Women Of Low Socioeconomic Status Research Articles

Prospective Cohort Study on the Effect of an Intervention to Reduce Household Air Pollution Among Sudanese Women and Children.

Background.Exposure to household air pollution through the burning of biomass fuels is a global health concern and can lead to negative health outcomes such as asthma and lung disease.Objectives.The goal of this four-year study was to determine whether an intervention to reduce household air pollution (HAP) which included health education and a new well-ventilated cooking location would reduce exposure to HAP, lower carbon monoxide (CO) levels and improve the health of women and children in Port Sudan, Sudan.Methods.In 2016, 115 women of low socioeconomic status and their children were invited to participate in the study at two women's centers. One hundred and eleven women consented to participate and were divided into study and control groups on the basis of home ownership. Women who owned their homes learned about the adverse effects of HAP and a well-ventilated outside cooking location (rakoobah) was provided. Control women did not receive HAP education or a rakoobah. Questionnaires were used to assess the effect of education and a new well-ventilated cooking location for a group of Sudanese women who cook with biomass fuels. CO-oximetry was performed. Each year from 2017–2019, the questionnaires and CO-oximetry were repeated.Results.Sixty-five women and 33 children were assigned to the study group and 46 women and 19 children were assigned to the control group in 2016. Women were enrolled in 2016 with CO levels of 17.8% and 17.4%, respectively. One year later some of the study group women had lower CO levels and others higher, while the CO levels of the controls were stable. An intensive HAP education program was started for the study group women. By 2019, the last study year, the CO levels of both the study and control group women had dropped to normal levels of 2.9% and 3.1%, respectively. Control group women may have benefited from the HAP education and modeled behavior of those in the study group.Conclusions.The health impact of the change in cooking location was unclear, yet both groups reported fewer health care visits in 2019. Education and an outside cooking location resulted in lower CO levels of Sudanese women and children.Participant Consent.ObtainedEthics Approval.The study was approved by the Penn State Milton S. Hershey Medical Center Institutional Review Board and the Ethics Committee of the Red Sea University Faculty of Medicine located in Port Sudan, Sudan.Competing Interests.The authors declare no competing financial interests.

INCIDENCE OF BACTERIAL VAGINOSIS IN THIRD TRIMESTER OF PREGNANCY AND NEONATAL OUTCOME

Bacterial vaginosis is a polymicrobial, superficial vaginal infection involving a reduction in the amount of hydrogen-peroxide-producing Lactobacillus and an overgrowth of anaerobic and Gram-negative or Gram-variable bacteria. Risk FactorsThe current predictors of BV have been limited to race, sexual activity, socioeconomic status, and perhaps vaginal douching. The reported prevalence of BV among pregnant women ranges from 10 percent to 35 percent, with higher rates occurring among African-American women, women of lower socioeconomic status, or women with prior sexually transmitted diseases. DiagnosisTwo diagnostic tests are commonly used for BV. Amsel criteria, the test most commonly used in the clinical setting, involves assessing four clinical conditions, with the existence of three or more conditions corresponding to a diagnosis of BV. The second diagnostic test involves a Gram stain of vaginal fluid and use of Nugent criteria to identify a case of BV. This method has been shown to have a high sensitivity and specificity compared with Amsel criteria (89 percent and 83 percent, respectively).

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study.

The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.

Digital Technology Needs in Maternal Mental Health: A Qualitative Inquiry.

Digital technologies offer many opportunities to improve mental healthcare management for women seeking pre- and-postnatal care. They provide a discrete, practical medium that is well-suited for the sensitive nature of mental health. Women who are more prone to experiencing peripartum depression (PPD), such as those of low-socioeconomic background or in high-risk pregnancies, can benefit the most from such technologies. However, current digital interventions directed towards this population provide suboptimal support, and their responsiveness to end user needs is quite limited. Our objective is to understand the digital terrain of information needs for low-socioeconomic status women with high-risk pregnancies, specifically within the management of their mental health. This qualitative study consists of semi-structured focus groups and interviews with a sample of nineteen patients. A total of eleven core themes emerged from participant comments. Resulting themes highlighted the need for digital technologies that promote personalized care, a sense of community, and improved provider communication.

A Critical Theoretical Approach to Cancer Disparities: Breast Cancer and the Social Determinants of Health.

Breast cancer is the most commonly experienced cancer among women. Its high rates of incidence and survival mean that a number of women will live it for periods of their lifetimes. Group differences in breast cancer incidence and mortality occur by race and ethnicity. For example, while white women are slightly more likely to be diagnosed with breast cancer, Black women are 40% more likely to die from the disease. In this article, rather than focusing the discussion on individual-level factors like health behaviors that have the potential to blame Black women and those living in poverty for their conditions, we view breast cancer disparities through the lens of Critical Race Theory, taking a historical perspective. This allows us to delve beyond individual risk factors to explore social determinants of breast cancer disparities at the population level, paying special attention to the myriad ways in which social factors, notably views of race and discriminatory public policies, over time have contributed to the disproportionate breast cancer mortality experienced by Black women. We suggest ways of addressing breast cancer disparities, including methods of training healthcare professionals and public policy directions, that include rather than marginalize Black and lower socioeconomic status women.

Trauma exposure and stress-related disorders in a large, urban, predominantly African-American, female sample.

The current study investigated the relationship between trauma exposure and psychopathology in a sample of predominately African-American women of low socioeconomic status (SES). Women (N = 7430) were recruited from medical clinics at two large public hospitals in Atlanta, GA, from 2005 to 2017. Women were assessed for sociodemographics, life-course trauma burden, posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) utilizing self-report and structured clinical interview assessments. The effects of trauma exposure on current and lifetime PTSD and MDD were examined. Ninety-one percent of women reported trauma exposure, 83% reported a monthly household income of less than $2000, and 41% reported a history of arrest. Regarding psychiatric diagnoses, 30.8% met the criteria for probable MDD, and 32.3% met the criteria for probable PTSD. History of childhood abuse and total lifetime trauma significantly increased PTSD and depressive symptoms with additional incremental trauma exposure. PTSD and depressive symptom scores (95% CI) increased from 5.5 (5.0-6.1) and 8.4 (7.9-9.0) in the no trauma group to 20.8 (20.1-21.5) and 20.4 (19.7-21.2), respectively, in those exposed to four or more types of trauma. These results show high rates of adult and childhood trauma exposure, PTSD, MDD, and an additive effect of lifetime trauma exposure on the development of PTSD and MDD in a sample of low SES African-American women. These findings bring light to the high psychiatric symptom burden in this population and call for increased availability of interventions to address symptoms as well as policies aimed at reducing trauma exposure across the lifespan.

Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice.

Black women are more likely to undergo surgery for uterine fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking fibroid treatment. We aimed to identify factors that shape Black women's fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences, and compare experiences across age and socioeconomic status. We conducted semistructured interviews with 37 Black women undergoing surgery for fibroid management. We used a thematic analysis to code transcripts and identify themes. Participants were predominately single, college educated, and insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Knowledge and perceptions of fibroids were also influenced by community norms and differed by socioeconomic status; women of higher socioeconomic status had greater fibroid awareness than women of lower socioeconomic status. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. Although several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians. Fibroid management decisions were influenced not only by interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver intersectional gynecologic care that centers the voices of Black women seeking fibroid treatment.

Socioeconomic inequality in prevalence of cigarette and Water-pipe smoking among Iranian adults: A blinder- Oaxaca decomposition Analysis

Background: To assess the association between socioeconomic inequality and the prevalence of tobacco smoking among Iranian adults in 2010. Methods: Data from the fifth national STEPS survey (WHO STEPwise approach to NCD Surveillance) were analyzed. A Blinder-Oaxaca decomposition method was applied to assess the association between socioeconomic inequality and the prevalence of daily cigarette and water pipe (WP) smoking among Iranian men and women. Results: From 10,615 participants in the survey, 4,203 (39.5%) participants appeared to be in the first and fifth quintiles of socioeconomic status (SES). For men, the prevalence of daily cigarette smoking was higher among those with low SES (23.1%) than those with high SES (11.1%) (P<0.001). The observed difference was mainly attributed to the educational level (8.6%). We found no significant difference in high compared to low SES women for cigarette smoking (P value= 0.881). Although there was no difference between high and low SES men for daily WP smoking, low SES women had a higher prevalence of WP smoking (4.4%) than high SES women (1.3%) (P value=0.027). Education level was the major factor (3.3%) to explain the corresponding difference. The difference in WP smoking in high and low SES men was not statistically significant (P value= 0.199). Conclusion: Cigarette smoking in men and WP smoking in women are associated with SES in Iran. Education was the main factor explaining the differences in the prevalence of cigarette and WP smoking in Iranian men and women. Results from this study must be considered as a pivotal basis for designing a tobacco control program at national and sub-national levels.

Impact of Intersecting Systems of Oppression on Diabetic Retinopathy Screening Among Those Who Identify as Women of Low Socioeconomic Status: Protocol for a Convergent Mixed Methods Study.

BackgroundBy 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender.ObjectiveWe aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019.MethodsUsing a convergent mixed methods design, we want to understand patients’, providers’, administrators’, and decision makers’ perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina.ResultsFor the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021.ConclusionsIn Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care.International Registered Report Identifier (IRRID)PRR1-10.2196/23492

Abstract PS9-58: Factors associated with sexual problems during adjuvant endocrine therapy

Abstract Background: Adjuvant endocrine therapy (AET) reduces recurrence and mortality in women with hormone receptor-positive (HR+) breast cancer (BC). Sexual problems are common during AET but are under-reported and under-treated in routine clinical care. Patient reported outcomes (PRO) improve clinician awareness of patient symptoms. We present an analysis of prospectively collected PRO from a clinic-based registry of women with HR+ BC receiving AET with the aim of identifying factors associated with developing or worsening sexual problems. Methods: Women with stage 0-III BC initiating AET were enrolled in a prospective clinic-based registry Mar 2012-Dec 2016. Participants completed PRO surveys at baseline (BL) and 3, 6, 12, 24, 36, 48 and 60 months (mo). Sexual problems were evaluated by the MOS Sexual Problems (MOS-SP) measure (range 0-100; higher scores indicate more sexual problems). Respondents rate severity of problems in 4 domains of sexual function on a 4-point scale (“not a problem”, “a little of a problem”, “somewhat of a problem” and “very much a problem”). We considered participants who responded “somewhat of a problem” or “very much a problem” for ≥1 domain to have a sexual problem at that time point. Based on the empirical rule effect size method, we defined clinically significant developing or worsening sexual problems during AET as an increase in MOS-SP score by ≥8 from BL. Women with MOS-SP score >92 at BL were excluded. Other PRO surveys were the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) scale and NIH PROMIS measures for pain interference, fatigue, depression, anxiety, physical function (PF) and sleep disturbance. We evaluated associations between worsening of PROMIS T-scores in 4-point increments and FACT-ES score in 5-point increments with change in the MOS-SP score by ≥8. Additional covariates were clinical and demographic factors including socioeconomic status (SES). We used neighborhood poverty (NP) rate >15% as a surrogate for low SES based on US census estimates of the % of persons in a zip code below the federal poverty line. We performed logistic regression with generalized estimating equations to account for repeated observations. The final multivariable model was determined with a forward stepwise selection algorithm. Results: Among 300 participants, 195 (65%) were post-menopausal, 252 (84%) white and 30 (10%) black, 134 (45%) on tamoxifen and 166 (55%) on an aromatase inhibitor. Stage distribution was 0: 28 (9%); I: 180 (60%); II-III: 92 (31%). Prior to ET, 132 (44%) had mastectomy, 84 (28%) had chemotherapy and 199 (66%) had radiation (RT). 40 (13%) were of low SES. Median follow-up is 56 mo. 165 (55%) participants reported ≥1 sexual problem during participation. At BL, median MOS-SP score was 8.32 (range 0-92). There was no significant change in mean MOS-SP score from BL to 48 mo (p=0.74). In univariate analyses, worsening scores on all PRO measures were associated with increase in MOS-SP score by ≥8, however on multivariate analysis, only worsening endocrine symptoms (OR 1.34, 95% CI 1.21-1.48, p<0.001) and PF (OR 1.08, 95% CI 0.99-1.18, p=0.06) were retained in the final model. Clinical variables in the final model associated with increase in MOS-SP score by ≥8 were mastectomy (OR 2.00, 95% CI 1.19-3.36, p=0.01) and RT (OR 1.82, 95% CI 1.05-3.16, p=0.03). Women of low SES were less likely to have increase in MOS-SP score by ≥8 (OR 0.49, 95% CI 0.24-0.98, p=0.04). Age, race, stage and type of ET were not associated with developing or worsening sexual problems. Conclusions: Women receiving AET at risk for developing or worsening sexual problems include those with worsening endocrine symptoms and worsening PF plus those who have undergone mastectomy or RT. Routine assessment for sexual problems in this population may reduce under-detection and identify women who can benefit from interventions to improve sexual function. Citation Format: Neha Verma, Amanda L. Blackford, David Lim, Elissa Thorner, Jennifer Lehman, Claire Snyder, Caroline A. Snyder, Vered Stearns, Karen L. Smith. Factors associated with sexual problems during adjuvant endocrine therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-58.

Zika virus public health crisis and the perpetuation of gender inequality in Brazil

BackgroundIn 2015–2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women’s negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies.MethodsWe conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18–40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women’s contraceptive use.ResultsCampaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male’s participation on Zika prevention and contraceptive management, while failing to take into account Brazil’s large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse.ConclusionGovernment and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.

Evaluating Depressive Symptoms Among Low-Socioeconomic-Status African American Women Aged 40 to 75 Years With Uncontrolled Hypertension

Depression is one of the leading causes of disability in the United States. African American women of low socioeconomic status with uncontrolled hypertension are at risk of having severe depressive symptoms, yet there is limited research about the mental health of this vulnerable population. Data from the Prime Time Sister Circles randomized clinical trial (PTSC-RCT) study can shed light on the prevalence of depressive symptoms among low-socioeconomic-status older African American women with hypertension. To determine the prevalence of depressive symptoms among low-socioeconomic-status African American women aged 40 to 75 years with uncontrolled hypertension who receive their care from a federally qualified health center (FQHC) and to identify risk factors associated with depressive symptoms. Cross-sectional analysis of data from the PTSC-RCT of depressive symptomology, measured using an adapted version of the 10-item Center for Epidemiological Studies Depression Scale Revised (CES-D-10). Descriptive statistics were used to characterize the study population. We used logistic regression models to investigate the factors associated with participants with or without symptoms of depression. We used baseline data from the PTSC-RCT study, including 316 African American English-speaking women between ages 40 and 75 years with hypertension (systolic blood pressure ≥140 mm Hg or diastolic ≥90 mm Hg), who received their primary care at a FQHC in Washington, DC, in 2017 and 2018 and were flagged by the FQHC as uncontrolled. We used the CES-D-10 from the Center for Epidemiologic Studies Depression Scale to measure presence of depressive symptoms. A total of 57.0% of the women in the study (180 of 316) scored greater than or equal to 10 on the CES-D-10. Depressive symptoms had a negative association with a postsecondary education (adjusted odds ratio [aOR], 0.492; 95% CI, 0.249-0.968) and a positive association with the number of chronic conditions (aOR, 1.235; 95% CI, 1.046-1.460) and smoking (aOR, 1.731; 95% CI, 1.039-2.881). In this study of low-income African American women with uncontrolled hypertension, more than half had symptoms of depression that was associated with less than high-school education, chronic conditions, and smoking. Low-income African American women with uncontrolled hypertension should be screened and adequately treated for depressive symptoms. ClinicalTrials.gov Identifier: NCT04371614.

Searching beyond the Lamppost to Reduce Breast Cancer Disparities.

Racial and ethnic differences in breast cancer occur by race/ethnicity in both incidence and mortality rates. Women of lower socioeconomic status likewise have poorer outcomes. When race alone is considered, incidence rates in the United States are highest among White women (130.8 per 100,000), with Black women close behind (126.7 per 100,000). Incidence is lowest among Asian/Pacific Islander women, at 93.2 per 100,000. Mortality differences are more pronounced, with Black women 40% more likely to die from breast cancer than White women (28.4 per 100,000 and 20.3 per 100,000, respectively). Mortality rates for Asian/Pacific Islander women (11.5 per 100,000) are far lower than for Black and White women. When age is considered, additional differences between Black and White women appear, in part accounted for by types of breast cancer experienced. Women of other racial/ethnic groups and socioeconomic status have received less scientific attention. In this article, we provide a brief overview of the evidence for social determinants of breast cancer and argue that the current reliance on race over racism and ethnicity contributes to our inability to eliminate breast cancer disparities in the United States and elsewhere in the world. We suggest alternatives to the current approach to research in breast cancer disparities.

Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias.

Studies in low-resource settings have highlighted disparities in person-centred maternity care (PCMC)-respectful and responsive care during childbirth-based on women's socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES bias in providers' perceptions of women's expectations and behaviours, as well as providers' general views regarding factors influencing differential treatment of women. We conducted a convergent mixed-methods study with 101 maternity providers in western Kenya. Implicit SES bias was measured using an adaptation of the Implicit Association Test (IAT) and explicit SES bias assessed using situationally specific vignettes. Qualitative data provided additional details on the factors contributing to disparities. Results provide evidence for the presence of both implicit and explicit bias related to SES that might influence PCMC. Differential treatment was linked to women's appearance, providers' perceptions of women's attitudes, assumptions about who is more likely to understand or be cooperative, women's ability to advocate for themselves or hold providers accountable, ability to pay for services in a timely manner, as well as situational factors related to stress and burnout. These factors interact in complex ways to produce PCMC disparities, and providing better care to certain groups does not necessarily indicate preference for those groups or a desire to provide better care to them. The findings imply the need for multilevel approaches to addressing disparities in maternity care. This should include provider training on PCMC and their biases, advocacy for women of low SES, accountability mechanisms, and structural and policy changes within health care settings.

Analysis of Predictors of Breast Cancer Screening among Japanese Women using Nationally Representative Survey Data, 2001-2013.

Objective:Predictors of participation in breast cancer screening in recent years or the trend of participation rate by predictors over the years has not been investigated in Japan. In this study, we investigated predictors for participation in breast cancer screening and analyzed the trend of participation rate depending on the predictors using nationally representative survey data in Japan. Methods:The data of “Comprehensive Survey of Living Conditions” in Japan from 2001 to 2013 were used. Participation in breast cancer screening was used as an outcome. Next, as explanatory variables, we used age group, marital status, living arrangements, educational level, household income, employment status, smoking status, regular outpatient visit status, and self-rated health status. Then, the participation rate for breast cancer screening was calculated for each of the factors over the years. In addition, multivariate logistic regression analysis was conducted to analyze the association between each factor and the participation rate using data from 2010 and 2013. Results:We found that non-married women, women with lower educational level, women with low household income, self-employed or unemployed women, smokers, and women with low self-rated health status were significantly less likely to participate in breast cancer screening. Conversely, the participation rate increased for all predictor groups from 2001 to 2013, and the increase in the participation rate for never-married women was particularly evident compared with the other marital statuses. However, significant differences in the participation rate for breast cancer screening existed depending on marital status, household income, employment status, and smoking status throughout the analyzed years. Conclusion:Our findings suggest that further recommendations for breast cancer screening are particularly needed among women of low socioeconomic status and those who are self-employed or unemployed to increase the participation rate in Japan.

Hope or desperation? A pseudocyesis in advanced maternal age in a woman with recurrent miscarriages: a case report and literature review

A pseudocyesis, which is a false impression by a woman that she is carrying a foetus, with accompanying pregnancy-related changes, is a vexing psychological phenomenon. The condition is rare, and the underlying mechanisms are not yet fully elucidated. However, pseudocyesis more commonly occurs among women of lower socioeconomic status with a chronic history of subfertility. Disadvantaged socioeconomic circumstances can lead to delayed presentation, with disappointment for the woman when she is eventually informed that she is not pregnant. To contribute to the body of literature regarding pseudocyesis, we present and discuss the case of 44-year-old woman with a history of nine recurrent miscarriages who was referred from the local clinic with elevated blood pressures after late booking at 36 weeks, without prior antenatal care or ultrasound scan. Subsequent clinical examination and ultrasonography revealed an empty uterus, leading to a diagnosis of a pseudocyesis. The patient was appropriately referred to the psychiatrists and physicians for further management.

Social Support and Community Integration in Users of Brazil's Basic Social Protection Policy

This study aimed to verify how community participation, family support, and sociodemographic variables relate to community integration. Participants were 201 individuals from the Brazilian state of Rio Grande do Sul, residing in the cities of Porto Alegre and Esteio, who benefited from a basic social protection program, PAIF (Proteção e Atendimento Integral à Família). The non-probability sample was mainly composed of low socioeconomic status women with a low educational level who were beneficiaries of social financial support programs. The research protocol comprised the Inventory of Family Support Perception, the Questionnaire of Community Social Support, and questions about sociodemographic characteristics. Correlation of PAIF participation duration with community integration was weak (r = 0.145, p < 0.05). A linear regression model showed that age (β = 0.323, p < 0.001), the monetary value of the benefit (β = 0.224, p = 0.002), and community participation (β = 0.234, p = 0.002) were predictors, accounting for 30.5% of the variance of community integration. Results indicate that, as people age in the community, they increase their integration. The amounts received by each family probably affect community integration because they expand access to community spaces and public services. Individuals with greater community support tools felt more welcome in the community network. Additional studies are needed to provide evidence for the effectiveness of social integration and health promotion interventions

Food habits in pregnancy and its association with gestational diabetes mellitus: results from a prospective cohort study in public hospitals of urban India

BackgroundFew studies have explored the relationship between food habits and the risk of gestational diabetes mellitus (GDM) in women from India. We aimed to investigate the associations of food habits and the risk of GDM.MethodsAs part of the MAASTHI prospective cohort study in urban Bengaluru, India, pregnant women between 18 and 45 years, less than 36 weeks of gestation were included. During baseline, the participant’s age, education, physical activity levels, and food habits were recorded. Screening of GDM was done by the World Health Organization diagnostic criteria using a 2-h 75-g oral glucose tolerance test between the 24th–36th weeks of gestation.ResultsWe included 1777 pregnant women in the study. We show that 17.6% of the women had GDM, of which 76.7% consume red meat. Red meat consumption was associated with an increased risk of GDM (aRR = 2.1, 95% CI 1.5, 2.9) after adjusting for age, family history of diabetes and socioeconomic status.ConclusionThe high intake of red meat consumption in pregnancy needs further examination. Also, future evaluations should consider evaluating the risk of red meat consumption against the combined effect of inadequate consumption of vegetables, fruits, and dairy products in pregnant women. Interventions to educate women in lower socioeconomic status on inexpensive, seasonal, and healthy food might be helpful.

Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival?

Background:Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival.Objective:We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality.Research Design:A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation.Subjects:A total of 14,183 Medicare beneficiaries with breast cancer in 2006–2008 or 2014–2015.Measures:All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data.Results:Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness.Conclusion:Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.

What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata.

BackgroundWomen of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women across socioeconomic strata in making breast cancer surgery choices.MethodsWe conducted a 3‐arm (Option Grid, Picture Option Grid, and usual care), multisite, randomized controlled superiority trial with surgeon‐level randomization. The Option Grid (text only) and Picture Option Grid (pictures plus text) conversation aids were evidence‐based summaries of available breast cancer surgery options on paper. Decision quality (primary outcome), treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care were measured from T0 (pre‐consultation) to T5 (1‐year after surgery.ResultsSixteen surgeons saw 571 of 622 consented patients. Patients in the Picture Option Grid arm (n = 248) had higher knowledge (immediately after the visit [T2] and 1 week after surgery or within 2 weeks of the first postoperative visit [T3]), an improved decision process (T2 and T3), lower decision regret (T3), and more SDM (observed and self‐reported) compared to usual care (n = 257). Patients in the Option Grid arm (n = 66) had higher decision process scores (T2 and T3), better coordination of care (12 weeks after surgery or within 2 weeks of the second postoperative visit [T4]), and more observed SDM (during the surgical visit [T1]) compared to usual care arm. Subgroup analyses suggested that the Picture Option Grid had more impact among women of lower SES and health literacy. Neither intervention affected concordance, treatment choice, or anxiety.ConclusionsPaper‐based conversation aids improved key outcomes over usual care. The Picture Option Grid had more impact among disadvantaged patients.Lay Summary The objective of this study was to understand how to help women with lower incomes or less formal education to make breast cancer surgery choices.Compared with usual care, a conversation aid with pictures and text led to higher knowledge. It improved the decision process and shared decision making (SDM) and lowered decision regret. A text‐only conversation aid led to an improved decision process, more coordinated care, and higher SDM compared to usual care. The conversation aid with pictures was more helpful for women with lower income or less formal education.Conversation aids with pictures and text helped women make better breast cancer surgery choices.