RESUMO
BACKGROUND: The aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down's syndrome and to examine the contribution of background and decision-making variables. METHODS: Pregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the 'Multidimensional Measure of Informed Choice' that has been developed and applied in the UK. RESULTS: In total, 71% of the Dutch women were classified as informed decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation. CONCLUSION: Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.
Assuntos
Tomada de Decisões , Síndrome de Down/diagnóstico , Etnicidade , Pais/psicologia , Diagnóstico Pré-Natal/psicologia , Síndrome de Down/etnologia , Feminino , Humanos , Consentimento Livre e Esclarecido , Países Baixos , Gravidez , Suriname/etnologia , Turquia/etnologiaRESUMO
OBJECTIVE: To evaluate ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome and to relate these to differences in participation. METHOD: The study population consisted of 270 pregnant women from Dutch, Turkish and Surinamese (African and South Asian) ethnic origin, attending midwifery or obstetrical practices in the Netherlands. Women were interviewed after booking for prenatal care. Considerations were assessed by one open-ended question and 18 statements that were derived from focus group interviews. Actual participation was assessed several months later. RESULTS: Women from ethnic minorities were less likely to participate in prenatal screening, which could be attributed to differences in age and religious identity. They more often reported acceptance of 'what God gives', low risk of having a child with Down syndrome and costs of screening as considerations not to participate in prenatal screening. They also reported many considerations in favour of participation, which did not differ from those of Dutch women but were less often consistent with actual participation in screening. CONCLUSIONS: Women from ethnic minorities should not be stereotyped as being uninterested in prenatal screening, but should be better informed about the consequences of prenatal screening and Down syndrome.
Assuntos
Síndrome de Down/diagnóstico , Doenças Fetais/diagnóstico , Programas de Rastreamento/psicologia , Diagnóstico Pré-Natal/psicologia , Adulto , Feminino , Humanos , Programas de Rastreamento/estatística & dados numéricos , Países Baixos , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Suriname/etnologia , Turquia/etnologiaRESUMO
OBJECTIVE: To develop a theoretical framework for analysing ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. METHODS: We applied Weinstein's Precaution Adoption Process (PAP) Model to the decision of whether or not to participate in prenatal screening for Down syndrome. The prenatal screening stage model was specified by reviewing the empirical literature and by data from seven focus group interviews with Dutch, Turkish and Surinamese pregnant women in the Netherlands. RESULTS: We identified 11 empirical studies on ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. The focus group interviews showed that almost all stages and determinants in the stage model were relevant in women's decision-making process. However, there were ethnic variations in the relevance of determinants, such as beliefs about personal consequences of having a child with Down syndrome or cultural and religious norms. DISCUSSION: The prenatal screening stage model can be applied as a framework to describe the decision-making process of pregnant women from different ethnic backgrounds. It provides scope for developing culturally sensitive, tailored methods to guide pregnant women towards informed decision-making on participation or non-participation in prenatal screening for Down syndrome.
Assuntos
Técnicas de Apoio para a Decisão , Síndrome de Down/diagnóstico , Síndrome de Down/etnologia , Aconselhamento Genético/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Diagnóstico Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Países Baixos , Gravidez , Suriname/etnologia , Turquia/etnologiaRESUMO
In order to evaluate the quality of obstetric care in Curacao, a systematic and comprehensive investigation of foetal and neonatal deaths was carried out in the 2-year period, 1984-1985. Two hundred and twenty-three (223) consecutive foetal and neonatal deaths occurred in the Island during this period. Asphyxia during labour was the principal cause of death in 35 (15.7 per cent) cases most of which occurred in term infants (25/35, 71 per cent). Intrapartum death occurred in 25 (71 per cent) cases and 10 (29 per cent) infants died in the early neonatal period. On the whole, patients' compliance with antenatal care was satisfactory. However, when the woman presented in labour, the attending physician or midwife often lacked information on the antecedents of the mother and pregnancy. In addition, inadequate intrapartum surveillance together with failure to respond appropriately to abnormalities in labour constituted the main factors which were associated with asphyxiated deaths. Moreover, asphyxial conditions were often preceded by inappropriate administration of oxytocin agents. On the basis of these findings, it is recommended to identify more clearly women whose pregnancies are considered to be at medium or high risk, to improve intrapartum surveillance and to reappraise criteria for referral to the hospital classified as level 2 (secondary care) (AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Asfixia Neonatal , Cuidado Pré-Natal , Trabalho de Parto , Mortalidade Infantil , Ocitocina/administração & dosagemRESUMO
In Curacao a systematic and comprehensive investigation of numerous factors, potentially associated with an increased risk of foetal and neontal mortality, was carried out in a 2-year period (1984-85). The inquiry was restricted to singleton births. Data on 205 women who experienced pregnancy loss were compared with those on 913 women who did not sustain foetal or noenatal loss. Data comprised information on maternal characteristics, clinical course of pregnancy and delivery, and neonatal characteristics. Of 130 factors measured, 14 were entered into a multivirate analysis. From the analysis 5 risk factors emerged as significant predictors of mortality: gestational age, birth weight, sex, foetal presentation and congenital anomalies. Factors such as social class, marital status, maternal age and parity were not associated with an increased risk of foetal and neontal mortality in Curacao. (AU)
Assuntos
Humanos , Gravidez , Recém-Nascido , Adulto , Feminino , Morte Fetal/epidemiologia , Mortalidade Infantil , Análise de Variância , Parto Obstétrico , Estilo de Vida , Fatores de Risco , Fatores Socioeconômicos , Índias OcidentaisRESUMO
The Perinatal Mortality Rate (PNMR) is considered to be an indicator of perinatal health. To ascertain the validity of the perinatal mortality statistics in Curacao, medical records and death certificates were reviewed over a five year period. Using a birth weight of 1,000 gm as a cut-off point, 366 foetal and first-week deaths were recovered from the statutory death certificates. Using similar criteria, 19 perinatal deaths, identified in the medical records, were not registered as such on the death certificates (registration failure 4.9 percent). Hence, the revised annual PNMR ranged from 19.0 to 31.2 per 1,000 births during the period 1979-1983. Additionally, the contribution of low birth weight (LBW)(<2,500gm) to perinatal mortality was examined during 1984-1985. LBW was associated with 68.6 percent of all perinatal deaths using a birth weight of 500gm as truncation point. However, it is argued that the high proportion of LBW to perinatal mortality is not the result of an adverse birth weight distribution of the Curacao population (AU)
Assuntos
Humanos , Recém-Nascido , Mortalidade Infantil , Atestado de Óbito , Recém-Nascido de Baixo Peso , Prontuários Médicos , Antilhas HolandesasRESUMO
Cancer of the cervix is the second most common cancer affecting women in Curacao. We reviewed, retrospectively, the records of all women with a newly diagnosed, histologically proven, cancer of the cervix or carcinoma in situ over a 10-year period (1973-1983). Although the total number of newly diagnosed cases of cervical cancer rose from 59 during the first five-year period to 70 in the second five-year period, the age-standardized prevalence rate remained the same (16.8 per 100,000 women per year). There was also an increase in the total number of newly diagnosed cases of carcinoma in situ during the second five-yuear period (1973- 1978 n=9 versus 1978-1983 n=31). However, no difference in age-standardized prevalence rate of carcinoma in situ could be established for the two five-year periods. The ratio of carcinoma in situ to cervical cancer was found to be low (1:2, 3-5, 6). Because the effectiveness of cytological screening for cervical cancer in terms of reducing the development of the disease (i.e. lowering the prevalence) and if the disease occurs, by reducing its severity (i.e. higher ratio of carcinoma in situ to cervical cancer) is well established, routine screening of women between 30 and 55 years of age is advised (AU)