Health as continuity and balance in life.

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interpretive-phenomenological method illustrates that the participants, experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did not view health and disease as polarized. Rather, disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.

A comparison of outcomes between joint and physician-only obstetric practices.

Since 1981, the cesarean birth rate of a joint practice has been consistently lower than that of physician-only practices at a private community hospital in Yolo County, California. This study sought to determine whether differences in perinatal outcomes were influenced by women's use of a joint versus a physician-only practice or were associated with parity, maternal age, or newborn birthweight. Data from the hospital's 1634 consecutive singleton births in 1990 were examined, using a prospective concurrent analytic cohort study design. Chi square statistics and stepwise logistic regressions were used for data analysis. The joint practice had a significantly lower rate of total cesarean births (9.3%) compared with the physician-only practices (17.7%); the frequencies of severe lacerations were 1.0 percent and 6.4 percent, respectively. No significant differences were found in parity, birthweight, or newborn outcomes in the two types of practice. Type of practice was the major determinant of cesarean birth (p < 0.0001). All variables studied, including type of practice, were significant determinants of primary cesarean birth. Parity and practice type were significant determinants of third- and fourth-degree lacerations (p < 0.0001). The type of practice from which women receive care is significantly associated with both method of birth and possibility of severe perineal trauma.