Referral Of Women Research Articles

Gender Bias in Diagnosis, Prevention, and Treatment of Cardiovascular Diseases: A Systematic Review.

Cardiovascular disease (CVDs) has been perceived as a 'man's disease', and this impacted women's referral to CVD diagnosis and treatment. This study systematically reviewed the evidence regarding gender bias in the diagnosis, prevention, and treatment of CVDs.Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched CINAHL, PubMed, Medline, Web of Science, British Nursing Index, Scopus, and Google Scholar. The included studies were assessed for quality using risk bias tools. Data extracted from the included studies were exported into Statistical Product and Service Solutions (SPSS, v26;IBM SPSS Statistics for Windows, Armonk, NY), where descriptive statistics were applied.A total of 19 studies were analysed. CVDs were less reported among women who either showed milder symptoms than men or had their symptoms misdiagnosed as gastrointestinal or anxiety-related symptoms. Hence, women had their risk factors under-considered by physicians (especially by male physicians). Subsequently, women were offered fewer diagnostic tests, such as coronary angiography, ergometry, electrocardiogram (ECG), and cardiac enzymes, and were referred to less to cardiologists and/or hospitalisation. Furthermore, if hospitalised, women were less likely to receive a coronary intervention. Similarly, women were prescribed cardiovascular medicines than men, with the exception of antihypertensive and anti-anginal medicines. When it comes to the perception of CVD, women considered themselves at lower risk of CVDs than men.This systematic review showed that women were offered fewer diagnostic tests for CVDs and medicines than men and that in turn influenced their disease outcomes. This could be attributed to the inadequate knowledge regarding the differences in manifestations among both genders.

Behavioral Outcomes and Neurodevelopmental Disorders Among Children of Women With Epilepsy

The association of fetal exposure to antiseizure medications (ASMs) with outcomes in childhood are not well delineated. To examine the association of fetal ASM exposure with subsequent adaptive, behavioral or emotional, and neurodevelopmental disorder outcomes at 2, 3, and 4.5 years of age. The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational cohort study conducted at 20 epilepsy centers in the US. A total of 456 pregnant women with epilepsy or without epilepsy were enrolled from December 19, 2012, to January 13, 2016. Children of enrolled women were followed up with formal assessments at 2, 3, 4.5, and 6 years of age. Statistical analysis took place from August 2022 to May 2023. Exposures included mother's epilepsy status as well as mother's ASM blood concentration in the third trimester (for children of women with epilepsy). Women with epilepsy were enrolled regardless of ASM regimen. The primary outcome was the Adaptive Behavior Assessment System, Third Edition (ABAS-3) General Adaptive Composite (GAC) score among children at 4.5 years of age. Children of women with epilepsy and children of women without epilepsy were compared, and the associations of ASM exposures with outcomes among exposed children were assessed. Secondary outcomes involved similar analyses of other related measures. Primary analysis included 302 children of women with epilepsy (143 boys [47.4%]) and 84 children of women without epilepsy (45 boys [53.6%]). Overall adaptive functioning (ABAS-3 GAC score at 4.5 years) did not significantly differ between children of women with epilepsy and children of women without epilepsy (parameter estimate [PE], 0.4 [95% CI, -2.5 to 3.4]; P = .77). However, in adjusted analyses, a significant decrease in functioning was seen with increasing third-trimester maximum ASM blood concentrations (PE, -7.8 [95% CI, -12.6 to -3.1]; P = .001). This decrease in functioning was evident for levetiracetam (PE, -18.9 [95% CI, -26.8 to -10.9]; P < .001) and lamotrigine (PE, -12.0 [95% CI, -23.7 to -0.3]; P = .04), the ASMs with sample sizes large enough for analysis. Results were similar with third-trimester maximum daily dose. This study suggests that adaptive functioning of children of women with epilepsy taking commonly used ASMs did not significantly differ from that of children of women without epilepsy, but there was an exposure-dependent association of ASMs with functioning. Thus, psychiatric or psychological screening and referral of women with epilepsy and their offspring are recommended when appropriate. Additional research is needed to confirm these findings.

Factors associated with late gestational age of diagnosis and/or delayed referral of fetuses with major structural malformations: A study in a tertiary care hospital in South India.

To evaluate the factors related to delayed diagnosis or referral of women with major congenital malformations in a tertiary care hospital in South India, with a specific emphasis on the socioeconomic and psychosocial aspects. A retrospective analysis was conducted on 107 pregnant women with confirmed fetal anomalies at Jawaharlal Institute of Postgraduate Medical Education and Research. Both qualitative and quantitative data were collected on factors related to the patient, physician, and healthcare system that could have contributed to the delay. In our study of 107 patients, 98.1% had at least one antenatal check-up before 20weeks. Among them, 75.2% (79/107) were advised to undergo a mid-trimester anomaly scan, and 70.8% (56/79) actually underwent the scan. However, 62.5% (35/56) of those who had the scan performed at the appropriate time had undetected abnormalities. Retrospective analysis showed that 28.5% (10/35) of these anomalies could have been detected as early as 12-14weeks of gestation. Additionally, 24.3% (26/107) of women were advised to undergo scans at or after 20weeks and 4.7% (5/107) had anomalies detected during the scan but were unaware about the findings until subsequent visits. Inadequate healthcare professional training, busy schedules, lack of awareness, and communication gaps were identified as potential reasons for delayed diagnosis. Psychosocial factors such as denial, fear, emotional distress, and anxiety also influenced decision-making and contributed to delayed medical care. Addressing healthcare provider training, communication between the healthcare professionals and the patients, and psychosocial factors are essential to prevent delays and improve pregnancy management. Future interventions should focus on awareness, providing comprehensive information, and support for parents facing fetal anomalies.

The sex gap in bladder cancer survival - a missing link in bladder cancer care?

The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.

Maternal characteristics associated with referral to obstetrician-led care in low-risk pregnant women in the Netherlands: A retrospective cohort study.

In the Netherlands, maternity care is divided into midwife-led care (for low-risk women) and obstetrician-led care (for high-risk women). Referrals from midwife-led to obstetrician-led care have increased over the past decade. The majority of women are referred during their pregnancy or labour. Referrals are based on a continuous risk assessment of the health and characteristics of mother and child, yet referral for non-medical factors and characteristics remain unclear. This study investigated which maternal characteristics are associated with women's referral from midwife-led to obstetrician-led care. A retrospective cohort study in one midwife-led care practice in the Netherlands included 1096 low-risk women during January 2015-17. The primary outcomes were referral from midwife-led to obstetrician-led care in (1) the antepartum period and (2) the intrapartum period. In total, 11 maternal characteristics were identified. Logistic regression models of referral in each period were fitted and stratified by parity. In the antepartum period, referral among nulliparous women was associated with an older maternal age (aOR, 1.07; 95%CI, 1.05-1.09), being underweight (0.45; 0.31-0.64), overweight (2.29; 1.91-2.74), or obese (2.65; 2.06-3.42), a preconception period >1 year (1.34; 1.07-1.66), medium education level (0.76; 0.58-1.00), deprivation (1.87; 1.54-2.26), and sexual abuse (1.44; 1.14-1.82). Among multiparous women, a referral was associated with being underweight (0.40; 0.26-0.60), obese (1.61; 1.30-1.98), a preconception period >1 year (1.71; 1.27-2.28), employment (1.38; 1.19-1.61), deprivation (1.23; 1.03-1.46), highest education level (0.63; 0.51-0.80), psychological problems (1.24; 1.06-1.44), and one or multiple consultations with an obstetrician (0.68; 0.58-0.80 and 0.64; 0.54-0.76, respectively). In the intrapartum period, referral among nulliparous women was associated with an older maternal age (1.02; 1.00-1.05), being underweight (1.67; 1.15-2.42), a preconception period >1 year (0.42; 0.31-0.57), medium or high level of education (2.09; 1.49-2.91 or 1.56; 1.10-2.22, respectively), sexual abuse (0.46; 0.33-0.63), and multiple consultations with an obstetrician (1.49; 1.15-1.94). Among multiparous women, referral was associated with an older maternal age (1.02; 1.00-1.04), being overweight (0.65; 0.51-0.83), a preconception period >1 year (0.33; 0.17-0.65), non-Dutch ethnicity (1.98; 1.61-2.45), smoking (0.75; 0.57-0.97), sexual abuse (1.49; 1.09-2.02), and one or multiple consultations with an obstetrician (1.34; 1.06-1.70 and 2.09; 1.63-2.69, respectively). This exploratory study showed that several non-medical maternal characteristics of low-risk pregnant women are associated with referral from midwife-led to obstetrician-led care, and how these differ by parity and partum period.

Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry

BackgroundCardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations. ObjectivesIn this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD. MethodsSex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) Registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting. ResultsSPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality. ConclusionsStress CMR demonstrated excellent prognostic performance with lower rates of invasive coronary angiography referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891)

Abstract B077: Evaluation of social resource screening, and factors associated with needs and referral for resources in cancer care: The Resource EQuIP study

Abstract Objectives: Social resource needs are downstream, actionable modifiers of the social determinants of health. As such, they greatly contribute to the persistence of cancer health disparities. We sought to evaluate the prevalence of basic social needs and desire for referral in women presenting for Gynecologic Oncology care. Methods: We examined the data from a cohort of women presenting to an outpatient Gynecologic Oncology clinic from June 2021-May 2022 at an urban academic medical center where a social needs screening-and-referral protocol was implemented into routine care in the quality improvement “Resource EQuIP” study. We estimated the prevalence of social needs, as well as the type and urgency of those needs, and the proportion of individuals with needs who desired a referral to our community resource assistance partner. We examined these estimates by race and ethnicity using Fisher’s exact tests. We used multivariable Poisson regression to identify factors independently associated with having at least one social need. Results: Among 978 patients offered the screening questionnaire, 90% (n=877) completed it. Of those, the median age was 58 years (interquartile range: 47-67), and 62% were White, 26% Black, and 13% Other race. Five percent identified as Hispanic. Half of the patients (52%) had Private insurance, 10% Medicaid, 28% Medicare, and 10% had another type of insurance. Overall, 16% (n=142) had at least one social need (range 1-7 needs), which ranged from 28% among Black, 15% among Other race and 11% among White women (p&amp;lt;0.01); 28% of Hispanic compared to 15% of non-Hispanic patients had needs (p&amp;lt;0.01). Most common needs included financial (11%), transportation (5%), help reading hospital materials (3%), and food and housing insecurity (2%). Of those with needs, women of minority race more frequently reported their needs as urgent (20% Black and 29% Other vs. 7% White; p=0.02). More than half (59%) desired a referral to our community resource assistance partner, which also varied by race: 67% Black, 94% Other race, 40% White (p&amp;lt;0.01), and by ethnicity: 92% of Hispanic and 56% of non-Hispanic women (p=0.02). On multivariable analysis, Black women were twice as likely to have a need compared to White women (RR=1.9, 95% CI: 1.4-2.8), and Hispanic women were 2.3 times as likely compared to non-Hispanic women (95% CI: 1.3-4.1). Having Medicaid vs. private insurance was associated with 2 times the risk of having a need (95% CI:1.3-3.0), and being a current smoker (RR=1.6, 95% CI: 1.04-2.5) or unmarried were associated with an increased risk (RR=1.9, 95%CI 1.3-2.7). Conclusions: While social needs were reported by fewer than one in five women in this diverse clinical population, women of minority race/ethnicity more frequently had social needs, and were more likely to desire referral to resources. Thus, these women may be more likely to benefit from social needs screening-and-referral programs, which could help us achieve cancer health equity. Analysis of program associations with attendance for care and health outcomes is ongoing. Citation Format: Anne F. Rositch, Stephanie L. Wethington, Ruoxi Yu, Angel Nkwain, Kristin Topel, Anna L. Beavis. Evaluation of social resource screening, and factors associated with needs and referral for resources in cancer care: The Resource EQuIP study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B077.

Clinical trial of a birth and parenting planning program for women diagnosed with fetal anomalies: A feasibility study.

We assessed the feasibility of the Birth and Parenting Planning (BPPing) program we developed to support women diagnosed with fetal anomalies. We conducted a feasibility study using a quasi-experimental, post-test only, non-equivalent groups design. We assessed feasibility from four aspects: (1) Demand: birth plan submitting rate (primary outcome); (2) Acceptability: woman's satisfaction of care scale (SATISFACTION) and Visual Analog Scale for care satisfaction; (3) Preliminary efficacy: women's recognition of being able to express and share her hopes scale (HOPES); and (4) Safety: obstetric/neonatal outcomes and frequency of women's referral to a psychological counselor. Fisher's exact test and Mann-Whitney U-test were used for data analysis. We enrolled 62 women with fetal anomalies attending a perinatal medical center for antenatal check-ups. Of these, 51 women (median age: 34 years) received either the BPPing program (intervention group: n=25) or the usual care (control group: n=26). The birth plan submitting rates were 96% (intervention group, 24/25) and 7.7% (control group, 2/26). The intervention group had a significantly higher total score on HOPES at postpartum (U=441.5, p=0.027). Upon subgroup analysis based on parity, in the intervention group only, the multiparas had a higher score on the SATISFACTION item, "I would recommend the care I received to someone in a similar situation". There were no adverse events in either group. The BPPing program was feasible in supporting women diagnosed with fetal anomalies in terms of demand, acceptability, preliminary efficacy, and safety.

Evaluation of racial disparities in time to presentation, diagnosis, and gynecologic oncology referral in women with serous endometrial cancer (431)

<b>Objectives:</b> The frequency and mortality of endometrial cancer (EC) continue to increase in the United States; this is most striking for aggressive EC subtypes, such as serous tumors. Black women have higher rates of serous EC and lower survival rates compared to White women. We aimed to delineate racial differences in diagnosis and referral between Black and White women with serous EC treated at a quaternary academic medical center as contributing factors to this disparity. <b>Methods:</b> We extracted the following from the electronic medical record of women with confirmed serous EC seen at our center from 2001-2019: demographics, presenting symptoms including duration, details of evaluation and diagnosis, dates of initial visit with gynecologic oncology, and stage of cancer at presentation. We categorized the time from symptom onset to initial evaluation, from presentation to diagnosis, and from diagnosis to visit with gynecologic oncology. Chi-square tests were used to compare these times across racial categories. <b>Results:</b> Data from the medical records of 248 women were analyzed (106 Black women and 142 White women). The median age was 68 years. Presenting symptoms were similar between Black and White women, with abnormal bleeding being the most common (82.8% of Black women, 82.3% of White women, p=0.84). A trend toward presentation at a higher stage was identified for Black women (41.2% Black women with stage III and IV disease, 33.1% White women with stage III and IV disease; p=0.26). Black women had a longer duration of symptoms prior to presentation: 36.4% of Black women presented after >3 months (mos) of symptoms, while 18% of White women presented after >3mo of symptoms (p=0.01). Black women trended toward longer times to diagnosis after the presentation: 45.9% of Black women were diagnosed >3mos after the presentation compared to 33.3% of White women (p=0.14). The mode of diagnosis was similar between Black and White women, with endometrial biopsy being the most common (66% of Black women, 54% of White women, p=0.06). There was no significant difference among these groups in time to see a gynecologic oncologist after a diagnosis was made: 94% of Black women were seen within one mo as compared to 92% of White women (p=0.38). <b>Conclusions:</b> We identified racial disparities in the presentation and diagnosis of serous EC, including a longer duration of symptoms prior to presentation for Black compared to White women. Statistical significance was not reached with regard to the difference in time to diagnosis after the presentation, but a trend was identified in this duration being longer for Black versus White women. No differences were noted in time to referral to gynecologic oncology after diagnosis between Black and White women. Future work should focus on outreach strategies to ensure timely workup for the signs and symptoms of EC among Black women.

Understanding the dynamics of support seeking in women with lived experience of non‐physical intimate partner violence (IPV) and the service responses—A qualitative study

AbstractNon‐physical abuse is a form of intimate partner violence (IPV), which negatively impacts physical and mental well‐being. The study objectives were to understand the process of support seeking amongst women who experience non‐physical IPV. Interviews were conducted with women who have experience of non‐physical IPV and support workers. The findings of this study suggest that women generally delay support seeking for non‐physical IPV as they are unable to recognise this form of violence. Increasing awareness about non‐physical IPV can be a prevention strategy to assist women in recognising this and seeking support. The important finding in our study that most of the women initially contacted a healthcare professional regarding the psychological impact of the non‐physical violence offers an opportunity for earlier intervention. Healthcare professionals are in a unique position to address the healthcare needs of women who experience IPV and can therefore assist in facilitating disclosure, offering support and referring to DV services. Training and education for professionals on all forms of IPV is required to improve identification and referral of women.

1055-P: Low Rate of Preconception Counseling and Near Absence of Contraception Provision by Endocrinologists for Women with Diabetes

Preconception counseling for reproductive-age women with type 1 and type 2 DM improves maternal-fetal outcomes. Endocrinologists are in a unique position to provide such important counseling and contraception or applicable referrals. In response to an increasing number of women referred to our prenatal clinic with poor glycemic control and unplanned pregnancies, we instituted a quality improvement initiative to improve preconception care at our academic center. We conducted a chart review of 96 women of reproductive age with at least one in-person visit for DM from July 2020-Oct 2021. Patients who were pregnant or had undergone sterilization were excluded. Fifty patients (mean age 34.5+/-6.7 yrs) met inclusion criteria. Of these, 66% had T1DM, 32% had T2DM and 26% had a HgbA1c ≤6.5%, recommended for pregnancy. Each woman had a mean of 2.1+/-1.2 visits with an endocrinology provider during these 15 mos. Only 4% had contraception specifically documented during a visit, although medical staff or other providers had documented contraception use in 56% of cases. No women received a contraception prescription. Endocrinologists did not document provision of preconception counseling to any of these women, although 14% had previously undergone counseling with a maternal fetal medicine provider. No women were referred to an OB-Gyn provider. Our data suggest that endocrinology providers infrequently provide preconception or contraception counseling or referrals for women with diabetes and underscores the striking need for a QI initiative. To this end, we are implementing a multifaceted intervention to educate providers on key aspects of preconception counseling and contraception provision, facilitate specialist referrals, simplify documentation, and provide patient education materials. We will assess the efficacy of our intervention with the ultimate goal of improving outcomes for this rapidly growing population of women with diabetes and their offspring. Disclosure R.Jeffers: None. L.Sayres: None. L.Abushamat: None. C.Nielsen: None. A.Zaman: None. L.A.Barbour: None.

Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study

BackgroundSouth Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town.MethodsThree antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients’ homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions.ResultsHealthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women’s attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components.ConclusionsThe acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day.

Narratives from Casa Tina Martins' Women's referral center: Aesthetics of existence in the struggle against gender violence

AbstractThis study intends to evidence narratives of the political experience of the Casa Tina Martins Women's Referral Center, to understand how the women of the group constitute and organize themselves against gender violence. This was done from the articulation between the esthetics of existence proposed by Foucault (2014) and the work of feminist authors such as Margareth Rago (2013) and others, in which the problematization of experiences that allow the subject to rethink the world can be seen as a way of understanding social oppression without reducing the subject to the role of inert victim, but showing how they are always invested by power in their ways of existing and resisting. Initially, an immersion in the Center was carried out from the perspective of Feminist Participatory Action Research (Ponic et al., 2010). Then, reports were collected to build narratives of participants. The field research showed that the participation and engagement in a social movement stem from the individual process of struggle with the various forms of subjection and violence in the life trajectory of each woman. Moreover, the Center could be understood as a core of teachings to all types of organizations since it is a remarkable experience that overlaps its political goal with its feminist ways of organizing as a “meta‐organizational” phenomenon. Finally, it was possible to consider Casa Tina Martins as an enabling space to question gender‐based violence and promote personal narratives by feminist women as political possibilities of resistance and social change.

Jewish Bathhouse Attendants as Key Figures for the Identification and Referral of Women in Distress: Contributors to Role Perception

Social workers often rely on non-professional community figures to identify and refer at-risk populations. One such figure is the Jewish “balanit” (plural: balaniyot), who assists women at the mikveh, a religious bathhouse for monthly purification. Mental health symptoms can come to light in this unique situation. This quantitative study drew on the feminist perspective and concept of the “moral third” to explore factors contributing to balaniyot's role perception regarding distressed women. Israeli balaniyot ( N = 166) completed self-report questionnaires assessing the role perception of aiding distressed women, and independent variables relating to commitment and connectedness to the victims (organizational commitment, years of experience, workdays), and acknowledgment of suffering (knowledge of distress situations, beliefs about violence toward women). Hierarchical regression showed that more weekly workdays, higher community belonging, and greater knowledge of distress situations contributed to role perception. Moreover, among participants with low community belonging, organizational commitment was associated with lower role perception. The findings suggest that organizational commitment may conflict with community belonging, requiring balaniyot to choose between them. The study indicates the need for specialized training to increase balaniyot's knowledge of distress situations and ensure that their organizational commitment is not strengthened at the expense of their crucial capability to aid distressed women.

Study Factors Involved in Maternal Deaths Attributed to COVID-19 in a Disadvantaged Area in Southeast of Iran.

Objective: It is a fact that coronavirus disease of 2019 (COVID-19) infection mortality rate is high, but the question is "what is the role of other factors in maternal death with COVID-19?" The present study aimed to understand the factors that prevent women from timely use of healthcare services and also the potential weaknesses of the healthcare system that cause the lack of quality healthcare services for women. Materials and methods: This case-series study was performed in the southeast of Iran. In total, 12 cases of maternal deaths attributed to COVID-19 were identified through the Iranian Maternal Mortality Surveillance System. The required information was collected through existing verbal autopsy data sets. In some cases, the family members had to be re-contacted and healthcare workers were asked to supply the missing information. The root cause analysis method was employed for data analysis. Results: From March 2020 to March 2021, the deaths of 12 women were attributed to COVID-19. The majority of these women lived in rural areas (58%) and had a secondary school education level or less (83.3%). The contributing factors were divided into three categories: barriers at the community level (no prenatal care, lack of trust, lack of recognition of the severity of disease, and attribution of symptoms to something else), at the primary health system level, and at the hospital level (fear of staff of being infected, non-compliance with guidelines, lack of team working, and problem with telehealth). Conclusion: The socio-cultural context and unmet healthcare needs hinder the utilization of available services. Moreover, factors at the level of the healthcare system prevent the timely detection and referral of women with COVID-19 to receive quality healthcare services. Using telehealth also did not help to appropriately triage pregnant women.

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

BackgroundPreeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed. AimThis study focuses on the midwife’s role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines. Method/designThis study was a qualitative document analysis of national and tertiary hospital policies related to midwives’ scope of practice in Ghana. Altheide’s five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents. ResultsThe findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia. ConclusionUniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives’ roles, and optimise maternal and fetal outcomes.

Self-Medication Among Pregnant Women: Prevalence and Associated Factors.

Objectives: The pregnancy period, with its peculiarities and specific symptoms that may or may not be physiological, can lead to medication use through prescription or even self-medication. This study aimed to assess self-medication practices among pregnant women, the most used medications, symptoms reported, and factors associated with this practice. Methods: This was a cross-sectional study conducted with pregnant women with an antenatal care (ANC) appointment in a tertiary teaching hospital referral in women’s health. From April 2019 to February 2020, 297 pregnant women were interviewed. Self-medication was considered as the use of any medicine (including medicinal plants (MPs), herbal products, and vitamins) without a medical or dental prescription. The period considered to assess self-medication practice was the last 60 days prior to the study interview. Results: Among the 297 women interviewed, 107 (36.0%) had practiced self-medication in the previous 60 days. Acetaminophen was the most used medication, and headache was the most frequent symptom reported by self-medicated pregnant women. Pregnant women with high-school (73 (68.2%) (OR = 2.52; 95% CI 1.17–5.43; p = 0.018)) or university-level (23 (21.5%) (OR = 2.82; 95% CI 1.15–6.94; p = 0.024)) education had a higher risk of practicing self-medication when compared to women with lower education. Women in the first gestational trimester (35 (32.7%) (OR = 3.61; 95% CI 1.64–7.96; p = 0.002)) and with two or more pregnancies (87 (81.2%) (OR = 1.96; 95% CI 1.07–3.60; p = 0.029)) were more likely to practice self-medication than pregnant women in the second or third gestational trimester and in the first pregnancy, respectively. Conclusion: Self-medication was practiced by a considerable proportion of our sample, with the majority being OTC drugs. The factors associated with self-medication can help to improve prevention strategies regarding self-medication during pregnancy.

Abstract 11141: Closing the Gap: Evaluating Gender Differences in TAVR Outcomes

Introduction: There are well documented differences in TAVR outcomes among men and women from pre-procedure to 30-days post procedure. However, there is less data comparing the long-term differences in outcomes between genders. This study investigated cardiovascular outcomes between these two groups within 6 months of undergoing a TAVR. Methods: We performed a retrospective study among patients undergoing TAVR between March 2018 and June 2020 at the University of Illinois-Chicago (UIC) in Chicago, Illinois. Primary outcomes included composite MACE (CV death, MI and/or CVA) and all-cause death. Secondary outcomes included change in peak gradient, mean gradient, aortic valve area, and ejection fraction. Outcomes were analyzed at 6 months following the procedure. T and Chi square tests were used to analyze continuous/categorical variables, respectively. Results: There was a total of 115 patients (female: 25, male: 90) in the analysis. The female cohort was older and had a higher BMI. At baseline, the women had a higher peak gradient when compared to the men (64 vs 48mmHg, p=0.03). At 6 months, MACE (female=1.7 vs male=7%, p=0.9) and all cause death (4 vs 4.4%, p=0.9) were statistically similar. There was no significant difference in the change in ejection fraction or aortic valve area between men and women. There was no difference between peak aortic valve gradient or mean aortic valve gradient (p&gt;0.05) between the groups immediately after the procedure or at 6 months following TAVR. Conclusion: Despite having higher baseline aortic valve gradients, women appeared to have similar procedural success and 6-month outcomes following TAVR as compared to men in this analysis. Women presenting with higher baseline gradients suggest that they may be under-diagnosed or misdiagnosed leading to delays in care. Further screening and earlier referral for women is important to maintaining good outcomes.

O-176 Secondary ovarian insufficiency (SOI) - a new infertility diagnosis

Abstract Study question Can, in contrast to primary ovarian insufficiency (POI), ovarian insufficiency also be caused as a secondary event (SOI)? Summary answer Adrenal hypo-androgenism, caused by insufficiency in androgen production by the zona reticularis, may mimic POI in clinical presentation. What is known already A variety of small and large animal models have, especially at small growing follicle stages, conclusively demonstrated the dependence of normal follicle maturation on adequate testosterone levels, a process mediated via the androgen receptor on granulosa cells. Increasing clinical evidence, moreover, has demonstrated clinical improvements in oocyte numbers and oocyte quality following androgen supplementation at these stages in hypo-androgenic women with premature ovarian aging (POA). Whether adrenal hypo-androgenism in extreme cases can, however, also lead to complete ovarian insufficiency mimicking POI, is unknown. Study design, size, duration Based on FSH levels &amp;gt;40.0 mIU/mL and amenorrhea, we searched our center’s electronic research data bank for patients who between 2016-2018 presented with a diagnosis of presumed POI. Participants/materials, setting, methods Among 78 POIs, 13 demonstrated low DHEAS (&amp;lt; 100 ug/dL), i.e., adrenal hypo-androgenism, 6 rejected egg donation and received DHEA (Fertinatal®, 25mg TID, Fertility Nutraceuticals, LLC, New York, N.Y., USA) and Coq10 (Ovoenergen®, 333mg TID,same ­manufacturer) before stimulation with 450IU FSH and 150 IU hMG (different ­manufacturers). All women were &amp;lt; age 41, demonstrated menopausal FSH (&amp;gt;40.0 mIU/mL), undetectable AMH, amenorrhea, &amp;gt; prior cycle cancellation, elevated SHBG, low total testosterone and low DHEAS (high DHEA/DHEAS). Main results and the role of chance Out of the 6 patients so stimulated, 5 demonstrated follicular responses following DHEA supplementation and 2/6 conceived spontaneously and delivered healthy offspring. One of these two is currently in treatment for another child. Limitations, reasons for caution To better understand adrenal control of ovaries via androgen production, further elucidation of endocrine signaling between adrenals and ovaries is required, including detection of unknown, though increasingly likely, feedback loops, considering that adrenals and ovaries share a primordium. Wider implications of the findings We confirmed existence of SOI due to adrenal hypoandrogenism, defined its phenotype, demonstrating that some patients with alleged POI actually exhibit SOI. Better pregnancy chances with adrenal SOI than POI, reemphasize the importance of correct differential diagnoses to avoid premature referrals of women into third-party egg donations Trial registration number N/A

P–407 Early pregnancy in the Emergency Department; presentation, management, outcome and the effect of COVID–19

Study questionHas the COVID–19 pandemic and public health guidance impacted referrals, outcome and management of early pregnancy in the emergency room?Summary answerCOVID–19 changed the way in which women sought guidance and accessed services in early pregnancy.What is known alreadySpontaneous miscarriage is the most common complication of pregnancy1. Experiencing an early pregnancy loss is often an unexpected and difficult time that can be physically traumatising2. A previous study looking at the experience of a miscarriage from both the female and male point of view identified that long waiting times surrounded by other pregnant women in the Emergency Department (ED) was particularly difficult part of the experience2. The COVID–19 pandemic had a significant impact on both hospital and community services. Public health advice also changed the way women accessed healthcare.Study design, size, durationRetrospective audit was performed over two six-month periods – July to December 2019 and March to August 2020. Two groups of data were collected; women who contacted the ED with concerns related to early pregnancy (under thirteen weeks gestation) and those who attended the ED with the same complaints. Information was cross referenced to see how many women contacted the ED prior to arrival and what, if any advice was given.Participants/materials, setting, methodsAll women under thirteen weeks gestation with a complaint of bleeding per vaginum (PV) or pain related to early pregnancy who presented to the ED in a large tertiary maternity unit were included in the audit. All women meeting the same criteria who contacted the ED by telephone were also included.Main results and the role of chanceOver the twelve months of data collection, 1274 women had their first visit to the ED. There were 270 further visits within the early pregnancy period recorded for the same cohort of women. Additionally, 1452 phone calls were recorded. There was a 38% (n = 293) decrease in women attending the emergency room in early pregnancy in 2020 during the first wave of COVID–19. There was a 16% (n = 110) increase in women contacting the ED for advice in early pregnancy in the same period in 2020. Women were more like likely to have been referred to the ED by their General Practitioner (GP) (OR 0.62, 95%CI 0.48–0.80) and to have phoned in advance of arrival (OR 1.55, 95%CI 1.17–2.04) in 2020. They were also more likely to have already had a previous ultrasound scan in the current pregnancy (OR 0.64, 95%CI 0.48–0.93). There was a significantly shorter waiting time for an appointment in the early pregnancy clinic in 2020 compared with 2019 (3.5 days versus 2.4 days, p = 0.002). There was no change in the number of women admitted (OR 1.19, 95%CI 0.81–1.74).Limitations, reasons for cautionSingle centre audit. Pregnancies only followed to booking visit/dating scan and outcome noted at that stage.Wider implications of the findings: The COVID–19 pandemic highlighted the need for more education around early pregnancy. Easily accessible information about local early pregnancy services gives women autonomy. Phone triage allowing referral of women to appropriate services, reduces ED visits. Standard training in early pregnancy ultrasound could reduce follow up referrals and admission rates.Trial registration numberNot applicable