Women's Health Care Providers Research Articles

Gynecological management of the breast cancer survivor.

Survival from breast cancer has continued to increase since the 1990's, and quality of life and gynecologic issues have been an increasingly important part of overall care. Common women's health issues such as contraception, pregnancy, menopause, and sexual functioning are uniquely affected by breast cancer diagnosis and treatment. Two-thirds of breast cancers are hormone-sensitive and adjuvant hormonal therapies like tamoxifen or aromatase inhibitors have substantially decreased the disease recurrence and contralateral breast cancer. These hormonal therapies can cause menopausal and sexual side effects, and women's healthcare providers need to understand safe and effective treatment options to manage them. Providingcounseling and evidence-based education is important for primary care providers and gynecologists who care for those women who have or previously had breast cancer. This review will focus on specific women's health issues pertaining to breast cancer and treatment.

Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City

Equitable access to HIV pre- and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers. From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre- and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice. Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing pre-exposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis. After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre- and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.

THE EFFECT OF SOCIO-DEMOGRAPHIC WITH AUB IN PERIMENOPAUSE

Background: The effect of socio-demographic on AUB in perimenopause.
 Methods: Prospective interventional study conducted at Kamla Nehru Hospital for State Mother and Child, IGMC Shimla.
 Results: In the present study according to the modified kuppuswamy socioeconomic scale AUB was found maximum in women belonging to lower middle class i.e 93 (40.6%) with confidence interval of 34.19-47.95% followed by upper lower class i.e 90 (39.3%) with confidence interval of 32.93-45.95% and least in upper class i.e 7 (3.05%) with confidence interval of 1.24-6.20%.
 Conclusion: In summary, abnormal uterine bleeding in perimenopausal patients is a common and important part of clinical practice for health-care providers of women.
 Keywords: AUB, SES, Bleeding

THE MENSTRUAL PATTERN OF AUB IN PERIMENOPAUSE

Background: The Menstrual pattern of AUB in perimenopause.
 Methods: Prospective interventional study conducted at Kamla Nehru Hospital for State Mother and Child, IGMC Shimla.
 Results: Menorrhagia was the most common presentation of AUB patients accounting for 65.5% of cases with confidence interval of 58.96-71.64% followed by continuous bleeding per vagina(BPV) accounting for 17.9% with confidence interval of 13.17-23.49% with the least being oligomenorrhea 0.87% with confidence interval of 0.11-3.12%.
 Conclusion: Abnormal uterine bleeding in perimenopausal patients is a common and important part of clinical practice for health-care providers of women.
 Keywords: AUB, Menstrual pattern, Bleeding

Pre-Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention.

HIV infection is a major public health problem for women in the United States. Prevention of new HIV infections is essential to the goal of eliminating HIV in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method recommended for women at increased risk for HIV infection, including during pregnancy and lactation. The recommended PrEP regimen is a fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine administered as a single daily dose. The initial evaluation for individuals desiring PrEP for HIV prevention includes obtaining a history, laboratory evaluation, and evaluation of the accessibility and acceptability of PrEP. Individuals using PrEP medications are seen every 3 months for follow-up. These follow-up visits include evaluation for signs and symptoms of seroconversion, management of side effects and adverse reactions, and evaluation of adherence to PrEP. Follow-up visits also include testing for HIV, sexually transmitted infections, and renal function and a review of HIV prevention and risk reduction methods. Despite known safety and efficacy of PrEP among women, PrEP use in women in the United States remains low. Gaps exist in HIV prevention that can in part be addressed by women's health care providers through risk screening and provision of HIV prevention methods. All providers of comprehensive sexual health care can and should assess individuals for risk factors for HIV infection and offer HIV prevention methods, including PrEP, to individuals at risk for HIV.

Effect of an educational intervention on women's healthcare provider knowledge gaps about breast density, breast cancer risk, and screening.

We sought to assess the effect of an educational intervention, based on DenseBreast-info.org website content, on women's healthcare provider knowledge of breast density, its risk and screening implications, and comfort level discussing these topics with patients. US-based women's healthcare providers participated in a web-based pretest/posttest study from May 14, 2019 to September 30, 2019. Pretest included demographics; comfort/knowledge discussing breast density impact on risk and screening; and educational material. Posttest contained the same knowledge and comfort questions. We assessed mean pretest/posttest score and comfort level differences (paired t tests) and pretest/posttest knowledge gap differences (McNemar test). We evaluated associations of baseline characteristics with pretest score and score improvement using multiple linear regression, and associations with knowledge gaps using logistic regression. Of 177 providers analyzed, 74.0% (131/177) were physicians and 71.8% (127/177) practiced obstetrics/gynecology. Average test score increased from 40.9% (5.7/14) responses correct pretest to 72.1% (10.1/14) posttest (P < 0.001). Pretest, 56.5% (100/177) knew women with extremely dense breasts have four-to-six-fold greater breast cancer risk than those with fatty breasts; 29.4% (52/177) knew risk increases with increasing glandular tissue; only 5.6% (10/177) knew 3D/tomosynthesis does not improve cancer detection in extremely dense breasts over 2D mammography; and 70.6% (125/177) would consider supplemental ultrasound after mammography in an average-risk 50-year old with dense breasts. Postintervention, these knowledge gaps resolved or reduced (all P < 0.005) and comfort in discussing breast density implications increased (all P < 0.001). Important knowledge gaps about implications of breast density exist among women's healthcare providers, which can be effectively addressed with web-based education.

Effect of Elastic Abdominal Binder on Post Cesarean Pain, Distress, Mobilization and Women’s Satisfaction

Background: Abdominal binder (AB) is one of the most effective non pharmacological method that decreases many adverse events after cesarean deliveries as pain and distress, it can also improve physical function and increase women's satisfaction. Aim of the study: This study aimed to assess the effect of elastic abdominal binder on post cesarean pain, distress, mobilization and women's satisfaction. Subjects and methods: Randomized Control Trial was utilized comparing two groups of intervention (AB) and control group (a routine hospital care). The study was carried out at New General Mansoura hospital specific at inpatient departments, and operative room, Egypt, from September 2019 to March 2020. Data was collected through five tools, A Structured Interview Questionnaire Schedule, the Numerical Rating Scale; Symptom Distress Scale ; 6MWT &women satisfaction likert scale. Results: This study found that there was a highly statistically significant difference about pain score in the 1st 8,24,48 hours after delivery and after one week in the binder group than control group, Also, a highly statistically significant difference in the distress symptoms in the 1st 24 hours and in 48 hours as well as after one week from delivery, the present study reported that there were a highly statistically significant different in the binder group versus the non-binder group related to 6MWT in the 1st 8 hours and on postoperative 24hrs, 48hrs&1 week. Also, women in the binder group were satisfied by using it. Conclusion: this study concluded that using AB after CS had a significantly improvement in the post cesarean pain, lowering distress symptoms & foster mobilization. Also, in early initiation of breast feeding. Recommendations: Increase awareness of women health care providers about positive effect of abdominal binder.

Migraine diagnosis and treatment: A knowledge and needs assessment of women's healthcare providers.

Studies suggest that migraine is often underdiagnosed and inadequately treated in the primary care setting, despite many patients relying on their primary care provider (PCP) to manage their migraine. Many women consider their women's healthcare provider to be their PCP, yet very little is known about migraine knowledge and practice patterns in the women's healthcare setting. The objective of this study was to assess women's healthcare providers' knowledge and needs regarding migraine diagnosis and treatment. The comprehensive survey assessing migraine knowledge originally developed for PCPs was used in this study, with the addition of a section regarding the use of hormonal medications in patients impacted by migraine. Surveys were distributed online, and primarily descriptive analyses were performed. The online survey was completed by 115 women's healthcare providers (response rate 28.6%; 115/402), who estimated that they serve as PCPs for approximately one-third of their patients. Results suggest that women's healthcare providers generally recognize the prevalence of migraine, but experience some knowledge gaps regarding migraine management. Despite 82.6% (95/115) of survey respondents feeling very comfortable or somewhat comfortable with diagnosing migraine, only 57.9% (66/114) reported routinely asking patients about headaches during annual visits. Very few were familiar with the American Academy of Neurology guidelines on preventative treatment (6.3%; 7/111) and the Choosing Wisely Campaign recommendations on migraine treatment (17.3%; 19/110), and many prescribed medications known to contribute to medication overuse headache. In addition, only 24.3% (28/115) would order imaging for a new type of headache, 35.7% (41/115) for worsening headache, and 47.8% (55/115) for headache with neurologic symptoms; respondents cited greater tendency with sending patients to an emergency department for the same symptoms. Respondents had limited knowledge of evidence-based, non-pharmacological treatments for migraine (i.e., biofeedback or cognitive behavioral therapy), with nearly none placing referrals for these services. Most providers were comfortable prescribing hormonal contraception (mainly progesterone only) to women with migraine without aura (80.9%; 89/110) and with aura (72.5%; 79/109), and followed American College of Obstetricians and Gynecologists (ACOG) guidelines to limit combination hormonal contraception for patients with aura. When queried, 6.3% or less (5/79) of providers would prescribe estrogen-containing contraception for women with migraine with aura. Only 37.3% (41/110) of respondents reported having headache/migraine education. Providers indicated interest in education pertaining to migraine prevention and treatment (96.3%; 105/109), migraine-associated disability (74.3%; 81/109), and diagnostic testing (59.6%; 65/109). Women's healthcare providers appear to have several knowledge gaps regarding the management of migraine in their patients. These providers would likely benefit from access to a headache-specific educational curriculum to improve provider performance and patient outcomes.

Self-reported disrespect and abuse by nurses and midwives during childbirth in Tanzania: a cross-sectional study

BackgroundFacility-based childbirth has increased globally. Unfortunately, there have also been reports of women experiencing disrespect and abuse by healthcare providers during childbirth. This study aimed to measure the prevalence of self-reported disrespect and abuse (D&A) by healthcare providers of women during childbirth in health facilities in Tanzania, and to clarify the factors related to D&A.MethodsA cross-sectional survey was conducted in public health facilities of three regions in Tanzania from September 2016 to October 2016. Nurses and midwives who had ever conducted deliveries completed a 22-item section about D&A and three sections about working conditions and environment. A model for predicting D&A based on several factors such as their characteristics, working conditions, and working environment was developed by conducting multiple regression analysis.ResultsThirty public health facilities in three regions within Tanzania were selected to reflect different levels of hospitals. Among 456 participants (nurses, midwives, and nursing assistants), 439 were included in the analysis. Average number of self-reported D&A out of 22 items was five, and nearly all participants (96.1%) reported enacting one form of D&A at the least and two forms of D&A at the most. About 25–44% of D&A items were in the forms related to women’s experiences with childbirth psychologically. Moreover, at least 10–30% of the participants enacted some form of D&A which could directly affect the well-being of mothers and babies. D&A scores increased with an increase in ‘working hours per week’ and ‘taking a break during evening shifts’. D&A scores decreased with an increase in the scores of the ‘two components of the Index of Working Satisfaction (professional status and interaction between nurses)’, and ‘any type of supervision for new nurse-midwives’.ConclusionMost studies about D&A of healthcare providers previously focused on the reports of women. To our knowledge, this is the first report that focused on D&A reported by healthcare providers. Working conditions and systems including personal relationships with colleagues were both positively and negatively related to D&A of healthcare providers rather than the provider’s individual and facility structural characteristics.

Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review.

To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC). Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief. Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

Agreement towards task sharing among gynecologist and general practitioners in north-eastern Germany

Abstract Background In Germany, a higher life expectancy of women coincides with shortages of health professionals. Besides gynecologists (Gyns), the main providers of ambulatory healthcare for women 50+ are general practitioners (GPs), which do not provide gynecological care. However, GPs and Gyns willingness share tasks has not yet been analysed systematically. The aim of this research project is to explore approval among and consent between GPs and Gyns for task sharing in women 50+. Methods In a quantitative postal survey (March-May 2018), a random sample of 66% of all GPs (n = 3,514) and all Gyns (n = 1,031) in the three German states was interviewed. The response rate was 25.5% for GPs and 51.2% for Gyns. The approval for task sharing (yes/no) was collected for 21 medical consultation themes (83 sub items) regarding women's health and general health of women 50+. For each sub item, the approval rates among and consent between the professional groups was calculated and sub items were group into medically coherent modules for interprofessional care. Multivariable regressions were calculated in order to explore the association of professional group with the medically coherent modules adjusted for covariates. Results In both professional groups, highest approval was reached for shared care of urinary incontinence, vaginal complaints and recurrent urinary tract infections. High approval and consent was present only for the sub items counselling for sexual health (GP = 52.30%, Gyn=48.91%) and colorectal cancer screening (GP = 48.66%, Gyn=44.70%). Approval was higher for counselling as compared to diagnostics and therapy. Cancer related task went along with low approval rates in both professional groups. Approval towards task sharing was higher among Gyns for all modules except for cancer screening. Conclusions The analysis identified single tasks for sharing in both groups and allows setting priorities through the classification according to approval and consent. Key messages Task sharing among GPs and Gyn could be an opportune answer to improve access to care of women 50+. Knowledge on GPs and Gyns attitudes towards task sharing can serve as common empiric ground for meaningful dialogues between research, policy and practice.

Identifying Cancer Screening Adherence in the Emergency Department Utilizing Research Associates.

Despite the demonstrated benefits of regular screening, a large proportion of the adult female population are out of compliance with recommendations from specialty societies regarding breast and cervical cancer. The current study investigated whether research associates (RAs) in the emergency department (ED) can usefully assess patients' recent compliance with breast and cervical cancer screening (BCCS) recommendations and provide information regarding how patients may access any recommended screening when it is overdue. RAs at 5 heterogeneous hospitals in the United States approached willing nonemergent female patients and visitors between the ages of 21 and 74years. After obtaining verbal consent, the participant's compliance with U.S. Preventive Service Task Force recommendations for BCCS was assessed. Participants found overdue for screening were provided information on how to obtain these recommended screenings. A total of 5419 participants were between 50 and 74years old and would be recommended to have breast cancer screening, and 11,667 participants were between 21 and 65years old and would be recommended to have cervical cancer screening. Among women of age for either of these screenings, 3169 reported that they did not have a women's primary health care provider (i.e., doctor, nurse practitioner, or physician assistant who manages women's primary health care issues). A total of 786 women (15% of women 50-74years old) were found to be out of compliance with breast cancer screening guidelines and 1208 women (12% of women 21 to 65years with intact uteruses) were found to be out of compliance with cervical cancer screening guidelines. Our results indicate that RAs can identify large numbers of women who should undergo BCCS screening across a variety of emergency department settings.

\u201cYou better use the safer one\u2026 leave this one\u201d: the role of health providers in women\u2019s pursuit of their preferred family planning methods

BackgroundUniversal access to quality sexual and reproductive health (SRH) services is pivotal to ensuring gender equality. In high-income countries, patient-provider interactions have been shown to shape women’s decisions about contraception, with poor exchanges decreasing method uptake and satisfaction. While significant progress has been made to increase women’s access to SRH services, in low- and middle-income countries, little is known about the quality of family planning patient-provider interactions. The primary objective of this analysis was to explore the role of health care providers in women’s family planning decision-making in Ethiopia.MethodsFrom July to August 2017, 10 focus group discussions (n = 80) and 30 in-depth interviews were conducted with women aged 15–49 and men aged 18+ recruited via purposive sampling from urban and rural sites in Ethiopia. Semi-structured interview guides explored women’s and girls’ empowerment in SRH surrounding sex, childbearing, and contraception. All interviews were conducted in Amharic, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data. Eleven codes specific to provider services for family planning were reviewed and matrixes creates for synthesis.ResultsThree primary themes emerged: the role of providers in women’s awareness of and demand for family planning services; selection and uptake of contraceptive methods; and discontinuation and switching of contraceptive methods. Results indicate that health extension workers were central to women’s awareness of family planning, and health providers’ endorsements were instrumental in decisions to adopt methods. The majority of respondents described positive interactions with providers and appreciated thorough counseling when considering using or switching methods. Some women, however, described health providers directing them toward long-acting methods by communicating inaccurate information or emphasizing disadvantages of short-acting methods. A few women described provider reluctance or resistance to switching methods, especially from implants.ConclusionsWomen shared many narratives about the central roles health providers played in their awareness and decision-making for family planning. Those narratives also included provider bias against women’s preferred methods. Further research and program assessments are needed to ascertain the extent to which these biases hinder women’s decision-making autonomy in using contraception.

Executive Summary of the Early-Onset Breast Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at an in-person meeting of stakeholder professional and patient advocacy organizations in April 2019. This article summarizes the relevant literature, existing guidance, and validated tools to guide health care providers in the prevention, early detection, and special considerations of early-onset breast cancer. Substantive knowledge gaps were noted and summarized to provide guidance for future research.

Hail Mary or Russian Roulette: Provider Knowledge and Attitudes Toward the Withdrawal Method of Contraception [02B

INTRODUCTION: Withdrawal is often perceived as an ineffective contraceptive method that is infrequently discussed by clinicians, despite frequent use and an efficacy level similar to condoms. It is also one of the few methods available to men. To address this discrepancy, we surveyed the knowledge and attitudes of women's healthcare providers about withdrawal. METHODS: In this IRB-approved, exempt study, surveys were distributed at four contraceptive health conferences across the United States. As part of a 16-item survey with open and close-ended questions, providers were asked about the effectiveness of withdrawal for pregnancy prevention and if and how they discussed withdrawal with their patients. Qualitative data were coded with 80% interrater reliability. Distribution frequencies and associations via chi-square tests are presented. RESULTS: Overall, 17.7% and 2% of respondents correctly identified typical and perfect use failure rates for withdrawal. Asked how they would respond if their patient reported withdrawal for contraception, half (55.3%) provided responses suggesting open-mindedness. Compared to other healthcare providers (such as physician assistants and nurses), physicians were more likely to endorse negative attitudes about using withdrawal (P&lt;.01). Half (51.1%) of providers do not list withdrawal as a method choice on reproductive history intake forms; only one-third routinely ask about this method. CONCLUSION: Better education about withdrawal and its efficacy as a contraceptive method are needed for practitioners to recognize the importance of its inclusion in their counseling, as well as to provide their patients with the data needed to make informed contraceptive choices.

PREPARE: protocol for a stepped wedge trial to evaluate whether a risk stratification model can reduce preterm deliveries among women with suspected or confirmed preterm pre-eclampsia

BackgroundPreeclampsia (PE) is a major cause of short and long-term morbidity for affected infants, including consequences of fetal growth restriction and iatrogenic prematurity. In Brazil, this is a special problem as PE accounts for 18% of preterm births (PTB). In the PREPARE (Prematurity REduction by Pre-eclampsia cARE) study, we will test a novel system of integrated care based on risk stratification and knowledge transfer, to safely reduce PTB.MethodsThis is a stepped wedge cluster randomised trial that will include women with suspected or confirmed PE between 20 + 0 and 36 + 6 gestational weeks. All pregnant women presenting with these findings at seven tertiary centres in geographically dispersed sites, throughout Brazil, will be considered eligible and evaluated in terms of risk stratification at admission. At randomly allocated time points, sites will transition to risk stratification performed according to sFlt-1/PlGF (Roche Diagnostics) measurement and fullPIERS score with both results will be revealed to care providers. The healthcare providers of women stratified as low risk for adverse outcomes (sFlt-1/PlGF ≤38 AND fullPIERS< 10% risk) will receive the recommendation to defer delivery. sFlt-1/PlGF will be repeated once and fullPIERS score twice a week. Rates of prematurity due to preeclampsia before and after the intervention will be compared. Additionally, providers will receive an active program of knowledge transfer about WHO recommendations for preeclampsia, including recommendations regarding antenatal corticosteroids for foetal benefits, antihypertensive therapy and magnesium sulphate for seizure prophylaxis. This study will have 90% power to detect a reduction in PTB associated with PE from a population estimate of 1.5 to 1.0%, representing a 33% risk reduction, and 80% power to detect a reduction from 2.0 to 1.5% (25% risk reduction). The necessary number of patients recruited to achieve these results is 750. Adverse events, serious adverse events, both anticipated and unanticipated will be recorded.DiscussionThe PREPARE intervention expects to reduce PTB and improve care of women with PE without significant adverse side effects. If successful, this novel pathway of care is designed for rapid translation to healthcare throughout Brazil and may be transferrable to other low and middle income countries.Trial registrationClinicalTrials.gov: NCT03073317.

Human Trafficking: ACOG COMMITTEE OPINION, Number 787.

Human trafficking, or modern-day slavery, is a global problem with broad reach that is often underrecognized in the United States. Victims of trafficking have been found in a wide range of legal and illegal business settings, and this frequently hidden population is most often exploited in the commercial sex industry, agriculture, factories, hotels, restaurants, as domestic workers, and by marriage brokers and some adoption firms. Human trafficking disproportionately affects underserved women and children, with more than 70% of trafficking cases involving women and girls and more than 90% of victims trafficked into the sex industry. Obstetrician-gynecologists and other women's health care providers are well-situated to identify and assist victims of human trafficking. Many trafficked individuals present to outpatient obstetrics and gynecology clinics, community health centers, family planning clinics, urgent care centers, and adolescent medicine clinics, and one half of all female victims of sex trafficking have visited the emergency department while involved in sex trafficking. Obstetrician-gynecologists and other women's health care providers should be aware of human trafficking, recognize signs of human trafficking, and be prepared to assist patients who are victims or who have been victims of human trafficking. This Committee Opinion has been updated to include screening questions and indicators to identify victims of human trafficking, additional information regarding reporting obligations for suspected human trafficking, and additional resources for survivors of human trafficking.

Women's healthcare providers: Work factors, personality, and stress

We assessed neuroticism, perceived stress, and work-related factors among obstetrician-gynecologists (ob-gyns), and examined the relationships between these variables. Surveys were sent to 500 physician members of the American College of Obstetricians and Gynecologists and we received 287 (57.4%) completed responses. Analyses included descriptive statistics and linear regressions. Ob-gyns reported high levels of perceived stress. After controlling for neuroticism, variables that significantly predicted stress levels included average hours worked, perception of working too many hours, colleague support for work–home balance, isolation due to gender/cultural differences, and perception of workplace control. Because these work-related factors are linked to stress even when controlling for neuroticism, administrators and physicians may consider whether any of these factors are modifiable to mitigate physician stress. This in turn may affect physicians' own health and the quality of care patients receive.

Innovations in Midwifery Education: The Academic Medical Center Model

Workforce analyses project a need for women's health care providers, especially in maternity care. With a stagnant number of certified nurse-midwife/certified midwife (CNM/CM) education programs, the present production of new CNMs/CMs is not robust enough to meet the growing demand. This article describes an existing but underutilized model for CNM/CM education programs, based in an academic medical center with an existing academic affiliation. Advantages include a federal funding source through the Centers for Medicare and Medicaid Services, lower tuition costs than most current programs, and expanded job satisfaction for CNMs/CMs in clinical practice.

Women's Healthcare Providers' Experiences and Perceptions of Discussing Obesity: A Needs Assessment Survey [34K

INTRODUCTION: Obesity is the most common co-morbidity occurring in women across their lifespans, associated with reproductive health problems, gynecologic and breast cancers, and numerous chronic conditions. Maternal obesity is associated with pregnancy complications, infant mortality, and childhood obesity. The goals of this study were to assess obstetrics and gynecology (Ob-Gyn) providers' experiences, attitudes, and practices pertaining to obesity counseling and to identify target areas for further training. METHODS: A needs assessment survey was distributed to 85 Ob-Gyn providers at a mid-sized academic medical center. Participants included physicians, trainees, and advanced practice providers. RESULTS: One quarter (25.6%) of respondents had never been trained to communicate with patients about obesity while 43.6% had not received training beyond medical or professional school. Fewer than half (45.2%) said they were at least somewhat comfortable addressing the topic of obesity, and only 18% felt at least somewhat successful (0% felt very successful). Providers who were more comfortable talking about obesity were also more confident about their patients' success, as well as their own success in counseling patients. A majority of providers (52.1%) discuss obesity often or always with pregnant patients with obesity (PWOs), while only 27.0% discuss obesity often or always with non-pregnant PWOs. Comorbidities and severity of obesity were the two most influential factors in deciding whether to discuss obesity. Pregnancy status and upward trend in weight gain were also important factors. CONCLUSION: These findings were used to design department-wide educational and faculty development opportunities intended to improve provider comfort and efficacy in discussing obesity.