Women's Health Providers Research Articles

Stress Urinary Incontinence

Dr. Nwanodi is Women's Health Provider, Myrtle Hilliard Davis Comprehensive Health Centers—Homer G. Philips Health Center, 2425 N. Whittier Street, St. Louis, MO 63113; E-mail: [email protected]. Unless otherwise noted, the faculty and staff's spouse(s)/life partner(s) (if any) have nothing to disclose. Dr. Nwanodi has disclosed that she was a member of the Covidien Clinical Advisory Board. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. The author has disclosed that the use of duloxetine, hormone therapy, functional electrical stimulation, vaginal cones, and incontinence pessaries for treatment of overactive bladder syndrome as discussed in this article has not been approved by the U.S. Food & Drug Administration. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This activity expires on May 30, 2012.

Referrals for Dental Care During Pregnancy

Oral health is essential to overall health in the prenatal period. Pregnancy is not a time to delay dental care. Several studies have shown an association between periodontal disease and poor pregnancy outcomes including preterm birth. Interventions to provide periodontal treatment to pregnant women yield inconsistent results regarding preterm birth but have established the safety of periodontal therapy during pregnancy. Postpartum women in poor dental health readily transmit the tooth decay pathogen Streptococcus mutans from their saliva to their infants, resulting in increased risk of early childhood caries. Preventive services and treatment for acute problems should be recommended, fears allayed, and women referred. Dental radiographs may be performed safely with the use of appropriate shielding. Nonemergent interventions are best provided between 14 and 20 weeks' gestation for comfort and optimal fetal safety. Most gravid women do not seek dental care. Increased interprofessional communication to encourage dentists to treat pregnant women will reduce the number of women without care. In states where it is available, Medicaid coverage of dental services for pregnant women is typically allowed during pregnancy and for 2 months postpartum. Women's health providers should understand the importance of protecting oral health during pregnancy and educate their patients accordingly.

Barriers to diaphragm use: the views of advanced practice nurses

Background and methodologyWomen have used the contraceptive diaphragm for decades. Although use has recently declined, the diaphragm may find a new role in STI/HIV and dual-prevention programmes when microbicides become...

A Guide for Preceptors of Advance Practice Nursing Students Caring for Women and Infants

Women's health care in the United States has been described as unsatisfactory and falling behind the Healthy People 2010 objectives. Inadequate health care due to a shortage of providers is especially problematic for women who are poor with lower socioeconomic status. Advanced practice nurses are well suited to address this need. In this article, preceptor and academic partnerships are discussed as strategies to make more qualified women's health and infant providers available.

Women's Health, Breast Health

Breast cancer is very common and seen in both premenopausal and postmenopausal women. Research into prevention, better screening, and more effective treatments is occurring continually, and changes are translated into clinical practice relatively quickly. It is important for women's health care providers to have an understanding of breast cancer treatments and the gynecologic side effects. For premenopausal women interested in fertility, options should be discussed prior to chemotherapy. Issues pertaining to pregnancy after breast cancer should be discussed in a multidisciplinary fashion, involving the obstetrician/gynecologist, breast surgeon, and oncologist. Ovarian suppression is often used as part of breast cancer treatment in premenopausal women with hormone positive disease, and menopausal symptoms may be severe. Hormonal therapies including tamoxifen and the aromatase inhibitors are used in the treatment of hormone positive breast cancers. Each of these drugs has a variety of gynecologic implications. Understanding the options for treatment for menopausal complaints in breast cancer patients is important for women's health providers. Although most breast cancers are sporadic, a small percentage will be due to mutations in the BRCA genes. It is important for women's health providers to take an appropriate family history and refer to genetic counselors for possible testing when hereditary cancer is suspected. This review focuses on the various women's health issues pertaining to breast cancer and treatment.

Availability of Gynecologic Services in the Department of Veterans Affairs

The optimum approach to providing the Congressionally mandated gender-specific services for which women veterans are eligible is unknown. We evaluated onsite availability of gynecologic services, clinic type and staffing arrangements, and the impact of having a gynecology clinic (GYN) and/or an obstetrician gynecologist (OBGYN) routinely available. We analyzed data from the 2001 national VHA Survey of Women Veterans Health Programs and Practices (n = 136 sites; response rate, 83%). We assessed availability of gynecologic services, and evaluated differences in availability by clinic type (designated women's health provider in primary care [PC], separate women's health clinic for primary care [WHC], and/or separate GYN) and staffing arrangements (OBGYN routinely involved versus not). Out of 133 sites, 77 sites (58%) offered services through a GYN and 56 sites (42%) did not have GYN. Seventy-two (54%) sites had a WHC. More sites with an OBGYN provided endometrial biopsies (91% vs. 20%), IUD insertion (85% vs. 14%), infertility evaluation (56% vs. 23%), infertility treatment (25% vs. none), gynecologic surgery (65 vs. 28%), p < .01. In comparison to sites without WHC, those with WHC were more likely to offer services onsite: endometrial biopsy odds ratio (OR) 6.0 (95% confidence interval [CI], 2.0-18.1); IUD insertion 4.4 (1.6-12.2); infertility evaluation 2.8 (1.2-6.3); and gynecologic surgery 2.3 (1.0-5.4). As the VA develops strategic plans for accommodating the growing number of women veterans, leaders should consider focusing on establishing WHC for primary care and routine availability of OBGYN or other qualified clinicians, rather than establishing separate GYN.

New therapeutic landscapes in Africa: Parental categories and practices in seeking infant health in the Republic of Guinea

In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. We draw on ethnographic research and illustrative evidence from 1550 ‘infant health biographies’ from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve.

The Impact of Lifestyle Risk Factors on Female Infertility

ABSTRACT Background: Over 2 million couples in the United States are infertile. The literature reflects a number of potential lifestyle risks that have been associated with the development of this condition; however, few studies have investigated these risks concurrently. With knowledge of the importance of behavioral threats to fertility, women's health care providers will be in a better position to screen and assist women to modify their fertility risks. Objectives: The objectives of this study were (1) to identify lifestyle factors associated with infertility in women by comparing a sample of infertile women with a group of fertile women and (2) to offer recommendations to women's health providers, on counseling women at risk for infertility. Methods: A re-examination of the 1995 National Survey of Family Growth (NSFG) allowed for the investigation of lifestyle factors associated with infertility in women. Using a conceptual model of health behavior to guide the selection of variables, together with multiple logistic regression techniques, an explanatory model of infertility was estimated on a sample of 824 women between the ages of 16 and 45 years. Results: Factors directly related to infertility included increasing age, a history of an ectopic pregnancy, current smoking, obesity, and self reported health status. Protective effects were associated with a history of condom use and having had a Pap smear in the last year. Conclusions and Implications: Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can utilize these visits to target appropriate interventions for initiating, repeating, and reinforcing messages on fertility risk.

IUD-related knowledge, attitudes and practices among Navajo Area Indian Health Service providers.

The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use--including those stemming from providers' IUD-related knowledge, attitudes and practices--could help expand use of the method. In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran-Mantel-Haenszel method. Overall, 69-78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty-five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type. Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.

Primary care of women: A guide for midwives and women's health providers

This weighty tome of 938 pages, at £44.99, addresses a diverse list of issues relevant to the health of women today. It has been edited by three American certified nurse midwives who hold professorships. Contributors to the book appear to have a multiplicity of qualifications, expertise and clinical and academic experience. This has resulted in a book that contains high quality information. Although written with American nurse midwives in mind, it will fill a distinct void in the availability of comprehensive text for British midwives on women's health issues. Similarly it would be useful for midwives who work comparably in other countries, as well as other health professionals with an interest in women's health. Student midwives will find the detail significantly beneficial.

Qualities and attributes desired in menopause clinicians

Objective To assess the qualities and attributes desired in menopause clinicians. Design Women ≥45 years of age ( n = 72) were surveyed about the qualities and attributes desired in their physician. Surveys were performed in physician waiting rooms in Connecticut. Results Although fewer men are entering the practice of ObGyn, more than 88% of peri- and post-menopausal women believe that gender does not affect the quality of their women's health provider. Among the 68 women from whom valid data were obtained, experience (95.6%), knowledge (95.6%), and ability (92.6%) were the most important qualities. Only 4.2% listed gender in the top three most important qualities. If the patient's visit was for wellness- and screening-related issues, 6.6% ( n = 4) preferred a male, 13.1% ( n = 8) preferred a female, and 80.3% ( n = 49) had no preference for gender. The percentage of patients preferring to see a female was slightly higher (29.2%) if the visit was for a pelvic exam, while the percentage preferring to see a male (14.5%) was greater if care involved gynecological surgery. Conclusions As medical practices meet the increasing demand of menopausal women, it is helpful to know the qualities and attributes that patients desire. Menopause clinicians should seek to convey experience, knowledge, and competence to their patients. A menopause practice should strive for a well-diversified team that will bring these qualities to menopausal patients. Given the shifting balance of male and female ObGyn providers, when hiring providers or establishing a menopause clinic, it is helpful to know that gender diversification is of minor importance.

Retirement among Florida's certified nurse-midwives: an impending workforce crisis

An anonymous survey was mailed to 499 CNMs in Florida in May 2001 to examine the impact of CNM retirement on the Florida women's health provider workforce and to estimate the replacement demand for CNMs. The survey also investigated where Florida's CNMs studied midwifery, reasons for choosing education programs, reasons for moving to Florida, and causes of underemployment of CNMs. Two hundred eighty respondents returned the survey. Thirty-nine percent of respondents received their midwifery education in Florida. Eighty-one percent of respondents were working as CNMs. From 2010 through 2025, an average of 11 CNMs in Florida will reach age 65 each year. These data indicate that retirement will generate demand for new CNMs in the next two decades. These data, along with future research tracking midwifery education, employment, and retirement, could be used to plan program funding, clinical site needs, and legislative support of midwifery.

Retirement Among Florida's Certified Nurse‐Midwives: An Impending Workforce Crisis

An anonymous survey was mailed to 499 CNMs in Florida in May 2001 to examine the impact of CNM retirement on the Florida women's health provider workforce and to estimate the replacement demand for CNMs. The survey also investigated where Florida's CNMs studied midwifery, reasons for choosing education programs, reasons for moving to Florida, and causes of underemployment of CNMs. Two hundred eighty respondents returned the survey. Thirty‐nine percent of respondents received their midwifery education in Florida. Eighty‐one percent of respondents were working as CNMs. From 2010 through 2025, an average of 11 CNMs in Florida will reach age 65 each year. These data indicate that retirement will generate demand for new CNMs in the next two decades. These data, along with future research tracking midwifery education, employment, and retirement, could be used to plan program funding, clinical site needs, and legislative support of midwifery.

The Transition to Web‐Based Education: Enhancing Access to Graduate Education for Women's Health Providers

Nurse‐midwives and women's health nurse practitioners have a long history as positive change agents in health care as well as education. This article chronicles the transition of a traditional face‐to‐face nurse‐midwife and women's health nurse practitioner graduate curriculum to a Web‐based format with campus seminars and clinical laboratories. This change was made to increase access to these graduate programs. A total of 20 courses, including both graduate core and specialty courses, was converted to the Web‐based format over a 3‐year period. Practical considerations for implementing a similar program, including faculty development and support, student orientation and ongoing support, development of a learning community, and time management, are discussed. The importance of listening to student feedback and partnering with them as the program continues to develop is emphasized as a key element of program evaluation and improvement.

The transition to web-based education: enhancing access to graduate education for women's health providers

Nurse-midwives and women's health nurse practitioners have a long history as positive change agents in health care as well as education. This article chronicles the transition of a traditional face-to-face nurse-midwife and women's health nurse practitioner graduate curriculum to a Web-based format with campus seminars and clinical laboratories. This change was made to increase access to these graduate programs. A total of 20 courses, including both graduate core and specialty courses, was converted to the Web-based format over a 3-year period. Practical considerations for implementing a similar program, including faculty development and support, student orientation and ongoing support, development of a learning community, and time management, are discussed. The importance of listening to student feedback and partnering with them as the program continues to develop is emphasized as a key element of program evaluation and improvement.

IUD-Related Knowledge, Attitudes and Practices Among Navajo Area Indian Health Service Providers

CONTEXT: The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use–including those stemming from providers’IUD-related knowledge, attitudes and practices–could help expand use of the method. METHODS: In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran-Mantel-Haenszel method. RESULTS: Overall, 69-78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty-five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type. CONCLUSIONS: Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.

IUD‐Related Knowledge, Attitudes and Practices Among Navajo Area Indian Health Service Providers

CONTEXT: The IUD once accounted for about half of contraceptive use among Navajo women but is now little used in this population, which has a high rate of unintended pregnancy. Identifying barriers to use–including those stemming from providers’IUD‐related knowledge, attitudes and practices–could help expand use of the method. METHODS: In 2000, 107 Navajo Area Indian Health Service providers who offer contraceptive services completed a mailed survey. Responses of women's health providers and other types of providers were compared, using the Cochran‐Mantel‐Haenszel method. RESULTS: Overall, 69‐78% of providers had good factual knowledge about the IUD and felt adequately prepared to insert a device or counsel women about it; considerably larger proportions of women's health providers than of others felt able to counsel about and insert IUDs. Sixty‐five percent of providers (88% of women's health providers and 50% of others) currently inserted IUDs, and only 8% (none of them women's health providers) never recommended the method. The main reasons providers cited for not recommending the IUD were concerns about its safety and about side effects (mentioned by 69% and 44%, respectively); these concerns did not differ by provider type. CONCLUSIONS: Provider education and training should focus on insertion techniques and on the safety of available IUDs. Training should be targeted not only to women's health providers, but to family practice physicians, nurse practitioners and other providers who offer family planning counseling and services.

Women’s health care: One size does not fit all

Women’s health care: One size does not fit all

Managed care and assessment of clinical outcomes.

While managed care strategies have been associated with reductions in the utilization of clinical resources, their impact on health care outcomes in general, and women's health services, in particular, remains unclear. This review summarizes recent literature regarding the impact of managed care on clinical resource use, outcomes of women's health services, and cost effectiveness of women's health care processes. Implications of these findings for women's health providers, women's health services and policy, and health services research are discussed.

Training in reproductive health and sexuality: the case of a regional program in Latin America.

Beginning in July 1993, a 5-year program has sought to provide social research, training, and technical assistance in reproductive health and sexuality in Argentina, Chile, Peru, and Colombia by 1) building research capacity and promoting an interdisciplinary approach to reproductive health and sexuality and 2) promoting a gender perspective to these issues. The target groups are women's nongovernmental organizations (NGOs); family planning, reproductive health, and women's health providers; and social scientists conducting health-related research. Training activities include regional workshops, a Regional Resident Fellowship Program to support graduate-level education, and provision of technical assistance. The first 3 years of the program have revealed that the basic training needs in these areas include 1) helping women's NGOs improve their record-keeping capacity, evaluation processes, theoretical and methodological background, and institutional-building ability; 2) sensitizing women's health providers to sociocultural dimension of health-illness issues and to a gender and human rights perspective; and 3) training social scientist researchers to apply their skills in applied research, develop their theoretical background, and improve research quality control procedures. The main challenges for training activities in the field of reproductive health and sexuality are posed by the complexity of the issues and their interdisciplinary nature.