Psychosocial Outcomes in Nondirected Uterus Donors 1 Y After Donation

Addressing Social Determinants of Health to Promote Health Equity for Latinx Families: A Mixed-Methods Study of the DULCE Intervention

BACKGROUND

Social determinants of health (SDOH) interventions within clinical settings have been proposed to address health-related social needs, but few studies have explored intervention needs and challenges for Latinx families. This sequential mixed-methods study examined the effect of Developmental Understanding and Legal Collaboration for Everyone (DULCE), a 6-month SDOH intervention conducted in pediatric clinics in California and Florida.

METHODS

Using survey data collected among Latinx caregivers who participated in the DULCE evaluation (n = 393), we examined changes in caregivers' depression, stress, and resilience, including differences by nativity. Qualitative interviews were conducted with DULCE participants (n = 16) across nativity to elucidate the components of the intervention that impacted caregiver outcomes.

RESULTS

DULCE led to significant increases in resilience among Latinx caregivers, especially immigrants, but no changes in depression or stress. Qualitative interviews illuminated that the following themes contributed to caregivers' resilience through the DULCE program: trusted relationship with family specialist caseworkers, connection to critical resources, addressing postpartum depression and social isolation, building caregivers' capacity to withstand challenges, and bolstering caregivers' confidence to seek resources independently.

DISCUSSION

Pediatric SDOH interventions are a promising strategy to support Latinx families in early childhood. Effective interventions for Latinx families, however, require strategies that pair resource connection with relationship building, address immigrants' and Latinx system avoidance, and incorporate additional supports or boosters for families experiencing extreme stress.

Living-Donor Uterus Transplantation: A Clinical Review

Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. More than 90 uterus transplantations have been performed worldwide, mostly from living donors. Living-donor (LD) UTx is a challenging surgical procedure since it poses ethical issues, and it is a high-risk and invasive surgery with higher hysterectomy-related risks compared to conventional hysterectomy. A total of 59 living-donor hysterectomies have been reported in the literature, including 35 performed with a laparotomic approach, 20 with a robotic approach and 4 with a laparoscopic approach. The mean donor age was 45.6 ± 9.1 years, and 22 were unrelated with the recipients, 34 were emotionally related (27 mothers, 5 sisters, 2 mother's sisters). The mean recipient age was 28.8 ± 4.5 years. Mayer-Rokitansky-Küster-Hauser syndrome was the most common indication for uterus transplant. Robotic living-donor hysterectomy had the longest operative time but resulted in a lower blood loss and postoperative stay compared to laparotomic and laparoscopic approaches. Twenty-nine births from LD-UTx have been reported, four after robotic living-donor hysterectomy and twenty-five after a laparotomic procedure. UTx is now an effective treatment for women with UFI. While living-donor UTx in some cases may be considered an experimental procedure, it offers the extraordinary possibility to give women the opportunity to have a pregnancy. Many efforts should be made to reduce the potential risks for donors, including the use of mini-invasive techniques, and the efficacy of UTx in the recipients, giving the potential harm of immunosuppression in a recipient of a non-life-saving organ.