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Cannedy S, McCoy M, Oishi K, Canelo I, Hamilton AB, Olmos-Ochoa TT. Coping with disruptive patients: Perspectives of primary care employees. Work 2024; 77:307-315. [PMID: 37638468 DOI: 10.3233/wor-230157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The impact of patient aggression on primary health care employees is underexplored, yet imperative to address, given high rates of burnout. OBJECTIVE We qualitatively explore perceptions of patient aggression among staff in women's health primary care at the Veterans Health Administration (VA). Our objective is to identify coping strategies that staf devised in response to aggressive behavior. METHODS We conducted semi-structured interviews with 60 VA women's health primary care employees in 2021 and 2022. Informed by the Job Demands-Resources theoretical model, we used rapid qualitative analysis to identify themes related to patient aggression and employee coping strategies. RESULTS Disruptive behaviors reported by participants included verbal and physical aggression. Staff cited disruptive patient behavior as emotionally draining and perceived a lack of consequences for low-level aggression. Respondents used coping strategies in response to patient aggression at three time points: before, during, and after a negative interaction. At each point, support from team members emerged as a dominant coping mechanism, as well as rapport-building with patients. CONCLUSION Patient aggression can negatively impact the work experiences of primary care employees. At VA, women's health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women's health employees in VA is critical given the need for a highly specialized workforce to address the complex health needs of women veterans.
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Affiliation(s)
- Shay Cannedy
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
| | - Matthew McCoy
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
| | - Kristina Oishi
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
| | - Ismelda Canelo
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Tanya T Olmos-Ochoa
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, CA, USA
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152
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Wu LY, Yang TH, Ou YC, Lin H. The role of probiotics in women's health: An update narrative review. Taiwan J Obstet Gynecol 2024; 63:29-36. [PMID: 38216265 DOI: 10.1016/j.tjog.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 01/14/2024] Open
Abstract
Probiotics, live microorganisms that confer health benefits to the host when administered in adequate amounts, have gained considerable attention for their potential role in maintaining women's health. This overview summarizes key clinical findings on the beneficial effects of probiotics in various aspects of women's health. Probiotics, particularly Lactobacillus species, contribute to vaginal health by promoting a balanced vaginal microbiome to prevent infections and maintain an acidic environment. In gynecologic conditions, probiotics show potential in preventing and managing bacterial vaginosis, vulvovaginal candidiasis, and sexually transmitted infections. Probiotic supplementation has also been associated with improvements in metabolic parameters and menstrual irregularities in polycystic ovary syndrome patients. During pregnancy, probiotics may be helpful in reducing the risk of gestational diabetes, maternal group B streptococcal colonization, obstetric anemia, and postpartum mastitis. In recent years, the potential role of probiotics in the prevention and management of gynecologic cancer has gained attention. Further research is needed to better understand the specific mechanisms and determine the optimal Lactobacillus strains and dosages regimens for gynecologic cancer prevention and therapy. In conclusion, probiotics offer a non-invasive and cost-effective approach to support women's health and prevent obstetric and gynecologic complications.
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Affiliation(s)
- Ling-Ying Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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153
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Sevik I, Ciceklioglu M. Healthcare Access Worsened for Women in Precarious Housing During the COVID-19 Pandemic: A Qualitative Study. Inquiry 2024; 61:469580241246478. [PMID: 38602064 PMCID: PMC11008088 DOI: 10.1177/00469580241246478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024]
Abstract
This research aims to gain an in-depth understanding of precariously housed women's experiences related to health and access to health care during the COVID-19 pandemic using a grounded theory approach. Qualitative data were obtained through interviews with 17 precariously housed women from Izmir, Turkey. Poor health among most participants was primarily attributed to unfavorable living conditions and weakened community networks. The COVID-19 pandemic exacerbated existing health issues due to barriers in accessing basic needs. Food insecurity was widespread during the pandemic and the critical role of aid and the inadequacy of social assistance in securing food were emphasized. Women's health perceptions were significantly shaped by gender, and gendered caregiving duties have restricted women's healthcare access. Access to healthcare was also limited by financial challenges, with health insurance being a crucial determinant. Longer waiting times, often exacerbated by the appointment system, and language were significant barriers to healthcare access. The findings propose that the participants were precarized by the blindness of COVID-19 measures to vulnerabilities, which resulted in deeper inequalities in housing, food, employment, and healthcare access. This research addresses the political, commercial, and social determinants of precariously housed women's health. Improving precariously housed women's health and wellbeing requires implementation of public policies targeting to improve housing quality, provide targeted assistance to food insecurity, promote gender inclusiveness, and foster gender empowerment.
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Affiliation(s)
- Irem Sevik
- Department of Public Health, Ege University Medical Faculty, Izmir, Turkey
| | - Meltem Ciceklioglu
- Department of Public Health, Ege University Medical Faculty, Izmir, Turkey
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Park Y, King J, Eggleston MM, Elias TI. Critical Lessons in Tailoring Interventions: Listening to WISEWOMAN Participants. Am J Health Promot 2024; 38:90-100. [PMID: 37670568 DOI: 10.1177/08901171231200779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. APPROACH Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. SETTING Women from across Pennsylvania, primarily from rural communities. PARTICIPANTS Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). METHODS – DATA COLLECTION AND ANALYSIS Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. RESULTS Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. CONCLUSION The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond.
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Affiliation(s)
- Yuae Park
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jennifer King
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Molly M Eggleston
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Power MC, Bennett EE, Lynch KM, Stewart JD, Xu X, Park ES, Smith RL, Vizuete W, Margolis HG, Casanova R, Wallace R, Sheppard L, Ying Q, Serre ML, Szpiro AA, Chen JC, Liao D, Wellenius GA, van Donkelaar A, Yanosky JD, Whitsel E. Comparison of PM2.5 Air Pollution Exposures and Health Effects Associations Using 11 Different Modeling Approaches in the Women's Health Initiative Memory Study (WHIMS). Environ Health Perspect 2024; 132:17003. [PMID: 38226465 PMCID: PMC10790222 DOI: 10.1289/ehp12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Many approaches to quantifying air pollution exposures have been developed. However, the impact of choice of approach on air pollution estimates and health-effects associations remains unclear. OBJECTIVES Our objective is to compare particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) concentrations and resulting health effects associations using multiple estimation approaches previously used in epidemiologic analyses. METHODS We assigned annual PM 2.5 exposure estimates from 1999 to 2004 derived from 11 different approaches to Women's Health Initiative Memory Study (WHIMS) participant addresses within the contiguous US. Approaches included geostatistical interpolation approaches, land-use regression or spatiotemporal models, satellite-derived approaches, air dispersion and chemical transport models, and hybrid models. We used descriptive statistics and plots to assess relative and absolute agreement among exposure estimates and examined the impact of approach on associations between PM 2.5 and death due to natural causes, cardiovascular disease (CVD) mortality, and incident CVD events, adjusting for individual-level covariates and climate-based region. RESULTS With a few exceptions, relative agreement of approach-specific PM 2.5 exposure estimates was high for PM 2.5 concentrations across the contiguous US. Agreement among approach-specific exposure estimates was stronger near PM 2.5 monitors, in certain regions of the country, and in 2004 vs. 1999. Collectively, our results suggest but do not quantify lower agreement at local spatial scales for PM 2.5 . There was no evidence of large differences in health effects associations with PM 2.5 among estimation approaches in analyses adjusted for climate region. CONCLUSIONS Different estimation approaches produced similar spatial patterns of PM 2.5 concentrations across the contiguous US and in areas with dense monitoring data, and PM 2.5 -health effects associations were similar among estimation approaches. PM 2.5 estimates and PM 2.5 -health effects associations may differ more in samples drawn from smaller areas or areas without substantial monitoring data, or in analyses with finer adjustment for participant location. Our results can inform decisions about PM 2.5 estimation approach in epidemiologic studies, as investigators balance concerns about bias, efficiency, and resource allocation. Future work is needed to understand whether these conclusions also apply in the context of other air pollutants of interest. https://doi.org/10.1289/EHP12995.
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Affiliation(s)
- Melinda C. Power
- Department of Epidemiology, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Erin E. Bennett
- Department of Epidemiology, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katie M. Lynch
- Department of Epidemiology, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - James D. Stewart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, Texas A&M Health Science Center School of Public Health, College Station, Texas, USA
| | - Eun Sug Park
- Texas A&M Transportation Institute, College Station, Texas, USA
| | - Richard L. Smith
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Will Vizuete
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Helene G. Margolis
- Department of Internal Medicine, School of Medicine, University of California at Davis, Sacramento, California, USA
| | - Ramon Casanova
- Department of Biostatics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Robert Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle WA, USA
| | - Qi Ying
- Zachry Department of Civil and Environmental Engineering, Texas A&M University, College Station, Texas, USA
| | - Marc L. Serre
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle WA, USA
| | - Jiu-Chiuan Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Duanping Liao
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Gregory A. Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical Engineering McKelvey School of Engineering, St. Louis, Missouri, USA
| | - Jeff D. Yanosky
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Eric Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Collins SA. Excluding Male Trainees in Obstetrics and Gynecology: Why We Do It and Why It's Wrong. Int Urogynecol J 2024; 35:31-34. [PMID: 38117297 DOI: 10.1007/s00192-023-05705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
This article explores the current landscape of clinical education in obstetrics and gynecology for medical students, residents, and fellows who identify as male. Academic, clinical instruction should be inclusive for the betterment of the training experience for all, but most importantly, for the betterment of women's health.
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Affiliation(s)
- Sarah A Collins
- Department of Obstetrics and Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, The University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA.
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158
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Ward SA, Cornely RM, Mendiola M, Royce CS, Winkelman WD, Hacker MR, Anand M. Education in Female Sexual Function and Dysfunction among American Urogynecologic Society Members: An Unmet Need. South Med J 2024; 117:7-10. [PMID: 38151244 PMCID: PMC10756638 DOI: 10.14423/smj.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Sexual function is an important component of women's health that has not been traditionally emphasized during medical training, suggesting that further education is needed to provide comprehensive patient care. The purpose of this study was to describe education and interest in female sexual function among urogynecology providers. METHODS Conducted in 2020, this was a cross-sectional survey of American Urogynecologic Society members assessing educational and clinical experience with female sexual function. RESULTS Of 642 members who opened the survey, 123 (19%) completed it. Most of the respondents were fellowship trained (70%), and 74% reported ≥10% of their patients had sexual function questions or concerns unrelated to prolapse or incontinence. Most (71%) of the members strongly agreed/agreed that they were comfortable evaluating and managing these patients. This was more common in providers who saw more patients (≥25%) with sexual function concerns (83%) compared with those who saw <25% (65%; P = 0.04). Most of the respondents reported receiving ≤1 lecture on normal sexual function (82%) or sexual dysfunction (85%) during medical training. Most (67%) would expand their practice if they received additional education. The most requested topics were disorders of desire (72%), orgasm (71%), and arousal (67%). The most common reasons for not expanding practice even with additional education were female sexual function not being of significant interest (30%) and time and interruption of practice flow (28%). CONCLUSIONS Most of the respondents felt comfortable caring for patients with sexual function concerns, but reported that they would expand their practice with additional education. The majority reported having received ≤1 female sexual function/dysfunction lecture during their medical training. This highlights a critical need and desire for more female sexual function education among the urogynecologic provider population.
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Affiliation(s)
- Sarah A. Ward
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts
| | | | - Monica Mendiola
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - William D. Winkelman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Michele R. Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Mallika Anand
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Carcel C, Haupt S, Arnott C, Yap ML, Henry A, Hirst JE, Woodward M, Norton R. A life-course approach to tackling noncommunicable diseases in women. Nat Med 2024; 30:51-60. [PMID: 38242981 DOI: 10.1038/s41591-023-02738-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/21/2024]
Abstract
Women's health has been critically underserved by a failure to look beyond women's sexual and reproductive systems to adequately consider their broader health needs. In almost every country in the world, noncommunicable diseases are the leading causes of death for women. Among these, cardiovascular disease (including heart disease and stroke) and cancer are the major causes of mortality. Risks for these conditions exist at each stage of women's lives, but recognition of the unique needs of women for the prevention and management of noncommunicable diseases is relatively recent and still emerging. Once they are diagnosed, treatments for these diseases are often costly and noncurative. Therefore, we call for a strategic, innovative life-course approach to identifying disease triggers and instigating cost-effective measures to minimize exposure in a timely manner. Prohibitive barriers to implementing this holistic approach to women's health exist in both the social arena and the medical arena. Recognizing these impediments and implementing practical approaches to surmounting them is a rational approach to advancing health equity for women, with ultimate benefits for society as a whole.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - Sue Haupt
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, South-West Sydney Local Health District, Sydney, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), South-Western Sydney Clinical School, Ingham Institute, UNSW, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Amanda Henry
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Jane E Hirst
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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Titcomb TJ, Richey P, Casanova R, Phillips LS, Liu S, Karanth SD, Saquib N, Nuño T, Manson JE, Shadyab AH, Liu L, Wahls TL, Snetselaar LG, Wallace RB, Bao W. Association of type 2 diabetes mellitus with dementia-related and non-dementia-related mortality among postmenopausal women: A secondary competing risks analysis of the women's health initiative. Alzheimers Dement 2024; 20:234-242. [PMID: 37563765 PMCID: PMC10916943 DOI: 10.1002/alz.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Alzheimer's disease (AD) and AD-related dementias (ADRD) are leading causes of death among older adults in the United States. Efforts to understand risk factors for prevention are needed. METHODS Participants (n = 146,166) enrolled in the Women's Health Initiative without AD at baseline were included. Diabetes status was ascertained from self-reported questionnaires and deaths attributed to AD/ADRD from hospital, autopsy, and death records. Competing risk regression models were used to estimate the cause-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the prospective association of type 2 diabetes mellitus (T2DM) with AD/ADRD and non-AD/ADRD mortality. RESULTS There were 29,393 treated T2DM cases and 8628 AD/ADRD deaths during 21.6 (14.0-23.5) median (IQR) years of follow-up. Fully adjusted HRs (95% CIs) of the association with T2DM were 2.94 (2.76-3.12) for AD/ADRD and 2.65 (2.60-2.71) for the competing risk of non-AD/ADRD mortality. DISCUSSION T2DM is associated with AD/ADRD and non-AD/ADRD mortality. HIGHLIGHTS Type 2 diabetes mellitus is more strongly associated with Alzheimer's disease (AD)/AD and related dementias (ADRD) mortality compared to the competing risk of non-AD/ADRD mortality among postmenopausal women. This relationship was consistent for AD and ADRD, respectively. This association is strongest among participants without obesity or hypertension and with younger age at baseline, higher diet quality, higher physical activity, higher alcohol consumption, and older age at the time of diagnosis of type 2 diabetes mellitus.
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Affiliation(s)
- Tyler J. Titcomb
- Department of Internal MedicineCarver College of MedicineUniversity of IowaIowa CityIowaUSA
- Department of EpidemiologyUniversity of IowaIowa CityIowaUSA
- Fraternal Order of Eagles Diabetes Research CenterUniversity of IowaIowa CityIowaUSA
| | - Phyllis Richey
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Ramon Casanova
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston SalemNorth CarolinaUSA
| | - Lawrence S. Phillips
- Atlanta VA Medical Center, DecaturGA and Department of MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Simin Liu
- Departments of EpidemiologyMedicine, and Surgery, and Center for Global Cardiometabolic HealthBrown UniversityProvidenceRhode IslandUSA
| | - Shama D. Karanth
- Department of Aging and Geriatric ResearchUniversity of FloridaGainesvilleFloridaUSA
| | - Nazmus Saquib
- Department of ResearchSulaiman Al Rajhi UniversityAl BukayriahSaudi Arabia
| | - Tomas Nuño
- Department of Epidemiology and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - JoAnn E. Manson
- Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Longjian Liu
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Terry L. Wahls
- Department of Internal MedicineCarver College of MedicineUniversity of IowaIowa CityIowaUSA
| | | | - Robert B. Wallace
- Department of Internal MedicineCarver College of MedicineUniversity of IowaIowa CityIowaUSA
- Department of EpidemiologyUniversity of IowaIowa CityIowaUSA
| | - Wei Bao
- Institute of Public Health SciencesDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of EndocrinologyInstitute of Endocrine and Metabolic DisordersFirst Affiliated Hospital of USTCDivision of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
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161
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Gibbs Leadership Prize: Best Manuscripts of 2023 in Women's Health Issues. Womens Health Issues 2024; 34:1-2. [PMID: 38103933 DOI: 10.1016/j.whi.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
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Berghella V, Aviram A, Chescheir N, de Costa C, Dicker P, Goggins A, Gupta JK, D'Hooghe TM, Odibo AO, Papageorghiou A, Saade G, Geary M. Improving trustworthiness in research in Women's Health: A collective effort by OBGYN Editors. Eur J Obstet Gynecol Reprod Biol 2024; 292:71-74. [PMID: 37976768 DOI: 10.1016/j.ejogrb.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Amir Aviram
- Dan Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Chescheir
- Department of Obstetrics & Gynecology, University of North Carolina, USA
| | - Caroline de Costa
- The Cairns Institute, James Cook University, Cairns, Queensland, Australia
| | - Patrick Dicker
- Department of Public Health & Epidemiology, RCSI, Dublin, Ireland
| | - Amy Goggins
- International Federation of Gynecology & Obstetrics, London, UK
| | | | - Thomas M D'Hooghe
- Research Group Reproductive Medicine, Department of Development and Regeneration, Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Belgium; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA; Global Medical Affairs Fertility, Research and Development, Merck Healthcare KGaA, Darmstadt, Germany
| | | | | | - George Saade
- Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, USA
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
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Datta BK, Ansa BE, Saucier A, Pandey A, Haider MR, Puranda R, Adams M, Coffin J. Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score. High Blood Press Cardiovasc Prev 2024; 31:55-63. [PMID: 38285323 DOI: 10.1007/s40292-023-00620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. AIM This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. METHODS Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. RESULTS We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. CONCLUSIONS These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, 1120 15th St., CJ 2300, Augusta, GA, 30912, USA.
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA.
| | - Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, 1120 15th St., CJ 2300, Augusta, GA, 30912, USA
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA
| | - Ashley Saucier
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Racquel Puranda
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malika Adams
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Janis Coffin
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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164
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Chen R, Gordon M, Chervenak F, Coverdale J. Addressing Moral Distress After Dobbs v. Jackson Women's Health Organization : A Professional Virtues-Based Approach. Acad Med 2024; 99:12-15. [PMID: 37816216 DOI: 10.1097/acm.0000000000005476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
ABSTRACT The June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization abolished federal protections for reproductive choice. In states where subsequent legislation has restricted or banned access to abortion services, physicians and trainees are prevented from providing ethically justified evidence-based care when patients with previable pregnancies are seeking an abortion. Pregnant patients' vulnerabilities, stress, and the undue burden that they experience when prevented from acting in accordance with their reproductive decision-making can evoke negative emotional consequences, including moral distress in clinicians. Moral distress occurs when clinicians feel a moral compulsion to act a certain way but cannot do so because of external constraints, including being hindered by state laws that curtail practicing in line with professional standards on reproductive health care. Moral distress has the potential to subvert prudent clinical judgment. The authors provide recommendations for managing moral distress in these circumstances based on the professional virtues. The fundamental professional virtues of integrity, compassion, self-effacement, self-sacrifice, and humility inform the management of moral distress and how to respond thoughtfully and compassionately, without over-identification or indifference to the plight of patients denied abortions. The authors also discuss the role of academic leaders and medical educators in cultivating a virtue-based professional culture at the forefront of clinical and educational processes in a post- Dobbs world.
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Thomas DT, Benson G, Gan A, Schwager S, Okeson B, Baechler CJ. Fourth Trimester: Assessing Women's Health Equity and Long-Term Cardiovascular Outcomes in a Large Midwestern Health System in 2021. Circ Cardiovasc Qual Outcomes 2024; 17:e010157. [PMID: 38009328 DOI: 10.1161/circoutcomes.123.010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Delaine Teabout Thomas
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
| | - Gretchen Benson
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
| | - Anna Gan
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
| | - Sarah Schwager
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
| | - Brynn Okeson
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
| | - Courtney Jordan Baechler
- Minneapolis Heart Institute Foundation, Minneapolis, MN (D.T.T., G.B., A.G., S.S., B.O., C.J.B.)
- Minneapolis Heart Institute, Minneapolis, MN (C.J.B.)
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166
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Oyediran K, Davis N. Relationship between health insurance enrolment and unintended pregnancy in Ghana. J Biosoc Sci 2024; 56:104-124. [PMID: 36852702 DOI: 10.1017/s0021932023000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
CONTEXT The effect of health insurance coverage on sexual and reproductive health, especially unintended pregnancy, has scantly been researched. Using the 2014 Ghana Demographic and Health Survey, the study examined the links between women's health insurance enrolment on unintended pregnancy in Ghana. METHOD The sample consisted of 9,396 women aged 15-49 years, but the analysis was limited to the 4,544 women who were pregnant in the two years preceding the survey. The effects of health insurance enrolment on unintended pregnancy was examined with the propensity score matching. The health insurance enrolment was the treatment variable and unintended pregnancy as the outcome variable. RESULTS This study showed that 66.0% of all women surveyed had health insurance coverage and 31.8% of all women of childbearing age who were currently or had previously been pregnant reported having at least one unintended pregnancy. Thirty percent of insured women had an unintended pregnancy, compared to 37% of uninsured women. The results showed that education, household wealth index, religion, and type of marital union were significant predictor of health insurance coverage among Ghanaian women. The PSM split the women based on their health insurance status. After matching, the difference between the insured and uninsured women reduces significantly. Results demonstrated that, the probability of unintended pregnancy was 0.312 among insured women and 0.351 among those not insured in Ghana. This implies that having health insurance coverage will help in reducing the likelihood of women experiencing unintended pregnancy. CONCLUSIONS Results highlight the importance of the target of universal health coverage under the sustainable development goal 3 and demonstrate that expanding existing health insurance schemes within Ghana could contribute to reducing the number unintended pregnancies experienced each year.
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Affiliation(s)
| | - Nikki Davis
- Senior Research, Monitoring, and Evaluation Advisor John Snow Inc.Arlington, VA22202
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167
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Dugan SA, Crawford SL, Wente K, Waetjen LE, Karvonen-Gutierrez C, Harlow SD. The association of urinary incontinence and disability among a diverse sample of midlife Study of Women's Health Across the Nation women. Menopause 2024; 31:18-25. [PMID: 38016162 PMCID: PMC10766380 DOI: 10.1097/gme.0000000000002282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE The aim of the study is to examine whether urinary incontinence (UI) type, frequency, and amount are associated with self-reported disability in a racially/ethnically diverse cohort of community-dwelling midlife women. METHODS Data were from longitudinal analyses of questionnaires from the multicenter, prospective cohort Study of Women's Health Across the Nation (SWAN). We used multivariable ordinal logistic regression to examine whether urinary incontinence type, frequency, and amount at the 13th follow-up were associated with the World Health Organization Disability Assessment Schedule at the 15th follow-up controlling for other factors (menopause status, body mass index, lifestyle and psychosocial factors, and disability at follow-up 13). RESULTS Urinary incontinence was associated with subsequent reports of disability in participants, particularly in the World Health Organization Disability Assessment Schedule domains of mobility ( P < 0.0001), communication ( P = 0.0057), and life activities ( P = 0.0407). Associations were strongest for mixed UI type compared with stress UI or urgency UI (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.26-2.17, P < 0.001), daily frequency of UI compared with monthly or less than weekly frequency of UI (OR = 1.61, 95% CI = 1.04-2.47, P < 0.001), and larger amounts of urine leakage compared with drops of leakage (OR = 2.98, 95% CI = 1.58-5.62, P < 0.0001) for mobility/getting around domain. CONCLUSIONS Urinary incontinence seems to have a strong association with multiple domains of disability, including mobility and interacting with others, after approximately 3.7 years. Thus, UI may be an important factor limiting social engagement among women. Screening for mixed UI and UI that occurs greater than weekly and in amounts requiring pads may yield better information regarding an individual's future disability risk and may preserve social interaction.
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Affiliation(s)
- Sheila A. Dugan
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Sybil L. Crawford
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, MA
| | - Karla Wente
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL
- College of Health Sciences, Rush University, Chicago, IL
| | - L. Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, CA
| | | | - Siobán D. Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Lakin K, Ha DT, Mirzoev T, Ha BTT, Agyepong IA, Kane S. "We can't expect much": Childbearing women's 'horizon of expectations' of the health system in rural Vietnam. Health Place 2024; 85:103166. [PMID: 38101200 DOI: 10.1016/j.healthplace.2023.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Dinh Thu Ha
- Hanoi University of Public Health, Hanoi, Viet Nam
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
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Álvarez AM, Vélez-Cuervo SM, Cardona-Maya WD. Reply to: "Comments on the article "Monkey pox and female sexual health"". Rev Colomb Obstet Ginecol 2023; 74:319-320. [PMID: 38421223 PMCID: PMC10911414 DOI: 10.18597/rcog.4149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Indexed: 03/02/2024]
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170
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Harris E. Even Mild Lack of Sleep Might Raise Women's Diabetes Risk. JAMA 2023; 330:2331-2332. [PMID: 38055296 DOI: 10.1001/jama.2023.24174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
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171
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Tang I, Rupley D. An Interactive Curriculum to Teach Person-Centered Contraceptive Counseling. MedEdPORTAL 2023; 19:11368. [PMID: 38116180 PMCID: PMC10728363 DOI: 10.15766/mep_2374-8265.11368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/22/2023] [Indexed: 12/21/2023]
Abstract
Introduction Following the Dobbs v. Jackson Women's Health Organization Supreme Court decision, it is increasingly important for all providers to be equipped to counsel on contraceptive options. Current curricula are insufficient for medical students to attain competency in contraceptive counseling. Quality contraceptive counseling requires patient-centered communication skills, which are also critical in many other clinical scenarios. Systematic teaching of patient-centered communication is lacking, both in contraceptive counseling and more broadly. Methods We developed a person-centered contraceptive counseling curriculum containing a reference guide, 5- to 10-minute interactive online module, and 30-minute formative standardized patient session for clerkship-year medical students. Performance during formative sessions was evaluated using a checklist, with standardized patients and preceptors providing real-time feedback. We used surveys of knowledge, self-perceived skills, and attitudes about patient-centered counseling to compare students who did and did not receive the curriculum. Results Twenty-seven students received the new curriculum. The reference guide and online module were easily integrated into a clinical rotation without requiring additional time spent by educators. The formative session required more resources to implement but was valuable for students to solidify the communication skills in the new curriculum. Checklist results showed that students demonstrated many of the counseling skills taught in the module. Survey results about the impact of the new curriculum were promising but limited by the small sample size. Discussion The curriculum successfully introduced patient-centered contraceptive counseling skills and provided a valuable practice opportunity. Other sites could adapt components of this curriculum to enhance education in person-centered contraceptive counseling.
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Affiliation(s)
- Irene Tang
- First-Year Resident, Department of Obstetrics and Gynecology, University of Washington School of Medicine
| | - Devon Rupley
- Assistant Professor, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
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172
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Bertrand KA, Delp L, Coogan PF, Cozier YC, Lenzy YM, Rosenberg L, Palmer JR. Hair relaxer use and risk of uterine cancer in the Black Women's Health Study. Environ Res 2023; 239:117228. [PMID: 37821068 PMCID: PMC10842360 DOI: 10.1016/j.envres.2023.117228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Chemical hair relaxers, use of which is highly prevalent among Black women in the US, have been inconsistently linked to risk of estrogen-dependent cancers, such as breast cancer, and other reproductive health conditions. Whether hair relaxer use increases risk of uterine cancer is unknown. METHODS In the Black Women's Health Study, 44,798 women with an intact uterus who self-identified as Black were followed from 1997, when chemical hair relaxer use was queried, until 2019. Over follow-up, 347 incident uterine cancers were diagnosed. We used multivariable Cox proportional hazards regression models, adjusted for age and other potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of hair relaxer use with risk of uterine cancer. RESULTS Compared to women who never used hair relaxers or used them infrequently (<4 years and ≤1-2 times/year), the HR for uterine cancer associated with heavy use (≥15 years and at least 5 times/year) was 1.18 (95% CI: 0.81, 1.71). However, among postmenopausal women, compared to never/light use, the HR for moderate use was 1.60 (95% CI: 1.01, 2.53), the HR for heavy use was 1.64 (1.01, 2.64), and the HR for ≥20 years of use regardless of frequency was 1.71 (1.08, 2.72). Results among premenopausal women were null. CONCLUSIONS In this large cohort of Black women, long-term use of chemical hair relaxers was associated with increased risk of uterine cancer among postmenopausal women, but not among premenopausal women. These findings suggest that hair relaxer use may be a potentially modifiable risk factor for uterine cancer.
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Affiliation(s)
- Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Lauren Delp
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Yolanda M Lenzy
- Lenzy Dermatology and Hair Loss Center, Chicopee, MA, USA; University of Connecticut Health Dermatology, Farmington, CT, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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173
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Lombardo PA. "A Vigorous Campaign against Abortion": Views of American Leaders of Eugenics v. Supreme Court Distortions. J Law Med Ethics 2023; 51:473-479. [PMID: 38088609 DOI: 10.1017/jme.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The Supreme Court decided Box v. Planned Parenthood of Indiana and Kentucky in 2019. Justice Clarence Thomas's opinion in the case claimed there was a direct connection between the legalization of abortion, in the late 20th Century, and the beginnings of the birth control movement a full three quarters of a century earlier. "Many eugenicists," Thomas argued, "supported legalizing abortion."Justice Samuel Alito highlighted similar claims in Dobbs v. Jackson Women's Health, citing a brief entitled "The Eugenic Era Lives on through the Abortion Movement." That brief was an echo of Justice Thomas' misguided attempt at history in the Box opinion. Similar claims reoccur in Judge Matthew Kacsmaryk's opinion in the Texas mifepristone case, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration.These false claims are the focus of this article. There is no evidence that early leaders of the eugenics movement supported abortion as part of the movement for birth control. It is accurate to describe those leaders as anti-abortion, and their followers as people who condemned abortion for moral, legal, and medical reasons.
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Hdidou Z. The BMJ Appeal 2023-24: Why the climate crisis is also a crisis for women's health. BMJ 2023; 383:2930. [PMID: 38164643 DOI: 10.1136/bmj.p2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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Ahmed A, Huberfeld N, McClain LC. INTRODUCTION: Securing Reproductive Justice After Dobbs. J Law Med Ethics 2023; 51:463-467. [PMID: 38088627 DOI: 10.1017/jme.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
When we conceptualized this symposium, Roe v. Wade1 was still the law of the land, albeit precariously. We aimed to commemorate its fiftieth anniversary by exploring historical, legal, medical, and related dimensions of access to abortion as well as the challenges ahead to secure reproductive justice. With the leak of the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization on May 2, 2022, we shifted to mark the dawn of a new era. In the nearly identical official opinion announced on June 24, 2022,2 Justice Samuel Alito, writing for the majority (6-3), overturned Roe and Planned Parenthood of Southeastern Pennsylvania v. Casey.3.
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Dixon S, Keating S, McNiven A, Edwards G, Turner P, Knox-Peebles C, Taghinejadi N, Vincent K, James O, Hayward G. What are important areas where better technology would support women's health? Findings from a priority setting partnership. BMC Womens Health 2023; 23:667. [PMID: 38093242 PMCID: PMC10720144 DOI: 10.1186/s12905-023-02778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Women's health has historically lacked investment in research and development. Technologies that enhance women's health ('FemTech') could contribute to improving this. However, there has been little work to understand which priority unmet needs should be a focus for women's health technology development. The voices of clinicians and those who experience and utilise these technologies (including those used at home or encountered in clinical settings) are needed to ensure that device development aligns with need, without risking exacerbating or creating health inequities. METHOD We undertook a priority setting partnership project exploring unmet needs in women's health and well-being where physical technologies or innovations could help. This comprised gathering feedback from: patients and clinicians using both qualitative surveys and discussions; collating and publishing these responses and asking for feedback; evidence checking unmet needs identified, and holding a partnership priority setting event to agree a top 10 and top 20 list of priorities. RESULTS We generated a 'longlist' of 54 suggestions for areas where better kit, devices or equipment could support women's health. For three, we found evidence of existing technologies which mitigated against that need. We took the remaining 51 suggestions to a partnership priority setting meeting which brought together clinicians and service users. Through discussion as this group, we generated a list of the top 10 areas identified as priorities for technological development and improvement. These included better devices to manage examination, diagnosis and treatment of pelvic pain (including endometriosis), prolapse care, continence (treatment and prevention, related to pregnancy and beyond), menstruation, vaginal pain and vaginismus, point of care tests for common infections, and nipple care when breastfeeding. CONCLUSION The top priorities suggest far-reaching areas of unmet need across women's life course and across multiple domains of health and well-being, and opportunities where innovation in the devices that people use themselves or encounter in health settings could potentially enhance health and healthcare experiences.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Sabrina Keating
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Neda Taghinejadi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katy Vincent
- Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Olivia James
- Exeter College, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Arguedas-Ramírez G, Wenner DM. Reproductive Justice Beyond Borders: Global Feminist Solidarity in the Post- Roe Era. J Law Med Ethics 2023; 51:606-611. [PMID: 38088629 DOI: 10.1017/jme.2023.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The global impact of Dobbs v. Jackson Women's Health Organization and the backlash towards reproductive justice that it represents warrant a global feminist response informed by broad theoretical and geopolitical lenses. We consider how a solidaristic, transnational feminist movement might learn from Latin American feminist movements that have been successful in uniting broad coalitions in the fight for reproductive justice as situated within far-reaching political goals. The success of such a global movement must be decolonial and must contend with the fact that overlapping realities of global inequality, severe poverty, extractivism, and western-backed violence are fundamentally implicated in reproductive justice.
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Ahmed A, Evans DP, Jackson J, Meier BM, Tomori C. Dobbs v. Jackson Women's Health: Undermining Public Health, Facilitating Reproductive Coercion. J Law Med Ethics 2023; 51:485-489. [PMID: 38088610 DOI: 10.1017/jme.2023.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Dobbs v. Jackson Women's Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health - the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure.
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Affiliation(s)
| | | | - Jason Jackson
- MASSACHUSETTS INSTITUTE OF TECHNOLOGY, CAMBRIDGE, MA, USA
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179
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Passarelli-Araujo H. The association between social support and self-rated health in midlife: are men more affected than women? CAD SAUDE PUBLICA 2023; 39:e00106323. [PMID: 38088736 PMCID: PMC10715567 DOI: 10.1590/0102-311xen106323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023] Open
Abstract
Social support from family and friends is recognized as an important social determinant of health, given its protective effects on individuals' physical and mental well-being. While most studies have focused on older adults, investigating midlife health is equally crucial since middle-aged individuals are also susceptible to the harmful health outcomes of inadequate social support from friends and family. This study contributes to the debate by examining whether social support is associated with self-rated health among middle-aged Brazilian adults and how this relationship varies between men and women. Using data from the nationwide Brazilian National Health Survey conducted in 2019, logistic regression models were employed to assess differences in self-rated health, accounting for confounding factors. The sample comprised 31,926 middle-aged adults, of which 52.5% were women. The overall prevalence of poor self-rated health was 40.7%, with a significant difference between men and women. Results from this study suggest that having no friends or family members to rely on, both during good and challenging times, was associated with poorer self-rated health. However, the strength of this association differs by gender, with social support from friends playing a more critical role in women's self-rated health. On the other hand, family support was associated with male self-rated health, particularly for men with three or more family members they can rely on. Future studies should consider cultural and contextual factors to better understand other dimensions of social support and its association with midlife health.
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Affiliation(s)
- Hisrael Passarelli-Araujo
- Centro de Desenvolvimento e Planejamento Regional, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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180
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Koranteng YB, Adu-Bonsaffoh K, Oppong-Yeboah B. Physiotherapy practice in women's health: awareness and attitudes of obstetricians and gynecologists in Ghana. BMC Womens Health 2023; 23:666. [PMID: 38082319 PMCID: PMC10714590 DOI: 10.1186/s12905-023-02705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physiotherapy is relatively well integrated into women's health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women's health among obstetricians/gynecologists and factors associated with its utilization in Ghana. METHODS A cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an "Awareness and Attitude Questionnaire" adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors' awareness level of physiotherapy's role in women's health and years of clinical practice. RESULTS Sixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29-65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists' role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors' awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors' attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice. CONCLUSION Although obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women's health in the hospital.
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Affiliation(s)
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.
| | - Bertha Oppong-Yeboah
- Department of Physiotherapy, University of Health and Allied Sciences, Ho, Ghana
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181
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Douglass E, Johnson C, Lucas G, Dowling S. "Work with us… to make it more accessible". What women with intellectual disabilities want from infant-feeding health resources: an exploratory study. Int Breastfeed J 2023; 18:67. [PMID: 38066508 PMCID: PMC10704706 DOI: 10.1186/s13006-023-00606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND More women with intellectual disabilities are becoming mothers but fewer are known to breastfeed compared with other women. Women with intellectual disabilities are entitled to accessible antenatal and infant feeding information, yet are rarely asked for their views on available resources. This article reports on the final stage of a UK project exploring how women with intellectual disabilities are supported to make infant feeding decisions. The wider project includes a scoping review and interviews with healthcare professionals, here we focus on the voices of the women themselves. METHODS Four women with an intellectual disability participated in a focus group where they were asked to give their views on the accessibility of currently available infant feeding resources and on alternative representations of infant feeding. All were interested in women's health issues, including infant feeding. Photo-elicitation was used to gather views on videos, bespoke 'Easy Read' material and several alternative representations of infant feeding. A transcription of the discussion was thematically analysed whilst a critical visual analysis was undertaken of the women's preferred images/resources. The study took place in Bristol, UK, during 2022. RESULTS Two themes were identified from the group discussion: 'The desire for choice' and 'How easy is 'Easy Read'?' The desire for choice was expressed in terms through agreements and disagreements about preferred imagery, differing tastes, and reasons for these preferences. We identified a challenge to 'Easy Read' as a default standard and concerns that some forms of 'Easy Read' can confuse rather than inform. Critical visual analysis identified the importance of the story and social setting of the preferred infant feeding image. CONCLUSIONS Findings suggest a need for a suite of resources, avoiding the one-size-fits-all approach, including people with an intellectual disability at every stage of the design and production process. Resources should recognise and embrace differences in terms of understanding, visual literacy and cultural taste, as well as being freely available to support women with intellectual disabilities to make informed infant feeding decisions. An accessible film was co-produced, to disseminate the findings from all three stages of the completed project.
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Affiliation(s)
- Emma Douglass
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Glenside Campus, Blackberry Hill, Fishponds, Bristol, BS16 1DD, UK
| | - Clare Johnson
- School of Arts, College of Arts, Technology and Environment, University of the West of England Bristol, City Campus, Arnolfini, 6 Narrow Quay, Bristol, BS1 4QA, UK
| | - Geraldine Lucas
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Glenside Campus, Blackberry Hill, Fishponds, Bristol, BS16 1DD, UK
| | - Sally Dowling
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK.
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182
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Standeven LR, Miller KN, Mallow A, Berger R, Little V. Reduction of anxiety symptoms among women within a collaborative care model and women's health settings. Prim Health Care Res Dev 2023; 24:e69. [PMID: 38047371 PMCID: PMC10790713 DOI: 10.1017/s1463423623000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/23/2023] [Accepted: 07/20/2023] [Indexed: 12/05/2023] Open
Abstract
AIM The purpose of this study is to focus on changes in anxiety symptoms among women treated in women's health practices and under a collaborative care model. BACKGROUND Research on collaborative care has largely focused on improving depressive and anxiety symptoms among adults in primary care settings. The applicability of collaborative care in other healthcare settings is underreported with limited research investigating if collaborative care has advantages in subpopulations treated in both traditional primary care settings and other healthcare settings, such as women's health practices. METHODS This study, completed through secondary data analysis of the electronic record of N = 219 women across three women's healthcare centers, evaluated if instituting a collaborative care model is associated with reduced anxiety symptoms and which factors (eg, primary diagnosis, duration of care, and use of psychotropic medications) are associated with anxiety outcomes. Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) at entry into and at termination from collaborative care services. RESULTS Overall, there was a significant reduction in average anxiety scores from baseline to termination of collaborative care (t(218) = 12.41, P < 0.001). There was a main effect for the duration of time receiving collaborative care services on anxiety score reduction (β = -0.28, SE = 0.06, P < 0.001) with a significant reduction in anxiety symptoms at the 90-day mark (t(218) = 10.58, P < 0.001). Therefore, collaborative care can be useful in women's health practices in reducing anxiety symptoms over a 90-day time period.
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Affiliation(s)
- Lindsay R. Standeven
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Reproductive Mental Health Center, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kristen N. Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Reproductive Mental Health Center, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alissa Mallow
- School of Social Work, Adelphi University, Poughkeepsie, NY, USA
| | - Roni Berger
- School of Social Work, Adelphi University, Poughkeepsie, NY, USA
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183
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Switchenko N, Shukla V, Mwenechanya M, Chomba E, Patel A, Hibberd PL, Ambalavanan N, Figueroa L, Mazariegos M, Krebs NF, Goudar SS, Derman R, Esamai F, Liechty EA, Bucher S, Saleem S, Goldenberg RL, Lokangaka A, Tshefu A, Bose CL, Koso-Thomas M, Tan S, Nolen T, McClure EM, Carlo WA. Neonatal Respiratory Support Utilization in Low- and Middle-Income Countries: A Registry-Based Observational Study. Neonatology 2023; 121:116-124. [PMID: 38048757 DOI: 10.1159/000534777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/11/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Newborns with hypoxemia often require life-saving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low- and middle-income countries, more term newborns received respiratory support than preterm newborns. METHODS This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women's and Children's Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 g and born from January 1, 2015, to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation. Test for trends over time were conducted using robust Poisson regression. RESULTS 177,728 (86.3%) infants included in this study were term, and 28,249 (13.7%) were preterm. A larger number of term infants (n = 5,108) received respiratory support compared to preterm infants (n = 3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p < 0.001). The rate of provision of respiratory support varied between sites. CONCLUSIONS Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.
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Affiliation(s)
- Nora Switchenko
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vivek Shukla
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Archana Patel
- Lata Medical Research Foundation, India and Datta Meghe Institute of Medical Sciences, Nagpur, India
| | | | | | | | | | - Nancy F Krebs
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J. N. Medical College, Belagavi, India
| | - Richard Derman
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fabian Esamai
- Department of Pediatrics, Moi University, Eldoret, Kenya
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Bloomington, Indiana, USA
| | - Sheri Bucher
- Department of Pediatrics, Indiana University, Bloomington, Indiana, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, New York, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Sylvia Tan
- RTI International, Durham, North Carolina, USA
| | - Tracy Nolen
- RTI International, Durham, North Carolina, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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184
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Ghorbani Z, Moghadam ZB, Mirghafourvand M, Vahidnia F, Ebrahimi E. A comprehensive interventional program based on the needs and concerns related to female genital cosmetic surgeries: protocol for a multistage mixed methods study. Reprod Health 2023; 20:177. [PMID: 38049840 PMCID: PMC10696663 DOI: 10.1186/s12978-023-01717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Dissatisfaction with one's body and the subsequent rise in the cosmetic surgery trend pose significant public health concerns today. One unusual cosmetic surgical procedure involves enhancing the genital area. Numerous healthy women and girls have recently sought Genital Cosmetic Surgery (GCS) for beauty or improved sexual performance. There is a concern that this phenomenon may be linked to developing a new standard for vulvovaginal appearance. This stringent standard could potentially adversely affect women's mental health in the future, growing feelings of insecurity and possibly leading teenagers to consider plastic surgery. Implementing empowering and awareness-raising programs for women and girls is crucial, especially in light of the constantly evolving gender norms and the medicalization of sexuality and beauty as social constructs. It is essential that such training is integrated into comprehensive sexual education programs for adolescents. These efforts align perfectly with the SDG, recognizing that education in sexual and reproductive health, ensuring access to health, and empowering women are fundamental rights for women and girls. To accomplish these objectives, we will conduct this study to elucidate the needs and concerns related to the increasing trend of GCS. By doing so, we can concentrate on the factors motivating women to undergo GCS. This approach will enable us to develop effective interventions to empower women and girls considering GCS, thus enhancing their sexual and reproductive health. METHODS AND OBJECTIVES The objectives of this multistage exploratory sequential mixed-method study will be structured into three phases: First phase: qualitative study. 1. In-depth interviews will be conducted to elucidate the needs and concerns associated with GCS with women with a history of GCS, spouses of willing participants, and women actively seeking these procedures. 2. A literature review in parallel with the qualitative phase will be conducted to gain insights into the needs and concerns of women worldwide considering GCS. Second phase: program design. 1. To formulate an intervention grounded in the primary priorities identified during the qualitative stage and informed by the literature review. 2. To prioritize the needs and concerns of women seeking GCS and to validate and endorse the intervention through input from an expert panel. Third phase: quantitative study. To assess and determine the effectiveness of the intervention designed to address the needs and concerns of women applying for GCS procedures. DISCUSSION This study marks the first attempt to design and assess an intervention addressing the needs and concerns of cosmetic surgeries performed on the female genital and reproductive system. The hope is that this study's compilation and implementation will yield substantial evidence and documentation regarding the impact of educational interventions on women's and girls' sexual and reproductive empowerment. Given the rising prevalence of GCS among unmarried teenagers, this approach is of utmost significance. It underscores the necessity for gynecological and midwifery service providers to have comprehensive guidance on GCS. Such guidance can be an essential resource for healthcare providers in this field.
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Affiliation(s)
- Zahra Ghorbani
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Zahra Behboodi Moghadam
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Vahidnia
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ebrahimi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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185
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Abstract
A recent editorial in this Journal argued that increasing surgical complexity coupled with more limited training calls for separating obstetrics from gynaecology. The speciality suffers manpower challenges and high attrition rates. There is an apparent gulf in approach between researchers focussing on the views of UK graduates or trainees and workforce planners who address the problem through overseas recruitment. Whilst available literature provides scant, if any, indication as to how to address current challenges, it is important that advocates for women's health assess and mitigate potential drawbacks when exploring the way forward.
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Affiliation(s)
- Marwan Habiba
- Department of Health Sciences, University of Leicester and University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, UK
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186
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Palacios S, Ayala G, González G, Badilla-Apuy CL, Marchena J, Martínez K, Mostajo D, Vernaza MS, Paradas A, Hernández L, Vásquez-Awad D, Celis-González C, de Melo NR. Combined oral contraceptives: update recommendations of the Latin American contraceptive association. Gynecol Endocrinol 2023; 39:2271072. [PMID: 37857350 DOI: 10.1080/09513590.2023.2271072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
Background: In recent years, new combined oral contraceptives (COCs) have become available, representing an advance in terms of individualization and compliance by users.Objective: To provide recommendations regarding COCs: formulations, use, efficacy, benefits and safety.Method: For these recommendations, we have used the modified Delphi methodology and carried out a systematic review of studies found in the literature and reviews performed in humans, published in English and Spanish in Pubmed, Medline and advanced medicine and computer networks until the year 2021, using the combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptives'.Results: Regarding the estrogen component, initially switching from mestranol (the pro-drug of ethinylestradiol) to ethinylestradiol (EE) and then reducing the EE dose helped reduce side effects and associated adverse events. Natural estradiol and estradiol valerate are already available and represent a valid alternative to EE. The use of more potent 19-nortestosterone-derived progestins, in order to lower the dose and then the appearance of non-androgenic progestins with different endocrine and metabolic characteristics, has made it possible to individualize the prescription of COC according to the profile of each woman.Conclusion: Advances in the provision of new COCs have improved the risk/benefit ratio by increasing benefits and reducing risks. Currently, the challenge is to tailor contraceptives to individual needs in terms of safety, efficacy, and protection of female reproductive health.
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Affiliation(s)
- Santiago Palacios
- Ginecologia y Obstetricia Department, Clínica Palacios de la Salud de la Mujer, Madrid, Spain
| | - Gabriela Ayala
- Ginecologia y Obstetricia Department, Hospital Metropolitano, Quito, Ecuador
| | - Gemarilis González
- Ginecología y Obstetricia Department, Consultorio América, Ciudad de Panamá, Panamá
| | - Can L Badilla-Apuy
- Ginecología y Obstetricia Department, Oncogine Servicios Médicos S.A., San José, Costa Rica
| | - Jeannette Marchena
- Ginecología y Obstetricia Department, Coordinadora de la Unidad de Medicina Reproductiva de las Clínicas AUNA y Clínica Delgado, Lima, Perú
| | - Katia Martínez
- Centro de Obstetricia y Ginecología, Health Service Medical Center, Santo Domingo, República Dominicana
| | - Desireé Mostajo
- Medical Director, Jefe Médico del Centro Médico PERINAT, Santa Cruz de la Sierra, Bolivia
| | - María S Vernaza
- Ginecología y Obstetricia Department, Laparoscopía Ginecológica, Clínica IMBANACO, Cali, Colombia
| | - Alejandro Paradas
- Obstetrics and Gynecology Department, Hospital Universitario, Maternidad La Altagracia, Santo Domingo, República Dominicana
| | - Luis Hernández
- Departamento de Ginecología y Obstetricia, Hospital Herrera Llerandi, Ciudad de Guatemala, Guatemala
| | - David Vásquez-Awad
- Ginecologia y Obstetricia Department, Academia Nacional de Medicina, Bogotá, Colombia
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187
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Dong C, Guan Q, Xu W, Zhang X, Jin B, Yu S, Xu X, Xia Y. Disentangling the age-related manner in the associations between gut microbiome and women's health: a multi-cohort microbiome study. Gut Microbes 2023; 15:2290320. [PMID: 38059752 PMCID: PMC10730178 DOI: 10.1080/19490976.2023.2290320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
Women's health encompasses life-course healthcare, and mounting evidence emphasizes the pivotal contribution of gut microbiota. Therefore, understanding the temporal dynamics of gut microbiota and how age influences disease-gut microbiota associations is essential for improving women's health. By analyzing metagenomic data from 3625 healthy women, we revealed significant effects of age on gut microbiota and age-dependent patterns in microbial features, such as relative abundance, Shannon index, and microbial network properties. Additionally, declining trends in the predictive accuracy of gut microbiota for age groups were shown using iterative sub-sampling based random forest (ISSRF) model. Age-specific species markers were also identified, many of which were shared across age groups. To investigate the influence of age on disease-gut microbiota associations, metagenomic data from 681 women with various disease conditions and 491 matched healthy controls were collected. A substantial proportion of species markers for inflammatory bowel disease (IBD), type 2 diabetes (T2D), atherosclerotic cardiovascular disease (ACVD), and impaired glucose tolerance (IGT) differed in relative abundance across age groups, and were also age-specific species markers. Besides, the microbiota-based probabilities of IBD and ACVD were positively correlated with age. Furthermore, the age specificity of disease-gut microbiota associations was explored using the ISSRF model. Associations between IBD and gut microbiota were age-specific, with reduced stability of disease species markers in childhood and adolescence, possibly due to decrease in the effect size between patients and controls. Our findings provided valuable insights into promoting healthy aging and developing personalized healthcare strategies for women.
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Affiliation(s)
- Chao Dong
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Quanquan Guan
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Xu
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaochen Zhang
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bowen Jin
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shumin Yu
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoyu Xu
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine and Offspring Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
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188
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Jain P, Binder A, Chen B, Parada H, Gallo L, Alcaraz J, Horvath S, Bhatti P, Whitsel E, Jordahl K, Baccarelli A, Hou L, Stewart J, Li Y, LaMonte M, Manson J, LaCroix A. The Association of Epigenetic Age Acceleration and Multimorbidity at Age 90 in the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2274-2281. [PMID: 36107798 PMCID: PMC10692424 DOI: 10.1093/gerona/glac190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Epigenetic age acceleration (EAA), a measure of accelerated biological aging, has been associated with an increased risk of several age-related chronic conditions. This is the first study to prospectively examine the relationship between EAA and both multimorbidity count and a weighted multimorbidity score among long-lived postmenopausal women. METHODS We included 1 951 women from the Women's Health Initiative who could have survived to age 90. EAA was estimated using the Horvath pan-tissue, Hannum, PhenoAge, and GrimAge "clocks." Twelve chronic conditions were included in the multimorbidity count. The multimorbidity score was weighted for each morbidity's relationship with mortality in the study population. Using mixed-effects Poisson and linear regression models that included baseline covariates associated with both EAA and multimorbidity, we estimated relative risks (RRs) and 95% confidence intervals (CIs) for the relationships between each EAA measure at the study baseline with both multimorbidity count and weighted multimorbidity score at age 90, respectively. RESULTS For every one standard deviation increase in AgeAccelPheno, the rate of multimorbidity accumulation increased 6% (RR = 1.06; 95% CI = 1.01-1.12; p = .025) and the multimorbidity score by 7% (RR = 1.07; 95% CI = 1.01-1.13; p = .014) for women who survived to age 90. The results for a one standard deviation increase in AgeAccelHorvath, AgeAccelHannum, and AgeAccelGrim with multimorbidity accumulation and score were weaker compared to AgeAccelPheno, and the latter 2 did not reach statistical significance. CONCLUSION AgeAccelPheno and AgeAccelHannum may predict multimorbidity count and score at age 90 in older women and, thus, may be useful as a biomarker predictor of multimorbidity burden in the last decades of life.
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Affiliation(s)
- Purva Jain
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Alexandra Binder
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California,USA
| | - Brian Chen
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Linda C Gallo
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - John Alcaraz
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California,USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, California,USA
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristina Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois,USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo―SUNY, Buffalo, New York, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Z LaCroix
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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189
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Jozkowski KN, Bueno X, Turner RC, Crawford BL, Lo WJ. People's knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision. Sex Reprod Health Matters 2023; 31:2233794. [PMID: 37565622 PMCID: PMC10424603 DOI: 10.1080/26410397.2023.2233794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Although media response to the Dobbs v. Jackson Women's Health Organization decision was widespread in the United States, the extent to which people were aware of the Mississippi law leading to the decision, the Dobbs v. Jackson case, is unclear, as are the resulting effects of the decision on legal abortion. As such, we examined people's awareness of abortion legality prior to and after the Dobbs v. Jackson decision announcement, as well as the potential implications associated with the decision (i.e. overturning of Roe v. Wade). We also examined people's attitudes toward abortion legality, specifically focusing on 15 weeks' gestation to correspond with the Mississippi law that led to Dobbs v. Jackson. Data were collected across two studies at different times. In Study 1, a 15-minute survey was administered to IPSOS' KnowledgePanel (N = 1014) prior to the decision announcement. A shorter version of that survey was administered to a second sample using NORC's AmeriSpeak Omnibus panel (N = 1002). Nearly half of that sample (42.2%) completed the survey prior to the decision announcement. People were generally unaware of the Mississippi law, the Dobbs v. Jackson case, and implications associated with the decision (e.g. overturning Roe v. Wade). People generally endorsed abortion being legal at 15 weeks or later, but this varied by circumstance. We did not find meaningful effects of the decision announcement on people's knowledge and attitudes. Our findings suggest that the intense response to the decision from the media and people involved in the abortion movement may not represent the general public's reaction.
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Affiliation(s)
- Kristen N. Jozkowski
- William L. Yarber Endowed Professor in Sexual Health, Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Xiana Bueno
- Assistant Research Scientist, Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Ronna C. Turner
- Professor, Educational Statistics and Research Methods, College of Education and Health Professions, University of Arkansas, Fayetteville, NC, USA
| | - Brandon L. Crawford
- Assistant Professor, Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Wen-Juo Lo
- Associate Professor, Educational Statistics and Research Methods, College of Education and Health Professions, University of Arkansas, Fayetteville, NC, USA
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190
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Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP). Maturitas 2023; 178:107853. [PMID: 37806008 DOI: 10.1016/j.maturitas.2023.107853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Menopausal symptoms can substantially impact quality of life. We studied somatic, psychological, and urogenital symptoms and their associated factors. DESIGN Cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups. METHODS In 2014-16, women aged 45 to 69 attending well-woman clinics at the National University Hospital Singapore completed the Menopause Rating Scale (MRS). Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols. We analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression. RESULTS Of the 1054 eligible women, 62.6 % reported at least one moderate to extremely severe symptom. The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes. Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95 % confidence interval: 2.88-33.34), poorer self-rated health status (2.18, 1.60-2.97), menstrual irregularity at 25 years (1.63, 1.07-2.49), and slower chair stands (1.49, 1.09-2.03). Age ≥65 (0.54, 0.30-0.94) and a lower level of education (0.45, 0.26-0.76) had significant inverse associations with total MRS score. CONCLUSIONS Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength. These data add to the limited Asian evidence and raise the profile of this important area of health.
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Affiliation(s)
- Susan Logan
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Level 3, 119074, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Beverly Wen Xin Wong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Joelle Hwee Inn Tan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore; Department of Epidemiology, Biostatistics & Occupational Health, McGill University Faculty of Medicine, 3605 Rue de la Montagne Montréal, Quebec H3G 2M1, Canada; Department of Pediatrics, McGill University Faculty of Medicine, 3605 Rue de la Montagne Montréal, Quebec H3G 2M1, Canada
| | - Eu-Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Level 3, 119074, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 12, 119228, Singapore.
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191
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Morse BL, Karian V. Supporting the Young Adulthood Transitions in Women With Migraine. Nurs Womens Health 2023; 27:457-466. [PMID: 37804861 DOI: 10.1016/j.nwh.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 10/09/2023]
Abstract
Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual's 18th birthday. Women's health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women's health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.
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192
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Billington EO, Miyagishima RC, Hasselaar C, Arain M. Women's perspectives regarding osteoporosis, fracture risk, and pharmacologic treatment: a cross-sectional study. Osteoporos Int 2023; 34:2069-2076. [PMID: 37608123 DOI: 10.1007/s00198-023-06890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
We assessed women's perspectives regarding early preventative therapy for osteoporosis. More than a third of early menopausal women were concerned about bone loss and future fractures, and approximately half were willing to take an intravenous or oral bisphosphonate around the time of menopause to preserve bone health. PURPOSE Bisphosphonate medications can prevent the substantial bone loss that occurs during early menopause, but little is known about whether women would accept bisphosphonate treatment at this time in their life, when imminent fracture risk is low. We assessed women's perspectives regarding bone loss, fracture risk, and preventative pharmacotherapy in early menopause. METHODS In this cross-sectional study, Canadian women aged ≥ 45 years were recruited via Facebook advertisement to complete an electronic survey. Primary outcome was the proportion of early menopausal respondents (≤ 5 years since final menstrual period) who were worried about bone loss and fractures. Secondary outcomes were the proportion of early menopausal women willing to accept pharmacologic intervention aimed at preventing either bone loss or future fractures. We compared responses between early menopausal women and older women (> 5 years since final menstrual period). RESULTS 2033 women responded to the Facebook advertisement, 1195 eligible women (aged: 45 to 89 years) started the survey, and 966 completed it. Among early menopausal respondents (N = 98), 38 (42%) were worried about future fractures and 9 of 25 (36%) who had a prior bone mineral density scan were worried about their results. A total of 42 (47%) were willing to start medication to prevent fractures, and 48 (54%) would start medication to prevent bone loss. Responses were comparable between early menopausal women and older women. CONCLUSION Menopausal women are concerned about bone loss and fractures. Many women would consider early menopausal pharmacotherapy, with the goals of preserving bone health and lowering their risk of fractures.
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Affiliation(s)
- Emma O Billington
- Cumming School of Medicine, Division of Endocrinology & Metabolism, University of Calgary, Richmond Road Diagnostic & Treatment Centre, Room 18118, 1820 Richmond Road SW, Calgary, AB, Canada.
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada.
| | | | - Charley Hasselaar
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - Mubashir Arain
- Health Systems Knowledge & Evaluation, Alberta Health Services, Alberta, Canada
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193
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Sheedy AN, Wactawski-Wende J, Hovey KM, LaMonte MJ. Discontinuation of hormone therapy and bone mineral density: does physical activity modify that relationship? Menopause 2023; 30:1199-1205. [PMID: 38019034 PMCID: PMC10688963 DOI: 10.1097/gme.0000000000002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Hormone therapy can positively impact bone mineral density after menopause. We explored bone mineral density change in postmenopausal women who discontinued hormone therapy after the Women's Health Initiative landmark 2002 trial results were published. We secondarily explored whether usual physical activity modified the results. METHODS Postmenopausal women participating in the Buffalo OsteoPerio study with information on hip bone density, hormone therapy use, and self-reported physical activity at two time points (1997-2001; 2002-2007) were included (N = 961). Hormone therapy included three groups according to use at baseline and year 5 (non/non; current/non; current/current). RESULTS At baseline (mean age, 65.9 years; SD, 6.7 years), 480 women were not using hormone therapy, while 481 were current users. Between the baseline and 5-year visits, 336 women using hormone therapy discontinued. Baseline total hip bone density was highest in current users. After 5 years, those who continued hormone therapy exhibited no bone loss; those who discontinued exhibited the greatest loss at the total hip of -0.021 gm/cm2. Women who never used hormone therapy exhibited some loss of -0.012 gm/cm2. Usual physical activity did not appreciably impact change in bone density in any group. CONCLUSIONS This prospective observational study explored the 5-year change in bone mineral density among older postmenopausal women after the landmark 2002 hormone therapy trial findings were released. We found bone density decreased in never-users and in women who discontinued use. Bone density was maintained in current users. Although usual physical activity did not mitigate bone loss, targeted physical activity regimens should be investigated.
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Affiliation(s)
- Alyssa N. Sheedy
- University at Buffalo, Jacobs School of Medicine and Biomedical Sciences
| | | | - Kathleen M. Hovey
- University at Buffalo, Department of Epidemiology and Environmental Health
| | - Michael J. LaMonte
- University at Buffalo, Department of Epidemiology and Environmental Health
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194
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Herr A. Abortion Access for Women in Custody in the Wake of Dobbs v. Jackson Women's Health. Am J Law Med 2023; 49:471-492. [PMID: 38563269 DOI: 10.1017/amj.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization made it drastically harder for women to access abortions. The Dobbs decision has had a disproportionate impact on women who are incarcerated or on some form of community supervision such as probation or parole. This Note analyzes a potential right to an abortion for women involved in the criminal justice system, even those living in states that have banned or deeply restricted abortion access after the Dobbs decision. In doing so, this Note looks for different constitutional avenues to protect incarcerated women's right to an abortion, including under the Eighth Amendment to the U.S. Constitution.
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Affiliation(s)
- Allison Herr
- Boston University School of Law, Boston, MA, USA
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195
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Hemming K, Melo P, Luo R, Taljaard M, Coomarasamy A. A re-analysis of 150 women's health trials to investigate how the Bayesian approach may offer a solution to the misinterpretation of statistical findings. BJOG 2023; 130:1629-1638. [PMID: 37381115 DOI: 10.1111/1471-0528.17570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To investigate whether a Bayesian interpretation might help prevent misinterpretation of statistical findings and support authors to differentiate evidence of no effect from statistical uncertainty. DESIGN A Bayesian re-analysis to determine posterior probabilities of clinically important effects (e.g., a large effect is set at a 4 percentage point difference and a trivial effect to be within a 0.5 percentage point difference). Posterior probabilities greater than 95% are considered as strong statistical evidence, and less than 95% as inconclusive. SAMPLE 150 major women's health trials with binary outcomes. MAIN OUTCOME MEASURES Posterior probabilities of large, moderate, small and trivial effects. RESULTS Under frequentist methods, 48 (32%) were statistically significant (p-value ≤ 0.05) and 102 (68%) statistically non-significant. The frequentist and Bayesian point estimates and confidence intervals showed strong concordance. Of the statistically non-significant trials (n = 102), the Bayesian approach classified the majority (94, 92%) as inconclusive, neither able to confirm or refute effectiveness. A small number of statistically non-significant findings (8, 8%) were classified as having strong statistical evidence of an effect. CONCLUSIONS Whilst almost all trials report confidence intervals, in practice most statistical findings are interpreted on the basis of statistical significance, mostly concluding evidence of no effect. Findings here suggest the majority are likely uncertain. A Bayesian approach could help differentiate evidence of no effect from statistical uncertainty.
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Affiliation(s)
- Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pedro Melo
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Rong Luo
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
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196
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Pezzali LG, Ferreira FV, Ferreira FV, Wender MCO. Impact of the new coronavirus (SARS-CoV-2) pandemic on climacteric women's health: Websurvey. Climacteric 2023; 26:594-600. [PMID: 37669691 DOI: 10.1080/13697137.2023.2246877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/15/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The menopausal transition is an important milestone in female reproductive life. Many studies have been conducted to assess the impact of the COVID-19 pandemic on women, but few of them focus on the climacteric population. This study aimed to investigate changes in the health and health care of climacteric women aged 40-70 years residing in Brazil during the pandemic period. METHOD A cross-sectional study was carried out using an electronic form with questions related to sociodemographic, clinical and gynecological data, treatments, access to health services and changes in behavior. RESULTS A total of 419 women answered the questionnaire. Sixty percent reported weight gain and 50.8% reported reduced physical activity practice. More than 80% reported worsening mental health and 66.1% had a change in their sleep pattern. More than half reported having difficulty accessing gynecological consultations and routine examinations. Women living in capital cities reported a greater change in alcohol consumption (p = 0.002). Income change was associated with a higher prevalence of weight gain (p = 0.033) and changes in sleep quality (p = 0.018). CONCLUSION We observed an important reduction in the health care of climacteric women during the pandemic period, such as a decrease in medical consultations and preventive examinations, worsening of life habits and deterioration in mental health.
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Affiliation(s)
- L G Pezzali
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil
| | - F V Ferreira
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil
| | - F V Ferreira
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M C O Wender
- Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil
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197
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Bluming AZ, Hodis HN, Langer RD. 'Tis but a scratch: a critical review of the Women's Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause 2023; 30:1241-1245. [PMID: 37847875 PMCID: PMC10758198 DOI: 10.1097/gme.0000000000002267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Use of menopausal hormone therapy (HT) fell precipitously after 2002, largely as a result of the Women's Health Initiative's report claiming that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate increased breast cancer risk and did not improve quality of life. More recently, Women's Health Initiative (WHI) publications acknowledge HT as the most effective treatment for managing menopausal vasomotor symptoms and report that CEE alone reduces the risk of breast cancer by 23% while reducing breast cancer death by 40%. Their sole remaining concern is a small increase in breast cancer incidence with CEE and medroxyprogesterone acetate (1 per 1,000 women per year) but with no increased risk of breast cancer mortality. This article closely examines evidence that calls even this claim of breast cancer risk into serious question, including the WHI's reporting of nonsignificant results as if they were meaningful, a misinterpretation of its own data, and the misleading assertion that the WHI's findings have reduced the incidence of breast cancer in the United States. A generation of women has been deprived of HT largely as a result of this widely publicized misinterpretation of the data. This article attempts to rectify this misunderstanding, with the goal of helping patients and physicians make informed joint decisions about the use of HT.
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Affiliation(s)
- Avrum Z. Bluming
- Department of Medicine, Keck School of Medicine, University of Southern California, San Diego, CA
| | - Howard N. Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, San Diego, CA
| | - Robert D. Langer
- Department of Family Medicine and Public Health, University of California, San Diego, CA
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198
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Seedat S, Halligan SL. Beyond bruises: the lifelong toll of violence on women's health. Nat Med 2023; 29:3008-3009. [PMID: 38081958 DOI: 10.1038/s41591-023-02654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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199
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Cabé N, Cabé J. [Women's vulnerability to alcohol and its impact on health]. Rev Infirm 2023; 72:19-21. [PMID: 38071010 DOI: 10.1016/j.revinf.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
At the same level of consumption as men, specific vulnerabilities often expose women to the more rapid onset of more serious illnesses (cardiovascular and liver diseases, cancers, brain and cognitive damage, sleep disorders, risk of accidents, etc.). This worrying fact is still little known by the general population. Special prevention measures are needed, such as dedicated campaigns for women, specific guidelines for lower-risk drinking, systematic early detection of risky drinking among women, and brief intervention in the event of problem drinking.
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Affiliation(s)
- Nicolas Cabé
- Service d'addictologie, Centre hospitalier universitaire de Caen, 14000 Caen, France; Normandie Université, UNICAEN, Inserm, U1237, PhIND - Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain de Caen-Normandie, Cyceron, 14000 Caen, France.
| | - Julien Cabé
- Service d'addictologie et pathologies duelles, Centre hospitalier universitaire de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Faculté de médecine, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
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200
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Thaxton L, Gonzaga MI, Tristan S. Abortion Policy: Legal, Clinical, and Medical Education Considerations. Clin Obstet Gynecol 2023; 66:759-772. [PMID: 37910072 DOI: 10.1097/grf.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Abortion is a frequent topic of policy debate in America and a central issue in politics since the Dobbs v Jackson Women's Health Supreme Court decision. A number of states have completely or nearly completely banned abortion and criminalized health care providers. People seeking abortion care are turning to alternatives outside the formal health care system or traveling to states that have preserved access. Approximately half of US Obstetrics/Gynecology residents will train in a state where abortion is illegal, lending to a frightening future where Obstetrics/Gynecologists are not trained to provide this common, sometimes life-saving, health care.
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Affiliation(s)
- Lauren Thaxton
- Department of Women's Health University of Texas at Austin Dell Medical School, Austin, Texas
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