Journal of women's health最新文献

Objective: The American College of Obstetricians and Gynecologists recommends offering genetic carrier screening (GCS) to all patients desiring pregnancy or who currently are pregnant. At our urban academic center, we observed that not all appropriate patients were offered GCS. This study aimed to target identified barriers, including health care provider comfort in offering GCS and lack of standardized resources, ultimately increasing the number of patients offered this testing. Methods: This project was implemented in an urban academic medical center's obstetrics and gynecology (OBGYN) clinic. A needs assessment was performed to determine the baseline comfort level of OBGYN providers regarding expanded GCS and identify barriers. Interventions, including a didactic educational session and template changes in the electronic medical record, were tailored to address the identified concerns. The impact of these interventions was evaluated using a postdidactic evaluation, statistical analyses, and tracked documentation of GCS counseling. Results: The average mean number of visits with documentation of GCS preference in the initial obstetric visit in the preintervention period (August to November 2020) was 38%. Preintervention needs assessment revealed limited provider comfort with offering expanded GCS. Evaluations following the didactic session demonstrated a significant increase in providers' comfort levels, particularly regarding pre- and post-GCS test counseling. The average number of visits documenting carrier screening preference substantially increased during and after the study period. Statistical analyses confirmed the significance of these improvements. Conclusions: Despite identified challenges and limitations, targeted educational interventions proved effective in improving provider confidence and increasing the number of visits with documentation of GCS preference.

Rationale: Obstructive sleep apnea (OSA) during pregnancy is linked to negative maternal and neonatal outcomes. Diagnosing OSA in this population is particularly challenging. Portable monitoring devices (PMD) present a potential alternative to polysomnography (PSG), but their effectiveness in pregnant women is uncertain. Objective: To evaluate diagnostic accuracy of a PMD to detect OSA in pregnant women. Methods: A prospective study of 136 middle-aged pregnant women (34 ± 4 years) in their third trimester of pregnancy (34 ± 3 weeks) who underwent laboratory type III PMD and PSG simultaneously. Results: Using an apnea-hypopnea index (AHI) ≥5 event/h by PSG, OSA was diagnosed in 10.3% of women (mild OSA: 86%; moderate OSA: 14%). An acceptable positive correlation was found between both tests in the AHI (r = 0.787; p < 0.001) and oxygen desaturation index (ODI) (r = 0.806; p < 0.001). The agreement limits between PSG and type III PMD were -4.1 to 5.4 for AHI and -6.0 to 4.5 for ODI. The sensitivity and specificity of type III PMD for an AHI ≥5 events/h were 57.1% and 99.2%, respectively, with a positive predictive value (PPV) of 88.9% and a negative predictive value (NPV) of 95.3%. On a receiver operating characteristic curve, the best cutoff point of AHI by type III PMD to identify OSA according to PSG criteria was 2.25 events/h. The sensibility and specificity for this point were 85.7% and 88.5%, respectively, with a PPV of 46.2% and NPV of 98.2%. Conclusions: A type III PMD with an AHI cutoff of 5 events/h could be a good alternative for OSA diagnosis in pregnant women. Additionally, an AHI ≥2.25 event/h demonstrates good diagnostic performance, but its low positive predictive value suggests that it is more appropriate as a screening tool. Further studies are needed to validate this sleep study tool in pregnant women, particularly in home settings.

Background: Gender bias is a pervasive issue in health care, contributing to poorer health outcomes for women compared with men. In the United States, studies have shown a slowly improving, but persistent, disparity exists for gender-specific procedures' relative value units (RVUs). This study aims to build on existing literature and conduct a large-scale analysis examining comparable gender-specific surgical procedures to determine whether there remains a disparity in RVUs/reimbursements for care provided to female patients. Methods: Using 110 CPT codes, we compared work RVU and reimbursement rates for facility and nonfacility procedures within the 2023 dataset for anatomically similar gender-specific procedures, verified by a group of gynecologists and urologists. We analyzed the procedures over a 20-year period with RVUs from 2003 to 2023 to determine how the difference between the gender-specific procedures was changing over time. We also used the same design and 22 current procedural terminology (CPT) codes as Goff (1997) and Benoit (2015) to compare RVUs between 1997, 2015, and 2023. Results: For the 55 gender-specific procedures, 41 (75%) had lower RVUs for procedures on female patients in 2023. RVUs for procedures on male patients were 30% higher on average. For facility reimbursement, 35 (64%) were higher for procedures on male patients-with a 25.6% higher reimbursement on average, correlating to an average reimbursement of $75.73 more for male procedures. For nonfacility reimbursements, male procedures were reimbursed 20% higher on average. Between 2003 and 2023, there were no statistically significant improvements in the reimbursement disparities for male versus female procedures, with male procedures consistently having an average RVU 31-34% higher. The disparity narrowed minimally between 1997, 2015, and 2023. Conclusion: There remain significant disparities between gender-specific procedures, with lower RVUs/reimbursements for procedures on female patients and minimal change over the past three decades. Addressing these disparities is crucial for achieving gender equity in health care and ensuring equally valued medical services.

Background: Endometriosis, dysmenorrhea, and respiratory symptoms affect large numbers of women. A possible association between asthma and endometriosis has been suggested; however, this relationship is unclear. Dysmenorrhea is very common, and potential associations with asthma symptoms are not known. Aim: To study asthma symptoms associated with endometriosis and dysmenorrhea in women. Methods: We used data from the main and women's questionnaires of the Respiratory Health in Northern Europe study, which included data from women (aged 39-65 years) from Aarhus, Gothenburg, Umeå, Uppsala, Reykjavik, Tartu, and Bergen. Current asthma status was defined by asthma medication usage or asthma attacks in the past 12 months. Asthma symptoms were defined as having ≥3 asthma symptoms in the last 12 months. The data were analyzed using logistic regressions adjusted for age, body mass index, and smoking status. Results: Among 4778 study participants, 201 had endometriosis, and 2154 had dysmenorrhea. Current asthma and asthma symptoms were reported by 14.9% and 12.9%, respectively, of women with endometriosis compared with 9.1% and 9.2%, respectively, of women without endometriosis. The associations of current asthma and asthma symptoms with endometriosis were statistically significant (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.25-2.81; and OR: 1.56, 95% CI: 1.01-2.39, respectively). Similar associations were found for dysmenorrhea (current asthma: OR: 1.48, 95% CI: 1.21-1.81; ≥3 asthma symptoms: OR: 1.61, 95% CI: 1.31-1.97). Conclusion: Our study revealed that asthma symptoms were associated with both endometriosis and dysmenorrhea. The associations with dysmenorrhea, which affects a large proportion of women, were almost as strong as the associations with diagnosed endometriosis.

Background: There is growing awareness that the experiences of neurodivergent people during menopause are not well understood. Menopause may be particularly challenging for autistic people due to common co-occurring conditions such as depression and differences in sensory processing. The few (mostly qualitative) studies to explore autism and menopause suggest that autistic traits may be exacerbated. Methods: In an online cross-sectional survey, we examined self-reported menopause symptoms of 342 people (autistic, n = 242 and non-autistic, n = 100) at different stages of their reproductive life (premenopausal [∼20% of sample], menopausal [∼30%], postmenopausal [∼50%]). Results: Autistic people reported significantly higher rates of bothersome psychological and somatic menopause symptoms than non-autistic people, but no differences were observed for vasomotor symptoms. Results indicated different patterns of psychological, somatic, and vasomotor symptoms between the autistic and non-autistic groups. People in the menopause and postmenopause groups reported negative changes in symptoms, but non-autistic women reported these as more negative than autistic women. Whether this finding is related to the observation that autistic people report more bothersome psychological and somatic symptoms before the menopause requires further investigation. Conclusion: This cross-sectional analysis suggests that autistic people may experience more bothersome symptoms during menopause compared with non-autistic people. Longitudinal studies examining change are required to fully understand the variables that impact individual experiences for autistic people.

Background: Unprecedented stressors have significantly impacted our nation. These occurrences compounded the prepandemic structural factors that disproportionately affect historically, economically, and socially marginalized communities of color and women as highlighted by the National Academies of Sciences, Engineering, and Medicine. In response, health care organizations and regulatory bodies have shifted from the quadruple aim to the quintuple aim to conceptualize health care improvement by adding to the prioritizing of the health workforce's well-being and advancing health equity (Nundy, Cooper, & Mate, 2022). The literature presents limited and conflicting information regarding workforce well-being based on demographic background. A 2021 report by the National Academies of Sciences, Engineering, and Medicine described the potential for race, ethnicity, gender identity, sexual orientation, age, and disability status to alter or amplify the career impacts of COVID-19 (National Academies of Sciences, Engineering, and Medicine, 2021). Methods: In 2020, the Association of American Medical Colleges (AAMC) convened a Women of Color and Intersectionality Initiative ("Initiative") to understand better and address factors contributing to the well-being challenges encountered in health systems by women of color (WOC). Results: Based on a rigorous review of existing data and national trends, the group concluded that WOC continue to exist and work at the margins and that the threat of "not belonging" is a key factor impacting their well-being. The authors, who are members of this AAMC WOC Intersectionality Initiative, identified key strategies in the domains of intersectionality and equity, work-life boundaries, gendered divisions of labor, and mental health and well-being for implementation and evaluation in future studies. Conclusion: Over the last 4 years, the health and scientific workforces have encountered staffing shortages, increased attrition rates, and an overall decline of wellness. Authors and thought leaders in this space have postulated the need to refine tools and methodologies to capture intersectional differences to inform strategy. This article presents recommendations from the Initiative that include solutions that prioritize intersectionality, which can be adopted by academic health systems to support the well-being of WOC.

Introduction: The 2021 update to the United States Preventive Services Task Force guidelines for lung cancer screening (LCS) aims to reduce disparities derived from sex, race/ethnicity, and socioeconomic status. Few studies have addressed adherence to LCS among female Veterans. Methods: To evaluate differences in adherence to LCS by sex, we conducted a retrospective cohort study within the VA Connecticut LCS Program between June 2013 and March 2020. Our primary outcome was nonadherence, defined as lack of completion of a chest CT scan within the guideline recommended interval plus a 90-day grace period. Eligible patients were enrolled in the screening program and had a baseline Lung-RADS score of 1, 2, or 3. Patients with Lung-Reporting and Data System (RADS) 4 were excluded due to variability in follow-up recommendations. We adjusted for age, race, smoking history, mental/medical comorbidities, and primary care (PC) visits (1-year after first/index CT). Logistic regression modeling was used to determine associations between sex and nonadherence overall and stratified by Lung-RADS 1-2 and Lung-RADS 3. Results: Among 4,711 Veterans, the overall rate of nonadherence was 34%. Female Veterans were 66% more likely nonadherent to follow-up (odds ratio [OR] = 1.66, confidence interval [CI] = 1.19-2.30) compared with male Veterans. Substance use disorder was associated with greater nonadherence (OR = 1.22, CI = 1.01-1.47). Lower nonadherence was observed among patients with COPD (OR = 0.77, CI = 0.66-0.9) and PC engagement (OR for nonadherence with 5 or more PC visits = 0.78, CI = 0.67-0.91). The associations between sex and nonadherence were similar in models stratified by Lung-RADS groups 1-2, although did not reach significance for the Lung-RADS 3 group. Discussion: In this cohort, female Veterans were more likely nonadherent. More work is needed to understand the distinct barriers to LCS follow-up among female Veterans. Health care system engagement significantly reduced nonadherence, which may partially explain higher rates of nonadherence among female Veterans who had fewer medical comorbidities.

Objectives: Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. Materials and Methods: We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (n = 54) or nonabortion gynecological care (n = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics. Results: This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is "morally acceptable and should be legal." Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (p < 0.001), with no differences by appointment type. Educational attainment (p = 0.03) and Democratic party affiliation (p = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, p = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, p < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care. Conclusions: Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.