Women's health reports (New Rochelle, N.Y.)最新文献

Background: There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery.

Methods: Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved.

Results: A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: (1) effective communication, education, and respect; (2) emotional support by care team; (3) intraoperative pain or discomfort; (4) varying acceptability around pain therapies; and (5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: (1) complexity of pain responses; (2) multiple pain control strategies; (3) effective communication during emergency cesarean delivery; (4) patient psychological well-being during cesarean delivery; and (5) barriers to observing the patients' birth plans.

Conclusion: Patients and providers alike desire pain management, psychological well-being, and effective communication during cesarean delivery. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments.

Objective: To describe breastfeeding behaviors and determinants in the 1-month postdelivery period among women in treatment for opioid use disorder.

Study design: Participants completed one questionnaire during pregnancy and one questionnaire at 1 month postpartum. Those who reported on the postpartum questionnaire that they had initiated breastfeeding were included in this analysis (N = 31). Infant feeding practices, receipt of lactation support, and demographic, psychosocial, and infant birth characteristics were compared between those who breastfed for at least 1 month and those who did not.

Results: In all, 45% of the participants were breastfeeding at 1 month post delivery. Among those who discontinued breastfeeding by 1 month post delivery, two-thirds reported that they had not breastfed for as long as they wanted. Breastfeeding continuation at 1 month was more common in participants who expressed prenatal breastfeeding intention, had shorter infant hospital length of stays, received lactation materials/support, and reported lower stress and depressive symptoms. Among those who stopped breastfeeding at 1 month, perception of low breast milk supply was the most frequently cited reason.

Conclusions: Lactation support programs are needed to help women with opioid use disorder meet their infant feeding goals. Such programs may want to consider simultaneously addressing maternal psychosocial factors.

Background: Although the postpartum period is an opportunity to promote long-term well-being and health systems usage, system complexities limit patients' abilities to optimize their longitudinal health. Postpartum patient navigation, an intervention that assists individuals in navigating health systems, is a novel innovation that may mitigate barriers to longitudinal care.

Methods: Within a recently completed randomized controlled trial (RCT), we conducted a secondary analysis of interviews with two navigators and a subset (N = 15) of navigated participants to describe gaps in the health care system. Semi-structured interview guides were used to conduct 11 sets of interviews with postpartum navigators. In the RCT, navigators supported publicly insured individuals for 1 year postpartum. Interviews focused on relationships with patients and care teams and reflections on health systems gaps which challenged care. Interviews were transcribed and analyzed using grounded theory. A randomly selected subset of interviews with navigated participants was analyzed to triangulate navigator-identified gaps.

Results: Navigators identified three major gaps in the care system for postpartum individuals: overall health system challenges, postpartum care challenges, and gaps in the transition to primary care. Health system challenges included fragmentation within the hospital system, fragmentation across distinct health care institutions, high task burden for patients, and lack of clear communication between patients and care teams. Postpartum care challenges included operational and logistical errors in care and the transient nature of obstetric care. Gaps in the transition to primary care included a lack of emphasis on the importance of primary care, lack of administrative support in the transition, and lack of communication between care teams.

Conclusion: Postpartum patient navigators elucidated health systems gaps that present challenges in maximizing the longitudinal well-being of birthing individuals. These results identify areas for systems improvements that could promote lifelong health.

Background: Dysmenorrhea is chronic and cyclic pain during menstruation and is a common gynecological problem worldwide. Although there are several reported risk factors for dysmenorrhea, the findings of previous studies are inconsistent. This study aimed to identify lifestyle factors associated with dysmenorrhea.

Methods: The study population comprised 36,665 premenopausal female nurses aged 20-49 years who completed the Japan Nurses' Health Study (JNHS) baseline survey. Out of grades 0-4 of menstrual pain, dysmenorrhea was defined as grades 2-4. Multivariable modified Poisson regression analysis was used to examine the associations between dysmenorrhea and possible risk factors, namely age, current menstrual cycle, marital status, parity, current body mass index (BMI), smoking status, alcohol consumption, work shift, physical activity, sleep duration, and soybean isoflavone intake.

Results: There was a significant negative association between age and the prevalence ratio (PR) of dysmenorrhea (p < 0.0001). Older age and parity were significantly associated with decreased multivariable-adjusted PRs. The factors significantly associated with increased PRs were an irregular menstrual cycle, being underweight (BMI < 18.5 kg/m²), smoking, consuming alcohol, short sleep duration, and night shift work. Although the age-adjusted PRs of total isoflavone aglycone equivalents, tofu intake, and miso soup intake showed a significant linear trend toward decreased PRs, there was a significant decrease in multivariable-adjusted PRs only in the "almost every day" tofu-intake group.

Conclusion: The JNHS baseline survey revealed that the factors associated with dysmenorrhea in Japanese women were age, parity, menstrual cycle, being underweight, and lifestyle factors, including soybean food intake.

Background: Emphysema has been linked to an elevated risk of lung cancer, yet the association between emphysema and breast cancer (BC) has not been established. Hence, our study aimed to investigate the potential correlation between emphysema as an exposure factor and BC as the outcome, while accounting for various covariates associated with BC.

Methods: Participants from the National Health and Nutrition Examination Survey database from 1998 to 2016 were selected for analysis. Initially, ineligible individuals were excluded from this analysis. Subsequently, chi-square test and t-test were independently executed to assess variances in covariates and exposure factors between patients with BC and controls, leading to the development of a baseline table. Subsequently, weighted multivariate logistic regression analysis was conducted to explore the potential association between emphysema and BC, resulting in the development of three logistic regression models. Additionally, risk stratification analysis using weighted stratified logistic regression was performed to analyze the impact of emphysema on BC across different populations.

Results: After excluding ineligible individuals, 4,937 participants remained, comprising 152 patients with BC and 4,785 controls. The baseline table revealed significant differences between BC and control samples in terms of emphysema (p = 1 × 10^-2), age (p = 5 × 10^-4), race (p = 1 × 10^-3), marital status (p = 5 × 10^-4), hypertension (p = 5 × 10^-4), and number of pregnancies (p = 2.1 × 10^-2). Furthermore, all p values for emphysema across the three model types were less than 0.05, indicating that the association between emphysema and BC was not significantly affected by other covariates. Meanwhile, the risk stratification analysis demonstrated that emphysema may be a risk factor for BC (odds ratio = 2.6, 95% confidence interval 1.25-5.41, p = 1.09 × 10^-2).

Conclusion: The study's findings indicating a correlation between emphysema and BC, with emphysema may be a risk factor for BC. This provides a potential theoretical basis for the development of BC treatment strategies.

Background: Educational programs for pregnant women delivered by dentists and midwives would prevent oral disorders in mothers and also impact the dental health of offspring.

Aim of the study: The main aim of this study is to evaluate the effect of an antenatal dental health education program on maternal and neonatal outcomes among Egyptian primigravida women.

Subjects and methods research design: A quasi-experimental research design was carried out. Subjects: 108 pregnant women who met the inclusion criteria. The sample size was two equal groups and divided into two groups (case and control).

Setting: The study was conducted at the prenatal clinic at Zagazig University Hospital.

Tools of data collection: The following four tools were used to achieve the study's purpose: a structured interview questionnaire; a scale for assessing knowledge, practice, and attitude; and an outcome checklist for tracking mother and baby outcomes throughout labor. In addition, prenatal education classes were held to enhance the pregnancy outcomes.

Results: According to the study's findings, women who participated in the dental education program had statistically significant positive knowledge, practices, and attitudes compared with those in the control group. In the case group, pregnancy outcomes were good and improved after attending the dental health program more than in the control group.

Conclusion: Designing and implementing an educational program on antenatal oral health had a significant effect on improving pregnancy outcomes.

Recommendation: An awareness educational program about dental care associated with pregnancy was necessary to be recommended.

Background: Burnout syndrome has become a great concern worldwide in recent decades. It can also lead to a negative effect on quality of work, life, and sexual dysfunction. This study assesses the prevalence of burnout syndrome and its association with sexual dysfunction among female nurses and midwives at a frontline hospital.

Material and methods: This cross-sectional study was conducted at Tu Du Hospital in Vietnam between February 1, 2023 and March 31, 2023. The study enrolled 485 female nurses and midwives. Among them, 426 women were eligible for the assessment of sexual disorders. This study used the Maslach Burnout Inventory-Human Services Survey toolkit to investigate burnout syndrome and the Female Sexual Function Index (FSFI) to determine sexual dysfunction.

Results: Of the 485 respondents, the burnout rate was 27.0%, of which emotional exhaustion (EE), depersonalization, and diminished personal achievement (PA) were found at 13.2%, 6.0%, and 18.4%, respectively. Factors relating to burnout included young age, work duration of less than 10 years, sleep disorders, high workload, insufficient salary, and job dissatisfaction. Among 426 respondents completing the FSFI tool, 12.0% of female health care workers experienced sexual dysfunction, of which decreased sexual desire appeared in 42.0% of participants. EE at work was associated with sexual health issues and almost all sexual dysfunction factors with a weak negative correlation coefficient. Reduced PA was related to general sexual status, anorgasmia, and dyspareunia with a weak positive correlation coefficient.

Conclusion: Overall, the prevalence of burnout and sexual disorders were 27.0% and 12.0%, respectively. Importantly, work-related factors were the main factors associated with burnout syndrome. EE and reduced PA were related to sexual disorders. These results underscore the need to assess support for the professional well-being of nurses and midwives. Further national-database studies are required to strengthen these findings.

Background and aim: Dysmenorrhea causes intense menstrual pain and symptoms such as cramps, headaches, and nausea. Nonsteroidal anti-inflammatory drugs (NSAIDs) offer relief but have limited efficacy and side effects, prompting interest in alternative therapies. This study evaluated a food supplement with Acmella oleracea and Boswellia serrata for dysmenorrhea symptom management in women with inadequate NSAIDs response.

Methods: This single-center retrospective study included 33 women aged 20-35 with dysmenorrhea-related symptoms who had experienced insufficient relief from NSAIDs alone. Participants received the food supplement in addition to NSAIDs over three menstrual cycles. The primary outcome was the reduction in pain intensity. Secondary outcomes included changes in NSAIDs use and symptom prevalence (e.g., cramps, lower back pain, and dyspareunia). Data were collected at baseline and after 3 months of treatment.

Results: After 3 months, general pain and migraine decreased significantly, with mean Numeric Rating Scale scores decreasing from 8.2 (±1.02) to 6.8 (±1.08; p < 0.0001) and from 8.3 (±0.90) to 4.8 (±0.87; p < 0.0001), respectively. NSAIDs use decreased by 40%, with 46.2% of patients no longer requiring NSAIDs. Symptom-specific reductions included cramps, lower back pain, muscle tension, lower abdominal cramps, and nausea. Dyspareunia showed a 25% reduction. The supplement was well-tolerated, with no adverse events reported.

Conclusions: These preliminary findings suggest that this food supplement may effectively reduce dysmenorrhea symptoms and reliance on NSAIDs in patients with insufficient response to conventional therapies. Further validation through randomized controlled trials is needed to confirm these results and establish the supplement's role in dysmenorrhea management.

Background: Lederman designed the prenatal self-evaluation questionnaire, which is a widely used tool for evaluating the psychological well-being and health perception of women during pregnancy. However, its structure and reliability may vary according to the population and cultural context in which it is applied. In Peru, no exhaustive studies have been conducted to validate the psychometric properties of this questionnaire.

Objective: Assess the psychometric properties of Lederman-designed prenatal self-evaluation questionnaire in a sample of Peruvian women using the network approach (BootEGA).

Methods: An instrumental investigation was conducted involving 790 women whose ages ranged from 18 to 45 years (M = 23.87, SD = 6.76). The network approach was used to analyze the data and evaluate the structure of the questionnaire.

Results: The results obtained revealed the presence of a network structure consisting of five dimensions. These dimensions showed stability levels (0.70) and optimal average loads (0.15), supporting the idea that Lederman designed the prenatal self-evaluation questionnaire be composed of five different dimensions. Furthermore, structural consistency showed that the questionnaire is accurate and stable, with estimates <0.99.

Conclusion: Using the network method, the psychometric robustness of the Lederman-designed prenatal self-evaluation questionnaire was satisfactorily validated in the sample of Peruvian women. These findings reinforce the questionnaire's relevance as a reliable tool for assessing psychological well-being during pregnancy, providing valuable insights for maternal health professionals.

Background: Maternal morbidity and mortality in the United States-and disparities therein-are significant and growing public health crises. Doulas (nonclinical perinatal support professionals) could be part of the solution, but there are significant barriers to health care in rural areas.

Methods: This study examines the facilitators and barriers rural communities face in accessing doulas and ideas for expanding doula work in rural communities. As part of a larger-mixed methods, community-engaged project on full-spectrum doula care in Georgia, this study surveyed and interviewed doulas in Georgia from June 2022 to January 2023. We conducted descriptive statistics and thematically analyzed the transcripts using memoing, coding, and group discussion.

Results: We surveyed and interviewed 22 doulas, 17 of whom serve rural clients including 7 who reported over 20% of their clientele are rural. Our main findings included (1) significant perinatal and social service gaps in rural areas, (2) rural poverty that impedes perinatal options, including doula access, (3) long distances between doulas, rural clients, and health care, and (4) childbirth education disparities, resulting in knowledge gaps that doulas could fill.

Discussion: These results are relevant to national maternal health equity efforts in rural communities and can inform policies, programs, and future research including Medicaid reimbursement, doula training, and community-engaged research with doulas.