising awareness and giving training for healthcare professionals may lead to better provision of sexual health support for midlife‐older women with Type 2 diabetes.
摘要
目的
以50岁及以上患有2型糖尿病的妇女为样本, 探讨初级保健中性讨论的障碍和促进因素。
设计
一项定性的、解释性的现象学分析研究。
方法
在2016年8月至2017年3月期间, 对10名年龄在50至83岁且患有2型糖尿病的女性进行了访谈。采用解释现象学分析对数据进行了分析。
结果
参与者报告了其性健康和幸福的变化, 将其归因于糖尿病、更年期、衰老和亲密关系的变化。并非所有的改变都认为是有问题的, 而实际上那些有问题的改变, 往往不会与医疗保健专业人员讨论。这些女性认为, 因为感到尴尬 (她们自己以及医疗保健专业人员都会感到尴尬) 、存在年龄歧视以及谈论老年女性性快感等社会禁忌, 专业人员不会提起性话题。性健康和幸福在女性生活中的地位也对初级保健的讨论造成了阻碍。
结论
这些调查结果表明, 性别、老龄化和性等社会禁忌对初级保健中性健康和幸福的讨论造成了障碍。要想克服这些障碍, 需要专业人员与患者建立融洽关系, 提供女性医疗保健专业人员以便患者咨询以及医疗保健专业人员不断进行沟通。
影响
2型糖尿病会对妇女的性健康和幸福产生负面影响。在进行本研究之前, 很少有证据表明患有2型糖尿病的中老年妇女在性保健方面面临障碍。本研究表明, 患有2型糖尿病的中老年妇女可能会遇到在初级保健中被忽视的性健康和幸福问题。此外,还表明妇女希望相关医疗保健专业人员能够对此类问题进行探讨。提高对保健专业人员的认识和培训, 可以更好地为患有2型糖尿病的中年老年妇女提供性健康支持。
The incidence of breast cancer increases with age. Despite this, most research in this field is aimed at the younger patient. Preliminary studies have shown that older women with breast cancer have ...distinct biological features compared to their younger counterparts. In addition, the focus of treatment of older women may not simply be curative but may be a trade-off between risks of treatment and impact on independence and quality of life. The Nottingham research programme is a unique programme dedicated to primary breast cancer in older women. There are two arms of the research programme 1) determining the biological differences of breast cancer in this cohort 2) exploring the use of geriatric assessment to understand the complex needs and factors contributing to treatment decision making in this group of patients. The overall aim of the research programme is to optimise both the biological and geriatric assessment of older women with primary breast cancer, to provide personalised data at diagnosis, on likely survival and quality of life outcomes following breast cancer treatment. This article will outline why this research programme is important, what it has achieved so far and future aspirations.
Despite national guidelines recommending omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy (RT) in older women with early-stage, hormone receptor-positive (HR+) breast ...cancer, these practices persist. This pilot study assesses whether a decision aid can target patient-level determinants of low-value treatments.
We adapted and pilot-tested a decision aid in women ≥70 years old with early-stage HR + breast cancer. Primary outcomes included acceptability and appropriateness of the decision aid. Secondary outcomes included treatment choice and satisfaction with decision.
Twenty-three patients enrolled in the trial. 19 completed survey one; 16 completed survey two. Primary outcomes demonstrated that 84% of patients agreed or strongly agreed the aid was acceptable and appropriate. Secondary outcomes demonstrated that 19% of patients underwent SLNB (below pre-intervention baseline), and 85% received adjuvant RT (change not statistically significant).
We demonstrate that a decision aid may effectively target patient-level factors contributing to overuse of low-value therapies.
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•Older women find a breast cancer decision aid highly acceptable and appropriate.•Patients report increased satisfaction with their treatment choices.•Patients endorse improved shared-decision making.•The decision aid may reduce utilization of low-value cancer therapies.
Trotman and Brody, along with expert contributors, view older women through a feminist lens and examine social constructs concerning aspects of aging, caregiving, elders' relationships with family, ...health, body image, and sexuality concerns. The authors define issues that are important to older women and their emotional health and bring into sharp relief some of the painful issues professionals must confront in counseling older women.
Objective
This study investigated whether loneliness or social isolation is associated with the onset of functional disability over 4 years among Chinese older populations.
Setting and Subjects
This ...study used data from the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Analyses were conducted with data from two waves (2011 and 2015) and were restricted to those respondents aged 50 and older and free of functional disability at baseline n = 5,154, mean age (SD) = 60.72 (7.51); male, 52.3%.
Method
Social isolation, loneliness and covariates were measured at baseline. Follow-up measures of new-onset ADL and IADL disability were obtained 4 years later. We stratified the sample by gender, and then used binary logistic regressions to evaluate the associations between baseline isolation, loneliness and new-onset ADL and IADL disability.
Results
For women, baseline social isolation was significantly associated with new-onset ADL (OR = 1.18, 95% CI = 1.07–1.30) and IADL (OR = 1.11, 95% CI = 1.01–1.21) disability; no significant association between loneliness and ADL or IADL disability was found. For men, neither social isolation nor loneliness was found to be significantly associated with ADL or IADL disability.
Conclusion
This longitudinal study found that social isolation, rather than loneliness, was significantly associated with functional disability over 4 years among women (but not men) in China. These findings expand our knowledge about the association between social relationships and functional status among non-Western populations.
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