Representative Sample Of Women Research Articles

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study.

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women. From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI. Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73. Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

Fluoride-related changes in the fetal cord blood proteome; a pilot study

BackgroundFluoride exposure during pregnancy has been associated with various effects on offspring, including changes in behavior and IQ. To provide clues to possible mechanisms by which fluoride may affect human fetal development, we completed proteomic analyses of cord blood serum collected from second-trimester pregnant women residing in northern California, USA.ObjectiveTo identify changes in cord blood proteins associated with maternal serum fluoride concentration in pregnant women.MethodsThe proteomes of 19 archived second-trimester cord blood samples from women living in northern California, USA, and having varied serum fluoride concentrations, were analyzed by quantitative mass spectrometry. The 327 proteins that were quantified were characterized by their abundance relative to maternal serum fluoride concentration, and subjected to pathway analyses using PANTHER and Ingenuity Pathway Analysis processes.ResultsPathway analyses showed significant increases in process related to reactive oxygen species and cellular oxidant detoxification, associated with increasing maternal serum fluoride concentrations. Pathways showing significant decreases included complement cascade, suggesting alterations in alterations in process associated with inflammation.ConclusionMaternal fluoride exposure, as measured by serum fluoride concentrations in a small, but representative sample of women from northern California, USA, showed significant changes in the second trimester cord blood proteome relative to maternal serum fluoride concentration.

Population-based study of eclampsia: Lessons learnt to improve maternity care.

Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012-2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0-4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.

Non-use and inadequate use of cervical cancer screening among a representative sample of women in the United States.

Women's adherence to the United States (U.S.) Preventive Services Task Force guidelines for cervical cancer screening was determined by examining predisposing, enabling, and needs factors from Andersen's Behavioral Model of Health Services Use conceptual framework. The outcome was operationalized as cervical cancer screening use, non-use, and inadequate-use. Multinomial logistic regression was conducted on data from the 2019 National Health Interview Survey of 7,331 eligible women aged 21-65. Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Non-Users than those aged 21-29. Hispanic, Asian, and American Indian/Alaska Native (AIAN) women were more likely to be Non-Users than White women. More educated women were less likely to be Non-Users. Foreign-born women <10 years in the U.S. were more likely to be Non-Users than U.S.-born women. Women with financial hardship were less likely to be Non-Users. Poorer women and uninsured women were more likely to be Non-Users. Women with children in their household were less likely to be Non-Users than those without children. Women who had a well-visit in the past year were less likely to be Non-Users. Women with a history of human papillomavirus (HPV) vaccination were less likely to be Non-Users. Compared with women who used cervical cancer screening services, women aged 30-65 were less likely to be Inadequate-Users. AIAN women were more likely to be Inadequate-Users. Women of other races were less likely to be Inadequate-Users. Employed women were less likely to be Inadequate-Users. Uninsured women were more likely to be Inadequate-Users. Women who had a well-visit within a year were less likely to be Inadequate-Users. Women with past HPV vaccination were more likely to be Inadequate-Users. Smokers were less likely to be Inadequate-Users. Predisposing, enabling, and needs factors are differently associated with non-use and inadequate use of cervical cancer screening. Understanding factors associated with the use, non-use, and inadequate use of cervical cancer screening is crucial to avoid or curb unnecessary tests, increased costs to both society and individuals, and the ill-allocation of limited resources.

Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries

ObjectiveTo measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DesignA cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SettingThirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. ParticipantsA total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FindingsThe overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and “avoid pain in labour” was the most common perceived benefit of caesarean section. Key conclusionsOur results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. Clinical trial registryThe QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

Evaluación de los indicadores de control de Tabaco el MPOWER de la Organización Mundial de la Salud desde una perspectiva de género en Antioquia, Colombia.

Objective: To examine women’s perceptions of the implementation and enforcement of the Colombian national tobacco legislation in Antioquia, Colombia, through the lens of the MPOWER indicators, which is the World Health Organization Framework Convention on Tobacco Control guide.Methods: This was a cross-sectional study with a representative sample of women over 18 years of age in the nine subregions of Antioquia, using a multi-stage probabilistic sampling. Results: Out of 4,383 women who participated in the study, only 35% were aware of Law 1335, with awareness being the highest among white and married participants with college degrees, who have private health insurance, or residents in middle and high socioeconomic status. The degree of implementation varied across subregions, and participants percei-ved that monitoring tobacco consumption (M) and protecting the population from tobac-co smoke (P) have high levels of implementation in Antioquia, while warnings about the dangers of tobacco use (W) and enforcing the prohibitions on advertising, promotion, and sponsorship (E) are weak. In terms of offering help for quitting (O), only 8.5% of smokers or former smokers ever sought assistance from health professionals to quit smoking and, among those, only 2% received treatment covered by their health insurance plan. Conclusions: Even though tobacco control legislation is established at the national level, its enforcement relies heavily on local strategies. In Antioquia, efforts should be placed on educational strategies regarding warnings of the harms associated with tobacco use, enfor-cement of advertising and promotion of tobacco products, and provision of evidence-based tobacco cessation treatments.

Intimate partner violence experienced by women living with-and without-disability in the European Union. A quantitative intersectional analysis.

This article aims to explore the specific combination and interactions of inequalities associated with experiencing Intimate Partner Violence that affects European women living with—or without—a disability. The analysis is based on the survey carried out by the European Union Agency for Fundamental Rights (FRA) between 2010 and 2012. In that survey, 42,002 women were interviewed, with a representative sample of women from each of the 28 countries of the European Union. We try to elucidate through a multiple logistic regression analysis if the experience of IPV is something that can simply be added to—or overlap with—social categories (feeling of household income, educational level, and marital status), the aggressor (partner abusing alcohol, partner violent against others), the relationship (duration, equal say in economic decisions), and the previous experience of IPV. The result of the analysis shows that living with a disability intersects with low income, which comes hand in hand with experiencing more violence. Other interactions like living with a disability when the woman is under 15 years and living with a disability and the partner abusing alcohol are also relevant. In terms of social policies, our result should induce investment in IPV prevention policies among poor women who live with a disability, who have a history of physical violence, and whose partners abuse alcohol.

Associations between depressive symptoms, socio-economic factors, traumatic exposure and recent intimate partner violence experiences among women in Zimbabwe: a cross-sectional study

BackgroundPopulation-based research on the cumulative effects of socio-economic conditions and trauma exposures, particularly women’s experiences of intimate partner violence (IPV) on their mental health in Zimbabwe, has been limited.AimOur study aimed to determine the associations between depressive symptoms and socio-economic factors, IPV, and traumatic exposures among a nationally representative sample of women from Zimbabwe.MethodsData was collected from 2905 women who volunteered to participate in a survey that had a multi-stage random sampling design. Depression was measured using the Centre for Epidemiologic Studies Depression Scale (CESD). Traumatic exposures included childhood trauma, life events, and experiences of IPV in the past year. We compared mean depression scores for different categories of variables, conducted linear regression modelling to investigate the bivariate and multivariate associations between variables and depressive symptoms’ outcomes, and applied Structural Equation Modelling (SEM) to investigate the inter-relationships between variables and depressive symptoms’ outcomes.ResultsFifteen percent of women self-reported depressive symptoms (CESD score ≥ 21). Higher depressive symptomatology was associated with lower socio-economic status, experiencing IPV, history of childhood and other traumatic events, experiencing non-partner rape, and HIV positive status. Women who could find money in an emergency and sought informal or professional emotional support were less at risk of severe depressive symptoms. Conversely, seeking informal and formal social support was positively associated with more severe depressive symptoms.ConclusionThis study contributes evidence showing that economic hardship, exposure to traumas including IPV, living with HIV, and low social support have a cumulative negative toll on mental health among Zimbabwean women from the general population. Programmes and services that respond to the mental ill-health effects reported by Zimbabwean women and prevention interventions that tackle the multiple risk factors for depression that we have identified must be prioritised.

A cluster randomized trial of delivery of intermittent preventive treatment of malaria in pregnancy at the community level in Malawi

BackgroundMalaria in pregnancy doubles the risk of low birthweight; up to 11% of all neonatal deaths in sub-Saharan Africa are associated with malaria in pregnancy. To prevent these and other adverse health consequences, the World Health Organization recommends administering intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine–pyrimethamine for all pregnant women at each antenatal care (ANC) visit, starting as early as possible in the second trimester. The target is for countries to administer a minimum of three doses (IPTp3+) to at least 85% of pregnant women.MethodsA cluster randomized, controlled trial was conducted to assess the effect of delivery of IPTp by community health workers on the coverage of IPTp3 + and ANC visits in Malawi. Community delivery of IPTp was implemented within two districts in Malawi over a 21-month period, from November 2018 to July 2020. In control sites, IPTp was delivered at health facilities. Representative samples of women who delivered in the prior 12 months were surveyed at baseline (n = 370, December 2017) and endline (n = 687, August 2020). A difference in differences analysis was conducted to assess the change in coverage of IPTp and ANC over time, accounting for clustering at the health facility level.ResultsOverall IPTp coverage increased over the study period. At baseline, women received a mean of 2.3 IPTp doses (range 0–5 doses) across both arms, and at endline, women received a mean of 2.8 doses (range 0–9 doses). Despite overall increases, the change in IPTp3 + coverage was not significantly different between intervention and control groups (6.9%, 95% CI: -5.9%, 19.6%). ANC4 + coverage increased significantly in the intervention group compared with the control group, with a difference-in-differences of 25.3% points (95% CI: 1.3%, 49.3%).ConclusionsIn order to reduce the burden of malaria in pregnancy, new strategies are needed to improve uptake of effective interventions such as IPTp. While community health workers’ delivery of IPTp did not increase uptake in this study, they may be effective in other settings or circumstances. Further research can help identify the health systems characteristics that are conducive to community delivery of IPTp and the operational requirements for effective implementation.Trial registration: ClinicalTrials.gov Identifier: NCT03376217. Registered December 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03376217.

Overweight and Obesity Associates With Diet Quality in Mothers of Newborn Babies

ObjectivesThe aim of this study was to investigate whether diet quality differs in women with normal weight (nw) and overweight or obesity (ow/ob) one month after delivery.MethodsData was collected with online questionnaires from early pregnancy until one month postpartum from a representative sample of women across Finland. Postpartum data (mean of 6.8 ± 1.9 weeks after delivery) was used in this study. Diet quality was measured with validated index of diet quality (IDQ, total score 0–15, scores ≥ 10 indicate good diet quality). In addition, IDQ components were evaluated by comparing to Finnish dietary recommendations. Ow/ob status was determined based on pre-pregnancy body mass index (BMI, ≥25 kg/m2) calculated from self-reported weight and height.ResultsOf the women, 96% (331/346) were breastfeeding and 32% had ow/ob. Good diet quality was observed in 49% of the women. The IDQ scores were lower in ow/ob women compared to nw women (8.9 ± 2.3 and 9.6 ± 2.1 respectively, p = 0.006). Considering the IDQ components, the proportion of ow/ob women consuming vegetables, fruit and berries ≥ 5 servings/day was lower than that of nw women (28% and 40% respectively, p = 0.041). Moreover, ow/ob women were less likely to consume fruit and berries (41% and 62% respectively, P < 0.001) and whole grain products daily compared to nw women (63% and 76% respectively, p = 0.015). No differences in the consumption of vegetables daily, fish ≥ 2 servings/week and vegetable-oil based spread on bread as well as having a regular meal pattern (skipping ≤ 2 main meals/week) were seen between nw and ow/ob women.ConclusionsOnly half of the women had good diet quality in this population of mainly breastfeeding women. The diet quality score of ow/ob women was lower and they consumed health-promoting foods less likely compared to nw women. Health-promoting diet of breastfeeding women is of vast importance considering impacts on breast milk composition as well as prevention of chronic lifestyle-related conditions including type 2 diabetes.Funding SourcesThis material is based upon work supported by Business Finland. Personal support for EK from the Diabetes Research Foundation, the Finnish Cultural Foundation (Varsinais-Suomi Regional Fund), the Jalmari and Rauha Ahokas Foundation and the Juho Vainio Foundation.

The Prevalence and Patterns of Menopausal Symptoms in Women Living with HIV

Increasing numbers of women with HIV are experiencing menopause. We use data from a large, representative sample of women with HIV to describe the prevalence and clustering of menopausal symptoms amongst pre-, peri- and post-menopausal women using hierarchical agglomerative cluster analysis. Of the 709 women included, 21.6%, 44.9% and 33.6% were pre-, peri- and post-menopausal, respectively. Joint pain (66.4%) was the most commonly reported symptom, followed by hot flashes (63.0%), exhaustion (61.6%) and sleep problems (61.4%). All symptoms were reported more commonly by peri- and post-menopausal women compared to pre-menopausal women. Psychological symptoms and sleep problems clustered together at all menopausal stages. Somatic and urogenital symptom clusters emerged more distinctly at peri- and post-menopause. We recommend regular and proactive assessment of menopausal symptoms in midlife women with HIV, with an awareness of how particular patterns of symptoms may evolve over the menopausal transition.

Age-Related Differences in Body Fatness and Nutritional Status in Large Sample of Serbian Women 20–70 Years of Age

Obesity due to increased body fatness has been recognized internationally as one of the leading factors affecting individual and public health. The aim of this study was to determine age-related differences in body fatness in a representative sample of women in Serbia. The study included 1937 Serbian females aged 20 to 69.9 years from all regions of the Republic of Serbia. The obesity and body fatness were analyzed using body mass index (BMI), body fat mass (BFM), percent of body fat (PBF), body fat mass index (BFMI), and visceral fat area (VFA). Multivariate analysis of variance with post hoc pairwise comparisons revealed the largest differences between the age categories in VFA followed by BFMI, PBF, and BMI. The prevalence of overweight, obese, and extremely obese subjects in the overall sample by BMI was 30.77, 1.32, and 1.40%, respectively. The prevalence was higher when calculated by PBF, with 37.84 and 20.11% for overweight and obese subjects. The prevalence of overweight and obesity, as calculated by BMI and PBF, was higher in older age groups of Serbian women. The prevalence of overweight women in the oldest group was 4.32 times higher, while the rate of obesity was 8.67 times higher than in the youngest group. Our results are a good basis for planning and implementing preventive health activities and monitoring changes in morphological parameters in Serbian women of different ages.

Latent profile analysis of stress and resilience among rural women: A cross-sectional study.

The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience. A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n=354). Data were collected to measure perceived stress, social support, chronic stress, and resilience. A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales. The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations.

Loneliness and Depression among Women in Poland during the COVID-19 Pandemic.

Background: The COVID-19 pandemic has forced many changes in the functioning of people all over the world in a short period of time. According to a WHO report (2020), it is women who are at a particular risk of the negative effects of the pandemic, especially in terms of mental health. Aim of study: The aim of the study was to assess the prevalence of anxiety, depression, irritability, and loneliness among adult women during the COVID-19 pandemic. Materials and methods: The study was conducted on a representative sample of women in Poland (n = 452). The data were collected using the HADS-M scale and the R-UCLA scale. Results: A low level of loneliness was found in 37.3% of the women, moderate in 38.9%, moderately high in 22.3% and very high in 1.3% of women. Self-rating of physical and mental health was significantly positively correlated with anxiety, depression, and irritability in HADS-M, and loneliness in R-UCLA. As the severity of loneliness increased, so did Hospital Anxiety and Depression Scale scores on all subscales (p < 0.001). Conclusions: The study group presented with mental well-being disorders in the form of anxiety and depression. Two in three women experienced loneliness.

How do Gender Norms and Childcare Costs Affect Maternal Employment Across US States?

In this article, we investigate how state-to-state differences in U.S. childcare costs and gender norms are associated with maternal employment. Although an abundance of research has examined factors that influence mothers’ employment, few studies explore the interrelationship between maternal employment and culture, policy, and individual resources across U.S. states. Using a representative sample of women in the 2017 American Community Survey along with state-level measures of childcare costs and gender norms, we examine the relationship between these state conditions and mothers’ probability of employment. We pay careful attention to differences in mothers’ level of education. Our results suggest that expensive childcare is associated with lower maternal employment, particularly for those with less education. For the college educated, expensive childcare is negatively associated with maternal employment in states with traditional gender norms that uphold mothers as primary caregivers. Among mothers with lower levels of education, gender norms have a limited association with employment. These findings suggest that highly educated mothers mobilize resources to remain in the labor force when paid work is supported by local gender norms. For less-educated mothers, expensive childcare predicts lower employment regardless of gender norms, indicating that structural constraints outweigh normative expectations among those with fewer resources.

The epidemiological landscape of anemia in women of reproductive age in sub-Saharan Africa

The role of geographical disparities of health-related risk factors with anemia are poorly documented for women of reproductive age in sub-Saharan Africa (SSA). We aimed to determine the contribution of potential factors and to identify areas at higher risk of anemia for women in reproductive age in SSA. Our study population comprised 27 nationally representative samples of women of reproductive age (15–49) who were enrolled in the Demographic and Health Surveys and conducted between 2010 and 2019 in SSA. Overall, we found a positive association between being anemic and the ecological exposure to malaria incidence [adjusted odds ratio (AOR) = 1.02, 95% confidence interval (CI) 1.02–1.02], and HIV prevalence (AOR = 1.01, CI 1.01–1.02). Women currently pregnant or under deworming medication for the last birth had 31% (AOR = 1.31, CI 1.24–1.39) and 5% (AOR = 1.05, CI 1.01–1.10) higher odds of having anemia, respectively. Similarly, women age 25–34 years old with low education, low income and living in urban settings had higher odds of having anemia. In addition, underweight women had 23% higher odds of suffering anemia (AOR = 1.23, CI 1.15–1.31). Females with low levels of education and wealth index were consistently associated with anemia across SSA. Spatial distribution shows increased risk of anemia in Central and Western Africa. Knowledge about the contribution of known major drivers and the spatial distribution of anemia risk can mitigate operational constraints and help to design geographically targeted intervention programs in SSA.

Preventable multiple high-risk birth behaviour and infant survival in Nigeria

BackgroundGlobally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria.MethodsThis cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child’s birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05).ResultsThe mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33–2.06) compared to their counterparts with no HrBBs.ConclusionMultiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.

Women's childbirth experiences: A content analysis from the Listening to Mothers in California survey.

The World Health Organization's recent recommendations on intrapartum care regard women's experience of care as an essential aspect of high-quality maternity care. A better understanding of women's perspectives on their childbirth experiences in the United States is needed to place women in the center of care and optimize their experience of childbirth. This study analyzed data from the Listening to Mothers in California survey completed by a representative sample of women who gave birth in 2016 in California hospitals. Responses to one or both open-ended questions about the best and worst part of respondent's hospital stay for childbirth were subject to a content analysis. Findings from 2539 participants included 2336 best and 1410 worst part responses. References to the attitudes and behaviors of health care practitioners were the most commonly reported (47% best and 29.1% worst part). Nurses were the most frequently mentioned practitioner type. Additional best part categories in rank order included the quality of physical care of the mom and feelings about the care experience. Additional worst part categories in rank order included the quality of the facility and food, delays in care, infant feeding, the quality of physical care of the mom, and lack of privacy. Women's hospital experiences during childbirth, while multidimensional in nature, are primarily shaped by their relationships with health care practitioners, the care provided, and the facility in which childbirth occurs. Women's feedback provides actionable information to promote a positive birth experience.

Developing and Testing an Instrument to Measure the Factors Affecting the Salt Restriction Behaviors among Women

Background: High salt intake is considered as one of the most important causes of hypertension and cardiovascular diseases. Measuring and identifying factors contributing to people's salt intake behaviors is important to evaluate effectiveness of interventions focusing on salt reduction behaviors. The purpose of this study was to develop and test a new theory of planned behavior (TPB)- based instrument to measure factors influencing three different salt intake behaviors (adding salt during cooking, at the table, purchasing salty food) among women. Study design: A mixed-method study. Methods: After the face and content validity of developed instrument were established, a representative sample of women (N= 300, age (SD):42.82(12.10)) were recruited to assess the construct validity using Partial Least Square confirmatory factor analysis. Coefficient alpha and composite reliability (CR) were used to establish reliability of instrument. The content validity index (CVI) and content validity ratio (CVR) were used to assess the content validity. Results: Assessing validity and reliability of instrument led to 56-item questionnaire. CVI was more than 0.70 and CVR more than 0.56. Internal consistency as assessed by Cronbach's alpha was acceptable. Convergent and discriminant validity were established. The GOF index for behavior one was 0.250, for behavior two was 0.414 and behavior three was 0.374. The results of confirmatory factor analysis indicate that TPB model has an acceptable fit with data. Conclusion: Our instrument provides a validated and reliable tool for assessing different aspects of salt intake behaviors in women to evaluate effectiveness of interventions focusing on salt reduction behaviors.

Lifetime experiences of violence against women and men in Sweden.

Aims: The aims of this cross-sectional study were to examine the prevalence of lifetime exposure to sexual, physical and psychological violence among a representative sample of women and men in Sweden, and to analyze if there were gender differences regarding the types of violence the participants were exposed to and by whom it was perpetrated. Methods: A survey containing questions about lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women and 10,000 men aged 18-74; 56.8% of the women and 46.5% of the men agreed to participate. Results: Sexual violence in childhood was reported by 26.4% of women and 22.1% experienced sexual violence in adulthood. Among men, 11% disclosed experiences of sexual violence in childhood and 4.5% in adulthood. Physical violence was experienced by 39.3% of women in childhood and by 18.8% as adults, often by a present or former partner. Among men, 59.3% were exposed to physical violence during childhood, often by a peer, and 20.4% as adults. Psychological violence in childhood was experienced by 58.1% of women in childhood and by 21.8% in adulthood. Among male respondents, 69.2% reported experiences of physiological violence in childhood, often by a peer, and 9.4% in adulthood. Conclusions: Lifetime violence exposure is common in the Swedish population. Though it affects both women and men, the patterns of type of violence and perpetrators are different. The results suggest that violence prevention early in life is important to target.