Women's Health Care Research Articles

Use of a Computerized Decisional Analysis Tool in Patients With Urgency Urinary Incontinence.

Decision analysis tools (DAT) are shared decision making instruments that include patient input on treatment goals and values that have been shown to decrease decisional regret in women's health care. We describe a novel, computerized DAT for patients with urinary incontinence (UI), and our primary aim was to assess the concordance between treatment fit as determined by the DAT and treatment selected after physician counseling in patients with urgency urinary incontinence and urgency predominant mixed urinary incontinence. We partnered with a health care startup to develop a computerized DAT incorporating evidence about UI and patient input about treatment goals and personal values. This is a retrospective cohort study examining the concordance of DAT-predicted treatments identified before consultation with the physician and those chosen after counseling. Electronic medical records were reviewed to abstract demographic, clinical data, and treatments chosen at the initial physician consultation. Because it was possible to pursue concurrent treatment options (ie, pelvic floor physical therapy and medications), the first 2 modalities identified in the treatment plan at consultation were abstracted. Descriptive statistics were conducted using SPSS®, we did not adjust for multiple comparisons. Four hundred eighty-nine patients met the inclusion criteria for our study, and 65% of the cohort chose treatment options after counseling that were concordant with their DAT best treatment fit. Patients choosing treatment for urgency urinary incontinence and urgency predominant mixed urinary incontinence using a novel, computer-based DAT to prepare for shared decision making with their physicians often choose to proceed with their top DAT-determined treatment fit after counseling.

PkM Kesehatan Reproduksi Perempuan Dalam Perspektif Ekonomi

Health and productivity are equally important and interconnected. Health is a primary asset. Without good health, achieving productivity becomes challenging. During the peak of the pandemic, funds were redirected from women's and girls' health to other life-saving services. There was also a lack of awareness and general prioritization. This led to a significant funding gap in women's healthcare. Furthermore, the lack of funding for women's health research means that specific challenges or diseases affecting women and girls remain unaddressed. They contribute economically and enrich their nation's wealth. Additionally, they play a crucial role in fostering intergenerational progress, thereby creating more opportunities for their children. An economy that neglects women and girls will widen the gender parity gap. Prioritizing the health of women and girls is a crucial path to building a healthier economy, society, and community. Identifying the issue, aiming to understand why women lack understanding regarding reproductive health issues linked to the post-pandemic economic perspective, is an effort to prioritize health, especially reproductive health. The implementation of Community Service Program (PKM) is carried out through an online webinar via Zoom Meeting link and YouTube on Saturday, February 25, 2023. This activity is in the form of a planned training in partnership with the Cipayung sub-district as part of the university's development efforts, involving an Obstetrician-Gynecologist doctor. The target audience includes lecturers, students, and the general public from all over Indonesia, with a total of 238 participants, including professors, students, nurses, midwives, and the public. Participants comprehend the provided material, engage in discussions, and pose questions about women's reproductive health from an economic perspective.Keywords: Community Service Program (PKM), Reproductive Health, Economy, Women.

Women's Health Care Committee, Japan Society of Obstetrics and Gynecology: Annual report-2023.

The Women's Health Care Committee was established in 2010 with the goal of improving women's health. In the current academic year, there are six subcommittees focusing on conducting the following surveys: (1) the current status of pregnancy-associated breast cancer in Japan; (2) surgery for disorders of sex development; (3) diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder; (4) obstetrics and gynecology-based treatment for patients with eating disorders in Japan; (5) multi-drug-resistant bacterial infections in the field of obstetrics and gynecology; and (6) changing the methodology of the treatment of dysmenorrhea and continuing medical education. The activities of each subcommittee are described below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2023;75(6):662-86).

Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States.

Bacterial vaginosis (BV) is a highly prevalent vaginal infection. Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary.

Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare.

Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services. Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts. Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities. Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed.

Understanding primary care perspectives on supporting women's health needs: a qualitative study.

A consultation for the Women's Health Strategy for England in 2022 highlighted a need to understand and develop how general practice can support women's health needs. To understand the perspectives and experiences of primary care practitioners (PCPs) about supporting women's healthcare needs. Interpretive qualitative research set in general practice in England. PCPs working in general practice settings were recruited through research and professional networks. Semi-structured interviews were conducted via telephone or Microsoft Teams, audiorecorded, transcribed verbatim, and analysed through reflexive thematic analysis. In total, 46 PCPs were interviewed. Participants had a range of roles and worked in a variety of primary care settings. Results are presented within six themes: 1) being alongside a person from cradle to grave; 2) maintaining the balance between general and specialist skills; 3) generalists and specialists combined make more than the sum of their parts; 4) striving for equity in a collapsing system; 5) firefighting with limited resources; and 6) the GP is being cast as the villain. The findings show that relationships and advocacy are valued as fundamental for women's health in general practice, and highlight the adverse impact of threats to these on staff and services. Developing specialist roles and bespoke services can foster staff wellbeing and could support retention. However, care is needed to ensure that service configuration changes do not result in clinician deskilling or rendering services inaccessible. Care is needed when services evolve to ensure that core aspects of general practice are not diminished or devalued. GP teams are well placed to advocate for their patients, including commitment to seeking equitable care, and these skills and specialist knowledge should be actively recognised, valued, and nurtured.

Abortion law in Aotearoa New Zealand.

This article outlines the history of abortion law in Aotearoa New Zealand from colonial times to the present. The struggle for law reform has been long and difficult, with marches and rallies, protests and placard-waving, and firebombing of abortion clinics. Aotearoa New Zealand elections have been fought on this issue. Abortion was regulated here under the Crimes Act until 2020. Finally, after 150 years, procuring an abortion in Aotearoa New Zealand is no longer a crime, it is a women's healthcare issue along with others relating to women's reproductive health, including obstetric, contraceptive, sexually transmitted disease and other gynaecological care. The new law promotes autonomy, reproductive health, patient safety and health equity. The abortion struggle serves as an illustration of our changing political and social landscape, with a public move from conservative towards more liberal values. However, the issue continues to divide people, and events in the United States have shown how quickly change can occur, with their Supreme Court overturning Roe v Wade and states now banning abortions. We should not be complacent.

YONIDHAWAN KARMA IN KAPHAJ YONIVYAPDA: LITERATURE REVIEW

A healthy woman is a promise to a healthy family & woman's health status is a complex arrangement controlled by a range of factors headed by her reproductive system. Infections pertaining to yoni are a burning problem for women irrespective of their age & socio-economic status. For the woman, it becomes very irritating as it affects her concentration & hampers her day-to-day life. It may lead to psychological upset, depression and thus affect a woman’s personality. In Ayurveda, gynaecological disorders have found immense importance in the field of medicine due to the fact that women have that unique ability to give birth. In Ayurveda, woman's healthcare is described in a separate section under the name of yonivyapada, including the majority of gynaecological disorders. The complaints of kaphaj yonivyapad are Yonigata strav, kandu, picchila strav, aplavedana, avedana 1 For the treatment of Kaphaja Yonivyapda Stanikchikitasa like Yonidhavan, Yonidhupan, Vartidharan, Yonipuran, Yoniprakshalan describe in Sanhita. Out of this, Yonidhavan found it effective in Kaphaj Yonivyapada. Yonidhavan means cleaning or purification of the yoni. Here effort has been put forth to make a conceptual study of Yonidhavan Karma in Kaphaj Yonivyapda.

Women's desires for mental health support following a pregnancy loss, termination of pregnancy for medical reasons, or abortion: A report from the STRONG Women Study

ObjectiveWe report on women's mental health care desires following a miscarriage, medical termination, or abortion. Method689 women completed a questionnaire on reproductive history, health care following miscarriage/medical termination/abortion, and current mental health. Descriptive statistics and logistic regression analyses examined: miscarriage/termination/abortion incidence, desires for mental health support following miscarriages/terminations/abortions, and current mental health. ResultsOf 365 women with a pregnancy history, 37% reported ≥1 miscarriage, 9% ≥1 medical termination, 16% ≥1 abortion, and 3% endorsed all three. Current mental health did not differ between women with a history of miscarriage/termination/abortion and those with only live births (p = 0.82). Following miscarriage, 68% of women discussed options for the medical management of pregnancy loss with their provider, 32% discussed grief/loss, and 25% received mental health care recommendations. Engagement in mental health services was reported by 16% of women with a history of miscarriage, 38% after medical termination, and 19% following an abortion. Of women who became pregnant after their most recent miscarriage/termination/abortion and did not receive mental health care, 55% wished they had received services during the subsequent pregnancy. ConclusionsWomen desire mental health care after miscarriages, medical terminations, or abortions, warranting improved access to mental health care for these individuals.

Perception of women in relation to self-image and structural chauvinism in a reference service in Pernambuco

We sought to understand the implications of structural chauvinism in the perception of women's self-image. We opted for a cross-sectional, qualitative and exploratory cohort approach, with women aged 19 to 25 years in an outpatient clinic that is a reference in women's health care, from November 2022 to May 2023. Data were collected through semi-structured, audio-recorded interviews, and transcribed. Data analysis was guided by the content analysis technique performed by Bardin. The sample included 10 women, with an average age of 21.8 years and all declared themselves as black or brown. Of the ten participants, one is transsexual and nine are cisgender. The categories revealed, through the women's reports, that they recognize the existence of machismo, but with a distance from its crossings in their lives. There was also a lack of awareness about the relevance of self-image, and a closer look at this dimension of the female psyche. It is understood that there is a long way to go in understanding this phenomenon, as well as in health professionals' strategies for prevention and intervention in women's health care.

Health care professionals' self-efficacy in identifying and treating human trafficking victims

BackgroundHuman trafficking is characterized as a violation of human rights that exploits males and females of any age for personal or financial gain. Recently, health care professionals have been identified as feasible change agents in this global issue. However, many health care professionals are not trained in identifying and treating human trafficking victims. Through human trafficking education, health care professionals have the potential to be better equipped to recognize and assist trafficking victims and guide them to the specialized care they need. ObjectiveThe purpose of this study was to measure the effect of a trauma-informed human trafficking education intervention and the impact of this training on the self-efficacy of health care professionals in identifying and recognizing human trafficking victims in healthcare settings. DesignThe study was a quasi-experimental research design with snowball and convenience recruitment Setting100 % virtual, online. ParticipantsHealth care professionals (N = 30) including Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Certified Medical Assistants, Certified Nursing Assistants, Emergency Medical Technicians, and Paramedics from a variety of healthcare settings. Methods30 min total program to include Qualtrics pre-intervention Violence Against Women Health Care Provider survey, 20 min educational intervention on YouTube©, and an identical Qualtrics post-intervention survey. ResultsTotal of 30 sets of paired data. The results showed statistically significant improvement in self-efficacy in all survey questions pre- and post-human trafficking educational intervention (p < .001). ConclusionsAn increase in health care professionals' self-efficacy in identifying and treating human trafficking victims yields better patient and health care system outcomes. Trauma-informed human trafficking education for all health care professionals is recommended.

Étude prospective sur 46 patientes de la pratique de l’IVG chirurgicale entre 14 et 16 SA : parcours de soins et complications

ObjectiveThis study aims to characterize the women's health care pathway and to evaluate the rate of complications during a surgical abortion according to the technique of dilatation and evacuation between 14 and 16 SA. MethodSingle-center prospective study at the Armand Trousseau Hospital with inclusion of women who had an abortion between 14 and 16 GA in the Obstetrics & Gynecology Department of the Armand Trousseau Hospital between March 2 and October 31, 2022. ResultsForty-six women underwent an abortion during this 8-month period. The average gestational age at which the abortions were performed was 15 weeks’ gestation with an median delay of 14.0 days between the date of discovery of the pregnancy and the date of the abortion with more than half of the women (65.2 %, N=30) having consulted for the first time for an abortion request before 14 weeks’ gestation. Of these women, 22 (48.9%) had to consult several hospitals before being treated. One woman (2.2% 95% CI [0.0–6.4]) had a haemorrhage defined by bleeding more than 500ml. Cervical suture for cervical tear was performed in four women (8.7% 95% CI [0.0–16.8]). There were no complications such as perforation, postoperative infection or surgical revision. No women were transfused. ConclusionThe introduction in our center of surgical abortion using the dilatation and evacuation technique performed between 14 and 16 weeks’ gestation wasn’t accompanied by significant morbidity. The women's pathway before the procedure probably contributed to the later performance of the abortion.

Women's wellness in the mountains: An exploration of medicinal plants among tibeto-burman groups in Thailand

Ethnopharmacological relevanceThis study offers valuable insight into the traditional healing practices of women's healthcare within four Tibeto-Burman groups. By focusing on women's wellness, the research sheds light on the often-neglected yet significant contributions made by women in the field of traditional medicine. Aims of the studyThe study seeks to address the gap of studies on the ethnobotany of women healthcare of the Tibeto-Burman groups in Thailand and to analyst the factors that could affect the diversity of ethnobotanical knowledge. Materials and methodsThe study compiled data from 15 group-informants residing in 12 different villages. The information gathering process involved a combination of free-listing, semi-structured interviews, group discussion, and the walk-to-the-wood method. To analyze the data, the researchers used various methods such as use-reports, Relative Frequency of Citation (RFC), Relative Importance Index (RI), and Cluster analysis. ResultsThis study identified 200 plant species used in traditional women's healthcare practices, with leaves being the most frequently used part. Drinking was the most common method for internal use, while bathing and steam were the most emphasized for external use. Blumea balsamifera and Buddleja asiatica had high RI and RFC. Cluster analysis revealed that group-informants were divided by ethnicity and geographical location. ConclusionThis study contributes to the understanding of traditional healthcare practices among Tibeto-Burman groups in Thailand, with a particular focus on women's wellness. The results provide insight into the ethnobotanical knowledge of these communities and highlight the important role played by women in traditional medicine. The study underscores the need for continued research in this field to preserve and utilize this valuable knowledge.

The "oldest and the newest of nurses": Nursing and the Professionalization of Obstetrics and Gynecology.

When in the late nineteenth century American physicians increasingly replaced midwives in the care of obstetrical and gynecological patients, they could do so only because they were aided by another emerging group of healthcare professionals: nurses. Nurses were instrumental in assisting physicians in the care of patients in labor and during recovery. They were also necessary for male physicians because the vast majority of nurses were women and their presence during gynecological and obstetrical treatments made it more socially acceptable for men to examine female patients. In hospital schools in the northeast and through long-distance nursing programs, physicians taught students about obstetrical nursing and instructed them to protect the modesty of female patients. They also tried to instill strict professional hierarchies between nurses and physicians, emphasizing that nurses should never attempt to deliver a patient without a physician. But as nursing emerged into a unique professional practice separate from that of physicians, nurses were able to negotiate better education in the care of laboring patients. In order to take over women's sexual and reproductive health care from traditional providers, physicians conceded to nurses' demands for more authority in patient care.

Efficient Metabolic Fingerprinting of Follicular Fluid Encodes Ovarian Reserve and Fertility.

Ovarian reserve (OR) and fertility are critical in women's healthcare. Clinical methods for encoding OR and fertility rely on the combination of tests, which cannot serve as a multi-functional platform with limited information from specific biofluids. Herein, metabolic fingerprinting of follicular fluid (MFFF) from follicles is performed, using particle-assisted laser desorption/ionization mass spectrometry (PALDI-MS) to encode OR and fertility. PALDI-MS allows efficient MFFF, showing fast speed (≈30 s), high sensitivity (≈60 fmol), and desirable reproducibility (coefficients of variation <15%). Further, machine learning of MFFF is applied to diagnose diminished OR (area under the curve of 0.929) and identify high-quality oocytes/embryos (p < 0.05) by a single PALDI-MS test. Meanwhile, metabolic biomarkers from MFFF are identified, which also determine oocyte/embryo quality (p < 0.05) from the sampling follicles toward fertility prediction in clinics. This approach offers a powerful platform in women's healthcare, not limited to OR and fertility.

Executive Summary of the Ovarian Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention awarded funding to the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about ovarian cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in February 2022. This article is the executive summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of ovarian cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Resilience of Gynecological and Obstetric Inpatient Care in Central Germany in Times of Repetitive Socioeconomic Shocks-An Epidemiological Study Assessing Standardized Health Services Indicators and Economic Status According to the aG-DRG Catalog.

Sequential socioeconomic shocks, including the COVID-19 pandemic, economic recession, or energy and refugee crises in the face of violent conflicts, have led to the failure of healthcare systems in Europe. Against this background, the aim of this study was to evaluate the resilience of regional gynecological and obstetric inpatient care using the example of a regional core medical provider in central Germany. Base data were retrieved from Marburg University Hospital and underwent standardized calculation and descriptive statistical assessment pursuant to the aG-DRG catalog. The data illustrate a decline in the average length of patient stays and average case complexity in combination with increasing patient turnover for the six-year observation period of 2017-2022. Core profitability of the departments of gynecology and obstetrics deteriorated in the year of 2022. The results suggest weakened resilience of gynecological and obstetrics inpatient care in the setting of a regional core medical provider in central Germany and indicate how it may have failed in core economic profitability. This is consistent with predictions about the lack of resilience of health systems and the critical economic situation of German hospitals in the face of ongoing socioeconomic shocks that collaterally endanger women's health care.

Anticipated Impact of Dobbs v Jackson Women's Health Organization on Training of Residents in Obstetrics and Gynecology: A Qualitative Analysis.

On June 24, 2022, the Supreme Court of the United States in the case of Dobbs v Jackson Women's Health Organization ended constitutional protection for abortion, thus severely restricting access to reproductive health care for millions of individuals. Concerns have arisen about the potential impact on medical students, residents, and fellows training in restricted areas and the effect on gynecologic training and the future provision of competent comprehensive women's health care in the United States. To qualitatively explore the anticipated impacts of the Dobbs ruling on training in obstetrics and gynecology (OB/GYN). A participatory action research approach employing methods of qualitative analysis was used. Trainees and leaders in national OB/GYN professional and academic organizations with missions related to clinical care and training of medical students, residents, and fellows in OB/GYN participated. Two focus groups were held via Zoom in July 2022. Using an iterative process, transcripts underwent coding by 2 independent researchers to identify categories and common themes. Themes were organized into categories and subcategories. An additional reviewer resolved discrepancies. Twenty-six OB/GYN leaders/stakeholders representing 14 OB/GYN societies along with 4 trainees participated. Eight thematic categories were identified: competency, provision of reproductive health care, residency selection, inequity in training, alternative training, law-based vs evidence-based medicine, morality and ethics, and uncertainty about next steps. This qualitative study of leaders and learners in OB/GYN identified 8 themes of potential impacts of the Dobbs ruling on current and future training in OB/GYN.

Women's health nurses' experiences of menopause: Considerations for nurse leaders.

Women's health nurses' experiences of menopause: Considerations for nurse leaders.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.