Womens Health Issues最新文献

Objectives: We explored Black women's experiences, concerns, decisions, and challenges of seeking care for urinary incontinence (UI).

Methods: After screening for UI, we collected questionnaires confirming UI bother. We performed semistructured, one-on-one interviews via video or phone with adult participants who self-identify as Black women and had symptoms of UI. We asked about experiences with UI, perceived impact on quality of life, care-seeking behaviors, and any challenges to seeking care. Audio recordings were transcribed and coded. We then explored the patterns and relationships between codes to identify categories and themes.

Results: We interviewed 24 Black women with UI, aged 19 to 73 years. All had some college education, and more than one-half had degrees ranging from associate to graduate. Five themes emerged: 1) UI symptoms bring up negative emotions and require adaptations; 2) normalization of UI decreases symptom reporting and care seeking; 3) participants' UI and other medical symptoms were often minimized or dismissed by clinicians; 4) participants desire routine UI screening by clinicians and enhanced UI education; and 5) participants encourage more diversity and higher quality care to improve patient trust.

Conclusions: In addition to embarrassment, Black women's challenges to seeking UI care include prior experiences of trauma within the health care system. Routine screening of patients, enhanced UI education, and provider trust building could improve Black women's experiences and willingness to seek UI care.

Objectives: Medical students value abortion education; however, there has been little study regarding participation in second-trimester procedures, which are less common yet receive significant societal attention. We aimed to explore medical students' perceptions of participation in second-trimester procedural abortions to optimize this educational experience.

Study design: We conducted qualitative semi-structured interviews with third- and fourth-year medical students who voluntarily participated in second-trimester dilation and evacuation cases. We coded interviews inductively and performed thematic content analysis until thematic saturation was reached.

Participants: We interviewed 25 medical students, including 16 third-year and nine fourth-year students. Most participants were female (64%) and white (58%) and had no prior abortion care experience (80%).

Results: Four major themes emerged: 1) students felt unprepared for second-trimester procedural abortions and were unable to find adequate educational resources for preparation; 2) students experienced complex emotional reactions to the procedures, often finding the experience more challenging than expected; 3) students observed implicit expectations and biases in the learning environment; and 4) students highly valued their involvement in abortion procedures, noting that participation was important for their future practice and allowed acquisition of essential clinical skills.

Conclusions: Medical students value the educational opportunity to participate in second-trimester procedural abortions; however, most feel unprepared for the technical and emotional aspects, despite utilizing available educational resources. To maximize educational experience and psychological safety, educators should develop specialized training resources. This could strengthen physician knowledge and comfort with abortion care in the future, ultimately improving patient care.

Background: Depression during the perinatal period is associated with negative outcomes for both mothers and children, including higher rates of chronic depression in mothers and physical, emotional, and cognitive issues in children. This study aimed to determine how the stressors of the COVID-19 pandemic contributed to prenatal and postpartum depressive symptoms among a sample of peripartum mothers who gave birth during the pandemic. This study also examined risk factors for postpartum depression, including prenatal depressive symptoms, demographic characteristics, timing of birth during the pandemic, pregnancy intention, birth expectations and experiences, and pandemic-related concerns.

Methods: This mixed methods study included data from online surveys using a convenience sample of 284 expectant mothers with due dates from April 2020 to September 2021, and qualitative interviews with a subset of participants. Depressive symptoms and risk for clinical depression were assessed using the Edinburgh Postnatal Depression Scale during the third trimester of pregnancy and again within 8 weeks postpartum. Multiple regression models examined potential risk factors to determine which variables most predicted participants' postpartum depressive symptoms and risk of clinical depression.

Results: Among this nonrepresentative, mostly white, and highly resourced sample, one-third of participants (33.8%) met the criteria for risk of clinical depression during the prenatal period, and 32.7% met this threshold in the postpartum period. Participants who reported higher levels of prenatal depressive symptoms, gave birth earlier in the pandemic, reported lower income, or had more pandemic-related concerns tended to report more postpartum depressive symptoms, controlling for demographic characteristics and other variables of interest. Peripartum mothers who reported symptoms consistent with risk of clinical depression prenatally were almost four times more likely to screen positive for depression in the postpartum period, even after controlling for other variables. In interviews, participants attributed negative emotions in pregnancy to uncertainty related to pandemic-related changes in care and expressed grief about missed pregnancy and postpartum experiences. In the postpartum period, some participants reported that their births were ultimately less stressful than anticipated.

Conclusions: Findings highlight the need for consistent and frequent depression screenings across the perinatal period, especially among participants who report depressive symptoms prenatally. Participants who gave birth early in the pandemic were at the highest risk of postpartum depression and may continue to need additional supports.

Objective: We used human-centered design to explore preferred consumer experiences for obtaining mifepristone for medication abortion care from a pharmacy.

Methods: We conducted a two-part virtual workshop series with the same 10 participants in March and April of 2022 to initiate the discovery phase of a human-centered design process. Most participants were residents of Illinois and all participants had uteruses and had either sought abortion care or supported someone who had. Co-developed and co-facilitated with a local abortion fund, workshops engaged participants to provide formative data for the development of recommendations for community health center clinicians and pharmacists. A simulated medication abortion care counseling session grounded group activities and discussions that explored the experience of filling a medication abortion prescription at a pharmacy or by mail. Data were analyzed for key themes and recommendations. Qualitative data were collected from the workshops. Data analysis was conducted in three iterative, parallel stages: 1) virtual whiteboard results from both workshops were analyzed deductively through spreadsheets and visualizations; 2) close reading was conducted for workshop transcripts and participant evaluations; and 3) document analysis was used to triangulate data across formats. Data were discussed periodically among the research team until consensus was reached.

Results: Five primary categories of questions and preferences emerged from workshop data concerning: logistics, privacy, cost, pharmacist refusal, and follow-up care. Researchers found that participants desired certain questions and concerns to be answered by specific provider types. Participants indicated a desire for further research and opportunities that prioritize lived experience and use storytelling and/or design methods to collect data.

Conclusions: Despite existing patient-oriented medication abortion resources, there is a need for patient resources to support pharmacy dispensing, and a corresponding need for clinician and pharmacist resources. These can help in-person and mail-order pharmacy dispensing TO be as consumer friendly as possible.

Background: Since the 2022 Dobbs v. Jackson Women's Health Organization Supreme Court decision revoked federal protection for abortion rights, many states have restricted abortion. Although news media covers this shifting landscape through reporting, this article documents how entertainment content is responding to this new reality in its storytelling.

Methods: The sample is from a public database of abortion plotlines on American television (abortiononscreen.org). I separated the sample of 150 plotlines into two groups: plotlines that filmed and/or aired pre-Dobbs (January 2020-August 2022) and those that aired post-Dobbs (September 2022-December 2023). Coding occurred in Microsoft Excel.

Results: Post-Dobbs, there was an increase in procedural abortion depictions compared with pre-Dobbs, but no change in the consistently low number of depictions of medication abortion. The post-Dobbs sample included a 10% increase in teen characters compared with pre-Dobbs. Pre-Dobbs, the vast majority of plotlines (77%) did not portray any barriers to abortion care. Post-Dobbs, 33% depicted barriers. The most common reason for abortion seeking in both samples was age (11%). Pre-Dobbs, the next most common was a mis-timed pregnancy (10%). Post-Dobbs, the next most common was health concerns (11%).

Conclusions: Since Dobbs, more television plotlines are portraying obstacles to abortion care, yet they continue to tell stories of white, non-parenting teenagers who make up a small percentage of real abortion patients. Plotlines overrepresent procedural abortion over the more common medication abortion. Depictions of health-related reasons for abortion seeking obscure more commonly provided reasons for abortions, such as mistimed pregnancies, caregiving responsibilities, and financial concerns. Considering the low levels of abortion knowledge nationwide, understanding what (mis)information audiences encounter onscreen is increasingly important.

Objectives: The Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery.

Methods: We conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data.

Results: We interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care.

Conclusions: Many of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.

Purpose: Prior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose.

Method: Data were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse-funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression.

Findings: Findings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers).

Conclusions: Findings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk to injection practices and overdose experiences.

Background: American Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States.

Methods: We analyzed 2016 ton 2020 Pregnancy Risk Assessment Monitoring System data (44 states and 2 other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth.

Results: Approximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%).

Conclusion: AI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.

Background: Adequate prenatal care is vital for positive maternal, fetal, and child health outcomes; however, differences in prenatal care utilization exist, particularly among rural populations. The COVID-19 pandemic accelerated the adoption of telehealth in prenatal care, but its impact on the adequacy of care remains unclear.

Methods: Using Pregnancy Risk Assessment Monitoring System (PRAMS) data, this study examined prenatal care adequacy during the early-pandemic year (2020) and pre-pandemic years (2016-2019) and investigated rural-urban inequities. Logistic regression models assessed the association between the pandemic year and prenatal care adequacy, and considered barriers to virtual care as a covariate.

Results: The sample consisted of 163,758 respondents in 2016-2019 and 42,314 respondents in 2020. Overall, the study participants were 12% less likely to receive adequate prenatal visits during the early-pandemic year (2020) compared with 2016-2019 (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] [0.86, 0.91]). Respondents in rural areas had lower odds of receiving adequate prenatal care compared with those in urban areas during both pre-pandemic years (aOR = 0.90; 95% CI [0.88, 0.93]) and the early-pandemic year (aOR = 0.94; 95% CI [0.88, 0.99]). However, after adjusting for barriers to virtual care, the difference between rural and urban areas in the early-pandemic year became nonsignificant (aOR = 0.93; 95% CI [0.78, 1.11]). Barriers to virtual care, including lack of phones, data, computers, internet access, and private space, were significantly associated with inadequate prenatal care.

Conclusion: During the early-pandemic year, PRAMS respondents experienced reduced adequacy of prenatal care. Although rural-urban inequities persisted, our results suggest that existing barriers to virtual care explained these inequities. Telehealth interventions that minimize these barriers could potentially enhance health care utilization among pregnant people.

Background: Most pregnancy-related deaths in Illinois are preventable. Many of those who died in recent years had at least one emergency department (ED) visit during pregnancy or the postpartum period. This suggests that with the proper training and education, EDs can play an important role in reducing maternal mortality.

Methods: A Task Force of 33 interdisciplinary stakeholders from across Illinois met monthly over 1 year to gather and develop educational content focused on obstetric emergency medicine and produce the Maternal Health Emergency Department Toolkit (Toolkit) training. A survey and listening session collected stakeholders' feedback about factors that supported Toolkit development, barriers, and recommendations for similar projects.

Results: The Task Force members adapted existing tools and developed novel resources to fill the gaps in maternal health education for the ED setting. The Toolkit consists of five educational modules including didactic information, case-based learning, and resources for additional reading and local implementation. The modules focus on ED recommendations from the Illinois Maternal Mortality Review Committees, triage and management of emergencies in perinatal patients, screening and treatment of mental health and substance use conditions, addressing trauma, performing resuscitation during pregnancy, and conducting safe and coordinated discharge of perinatal patients from the ED. Task Force members described the inclusion of experts with interdisciplinary knowledge, working in small groups, and grounding the educational content in maternal health data as factors contributing to the project's success. They identified scheduling conflicts as a challenge and recommended future projects like this one include more ED providers and staff members.

Conclusion: Through promoting cross-disciplinary engagement, education, and collaboration with obstetrics and other service lines, the Toolkit can help fill the gaps in maternal ED education to decrease maternal mortality and morbidity in Illinois.