Health Services For Women Research Articles

In search of 'community': a critical review of community mental health services for women in African settings.

Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.

Community pharmacies to provide women's health services in Scotland

Community pharmacies to provide women's health services in Scotland

Minangkabau matrilineal society perception of pregnant women's health services

Minangkabau matrilineal society perception of pregnant women's health services

"Nuns Don't Get Cervical Cancer": A Reproductive-Justice Approach to Understanding the Cervical-Cancer Prevention Crisis in Ireland

"Nuns Don't Get Cervical Cancer":A Reproductive-Justice Approach to Understanding the Cervical-Cancer Prevention Crisis in Ireland Beth Sundstrom (bio) From 2015 to 2018 scandals surrounding the human papilloma-virus (HPV) and cervical-cancer screening in the Republic of Ireland revealed serious deficiencies in the nation's health-care system. A misinformation campaign conducted in 2015 about the HPV vaccine resulted in a sharp decline in Irish vaccination levels, and in 2018 Ireland's CervicalCheck screening program was revealed to be flawed. In the Scally Report (2018), a scoping inquiry into the problems at CervicalCheck, key informants pointed to the significant gendered failings of the Irish health-care system, noting that "there is a history of looking at women's health services as being secondary," "women and women's rights are not taken seriously," and "paternalism is alive and well." The report identified the need for expert and committed attention to women's issues within the health-care system.1 Through an analysis of two scandals, the CervicalCheck screening program and the HPV-vaccination-misinformation campaign, this study investigates the cervical-cancer prevention crisis in Ireland through the lens of reproductive justice. HPV vaccination and cervical screening are health behaviors that illuminate the intersection of oppressions based on race, ethnicity, socioeconomic position, ability, [End Page 292] age, gender, sexual orientation, and immigration status.2 These categories are best analyzed through an approach that foregrounds concepts of reproductive justice, underscoring intersectional oppressions in women's health care and advocating for truth telling as resistance. Indeed, this article is among the first studies to apply a reproductive-justice approach to the issues surrounding cervical-cancer prevention and HPV vaccination. Both the CervicalCheck screening program and the misinformation campaign about HPV vaccinations were rooted in unethical communication by the state and nongovernmental actors. Unethical communication is ingrained in hegemonic, paternalistic sociopolitical practices that mirror narratives of oppression based on gender, ethnicity, and nationality.3 By contrast, ethical communication is "socially oriented, empathically situated, and responsive to others."4 In the midst of Ireland's cervical-cancer prevention crisis, women and public-health advocates confronted unethical communication through digital intersectional communication by engaging in storytelling and truth telling about health, illness, and the body to confront, challenge, and change Ireland's health-care system. By privileging the voices of activists and experts in this article, I argue that the ways in which women and public-health advocates confronted the cervical-cancer prevention crisis in Ireland may be understood as a triumph of truth telling over the failure of unethical communication. Methods This qualitative study was part of a larger research project investigating reproductive justice in Ireland. This project offers a novel multiple-methods approach incorporating a variety of sources. Through a Fulbright U.S. Scholars Grant, I completed document analysis, interviews with activists, and participant observation in Ireland from [End Page 293] September to December 2018. Developing convergence of multiple sources of evidence provided data triangulation. To strengthen the reliability of the study, I followed Yin's principles to maintain a chain of evidence and organize the data collected for the study into an evidentiary base that included documents, field notes, interview transcriptions, and narrative compilations.5 I received institutional review-board approval for this research. The document-analysis portion of the study includes an investigation of published documentation on cervical-cancer prevention, including archival records and physical artifacts as well as traditional and social media. Archival research was conducted at the Boole Library, University College Cork, in its archival holdings of the records of the Attic Press, which included materials from the Irish women's movement covering the 1970s to the 1990s. I also conducted qualitative in-depth interviews with fifteen Irish activists working on reproductive justice; the quotations from activists in this article come from these interviews. In order to maintain the confidentiality of participants, all quotes from these interviews are included anonymously in this article. I also completed more than twenty hours of informal meetings and participant observation with experts and activists in Ireland. I collected publicly accessible documents (e.g., websites, press releases, reports, tweets, Facebook posts, YouTube videos, etc.) from twenty women's organizations. I...

Supplemental Material for Preconception Health Services for Women With Opioid Use Disorder (OUD): A Review and Best Practice Recommendation

Supplemental Material for Preconception Health Services for Women With Opioid Use Disorder (OUD): A Review and Best Practice Recommendation

Quality of life among women veterans.

Of 23 million US veterans, 2 million are women. Female veterans often have physical and mental health disorders, but only 6.5% use the Veterans Health Administration (VA) system. Health care for women veterans is challenging in a health care system unfamiliar with this population. The purpose of this study was to investigate how receipt of treatment by female veterans at a VA women's health specialty clinic affected levels of distress, quality of life (QOL), and depression. A retrospective record review was completed on 51 female veterans between the ages of 40 and 60 years attending a VA clinic. The clinic provides comprehensive women's health services to female veterans. Multiple linear regression models were fit to explore QOL and depression levels with socioeconomic status, parity, years of service, and military sexual trauma (MST). Female veterans had significantly lower baseline scores for QOL than did a comparison group. The only significant predictor associated with higher health-related symptom scores at baseline was a history of MST (β = 0.363; t = 2.44; p = .02). Means and standard deviations for total scores were significantly higher than those of the comparison group. Higher symptom scores indicated lower QOL among female veterans. Study findings suggested that timely, comprehensive, gender-specific health care can significantly improve overall QOL and depression levels. Nurse practitioners play a leading role in providing primary care to this population with significant potential to impact QOL, depression levels, and overall health of female veterans.

Comprehensive Women Health Services at Beverage-Producing Industries of Limpopo (South Africa): Women's Perspective.

(1) Background: Women remain highly vulnerable to numerous risks at work, including labor rights violations, violence and harassment, myriad general and reproductive health risks. The availability of the comprehensive services remains the only hope for these women, yet very little is known about their perspective. (2) Aim: To determine the experiences of women regarding the availability of comprehensive women’s health services in the industries of Limpopo (South Africa). (3) Methods: The project adopted the qualitative research method to determine the experiences of women related to the availability of comprehensive women’s health services. Non-probability purposive and convenience sampling was used to select 40 women employed in two beverage producing industries. A semi-structured interview with an interview guide was used to collect data that were analyzed using thematic analysis. (4) Results: Four themes emerged about the available health services in the two industries; diverse experiences related to available women’s health services, knowledge related to women’s health services, and diverse description of women’s health services practice and risks. The themes are interpreted into ten sub-themes. (5) Conclusions and Recommendations: There is a lack of available comprehensive women health services at the two beverage producing industries. Thus, women face challenges regarding accessing comprehensive women’s reproductive health care services as well as being exposed to health hazards such as burns, bumps, injuries and suffering from inhalation injuries and burns from moving machines, noise, slippery floors, and chemicals that are used for production in the industry. Women expressed dissatisfaction in the industries regarding the provided general health and primary healthcare services that have limited women’s health-specific services. We recommended that the industries should prioritize designing and developing the comprehensive women health services that to enable women at the industries to have access to good-quality reproductive health care and effective interventions.

Mental Health Diagnoses and Opioid Use Among Women with Chronic Pelvic Pain and Endometriosis

Study Objective To examine the differences in mental health diagnoses and opioid use in reproductive-age women with a diagnosis of endometriosis or chronic pelvic pain (CPP) compared to a general gynecology population. Design Retrospective cohort study of women evaluated in 2016 in a women's health service line of a large hospital system. One year of proceeding data and three years of follow up data were analyzed. Setting Women who presented for care to a women's health service providers at a large hospital system. Patients or Participants 247,781 non-pregnant females aged 18-50 with records in the electronic medical system (EMR) in year 2016 were analyzed in this study. Interventions N/A Measurements and Main Results Women with a diagnosis of endometriosis (3,883) and CPP (21,619) had significantly increased rates of depression (17.7% and 16.6% respectively), post-traumatic stress disorder (1.2% and 1.1%) and anxiety (25.4% and 21.5%) as compared to the general gynecology population rate of depression (11.1%), PTSD (0.6%), and anxiety (15.5%; all p Conclusion In addition to screening women with CPP and endometriosis for mental health disorders, surgery for excision of endometriosis in women with a diagnosis of endometriosis should be considered as a modality to decrease rates of substance abuse in this population. This data underscores the importance of a multidisciplinary approach to optimize care for these patients.

Implementasi E-Government Kulon Progo: Inovasi Dinas Kesehatan Melalui Aplikasi BumilKU 2019

Based on Indonesia committement on sustainable development, health improvement is a prominent issue. As an implementation of public service innovation, the Kulon Progo Regional Government through the Health Office plays a role in improving the quality of health services for pregnant women by creating the BumilKU application. Considering the importance of measuring the role of organizational performance on aspects of public service quality which refers to the e-government paradigm, this study aims to explain the performance of local governments in providing services to pregnant women through the BumilKU application. The data used in this study came from interviews, document studies, and literature studies related to research discussions. Based on several indicators of organizational performance measurement, pregnant women's health services utilize and use the BumilKU application effectively and efficiently. During the use of the application, the Health Office gets results according to the expected performance targets. Although the use of the BumilKU application did not significantly reduce the maternal mortality rate in 2019, based on the aspect of monitoring the condition of pregnant women in Kulon Progo, the performance of the Health Office has improved compared to the previous year. Services for pregnant women are carried out according to procedures and received good response from the community.

Improving Preventive Care for Women through a Provider Reminder Tool.

To determine the association of utilization of health maintenance tables (HMTs) as a provider reminder tool within the electronic medical record with the completion of women's preventive health services. Guidelines from the US Preventive Services Task Force and the Advisory Committee on Immunization Practices were used to create the HMT. The study sample consisted of female patients between 18 and 74 years of age who visited the University of Florida Internal Medicine Clinic at Medical Plaza between February 15, 2016 and June 24, 2016. We determined whether a reminder system was used for each visit and whether the following preventive health services were up to date: breast cancer screening, cervical cancer screening, and human papillomavirus vaccination. χ2 tests of independence were performed to compare the number of up-to-date preventive measures associated with each provider reminder type. We divided the visits into four groups based on the type of provider reminder used: the HMT, the computer-generated reminder .HM, simple annotation, and no reminder. Compared with .HM, no reminder, and all non-HMT, HMT utilization had a statistically significant positive association with the completion of breast and cervical cancer screening and human papillomavirus vaccination. The difference between the HMT and simple annotation groups did not achieve statistical difference, however. Despite well-established, evidence-based guidelines for screening tests and immunizations effective in reducing cancer-related morbidity and mortality, significant gaps in routine preventive care remain. The HMT may be a provider-friendly and cost-effective reminder tool to enhance the preventive health care of women.

Gravidez no puerpério: os fatores que contribuem para uma gestação no ciclo puerperal

O objetivo deste estudo foi analisar os fatores que mais contribuíram para a gravidez no puerpério. Tratou-se de uma pesquisa descritiva exploratória de abordagem qualitativa, que foi realizada no serviço de Saúde da mulher de dois municípios do interior do Estado do Rio de Janeiro e no Ambulatório de Medicina Integrada de um Hospital Escola, no setor de obstetrícia, com uma amostra de 30 mulheres, onde estas foram entrevistadas para a coleta de dados na atenção ao objetivo proposto. Os dados foram analisados mediante a categorização de respostas. Participaram da pesquisa 30 mulheres, na faixa etária predominante 40%, em relação ao número de filhos 27% relataram 04 ou mais filhos, sobre o intervalo de tempo entre as gestações 50% relataram 01 anos de intervalo e 67% relataram que a gravidez não foi planejada. Foram criadas três categorias de análise dos dados a saber: a) Comunicação ineficaz com puérperas em relação a prevenção de gravidez precoce; b)A falta do planejamento familiar como parte integral no cuidado à saúde da puérpera; e c) A falta de dedicação no uso dos métodos contraceptivos após a gestação. Concluiu-se que de acordo com a amostra do estudo que os fatores que mais influenciam para a gravidez no puerpério estão ligados a ausência de comunicação, falta de planejamento familiar tendo como consequência também fator contribuinte a falta de dedicação em relação à anticoncepção no puerpério.

Spatial barriers as moral failings: What rural distance can teach us about women's health and medical mistrust

Policy attention to growing rural “health care deserts” tends to identify rural distance as a primary spatial barrier to accessing care. This paper brings together geography, health policy, and ethnographic methods to instead theorize distance as an expansive and illuminating concept that highlights place-based expertise. It specifically engages rural women's interpretations of rural distance as a multifaceted dimension of accessing health care, which includes but is not limited to women's health services and maternity care. Presenting qualitative research with 51 women in a rural region of the U.S., thematic findings reveal an interpretation of barriers to rural health care as moral failings rather than as purely spatial or operational challenges, along with wide communication of negative health care experiences owing to spatially-disparate but trusted social networks. Amid or owing to the rural crisis context, medical mistrust here emerges as a meaningful but largely unrecognized barrier to rural women's ability—and willingness—to obtain health care. This underscores how a novel interpretation of distance may inform policy efforts to address rural medical deserts.

Medical abortion.

Medical abortion (using mifepristone followed by misoprostol to end an early pregnancy) isa more accessible and less invasive option than surgical termination and can be provided in primary care settings. However, few general practitioners (GPs) currently provide this service, and there remains great inequity in access to abortion across Australia, particularly foryoung women and those living in rural and remote area. The aim of this article is to help Australian GPs better understand the practical and legal considerations of providing medical abortion to patients. Provision of medical abortion is well within the scope of community general practice and improves the comprehensiveness of women's sexual and reproductive health services that GPs can deliver. This article will help GPs to better understand the process involved in providing medical abortion, including the practical considerations for patients; be better equipped to support patients who have decided that medical abortion is an appropriate choice for them; and make aninformed decision as to whether to become a provider of medical abortion.

The Effect of Antepartum Depression on the Outcomes of Pregnancy and Development of Postpartum Depression: A prospective cohort study of Omani women.

ObjectivesThis study aimed to identify the relationship between antenatal depression and pregnancy outcomes, including the risk of developing postpartum depression in Oman.MethodsThis follow-up prospective longitudinal cohort study included pregnant women attending primary healthcare institutions in Muscat, Oman from January to November 2014. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal and postnatal depression. Pregnant Omani women with a gestational age ≥32 weeks attending 12 local health centres for antenatal care in Muscat were invited to participate. Recruited women were followed-up at 6–8 weeks after delivery. The following pregnancy outcomes were assessed: mode of delivery (normal or Caesarean section [CS]), gestational age at delivery (preterm or full-term), baby’s birth weight and development of postnatal depression.ResultsA total of 959 women participated in this study (response rate: 97.3%). In total, 233 women (24.4%) had antenatal depression with a score of ≥13 on the EPDS. Of the 592 participants (61.7%) who attended postnatal clinics at 6–8 weeks post-delivery, 126 (21.3%) were positive for postnatal depression. Logistic multivariate regression analysis showed that antenatal depression was associated with increased risk of CS (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.20–2.66) and postnatal depression (OR = 8.63; 95% CI: 5.56–13.39).ConclusionScreening women for antenatal depression and providing appropriate management may reduce adverse pregnancy outcomes and the risk of developing postnatal depression.

How Collaborative Practice Agreements Impede the Administration of Vital Women's Health Services.

Women's health services delivered by nurse practitioners (NP) and certified nurse-midwives (CNM) are safe and effective, often providing a crucial point of access in underserved regions. However, restrictive and unnecessary regulatory requirements, such as collaborative practice agreements, create artificial barriers to practice. This analysis used a subsample of respondents from a large national study focused on the common challenges and practice restrictions introduced by collaborative practice agreements. This cohort included respondents licensed in all 22 states that place some level of restriction on one or both roles. This study used univariable and multivariable logistic regression to examine the financial and administrative constraints collaborative practice agreements place on NPs and CNMs. The median fee to establish a collaborative agreement was $500 (n = 25; interquartile range [IQR], $175-$1200; range, $30-$3000). The monthly median fee to maintain a collaborative agreement was $500 (n = 29; IQR, $250-$1200; range, $100-$2000). NPs and CNMs working in rural areas and remotely are more likely to encounter barriers to practice. Similarly, the loss or lack of supervising physicians and fees were also identified as impediments to care. Removing unnecessary regulatory requirements permits NPs and CNMs to be full market participants, thereby allowing them to address health care disparities in women's health and primary care settings. Targeted legislative efforts should seek to improve access to these vital services and re-establish evidence-based patient care and safety best practices as the drivers of health care regulation.

The Determination Of The Factors And Expectations Which Affect The Utilization of Health Services In Women: A Qualitative Research

Aim: To determine the behaviors, expectations and experiences about health-sickness of women from society, to evaluate the socio-cultural characteristics of these behaviors. Method: This research is qualitative, planned as “case study”. The research is sampled as goal-oriented maximum variation and 31 women included who are between 17-77 with different socio-cultural characteristics. Four focused interviews were conducted. Before the study, participants were informed and a questionnaire was used to question socio-demographic characteristics. The interviews were made at participants’ houses. One interviewer and two observers was ready in each session. The voice recordings and observers’ notes were trasncripted. No names have been transcribed. Each of the interviews were analyzed thematically, were commonised to reach research findings. Results: According to the analysis, there are five theme topics. 1. Physician (professionalism) characteristics affecting the choice of doctor (skills, attitude, gender, knowledge). 2. Expectations and behaviours about services related to women's health (afraid of the examination style, expectations of confidentiality and sympathy, prejudices). 3. Reasons for choosing health institutions (attitude of health workers, gender of doctor, hospital facilities, accessibility, prejudices, queue waiting). 4. Unmet health needs and thoughts about the causes (fear of malpractice, shyness, financial impossibilities, advanced appointments). 5. Attitudes on Family Health Centers (reasons for not using: lack of equipment, crowd, existing habits, doctor’s attitude, distrust to doctor's knowledge). The participants repeated that dental health services are the most difficult to obtain. Conclusion: Socio-cultural characteristics, health services presentation and attitude of health workers influences expectations of individuals about utilization of health services. Therefore, when planning trainings of health workers, the applicants' health perceptions affected by the socio-cultural characteristics, learning methods which allows the development of a positive attitude and improves communication skills should be considered. Also, in the organization of health services, taking into account the factors affecting applicants' utilization of health services will be effective for the elimination the unmet needs. Amaç: Bu çalışma, toplumumuzdaki kadınların sağlık ve hastalık davranışlarını, beklentilerini ve bu alanda yaşadıklarını ortaya koymayı ve bu davranışların sosyo-kültürel özelliklerini değerlendirmeyi amaçlamaktadır. Yöntem: Araştırmamız niteliksel tipte olup, “durum çalışması” şeklinde planlanmıştır. Araştırmaya amaca yönelik maksimum çeşitlilik örneklemesi ile farklı sosyokültürel özelliklere sahip 17-77 yaş aralığındaki 31 kadın dahil edilmiştir. Çalışmada 7-8 kişilik dört odak grup görüşmesi gerçekleştirilmiştir. Çalışma öncesi katılımcılar bilgilendirilmiş, sosyo-demografik özellikleri sorgulayan bir anket uygulanmıştır. Görüşmeler katılımcıların bu amaç için toplandığı evlerde yapılıp, ses kayıt cihazı ile kayıt altına alınmış; kişi-yer isimleri kayıtlara geçmemiştir. Görüşmelerde bir görüşmeci, iki gözlemci hazır bulunmuştur. Her odak görüşme, kayıt ve gözlemci notları çözümlenerek tematik analiz edilmiş, kodlar üzerinde tartışılıp, ortaklaştırılarak bulgulara erişilmiştir. Bulgular: Ortaklaştırma sonrası ortaya çıkan 5 tema şöyledir: 1. Doktor seçimini etkileyen hekimlik (Profesyonellik) özellikleri (beceri, tutum, tavır, cinsiyet, bilgi). 2. Kadın sağlığı hizmetlerine özgü beklentiler ve davranışlar (muayene şeklinden çekinme, mahremiyet ve anlayış beklentisi, önyargı). 3. Sağlık kurumlarını tercih etme/etmeme nedenleri (sağlık personelinin tavrı, doktorun cinsiyeti, hastanenin imkânları, ulaşılabilirlik, önyargılar, sıra bekleme). 4. Karşılanamayan sağlık ihtiyaçları ve nedenlerine ait düşünceler (komplikasyon korkusu, utangaçlık, maddi olanaksızlık, ileri tarihli randevular). 5. Aile Sağlığı Merkezleri ile ilgili tutumlar (yararlanamama nedenleri olarak donanım eksikliği, kalabalık, var olan alışkanlık, doktorun tavrı, doktorun bilgisine güvensizlik). Katılımcıların ulaşmakta güçlük çektiği hizmetler içinde en sık tekrar eden ifade “diş sağlığı” olmuştur. Sonuç: Bireylerin sağlık hizmetlerinden yararlanmasını sosyokültürel özellikleri, sağlık hizmetlerinin sunum şekli ve sağlık çalışanlarının tutumu ile ilgili beklentileri etkilemektedir. Dolayısıyla sağlık çalışanlarının mesleki eğitimleri planlanırken başvuranların sağlık algısını etkileyen sosyokültürel özelliklerin dikkate alınması, iletişim becerilerini geliştiren ve olumlu tutum gelişimini sağlayan öğrenme yöntemlerinin kullanılması düşünülmelidir. Ayrıca sağlık hizmetlerinin örgütlenmesinde, başvuranların sağlık hizmetlerinden yararlanmasını etkileyen nedenlerin dikkate alınması karşılanmayan gereksinimlerin giderilmesi açısından etkili olacaktır.

Factors associated with long-acting reversible contraception use among women Veterans in the ECUUN study

ObjectivesThe objective of this study is to understand patient-, provider- and system-level factors associated with long-acting reversible contraception (LARC) use among women Veterans and with receipt of LARC methods within the Veterans Affairs (VA) system. Study designWe analyzed data from a national telephone-based survey of 2302 women ages 18–44 receiving primary care in VA. Multivariable regression was used to examine adjusted associations of participant-reported patient-, provider- and facility-level factors with LARC use and within-VA receipt of LARC among women Veterans. ResultsAmong 987 women Veterans at risk of unintended pregnancy, 294 (30%) reported using LARC, 65% of whom had received their method within VA. Higher LARC use was observed among women who were multiparous vs. nulliparous [adjusted odds ratio (aOR)=1.52; 95% confidence interval (CI)=1.04–2.22] and did not desire future pregnancies (aOR=1.88; 95% CI=1.31–2.68). Although overall LARC uptake was not associated with any provider- or facility-level factors, receipt of these methods within VA was associated with receiving both general and gender-specific health care by a single provider (aOR=2.81; 95% CI=1.20–6.61) and with receiving care within a women's health clinic (aOR=2.54; 95% CI=1.17–5.50). ConclusionsWhile patient-level factors were more strongly correlated with use of LARC, provider- and system-level factors influence whether women received these methods within VA. ImplicationsThis study of patient-, provider- and system-level correlates of LARC use in VA, the country's largest integrated healthcare system, highlights that women Veterans share similar patient-level factors associated with LARC use as the general population and that continuity with providers and comprehensive women's health services can facilitate LARC access.

The Effect of Ammuntuli BijaTianang Na Beja-Beja Model on Knowledge, Motivation, and Attitude of Pregnant Women's Health Services in Jeneponto District, indonesia

The Effect of Ammuntuli BijaTianang Na Beja-Beja Model on Knowledge, Motivation, and Attitude of Pregnant Women's Health Services in Jeneponto District, indonesia

Foundations for the development and implementation of a women's and perinatal health information model for management in Latin AmericaFundamentos do desenvolvimento e implementação de um modelo de informação em saúde da materna e perinatal orientado à gestão na América Latina

RESUMENObjetivoEl Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN).MétodosEl estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial.ResultadosSe identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital.ConclusionesEste modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.

Obesity and Disparities in Human Papillomavirus Vaccination for U.S. Adolescent Girls and Young Women.

Obesity is recognized as a barrier to receiving women's preventive health services, including cervical and breast cancer screening. Little is known about whether obesity is associated with a lower incidence of human papillomavirus (HPV) vaccination, another important preventive care service for adolescent girls and young women. The objective of this study was to determine if adolescent girls and young women with obesity are less likely to receive HPV vaccination compared with individuals with normal weight. We examined whether HPV vaccination was associated with obesity status in women aged 9-30years surveyed from 2009 to 2016 by the U.S. National Health and Nutrition Examination Survey. Results from logistic and linear regression models were adjusted for age, race, income, insurance status, self-reported health, and health care use, accounting for the weighted survey design. The final cohort included 5,517 women. Overall, 32.9% of participants reported vaccination, with a mean age at vaccination of 15.8years. Adolescent girls and young women with obesity were less likely to report vaccination; the adjusted odds ratio of vaccination was 0.79 (p=.01) compared with normal weight women. Among those vaccinated, the age at vaccination was significantly older for women with obesity, 16.3years compared with 15.2years (p=.002), but there was no difference in the completion of the vaccination series rate by obesity. Adolescent girls and young women with obesity were less likely to report HPV vaccination and, if they were vaccinated, received the vaccination at a later age.