Womens Health Issues最新文献_第9页

Racial/Ethnic and Nativity Inequalities in Gestational Diabetes Mellitus: The Role of Psychosocial Stressors 种族/民族和出生不平等在妊娠糖尿病:社会心理应激源的作用。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.06.007

Kristin Erbetta PhD, MPH, MSW , Joanna Almeida ScD, MPH, MSW, Kristie A. Thomas PhD, MSW

Introduction

Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM.

Methods

We used New York City Pregnancy Risk and Assessment Monitoring System data (2009–2014) linked with birth certificate items (n = 7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM.

Results

U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio, 2.18; 95% confidence interval, 1.53–3.11), Hispanic (adjusted risk ratio, 1.57; 95% confidence interval, 1.10–2.25), or Asian/Pacific Islander (adjusted risk ratio, 4.10; 95% confidence interval, 3.04–5.52) women compared with U.S.-born White women.

Conclusions

Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant women and women from minoritized racial/ethnic groups. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.

在美国，妊娠期糖尿病(GDM)的种族/民族和出生差异持续存在。与这些差异相关的已确定因素并不能完全解释这些差异。研究已经认识到心理社会压力是GDM的一个潜在的可改变的危险因素。方法:我们使用纽约市妊娠风险和评估监测系统数据(2009-2014年)与出生证明项目(n = 7632)进行双变量和多变量分析，以检验12种社会心理压力源(以三种方式建模:个体压力源、分组压力源、压力结构)与GDM在种族/民族和出生地之间的关系，以及压力源是否解释了GDM的种族/民族/出生地差异。结果:美国和外国出生的黑人和西班牙裔女性报告的压力源高于美国出生的白人女性。在完全调整的模型中，金融压力结构与GDM调整风险增加51%相关，并且添加所有压力源使风险增加一倍。心理社会压力因素不能解释外国出生的黑人患GDM的风险升高(调整后的风险比，2.18;95%可信区间，1.53-3.11)，西班牙裔(调整风险比，1.57;95%可信区间，1.10-2.25)，或亚洲/太平洋岛民(调整后的风险比，4.10;95%可信区间(3.04-5.52)，与美国出生的白人女性相比。结论:与美国出生的白人女性相比，历史上少数种族/民族和移民女性患心理社会压力源和GDM的风险更高。尽管经济和所有压力因素预测GDM的风险更高，但它们并不能解释移民妇女和少数种族/民族妇女GDM风险的增加。为了促进更健康的怀孕和分娩结果，有必要进一步研究种族/民族和出生地在压力暴露和GDM发生率方面的不平等。

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引用次数: 0

Trends in Maternal Weight Disparities: Statewide Differences in Rural and Urban Minnesota Residents From 2012 to 2019 孕产妇体重差异趋势:2012年至2019年明尼苏达州农村和城市居民的全州差异

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-11-01 DOI: 10.1016/j.whi.2023.07.001

Rebecca L. Emery Tavernier PhD , Marcia B. McCoy MPH , Catherine A. McCarty PhD, MPH, HEC-C , Susan M. Mason PhD, MPH

Introduction

Despite research showing substantial weight disparities along the rural–urban continuum, little work has attempted to identify differences in prepregnancy weight status or gestational weight gain (GWG) outcomes between rural and urban birthing people. As such, the goals of this research were to 1) document the prevalence of prepregnancy overweight and obesity and excessive GWG in rural and urban birthing people and 2) examine changes in rural and urban prepregnancy overweight or obesity and excessive GWG over time.

Methods

Birth certificate data provided sociodemographic variables, prepregnancy body mass index, GWG, and rurality status on 465,709 respondents who gave birth in Minnesota from 2012 to 2019. A series of regression models estimated risk differences in 1) prepregnancy weight status and 2) excessive GWG between rural and urban respondents over time, controlling for relevant covariates.

Results

Rural individuals had a 4.9 percentage-point (95% confidence interval, 4.5–5.3) higher risk of having prepregnancy overweight or obesity compared with urban individuals, and a 2.6 percentage-point (95% confidence interval, 1.9–3.3) higher risk of gaining excessive gestational weight. The disparities in prepregnancy overweight or obesity and excessive gestational weight between rural and urban individuals widened over time.

Conclusions

These findings contribute to accumulating evidence documenting notable health disparities between rural and urban individuals during the perinatal period and support the need to develop prevention and treatment efforts focused on improving the weight-related health of individuals living in rural communities.

导言:尽管有研究显示城乡之间存在着巨大的体重差异，但很少有研究试图确定农村和城市分娩人群在孕前体重状况或妊娠期体重增加(GWG)结果方面的差异。因此，本研究的目标是1)记录农村和城市生育人群孕前超重、肥胖和过量GWG的流行情况;2)检查农村和城市孕前超重、肥胖和过量GWG随时间的变化。方法:出生证明数据提供了2012年至2019年在明尼苏达州分娩的465,709名受访者的社会人口统计学变量、孕前体重指数、GWG和农村状况。在控制相关协变量的情况下，一系列回归模型估计了农村和城市受访者在1)孕前体重状况和2)过量GWG随时间的风险差异。结果:农村个体孕前超重或肥胖的风险比城市个体高4.9个百分点(95%置信区间，4.5-5.3)，妊娠体重过重的风险比城市个体高2.6个百分点(95%置信区间，1.9-3.3)。随着时间的推移，农村和城市个体在孕前超重或肥胖和妊娠体重过高方面的差异越来越大。结论:这些发现有助于积累证据，证明农村和城市个体在围产期之间存在显著的健康差异，并支持需要开展预防和治疗工作，重点改善生活在农村社区的个体的体重相关健康。

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引用次数: 0

Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments 资深看护人对医疗预约期间儿童保育援助需求的看法。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-10-12 DOI: 10.1016/j.whi.2023.08.005

Megan Shepherd-Banigan PhD, MPH , Shay Cannedy PhD , Adriana Rodriguez PhD , Madison Burns BS , Sandra Woolson MPH , Alison Hamilton MPH, PhD , Ismael Quiroz MPA , Hanh Matthews MHA, MLS, MB (ASCP) , Diane Garber-Cardwell , Kaileigh G. Byrd BS , Adrian Brown BA , Karen M. Goldstein MD, MSPH

Purpose

In 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement.

Methods

Survey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics. Qualitative data were collected from 19 veterans through focus groups and analyzed using rapid thematic analysis.

Findings

More than 75% of veterans surveyed indicated that they required childcare assistance during health care appointments and 73% reported barriers to finding childcare. Prominent barriers included the high cost of childcare and not having a trusted source of childcare. Nearly 58% of survey respondents reported missed or canceled VA health care appointments due to childcare challenges. Furthermore, 35% of surveyed veterans reported that their children had accompanied them to an appointment in the past year. Among these veterans, 59% brought their children into the exam room. Focus group participants discussed how having children present during their health care appointments hampered communication with health care providers.

Conclusions

Veterans report that lack of childcare keeps them from attending and remaining focused on the provider during their health care visits, which could compromise quality of care. As one of the only health systems in the United States that will offer childcare assistance, VCAP presents an opportunity to improve health care access and quality by reducing missed appointments and suboptimal care.

目的：2020年，国会通过立法，建立了国家退伍军人儿童保育援助计划（VCAP），目标是通过退伍军人健康管理局（VA）接受护理的符合条件的退伍军人。该需求评估描述了资深幼儿看护人的儿童保育需求，并探讨了儿童保育不足对医疗保健参与的影响。方法：收集2000名有依赖儿童的VA用户的调查数据；使用标准描述性统计对数据进行分析。通过焦点小组从19名退伍军人中收集定性数据，并使用快速主题分析进行分析。调查结果：超过75%的受访退伍军人表示，他们在医疗保健预约期间需要儿童保育援助，73%的人表示在寻找儿童保育方面存在障碍。突出的障碍包括高昂的儿童保育费用和没有可靠的儿童保育来源。近58%的受访者表示，由于育儿方面的挑战，他们错过或取消了弗吉尼亚州的医疗预约。此外，35%的受访退伍军人表示，他们的孩子在过去一年里曾陪同他们赴约。在这些退伍军人中，59%的人把他们的孩子带进了考场。焦点小组参与者讨论了在医疗预约期间让孩子在场如何阻碍与医疗服务提供者的沟通。结论：退伍军人报告说，缺乏儿童保育使他们在医疗保健就诊期间无法就诊，也无法专注于提供者，这可能会影响护理质量。作为美国唯一提供儿童保育援助的卫生系统之一，VCAP提供了一个机会，通过减少错过预约和次优护理，提高医疗服务的可及性和质量。

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引用次数: 0

Racial and Ethnic Disparities in Patient Experience and Diabetes Self-Management Among Nonpregnant Women of Childbearing Age With Diabetes in the United States: A Scoping Review, 1990 to 2020 美国糖尿病育龄非孕妇患者经历和糖尿病自我管理的种族和民族差异：范围界定综述，1990年至2020年。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-10-04 DOI: 10.1016/j.whi.2023.08.004

Grace E. Brannon PhD , Tiffany B. Kindratt PhD, MPH , Godfred O. Boateng PhD, MPhil , Bala Yadu Vamsi Sankuratri BDS, MPH , Kyrah K. Brown PhD

Objective

This scoping review aimed to identify any empirical literature describing racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women (aged 18–49 years) of childbearing age with diabetes in the United States.

Methods

This scoping review followed the Arksey and O'Malley methodological framework. We used a comprehensive search strategy to identify articles published from 1990 to 2021 in PubMed, CINAHL, EMBASE, Web of Science, the Cochrane Library, and Proquest Digital Dissertation and Theses. Two independent reviewers used Covidence, a web-based review management software, to screen articles by title and abstract, and then by full-text articles based on inclusion and exclusion criteria. A third reviewer arbitrated any disagreements.

Results

Of the original 6,115 peer-reviewed studies identified, eight fit the eligibility criteria. In research on nonpregnant women of childbearing age in the United States, four studies investigated racial and ethnic disparities in patient experience, and seven of the eight eligible studies investigated racial and ethnic disparities in diabetes self-management outcomes. No eligible studies examining racial and ethnic variations in the association between patient experience and diabetes self-management were found.

Conclusions

This scoping review identified limited available studies examining racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women of childbearing age in the United States. Future studies should examine these relationships to fill the gap in research. These findings are relevant as the prevalence of diabetes is increasing worldwide and racially/ethnically minoritized women are disproportionately affected.

目的：本范围界定综述旨在确定任何描述美国育龄糖尿病非孕妇（18-49岁）患者体验和糖尿病自我管理方面种族和民族差异的实证文献。方法：本范围综述遵循Arksey和O'Malley方法论框架。我们使用全面的搜索策略来识别1990年至2021年发表在PubMed、CINAHL、EMBASE、Web of Science、Cochrane图书馆和Proquest数字论文和论文上的文章。两名独立评审员使用基于网络的评审管理软件Covidence，按照标题和摘要对文章进行筛选，然后根据纳入和排除标准对全文文章进行筛选。第三位评审员对任何分歧进行仲裁。结果：在最初确定的6115项同行评审研究中，有8项符合资格标准。在对美国育龄非孕妇的研究中，四项研究调查了患者体验中的种族和族裔差异，八项符合条件的研究中有七项调查了糖尿病自我管理结果中的种族差异。没有发现符合条件的研究检查患者经历与糖尿病自我管理之间的种族和民族差异。结论：这项范围界定综述确定了有限的可用研究，这些研究考察了美国育龄非孕妇在患者体验和糖尿病自我管理方面的种族和民族差异。未来的研究应该研究这些关系，以填补研究中的空白。这些发现是相关的，因为糖尿病的流行率在全球范围内不断增加，种族/族裔少数的妇女受到的影响尤为严重。

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引用次数: 0

Characteristics Associated With Physician Bias in Contraceptive Recommendations 避孕建议中与医生偏见相关的特征。

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-21 DOI: 10.1016/j.whi.2023.08.003

Natalie DiCenzo MD , Kristyn Brandi MD, MPH , Kylie Getz MPH , Glenmarie Matthews MD, MBA, MS

Objective

We aimed to examine associations between obstetrician-gynecologist (OBGYN) contraceptive recommendations and sociodemographic characteristics of patients and recommending physicians.

Methods

OBGYNs affiliated with residency programs across the United States were recruited via email to participate in an online exploratory survey depicting scenarios of reproductive-age women of differing race and socioeconomic status, all other factors identical, and were asked to provide contraceptive recommendations. The χ² test, Fisher's exact tests, and logistic regression were used to analyze recommendation differences based on physician and patient characteristics.

Results

Of 172 physician respondents, large proportions self-identified as white (74%) and attending physicians (56%) from the Mid-Atlantic (42%). In multivariate logistic regression, self-administered methods (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.2–0.8) and condoms (OR, 0.5; 95% CI, 0.3–0.9) were recommended significantly less to Black high SES patients compared with white high SES patients. Non-white physicians recommended tubal ligation (OR, 0.7; 95% confidence interval [CI], 0.5–0.9) significantly less than white physicians, and recommended long-acting reversible contraception (OR, 3.3, CI 2.2–5.2) and condoms (OR, 1.4; 95% CI, 1.1–1.9) significantly more. Trainee physicians recommended self-administered methods (OR, 0.3; 95% CI, 0.2–0.4), condoms (OR, 0.2; 95% CI, 0.2–0.3), and tubal ligation (OR, 0.4; 95% CI, 0.3–0.6) significantly less than attending physicians.

Conclusions

OBGYN contraceptive recommendations differed based on patients’ perceived race and SES. Recommendations also differed based on race, training level, and geographic location of the recommending physician. Results suggest that physician bias contributes to contraceptive recommendations. OBGYNs should receive education about contraceptive coercion and patient-centered decision-making so that they provide high-quality counseling to all patients.

目的：我们旨在检验妇产科医生（OBGYN）的避孕建议与患者和推荐医生的社会人口学特征之间的关系。方法：通过电子邮件招募美国各地住院项目的妇产科医生参加一项在线探索性调查，该调查描述了不同种族和社会经济地位、所有其他因素相同的育龄妇女的情景，并要求他们提供避孕建议。采用χ2检验、Fisher精确检验和逻辑回归分析基于医生和患者特征的推荐差异。结果：在172名医生受访者中，很大一部分人自称白人（74%），而来自大西洋中部的主治医生（56%）（42%）。在多变量逻辑回归中，自我管理方法（比值比[OR]，0.5；95%置信区间[CI]，0.2-0.8）和避孕套（比值比，0.5；95%CI，0.3-0.9）被推荐给黑人高SES患者的次数明显少于白人高SES病人。非白人医生推荐的输卵管结扎术（OR，0.7；95%置信区间[CI]，0.5-0.9）明显低于白人医生，推荐的长效可逆避孕法（OR，3.3，CI 2.2-5.2）和避孕套（OR，1.4；95%CI，1.1-1.9）明显高于白人医生。实习医生推荐的自我管理方法（OR，0.3；95%置信区间，0.2-0.4）、避孕套（OR，0.2；95%置信度，0.2-0.3）和输卵管结扎术（OR，0.4；95%置信指数，0.3-0.6）明显少于主治医生。结论：妇产科的避孕建议因患者的种族和社会经济地位而不同。推荐医生的种族、培训水平和地理位置也不同。结果表明，医生的偏见有助于避孕建议。妇产科医生应接受避孕强制和以患者为中心的决策教育，以便为所有患者提供高质量的咨询。

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引用次数: 0

Social Determinant Pathways to Hypertensive Disorders of Pregnancy Among Nulliparous U.S. Women 美国无妊娠期妇女妊娠高血压疾病的社会决定因素途径

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-16 DOI: 10.1016/j.whi.2023.08.001

Monica H. Keith PhD , Melanie A. Martin PhD

Background

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality in the United States and impact Black mothers at disproportionately higher rates. Hypertensive disparities among racialized groups are rooted in systemic inequalities, and we hypothesize that clinical markers of allostatic load capture embodied disparities in stressors that can link upstream social determinants of health with downstream hypertensive outcomes.

Methods

We analyzed observational cohort data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (n = 6,501) and developed a structural equation model linking latent social determinants of health, longitudinal markers of allostatic load across gestation, and hypertensive pregnancy outcomes in a multigroup framework.

Results

Non-Hispanic Black mothers-to-be (n = 1,155) showed higher rates of hypertensive disorders of pregnancy (32%) than non-Hispanic white women (n = 5,346, 23%). Among both groups, the social environment showed stronger direct effects on allostatic markers than via behaviorally mediated dietary, exercise, or smoking pathways. Demographic aspects of the social environment (e.g., household income, partnered status) were the most salient predictor of hypertensive risk and showed stronger effects among Black women.

Conclusions

Embodied stress rooted in the social environment is a major path driving maternal hypertensive disparities in the United States, with effects that vary across racialized groups. These pathway findings underscore the greater impact of systemic stressors relative to individual health behaviors. More comprehensive and detailed analyses of sociostructural domains are needed to identify promising avenues for policy and intervention to improve maternal health.

妊娠期高血压疾病是美国孕产妇发病和死亡的主要原因，黑人母亲的发病率更高。种族化群体之间的高血压差异根植于系统性的不平等，我们假设，适应负荷捕获的临床标记体现了压力源的差异，这些压力源可以将健康的上游社会决定因素与下游高血压结果联系起来。方法:我们分析了来自“未分娩妊娠结局研究:监测准妈妈”(n = 6,501)的观察队列数据，并建立了一个结构方程模型，将健康的潜在社会决定因素、妊娠期间适应负荷的纵向标记和多组框架中的高血压妊娠结局联系起来。结果非西班牙裔黑人准妈妈(1155例)妊娠期高血压疾病发生率(32%)高于非西班牙裔白人孕妇(5346例，23%)。在这两组中，社会环境对适应标记的直接影响比行为介导的饮食、运动或吸烟途径更强。社会环境的人口统计学方面(如家庭收入、伴侣状况)是高血压风险最显著的预测因素，在黑人妇女中表现出更强的影响。结论根植于社会环境的身体压力是导致美国孕产妇高血压差异的主要途径，其影响在不同种族群体中存在差异。这些途径的发现强调了与个体健康行为相关的系统性压力源的更大影响。需要对社会结构领域进行更全面和详细的分析，以确定有希望的政策和干预途径，以改善孕产妇保健。

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引用次数: 0

Consent for Examinations Under Anesthesia With Learners at the Time of Abortion: Physician Perspectives 同意在麻醉下与学习者在堕胎时进行检查：医生的观点

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-01 DOI: 10.1016/j.whi.2023.03.010

Kaitlin Ellis MD , Kristin Pascoe MD , Courtney Amegashie BA , Adrianne Dade MD , Victoria deMartelly MPH , Julie Chor MD, MPH

Introduction

Although obtaining specific consent for examinations under anesthesia with learners is recommended by major professional organizations and mandated by many state laws and institutions, it is not practiced universally. We sought to investigate physicians’ experiences using a formalized process to obtain consent from patients presenting for surgical abortions under anesthesia for pelvic examinations with learners.

Methods

Semistructured qualitative interviews were conducted with residents, fellows, and faculty who work or have rotated in a single family planning clinic after the clinic introduced this consent process. Participants were asked about their experiences obtaining informed consent from patients for examinations under anesthesia with learners. Interviews were audiorecorded, transcribed, and analyzed using modified grounded theory. All study procedures were institutional review board approved.

Results

Twenty interviews were performed, achieving thematic saturation, with 14 residents, 4 fellows, and 2 faculty members. Participants described initial discomfort with the consent process and their wording choices, which improved with increased familiarity and almost universal patient acceptance. Some participants felt that an informal training or practice before obtaining informed consent may have been helpful. Participants stressed the importance of this consent process to foster patient autonomy and choice. Participants reported that the fact that patients were presenting for abortion care did not influence their overall process or comfort level obtaining consent for pelvic examinations under anesthesia with learners; however, some noted that they gave patients more time to process the consent or used more intentional language during these encounters.

Conclusions

Physicians desire and accept the integration of a formal consent process for examinations under anesthesia with learners at the time of abortion.

引言尽管主要专业组织建议并由许多州法律和机构强制要求学生在麻醉下进行考试时获得特定同意，但这并不是普遍的做法。我们试图调查医生使用正式程序获得患者同意的经验，这些患者在麻醉下进行手术流产，并与学习者一起进行骨盆检查。方法采用半结构化的定性访谈方法，对在一家计划生育诊所工作或轮换的住院医师、研究员和教员进行访谈。参与者被问及他们与学习者在麻醉下进行检查时获得患者知情同意的经历。访谈被录音，转录，并使用修正的基础理论进行分析。所有研究程序均由机构审查委员会批准。结果共进行了20次访谈，达到了主题饱和，共有14名住院医师、4名研究员和2名教员。参与者描述了最初对同意过程和措辞选择的不适，随着熟悉程度的提高和患者几乎普遍接受，这种不适有所改善。一些与会者认为，在获得知情同意之前进行非正式培训或实践可能会有所帮助。与会者强调了这一同意程序对培养患者自主性和选择的重要性。参与者报告说，患者接受堕胎护理的事实并没有影响他们在麻醉下与学习者一起获得骨盆检查同意的整体过程或舒适度；然而，一些人指出，他们给了患者更多的时间来处理同意书，或者在这些遭遇中使用了更多有意的语言。结论物理学家希望并接受在堕胎时与学习者一起在麻醉下进行检查的正式同意程序。

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引用次数: 1

A Mixed-Methods Evaluation of Virtually Delivered Group-Based Mothers and Babies for Latina Immigrant Mothers 拉丁裔移民母亲虚拟分娩组母婴的混合方法评价

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-01 DOI: 10.1016/j.whi.2023.05.005

Rheanna Platt MD, PhD , Caroline P. Martin PhD , Olivia Perry MSPH , Lindsay Cooper MA , Darius Tandon PhD , Rebecca Richman MSN/MPH, RN , Amie F. Bettencourt PhD , Sarah Polk MD, ScD

Background

Immigrant Latinas are at higher risk for postpartum depression (PPD) than the general perinatal population, yet face numerous barriers to accessing mental health services. The goal of this study was to pilot an enhanced virtual group delivery of a PPD prevention program, Mothers and Babies (MB), among immigrant Latinas engaged in early childhood programming.

Methods

Forty-nine Spanish-speaking mothers participated in one of four MB virtual groups, facilitated by trained bilingual staff at affiliated early learning centers. MB was enhanced to also target social determinants of health. A mixed-methods design was used to evaluate MB using participant interviews and pre–post surveys measuring depressive symptoms, parenting distress, and self-efficacy to manage emotions.

Results

On average, participants attended 69% of MB virtual sessions and rated group cohesiveness at a 4.6 on a 5-point scale. Paired-samples t tests showed significant reductions in depressive symptoms (Cohen's d = 0.29; p = .03) and parenting distress (Cohen's d = 0.31; p = .02), and improved self-efficacy to manage emotions (Cohen’s d = −0.58; p < .001). Participants reported both benefits and drawbacks of the virtual format and provided largely favorable feedback on program enhancements.

Conclusions

Results provide initial evidence for the acceptability, feasibility, and effectiveness of an enhanced virtual group PPD prevention program for immigrant Latinas, delivered in partnership with local early learning centers. These findings have important implications for extending the reach of preventive interventions among a population that faces many structural and linguistic barriers to traditional forms of mental health service delivery.

背景拉丁裔移民患产后抑郁症(PPD)的风险高于一般围产期人口，但在获得精神卫生服务方面面临许多障碍。本研究的目的是在从事早期儿童规划的拉丁裔移民中试点一种增强的PPD预防项目“母亲和婴儿”(MB)的虚拟小组交付。方法49名讲西班牙语的母亲参加了四个MB虚拟小组中的一个，由附属早教中心训练有素的双语工作人员提供指导。MB得到加强，也针对健康的社会决定因素。采用混合方法设计，通过参与者访谈和前后调查来评估MB，测量抑郁症状、养育压力和自我效能来管理情绪。结果平均而言，参与者参加了69%的MB虚拟会议，并将团队凝聚力评为4.6分(满分为5分)。配对样本t检验显示抑郁症状显著减少(Cohen’s d = 0.29;p = 0.03)和养育压力(Cohen’s d = 0.31;p = .02)，提高自我效能感管理情绪(Cohen’s d = - 0.58;p & lt;措施)。参与者报告了虚拟格式的优点和缺点，并对程序增强提供了很大程度上有利的反馈。结论:研究结果为拉丁裔移民虚拟群体PPD预防项目的可接受性、可行性和有效性提供了初步证据，该项目与当地早期学习中心合作实施。这些发现对于在传统形式的精神卫生服务提供面临许多结构和语言障碍的人群中扩大预防性干预措施的范围具有重要意义。

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引用次数: 0

Levonorgestrel Emergency Contraception Information Accuracy From West Virginia Community Pharmacies: A Mystery Caller Approach 西弗吉尼亚州社区药房的左炔诺孕酮紧急避孕信息准确性：一种神秘的来电方法

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-01 DOI: 10.1016/j.whi.2023.04.001

Amie M. Ashcraft PhD, MPH , Charles D. Ponte PharmD , Caitlin Montgomery MPH , Sara Farjo DO , Pamela J. Murray MD, MHP

Background

To ensure access to effective levonorgestrel (LNG) emergency contraception (EC), pharmacies must keep medication in stock or available for quick delivery, and pharmacists must be knowledgeable about sales restrictions and the therapeutic window for EC. We conducted a mystery caller study to assess LNG EC availability and information accuracy provided by staff in West Virginia community pharmacies.

Methods

A female research team member posed as a 16-year-old caller to ask pharmacy staff questions about whether LNG EC was in stock, the requirements for purchase, and when it should be taken for effectiveness. Data were analyzed with SPSS using the Pearson's χ² test to determine if there was a relationship between pharmacy type and response accuracy to our questions about point-of-sale requirements and timing for effectiveness for LNG EC.

Results

Of the 506 pharmacies in the sample, 275 (54.3%) were chain pharmacies and 231 (45.7%) were independent. Overall, chain pharmacies provided significantly more accurate answers than independent pharmacies on all point-of-sale requirements. Regarding timing for effectiveness, 49.2% of all pharmacies provided an accurate response (62.9% for chain pharmacies vs. 32.9% for independent pharmacies).

Conclusions

Overall, availability and accuracy regarding LNG EC were poor in West Virginia pharmacies. Pharmacists, particularly those at independent pharmacies serving rural communities, are in a critical and powerful position to influence community health by providing accurate and timely information and access to all contraceptive options, including LNG EC.

背景为了确保获得有效的左炔诺孕酮紧急避孕（EC），药店必须保持药物库存或可快速交付，药剂师必须了解销售限制和EC的治疗窗口。我们进行了一项神秘来电研究，以评估西弗吉尼亚州社区药房工作人员提供的液化天然气EC的可用性和信息准确性。方法一名女性研究小组成员冒充一名16岁的来电者，向药房工作人员询问液化天然气EC是否有库存、购买要求以及何时服用是否有效等问题。使用SPSS使用Pearsonχ2检验对数据进行分析，以确定药房类型和对我们关于销售点要求和液化天然气EC有效性时间的问题的回答准确性之间是否存在关系。结果在样本中的506家药店中，275家（54.3%）是连锁药店，231家（45.7%）是独立药店。总的来说，连锁药店在所有销售点要求上都比独立药店提供了更准确的答案。关于有效性的时间安排，49.2%的药店提供了准确的反应（连锁药店为62.9%，独立药店为32.9%）。结论西弗吉尼亚州药店关于液化天然气EC的总体可用性和准确性较差。药剂师，特别是为农村社区服务的独立药店的药剂师，通过提供准确及时的信息和获得包括液化天然气EC在内的所有避孕选择，在影响社区健康方面处于关键和强大的地位。

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引用次数: 0

Intimate Partner Violence, Child Custody, and Financial Issues Among Female Suicide Decedents With Known Intimate Partner Problems: National Violent Death Reporting System, 2018 亲密伴侣暴力、子女抚养权和已知亲密伴侣问题的女性自杀死者的经济问题:国家暴力死亡报告系统，2018

IF 3.2 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Womens Health Issues

Pub Date : 2023-09-01 DOI: 10.1016/j.whi.2023.04.005

Laura Johnson PhD, MSW

Background

Hardships such as custody issues and financial stress may increase suicide risk for individuals experiencing intimate partner problems, particularly intimate partner violence (IPV). The objective of this study was to examine associations among custody issues, financial strain, and IPV among female suicide decedents with known intimate partner problems using data from the National Violent Death Reporting System (NVDRS).

Methods

NVDRS data from 2018, which comes from 41 U.S. states, was used to examine the nature and frequency of custody and financial strain and IPV among a sample of 1,567 female suicide decedents with known intimate partner problems (e.g., divorce, breakup, argument). Case narratives were used to extract detailed information about these situations.

Results

IPV was documented in 22.14% of cases. Compared with those without documented IPV, cases with documented IPV were more likely to include custody issues (3.44% vs. 6.34%). Controlling for demographic characteristics and mental health, documented child custody issues were associated with greater odds of IPV (odds ratio = 1.80; 95% confidence interval = 1.03–3.16). Financial strain was not statistically significantly associated with child custody issues or IPV among this sample.

Conclusions

Child custody issues can contribute to suicide among women with known intimate partner problems and are positively associated with IPV. Suicide prevention and intervention efforts should recognize child custody issues as a risk factor, particularly when coupled with IPV. There is also a need to promote policies and services that improve the financial and civil legal circumstances of IPV survivors.

监护问题和经济压力等困难可能会增加经历亲密伴侣问题，特别是亲密伴侣暴力(IPV)的个人的自杀风险。本研究的目的是利用国家暴力死亡报告系统(NVDRS)的数据，研究已知有亲密伴侣问题的女性自杀者的监护问题、经济压力和IPV之间的关系。方法采用2018年来自美国41个州的snvdrs数据，对1567名已知有亲密伴侣问题(如离婚、分手、争吵)的女性自杀死者的监护、经济压力和IPV的性质和频率进行研究。案例叙述用于提取这些情况的详细信息。结果22.14%的病例中存在静脉曲炎。与没有IPV记录的人相比，IPV记录的案件更有可能包括监护权问题(3.44%对6.34%)。控制人口统计学特征和心理健康，记录在案的儿童监护权问题与IPV的较大几率相关(优势比= 1.80;95%置信区间= 1.03-3.16)。在这个样本中，财务压力与儿童监护问题或IPV没有统计学上的显著关联。结论子女抚养权问题可能导致已知有亲密伴侣问题的妇女自杀，并与IPV呈正相关。自杀预防和干预工作应认识到儿童监护问题是一个风险因素，特别是当与IPV相结合时。还需要促进改善IPV幸存者的经济和民事法律环境的政策和服务。

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引用次数: 0