Womens Health Issues最新文献_第6页

Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice 乳房再造中的财务毒性考虑因素：研究与实践建议》。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2024.01.005

Hannah Kinzer MPH , Clara N. Lee MD, MPP , Krista Cooksey BA , Terence Myckatyn MD , Margaret A. Olsen PhD, MPH , Randi Foraker PhD, MA, FAHA, FAMIA, FACMI , Anna Rose Johnson MD, MPH , Mary C. Politi PhD

引用次数: 0

Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence 亲密伴侣暴力女性幸存者的头部伤害、勒颈、心脏代谢健康和功能障碍之间的关系。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.11.002

Michelle M. Pebole PhD, MA , Katherine M. Iverson PhD , Catherine B. Fortier PhD , Kimberly B. Werner PhD , Jennifer R. Fonda PhD, MA , Alyssa Currao MPH , James W. Whitworth PhD , Regina E. McGlinchey PhD , Tara E. Galovski PhD

Objective

Head injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV.

Methods

Participants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1).

Results

Head injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06–.13; ds: 0.51–1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R² = 0.37, p < .01) and several of its associated domains: cognition (R² = 0.34, F(8,42) = 2.73, p = .01), mobility (R² = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R² = 0.33, F(8,42) = 2.59, p = .02).

Conclusions

Findings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.

目的：在亲密伴侣暴力（IPV）的情况下，头部受伤和勒死的情况非常普遍，但很少有研究探讨这些伤害对身体健康和功能状态的潜在影响。这项试验性研究探讨了伤害类型（头部伤害、勒颈）和严重程度（无伤害、亚撞击性头部伤害、创伤性脑损伤；无勒颈、勒颈、意识丧失的勒颈）与 IPV 女性幸存者的心脏代谢健康生物标志物和自我报告的功能相关程度：方法：51 名出生时即被指定为女性的幸存者在其一生中经历过 IPV，并在 DSM-5 的创伤后应激障碍核对表中筛查出可能患有创伤后应激障碍（PTSD）（平均年龄 = 32.6 岁，SD = 7.1）：结果：头部受伤与血糖水平的上升有显著的统计学关系（p = .01，d = 1.10）。高密度脂蛋白、低密度脂蛋白和腰臀比（PS：.06-.13；DS：0.51-1.30）也向更高风险值转变，其效应大小为中强。绞窄与胆固醇水平升高有关，影响程度适中（P = 0.20，D = 0.59）。考虑到年龄、教育程度、创伤后应激障碍症状、童年创伤、勒死和头部损伤的回归模型可预测功能性残疾状况（R2 = 0.37，P 2 = 0.34，F(8,42) = 2.73，P = .01）和行动能力（R2 = 0.47，F(8,42) = 4.82，P 2 = 0.33，F(8,42) = 2.59，P = .02）：研究结果表明，有必要针对有头部损伤史的 IPV 女性幸存者的身体健康合并症开发综合治疗方法，以改善其日常功能和生活质量。

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引用次数: 0

Characteristics of U.S. Abortion Patients Who Obtained Care Out of State Prior to the Overturning of Roe v. Wade 罗伊诉韦德案被推翻前在州外接受治疗的美国堕胎患者的特征。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.10.003

Sarah M. Axelson MSW , Riley J. Steiner PhD, MPH , Rachel K. Jones PhD

Context

In light of the Dobbs v. Jackson Women's Health Organization decision overturning Roe v. Wade, the number of people who need to travel out of state for abortion is increasing as several states impose abortion bans. Better understanding the characteristics of patients who obtained out-of-state abortions before the decision can provide a reference point for future research and inform efforts to improve abortion access.

Methods

We used data from the 2014 Abortion Patient Survey, administered by the Guttmacher Institute, to examine the prevalence and characteristics of patients obtaining nonhospital abortions outside of their state of residence. We examined bivariate and multivariable associations between selected characteristics and obtaining an abortion out of state.

Results

Six percent of abortion patients traveled out of state for care. Among patients who obtained their abortion out of state, more than half (56.9%) were non-Hispanic (NH) white, 26.6% were non-Hispanic Black, and 10.2% were Hispanic. Two-fifths (43.9%) resided in the South, one-third (34.3%) resided in the Midwest, 15% resided in the Northeast, and 7% resided in the West. More than one-third (38.2%) had family incomes below 100% of the federal poverty level (FPL), and two-thirds (67.7%) paid out of pocket; only 3% used Medicaid. Profiles of out-of-state abortion patients differed from in-state abortion patients by all characteristics except age. In adjusted analyses, NH Black (adjusted odds ratio [AOR]: 0.76; 95% confidence interval [CI]: 0.61–0.96), NH Asian, South Asian, and Asian Pacific Islander (AOR: 0.37; 95% CI: 0.20–0.67), and Hispanic (AOR: 0.46; 95% CI: 0.33–0.64) patients had lower odds of traveling out of state compared with their NH white counterparts. Compared with those paying for their abortion with private insurance, those who paid out of pocket had higher odds of traveling out of state (AOR: 1.75; 95% CI: 1.29–2.37) and those paying with Medicaid had lower odds (AOR: 0.27; 95% CI: 0.15–0.47).

Conclusion

Given the observed differences by race/ethnicity and method of payment for abortion, people of color and those without resources to pay out of pocket may especially benefit from efforts to support access to abortion care via interstate travel as an increasing number of states ban abortion.

背景：鉴于多布斯诉杰克逊妇女健康组织案（Dobbs v. Jackson Women's Health Organization）的判决推翻了罗伊诉韦德案（Roe v. Wade），随着多个州实施堕胎禁令，需要到州外堕胎的人数正在增加。更好地了解在该判决之前在州外堕胎的患者的特征，可为今后的研究提供参考，并为改善堕胎途径提供依据：我们使用古特马赫研究所（Guttmacher Institute）管理的 2014 年堕胎患者调查数据，研究了在居住州外进行非医院堕胎的患者的患病率和特征。我们研究了所选特征与在州外进行人工流产之间的双变量和多变量关联：结果：6%的人工流产患者前往州外接受治疗。在州外堕胎的患者中，一半以上（56.9%）为非西班牙裔（NH）白人，26.6%为非西班牙裔黑人，10.2%为西班牙裔。五分之二（43.9%）居住在南方，三分之一（34.3%）居住在中西部，15%居住在东北部，7%居住在西部。超过三分之一（38.2%）的人家庭收入低于联邦贫困线（FPL）的 100%，三分之二（67.7%）的人自掏腰包，只有 3% 的人使用医疗补助。除年龄外，州外人工流产患者与州内人工流产患者的所有特征均有所不同。在调整后的分析中，与新罕布什尔州的白人患者相比，新罕布什尔州的黑人（调整后的几率比 [AOR]：0.76；95% 置信区间 [CI]：0.61-0.96）、新罕布什尔州的亚裔、南亚和亚太岛民（AOR：0.37；95% CI：0.20-0.67）以及西班牙裔（AOR：0.46；95% CI：0.33-0.64）患者出州旅行的几率较低。与使用私人保险支付人工流产费用的患者相比，自费患者出州旅行的几率更高（AOR：1.75；95% CI：1.29-2.37），而使用医疗补助支付的患者出州旅行的几率较低（AOR：0.27；95% CI：0.15-0.47）：鉴于观察到的种族/民族差异和堕胎付款方式的不同，随着越来越多的州禁止堕胎，有色人种和没有自费资源的人群可能会特别受益于支持通过州际旅行获得堕胎护理的努力。

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引用次数: 0

Effects of Georgia's Medicaid Family Planning Waiver on Pregnancy Characteristics and Birth Outcomes 佐治亚州医疗补助计划生育豁免对妊娠特征和分娩结果的影响。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.11.004

Gery P. Guy Jr. PhD, MPH , E. Kathleen Adams PhD, MS , Sara K. Redd PhD, MSPH , Anne L. Dunlop MD, MPH

Introduction

Medicaid family planning waivers can increase access to health care services and have been associated with lower rates of unintended pregnancy, which is associated with a higher risk of negative birth outcomes such as preterm birth and low birthweight. The objective of this study was to test the effect of Georgia's Medicaid family planning waiver, Planning for Healthy Babies (P4HB), on pregnancy characteristics and birth outcomes.

Materials and Methods

We used the Pregnancy Risk Assessment Monitoring System (PRAMS) survey data in pre- (2008–2009) and two post-periods (2012–2013; 2017–2019). We identified those likely eligible for P4HB in Georgia (n = 1,967) and 10 comparison states (n = 13,449) and tested for effects using state and year fixed effects difference-in-differences modeling.

Results

P4HB was associated with a 13.3 percentage-point (pp) decrease in unintended pregnancy in the immediate post-period (p < .01) and an 11.4 pp decrease in the later post-period (p < .05). For the immediate post-period, P4HB was also associated with a 29.2 pp increase in the probability of prepregnancy contraception (p < .001) and a 1.1 pp decrease in the probability of a very low birthweight (VLBW) birth (p < .01). The reduction in VLBW birth was significant for non-Hispanic Black mothers (−3.9 pp; p < .05) but not for mothers of other races/ethnicities.

Discussion

Medicaid family planning waivers are an important structural policy intervention that can improve reproductive health care, particularly in states without Medicaid expansion. These waivers may also help address long-standing racial/ethnic disparities in access to reproductive health care and, potentially, adverse pregnancy and birth outcomes. However, the initial increase in pregnancies among people using contraception indicates that care must be taken to ensure that recipients have access to effective methods of contraception and receive counseling on effective use in order to avoid unintended consequences as more individuals try to prevent a pregnancy.

导言：医疗补助（Medicaid）计划生育减免计划可以增加获得医疗保健服务的机会，并与降低意外怀孕率有关，而意外怀孕与早产和低出生体重等不良出生结果的高风险有关。本研究的目的是测试佐治亚州医疗补助计划生育减免计划 "健康婴儿计划（P4HB）"对妊娠特征和出生结果的影响：我们使用了妊娠风险评估监测系统（PRAMS）在前期（2008-2009 年）和后期（2012-2013 年；2017-2019 年）的调查数据。我们在佐治亚州（n = 1,967）和 10 个对比州（n = 13,449）确定了可能符合 P4HB 条件的人群，并使用州和年份固定效应差分模型检验了效果：结果：P4HB 与紧随其后的意外怀孕率下降 13.3 个百分点（pp）有关（p 讨论）：医疗补助"（Medicaid）计划生育豁免是一项重要的结构性政策干预措施，可以改善生殖保健，尤其是在没有扩大 "医疗补助 "的州。这些豁免也有助于解决长期存在的种族/民族在获得生殖健康护理方面的差异，以及潜在的不良妊娠和分娩结果。然而，使用避孕药具的人群中怀孕人数的初步增加表明，必须注意确保受助人能够获得有效的避孕方法，并接受关于有效使用的咨询，以避免随着越来越多的人尝试避孕而产生意外后果。

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引用次数: 0

“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers "我没想到会问这个问题"：大学生健康中心对人工流产转介请求的回应。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.12.003

Priyanka Anand MD , Licia Bravo BS , Sarah Gutman MD, MSPH , Arden McAllister MPH , Shimrit Keddem PhD , Sarita Sonalkar MD, MPH

Background

Women 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers.

Procedures

We conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral.

Main Findings

A total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance; coercion; misleading language; questioning the caller's autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies.

Conclusions

Abortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.

背景：在所有年龄组中，18-24 岁女性意外怀孕的比例最高，因此是需要人工流产服务的重要人群。先前的研究表明，只有一半的大学生健康中心提供适当的人工流产转介服务。我们的目标是更好地了解大学生健康中心的转诊经验和人工流产转诊的障碍：2017 年 6 月至 2018 年 4 月期间，我们在宾夕法尼亚州的所有四年制大学开展了一项 "秘密来电 "研究，使用结构化脚本要求进行人工流产转介。我们对通话进行了转录，使用迭代开发的编码手册进行编码，并分析了与人工流产转介的障碍和促进因素相关的主题：共审查了 202 份完整的记录誊本。出现的主题包括对人工流产转介的了解、经验和舒适度；支持、同情和保证；胁迫；误导性语言；质疑来电者的自主权；以及反对转介的机构政策。大多数工作人员对人工流产转介缺乏了解，也不熟悉。虽然一些工作人员对来电者表示支持，但其他工作人员则使用胁迫性语言试图劝阻来电者不要堕胎。许多工作人员援引了反对堕胎转介的宗教机构政策，并表达了对此类政策的不同感受：学生健康中心的堕胎转介缺乏一致性。工作人员经常不具备提供适当人工流产转介所需的知识，在回应转介请求时使用胁迫性语言，并使人工流产污名化永久化。一些保健工作人员使用胁迫性或回避性语言，进一步污名化了来电者的堕胎转介请求。学院保健中心应改善有关堕胎转介的培训和资源，以确保他们提供适当、高质量的护理。

{"title":"“I Wasn't Expecting That Question”: Responses to Requests for Abortion Referral at College Student Health Centers","authors":"Priyanka Anand MD , Licia Bravo BS , Sarah Gutman MD, MSPH , Arden McAllister MPH , Shimrit Keddem PhD , Sarita Sonalkar MD, MPH","doi":"10.1016/j.whi.2023.12.003","DOIUrl":"10.1016/j.whi.2023.12.003","url":null,"abstract":"<div><h3>Background</h3><p>Women 18–24 years of age have the highest proportion of unintended pregnancies of any age group, and thus represent a significant population in need of abortion services. Prior research indicated that only half of college student health centers provide appropriate abortion referrals. Our objective was to better understand the referral experience and barriers to abortion referral at college student health centers.</p></div><div><h3>Procedures</h3><p>We conducted a “secret caller” study at all 4-year colleges in Pennsylvania between June 2017 and April 2018, using a structured script requesting abortion referral. Calls were transcribed, coded using an iteratively developed codebook, and analyzed for themes related to barriers and facilitators of abortion referral.</p></div><div><h3>Main Findings</h3><p>A total of 202 completed transcripts were reviewed. Themes that emerged were knowledge, experience, and comfort with abortion referral; support, empathy, and reassurance<span><span>; coercion; misleading language; questioning the caller's </span>autonomy; and institutional policy against referral. Most staff lacked knowledge and comfort with abortion referral. Although some staff members made supportive statements toward the caller, others used coercive language to try to dissuade the caller from an abortion. Many staff cited religious institutional policies against abortion referral and expressed a range of feelings about such policies.</span></p></div><div><h3>Conclusions</h3><p>Abortion referrals at student health centers lack consistency. Staff members frequently did not have the knowledge needed to provide appropriate abortion referrals, used coercive language in responding to requests for referrals, and perpetuated abortion stigma. Some health staff used coercive or evasive language that further stigmatized the caller's request for an abortion referral. College health centers should improve training and resources around abortion referral to ensure they are delivering appropriate, high-quality care.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513983","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

Early Childcare Precarity and Subsequent Maternal Health 早期儿童保育不稳定和随后的孕产妇健康。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.10.002

Carol Duh-Leong MD, MPP , Caitlin F. Canfield PhD , Anne E. Fuller MD, MS , Rachel S. Gross MD, MS , Nancy E. Reichman PhD

Purpose

We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.

Study Design

We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.

Results

Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11–2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23–2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13–2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22–2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B −0.45; 95% CI, −0.80 to −0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.

Conclusion

Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

目的:我们研究了早期儿童保育不稳定性或儿童保育安排的安全性和可靠性与随后的孕产妇健康之间的潜在关联。研究设计:我们对2,836名儿童母亲的调查反馈进行了二次分析，这些母亲参与了“家庭与儿童健康的未来”研究。我们评估了以下托儿措施:不安全托儿、不安全托儿与缺勤、不充分的托儿和紧急托儿支持。我们使用具有稳健标准误差的线性和逻辑回归模型来检验这些指标在儿童3岁时与儿童9岁后的母亲健康结果(整体健康、抑郁和养育压力)之间的关联。然后，我们检查了1岁和3岁儿童保育措施的附加经验对孕产妇健康结果的影响。结果:早期托儿不足增加了后来产妇整体健康状况不佳的几率(调整优势比[aOR]， 1.64;95%可信区间[CI]， 1.11-2.41)。所有早期儿童保育不稳定措施都增加了母亲抑郁的几率(儿童保育不安全[aOR, 1.64;95% ci, 1.23-2.18];不安全托儿与缺勤[aOR, 1.58];95% ci, 1.13-2.22];儿童保育不足[aOR, 1.75;95% ci, 1.22-2.51])。紧急托儿支持降低了孕产妇不良健康结局的几率(整体健康状况差[aOR, 0.65;95% CI, 0.48 ~ 0.88];抑郁[aOR, 0.73;95% CI, 0.54 ~ 0.99];父母压力[B -0.45];95% CI， -0.80 ~ -0.10])。与短时间体验相比，长时间体验与孕产妇健康有更强的关联。结论:早期托儿不稳定与孕产妇健康存在长期不良关联，紧急托儿支持似乎有利于孕产妇健康。对研究人员、临床医生和决策者来说，这些发现突出了儿童保育不稳定是妇女健康的一个社会决定因素。

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引用次数: 0

Hispanic Women's Perceptions of Neural Tube Defects and Folic Acid Supplementation: A Qualitative Study 西班牙裔女性对神经管缺陷和叶酸补充剂的认知：一项定性研究。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.08.006

Roxanne Mirabal-Beltran PhD , Katherine Monogue-Rines RN , Kylie Riva RN , Nandi Dube , Pamela Donohue ScD, MS

Introduction

In the United States, the prevalence of neural tube defects (NTDs) is higher among infants born to Hispanic women compared with those born to non-Hispanic women. The purpose of this study is to investigate perceptions of NTDs and the use of folic acid and folate as a preventive measure among Hispanic women.

Methods

Purposive sampling was used to recruit Hispanic women from a prenatal clinic in a Northeastern metropolitan city. In-depth interviews were conducted by native Spanish-speaking researchers using a semistructured interview guide. Thematic analysis was used to develop themes related to a priori domains.

Findings

The study sample consisted of 26 Hispanic women representing nine countries of origin. Four themes were revealed: dietary sources of folic acid, awareness of folic acid supplementation and fortification, preferences for receiving health information, and factors in decision-making concerning an NTD diagnosis.

Conclusions

This study highlights the importance of early and targeted educational interventions sensitive to the cultural needs of this population. Results suggest that current NTD health education efforts may not be sufficient to increase our participants’ knowledge of NTD. Additionally, the disparity may be multimodal, potentially influenced by insufficient understanding of prenatal folic acid use and the role of religiosity in decision-making during pregnancy. If Hispanic women are more likely to continue pregnancies affected by NTDs, this factor could be a part of NTD disparities. Exploring factors beyond supplementation and fortification that might influence rates of NTDs at birth in the U.S. Hispanic population can help to inform prevention efforts.

引言：在美国，西班牙裔女性所生婴儿的神经管缺陷（NTD）患病率高于非西班牙牙裔女性。本研究的目的是调查西班牙裔妇女对NTD的认知以及叶酸和叶酸作为预防措施的使用情况。方法：采用目的性抽样方法，从东北大城市的一家产前诊所招募西班牙裔妇女。以西班牙语为母语的研究人员使用半结构化的访谈指南进行深度访谈。专题分析用于开发与先验领域相关的专题。研究结果：研究样本包括来自9个原籍国的26名西班牙裔女性。揭示了四个主题：叶酸的饮食来源、叶酸补充和强化的意识、接受健康信息的偏好以及NTD诊断决策中的因素。结论：本研究强调了对这一人群的文化需求敏感的早期和有针对性的教育干预的重要性。结果表明，目前的NTD健康教育工作可能不足以增加参与者对NTD的了解。此外，这种差异可能是多模式的，可能受到对产前叶酸使用和宗教信仰在妊娠决策中的作用了解不足的影响。如果西班牙裔女性更有可能因NTD而继续怀孕，这一因素可能是NTD差异的一部分。探索补充和强化之外可能影响美国西班牙裔人口出生时NTD发病率的因素，有助于为预防工作提供信息。

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引用次数: 0

Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use 马萨诸塞州妇产科医生使用米非司酮的情况：使用的流行率和预测因素。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.11.007

Emily Newton-Hoe MPH, MPA , Alice Lee MD , Jennifer Fortin MPH , Alisa B. Goldberg MD, MPH , Elizabeth Janiak ScD , Sara Neill MD, MPH

Objectives

We estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use.

Methods

We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training.

Results

A total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications.

Conclusions

Sufficient medication abortion training during residency significantly predicts whether obstetrician-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of Roe v. Wade will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.

目标：我们估算了马萨诸塞州独立执业的妇产科医生根据循证适应症使用米非司酮的流行率，并探讨了与使用米非司酮相关的人口统计学和执业相关因素：我们使用了一项横断面调查的数据，调查对象为从美国医学协会医生主档案中识别出的马萨诸塞州妇产科医生。我们测量了米非司酮在四种临床情况下的使用率：早期妊娠流产、药物流产、扩张和排空手术前的宫颈准备以及引产前的宫颈准备。根据执业类型、执业年限、医生性别和药物流产培训史，采用多元回归法计算出这些情况下使用米非司酮的几率：共有 198 名妇产科医生对调查做出了回复（回复率=29.0%）；本分析仅限于 158 名非住院医师或研究员的受访者。总体而言，46.0% 的人使用米非司酮治疗早期妊娠流产，38.6% 的人使用米非司酮治疗药物流产。使用米非司酮进行扩宫和排空前宫颈准备（26.0%）或引产前宫颈准备（26.4%）的受访者较少。在学术实践环境中、从业年限较长、性别为女性、接受过充分的药物流产培训的受访者使用米非司酮用于一种或多种循证临床适应症的可能性明显更高：结论：在住院医生实习期间接受过充分的药物流产培训可显著预测妇产科医生是否在实践中使用米非司酮。美国最高法院推翻了 "罗伊诉韦德案"，这将使州一级的堕胎禁令和限制生效，从而减少住院医师培训期间接受堕胎培训的机会。增加米非司酮的培训和使用对于公平获得生殖健康服务至关重要。可能需要制定进一步的干预措施，以增加米非司酮在非学术实践环境中的使用。

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引用次数: 0

“Something Has to Be Done to Make Women Feel Safe”: Women Veterans’ Recommendations for Strengthening the Veterans Crisis Line for Women Veterans "必须采取措施让妇女感到安全"：女退伍军人关于加强女退伍军人危机热线的建议》（Women Veterans' Recommendations for Strengthening the Veterans Crisis Line for Women Veterans）。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.12.002

Melissa E. Dichter PhD, MSW , Aneeza Z. Agha MA , Lindsey L. Monteith PhD , Lauren S. Krishnamurti PhD , Katherine M. Iverson PhD , Ann Elizabeth Montgomery PhD

Objective

Women represent 15% of veteran callers to the Veterans Crisis Line (VCL); there has been little research identifying the experiences and needs of women veterans who use the VCL. The objective of this study was to identify women veterans’ experiences with and recommendations for strengthening VCL services for women.

Method

We conducted qualitative interviews with 26 women veterans across the United States who had contacted the VCL in the preceding year. Interviews were conducted by telephone in 2022 and were audio recorded and transcribed. A team-based content analysis approach was used to identify participants’ concerns around contacting the VCL and recommendations for strengthening the service.

Results

Interviews revealed women veterans’ concerns with regard to contacting the VCL related to responder gender, appropriateness of VCL services for veterans not at imminent risk for suicide, and potential consequences of contacting the VCL. Key recommendations included letting veterans select the gender of the responder who takes their call, providing more information to potential callers about what to expect from VCL calls, and raising awareness about and maintaining options for caller anonymity.

Conclusions

This study uniquely focused on women veterans’ experiences and perspectives, in their own voices. Findings point to trauma-informed approaches supporting women veteran callers to the VCL and may also hold implications for other similar crisis hotline services.

目标：女性退伍军人占退伍军人危机热线（VCL）来电者的 15%；关于使用 VCL 的女性退伍军人的经历和需求的研究很少。本研究的目的是了解女性退伍军人在使用退伍军人危机热线方面的经验，并就如何加强针对女性的退伍军人危机热线服务提出建议：我们对全美 26 名在上一年联系过退伍军人服务中心的女性退伍军人进行了定性访谈。访谈于 2022 年通过电话进行，并进行了录音和转录。访谈采用基于团队的内容分析方法，以确定参与者在联系退伍军人服务中心方面的顾虑以及加强服务的建议：访谈显示，女性退伍军人对联系退伍军人服务中心的顾虑涉及应答者性别、退伍军人服务中心的服务是否适合没有迫切自杀风险的退伍军人，以及联系退伍军人服务中心的潜在后果。主要建议包括：让退伍军人选择接听电话的应答者的性别；向潜在来电者提供更多信息，使其了解对自愿者联络中心电话的期望；提高对来电者匿名选择的认识并维持匿名选择：这项研究以女性退伍军人的亲身经历和视角为重点。研究结果表明了支持女性退伍军人致电 VCL 的创伤知情方法，并可能对其他类似的危机热线服务产生影响。

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引用次数: 0

Changes in Commercial Insurance Claims for Contraceptive Services During the Beginning of the COVID-19 Pandemic—United States, January 2019–September 2020 2019 年 1 月至 2020 年 9 月 COVID-19 大流行初期美国避孕服务商业保险索赔的变化。

IF 3.2 2区医学 Q1 Nursing

Womens Health Issues

Pub Date : 2024-03-01 DOI: 10.1016/j.whi.2023.10.004

Kathryn M. Curtis PhD, Aniket D. Kulkarni MBBS, MPH, Antoinette T. Nguyen MD, MPH, Lauren B. Zapata PhD, Katherine Kortsmit PhD, MPH, Ruben A. Smith PhD, Maura K. Whiteman PhD

Objective

We describe changes in commercial insurance claims for contraceptive services during the beginning of the COVID-19 pandemic.

Methods

We analyzed commercial insurance claims using IQVIA PharMetrics Plus data from more than 9 million U.S. females aged 15–49 years, enrolled during any month, January 2019 through September 2020. We calculated monthly rates of outpatient claims for intrauterine devices (IUDs), implants, and injectable contraception and monthly rates of pharmacy claims for contraceptive pills, patches, and rings. We used Joinpoint regression analysis to identify when statistically significant changes occurred in trends of monthly claims rates for each contraceptive method. We calculated monthly percentages of claims for contraceptive counseling via telehealth.

Results

Monthly claims rates decreased for IUDs (−50%) and implants (−43%) comparing February 2020 with April 2020 but rebounded by June 2020. Monthly claims rates for injectables decreased (−19%) comparing January 2019 with September 2020, and monthly claims rates for pills, patches, and rings decreased (−22%) comparing July 2019 with September 2020. The percentage of claims for contraceptive counseling occurring via telehealth was low (<1%) in 2019, increased to 34% in April 2020, and decreased to 9–12% in June–September 2020.

Conclusions

Substantial changes in commercial insurance claims for contraceptive services occurred during the beginning of the COVID-19 pandemic, including transient decreases in IUD and implant claims and increases in telehealth contraceptive counseling claims. Contraceptive claims data can be used by decision makers to identify service gaps and evaluate use of interventions like telehealth to improve contraceptive access, including during public health emergencies.

目的我们描述了 COVID-19 大流行初期避孕服务商业保险理赔的变化：我们使用 IQVIA PharMetrics Plus 数据对商业保险理赔进行了分析，这些数据来自 900 多万 15-49 岁的美国女性，她们在 2019 年 1 月至 2020 年 9 月期间的任何一个月都参加了保险。我们计算了宫内节育器 (IUD)、植入物和注射避孕药的月门诊报销率，以及避孕药、避孕贴和避孕环的月药房报销率。我们使用 Joinpoint 回归分析来确定每种避孕方法的月索赔率趋势何时发生统计学意义上的显著变化。我们计算了通过远程医疗提供避孕咨询的月报销比例：与 2020 年 2 月和 2020 年 4 月相比，宫内节育器（-50%）和皮下埋植剂（-43%）的月报销率有所下降，但到 2020 年 6 月又有所回升。与 2019 年 1 月和 2020 年 9 月相比，注射剂的月报销率下降了（-19%），与 2019 年 7 月和 2020 年 9 月相比，药片、避孕贴和避孕环的月报销率下降了（-22%）。通过远程医疗进行避孕咨询的理赔比例较低（结论：在 COVID-19 大流行初期，避孕服务的商业保险理赔发生了重大变化，包括宫内节育器和皮下埋植器理赔的短暂下降以及远程医疗避孕咨询理赔的增加。决策者可利用避孕药具理赔数据来确定服务缺口，并评估远程医疗等干预措施的使用情况，以改善避孕药具的获取，包括在公共卫生突发事件期间。

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引用次数: 0