Sexual & Reproductive Healthcare最新文献

英文中文

Hysterectomy and medical financial hardship among U.S. women 子宫切除术与美国妇女的医疗经济困难

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-28 DOI: 10.1016/j.srhc.2024.101019

Biplab Kumar Datta , Ashwini Tiwari , Yara H. Abdelgawad , Ruhun Wasata

Objective

Hysterectomy is one of the common surgical procedures for women in the United States. Studies show that hysterectomy is associated with elevated risk of developing chronic conditions, which may cause financial toxicity in patients. This study aimed to assess whether women who underwent hysterectomy had a higher risk of experiencing medical financial hardship compared to women who didn’t.

Methods

Using data on 32,823 adult women from the 2019 and 2021 waves of the National Health Interview Survey, we estimated binomial and multinomial logistic regressions to assess the relationship between hysterectomy and financial hardship, defined as problems paying or unable to pay any medical bills. Further, we performed a Karlson-Holm-Breen (KHB) decomposition to examine whether the association could be explained by chronic comorbidity.

Results

While the prevalence of financial hardship was 13.6 % among all women, it was 16.2 % among women who underwent a hysterectomy. The adjusted odds of experiencing medical financial hardship among women with a hysterectomy were 1.36 (95 % CI: 1.22–1.52) times that of their counterparts who did not have a hysterectomy. The KHB decomposition suggested that 34.5 % of the size of the effect was attributable to chronic conditions. Women who had a hysterectomy were also 1.45 (95 % CI: 1.26–1.67) times more likely to have unpaid medical debts.

Conclusions

Our results suggested that women, who underwent a hysterectomy in the US, were vulnerable to medical financial hardship. Policy makers and health professionals should be made aware of this issue to help women coping against this adversity.

目的子宫切除术是美国妇女常见的外科手术之一。研究表明，子宫切除术与罹患慢性疾病的风险升高有关，这可能会给患者带来经济上的负担。本研究旨在评估与未接受子宫切除术的女性相比，接受子宫切除术的女性是否会有更高的医疗经济困难风险。方法利用2019年和2021年两波全国健康访谈调查（National Health Interview Survey）中32,823名成年女性的数据，我们估计了二项式和多项式逻辑回归，以评估子宫切除术与经济困难之间的关系，经济困难的定义是有问题支付或无法支付任何医疗账单。此外，我们还进行了卡尔森-霍尔姆-布林（Karlson-Holm-Breen，KHB）分解，以检验慢性合并症是否可以解释这种关联。结果虽然在所有女性中，经济困难的发生率为 13.6%，但在接受子宫切除术的女性中，这一比例为 16.2%。接受过子宫切除术的妇女经历医疗经济困难的调整后几率是未接受子宫切除术的妇女的 1.36 倍（95 % CI：1.22-1.52）。KHB 分解表明，34.5% 的影响可归因于慢性病。我们的研究结果表明，在美国接受子宫切除术的妇女很容易陷入医疗经济困境。决策者和医疗专业人员应该意识到这一问题，以帮助妇女应对这一困境。

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引用次数: 0

The vital role of birth centers in modern maternity care 分娩中心在现代产妇护理中的重要作用

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-26 DOI: 10.1016/j.srhc.2024.101020

Emma M Swift, Berglind Halfdansdottir

引用次数: 0

Comment on the study by Aanstad et al. “Intrapartum fetal monitoring practices in Norway: A population-based study” 就 Aanstad 等人的研究 "挪威的产前胎儿监护实践：基于人口的研究"

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-23 DOI: 10.1016/j.srhc.2024.101018

Katariina Laine , Sari Räisänen , Branka M. Yli , Tiril Tingleff

引用次数: 0

A low cesarean section rate is not a reason for overusing CTG 剖宫产率低不是过度使用 CTG 的理由

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-23 DOI: 10.1016/j.srhc.2024.101017

Kristin Jerve Aanstad , Are Hugo Pripp , Rebecka Dalbye , Aase Devold Pay , Anne Cathrine Staff , Anne Kaasen , Ellen Blix

引用次数: 0

A qualitative study of the experience of doula support to women in socially disadvantaged positions in Sweden: The voices of women and doulas 对瑞典处于社会弱势地位的妇女获得朵拉支持的经验进行定性研究：妇女和助产士的声音

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-15 DOI: 10.1016/j.srhc.2024.101016

Pia Gudmundsson , Helen Elden , Anna Larsson , Johanna Sundén , Anja Björkman , Helena Tegnér , Karolina Linden

Background

Women in socially disadvantaged positions face increased risk of fear of birth, birth complications, and postpartum depression, highlighting the need for targeted interventions for this group. Doula support is associated with positive emotional and medical outcomes for mother and child. Experience of doula support for women in socially disadvantaged positions in Sweden remains unexplored.

Aim

To describe experiences of doula support within a project for women in socially disadvantaged positions in Sweden.

Methods

In-depth interviews with seven women and focus group discussions with twelve doulas in a Doula support project were conducted. Data was analysed with inductive content analysis.

Results

Women and doulas described experiences of doula support as a significant relationship with challenges, due to unclear boundaries for the support, and the time and trust needed to establish the relationship. The support was perceived as comprehensive, far exceeding traditional doula support, with extensive assistance provided postpartum. The project was regarded as meaningful, and that it led to positive birth experiences.

Conclusions

Women in socially disadvantaged positions may benefit from doula support during the perinatal period. The support fosters feelings of calmness, security and empowerment, and alleviates feelings of isolation, which is crucial for a positive birth experience. Support for these women is complex due to increased social needs, leading to unclear expectations of the doula’s role. Support from colleagues is deemed crucial. Future projects should establish clear frameworks and a supportive structure for doulas.

背景处于社会弱势地位的妇女面临着更高的分娩恐惧、分娩并发症和产后抑郁风险，这突出表明需要对这一群体进行有针对性的干预。朵拉支持与母婴的积极情感和医疗结果相关。目的描述瑞典社会弱势妇女在一个项目中获得朵拉支持的经验。方法在一个朵拉支持项目中对七名妇女进行了深入访谈，并对十二名朵拉进行了焦点小组讨论。结果妇女和朵拉将朵拉支持描述为一种具有挑战性的重要关系，这是因为支持的界限不明确，以及建立这种关系需要时间和信任。朵拉的支持被认为是全面的，远远超过了传统的朵拉支持，并在产后提供了广泛的帮助。结论处于社会弱势地位的妇女在围产期可能会从朵拉支持中受益。朵拉的支持可促进平静感、安全感和力量感，并减轻孤独感，这对积极的分娩体验至关重要。由于社会需求的增加，对这些妇女的支持非常复杂，导致对朵拉角色的期望不明确。来自同事的支持被认为是至关重要的。未来的项目应为朵拉建立明确的框架和支持性结构。

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引用次数: 0

“But I’m not a professional” − How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study "但我不是专业人员"--高危妊娠妇女如何表达家庭远程监控的体验；定性访谈研究

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-10 DOI: 10.1016/j.srhc.2024.101015

Jane M. Bendix , Mikala Heinsen , Mette G. Backhausen

Objectives

Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring.

Methods

A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation.

Results

Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an ‘Empowering yet challenging responsibility’ as well as an ‘Extended patient-clinician partnership.’ There were pros and cons as to the influence of telemonitoring in everyday life; ‘Tele-comfort yet ambivalence’ and that it could be accompanied by annoying practical issues; ‘Accompanying remote issues.’

Conclusions

Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.

目的远程监测高危妊娠并发症是一种新方法，它利用移动和无线技术提供远程产科护理。新的证据表明，基于家庭的产科远程监护不仅可行，而且是住院或频繁门诊护理的安全替代方案。由于人们对实施产科远程监护的看法知之甚少，本研究探讨了患有妊娠并发症的妇女在实施家庭远程监护过程中的体验。研究方法：本研究采用半结构式定性访谈的方式，采访了在实施高危妊娠并发症家庭远程监护过程中具有丰富经验的妇女。采用了有目的的抽样策略和数据饱和，然后进行逐字记录。结果15 位信息提供者参与了研究，并提出了四大主题。研究显示，进行远程监控总体上是一种积极的体验，被认为是一种 "赋权而又具有挑战性的责任 "以及一种 "病人与医生之间的扩展合作关系"。对于远程监护在日常生活中的影响；"远程舒适感与矛盾感"，以及可能伴随着恼人的实际问题；"伴随着远程问题"，既有优点也有缺点。人们对远程监护在日常生活中的影响和矛盾性提出了利弊意见，并认为远程监护可能伴随着恼人的实际问题。患者对远程监护的看法和体验是重要的临床知识，在制定远程监护计划时必须加以考虑，最好是在共同决策过程中加以考虑。

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引用次数: 0

Optimizing the role of midwives in humanitarian and developmental settings 优化助产士在人道主义和发展环境中的作用

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-08 DOI: 10.1016/j.srhc.2024.101014

Tewodros Seyoum, Jama Ali Egal

引用次数: 0

Discrimination against Roma women during childbirth? Unraveling the underlying effects of ethnic and socio-economic factors 罗姆妇女在分娩时受到歧视？解读种族和社会经济因素的潜在影响。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-08-05 DOI: 10.1016/j.srhc.2024.101013

Laura Szabó, Zsuzsanna Veroszta

Objective

This study aims to identify discrimination in maternity care experienced by Roma women in Hungary, due to ethnic and socio-economic factors.

Methods

We used data from the Cohort’18 Hungarian Birth Cohort Study, covering births in 2018–2019 (n = 7805). Face-to-face interviews were conducted by health visitors during pregnancy and six months postpartum. Differences in obstetric care were tested using Welch’s ANOVA. Logistic regression models estimated the influence of Roma ethnicity on birth position, adjusting for socio-economic variables. Odds ratios with 95 % confidence intervals and adjusted predictions were calculated.

Results

Roma mothers had a lower rate of caesarean section due to fewer planned interventions (13.3% vs. 19.1% for non-Roma mothers). Roma women were less likely than non-Roma women to have a birth attended by a private obstetrician (15% vs. 52.6%) and less likely to have a family member present at the birth (40% vs. 65.5%). For vaginal births, 61.3% of Roma women had their birth position dictated by hospital staff, compared with 40.6% of non-Roma women. Ethnic background significantly influenced the choice of birth position, but these associations were attenuated after adjustment for socio-economic and territorial factors. Variables such as the presence of a private obstetrician, family support, and residence in Central Hungary reduced the likelihood of giving birth in a fixed position.

Conclusion

Roma women face significant disadvantages in maternity care in Hungary. Ethnic background has a negative impact on the quality of care, but it is also significantly influenced by adverse socio-economic and regional factors.

目的：本研究旨在确定匈牙利罗姆妇女因种族和社会经济因素而在孕产妇护理方面遭受的歧视：本研究旨在确定匈牙利罗姆妇女因种族和社会经济因素而在产科护理方面遭受的歧视：我们使用了 Cohort'18 匈牙利出生队列研究的数据，涵盖了 2018-2019 年的新生儿（n = 7805）。健康访视员在孕期和产后六个月进行了面对面访谈。产科护理的差异采用韦尔奇方差分析进行检验。逻辑回归模型估算了罗姆族对胎位的影响，并对社会经济变量进行了调整。计算出了带有 95 % 置信区间的比率和调整后的预测值：结果：罗姆产妇的剖腹产率较低（13.3%，非罗姆产妇为 19.1%），原因是计划干预较少。与非罗姆妇女相比，罗姆妇女由私人产科医生接生的几率较低（15% 对 52.6%），由家人陪伴分娩的几率也较低（40% 对 65.5%）。对于阴道分娩，61.3%的罗姆妇女的分娩姿势由医院工作人员决定，而非罗姆妇女的这一比例为 40.6%。种族背景对分娩体位的选择有很大影响，但在对社会经济和地域因素进行调整后，这些相关性有所减弱。有私人产科医生、家庭支持和居住在匈牙利中部等变量降低了以固定体位分娩的可能性：结论：在匈牙利，罗姆妇女在产科护理方面面临严重的不利因素。种族背景对护理质量有负面影响，但不利的社会经济和地区因素也对其有重大影响。

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引用次数: 0

Women’s experiences of maternal near miss: Qualitative findings from Malawi 妇女对孕产险情的经历：马拉维的定性研究结果。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-31 DOI: 10.1016/j.srhc.2024.101012

Monica Patricia Malata , Alisa Jenny , Dilys Walker , Luis Aaron Gadama

Objective

This study explored the experiences of women with maternal near miss and their perceptions of the quality of care they received in three facilities in Malawi.

Methods

This study employed a qualitative phenomenological approach. Data were collected using in depth interviews and analysed using thematic content analysis. The data were collected in three hospitals between September and November 2020. The purposively selected participants were 18 women meeting criteria for maternal near miss related to obstetric haemorrhage (6), hypertensive disorders (7), sepsis (2) and ruptured ectopic pregnancy (3).

Results

Women’s experiences of maternal near miss fell under four broad themes; (a) realisation of the near miss; (b) religious beliefs and interpretation of near miss; (c) social and economic aspects of maternal near miss; and d) perceptions of quality of care. Women’s initial emotional responses were fear and anxiety but were soon overshadowed by the fear for their babies’ wellbeing. Most women perceived the care they received as timely, adequate, and respectful, yet many women also expressed that their service providers did not provide an opportunity to openly discuss their condition.

Conclusions

The experience of near miss goes beyond the immediate physical discomforts and has psychological, economic, and social consequences for women and their families. Despite women’s perception of care as respectful, there are still communication gaps with their service providers. Campaigns to improve the communication between providers and patients and their families in situation of severe morbidity warrant consideration.

目的本研究探讨了马拉维三家医疗机构中孕产妇险些失手的经历及其对所获医疗质量的看法：本研究采用定性现象学方法。数据收集采用深度访谈法，分析采用主题内容分析法。数据于 2020 年 9 月至 11 月期间在三家医院收集。有目的性地选取了 18 名符合孕产妇险情标准的妇女作为研究对象，她们分别患有产科出血（6 例）、高血压疾病（7 例）、败血症（2 例）和宫外孕破裂（3 例）：妇女对产妇险情的经历分为四大主题：(a) 意识到险情的发生；(b) 宗教信仰和对险情的解释；(c) 产妇险情的社会和经济方面；(d) 对护理质量的看法。妇女最初的情绪反应是恐惧和焦虑，但很快就被对婴儿健康的担忧所掩盖。大多数妇女认为她们得到的护理是及时、充分和受到尊重的，但许多妇女也表示，她们的服务提供者没有提供公开讨论她们病情的机会：险些失手的经历不仅仅是直接的身体不适，还会对妇女及其家庭造成心理、经济和社会影响。尽管妇女认为护理工作是受尊重的，但她们与服务提供者之间的沟通仍然存在差距。应考虑开展活动，改善严重发病情况下服务提供者与患者及其家属之间的沟通。

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引用次数: 0

Social disparities in delivery choice among patients with history of cesarean 有剖腹产史的患者在分娩选择上的社会差异。

IF 1.4 3区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Sexual & Reproductive Healthcare

Pub Date : 2024-07-31 DOI: 10.1016/j.srhc.2024.101011

Sara R. Wetzler , Nicola F Tavella , Lily McCarthy , Gabriele Baptiste , Toni Stern , Chelsea DeBolt , Angela Bianco

Objective

Given the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice.

Methods

This was a retrospective cohort study of patients with a history of one CD between April 29, 2015–April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI).

Results

1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD.

Conclusion

These findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.

研究目的鉴于人们呼吁通过鼓励剖宫产后试产（TOLAC）来降低非医学指征的剖宫产率（CD），本研究调查了选择 TOLAC 与计划内重复剖宫产（SRCD）的患者的社会特征，以确定分娩方式选择上的差异：这是一项回顾性队列研究，研究对象是 2015 年 4 月 29 日至 2020 年 4 月 29 日期间有过一次剖宫产史的患者。患者根据入院时选择的分娩方式进行划分。卡方检验检验了组间的比例差异，逻辑回归模型检验了根据种族/民族、医疗保险、孕前体重指数和社会弱势指数（SVI）等社会依赖类别选择 TOLAC 与 SRCD 的奇数比：共纳入 1,983 名患者。多变量逻辑回归模型显示，高 SVI（参考：低/中 SVI）（AOR：2.0，CI：1.5，2.5）、自我认同为黑人/非裔美国人（AOR：2.4，CI：1.6，3.6）或西班牙裔/拉丁裔（AOR：2.0，CI：1.4，2.8）（参考：白人）、有公共保险（参考：私人保险）（AOR：3.7，CI：2.8，5.0）、BMI 肥胖（参考：非肥胖 BMI）的人更有可能选择 TOLAC 而不是 SRCD：这些研究结果表明了分娩方式偏好的差异。结论：这些研究结果表明了患者对分娩方式的偏好存在差异，特别是弱势患者更倾向于选择 TOLAC，这表明社会和经济因素可能在分娩方式的偏好中起到一定作用。这些发现对改善个体化咨询和围绕分娩方式共同决策具有重要意义。

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