Uneasy allies: pro-choice physicians, feminist health activists and the struggle for abortion rights.

Abortion represents a particularly interesting subject for a social movements analysis of healthcare issues because of the involvement of both feminist pro-choice activists and a segment of the medical profession. Although both groups have long shared the same general goal of legal abortion, the alliance has over time been an uneasy one, and in many ways a contradictory one. This paper traces points of convergence as well as points of contention between the two groups, specifically: highlighting the tensions between the feminist view of abortion as a women-centred service, with a limited, 'technical' role for the physicians, and the abortion-providing physicians' logic of further medicalization/professional upgrading of abortion services as a response to the longstanding marginality and stigmatisation of abortion providers. Only by noting the evolving relationships between these two crucial sets of actors can one fully understand the contemporary abortion rights movement. We conclude by speculating about similar patterns in medical/lay relationships in other health social movements where 'dissident doctors' and lay activists are similarly seeking recognition for medical services that are controversial.

Women's health centers and minority women: addressing barriers to care. The National Centers of Excellence in Women's Health.

New models of care delivery have been developed to better coordinate and integrate healthcare for women. In the United States, one of the challenges is to incorporate the needs of racial and ethnic minority populations into these newer care paradigms. This paper begins with a brief historical review of the experience of racial and ethnic minorities in the American healthcare system to provide a context for discussing barriers and limitations of more traditional models of women's healthcare. Specific approaches used by National Centers of Excellence in Women's Health are presented as examples of strategies that may be implemented by other communities to address these barriers.

Adding aging and gender to the women's health agenda.

The complex interaction of medical, social, and economic factors that affect women's wellness as they age requires a new paradigm that bridges the gap between those who are concerned about aging issues and those concerned about women's health. In this article, we begin this endeavor by advancing three interrelated themes: (1) there is a gendered relationship between socioeconomic structures and health over time; (2) there are gender-specific implications of health care financing and policy; and (3) there are health consequences to the gendered nature of caregiving.

Identifying and caring for underserved populations: experience of the National Centers of Excellence in Women's Health.

From 1996 through 1998, 18 National Centers of Excellence in Women's Health (CoEs) were designated by the Office on Women's Health (OWH) of the U.S. Department of Health and Human Services (DHHS). These CoEs were charged with developing standards for comprehensive, multidisciplinary, and culturally competent approaches to women's health. One specific mandate to the CoEs was to address the needs of underserved women. This paper presents the efforts of the CoE Racial and Ethnic Minority and Underserved Women Working Group to describe the work done within the CoEs to meet this mandate. One method of defining underserved populations is the seven-point definition used in the current "Index for Primary Care Shortage," which categorizes underserved populations based on characteristics including race, ethnicity, geography, and health outcomes. The definition allows the local identification of underserved communities based on this group of variables. The analysis included in this paper focuses specifically on the CoEs' efforts to operationalize this definition in order to meet the clinical care needs of women who are of low socioeconomic status (SES), racial or ethnic minorities, or non-English speaking. A brief review of the literature linking these characteristics to being underserved is provided, followed by examples of ongoing activities at the 15 currently funded CoEs, to understand the needs of diverse women, to improve the quality of care provided to women, and to address healthcare needs of underserved women who meet this definition. Efforts to serve three additional underserved populations defined by age, sexual orientation, and disability status are also presented.

A conceptual model for the recruitment of diverse women into research studies.

Researchers' understanding of recruitment and retention of study subjects is in its infancy. To address the dearth of information on the underrepresentation of diverse populations of women in research studies relating to health issues, the University of California, San Francisco (UCSF) National Center of Excellence in Women's Health completed a comprehensive examination of issues related to recruitment. By synthesizing data from literature reviews, focus groups, surveys, one-on-one interviews, and direct experience recruiting diverse populations of women for research, a conceptual model was developed. This model outlines the interplay of three factors found to be relevant to the recruitment of diverse populations of women into research studies: awareness, acceptance, and access. Practical examples of cost-effective recruitment strategies to be considered for implementation to increase the presence of awareness, acceptability, and access are included in this report.

Women's satisfaction with primary care: a new measurement effort from the PHS National Centers of Excellence in Women's Health.

This paper describes efforts by the National Centers of Excellence in Women's Health to develop a woman-specific primary care satisfaction instrument suitable for quality improvement and research.

Challenges of recruitment: focus groups with research study recruiters.

To rectify the historic lack of research on women's health and the exclusion of women from many significant clinical trials, regulations have been promulgated requiring the inclusion of women and minorities in research studies. Acknowledging that the National Institutes of Health (NIH) mandate has resulted in more inclusive research, the unintended consequences associated with implementation of these regulations must also be explored. While the requirements preclude the use of cost as a reason for excluding women and/or minorities, the additional funding necessary to recruit adequate numbers of study participants has not been provided. Consequently, study recruiters often face unacknowledged expectations and job pressures as they attempt to meet recruitment goals. While it is important to support the NIH mandate, the additional stress imposed upon research study recruiters must also be recognized. Focus groups with study recruiters from various backgrounds and types of research provide an understanding of the challenges recruiters face when attempting to recruit diverse populations of women into research, and provide an understanding of the impact of recruitment goals on study recruiters' job satisfaction.

National Centers of Excellence: moving ahead with the federal agenda.

The University of California at San Francisco stands as a model for integrated, comprehensive healthcare services for women--encouraged and supported by a grant from the U.S. Public Health Service Office on Women's Health. Meeting government criteria is not easy, says Manager Tracy Weitz--but satisfied customers make the effort worthwhile.

Hypertension and micro-albuminuria in diabetic patients taking indapamide.

The effects of indapamide on diabetic patients with micro-albuminuria were evaluated in a multicentre study to assess the advantages of this compound in long-term renal protection. Thirty-two hypertensive diabetic patients (10 males, 22 females, aged 46-84 years) were given indapamide at 2.5 mg/day for a 2-month period. There was a significant fall in systolic blood pressure (174 +/- 18 to 148 +/- 12 mmHg, P less than 0.001) and diastolic blood pressure (95 +/- 13 to 85 +/- 8 mmHg, P less than 0.001) and in the albumin excretion rate (median, 40.8 to 18.9 mg/l; P less than 0.05). Blood glucose, glycosylated haemoglobin, electrolytes, creatinine and serum lipids remained unchanged. There was a small but significant correlation between changes in systolic blood pressure and changes in albuminuria (r = 0.04, P less than 0.05). Thus, the effect of indapamide on albumin excretion cannot be explained by a decrease in the intraglomerular perfusion pressure alone. Indapamide, therefore, might be of potential interest in the long-term renal protection of the diabetic patient with elevated blood pressure values and/or micro-albuminuria.

Assessment of indapamide in elderly hypertensive patients with special emphasis on well-being.

One hundred forty-nine patients between 56 and 80 years of age with mild to moderate hypertension received indapamide (2.5 mg per day) monotherapy for 12 weeks. In addition to studies of the efficacy and tolerance of indapamide, the study comprised an assessment of well-being, which was carried out objectively by the physician, and subjectively by the patient himself, by means of a list of complaints and a visual analogue scale. The mean blood pressure was lowered from 179/91 mm Hg (supine) before treatment to 149/81 mm Hg at the end of the treatment. The general well-being of the patients, as judged by the physician, showed a markedly positive evolution. The patients themselves indicated that their most frequent symptoms, such as sleep disorders, functional organic disturbances, and sensory and motor fatigue, had improved by 65 to 85 percent, indicating a tendency to better compliance.

[Prevention of motion sickness with a transdermal therapeutic system containing scopolamine. A randomized, comparative double-blind study in the German Federal Navy]. / Kinetoseprophylaxe mit TTS-Scopolamin. Eine randomisierte, vergleichende Doppelblindstudie bei der Bundesmarine.

To test the prophylactic value of anti-motion sickness drugs, a randomized double-blind trial was undertaken on 46 young, healthy, male volunteer marines. Comparison was made between a transdermal therapeutic system (TTS) containing as the effective agent scopolamine (TTS-scopolamine) and proprietary meclozine tablets. An artificial "sea voyage" served to produce motion sickness, each subject sitting by himself on an artificially tilting "island", on two days for 30 minutes. Without treatment, 19 of the 46 subjects developed symptoms of motion sickness requiring treatment. After administration of TTS-scopolamine or meclozine tablets (double-dummy technique) the motion sickness score was reduced by 89% and 59%, respectively. There was a reduction on the visual analog scale of 98% and 59%, respectively. Probability of error (Fisher's exact probability test) for assuming therapeutic advantage of TTS-scopolamine over meclozine tablets was 13.5%. A pre-set significance level of 5% was thus not reached. This trial shows that TTS-scopolamine, even in a brief exposure, has at least the same effectiveness as meclozine, in addition to avoiding the gastrointestinal tract and maintaining with certainty a constant blood level over three days.