Womens Health Issues最新文献_第2页

Menstrual Equity Behind Bars: A Call for National Policy Reform 监狱里的月经平等：呼吁国家政策改革。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.11.001

Anisha V. Patel BA , Sahara Suliman , Ankita Patil BA, MS , Harini Thiruvengadam , Ran Zhang PhD

引用次数: 0

Provider Perspectives on De-Implementation of Routine Blood Typing and Rh Immune Globulin Administration in the First Trimester: A Qualitative Study 提供者对在妊娠早期取消常规血型和Rh免疫球蛋白管理的观点：一项定性研究。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.10.001

Emma V. Gilmore MD, Madeline V. Smith MPH, Cecelia Tannous-Taylor BA, Arden McAllister MPH, Courtney A. Schreiber MD, MPH, Sarita Sonalkar MD, MPH

Objective

To avoid the consequences of sensitization that can occur when people with Rh-negative blood are pregnant with Rh-positive fetuses and experience bleeding, obstetrician-gynecologists have historically administered prophylactic Rh immune globulin for any first trimester bleeding, including abortion and pregnancy loss. As the research base has evolved, many professional societies have changed their recommendations on the use of blood typing and Rh immune globulin administration for first trimester bleeding, but widespread practice has yet to change. We aimed to understand barriers to de-implementation of routine testing and prophylaxis for first trimester bleeding events from the perspective of obstetrician-gynecologist physicians.

Study Design

We conducted qualitative in-depth interviews with obstetrician-gynecologists who provide first trimester pregnancy care. Guided by the Integrated Behavior Model and the Consolidated Framework for Implementation Research, we elicited participants’ perceived barriers to de-implementation of routine Rh testing and Rh immune globulin prophylaxis for first trimester bleeding and suggestions for de-implementation strategies. Data were coded iteratively and analyzed thematically.

Results

Twenty physicians completed interviews. Participants were based in 11 states and worked in settings that included teaching hospitals, freestanding abortion clinics, private practices, and the carceral system. Barriers to de-implementation included a lack of familiarity with evidence and limited time to engage in change initiatives. Although society guidance change was considered an essential component in discontinuing this longstanding practice, other drivers of practice change were reported to be additional studies on Rh sensitization in the first trimester, leadership support, and educational initiatives for providers and patients.

Conclusions

Obstetrician-gynecologists in this study favored de-implementation of routine blood typing and Rh immune globulin prophylaxis in first trimester bleeding but lacked sufficient support. Practice change becomes more likely when providers feel confident in their grasp of evidence, institutional leaders support change, and relevant professional societies are aligned in their guidance.

目的：为避免Rh阴性血孕妇与Rh阳性胎儿出血时可能发生的致敏后果，妇产科医生历来对任何妊娠早期出血（包括流产和流产）给予预防性Rh免疫球蛋白。随着研究基础的发展，许多专业协会已经改变了他们对使用血型和Rh免疫球蛋白治疗妊娠早期出血的建议，但广泛的做法尚未改变。我们的目的是从妇产科医生的角度了解取消常规检查和预防妊娠早期出血事件的障碍。研究设计：我们对提供妊娠早期护理的妇产科医生进行了定性深入访谈。在综合行为模型和实施研究综合框架的指导下，我们得出了参与者对取消常规Rh检测和Rh免疫球蛋白预防妊娠早期出血的障碍以及取消实施策略的建议。对数据进行迭代编码和主题分析。结果：20名医生完成访谈。参与者来自11个州，在教学医院、独立堕胎诊所、私人诊所和医疗系统等环境中工作。去实施的障碍包括缺乏对证据的熟悉，以及参与变革倡议的时间有限。虽然社会指导的改变被认为是终止这种长期做法的重要组成部分，但据报道，其他推动实践变化的因素包括妊娠早期Rh致敏的额外研究、领导支持以及对提供者和患者的教育举措。结论：在这项研究中，妇产科医生倾向于在妊娠早期出血时取消常规血型和Rh免疫球蛋白预防，但缺乏足够的支持。当提供者对他们掌握的证据有信心，机构领导人支持变革，以及相关专业协会在他们的指导下保持一致时，实践变革就更有可能发生。

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引用次数: 0

Patient Experiences in Accessing Reproductive Health Services for Women With Cognitive, Intellectual, and Developmental Disabilities: A Systematic Review 认知、智力和发育障碍妇女获得生殖健康服务的患者经验：一项系统综述。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.10.008

Claire Chang BS, BA , Rogie Royce Carandang PhD, MPH, MSc, RPh , Jillian Silverberg MSLIS, MA , Claire Surkis BA , Shayna D. Cunningham PhD , Katie Wang PhD , Neena Qasba MD, MPH

Introduction

Individuals with disabilities face barriers to care. Using a life-course and socio-ecological perspective, we reviewed studies on the experiences of individuals with cognitive, intellectual, and developmental disabilities (CIDD) in accessing sexual and reproductive health (SRH) services.

Methods

We systematically searched six online databases and gray literature, selecting studies published from January 2010 to June 2024 written in English. Narrative synthesis was used to identify key themes using the socio-ecological framework. Data were collected by using a standardized extraction form following the Population, Intervention, Comparator, and Outcome format. We conducted assessments of risk of bias and certainty of evidence using standardized tools. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for quantitative studies and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) for qualitative studies.

Results

Of 5,595 studies screened, 26 were included in the final analysis, with almost perfect inter-rater reliability (kappa = .87). SRH service categories included preventive care, puberty/menarche, family planning, pregnancy and fertility, reproductive cancer treatment, and general SRH services. We found lower receipt of preventive care services, lower use of contraception, higher rates of sterilization, and worse obstetric outcomes for individuals with CIDD compared with those without CIDD. Caregiver support was an interpersonal factor well represented in the literature, whereas the patient perspective was underrepresented.

Conclusions

Future research and policy efforts should prioritize the perspectives of individuals with CIDD, particularly during puberty/menarche and menopause. Studies indicate a need for patient-centered approaches, caregiver support, provider training in disability-inclusive care, and accessible healthcare infrastructure to reduce barriers to care.

引言：残疾人在护理方面面临障碍。从生命历程和社会生态的角度，我们回顾了认知、智力和发育障碍（CIDD）个体在获得性健康和生殖健康（SRH）服务方面的研究。方法：系统检索6个网络数据库和灰色文献，选取2010年1月至2024年6月发表的英文文献。使用叙事综合来确定使用社会生态框架的关键主题。数据的收集采用标准化的提取表格，遵循人口、干预、比较和结果格式。我们使用标准化工具对偏倚风险和证据确定性进行了评估。定量研究采用推荐、评估、发展和评价分级法（GRADE）评估证据的确定性，定性研究采用定性研究综述证据置信度（GRADE- cerqual）评估证据的置信度。结果：在筛选的5595项研究中，有26项被纳入最终分析，具有几乎完美的评分间信度（kappa = .87）。性健康和生殖健康服务类别包括预防保健、青春期/月经初潮、计划生育、怀孕和生育、生殖癌症治疗和一般性健康和生殖健康服务。我们发现，与没有CIDD的人相比，患有CIDD的人接受预防性护理服务的比例较低，避孕药具的使用率较低，绝育率较高，产科结局较差。在文献中，照顾者的支持是一个人际关系因素，而患者的观点却没有得到充分的体现。结论：未来的研究和政策努力应优先考虑CIDD患者的观点，特别是在青春期/月经初潮和更年期。研究表明，需要以患者为中心的方法、护理人员的支持、残疾人包容性护理的提供者培训和无障碍医疗保健基础设施，以减少护理障碍。

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引用次数: 0

Prenatal Education to Support Pregnant People's Awareness, Knowledge, and Reported Oral Exposure and Risk Reduction Behaviors Surrounding Congenital Cytomegalovirus 产前教育以支持孕妇对先天性巨细胞病毒的认识、知识、报告的口服暴露和减少风险行为。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.11.004

Marissa Diener PhD , Shaistah Din BS , Jessica Sharma BS , Louisa A. Stark PhD , Torri D. Metz MD, MS , Sara J. Knight PhD , Luke Hansen MD , Abel Chavez BS , Taylor Redding MD , Nathan Blue MD , Albert H. Park MD

Background

Congenital cytomegalovirus (cCMV) is the most common transplacental infection and the leading cause of nongenetic sensorineural hearing loss, and it can cause intellectual disability and psychomotor delay. Despite its prevalence and consequences, it is less well known than other childhood diseases. The purpose of this study was to assess educational materials for cCMV and to examine whether these materials increased pregnant patients’ awareness, knowledge, and reported behaviors related to cCMV risk reduction and oral exposures. The secondary objectives were to compare the effectiveness of written and video educational materials and remote and in-person education.

Methods

Pregnant patients (N = 136) were randomized into a print (n = 76) or video (n = 60) educational intervention. Some (n = 73) participants received the education remotely via e-mail after their clinic visit; others (n = 63) received it in person at the clinic. Participants completed a survey assessing appraisals of the education materials and their awareness, knowledge, and reported oral exposure and risk reduction behaviors surrounding cCMV before and approximately 1 month after receiving the education.

Results

Knowledge of cCMV in both educational groups significantly improved, but video education was significantly more effective than print. Remote education was more effective than in-person education. Despite gains in knowledge, reported risk reduction behaviors and oral exposure behaviors did not improve. Perceptions of ease of implementation were related to greater reported risk reduction behaviors and fewer oral exposures after education.

Conclusions

Simple educational materials can improve knowledge of cCMV during pregnancy, but more intensive intervention may be needed to change behaviors, especially for individuals who experience barriers to implementing risk reduction behaviors.

背景：先天性巨细胞病毒（cCMV）是最常见的经胎盘感染，是导致非遗传性感音神经性听力损失的主要原因，可导致智力残疾和精神运动迟缓。尽管它很流行，后果也很严重，但与其他儿童疾病相比，它不太为人所知。本研究的目的是评估cCMV的教育材料，并检查这些材料是否增加了妊娠患者对cCMV风险降低和口服暴露相关的意识、知识和报告行为。第二个目标是比较书面和录像教育材料以及远程和面对面教育的有效性。方法：136例孕妇随机分为纸媒（76例）和视频（60例）两组进行教育干预。一些（n = 73）参与者在诊所访问后通过电子邮件接受远程教育；其他人（n = 63）在诊所亲自接受了治疗。参与者完成了一项调查，评估他们在接受教育之前和大约1个月后对教育材料及其对cCMV的认识、知识、口腔暴露和风险降低行为的评估。结果：两组学生对cCMV知识的掌握程度均有显著提高，但视频教育明显优于纸媒教育。远程教育比面对面教育更有效。尽管知识有所增加，但报告的降低风险行为和口腔暴露行为并没有改善。易于实施的认知与更多报告的降低风险行为和教育后较少的口腔暴露有关。结论：简单的教育材料可以提高对妊娠期cCMV的认识，但可能需要更深入的干预来改变行为，特别是对于那些在实施降低风险行为方面遇到障碍的个体。

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引用次数: 0

“Cementing Our Place on the Right Side of History”: Primary Care Perspectives on Mifepristone Provision Post-Dobbs “巩固我们在历史正确一边的地位”：多布斯后米非司酮提供的初级保健观点。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.10.005

Hannah Shireman MA , Annie Feldkamp BA , Valeria Hernandez BA , Meera Sakthivel MD , Elizabeth Janiak ScD , Debra Stulberg MD, MAPP

Purpose

We explored clinician and staff perspectives on primary care integration and provision of mifepristone following the Dobbs v. Jackson Women's Health Organization decision that removed the federal right to abortion.

Methods

In this qualitative study, 41 interviews were conducted with clinicians and staff from three Midwestern clinics that participated in a 1-year learning collaborative (9/2022–8/2023) designed to help primary care settings implement mifepristone for abortion and early pregnancy loss care. Interviews were transcribed verbatim, coded by two researchers independently, and analyzed thematically using inductive and deductive techniques.

Results

Interviewees included clinicians (n = 14) and clinical support (n = 17), administrative management (n = 6), and patient-facing administrative (n = 4) staff. Dobbs created a sense of urgency among clinicians and staff, resulting in increased motivation to overcome barriers to mifepristone implementation. Participants felt that providing mifepristone aligned with primary care values, including patient-centeredness and access to care for all. The post-Dobbs political climate, along with federal cases attempting to hinder access to medication abortion, created uncertainty at the institutional and individual levels.

Conclusions

Participants in our sample expressed that the Dobbs decision increased their clinics’ motivation to overcome barriers and expand access to abortion and early pregnancy loss care. Other primary care providers may consider leveraging concern about mounting abortion restrictions to advance access to this care in their own settings.

目的：在多布斯诉杰克逊妇女健康组织决定取消联邦堕胎权后，我们探讨了临床医生和工作人员对初级保健整合和提供米非司酮的看法。方法：在本定性研究中，对来自中西部三家诊所的临床医生和工作人员进行了41次访谈，这些诊所参加了为期1年的学习协作（2022年9月至2023年8月），旨在帮助初级保健机构实施米非司酮用于流产和早期妊娠丢失护理。访谈被逐字记录下来，由两名研究人员独立编码，并使用归纳和演绎技术进行主题分析。结果：受访者包括临床医生（n = 14）和临床支持人员（n = 17）、行政管理人员（n = 6）和面向患者的行政管理人员（n = 4）。多布斯在临床医生和工作人员中创造了紧迫感，从而增加了克服米非司酮实施障碍的动力。与会者认为，提供米非司酮符合初级保健的价值观，包括以患者为中心和所有人获得护理。后多布斯时代的政治气候，以及试图阻碍药物流产的联邦案件，在机构和个人层面造成了不确定性。结论：我们样本中的参与者表示，Dobbs的决定增加了他们诊所克服障碍和扩大获得堕胎和早期妊娠流产护理的动力。其他初级保健提供者可以考虑利用对日益增加的堕胎限制的关注，在他们自己的环境中促进获得这种护理。

{"title":"“Cementing Our Place on the Right Side of History”: Primary Care Perspectives on Mifepristone Provision Post-Dobbs","authors":"Hannah Shireman MA , Annie Feldkamp BA , Valeria Hernandez BA , Meera Sakthivel MD , Elizabeth Janiak ScD , Debra Stulberg MD, MAPP","doi":"10.1016/j.whi.2025.10.005","DOIUrl":"10.1016/j.whi.2025.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>We explored clinician and staff perspectives on primary care integration and provision of mifepristone following the <em>Dobbs v. Jackson Women's Health Organization</em> decision that removed the federal right to abortion.</div></div><div><h3>Methods</h3><div>In this qualitative study, 41 interviews were conducted with clinicians and staff from three Midwestern clinics that participated in a 1-year learning collaborative (9/2022–8/2023) designed to help primary care settings implement mifepristone for abortion and early pregnancy loss care. Interviews were transcribed verbatim, coded by two researchers independently, and analyzed thematically using inductive and deductive techniques.</div></div><div><h3>Results</h3><div>Interviewees included clinicians (<em>n</em> = 14) and clinical support (<em>n</em> = 17), administrative management (<em>n</em> = 6), and patient-facing administrative (<em>n</em> = 4) staff. <em>Dobbs</em> created a sense of urgency among clinicians and staff, resulting in increased motivation to overcome barriers to mifepristone implementation. Participants felt that providing mifepristone aligned with primary care values, including patient-centeredness and access to care for all. The post-<em>Dobbs</em> political climate, along with federal cases attempting to hinder access to medication abortion, created uncertainty at the institutional and individual levels.</div></div><div><h3>Conclusions</h3><div>Participants in our sample expressed that the <em>Dobbs</em> decision increased their clinics’ motivation to overcome barriers and expand access to abortion and early pregnancy loss care. Other primary care providers may consider leveraging concern about mounting abortion restrictions to advance access to this care in their own settings.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 37-44"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Availability of Onsite Childcare Is Associated With Female Resident Representation: A Cross-Sectional Study 现场托儿服务的可用性与女性常驻代表相关：一项横断面研究。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.10.006

Dhimitri A. Nikolla DO, MS , Kaitlin M. Bowers DO , Vishnu Mudrakola DO , Caroline A. Colleran DO , Jestin N. Carlson MD, MS, MHA , Richelle J. Cooper MD, MSHS

Introduction

Physicians in training are of an age at which becoming or planning to become a parent is common. Female physician parents have greater childcare responsibilities and stress compared with their male colleagues. Therefore, we aimed to estimate the proportion of U.S. residencies with available onsite childcare and examine the association between onsite childcare and female resident representation at the program level.

Materials and Methods

We conducted a cross-sectional study of U.S. residencies from the 10 largest specialties, using 2022 program-level data reported within the Fellowship and Residency Electronic Interactive Database Access (FREIDA) catalog. We compared the percentage of female residents between programs that reported available versus unavailable onsite childcare, excluding programs with missing values for onsite childcare or percentage of female residents. To isolate the within-specialty association, we performed group mean centering by specialty for the primary outcome, the percentage of female residents. We used regression, adjusting for specialty, subsidized childcare, percentage of female faculty (specialty-centered), and clustering by program sponsor to examine the association between onsite childcare and female resident representation.

Results

We included 3,118 of 3,364 programs with available data, and 2,417 (77.5%) did not have onsite childcare. The percentage of female residents (specialty-centered) was lower among programs without onsite childcare than those with onsite childcare (−.38 ± standard deviation 12.99 vs. 1.32 ± 12.36, adjusted coefficient 1.55, 95% confidence interval [.21, 2.90]).

Conclusions

Most training programs in the United States lack available onsite childcare for residents, and onsite childcare was associated with the percentage of female residents.

简介：正在接受培训的医生正处于成为或计划成为父母的年龄。女医师父母比男医师父母承担更大的育儿责任和压力。因此，我们的目的是估计美国住院医师提供现场托儿服务的比例，并检查现场托儿服务与女性住院医师在项目层面的代表性之间的关系。材料和方法：我们对美国10个最大专业的住院医师进行了横断面研究，使用了奖学金和住院医师电子交互数据库访问（FREIDA）目录中报告的2022年项目级数据。我们比较了报告提供和不提供现场托儿服务的项目中女性居民的百分比，排除了现场托儿服务缺失值或女性居民百分比的项目。为了分离专业内的关联，我们对主要结局（女性住院医师的百分比）按专业进行了分组平均居中。我们使用回归，调整了专业、补贴儿童保育、女性教师百分比（以专业为中心）和项目赞助商的聚类，以检验现场儿童保育和女性住院医师代表之间的关系。结果：我们纳入了3364个项目中的3118个，其中2417个（77.5%）没有现场托儿服务。无现场托儿服务的项目中女性住院医师（以专业为中心）比例低于有现场托儿服务的项目（- 0.38±标准差12.99比1.32±12.36，调整系数1.55,95%置信区间）。21日,2.90])。结论：美国大多数培训项目缺乏为住院医师提供的现场托儿服务，而现场托儿服务与女性住院医师的比例有关。

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引用次数: 0

Matrescence: A Critical and Sensitive Period in the Maternal and Child Health (MCH) Life Course Perspective 孕期：母婴健康（MCH）生命历程视角中的一个关键和敏感时期。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2026-01-01 DOI: 10.1016/j.whi.2025.10.009

Mounika Parimi MPH, Cassondra Marshall DrPH, MPH, Ndola Prata MD, MSc

引用次数: 0

Assessing the Effect of the COVID-19 Pandemic on Abortion Care Utilization and Delays and Whether There Was a Differential Impact Among Latinas in North Carolina. 评估COVID-19大流行对北卡罗来纳州拉丁裔堕胎护理利用和延迟的影响以及是否存在差异影响

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-12-27 DOI: 10.1016/j.whi.2025.11.003

Marissa Velarde, Ilene S Speizer, Audrey Pettifor, Mara Buchbinder, Amy G Bryant, Liza Fuentes, Sian Curtis

Objective: We evaluated the effect of the COVID-19 pandemic on abortion service utilization and delays to care among people in North Carolina and assessed whether there was a differential impact between Latinas and non-Hispanic white patients.

Methods: We used state-level data to examine abortions performed in North Carolina health facilities from 2016 to 2021 (N = 167,058). We employed an interrupted time-series analysis to assess changes in the monthly number of abortions and the monthly proportion of abortions at 13 weeks or later gestation both at the pandemic onset (March 2020) and after (April 2020-December 2021). Primary analyses were conducted for all abortion patients and secondary analyses were limited to Latina patients and compared with non-Hispanic white patients.

Main findings: There was no significant change in the monthly number of abortions at the pandemic onset. After March 2020, there was a significant increase in the monthly number of abortions among the total study population. The monthly abortion count also increased for both groups between April 2020 and December 2021, though Latina patients had a greater monthly increase than non-Hispanic white patients. The proportion of abortions at 13 weeks or later dropped significantly at the pandemic onset among the total population by 1.5 (95% confidence interval [-2.3, -.7]) percentage points and remained at approximately the same level thereafter.

Principal conclusions: The COVID-19 pandemic was associated with an increase in monthly abortion counts through 2021 and a decrease in the proportion of abortions after the first trimester at the pandemic's onset.

目的：我们评估COVID-19大流行对北卡罗来纳州人流服务利用和延误护理的影响，并评估拉丁裔和非西班牙裔白人患者之间是否存在差异影响。方法：我们使用州级数据来检查2016年至2021年在北卡罗来纳州卫生机构进行的堕胎（N = 167,058）。我们采用了中断时间序列分析来评估大流行开始时（2020年3月）和之后（2020年4月- 2021年12月）每月堕胎数和妊娠13周或更晚的每月堕胎比例的变化。对所有流产患者进行了初步分析，对拉丁裔患者进行了二级分析，并与非西班牙裔白人患者进行了比较。主要发现：在大流行开始时，每月堕胎数量没有显著变化。2020年3月以后，研究人群中每月的堕胎数量显著增加。在2020年4月至2021年12月期间，两组患者的每月堕胎次数也有所增加，尽管拉丁裔患者的月增长率高于非西班牙裔白人患者。在大流行病开始时，13周或更晚的堕胎比例在总人口中显著下降了1.5个百分点（95%可信区间[-2.3,- 0.7]），此后大致保持在同一水平。主要结论：到2021年，2019冠状病毒病大流行与每月堕胎数量增加以及大流行开始时妊娠头三个月后堕胎比例下降有关。

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引用次数: 0

Patient Characteristics Associated With Group Prenatal Care Attendance in a Randomized Controlled Trial. 一项随机对照试验中与群体产前护理出勤率相关的患者特征。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-12-23 DOI: 10.1016/j.whi.2025.07.005

Emily A Doherty, Sarah Griffin, Kathleen B Cartmell, Moonseong Heo, Liwei Chen, Jessica L Britt, Amy H Crockett

Introduction: Group prenatal care (GPNC) represents a promising alternative to individual prenatal care (IPNC) for better perinatal outcomes. Some studies suggest better perinatal outcomes with more GPNC sessions attended. The present study sought to examine patient characteristics associated with higher or lower GPNC session attendance.

Methods: We conducted a secondary analysis of data collected in a single-site randomized controlled trial comparing GPNC to IPNC, focusing solely on patients assigned to GPNC. The outcome of interest was GPNC session attendance. Predictors evaluated included patient sociodemographic, psychosocial, health, and health behavior characteristics. The association of patient characteristics with session attendance was assessed using Zero-Inflated Poisson regression.

Results: The sample (n = 1,068) was racially diverse (40.7% Black, 35.8% white, 22.1% Hispanic) and largely Medicaid eligible (92.3%). The characteristics of older age (adjusted relative risk [aRR] = 1.01; 95% confidence interval [CI] [1.00, 1.01]; p = .012), foreign nativity (aRR = 1.14; 95% CI [1.06, 1.22]; p < .001), and prenatal distress (aRR = 1.09; 95% CI [1.01, 1.19]; p = .030) were associated with higher session attendance. Being in a committed relationship but unmarried (aRR = .91; 95% CI [.85, .97]; p = .007), less than high school education (aRR = .89; 95% CI [.82, .97]; p = .007), depressive symptoms (aRR = .93; 95% CI [.87, .99]; p = .027), housing instability (aRR = .92; 95% CI [.84, .99]; p = .049), housing issues (aRR = .88; 95% CI [.80, .97]; p = .008), life stressors (aRR = .92; 95% CI [.86, .98]; p = .010), gestational diabetes (aRR = .81; 95% CI [.71, .91]; p < .001), and smoking (aRR = .92; 95% CI [.85, .99]; p = .040) were associated with lower session attendance.

Discussion: Patient characteristics were differentially associated with GPNC session attendance. Given that patients with less education, more depressive symptoms, housing instability, stressors, gestational diabetes, and prenatal cigarette use attended fewer sessions, adaptations to the GPNC model to reduce attendance barriers for these groups should be considered.

小组产前护理（GPNC）代表了一个有希望的替代个人产前护理（IPNC）更好的围产期结局。一些研究表明，参加更多的GPNC会议可以获得更好的围产期结果。本研究试图检查与GPNC会议出席率较高或较低相关的患者特征。方法：我们对一项比较GPNC和IPNC的单点随机对照试验收集的数据进行了二次分析，只关注分配给GPNC的患者。感兴趣的结果是GPNC会议出席率。评估的预测因素包括患者的社会人口学、心理社会、健康和健康行为特征。使用零膨胀泊松回归评估患者特征与会议出席率的关系。结果：样本（n = 1,068）具有种族多样性（黑人40.7%，白人35.8%，西班牙裔22.1%），并且大部分符合医疗补助计划（92.3%）。年龄较大（校正相对危险度[aRR] = 1.01； 95%可信区间[CI] [1.00, 1.01]; p = 0.012）、外国出生（aRR = 1.14; 95% CI [1.06, 1.22]; p < .001）和产前焦虑（aRR = 1.09; 95% CI [1.01, 1.19]; p = 0.030）的特征与较高的出勤率相关。有一段忠诚的关系但未婚(aRR = 0.91; 95% CI[。85 .97点);p = .007)，低于高中教育程度(aRR = .89; 95% CI[。82 .97点);p = .007)，抑郁症状(aRR = .93; 95% CI[。87年,获得);p = 0.027)，住房不稳定性(aRR = 0.92; 95% CI[。84年,获得);p = 0.049)，住房问题(aRR = 0.88; 95% CI[。80 .97点);p = 0.008)，生活压力因素(aRR = 0.92; 95% CI[。86 .98];p = 0.010)，妊娠期糖尿病(aRR = 0.81; 95% CI[。71 .91点);p < 0.001)和吸烟(aRR = 0.92; 95% CI[。85年,获得);P = 0.040)与较低的出勤率相关。讨论：患者特征与GPNC会议出席率存在差异。考虑到受教育程度较低、抑郁症状较多、住房不稳定、压力源、妊娠糖尿病和产前吸烟的患者参加的会议较少，应考虑对GPNC模型进行调整，以减少这些群体的出勤障碍。

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引用次数: 0

Obstetrics and Gynecology Residents' Perspectives on Obtaining Out-of-state Abortion Skills Training Post Dobbs: A Qualitative Study. 妇产科住院医师对获得州外流产技能培训岗位的看法：一项定性研究。

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2025-12-13 DOI: 10.1016/j.whi.2025.11.002

Fathima Wakeel, Nikitha Ram, Laxmi Thakkar, Vanessa Perillo, Danielle Johnson

Purpose: Despite the direct impact of obstetrics and gynecology (OB/GYN) residency training on patient care, little research has examined how the Dobbs decision affects residents in abortion-restricting states who must travel out of state for abortion training. This study qualitatively explores the perceptions of OB/GYN residents living in abortion-restricting states and the impacts of obtaining out-of-state abortion skills training (OSAST) post-Dobbs.

Methods: Data are from a sample comprising 19 OB/GYN residents living in states that banned abortion or set 6-week gestational limits. Residents had either completed (n = 7), planned to complete (n = 11), or were unsure about completing (n = 1) OSAST. Participants completed semistructured interviews, and grounded theory analysis identified themes relating to their lived experiences with and impacts of OSAST.

Results: Seven key themes were identified in the data: financial challenges, personal life disruptions, emotional safety, administrative and legal obstacles, training adequacy concerns, future employment plans, and ethical and professional decision-making. Participants described substantial financial, logistical, social, and emotional challenges in obtaining abortion training. Limited access to abortion training impacted residents' perceived clinical competence and confidence in their ability to provide abortion care in the future.

Conclusion: OB/GYN residents' worries about their clinical competence given training constraints raise concerns about the ability of the future OB/GYN workforce to provide high-quality abortion care, particularly for patients already facing critical health disparities. The challenges they described suggest that residents seeking OSAST could benefit from additional support to streamline administrative processes and ease the process of temporary relocation.

目的：尽管妇产科（OB/GYN）住院医师培训对患者护理有直接影响，但很少有研究调查多布斯决定如何影响堕胎限制州的住院医师，他们必须离开州去接受堕胎培训。本研究定性地探讨了生活在限制堕胎州的妇产科住院医师对堕胎的看法，以及在多布斯后接受州外堕胎技能培训（OSAST）的影响。方法：数据来自19名居住在禁止堕胎或设定6周妊娠限制的州的妇产科医生。居民已完成（n = 7）、计划完成（n = 11）或不确定完成（n = 1） OSAST。参与者完成了半结构化访谈，基础理论分析确定了与他们的生活经历和OSAST影响相关的主题。结果：在数据中确定了七个关键主题：财务挑战、个人生活中断、情感安全、行政和法律障碍、培训充分性问题、未来就业计划以及道德和专业决策。参与者描述了在获得堕胎培训时所面临的巨大经济、后勤、社会和情感挑战。有限的流产培训机会影响了住院医师的临床能力和对未来提供流产护理能力的信心。结论：由于培训限制，妇产科住院医师对自己临床能力的担忧，引发了对未来妇产科工作人员提供高质量堕胎护理能力的担忧，特别是对已经面临严重健康差距的患者。他们所描述的挑战表明，寻求OSAST的居民可以从精简行政程序和简化临时搬迁过程的额外支持中受益。

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