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Evaluating the Full Plate Living lifestyle intervention in low-income monolingual Latinas with and without food insecurity 评估在有和没有粮食不安全的低收入单语拉丁美洲人的全餐生活方式干预
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221091350
Maud Joachim-Célestin, Nicholas J. Rockwood, Camille Clarke, S. Montgomery
Introduction: Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity. Objectives: The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach. Methods: Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months. Results: At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without. We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas. Conclusion: Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.
导言:长期以来,粮食不安全一直与身体和精神健康状况不佳有关,特别是在代表性不足的少数民族妇女中。尽管为减少粮食不安全做出了努力,但生活在美国的拉丁裔的发病率继续上升,并且仍然高得不成比例。在2019冠状病毒病大流行期间,拉丁裔报告的心理健康症状比其他任何族裔都要严重。迫切需要减轻拉丁裔人与粮食不安全有关的健康负担,需要采取更有针对性和创新的办法。事实证明,在服务不足的人群中,采用普及教育方法的干预措施是有效的,特别是由社区卫生工作者提供的干预措施。然而,参与者的粮食不安全状况往往没有报告,也不清楚有无粮食不安全状况的结果是否有所不同。目的:这项准实验研究的目的是在社区卫生工作者采用流行教育方法领导的多成分健康干预后,检查有和没有粮食不安全的拉丁美洲人的身心健康变化。方法:纳入的肥胖拉丁裔(N = 98)有或没有食物不安全,对人口统计学、健康行为和心理健康调查做出了回应,并在基线、干预后立即和3个月时完成了生物特征测量。结果:在基线时,食物不安全的参与者比没有食物不安全的参与者报告更多的焦虑和抑郁,但平均体重指数是相当的。抑郁、焦虑和体重指数在3个月后较低,组间无统计学差异。粮食不安全的参与者从干预中受益的程度与没有粮食不安全的参与者一样多。我们发现,虽然社区卫生工作者不是有执照的卫生保健专业人员,但通过适当的培训和支持,他们能够成功地降低粮食不安全的拉丁美洲人患慢性病的风险,改善他们的心理健康症状。结论:鉴于有希望的结果,应在拉丁裔社区粮食不安全妇女中更大规模地实施类似的干预措施。还应探讨长期可持续性。
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引用次数: 1
Metabolic syndrome in middle-aged and older women: A cross-sectional study 中老年妇女代谢综合征:一项横断面研究
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455065211070673
M. A. Moreira, S. D. da Câmara, S. Fernandes, I. G. Azevedo, Alvaro Campos Cavalcanti Maciel
Objective: This study aims to compare the prevalence of metabolic syndrome between different age groups of middle-aged and older women and to assess whether these differences are independent of potential covariates. Methods: Study conducted with 510 women divided into three age groups: 45–54, 55–64 and 65–74 years. Socioeconomic, reproductive and lifestyle variables were self-reported. We defined metabolic syndrome using the National Cholesterol Education Program Adult Treatment Panel III criteria (abdominal obesity, diabetes, reduced high-density lipoprotein, elevated triglycerides, and hypertension). Logistic regression assessed the association between age groups, and metabolic syndrome was adjusted for covariates (socioeconomic variables, age at menarche and at first childbirth, parity, menopausal status, physical activity variables and smoking). Results: Women aged 55–64 years presented higher prevalence of all metabolic syndrome criteria than the other groups, except for abdominal obesity, which was higher in the oldest group. In the fully adjusted analysis, the 55–64 years age group continues to exhibit significantly higher odds of presenting metabolic syndrome when compared to the youngest group (45–54 years) (OR = 2.257; 95% CI = 1.20:4.24). There was no statistical difference in the odds of presenting metabolic syndrome when comparing the oldest and the youngest groups (OR = 1.500; 95% CI = 0.85:2.65). Conclusion: The higher prevalence of metabolic syndrome among those aged 55–64 years may indicate that middle-aged women become unhealthy earlier in the life course and that many of them may die prematurely. This result highlights the importance of screening metabolic syndrome earlier in the midlife and the need for public health policies aimed at reducing adverse effects in later years.
目的:本研究旨在比较中老年妇女不同年龄组代谢综合征的患病率,并评估这些差异是否独立于潜在的协变量。方法:对510名女性进行研究,分为三个年龄组:45-54岁、55-64岁和65-74岁 年。自我报告社会经济、生殖和生活方式变量。我们使用国家胆固醇教育计划成人治疗小组III标准(腹部肥胖、糖尿病、高密度脂蛋白降低、甘油三酯升高和高血压)来定义代谢综合征。Logistic回归评估了年龄组之间的相关性,并对代谢综合征的协变量(社会经济变量、初潮和初产时的年龄、产次、更年期状态、体力活动变量和吸烟)进行了调整。结果:55-64岁的女性 除了腹部肥胖,年龄最大的组的所有代谢综合征标准的患病率都高于其他组。在完全调整的分析中,55-64 与最年轻的组相比,岁年龄组出现代谢综合征的几率仍然明显更高(45-54 年)(或 = 2.257;95%CI = 1.20:4.24)。当比较年龄最大组和最年轻组时,出现代谢综合征的几率没有统计学差异(OR = 1.500;95%CI = 0.85:2.65)。结论:55-64岁人群中代谢综合征的患病率较高 年龄可能表明中年妇女在生命的早期变得不健康,其中许多人可能过早死亡。这一结果突出了在中年早期筛查代谢综合征的重要性,以及制定旨在减少晚年不良影响的公共卫生政策的必要性。
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引用次数: 0
Puerperal sepsis-related knowledge and reported self-care practices among postpartum women in Dar es salaam, Tanzania 坦桑尼亚达累斯萨拉姆产后妇女的产褥病相关知识和自我保健实践报告
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221082954
Dorice B Nchimbi, A. Joho
Background: Knowledge and reported self-care practices of postpartum women are important for early detection, prevention and treatment of puerperal sepsis. Objectives: This study analyzes the knowledge and self-care practices for prevention of puerperal sepsis and their determinants among postpartum women. Methods: A hospital-based analytical cross-sectional study which included 343 postpartum women was conducted from February to March 2021. Data were collected using interviewer-administered questionnaire. Predictors of knowledge and self-care reported practice were determined using binary logistic regression. p < 0.05 was considered significant. Results: More than half (n = 213, 62.1%) of the postpartum women had adequate knowledge on prevention of puerperal sepsis. Only 39 (11.4%) of the women reported adequate self-care practices toward prevention of puerperal sepsis. Secondary education (adjusted odds ratio = 0.18, 95% confidence interval = 0.06–0.49, p = 0.001), tertiary education (adjusted odds ratio = 0.52, 95% confidence interval = 0.19–1.38, p = 0.021) and getting information from healthcare providers (adjusted odds ratio = 1.06, 95% confidence interval = 0.55–2.06, p = 0.049) were significant determinants of knowledge on prevention of puerperal sepsis. Also, secondary education (adjusted odds ratio = 0.11, 95% confidence interval = 0.04–0.30, p = 0.001), tertiary education (adjusted odds ratio = 0.16, 95% confidence interval = 0.06–0.39, p = 0.001), and having more than four antenatal care visits (adjusted odds ratio = 1.21, 95% confidence interval = 0.49–3.27, p = 0.041) were significant determinants of reported self-care practices for prevention of puerperal sepsis. Conclusion: A significant gap in reported self-care practices to prevent puerperal sepsis was evidence. Secondary and tertiary education were significant predictors for both knowledge and self-care reported practices. Special attention should be given to women with low education level.
背景:产后妇女的知识和自我护理实践对产后败血症的早期发现、预防和治疗很重要。目的:本研究分析了产后妇女预防产后败血症的知识和自我护理实践及其决定因素。方法:2021年2月至3月,对343名产后妇女进行了一项基于医院的横断面分析研究。使用访谈者管理的问卷收集数据。使用二元逻辑回归确定知识和自我护理报告实践的预测因素。p < 0.05被认为是显著的。结果:超过一半(n = 213例(62.1%)产后妇女对预防产后败血症有足够的认识。只有39名(11.4%)妇女报告了足够的自我护理措施来预防产后败血症。中等教育(调整后的比值比 = 0.18,95%置信区间 = 0.06–0.49,p = 0.001),高等教育(调整后的比值比 = 0.52,95%置信区间 = 0.19–1.38,p = 0.021),并从医疗保健提供者那里获得信息(调整后的比值比 = 1.06,95%置信区间 = 0.55–2.06,p = 0.049)是预防产后败血症知识的重要决定因素。此外,中等教育(调整后的比值比 = 0.11,95%置信区间 = 0.04–0.30,p = 0.001),高等教育(调整后的比值比 = 0.16,95%置信区间 = 0.06–0.39,p = 0.001),并且有四次以上的产前护理就诊(调整后的比值比 = 1.21,95%置信区间 = 0.49–3.27,p = 0.041)是报告的预防产后败血症的自我护理实践的重要决定因素。结论:据报道,在预防产后败血症的自我护理实践方面存在显著差距。中等和高等教育是知识和自我保健报告实践的重要预测因素。应特别关注受教育程度低的妇女。
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引用次数: 7
Justice for Incarcerated Moms Act of 2021: Reflections and recommendations 2021年《为被监禁母亲伸张正义法案》:反思和建议
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221093037
Rebecca J. Shlafer, Erica Gerrity, Chauntel Norris, Rachel Freeman-Cook, Carolyn B Sufrin
In the last five decades, the number of women behind bars in the United States has risen exponentially. It is now estimated that there are nearly 58,000 admissions of pregnant people—disproportionately women of color—to jails and prisons each year. Recognizing the urgency and consequences of mass incarceration on pregnant people, their families, and communities, House Resolution 948: Justice for Incarcerated Moms Act of 2021 was introduced to Congress as a part of the Black Maternal Health Momnibus. The Justice for Incarcerated Moms Act aims to improve health care and promote dignity for incarcerated pregnant and parenting people through an array of policies and oversight. In this article, we review and reflect on the components of this bill within their broader public health and reproductive justice contexts. We close with recommendations for policymakers and professionals committed to promoting equity and justice for pregnant and postpartum incarcerated people.
在过去的五十年里,美国入狱的女性人数呈指数级增长。据估计,每年有近5.8万名孕妇——尤其是有色人种女性——被送入监狱。认识到大规模监禁对孕妇、孕妇家庭和社区的紧迫性和后果,众议院第948号决议:2021年《为被监禁母亲伸张正义法案》作为《黑人孕产妇健康Momnibus》的一部分提交国会。《为被监禁母亲伸张正义法》旨在通过一系列政策和监督,改善被监禁孕妇和养育子女的人的医疗保健,提高他们的尊严。在这篇文章中,我们在更广泛的公共卫生和生殖正义背景下审查和反思了该法案的组成部分。最后,我们向致力于促进孕妇和产后被监禁者公平正义的政策制定者和专业人士提出建议。
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引用次数: 2
Factors associated with viral suppression among cisgender women living with human immunodeficiency virus in the United States: An integrative review 美国感染人类免疫缺陷病毒的顺性别女性中与病毒抑制相关的因素:一项综合综述
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221092267
Titilola Labisi, A. Podany, N. Fadul, Jason D. Coleman, Keyonna M. King
Introduction: Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. Objectives: This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. Methods: We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. Results: Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use (n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen (n = 3), and intimate partner violence (n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. Conclusion: Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre–post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.
引言:在美国,女性占新诊断的人类免疫缺陷病毒的23%,但研究仍然不足。坚持抗逆转录病毒疗法和由此产生的病毒抑制是预防人类免疫缺陷病毒传播、降低耐药性风险和改善健康结果的关键。目的:这篇综述确定并综合了美国的同行评审研究,描述了感染人类免疫缺陷病毒的顺性别女性中与病毒抑制相关的因素。方法:我们检索了五个数据库:护理与联合健康累积指数(CINAHL)、PubMed、Embase、Scopus和PsycINFO,并使用系统评价首选报告项目和荟萃分析声明报告了研究结果。符合条件的研究包括:(1)自2010年以来发表的同行评审的英语文章;(2) 仅包括顺性别妇女;(3) 参与者年龄至少为18岁;(4) 报告的病毒载量指标;以及(5)在美国进行。结果:共回顾了14项研究。八项研究涉及感染人类免疫缺陷病毒的成年妇女,四项仅招募孕妇,两项仅包括少数民族妇女。最常见的与病毒抑制负相关的因素是物质使用(n = 4) ,其次是健康保险的可用性、财务限制、人类免疫缺陷病毒治疗方案的复杂性(n = 3) ,以及亲密伴侣暴力(n = 2) 。其他因素包括抑郁、种族和年龄。此外,所有四项仅包括孕妇的研究都报告称,早期人类免疫缺陷病毒护理是产前和产后低病毒载量的重要预测因素。结论:药物使用、经济拮据、缺乏医疗保险、人类免疫缺陷病毒治疗方案类型、亲密伴侣暴力和妊娠前后晚期人类免疫缺陷病毒护理是与病毒抑制呈负相关的最常见因素。关于与变性人和农村人口相关的病毒抑制因素的数据很少。需要进行更多的人体免疫缺陷病毒研究,以探索与美国农村地区跨性别女性和顺性别女性的人体免疫缺陷疫苗治疗结果相关的因素。
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引用次数: 4
Helicobacter pylori infection and related factors among pregnant women at Debre Tabor General Hospital, Northwest Ethiopia, 2021: Anemia highly related with H. pylori 埃塞俄比亚西北部Debre Tabor综合医院孕妇幽门螺杆菌感染及相关因素,2021:贫血与幽门螺杆菌高度相关
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221092266
H. Yisak, Debaka Belete, Yeserk Mahtsentu
Introduction: Infection with Helicobacter pylori is one of the most frequent chronic bacterial illnesses in humans. Pregnant mothers are the populations most vulnerable to H. pylori infection. The objective of this study was to assess the prevalence of H. pylori infection and associated factors among pregnant mothers having antenatal care at Debre Tabor General Hospital, Debre Tabor, Ethiopia, 2021. Methods and materials: Institutional based cross-sectional study design was conducted on 290 pregnant women. The stool antigen test is used to detect the active presence of the H. pylori antigen in the feces. Bivariate and multivariable logistic regression analyses were carried out to assess potential factors responsible for H. pylori infection. Variables associated with the prevalence of H. pylori infection with (p-value < 0.05) were considered statistically significant. Results: The prevalence of H. pylori infection was 17.9%, with 95% (CI: 13.4%–22.3%). In all, 65.4% of H. pylori infection positive mothers had gastrointestinal problems and developed symptoms like abdominal cramp and diarrhea 1 (1.92%), loss of appetite 10 (19.23%), hiccups 9 (17.31%), abdominal pain which worsens when the stomach is empty 19 (36.54%), indigestion, and frequent heart burn 13 (25%) during the present pregnancy. Lesser frequency of handwashing practice AOR = 3.09, 95% CI (1.14–8.34), use of soap for handwashing AOR = 0.44, 95% CI (0.19–0.98), eating unwashed vegetables and fruits AOR = 2.279, 95% CI (1.03–5.04), and not being anemic AOR = 0.268, 95% CI (0.10– 0.71), were significantly associated with H. pylori infection. Conclusions: This study shows that the prevalence of H. pylori infection among pregnant women was low compared with that of the general population. Although in the lower prevalence, the level of anemia was strongly associated with the prevalence of H. pylori infection. This implies that H. pylori infection is a public health problem.
引言:幽门螺杆菌感染是人类最常见的慢性细菌性疾病之一。孕妇是最容易感染幽门螺杆菌的人群。本研究的目的是评估2021年在埃塞俄比亚Debre Tabor Debre Tabor-综合医院接受产前护理的孕妇中幽门螺杆菌感染的流行率和相关因素。方法和材料:对290名孕妇进行了基于机构的横断面研究设计。粪便抗原测试用于检测粪便中幽门螺杆菌抗原的活性存在。进行双变量和多变量逻辑回归分析,以评估幽门螺杆菌感染的潜在因素。与幽门螺杆菌感染流行率相关的变量(p值 < 0.05)被认为具有统计学意义。结果:幽门螺杆菌感染的患病率为17.9%,95%(CI:13.4%-22.3%)。总的来说,65.4%的幽门螺杆菌阳性母亲有胃肠道问题,并出现腹部痉挛和腹泻1(1.92%)、食欲不振10(19.23%)、打嗝9(17.31%)、空腹时腹痛恶化19(36.54%)、消化不良,在本次妊娠期间频繁的心脏烧伤13例(25%)。洗手次数较少AOR = 3.09,95%置信区间(1.14-8.34),使用肥皂洗手AOR = 0.44,95%置信区间(0.19–0.98),食用未清洗的蔬菜和水果AOR = 2.279,95%置信区间(1.03–5.04),无贫血AOR = 0.268,95%CI(0.10-0.71)与幽门螺杆菌感染显著相关。结论:本研究表明,与普通人群相比,孕妇幽门螺杆菌感染的患病率较低。尽管患病率较低,但贫血水平与幽门螺杆菌感染的患病率密切相关。这意味着幽门螺杆菌感染是一个公共卫生问题。
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引用次数: 4
Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia 埃塞俄比亚机构交付利用相关因素的多层次分析
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221099505
Sali Suleman Hassen, Sebwedin Surur Jemal, Meseret Mesfin Bambo, Mesfin Esayas Lelisho, Seid Ali Tareke, Amanuel Mengistu Merera, Admasu Markos Kontuab
Background: The maternal mortality rate in poor nations remains unacceptably high. The purpose of this study was to identify factors associated with institutional delivery usage. Methods: The data came from the Ethiopian mini demographic and health survey, which was conducted in 2019. This study comprised 3978 women of reproductive age who had given birth within the previous 5 years. To uncover significantly linked parameters associated with institutional delivery, we used a multilevel logistic regression model. Statistical significance was declared at p < 0.05, and we assessed the strength of association using adjusted odds ratios with 95% confidence intervals. Results: More than half of the women (53.67%) among 3978 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, women in age group 45–49 (AOR = 2.43, 95% CI: 1.280, 4.591), primary educational level (AOR = 2.21, 95% CI: 1.864, 2.625, secondary and above education level (AOR = 6.37, 95% CI: 4.600, 8.837), being Muslim (AOR = 2.57, 95% CI: 1.245, 2.166), women who visited ANC service four up to seven times (AOR = 2.75, 95% CI: 2.175, 3.473), women visited ANC service eight times and above (AOR = 3.295% CI: 1.685, 6.050), women who reside in middle wealth index (AOR = 1.57, 95% CI: 1.273, 1.950), and rich wealth index (AOR = 3.43, 95% CI: 2.782, 4.225) were more likely to give birth at health institution compared to their counterparts. Furthermore, women being in rural area (AOR = 0.34, 95% CI:- 0.283, 0.474) and protestant women (AOR = 0.1.57, 95% CI: 0.479, 0.852) were less likely to deliver at health institution. Conclusions: Ethiopia still has a low level of institutionalized delivery. Institutional delivery in Ethiopia should be improved through context-specific and personalized programs, such as educating women and enhancing access to ANC services.
背景:贫穷国家的产妇死亡率仍然高得令人无法接受。本研究的目的是确定与机构交付使用相关的因素。方法:数据来自2019年进行的埃塞俄比亚小型人口与健康调查。这项研究包括3978名育龄妇女,她们在过去5年内生过孩子。为了揭示与机构交付相关的显著关联参数,我们使用了多层次逻辑回归模型。p < 0.05为统计学显著性,我们使用95%置信区间的校正优势比评估关联强度。结果:3978例末次分娩妇女中,半数以上(53.67%)在卫生机构分娩。在多水平logistic回归分析中,45-49岁年龄组妇女(AOR = 2.43, 95% CI: 1.280, 4.591)、小学教育程度(AOR = 2.21, 95% CI: 1.864, 2.625)、中学及以上教育程度(AOR = 6.37, 95% CI: 4.600, 8.837)、穆斯林(AOR = 2.57, 95% CI: 1.245, 2.166)、4 - 7次ANC服务的妇女(AOR = 2.75, 95% CI: 2.175, 3.473)、8次及以上ANC服务的妇女(AOR = 3.295% CI:1.685, 6.050),生活在中等财富指数(AOR = 1.57, 95% CI: 1.273, 1.950)和富裕财富指数(AOR = 3.43, 95% CI: 2.782, 4.225)的妇女更有可能在卫生机构分娩。此外,农村妇女(AOR = 0.34, 95% CI:- 0.283, 0.474)和新教妇女(AOR = 0.1.57, 95% CI: 0.479, 0.852)在卫生机构分娩的可能性较小。结论:埃塞俄比亚的制度化分娩水平仍然很低。应通过具体情况和个性化的方案改善埃塞俄比亚的机构交付,例如教育妇女和增加获得ANC服务的机会。
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引用次数: 3
A qualitative analysis of Medicaid beneficiaries perceptions of prenatal and immediate postpartum contraception counseling 医疗补助受益人对产前和产后立即避孕咨询看法的定性分析
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221124079
Lindsey Yates, S. Birken, T. Thompson, G. Stuart, S. Greene, K. Hassmiller Lich, Morris Weinberger
Objectives: In the United States, about four out of every ten births are financed by Medicaid, making it a program that is key in addressing racial disparities in maternal health. Many women covered by Medicaid have access to prenatal and immediate postpartum contraception counseling that can aid them in their postpartum contraception decision-making. However, existing inequities within Medicaid and a history of reproductive harms targeting Black women and women with low incomes may contribute to women with Medicaid having different experiences of contraception counseling. This qualitative study explores how Black women and White women insured by Medicaid perceive prenatal and immediate postpartum contraception counseling and identifies additional factors that shape their contraception decision-making. Methods: We conducted semi-structured interviews with 15 Medicaid beneficiaries who delivered at a public teaching hospital in North Carolina. Interviews focused on women’s beliefs about planning for pregnancy, experiences with prenatal and immediate postpartum contraception counseling, and perceived need for postpartum contraception. We used a priori and emergent codes to analyze interviews. Results: Seven Black women and eight White women completed interviews 14–60 days postpartum. All women reported receiving prenatal and immediate postpartum counseling. Several women described receiving prenatal counseling, reflective of patient-centered contraception counseling, that helped in their postpartum contraception decision-making; one woman described receiving immediate postpartum counseling that helped in her decision-making. Some Black women reported receiving unsupportive/coercive contraception counseling. In addition to contraception counseling, past reproductive health experiences and future pregnancy intentions were salient to women’s contraception decision-making. Conclusions: Prenatal and immediate postpartum contraception counseling can help some Medicaid beneficiaries with their postpartum contraception decision, but past reproductive health experiences and future pregnancy intentions are also relevant. Counseling that does not consider these experiences may be harmful, particularly to Black women, further contributing to racial disparities in maternal postpartum health outcomes.
目标:在美国,大约每10个分娩中就有4个是由医疗补助计划资助的,这使它成为解决孕产妇保健中种族差异的关键方案。许多接受医疗补助的妇女可以获得产前和产后立即避孕咨询,这可以帮助她们做出产后避孕的决定。然而,医疗补助中存在的不平等,以及针对黑人妇女和低收入妇女的生殖伤害历史,可能会导致接受医疗补助的妇女在避孕咨询方面有不同的经历。本定性研究探讨了黑人妇女和白人妇女如何接受医疗补助保险的产前和产后立即避孕咨询,并确定了影响其避孕决策的其他因素。方法:我们对15名在北卡罗莱纳州公立教学医院分娩的医疗补助受益人进行了半结构化访谈。访谈的重点是女性对怀孕计划的看法,产前和产后立即避孕咨询的经历,以及产后避孕的感知需求。我们使用先验和紧急代码来分析访谈。结果:7名黑人妇女和8名白人妇女在产后14-60天完成了访谈。所有的女性都接受了产前和产后咨询。一些妇女描述了接受产前咨询,反映了以患者为中心的避孕咨询,这有助于产后避孕决策;一名妇女描述说,她接受了产后立即咨询,帮助她做出了决定。据报道,一些黑人妇女接受了不支持或强制的避孕咨询。除避孕咨询外,过去的生殖健康经历和未来怀孕意图对妇女的避孕决策也有显著影响。结论:产前和产后立即避孕咨询可以帮助一些医疗补助受益人做出产后避孕决定,但过去的生殖健康经历和未来的怀孕意图也有相关性。不考虑这些经历的咨询可能是有害的,特别是对黑人妇女,进一步加剧了产妇产后健康结果的种族差异。
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引用次数: 0
‘We go where we know’: Reflections from Mobilizing for PrEP and Sexual Health (MobPrESH) – A peer-led PrEP education programme across England, for and by women and non-binary people “我们去我们知道的地方”:动员预防措施和性健康的反思(MobPrESH)——一个由同龄人主导的英格兰预防措施教育项目,为妇女和非二元性人群服务
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221091727
P. Grenfell, Sabrina Rafael, J. Calliste, W. Nutland
Background: Pre-exposure prophylaxis is a highly effective method of HIV prevention but few women know about it, have access to it, or see it as relevant to them. In 2019, grassroots organization PrEPster piloted a peer-led intervention, MobPrESH (Mobilizing for Pre-Exposure prophylaxis (PrEP) and Sexual Health), across three sites in England, to mobilize for PrEP and sexual health with communities of women and non-binary people most affected by HIV, including Black women and non-binary people, people of colour, migrants, and transgender (trans) women. Objectives: We aimed to explore the accessibility, feasibility, acceptability, and ‘fidelity’ of MobPrESH, from the perspectives of peer mobilizers and project staff. Methods: We conducted focus group discussions and qualitative interviews with nine peer mobilizers (most identified as Black cisgender (cis) women) and six project staff (including Black and white cis women and non-binary people). We analysed data thematically, iteratively, and inductively, informed by concepts of reproductive and social justice. Results: We present findings in five thematic areas: connecting and relating to situate sexual health discussions, navigating silence and stigma, connecting within and across communities, competing pressures and structural hostilities, and resources and continuity. Community knowledge-building about PrEP is a slow, iterative process that needs investment and creation of trusted spaces that centre communities’ needs and concerns. Peer mobilizers and the communities they engaged with had competing demands in their lives, and knowledge-raising about PrEP was impacted by intersecting stigmas, discrimination, and oppressions around HIV status, racism, misogyny, transphobia, homophobia, and anti-sex worker rhetoric. Conclusions: Peer-led PrEP interventions require funding and foregrounding, particularly for women and non-binary people who are Black, trans, migrants, and people of colour, situated relative to their wider health needs, life pressures, and priorities. This requires concurrent challenge of the racist and patriarchal structures that continue to obscure the sexual and reproductive health needs of racially minoritized and marginalized women and non-binary people.
背景:暴露前预防是一种非常有效的艾滋病毒预防方法,但很少有妇女了解它,能够获得它,或认为它与她们有关。2019年,草根组织PrEPster在英格兰的三个地点试行了一项同伴主导的干预措施MobPrESH(动员进行暴露前预防(PrEP)和性健康),以动员受艾滋病毒影响最严重的妇女和非二元人群社区的PrEP和性健康,包括黑人妇女和非二元人群、有色人种、移民和变性(跨性别)妇女。目的:我们旨在从同行动员者和项目人员的角度探讨MobPrESH的可访问性、可行性、可接受性和“保真度”。方法:我们对9名同伴动员者(大多数为黑人顺性女性)和6名项目工作人员(包括黑人和白人顺性女性以及非二元性别者)进行了焦点小组讨论和定性访谈。我们分析数据主题,迭代,归纳,由生殖和社会正义的概念通知。结果:我们在五个主题领域提出了研究结果:连接和相关情境性健康讨论,导航沉默和耻辱,社区内部和社区之间的联系,竞争压力和结构性敌对,以及资源和连续性。关于预防PrEP的社区知识建设是一个缓慢而反复的过程,需要投资和创造以社区需求和关切为中心的可信空间。同伴动员者和他们参与的社区在他们的生活中有相互竞争的需求,关于预防措施的知识提高受到围绕艾滋病毒状况、种族主义、厌女症、跨性别恐惧症、同性恋恐惧症和反性工作者言论的交叉污名、歧视和压迫的影响。结论:同伴主导的PrEP干预措施需要资金和前景,特别是对于妇女和黑人、跨性别者、移民和有色人种等非二元人群,相对于他们更广泛的健康需求、生活压力和优先事项。这需要同时挑战种族主义和父权制结构,这些结构继续掩盖在种族上处于少数地位和边缘地位的妇女和非二元性别者的性健康和生殖健康需要。
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引用次数: 7
Lower-limb progressive paraparesis management and diagnosis overview in a pregnant woman with vertebral haemangioma 妊娠椎体血管瘤患者下肢进行性截瘫的处理和诊断综述
IF 2.4 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2022-01-01 DOI: 10.1177/17455057221099018
Lívia Ridzoňová, M. Fedičová, Tomaš Andráš, P. Urdzík, Z. Gdovinová
Vertebral haemangioma is a benign vascular tumour mostly seen in the thoracic region of the spine. Spinal haemangiomas are usually asymptomatic and are discovered incidentally. In a few patients, however, aggressive vertebral haemangiomas can cause local pain, radicular pain or neurologic deficits, which result from neural compression. The aetiology of the origin is unclear and is probably multifactorial. Hormonal and biological changes in pregnant women can lead to accelerated vascular growth of haemangioma. In our report, we present the case of a pregnant patient who was diagnosed with an aggressive vertebral haemangioma that further led to progressive paraparesis. We had to take the fact that she was pregnant into account in the diagnostic procedure, in the choice of examination method and also in the method of therapy. The goal of this case report is threefold: (1) provide an overview of the possible methods of management, specifically imaging, which will aid in diagnosis and based on that, (2) determining the appropriate therapy and (3) review the risks and benefits of each will be presented when choosing individual approaches.
椎体血管瘤是一种良性血管肿瘤,多见于脊柱的胸椎区域。脊髓血管瘤通常无症状,是偶然发现的。然而,在少数患者中,侵袭性椎体血管瘤可引起局部疼痛、神经根痛或神经功能缺损,这是由神经压迫引起的。病因尚不清楚,可能是多因素的。孕妇的荷尔蒙和生理变化可导致血管瘤的血管加速生长。在我们的报告中,我们提出了一个怀孕的病人谁被诊断为侵袭性椎体血管瘤,进一步导致进行性截瘫的情况。在诊断过程中,在选择检查方法和治疗方法时,我们必须考虑到她怀孕的事实。本病例报告的目的有三个:(1)概述可能的治疗方法,特别是成像,这将有助于诊断,并以此为基础;(2)确定适当的治疗方法;(3)在选择单独的治疗方法时,回顾每种方法的风险和益处。
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引用次数: 0
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Womens Health
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