Breast health care. A review.

Breast health care was rarely acknowledged in the health and science fields prior to this century and has only begun, in recent years, to receive attention outside of pregnancy/lactation or cancer screening and treatment. Yet much health care is involved with regard to this reproductive and sexual organ. With any group of clients, practitioners of women's health care must address an assortment of breast health matters. This article offers an overview of the history of breast health care, the epidemiology of benign breast conditions and cancer, the anatomy and physiology of the breast, and breast development over the lifespan. Also presented are a review of breast assessment and examination, suggestions for routine care of the breast, and an overview of major health issues related to this reproductive organ. Health issues addressed include, among others, nodular and cystic changes, nipple discharge, breast/nipple pain, mastitis, elective alterations, and cancer. Discussion is focused on the latest approaches to optimal breast health care.

The menopausal experience of African American women: overview and suggestions for research.

Menopause and its effects on women's health status and needs have only recently received the increased attention of scholars and clinicians that many feel is long overdue. However, one major area of neglect that continues today regards the climacteric in minority populations within the United States, including the largest minority group, African Americans. This review summarizes issues that have potentially limited the amount of information available regarding menopause in African Americans. These issues include differing perspectives on the climacteric within research and clinical arenas, the difficulty of studying race as a variable in scholarly investigations, and methodological factors that have led to underrepresentation of minorities in studies of menopause. General considerations, as well as specific suggestions, for research questions when investigating the climacteric experiences of African American women are offered.

The relation of cortisol reactivity and anxiety to perinatal outcome in primiparous adolescents.

The relation of cortisol reactivity and self-report anxiety to perinatal outcomes was examined in a sample of 38 primiparous adolescents. Maternal cortisol and anxiety levels obtained in the first half of pregnancy and in mid-third trimester were found to be related to the gestational age of newborns, with higher levels of cortisol and/or anxiety predicting greater chance of pre- or postmature birth. However, when measured over time, a greater increase in cortisol levels was more predictive of positive perinatal outcomes, such as no meconium in labor. These findings suggest that certain levels of maternal reactivity/anxiety are necessary for positive perinatal outcomes.

Barriers to breast cancer screening in older women. A review.

As health care reform unfolds over the next several years, nurse-midwives will be increasingly addressing issues of health care in women of all ages across the life span. For older women, a prevalent condition that has received minimal attention in this age group has been breast cancer. Distinctions have been noted in the literature between older and younger women in terms of the biology, screening, and treatment of breast cancer. Despite theories that breast tumors in older individuals are more indolent and slower growing than those found in younger women, older women's mortality from breast cancer is higher. Although part of this is theorized to be due to other biologic processes, such as increased immune suppression with aging, it appears that most of the distinction between the courses of breast cancer in older and younger individuals has been related to decreased screening during advanced age. This manuscript describes the individual client, health care provider, and health care system barriers to each of the three major elements of breast cancer screening--breast self-examination, clinical breast examination, and mammography. Suggestions and caveats including ethical, legal, and political issues regarding breast cancer screening in older women are presented.

Cortisol reactivity and self-report anxiety in the antepartum: predictors of maternal intrapartal outcomes in gravid adolescents.

A prospective, longitudinal investigation of the relation between cortisol reactivity, self-report anxiety and labor and delivery outcomes was undertaken in a sample of non-urban pregnant adolescents. Cortisol and anxiety levels obtained in the first half of pregnancy and again in mid-third trimester were found to be related positively to several individual negative labor and delivery outcomes, as well as to a summary score of negative maternal intrapartal outcomes. However, when changes in cortisol and anxiety over pregnancy were examined, greater increases in cortisol and anxiety over time were negatively related to individual negative intrapartal outcomes, as well as to the maternal intrapartal outcomes summary score. Findings indicate that while an assessment of how individuals react to stress at certain points during pregnancy may be predictive of intrapartal outcomes, longitudinal examinations of gravid women's reactivity/anxiety states may be more indicative of their psychophysiological preparation for the intrapartum, and may be more predictive of outcome.

Overview of contemporary families.

Perceptions and definitions of the term family have always been varied and complex. Hence, an overview of contemporary families is presented here from several perspectives. First, families as they have been perceived by nursing and social science theorists are reviewed. Demographic changes in the family over the last two decades are then presented, followed by an examination of issues faced by families as they change over time. Finally, families as they exist within varying cultural and social contexts are discussed. Emphasis is placed on the need for health care providers to be flexible in defining and working with individual patients and their families.

The life span perspective: a developmental approach to community health nursing.

Following the nursing theorists' tradition of using an interdisciplinary approach to community health model building, the concepts of the life span perspective on human development were applied to the practice of community health nursing. As with the perception of individual development from this perspective, communities are viewed as evolving over time, with changes occurring across levels of influence--human, societal, historical, and cultural. These levels are interdependent, and factors from any one or more can affect the growth and functioning of the community. Implied in this interdependence is the ability not only to intervene in a community's development, but to go beyond this and recognize that a community has a degree of control over its own development. To be accurate and thorough in working with communities, the community health nurse who takes a life span perspective must be cognizant of the fact that communities do exist in a continual, multilevel, interactive manner that develops through time. Demonstrating the practical use of this perspective, a model for the assessment phase of the nursing process as applied to community study was developed. A pilot study was performed using this model, and initial results suggest that taking a life span perspective toward community health is both valid and practical, and warrants further scholarly investigation.

Feminism and nurse-midwifery. Historical overview and current issues.

Despite the fact that the profession of nurse-midwifery and feminism are both disciplines concerned with women and issues affecting women's lives, there has been little investigation or acknowledgement of relationships between their two paradigms. The work presented here is an attempt to discover both similarities and differences between nurse-midwifery and feminist thought. Using a historical approach, it is shown that despite the common goal of improving and maintaining women's status in the world, whether in general or more specifically with regard to health, feminist theorists and nurse-midwives, to a large degree, have worked separately from each other, rarely acknowledging in any formal way the importance of the other discipline. Current issues that have an effect on the practice of nurse-midwifery today--lay midwifery, the profession of nursing, and nurse-midwifery research--are presented in relation to contemporary feminist thought.