Womens Health Issues最新文献

Objectives: This study analyzed the extent to which variations in state preterm birth rates are associated with state reproductive rights policies after accounting for individual risk factors.

Methods: The study analyzed preterm (<37 weeks) births using the 2022 National Vital Statistics System Natality File. State reproductive rights policy scores were obtained from the Institute for Women's Policy Research (IWPR) 2022 Reproductive Rights Index. IWPR scores were trichotomized to reflect approximately one-third of births occurring in most-restrictive, somewhat-restrictive, and least-restrictive states. Logistic regression was used to estimate the likelihood of preterm birth, testing the independent significance of state reproductive rights restrictions after adjusting for maternal characteristics. Sensitivity analyses adjusted for other state characteristics.

Results: Among 3,530,543 births analyzed, mean preterm birth rates ranged from a mean of 9.4% in the group of the least-restrictive states to a mean of 11.2% in the group of most-restrictive states. The highest rates were in Mississippi (14.3%), Louisiana (13.3%), and West Virginia (13.3%), all in the most-restrictive category. There was an r = .54 correlation between state IWPR scores and preterm birth percentage (p < .001). After adjusting for sociodemographic and clinical risk factors, births in the most-restrictive states had 20% higher and somewhat-restrictive states had 16% higher odds of preterm birth as compared with births in the least-restrictive states, with state rankings attenuated but remaining significant after inclusion of other state characteristics.

Conclusion: Although this study cannot establish causal inference, restrictive reproductive rights may be linked to prematurity through higher rates of unintended pregnancy and greater maternal comorbidity. Study findings add to a growing literature on health status differences between states associated with restrictive reproductive rights legislation.

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.

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.

Background: Intimate partner violence (IPV) is a prevalent source of stress and trauma among women, especially among women who use substances. However, IPV-related trauma is not widely addressed in substance use disorder (SUD) treatment and research on the influence of IPV on SUD is limited. We aimed to explore women's perspectives on the impacts of IPV on their substance use and recovery and identify associated service needs.

Methods: We conducted semi-structured interviews with women who experienced IPV and received SUD treatment at a safety-net health system in Massachusetts (June-October 2023). Pre-interview questionnaires captured demographic characteristics and histories of IPV, substance use, and receipt of SUD services. Interviews were audio-recorded, transcribed, and thematically analyzed using content analysis with an iterative inductive and deductive team-based analytic process.

Results: Twelve participants who identified as non-Hispanic Black (n = 2), non-Hispanic white (n = 7), Hispanic (n = 2), and more than one race (n = 1) completed interviews. All participants had experienced substance use and IPV. We identified three themes related to the perceived impact of IPV on substance use recovery and service access: 1) partner's coercive and controlling behaviors can contribute to women's substance use and inhibit SUD service engagement, 2) mental health impacts of IPV can exacerbate substance use and inhibit engagement in SUD services, and 3) women value mental health and IPV supportive services, along with SUD treatment, for their recovery.

Conclusion: Our findings highlight the need for co-addressing mental health and IPV concerns with SUD treatment to support women's recovery, including increased mental health and peer support to complement SUD treatment. Implementing a trauma-informed approach in SUD treatment could help address the underlying sources of stress and trauma among women to improve SUD treatment outcomes and overall well-being.

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.

Background: Polycystic ovary syndrome (PCOS) is a chronic medical condition characterized by ovulatory dysfunction, hyperandrogenism, and/or polycystic ovary morphology. Data on rates of PCOS among active-duty service members (ADSMs) are limited, despite high risk for medical comorbidities (e.g., obesity, type 2 diabetes) that could negatively impact ADSMs' health and military careers. This study aimed to describe the incidence and prevalence of PCOS and possible PCOS (i.e., both ovulatory dysfunction and hyperandrogenism) among ADSMs.

Methods: This retrospective cohort study accessed data from the Military Health System Data Repository between 2018 and 2022. ADSMs with a PCOS International Classification of Diseases, 10^th Revision (ICD-10) code or ICD-10 codes indicative of irregular menstruation and hyperandrogenism within a 12-month period (i.e., possible PCOS) were identified. The yearly incidence and prevalence of PCOS/possible PCOS were computed per 10,000 female ADSMs, and Jonckheere-Terpstra tests for trend(s) were conducted.

Results: During the surveillance period, 15,059 ADSMs met the criteria for PCOS or possible PCOS (55% white, 16% Hispanic/Latina; 44% aged 22-27 years; 85% enlisted, 13% officers). The yearly incidence rate of PCOS/possible PCOS ranged from 73 per 10,000 female ADSMs in 2018 to 103 per 10,000 female ADSMs in 2022 and did not change significantly (p = .33). The prevalence of PCOS/possible PCOS increased significantly (p = .01) from 210 per 10,000 female ADSMs in 2018 to 380 per 10,000 female ADSMs in 2022.

Conclusion: Approximately 4% of ADSMs had a diagnosis of PCOS during the 5-year surveillance period, and about 1% of ADSMs newly met criteria for PCOS each year. More research is needed to determine the health care needs of ADSMs with PCOS.