Womens Health Issues最新文献

{"title":"Provider Perspectives on De-Implementation of Routine Blood Typing and Rh Immune Globulin Administration in the First Trimester: A Qualitative Study","authors":"Emma V. Gilmore MD,&nbsp;Madeline V. Smith MPH,&nbsp;Cecelia Tannous-Taylor BA,&nbsp;Arden McAllister MPH,&nbsp;Courtney A. Schreiber MD, MPH,&nbsp;Sarita Sonalkar MD, MPH","doi":"10.1016/j.whi.2025.10.001","DOIUrl":"10.1016/j.whi.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Study Design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 45-51"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497132","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}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 79-88"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146669379","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}

{"title":"Patient Experiences in Accessing Reproductive Health Services for Women With Cognitive, Intellectual, and Developmental Disabilities: A Systematic Review","authors":"Claire Chang BS, BA ,&nbsp;Rogie Royce Carandang PhD, MPH, MSc, RPh ,&nbsp;Jillian Silverberg MSLIS, MA ,&nbsp;Claire Surkis BA ,&nbsp;Shayna D. Cunningham PhD ,&nbsp;Katie Wang PhD ,&nbsp;Neena Qasba MD, MPH","doi":"10.1016/j.whi.2025.10.008","DOIUrl":"10.1016/j.whi.2025.10.008","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 20-36"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582717","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}

{"title":"Prenatal Education to Support Pregnant People's Awareness, Knowledge, and Reported Oral Exposure and Risk Reduction Behaviors Surrounding Congenital Cytomegalovirus","authors":"Marissa Diener PhD ,&nbsp;Shaistah Din BS ,&nbsp;Jessica Sharma BS ,&nbsp;Louisa A. Stark PhD ,&nbsp;Torri D. Metz MD, MS ,&nbsp;Sara J. Knight PhD ,&nbsp;Luke Hansen MD ,&nbsp;Abel Chavez BS ,&nbsp;Taylor Redding MD ,&nbsp;Nathan Blue MD ,&nbsp;Albert H. Park MD","doi":"10.1016/j.whi.2025.11.004","DOIUrl":"10.1016/j.whi.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Pregnant patients (<em>N</em> = 136) were randomized into a print (<em>n</em> = 76) or video (<em>n</em> = 60) educational intervention. Some (<em>n</em> = 73) participants received the education remotely via e-mail after their clinic visit; others (<em>n</em> = 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 52-61"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866065","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}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 62-69"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146669381","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}

{"title":"“Cementing Our Place on the Right Side of History”: Primary Care Perspectives on Mifepristone Provision Post-Dobbs","authors":"Hannah Shireman MA ,&nbsp;Annie Feldkamp BA ,&nbsp;Valeria Hernandez BA ,&nbsp;Meera Sakthivel MD ,&nbsp;Elizabeth Janiak ScD ,&nbsp;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}

{"title":"Availability of Onsite Childcare Is Associated With Female Resident Representation: A Cross-Sectional Study","authors":"Dhimitri A. Nikolla DO, MS ,&nbsp;Kaitlin M. Bowers DO ,&nbsp;Vishnu Mudrakola DO ,&nbsp;Caroline A. Colleran DO ,&nbsp;Jestin N. Carlson MD, MS, MHA ,&nbsp;Richelle J. Cooper MD, MSHS","doi":"10.1016/j.whi.2025.10.006","DOIUrl":"10.1016/j.whi.2025.10.006","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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]).</div></div><div><h3>Conclusions</h3><div>Most training programs in the United States lack available onsite childcare for residents, and onsite childcare was associated with the percentage of female residents.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 62-69"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551468","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}

{"title":"Matrescence: A Critical and Sensitive Period in the Maternal and Child Health (MCH) Life Course Perspective","authors":"Mounika Parimi MPH,&nbsp;Cassondra Marshall DrPH, MPH,&nbsp;Ndola Prata MD, MSc","doi":"10.1016/j.whi.2025.10.009","DOIUrl":"10.1016/j.whi.2025.10.009","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 3-7"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716103","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}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 70-78"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146669380","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}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"36 1","pages":"Pages 3-7"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146669386","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}