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Evolving the Health Care Service Model for Menopause With Digital Health 以数字健康发展更年期保健服务模式
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.03.005
Constance Guille MD, MSCR , Hannah Jahnke PhD, Neel Shah MD, MPP, Natalie Henrich PhD, MPH
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引用次数: 0
Impact of Dobbs v. Jackson Women's Health Organization on Obstetrics and Gynecology Training One Year Later: Qualitative Analysis of Physician Perspectives Dobbs诉Jackson妇女健康组织对1年后妇产科培训的影响:医师观点的定性分析。
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.005
Sarah E. Andiman MD , A. Jenna Beckham MD, MSPH , Gabriela E. Halder MD, MPH , Angela DiCarlo-Meacham MD , William D. Winkelman MD , Shunaha Kim-Fine MD, MS , Rebecca Rogers MD , Cheryl Iglesia MD , Cara L. Grimes MD, MAS , Society of Gynecologic Surgeons Collaborative Research in Pelvic Surgery Consortium (SGS CoRPS)

Background

On June 24, 2022, the Supreme Court of the United States' Dobbs v. Jackson Women's Health Organization decision ended constitutional protection for abortion, resulting in severely restricted access to reproductive health care and raising concerns about the repercussions on obstetrics and gynecology trainees.

Objective

This qualitative study examines the observed effects of the Dobbs decision on obstetrics and gynecology training and practice one year out.

Methods

Obstetrics and gynecology physicians involved in patient care and medical education were invited to participate in online focus groups. We attempted to recruit participants from a diversity of subspecialties and regions of the United States. Eighteen physicians participated in five sessions conducted July–October 2023. Using an iterative process, two independent researchers coded transcripts to identify themes and subthemes. An additional reviewer resolved discrepancies.

Results

Eight themes were identified: dichotomy of care in restrictive versus protective states, loss of the patient-physician relationship, moral distress to physicians, legal concerns for physicians, new issues for training programs, loss of patient care experiences for trainees, loss of access to care for patients, and disappointment and frustration with policy makers. Themes were grouped into their effects on patients, trainees, physicians, and society overall, reflecting negative changes in patient care, training, and physician morale.

Conclusions

This qualitative study found that physicians see the Dobbs ruling as having negative effects on patients, trainees, and physicians. Participants observed that these changes are leading to a dichotomy of care in which patients in restrictive and protective states receive different care and some patients may not receive medically necessary treatment.
背景:2022年6月24日,美国最高法院对“多布斯诉杰克逊妇女健康组织案”的判决结束了宪法对堕胎的保护,严重限制了获得生殖保健的机会,并引发了对妇产科学员影响的担忧。目的:本定性研究考察多布斯决策对一年后妇产科培训和实践的影响。方法:邀请参与患者护理和医学教育的妇产科医师参与在线焦点小组。我们试图从美国不同的亚专业和地区招募参与者。18名医生参加了2023年7月至10月进行的五次会议。两位独立研究人员使用迭代过程对文本进行编码,以确定主题和副主题。另一位审稿人解决了差异。结果:确定了八个主题:限制与保护状态下的护理二分法,医患关系的丧失,医生的道德困扰,医生的法律问题,培训计划的新问题,学员失去患者护理经验,患者失去获得护理的机会,以及对政策制定者的失望和沮丧。主题被分为对病人、受训者、医生和整个社会的影响,反映了病人护理、培训和医生士气的负面变化。结论:本定性研究发现,医生认为Dobbs裁决对患者、受训者和医生都有负面影响。与会者注意到,这些变化导致护理的两分法,即处于限制性和保护性状态的患者得到不同的护理,有些患者可能得不到医疗上必要的治疗。
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引用次数: 0
Menopause-Related Service Needs in Veterans Health Administration Medical Centers: Findings From the Women's Health Practice-Based Research Network Menopause Practice Scan 退伍军人健康管理医疗中心的绝经相关服务需求:来自妇女健康实践研究网络绝经实践扫描的发现
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.004
Susan J. Diem MD, MPH , Haley A. Miles-McLean PhD , Diane V. Carney MA , Jeanette E. Shekelle MPH , Francesca Nicosia PhD , Susan M. Frayne MD, MPH , Elizabeth M. Yano PhD, MSPH , Carolyn J. Gibson PhD, MPH, MSCP

Background

Information about the state of menopause-related care in the Veterans Health Administration (VA) is needed to identify targets for intervention and resource development across the national VA Health Care System.

Procedures

A brief electronic key informant survey designed to assess current menopause-related services, resources, and needs in VA primary care was distributed to all active VA Women's Health Practice-Based Research Network (WH-PBRN) Site Leads. The survey included structured items, with responses summarized with descriptive statistics, and open-ended prompts, with answers analyzed using directed content analysis.

Findings

Key informant surveys were completed by 60 of 73 active WH-PBRN sites (response rate 82%). Most sites reported a range of available resources; 88% reported having VA-based consultants (e.g., gynecologists, pharmacists, and/or endocrinologists) available to assist primary care providers with pharmacological management of menopause symptoms. However, sites named a need for educational materials, menopause-focused classes or groups, and resources or support for a variety of menopause-associated issues. Sites overwhelmingly reported that menopause care was made easier by the availability and/or integration of menopause-trained specialty providers in the primary care setting, adequate menopause training for primary care providers, and time in appointments to address complex care issues.

Conclusions

In this survey of primary care settings at WH-PBRN sites across the VA Health Care System, sites highlighted the importance of available resources, time in appointments, training for primary care providers, and the availability and integration of menopause-informed specialty care services for comprehensive menopause care in the VA setting. Improving the VA's care model for menopause also has the potential to inform efforts to improve services in other health systems.
背景:需要了解退伍军人卫生管理局(VA)的绝经相关护理状况,以确定整个国家VA卫生保健系统的干预目标和资源开发。程序:一份简短的电子关键信息调查,旨在评估VA初级保健中当前与更年期相关的服务、资源和需求,并分发给所有活跃的VA妇女健康实践研究网络(WH-PBRN)站点领导。调查包括结构化的项目,用描述性统计总结回答,和开放式提示,用直接内容分析分析答案。结果:73个活跃的WH-PBRN位点中有60个完成了关键信息调查(应答率82%)。大多数站点报告了一系列可用资源;88%的人报告有基于va的咨询师(如妇科医生、药剂师和/或内分泌学家)可以帮助初级保健提供者对更年期症状进行药理学管理。然而,网站指出需要教育材料,以更年期为重点的课程或小组,以及各种更年期相关问题的资源或支持。网站压倒性地报告说,更年期护理变得更容易,因为在初级保健环境中有更年期培训的专业提供者,对初级保健提供者进行了充分的更年期培训,并有时间预约解决复杂的护理问题。结论:在对VA卫生保健系统中WH-PBRN站点的初级保健设置的调查中,站点强调了可用资源、预约时间、初级保健提供者培训的重要性,以及在VA环境中全面绝经护理的绝经知情专业护理服务的可用性和整合。改善退伍军人管理局的更年期护理模式也有可能为其他卫生系统改善服务的努力提供信息。
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引用次数: 0
Integrating Payor-Segregated Outpatient OBGYN Care Models: The Clinician Perspective 整合付费隔离门诊妇产科护理模式:临床医生的观点。
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.002
Arina Chesnokova MD, MPH, MSHP , Allison Schachter BA , Elizabeth Clement MD , Sarita Sonalkar MD, MPH , Marilyn Schapira MD, MPH , Florencia Polite MD , Abike James MD, MPH , Sindhu Srinivas MD, MSCE , Elizabeth Howell MD, MPP , Rebecca Hamm MD, MSCE

Purpose

Significant and unacceptable racial disparities in maternal health and gynecologic outcomes exist in the United States, with ambulatory care being a potential contributor. In many academic medical centers (AMCs), publicly insured and uninsured patients receive care in clinics staffed primarily by residents under attending supervision, whereas those with private insurance see attending physicians at a different site. This segregation by payor can translate to de facto racial segregation. This study explores clinician perspectives on payor-segregated care delivery by resident and attending sites in a major AMC and their opinions on integrating these sites.

Methods

We conducted semi-structured interviews with attending physicians and advanced practice providers (APPs) from both sites. The interview guide focused on: 1) perceived value of the current care model, 2) attitudes toward care integration, and 3) barriers and facilitators to integration. Interviews were conducted from October 2022 to January 2023 until thematic saturation was achieved. Data analysis involved an integrated approach with grounded theory, with 20% of transcripts double-coded (k = .90).

Results

We interviewed 15 clinicians (10 attendings, five APPs). Although clinicians recognized some value in the existing segregated system, they supported ending it as a moral imperative to combat inequity. They also highlighted challenges and expressed concerns about feasibility of integration. Concerns encompassed maintaining patient-clinician continuity, acceptance of trainees by privately insured patients, potential erosion of mission-driven care, and the risk of racist interactions if a safe space for a vulnerable community is disrupted. Clinicians stressed the need for resources and small-scale trials before full-scale integration.

Conclusion

Although clinicians expressed unity around the concept of integrating ambulatory care delivery, a path toward implementing an alternative model of care remains unclear. This study provides initial insights into disparities in ambulatory OBGYN care and may guide health systems considering care integration.
目的:在美国,孕产妇保健和妇科结果存在显著的和不可接受的种族差异,门诊护理是一个潜在的因素。在许多学术医疗中心(amc),公共保险和没有保险的病人在主要由住院医生监督的居民组成的诊所接受治疗,而那些有私人保险的人在不同的地点看主治医生。这种付款人的隔离可以转化为事实上的种族隔离。本研究探讨了临床医生对主要AMC中住院医师和主治医师对付费隔离式医疗服务的看法,以及他们对整合这些站点的看法。方法:我们对两家医院的主治医生和高级执业医师(app)进行了半结构化访谈。访谈指南的重点是:1)当前护理模式的感知价值,2)对护理整合的态度,以及3)整合的障碍和促进因素。采访从2022年10月到2023年1月进行,直到主题饱和。数据分析采用基于理论的综合方法,20%的转录本双编码(k = 0.90)。结果:我们采访了15名临床医生(10名主治医师,5名app)。尽管临床医生认识到现有隔离制度的一些价值,但他们支持结束这种制度,认为这是打击不平等的道德要求。他们还强调了挑战,并对一体化的可行性表示关切。人们担心的问题包括保持病人和临床医生的连续性,私人保险患者接受培训生,使命驱动型护理的潜在侵蚀,以及如果脆弱社区的安全空间被破坏,种族主义互动的风险。临床医生强调在全面整合之前需要资源和小规模试验。结论:尽管临床医生对整合门诊护理交付的概念表示一致,但实施另一种护理模式的途径仍不清楚。这项研究提供了初步的见解,在门诊妇产科护理差距,并可能指导卫生系统考虑护理整合。
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引用次数: 0
Birth-Intention Time Horizon as a Predictor of Contraceptive Method Effectiveness 生育意向时间范围作为避孕方法有效性的预测因子。
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.04.006
Yuko Hara PhD , Michael S. Rendall PhD

Background

Both contraceptive method research and contraceptive program designs have given more attention to if a woman currently wants to have a child than to when she wants a child. We examine how predictive is a woman's intended duration to a (next) birth for her type of contraceptive method currently used, ranked by the method's effectiveness. We hypothesize that a longer intended duration will be associated with choosing a more effective method.

Methods

We pooled observations of women (n = 7,324 in total) across the two population-representative surveys in Delaware and Maryland: the Behavioral Risk Factor Surveillance System and the Survey of Women. We classified birth-timing intentions into wanting a child in less than 2 years, wanting a child but being uncertain when, wanting a child in 2 or more years, and not wanting (additional) children. Contraceptive method was classified as highly effective (intrauterine devices and implants), moderately effective (e.g., contraceptive pills), less effective (e.g., condoms), and no method. We used multinomial logistic regression to estimate relative risk ratios and predicted probabilities of using each method type, and no method, adjusting for sociodemographic characteristics.

Results

As a woman's birth-timing intention horizon lengthens, her probability of using a highly effective method increases, and her probability of using no method decreases. Being uncertain about birth timing is associated with a substantially lower probability of using any type of contraceptive method relative to having clear intentions.

Conclusions

Our findings underscore the importance for contraceptive counseling and contraceptive access program design of considering birth-timing intentions beyond the year immediately ahead.
背景:避孕方法研究和避孕方案设计都更关注女性目前是否想要孩子,而不是她想要孩子的时间。我们研究了女性目前使用的避孕方法的预期持续时间对其(下一次)分娩的预测程度,并根据方法的有效性进行了排名。我们假设,更长的预期持续时间将与选择更有效的方法有关。方法:我们汇集了特拉华州和马里兰州两项具有人口代表性的调查中的妇女观察结果(n = 7324):行为风险因素监测系统和妇女调查。我们将生育意向分为想在2年内要一个孩子,想要一个孩子但不确定是什么时候,想在2年或更长时间内要一个孩子,以及不想要(额外的)孩子。避孕方法分为高效(宫内节育器和植入物)、中等有效(如避孕药)、低效(如避孕套)和无方法。我们使用多项逻辑回归来估计相对风险比,并预测使用每种方法类型的概率,以及不使用方法的概率,并根据社会人口统计学特征进行调整。结果:随着女性生育意向视界的延长,使用高效方法的概率增加,不使用有效方法的概率降低。与有明确的意图相比,不确定生育时间与使用任何避孕方法的可能性都大大降低有关。结论:我们的研究结果强调了避孕咨询和避孕获取方案设计的重要性,考虑生育计划的意图,超越了即将到来的一年。
{"title":"Birth-Intention Time Horizon as a Predictor of Contraceptive Method Effectiveness","authors":"Yuko Hara PhD ,&nbsp;Michael S. Rendall PhD","doi":"10.1016/j.whi.2025.04.006","DOIUrl":"10.1016/j.whi.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Both contraceptive method research and contraceptive program designs have given more attention to if a woman currently wants to have a child than to when she wants a child. We examine how predictive is a woman's intended duration to a (next) birth for her type of contraceptive method currently used, ranked by the method's effectiveness. We hypothesize that a longer intended duration will be associated with choosing a more effective method.</div></div><div><h3>Methods</h3><div>We pooled observations of women (<em>n</em> = 7,324 in total) across the two population-representative surveys in Delaware and Maryland: the Behavioral Risk Factor Surveillance System and the Survey of Women. We classified birth-timing intentions into wanting a child in less than 2 years, wanting a child but being uncertain when, wanting a child in 2 or more years, and not wanting (additional) children. Contraceptive method was classified as highly effective (intrauterine devices and implants), moderately effective (e.g., contraceptive pills), less effective (e.g., condoms), and no method. We used multinomial logistic regression to estimate relative risk ratios and predicted probabilities of using each method type, and no method, adjusting for sociodemographic characteristics.</div></div><div><h3>Results</h3><div>As a woman's birth-timing intention horizon lengthens, her probability of using a highly effective method increases, and her probability of using no method decreases. Being uncertain about birth timing is associated with a substantially lower probability of using any type of contraceptive method relative to having clear intentions.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the importance for contraceptive counseling and contraceptive access program design of considering birth-timing intentions beyond the year immediately ahead.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 292-299"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250323","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
Military Exposures and Early Menopause: Findings From the Gulf War Era Cohort Study (GWECS) 军事暴露和早期绝经:来自海湾战争时期队列研究(GWECS)的发现。
IF 2.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-07-01 DOI: 10.1016/j.whi.2025.05.001
Carolyn J. Gibson PhD, MPH , Guichan Cao MS , Sabra Inslicht PhD , Allison D. Altman PhD , Caitlin E. Haas BS, BA , Aaron Schneiderman PhD, MPH, RN , Erin Dursa PhD, MPH

Objective

Traumatic and environmental exposures during military service may affect reproductive health and ovarian aging, putting women veterans at risk for early menopause. We examined relationships between military exposures and possible early menopause among women 1990–1991 Gulf War veterans.

Methods

This is a longitudinal analysis of data from the Gulf War Era Cohort Study. Women Gulf War veterans who completed baseline (1995) and follow-up assessments (2012) and were aged ≤45 at follow-up were included. Military exposures (Gulf War deployment, military environmental exposures [MEEs], Gulf War Illness, military sexual trauma [MST]) and posttraumatic stress disorder (PTSD) were assessed at baseline. Participants were categorized as having possible early menopause if in response to follow-up survey questions about menstruation they indicated menopause or having no periods for 1 year. Associations among military exposures, PTSD, and possible early menopause were examined with logistic regression models.

Results

The analytic sample included 668 women veterans. Among Gulf War–deployed veterans (n = 384), 63% reported MEEs and 26% reported MST during deployment. Within the total sample, 57% met criteria for Gulf War Illness, and 23% met criteria for probable PTSD. At follow-up, 15% had possible early menopause. In adjusted analyses, Gulf War Illness (odds ratio [OR] 1.83; 95% confidence interval [CI] [1.14, 2.95]) and probable PTSD (OR 2.45; 95% CI [1.54, 3.90]) were significantly associated with possible early menopause.

Conclusion

Women veterans may be vulnerable to early menopause (under age 45), which brings additional care considerations for health promotion and symptom management. Menopause care in the Department of Veterans Affairs should include consideration of PTSD and comorbid chronic conditions such as Gulf War Illness, key veteran-centric clinical correlates that may influence the onset and experience of menopause.
目的:服役期间的创伤和环境暴露可能影响生殖健康和卵巢老化,使女性退伍军人面临提前绝经的风险。我们研究了1990-1991年海湾战争女性退伍军人的军事暴露与可能的提前绝经之间的关系。方法:这是对海湾战争时期队列研究数据的纵向分析。女性海湾战争退伍军人完成基线(1995年)和随访评估(2012年),随访时年龄≤45岁。军事暴露(海湾战争部署、军事环境暴露[MEEs]、海湾战争疾病、军事性创伤[MST])和创伤后应激障碍(PTSD)在基线时进行评估。如果参与者在回答关于月经的后续调查问题时表示更年期或1年内没有月经,他们就被归类为可能提前绝经。用logistic回归模型检验了军事暴露、创伤后应激障碍和可能的早期绝经之间的关系。结果:分析样本包括668名女性退伍军人。在海湾战争中服役的退伍军人(n = 384)中,63%报告了MEEs, 26%报告了MST。在总样本中,57%符合海湾战争疾病的标准,23%符合可能的创伤后应激障碍的标准。在随访中,15%的人可能提前绝经。在校正分析中,海湾战争病(优势比[OR] 1.83;95%可信区间[CI][1.14, 2.95])和可能的PTSD (OR 2.45;95% CI[1.54, 3.90])与可能的提前绝经显著相关。结论:45岁以下的女性退伍军人可能容易出现提前绝经,这需要在健康促进和症状管理方面进行额外的护理。退伍军人事务部的更年期护理应包括考虑创伤后应激障碍和合并症慢性疾病,如海湾战争病,这些以退伍军人为中心的关键临床相关因素可能会影响更年期的发生和经历。
{"title":"Military Exposures and Early Menopause: Findings From the Gulf War Era Cohort Study (GWECS)","authors":"Carolyn J. Gibson PhD, MPH ,&nbsp;Guichan Cao MS ,&nbsp;Sabra Inslicht PhD ,&nbsp;Allison D. Altman PhD ,&nbsp;Caitlin E. Haas BS, BA ,&nbsp;Aaron Schneiderman PhD, MPH, RN ,&nbsp;Erin Dursa PhD, MPH","doi":"10.1016/j.whi.2025.05.001","DOIUrl":"10.1016/j.whi.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>Traumatic and environmental exposures during military service may affect reproductive health and ovarian aging, putting women veterans at risk for early menopause. We examined relationships between military exposures and possible early menopause among women 1990–1991 Gulf War veterans.</div></div><div><h3>Methods</h3><div>This is a longitudinal analysis of data from the Gulf War Era Cohort Study. Women Gulf War veterans who completed baseline (1995) and follow-up assessments (2012) and were aged ≤45 at follow-up were included. Military exposures (Gulf War deployment, military environmental exposures [MEEs], Gulf War Illness, military sexual trauma [MST]) and posttraumatic stress disorder (PTSD) were assessed at baseline. Participants were categorized as having possible early menopause if in response to follow-up survey questions about menstruation they indicated menopause or having no periods for 1 year. Associations among military exposures, PTSD, and possible early menopause were examined with logistic regression models.</div></div><div><h3>Results</h3><div>The analytic sample included 668 women veterans. Among Gulf War–deployed veterans (<em>n</em> = 384), 63% reported MEEs and 26% reported MST during deployment. Within the total sample, 57% met criteria for Gulf War Illness, and 23% met criteria for probable PTSD. At follow-up, 15% had possible early menopause. In adjusted analyses, Gulf War Illness (odds ratio [OR] 1.83; 95% confidence interval [CI] [1.14, 2.95]) and probable PTSD (OR 2.45; 95% CI [1.54, 3.90]) were significantly associated with possible early menopause.</div></div><div><h3>Conclusion</h3><div>Women veterans may be vulnerable to early menopause (under age 45), which brings additional care considerations for health promotion and symptom management. Menopause care in the Department of Veterans Affairs should include consideration of PTSD and comorbid chronic conditions such as Gulf War Illness, key veteran-centric clinical correlates that may influence the onset and experience of menopause.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 4","pages":"Pages 276-282"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337157","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
Perceived Infertility and Contraceptive Use Among Reproductive-Aged Women in Ohio 俄亥俄州育龄妇女的不孕症和避孕药具使用。
IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.007
Kayla M. Alvis MS, PhD , Jess Keesee MD , Marta Bornstein MPH, PhD , Abigail Norris Turner PhD , Meredith Pensak MD, MPH , Priya R. Gursahaney MD, MS

Objective

This study examines the association between sociodemographic factors and perceived infertility, as well as between perceived infertility, contraceptive use, and contraceptive method type.

Study Design

We analyzed the Ohio Survey of Women baseline data collected in 2018–2019 (N = 2,568). Using logistic regression, we assessed the association between sociodemographic characteristics and perceived infertility. We then used multivariate logistic regression and multinomial regression to estimate the association between perceived infertility and any contraceptive use and contraception method type (long-acting reversible, hormonal short-acting reversible, and coital-dependent methods).

Results

Age, race, marital status, household income, and prior pregnancies were associated significantly with odds of perceived infertility. Of those who said they were not at all likely to be infertile, 73% reported using any contraception compared to 63% of those who said they were somewhat to very likely to be infertile. In multivariable analyses, those who reported perceived infertility had 31% lower odds of using contraception than those who did not (adjusted odds ratio = 0.7; 95% confidence interval [0.5, 1.0]). Those with perceived infertility had twice the odds of using no contraception than using long-acting reversible methods compared with those without perceived infertility.

Conclusions

Reproductive-aged women in Ohio who perceive they may have difficulty becoming pregnant or be infertile have lower odds of using contraception, particularly long-acting reversible methods, compared with those who do not perceive they may be infertile. Improved education on infertility may be warranted to support individuals, particularly in groups with higher odds of perceived infertility, in making informed choices about contraception.
目的:本研究探讨了社会人口学因素与不孕症之间的关系,以及不孕症、避孕药使用和避孕方法类型之间的关系。研究设计:我们分析了2018-2019年收集的俄亥俄州妇女基线调查数据(N = 2568)。使用逻辑回归,我们评估了社会人口学特征与感知不孕症之间的关系。然后,我们使用多元逻辑回归和多项回归来估计感知不孕症与任何避孕使用和避孕方法类型(长效可逆、激素短效可逆和性交依赖方法)之间的关联。结果:年龄、种族、婚姻状况、家庭收入和怀孕史与不孕症发生率显著相关。在那些说自己完全不可能不孕的人中,73%的人说自己采取了避孕措施,相比之下,63%的人说自己有点或很可能会不孕。在多变量分析中,那些认为自己不孕的人使用避孕措施的几率比那些没有使用避孕措施的人低31%(校正优势比= 0.7;95%置信区间[0.5,1.0])。与那些没有察觉到不孕症的人相比,那些觉察到不孕症的人不采取避孕措施的几率是使用长效可逆方法的两倍。结论:在俄亥俄州,认为自己可能难以怀孕或不孕的育龄妇女使用避孕措施的几率较低,特别是长效可逆方法,与那些不认为自己可能不孕的妇女相比。加强对不孕不育的教育可能是有必要的,以支持个人,特别是在认为不孕不育的可能性较高的群体中,对避孕作出知情的选择。
{"title":"Perceived Infertility and Contraceptive Use Among Reproductive-Aged Women in Ohio","authors":"Kayla M. Alvis MS, PhD ,&nbsp;Jess Keesee MD ,&nbsp;Marta Bornstein MPH, PhD ,&nbsp;Abigail Norris Turner PhD ,&nbsp;Meredith Pensak MD, MPH ,&nbsp;Priya R. Gursahaney MD, MS","doi":"10.1016/j.whi.2025.02.007","DOIUrl":"10.1016/j.whi.2025.02.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study examines the association between sociodemographic factors and perceived infertility, as well as between perceived infertility, contraceptive use, and contraceptive method type.</div></div><div><h3>Study Design</h3><div>We analyzed the Ohio Survey of Women baseline data collected in 2018–2019 (<em>N</em> = 2,568). Using logistic regression, we assessed the association between sociodemographic characteristics and perceived infertility. We then used multivariate logistic regression and multinomial regression to estimate the association between perceived infertility and any contraceptive use and contraception method type (long-acting reversible, hormonal short-acting reversible, and coital-dependent methods).</div></div><div><h3>Results</h3><div>Age, race, marital status, household income, and prior pregnancies were associated significantly with odds of perceived infertility. Of those who said they were not at all likely to be infertile, 73% reported using any contraception compared to 63% of those who said they were somewhat to very likely to be infertile. In multivariable analyses, those who reported perceived infertility had 31% lower odds of using contraception than those who did not (adjusted odds ratio = 0.7; 95% confidence interval [0.5, 1.0]). Those with perceived infertility had twice the odds of using no contraception than using long-acting reversible methods compared with those without perceived infertility.</div></div><div><h3>Conclusions</h3><div>Reproductive-aged women in Ohio who perceive they may have difficulty becoming pregnant or be infertile have lower odds of using contraception, particularly long-acting reversible methods, compared with those who do not perceive they may be infertile. Improved education on infertility may be warranted to support individuals, particularly in groups with higher odds of perceived infertility, in making informed choices about contraception.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 180-187"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744262","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
Contraception Coverage Policy in the United States: History and Current Challenges 美国避孕覆盖政策:历史和当前的挑战。
IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.03.002
Carol S. Weisman PhD , Diana Velott MPA, MS , Amy Zheng MD , Sarah Horvath MD, MSHP , Douglas Leslie PhD , Cynthia H. Chuang MD, MSc

Background

State and federal policies have aimed to expand access to contraception by providing coverage of its costs in both public and private health insurance. Yet barriers to contraception coverage remain and are expected to increase after the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization. This paper describes the history of these policies and current challenges.

Methods

We constructed a chronology of federal and state policies providing coverage of the cost of contraception in both public and private health insurance, from establishment of the federal right to contraception through 2024, using published sources and public datasets. We aligned the chronology with the history of the development of contraception technology and practices, as described by historians and social scientists, and with political and legal challenges.

Results

Following establishment of a federal right to contraception after nearly a century of restrictions under the 1873 Comstock Act, three waves of contraception coverage policymaking sought to increase access to contraception by making it more affordable to consumers. These waves included options for states to expand coverage for contraception within the Medicaid program; passage of state contraception coverage equity laws to ensure parity for contraceptive coverage in private health plans; and the Affordable Care Act's national contraceptive coverage requirement and its subsequent modifications, clarifications, and codifications. Post-Dobbs, challenges to contraception coverage include efforts to redefine certain contraceptives as abortifacients and to resurrect some of the restrictions of the Comstock Act. The requirement of no-cost coverage of preventive services is also threatened.

Conclusion

Contraception coverage policy will be impacted by ongoing challenges to contraception and abortion access, as well as changing contraceptive technology and modes of delivery.
背景:州和联邦政策旨在通过在公共和私人健康保险中提供避孕费用的覆盖范围来扩大获得避孕的机会。然而,避孕覆盖的障碍仍然存在,预计在2022年美国最高法院对多布斯诉杰克逊妇女健康组织一案作出裁决后,这种障碍将会增加。本文描述了这些政策的历史和当前的挑战。方法:我们使用公开的来源和公共数据集,构建了从联邦避孕权建立到2024年,联邦和州在公共和私人健康保险中提供避孕费用覆盖的政策年表。按照历史学家和社会科学家的描述,我们将避孕技术和实践的发展史与政治和法律挑战结合起来。结果:在1873年《科姆斯托克法案》(Comstock Act)的限制下,经过近一个世纪的限制,联邦政府确立了避孕权,此后,三次避孕覆盖政策制定浪潮试图通过让消费者更负担得起避孕措施来增加避孕机会。这些浪潮包括各州在医疗补助计划中扩大避孕覆盖范围的选择;通过国家避孕保险公平法,以确保私人健康计划中避孕保险的平等;以及《平价医疗法案》的全国避孕覆盖要求及其随后的修改、澄清和编纂。多布斯案之后,对避孕措施覆盖范围的挑战包括努力将某些避孕措施重新定义为堕胎药,并恢复《科姆斯托克法案》的一些限制。免费提供预防服务的要求也受到威胁。结论:避孕覆盖政策将受到避孕和流产获取面临的持续挑战以及避孕技术和分娩方式的变化的影响。
{"title":"Contraception Coverage Policy in the United States: History and Current Challenges","authors":"Carol S. Weisman PhD ,&nbsp;Diana Velott MPA, MS ,&nbsp;Amy Zheng MD ,&nbsp;Sarah Horvath MD, MSHP ,&nbsp;Douglas Leslie PhD ,&nbsp;Cynthia H. Chuang MD, MSc","doi":"10.1016/j.whi.2025.03.002","DOIUrl":"10.1016/j.whi.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>State and federal policies have aimed to expand access to contraception by providing coverage of its costs in both public and private health insurance. Yet barriers to contraception coverage remain and are expected to increase after the 2022 U.S. Supreme Court decision in <em>Dobbs v. Jackson Women's Health Organization</em>. This paper describes the history of these policies and current challenges.</div></div><div><h3>Methods</h3><div>We constructed a chronology of federal and state policies providing coverage of the cost of contraception in both public and private health insurance, from establishment of the federal right to contraception through 2024, using published sources and public datasets. We aligned the chronology with the history of the development of contraception technology and practices, as described by historians and social scientists, and with political and legal challenges.</div></div><div><h3>Results</h3><div>Following establishment of a federal right to contraception after nearly a century of restrictions under the 1873 Comstock Act, three waves of contraception coverage policymaking sought to increase access to contraception by making it more affordable to consumers. These waves included options for states to expand coverage for contraception within the Medicaid program; passage of state contraception coverage equity laws to ensure parity for contraceptive coverage in private health plans; and the Affordable Care Act's national contraceptive coverage requirement and its subsequent modifications, clarifications, and codifications. Post-<em>Dobbs</em>, challenges to contraception coverage include efforts to redefine certain contraceptives as abortifacients and to resurrect some of the restrictions of the Comstock Act. The requirement of no-cost coverage of preventive services is also threatened.</div></div><div><h3>Conclusion</h3><div>Contraception coverage policy will be impacted by ongoing challenges to contraception and abortion access, as well as changing contraceptive technology and modes of delivery.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 151-158"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040948","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
Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals 商业保险生育个体自付保险费用与心理治疗使用的关系。
IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.003
Stephanie V. Hall PhD, MPH , Andrea Pangori MS , Anca Tilea MPH , Kara Zivin PhD, MS, MA, MFA , Anna Courant MFA, MSN, RN, CPNP-PC , Amy Schroeder MA , A. Mark Fendrick MD , Vanessa K. Dalton MD, MPH

Background

Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.

Objectives

In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.

Methods

This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.

Results

The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).

Discussion

Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.
背景:围产期情绪和焦虑障碍(PMADs)是常见的、负担沉重的、昂贵的妊娠并发症,但很少有人得到治疗。自付费用(OOPCs)可能是PMAD治疗的重大障碍。目的:在有活产记录的商业保险参保人群中,我们试图确定OOPCs高于中位数的商业保险计划是否比OOPCs低于中位数的商业保险计划有更低的心理治疗使用率和数量,以及使用率是否因收入或心理健康状况而异。方法:本系列横断面研究使用Optum的去识别Clinformatics®数据集市数据库(2016-2020)。我们使用逻辑回归来检验预测心理治疗使用的关联。我们的样本包括来自38,512个保险计划的199,022名参保者的219,043名独特出生。我们将所有参保者的oopc分为低或高、收入低于联邦贫困线的400%或等于或高于联邦贫困线的400%,以及声称是否患有PMAD。结果:心理治疗的OOPC中位数从2016年的49美元上升到2020年的54美元。低OOPC计划的参与者使用心理治疗的可能性是高OOPC计划参与者的1.12倍,95%可信区间[1.10,1.15]。无论OOPC水平如何,低收入的ppmad患者接受心理治疗的次数相同(低OOPC计划和高OOPC计划分别为5次)。按OOPC计划水平划分,高收入参选者参加心理治疗的次数更多(低OOPC计划参选者7次,高OOPC计划参选者6次)。讨论:在高收入入组者中,较高的OOPC与较低的心理治疗使用率相关,而低收入入组者无论OOPC水平如何,都较少使用心理治疗。减少或取消pads的费用分摊可以改善获取和增强公平性。
{"title":"Association Between Out-of-Pocket Insurance Costs and Psychotherapy Utilization Among Commercially Insured Birthing Individuals","authors":"Stephanie V. Hall PhD, MPH ,&nbsp;Andrea Pangori MS ,&nbsp;Anca Tilea MPH ,&nbsp;Kara Zivin PhD, MS, MA, MFA ,&nbsp;Anna Courant MFA, MSN, RN, CPNP-PC ,&nbsp;Amy Schroeder MA ,&nbsp;A. Mark Fendrick MD ,&nbsp;Vanessa K. Dalton MD, MPH","doi":"10.1016/j.whi.2025.02.003","DOIUrl":"10.1016/j.whi.2025.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal mood and anxiety disorders (PMADs) are common, burdensome, and costly pregnancy complications, yet few receive treatment. Out-of-pocket costs (OOPCs) may represent a significant barrier to PMAD treatment.</div></div><div><h3>Objectives</h3><div>In a population of commercially insured enrollees with a documented live birth, we sought to determine whether commercial insurance plans with above-median OOPCs had lower rates and amounts of psychotherapy utilization than plans with below-median OOPCs and whether utilization differed by income or mental health status.</div></div><div><h3>Methods</h3><div>This serial, cross-sectional study used Optum's de-identified Clinformatics® Data Mart Database (2016–2020). We tested associations using logistic regression predicting psychotherapy utilization. Our sample included 219,043 unique births from 199,022 enrollees in 38,512 insurance plans. We categorized all enrollees as having low or high OOPCs, income below 400% of the federal poverty level or at or above 400% federal poverty level, and claims indicating a PMAD or not.</div></div><div><h3>Results</h3><div>The median OOPC for psychotherapy rose from $49 in 2016 to $54 in 2020. Enrollees in low OOPC plans were 1.12 (95% confidence interval [1.10, 1.15]) times more likely to utilize psychotherapy than those in high OOPC plans. Lower-income enrollees with PMADs attended the same number of psychotherapy visits regardless of OOPC level (five visits for low and high OOPC plans). Higher-income enrollees attended more psychotherapy by OOPC plan level (seven visits for low OOPC plans vs. six visits for high OOPC plans).</div></div><div><h3>Discussion</h3><div>Higher OOPCs were associated with lower psychotherapy utilization among higher-income enrollees, whereas lower-income enrollees used less psychotherapy regardless of OOPC level. Reducing or eliminating cost sharing for PMADs may improve access and enhance equity.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 143-150"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693946","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
The State of VA-funded Women Veterans’ Health Systems Research 弗吉尼亚州资助的女性退伍军人健康系统研究。
IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2025-05-01 DOI: 10.1016/j.whi.2025.02.006
Amanda E. Borsky DrPH, MPP , Aimee Kroll-Desrosiers PhD , Adriana Rodriguez PhD , Karissa Fenwick PhD, MSW , Jessica K. Friedman PhD, MPH, MSc , Elizabeth M. Yano PhD, MSPH

Background

Women veterans are the fastest-growing population of new users within the Department of Veterans Affairs (VA) health care delivery system. This paper aims to characterize the scope of women's health research funded by VA Health Systems Research (HSR) over the past 10 years.

Methods

Ten years of data (2014–2023) were obtained from a VA financial database that captures research projects that started on or after January 1, 2014. Projects were coded for topical areas and study types.

Results

VA HSR funded 91 women's health studies over the past 10 years. The number of active projects grew from 7 in 2014 to 50 in 2023, with a parallel increase in total funding amount for women's health-focused research projects (nearly $570,000 in 2014 and $8.1 M in 2023). Descriptive or epidemiological studies were the most prominent study type (55% of active projects) and there was a steady increase in intervention and implementation studies. The most common topics were mental health and/or substance use (22% of projects), followed by reproductive health (13%), access/rural health (13%), other chronic conditions (12%), violence and trauma exposure (10%), primary care and prevention (8%), pain (7%), other (5%), comorbidities (3%), post-deployment health (3%), aging and long-term care (2%), and cancer (2%).

Conclusions

Overall, our findings indicate that HSR funding for studies focused on women veterans' health has grown over the last decade, and those studies have diversified in topics and types of study designs. As a learning health system, VA can use these findings to prioritize its future women's health research funding to meet the health needs of women veterans.
背景:女性退伍军人是退伍军人事务部(VA)卫生保健服务系统中增长最快的新用户群体。本文旨在描述过去10年由VA卫生系统研究(HSR)资助的妇女健康研究的范围。方法:从VA财务数据库中获取10年(2014-2023)的数据,该数据库捕获了2014年1月1日或之后开始的研究项目。项目按照主题领域和研究类型进行编码。结果:VA HSR在过去10年中资助了91项妇女健康研究。活跃项目的数量从2014年的7个增加到2023年的50个,以妇女健康为重点的研究项目的资助总额也相应增加(2014年近57万美元,2023年810万美元)。描述性或流行病学研究是最主要的研究类型(占活跃项目的55%),干预和实施研究稳步增加。最常见的主题是精神健康和/或药物使用(占项目的22%),其次是生殖健康(13%)、可及性/农村健康(13%)、其他慢性病(12%)、暴力和创伤暴露(10%)、初级保健和预防(8%)、疼痛(7%)、其他(5%)、合并症(3%)、部署后健康(3%)、老龄化和长期护理(2%)以及癌症(2%)。结论:总体而言,我们的研究结果表明,在过去十年中,高铁对女性退伍军人健康研究的资助有所增加,这些研究的主题和研究设计类型也有所多样化。作为一个学习型健康系统,VA可以利用这些发现来优先考虑其未来的女性健康研究资金,以满足女性退伍军人的健康需求。
{"title":"The State of VA-funded Women Veterans’ Health Systems Research","authors":"Amanda E. Borsky DrPH, MPP ,&nbsp;Aimee Kroll-Desrosiers PhD ,&nbsp;Adriana Rodriguez PhD ,&nbsp;Karissa Fenwick PhD, MSW ,&nbsp;Jessica K. Friedman PhD, MPH, MSc ,&nbsp;Elizabeth M. Yano PhD, MSPH","doi":"10.1016/j.whi.2025.02.006","DOIUrl":"10.1016/j.whi.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Women veterans are the fastest-growing population of new users within the Department of Veterans Affairs (VA) health care delivery system. This paper aims to characterize the scope of women's health research funded by VA Health Systems Research (HSR) over the past 10 years.</div></div><div><h3>Methods</h3><div>Ten years of data (2014–2023) were obtained from a VA financial database that captures research projects that started on or after January 1, 2014. Projects were coded for topical areas and study types.</div></div><div><h3>Results</h3><div>VA HSR funded 91 women's health studies over the past 10 years. The number of active projects grew from 7 in 2014 to 50 in 2023, with a parallel increase in total funding amount for women's health-focused research projects (nearly $570,000 in 2014 and $8.1 M in 2023). Descriptive or epidemiological studies were the most prominent study type (55% of active projects) and there was a steady increase in intervention and implementation studies. The most common topics were mental health and/or substance use (22% of projects), followed by reproductive health (13%), access/rural health (13%), other chronic conditions (12%), violence and trauma exposure (10%), primary care and prevention (8%), pain (7%), other (5%), comorbidities (3%), post-deployment health (3%), aging and long-term care (2%), and cancer (2%).</div></div><div><h3>Conclusions</h3><div>Overall, our findings indicate that HSR funding for studies focused on women veterans' health has grown over the last decade, and those studies have diversified in topics and types of study designs. As a learning health system, VA can use these findings to prioritize its future women's health research funding to meet the health needs of women veterans.</div></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"35 3","pages":"Pages 205-218"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744265","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
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Womens Health Issues
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