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Schuklenk U. Conscientious objection in medicine: accommodation versus professionalism and the public good. Br Med Bull 2018; 126:47-56. [PMID: 29608648 DOI: 10.1093/bmb/ldy007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/15/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In recent years questions have arisen about the moral justification for the accommodation of health care professionals who refuse, on conscience grounds as opposed to professional grounds, to provide particular professional services to eligible patients who request that kind of service. SOURCE OF DATA Literature review. AREAS OF DISAGREEMENT Central to concerns about the accommodation claims of conscientious objectors is that health care professionals volunteer to join their professions that typically they are the monopoly providers of such services and that a health care professional's refusal to provide professional services on grounds that are not professional judgements amounts to unprofessional conduct. Defenders of conscientious objection maintain that in a liberal society respect for a professional's conscience is of sufficient importance that conscientious objectors ought to be accommodated. To deny conscientious objectors accommodation would reduce diversity in the health care professions, it would deny objectors unfairly equality of opportunity, and it would constitute a serious threat to the moral integrity of conscientious objectors. GROWING POINTS The legal literature on the subject is growing due to the impossibility of satisfactory compromises.
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Affiliation(s)
- Udo Schuklenk
- Department of Philosophy, Queen's University, John Watson Hall 309, Bader Lane, Kingston, Ontario, Canada
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Magnusson BM, Nield JA, Lapane KL. Age at first intercourse and subsequent sexual partnering among adult women in the United States, a cross-sectional study. BMC Public Health 2015; 15:98. [PMID: 25884406 PMCID: PMC4328838 DOI: 10.1186/s12889-015-1458-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Concurrency and serial monogamy may increase risk for STIs when gaps fall within the infectious period. This study examined the association between early sexual debut and concurrent or serial sexual partnering among heterosexual adult women. METHODS We identified 6,791 heterosexually active women, ages 21-44, from the 2006-2010 National Survey of Family Growth, a multi-stage probability sample of women in the United States. Self-reported age at first intercourse was categorized as <15, 15-17 and ≥18 years (referent). Sexual partnering was defined as concurrency (within the same month), serial monogamy with either a 1-3 month, or ≥4 month gap between partners, or monogamy (referent) in the year prior to interview. Polytomous logistic models provided adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS Concurrent partnerships in the year prior to interview were reported by 5.2% of women. Serial monogamy with a 1-3 month gap was reported by 2.5% of women. Compared with women whose sexual debut was ≥18 years, those <15 years at sexual initiation had 3.7 times the odds of reporting concurrent partnerships (aOR: 3.72; 95% CI: 2.46-5.62). Women <15 years of age at sexual debut had twice the odds of serial monogamy with gap lengths of 1-3 months between partners (aOR1-3 months: 2.13; 95% CI 1.15-3.94) as compared to women ≥18 years at sexual debut. CONCLUSIONS Sexual debut at <15 years is associated with both concurrency and serial monogamy with 1-3 month gaps between partners in U.S. women aged 21-44.
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Affiliation(s)
- Brianna M Magnusson
- Department of Health Science, College of Life Sciences, Brigham Young University, 229-B Richards Building, Provo, UT, 84602, USA.
| | - Jennifer A Nield
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, 830 E. Main Street, 8th Floor, PO Box 980212, Richmond, VA, 23298-0212, USA.
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, AC7-073, Worcester, MA, 06155, USA.
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Choma K, McKeever AE. Cervical Cancer Screening in Adolescents: An Evidence-Based Internet Education Program for Practice Improvement Among Advanced Practice Nurses. Worldviews Evid Based Nurs 2014; 12:51-60. [DOI: 10.1111/wvn.12071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Kim Choma
- Certified Registered Nurse Practitioner-Clinical Practice; and Clinical Lecturer, Rutgers University; College of Nursing, Summit; NJ
| | - Amy E. McKeever
- Assistant Professor; Villanova University; College of Nursing; Villanova PA
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McKeever AE, Bloch JR, Marrell M. Human papillomavirus vaccination uptake and completion as a preventive health measure among female adolescents. Nurs Outlook 2014; 63:341-8. [PMID: 25982773 DOI: 10.1016/j.outlook.2014.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 08/20/2014] [Accepted: 08/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND National coverage for the human papillomavirus (HPV) vaccine falls short of the targeted goals for Healthy People 2020 with disparities in completion rates noted in minority adolescent female populations. The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates. METHODS By reviewing the literature, the authors show that the two human papillomavirus (HPV) vaccines, Gardasil and Cervarix, have presented unprecedented opportunities to prevent morbidity and mortality from cervical cancer. CONCLUSION The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.
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Affiliation(s)
- Amy E McKeever
- Villanova University, College of Nursing, Villanova, PA.
| | - Joan Rosen Bloch
- Drexel University, College of Nursing and Health Professions, Philadelphia, PA
| | - Maldelena Marrell
- Retail Medicine, Temple University College of Health Professions and Social Work, Philadelphia, PA
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Lozman RL, Belcher A, Sloand E. Does a 30-min quality improvement clinical practice meeting reviewing the recommended Papanicolaou test guidelines for adolescents improve provider adherence to guidelines in a pediatric primary care office? J Am Assoc Nurse Pract 2013; 25:584-7. [PMID: 24170532 DOI: 10.1111/1745-7599.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this quality improvement project was to evaluate adherence to Papanicolaou (Pap) test guidelines 6 months prior to and 6 months following a 30-min educational clinical practice meeting in a pediatric primary care office. Guidelines for Pap tests have been revised in recent years by the American Academy of Obstetrics and Gynecology, the American Cancer Society, and the U.S. Preventive Task Force, but providers often do not adhere to the guidelines. DATA SOURCES A total of 777 charts from a pediatric primary care office were reviewed. Eighty-four percent (652) met criteria for inclusion. CONCLUSIONS Among sexually active adolescents, there was a statistically significant relationship between rates of Pap tests following the clinical practice meeting (χ(2) (1) = 13.5, p = .001). Prior to the meeting there were 29 Pap tests recorded, whereas after there were two Pap tests done. After the focused clinical practice meeting, providers performed far fewer Pap tests, which is in accordance with the guidelines for this population. IMPLICATIONS FOR PRACTICE Providers may not always practice in accordance with recommended clinical practice guidelines for various reasons. Focused, in-office educational interventions via clinical practice meetings may be an effective way of discussing recommended guidelines to improve provider adherence.
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Affiliation(s)
- Rebecca L Lozman
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Roland KB, Benard VB, Soman A, Breen N, Kepka D, Saraiya M. Cervical cancer screening among young adult women in the United States. Cancer Epidemiol Biomarkers Prev 2013; 22:580-8. [PMID: 23355601 DOI: 10.1158/1055-9965.epi-12-1266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cervical cancer screening guidelines have evolved significantly in the last decade for young adult women, with current recommendations promoting later initiation and longer intervals. METHODS Using self-reported cross-sectional National Health Interview Survey (NHIS) 2000-2010 data, trends in Papanicolaou (Pap) testing among women ages 18-29 years were examined. NHIS 2010 data were used to investigate age at first Pap test (N = 2,198), time since most recent Pap test (n = 1,622), and predictors of Pap testing within the last 12 months (n = 1,622). RESULTS The percentage of 18-year-olds who reported ever having a Pap test significantly decreased from 49.9% in 2000 to 37.9% in 2010. Mean age at first Pap test in 2010 was significantly younger for non-Hispanic black women (16.9 years), women < high school education (16.9 years), women who received the HPV vaccine (17.1 years), and women who have ever given birth (17.3 years). The majority reported their last Pap test within the previous 12 months (73.1%). Usual source of healthcare (OR, 2.31) and current birth control use (OR, 1.64) significantly increased chances of having a Pap test within the previous 12 months. CONCLUSIONS From 2000 to 2010, there was a gradual decline in Pap test initiation among 18-year-olds; however, in 2010, many women reported ≤12 months since last screening. Evidence-based guidelines should be promoted, as screening young adult women for cervical cancer more frequently than recommended can cause considerable harms. IMPACT A baseline of cervical cancer screening among young adult women in the United States to assess adherence to evidence-based screening guidelines.
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Affiliation(s)
- Katherine B Roland
- Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, MS K-55, Atlanta, GA 30341, USA.
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Henderson JT, Saraiya M, Martinez G, Harper CC, Sawaya GF. Changes to cervical cancer prevention guidelines: effects on screening among U.S. women ages 15-29. Prev Med 2013; 56:25-9. [PMID: 23137444 PMCID: PMC4350673 DOI: 10.1016/j.ypmed.2012.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/17/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15-29 before and after the first evidence-based recommendations for reduced cervical cancer screening. METHOD We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006-2008, stratified by age (15-17, 18-20, 21-29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables. RESULTS Among females ages 15-17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18-20, 24% were screened too early in 2006-2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women. CONCLUSION Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening.
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Affiliation(s)
- Jillian T. Henderson
- University of California, San Francisco, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, 3333 California Street, Suite 335, San Francisco, CA 94118
| | - Mona Saraiya
- Centers for Disease Control & Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, 4770 Buford Hwy NE, MS K-55, Atlanta, GA 30341
| | - Gladys Martinez
- Centers for Disease Control & Prevention, National Center for Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch, 3311 Toledo Road, Hyattsville, MD 20782
| | - Cynthia C. Harper
- University of California, San Francisco, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, 3333 California Street, Suite 335, San Francisco, CA 94118
| | - George F. Sawaya
- University of California, San Francisco, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, 3333 California Street, Suite 335, San Francisco, CA 94118
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Hsu YY, Cheng YM, Hsu KF, Fetzer SJ, Chou CY. Knowledge and beliefs about cervical cancer and human papillomavirus among Taiwanese undergraduate women. Oncol Nurs Forum 2011; 38:E297-304. [PMID: 21708525 DOI: 10.1188/11.onf.e297-e304] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess knowledge and attitudes regarding cervical cancer and human papillomavirus (HPV) among undergraduate women in Taiwan. DESIGN A descriptive cross-sectional design. SETTING Five universities in southern Taiwan. SAMPLE 953 undergraduate women aged 17-36 years. METHODS The self-administered HPV Belief questionnaire was used to collect data on knowledge and beliefs regarding cervical cancer, Pap testing, and HPV. MAIN RESEARCH VARIABLES Knowledge, beliefs, cervical cancer, Pap testing, HPV, likelihood of cervical cancer, and HPV infection. FINDINGS Seventy percent of participants agreed that cervical cancer could be prevented and was a severe disease, and 80% knew the purpose of Pap testing. Forty-nine percent were aware of HPV. Undergraduate women with an awareness of HPV were more likely to be older, studying a health-related major, have a higher class standing, have a personal history of gynecologic visits, and have had a Pap test. Neither family history of gynecologic cancer nor sexual experience predicted HPV awareness, although sexual experience had a significant association with the knowledge and beliefs of cervical cancer. Most of the undergraduate women believed themselves unlikely to acquire cervical cancer or HPV infection. CONCLUSIONS Undergraduate women in Taiwan have limited knowledge of cervical cancer and HPV. Awareness of the likelihood of HPV infection is low among undergraduate women, even those who are sexually active. IMPLICATIONS FOR NURSING Educational campaigns focusing on cervical cancer screening and HPV infection are needed, particularly for sexually active undergraduate women.
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Affiliation(s)
- Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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DeMaria AL, Hollub AV, Herbenick D. Using Genital Self‐Image, Body Image, and Sexual Behaviors to Predict Gynecological Exam Behaviors of College Women. J Sex Med 2011; 8:2484-92. [DOI: 10.1111/j.1743-6109.2011.02379.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Price RA, Koshiol J, Kobrin S, Tiro JA. Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine. Vaccine 2011; 29:4238-43. [PMID: 21473953 PMCID: PMC3105777 DOI: 10.1016/j.vaccine.2011.03.076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/14/2011] [Accepted: 03/22/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND If women who receive the human papillomavirus (HPV) vaccine are unduly reassured about the cancer prevention benefits of vaccination, they may choose not to participate in screening, thereby increasing their risk for cervical cancer. This study assesses adult women's knowledge of the need to continue cervical cancer screening after HPV vaccination, describes Pap test intentions of vaccinated young adult women, and evaluates whether knowledge and intentions differ across groups at greatest risk for cervical cancer. METHODS Data were from the 2008 Health Information National Trends Survey (HINTS) and the 2008 National Health Interview Survey (NHIS), which initiated data collection approximately 18 months after the first FDA approval of an HPV vaccine. We calculated associations between independent variables and the outcomes using chi-square tests. RESULTS Of 1586 female HINTS respondents ages 18 through 74, 95.6% knew that HPV-vaccinated women should continue to receive Pap tests. This knowledge did not vary significantly by race/ethnicity, education, income, or healthcare access. Among 1101 female NHIS respondents ages 18-26 who had ever received a Pap test, the proportion (12.7%; n=139) who reported receipt of the HPV vaccine were more likely than those not vaccinated to plan to receive a Pap test within three years (98.1% vs. 92.5%, p<0.001). CONCLUSIONS US adult women possess high knowledge and intention to participate in Pap testing after HPV vaccination. The vast majority of young adult women who received the HPV vaccine within its first two years on the market intend to participate in cervical cancer screening in the near future. Future studies are needed to examine whether those vaccinated in adolescence will become aware of, and adhere to, screening guidelines as they become eligible.
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Affiliation(s)
- Rebecca Anhang Price
- Work completed at: SAIC-Frederick, Inc. while a contractor to: Applied Cancer Screening Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard EPN 4096 Bethesda, MD 20852
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Bethesda, MD 20852
| | - Sarah Kobrin
- Applied Cancer Screening Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard Bethesda, MD 20852
| | - Jasmin A. Tiro
- Division of Behavioral and Communication Sciences, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390
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Zhang S, Thomas J, Thibodeaux J, Bhalodia A, Abreo F. Teenage cervical screening in a high risk American population. Cytojournal 2011; 8:9. [PMID: 21713014 PMCID: PMC3119383 DOI: 10.4103/1742-6413.81773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 03/12/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The new 2009 ACOG guideline for cervical cytology screening changed the starting age to 21 years regardless of the age of onset of sexual intercourse. However, many recent studies have shown a dramatic increase in the incidence of cervical epithelial abnormalities among adolescents within the past two decades. MATERIALS AND METHODS For this study, the reports of 156,342 cervical cytology were available of which 12,226 (7.8%) were from teenagers. A total of 192 teenagers with high grade intraepithelial lesion (HSIL) cervical cytology were identified. The ages ranged from 13 to 19 years with a mean of 17.7 years and a median of 18 years. Among them, 31.3% were pregnant, 12.0% were postpartum, and 13.5% were on oral contraceptive. Ninety-eight had prior cervical cytology. RESULTS The teenagers had statistically significant higher detection rates of overall abnormal cervical cytology (23.6% vs. 6.6%, P = 0), with 15.4% vs. 3.2% (P = 0) of low grade intraepithelial lesion (LSIL) and 1.8% vs. 1.0% (P = 2.56 × 10(-13) ) of HSIL compared to women ≥20 years. The teenage group had the highest abnormal cytology among all age groups. The LSIL/HSIL ratio was 8.5:1 for teenagers and 3.1:1 for women ≥20 years. A total of 131 teenagers had cervical biopsies within 12 months of the HSIL cytology, with diagnoses of 39 CIN 3, 1 VAIN 3, 15 CIN 2, 62 CIN 1, and 14 had a negative histology (CIN 0). Only in 19 of these 39 women, the CIN 2/3 lesion proved to be persistent. CONCLUSION We conclude that cytology screening of high risk teenagers is effective in detecting CIN 2/3 lesions. Moreover, treatment and careful follow-up can be realized.
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Affiliation(s)
- Songlin Zhang
- Department of Pathology, Louisiana State University Health Science Center, Shreveport, LA 71130, USA
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Practice improvement in cervical screening and management: symposium on management of cervical abnormalities in adolescents and young women. J Low Genit Tract Dis 2010; 14:238-340; author reply 240. [PMID: 20592562 DOI: 10.1097/lgt.0b013e3181d95ad6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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