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1.
BMC Pregnancy Childbirth ; 21(1): 198, 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33691651

RESUMEN

BACKGROUND: In November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women's empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women's empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women's empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model. METHODS: The most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women's empowerment captured in the DHS. The 30 variables on women's empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results. RESULTS: The proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women's empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries. CONCLUSION: This study highlights the significant impact of women's empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.


Asunto(s)
Empoderamiento , Conductas Relacionadas con la Salud , Aceptación de la Atención de Salud , Mujeres Embarazadas/psicología , Atención Prenatal , Mejoramiento de la Calidad/organización & administración , Adulto , África del Sur del Sahara/epidemiología , Demografía , Femenino , Salud Global/normas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Primer Trimestre del Embarazo , Atención Prenatal/métodos , Atención Prenatal/psicología , Atención Prenatal/normas , Salud de la Mujer/normas
2.
BMC Pregnancy Childbirth ; 21(1): 192, 2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33676440

RESUMEN

BACKGROUND: Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA. METHODS: We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates. RESULTS: The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa. CONCLUSION: The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.


Asunto(s)
Accesibilidad a los Servicios de Salud/normas , Servicios de Salud Materna , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Prenatal , Determinantes Sociales de la Salud , África del Sur del Sahara/epidemiología , Factores Epidemiológicos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Servicios de Salud Materna/normas , Servicios de Salud Materna/estadística & datos numéricos , Embarazo , Atención Prenatal/organización & administración , Atención Prenatal/normas , Atención Prenatal/estadística & datos numéricos , Mejoramiento de la Calidad/organización & administración , Población Rural , Determinantes Sociales de la Salud/normas , Determinantes Sociales de la Salud/estadística & datos numéricos , Salud de la Mujer/normas
5.
Diabetes Res Clin Pract ; 172: 108654, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33422587

RESUMEN

AIMS: To undertake a qualitative study of a multimodal behavioural intervention and research protocol developed to improve wellness in women with type 2 diabetes mellitus (T2DM), the Women's Wellness with Type 2 Diabetes program (WWDP). METHODS: Semi-structured interviews were conducted with 15 participants who completed the WWDP. The interviews were transcribed verbatim and analysed thematically in an iterative process. RESULTS: Themes developing from interviews were broadly grouped into three domains, 1) Hope for a better everyday life; 2) Reflection of the program and its contents; and 3) Impacts on health and wellbeing. Participants viewed the WWDP as a necessary and valuable approach that was crucial in helping them adopt strategies to improve their wellbeing and prevent complications associated with T2DM. Some participants expressed ambivalence towards their adherence to the program due to day-to-day life commitments. The most appreciated feature of the program were the individualised approach adopted by the consultation nurse via skype, convenient appointments, the provision of credible and factual information and the accessible website. CONCLUSIONS: This study critically evaluated perceptions of participants towards the WWDP and provided important recommendations for improving the delivery and sustainability of the program in future. Participants perceived the program as an effective means of supporting their T2DM self-management and improving wellbeing.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Promoción de la Salud/métodos , Salud de la Mujer/normas , Anciano , Australia , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Reino Unido
8.
J Med Internet Res ; 22(4): e15906, 2020 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-32271152

RESUMEN

BACKGROUND: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. OBJECTIVE: The objective of our study was to describe online health information-seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. METHODS: The study population included 72,806 women aged 65 years and older enrolled in the Women's Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. RESULTS: Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% [38,481/42,887] vs 87% [26,017/29,919]), earned a higher income (over $US 50,000: 55% [23,410/42,887] vs 33% [9991/29,919]), achieved a higher educational level (more than high school: 87% [37,493/42,887] vs 75% [22,377/29,919]), and were more likely to live with a partner (52% [22,457/42,887] vs 36% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information-seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information. CONCLUSIONS: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources.


Asunto(s)
Enfermedad Crónica/epidemiología , Conducta en la Búsqueda de Información/fisiología , Telemedicina/métodos , Salud de la Mujer/normas , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
9.
Int J Equity Health ; 19(1): 55, 2020 04 25.
Artículo en Inglés | MEDLINE | ID: mdl-32334577

RESUMEN

BACKGROUND: Reduction of health gaps between ethno-cultural groups has become a major concern for health services, with a strong emphasis on eliminating social and cultural barriers and improving accessibility for diverse populations. METHODS: The study is based on a Participatory Action Research where an involved researcher accompanied the project for a decade, as well as on eleven in-depth interviews with Bedouin women-mediators working in a perinatal health promotion project in Israel. RESULTS: The research analyzes the work of Bedouin women health mediators who mediate between their Bedouin community and institutional health services and bridge over cultural gaps. The study presents the complex task of transferring messages across cultures, dealing with socio-cultural imperatives and the intricacy of multilayered power relations. The findings reveal an evolving process, beginning with a pragmatic mediation model in which the mediators are limited to instruction of pre-defined health materials, toward a transformative model of creating a ground for encouraging the mediators to act creatively according to socio-cultural circumstances. CONCLUSION: The research elaborates on the adoption and implementation of the transformative approach in mediation and provides further understanding of the complexity of mediation role in sensitive issues such as pregnancy, birth and infant care.


Asunto(s)
Árabes/psicología , Asistencia Sanitaria Culturalmente Competente/normas , Guías como Asunto , Promoción de la Salud/métodos , Accesibilidad a los Servicios de Salud/normas , Atención Perinatal/normas , Salud de la Mujer/normas , Adulto , Actitud Frente a la Salud , Femenino , Humanos , Israel , Persona de Mediana Edad , Embarazo , Adulto Joven
11.
Obstet Gynecol ; 135(5): 1059-1068, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32282602

RESUMEN

We aim to make evident that solely referencing cisgender women in the context of sexual and reproductive health-particularly pregnancy planning and care-excludes a diverse group of transgender and gender nonbinary people who have sexual and reproductive health needs and experiences that can be similar to but also unique from those of cisgender women. We call on clinicians and researchers to ensure that all points of sexual and reproductive health access, research, sources of information, and care delivery comprehensively include and are accessible to people of all genders. We describe barriers to sexual and reproductive health care and research participation unique to people of marginalized gender identities, provide examples of harm resulting from these barriers, and offer concrete suggestions for creating inclusive, accurate, and respectful care and research environments-which will lead to higher quality health care and science for people of all genders.


Asunto(s)
Atención a la Salud/normas , Accesibilidad a los Servicios de Salud , Servicios de Salud para las Personas Transgénero/normas , Servicios de Salud Reproductiva/normas , Salud de la Mujer/normas , Atención a la Salud/métodos , Femenino , Humanos , Masculino , Embarazo , Salud Reproductiva/normas , Personas Transgénero
12.
BMC Cancer ; 20(1): 247, 2020 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-32209062

RESUMEN

BACKGROUND: Increased knowledge of breast cancer risk factors has meant that we are currently exploring risk-based screening, i.e. determining screening strategies based on women's varying levels of risk. This also enables risk management through primary prevention strategies, e.g. a lifestyle programme or risk-reducing medication. However, future implementation of risk-based screening and prevention will warrant significant changes in current practice and policy. The present study explores women's perceptions of the implementation and organisation of risk-based breast cancer screening and prevention to optimise acceptability and uptake. METHODS: A total of 143 women eligible for breast cancer screening in the Netherlands, the United Kingdom, and Sweden participated in focus group discussions. The focus group discussions were transcribed verbatim and the qualitative data was analysed using thematic analysis. RESULTS: Women from all three countries generally agreed on the overall proceedings, e.g. a risk assessment after which the risk estimate is communicated via letter (for below average and average risk) or consultation (for moderate and high risk). However, discrepancies in information needs, preferred risk communication format and risk counselling professional were identified between countries. Additionally, a need to educate healthcare professionals on all aspects of the risk-based screening and prevention programme was established. CONCLUSION: Women's insights identified the need for country-specific standardised protocols regarding the assessment and communication of risk, and the provision of heterogeneous screening and prevention recommendations, monitoring the principle of solidarity in healthcare policy.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/prevención & control , Implementación de Plan de Salud/métodos , Salud de la Mujer/normas , Anciano , Detección Precoz del Cáncer/normas , Femenino , Grupos Focales , Comunicación en Salud , Personal de Salud/educación , Humanos , Persona de Mediana Edad , Países Bajos , Investigación Cualitativa , Gestión de Riesgos , Suecia , Reino Unido
13.
Artículo en Inglés | MEDLINE | ID: mdl-32150950

RESUMEN

Menarche is the first occurrence of a woman's menstruation, an event that symbolizes reproductive capacity and the transition from childhood into womanhood. The global average age for menarche is 12 years and this has been declining in recent years. Many factors that affect the timing menarche in girls could be affected by climate change. A systematic literature review was performed regarding the timing of menarche and four publication databases were interrogated: EMBASE, SCOPUS, PubMed, and Cochrane Reviews. Themes were identified from 112 articles and related to environmental causes of perturbations in menarche (either early or late), disease causes and consequences of perturbations, and social causes and consequences. Research from climatology was incorporated to describe how climate change events, including increased hurricanes, avalanches/mudslides/landslides, and extreme weather events could alter the age of menarche by disrupting food availability or via increased toxin/pollutant release. Overall, our review revealed that these perturbations in the timing of menarche are likely to increase the disease burden for women in four key areas: mental health, fertility-related conditions, cardiovascular disease, and bone health. In summary, the climate does have the potential to impact women's health through perturbation in the timing of menarche and this, in turn, will affect women's risk of disease in future.


Asunto(s)
Cambio Climático , Menarquia , Salud de la Mujer , Niño , Femenino , Humanos , Menarquia/fisiología , Salud de la Mujer/normas , Salud de la Mujer/tendencias
14.
Clin Chest Med ; 41(1): 53-65, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32008629

RESUMEN

Lung cancer in women is a modern epidemic and a major health crisis. Cigarette smoking remains the most important risk factor for lung cancer, and unfortunately smoking rates are either stabilized or continue to increase among women. Women may not be more susceptible to the carcinogenic effects of tobacco, but the biology of lung cancer differs between the sexes. This paper summarizes the biological sex differences in lung cancer, including molecular abnormalities, growth factor receptors, hormonal influences, DNA repair capacity, as well as differences in the histology and treatment outcomes of lung cancer in women.


Asunto(s)
Neoplasias Pulmonares/epidemiología , Salud de la Mujer/normas , Femenino , Humanos , Neoplasias Pulmonares/patología , Factores de Riesgo
16.
Support Care Cancer ; 28(8): 3847-3854, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31836939

RESUMEN

INTRODUCTION: Breast cancer (BC) and its treatment is associated with several physical and psychosocial changes that may influence sexuality for years after treatment. Women with BC show significantly greater rates of sexual dysfunction than do healthy women. The purpose of the study was to evaluate how a BC diagnosis associates with women's perceived sexuality and sexual satisfaction. MATERIAL AND METHODS: The data of the ongoing prospective Health and Social Support (HeSSup) survey was linked with national health registries. Respondents with registry data confirmed BC (n = 66), mental depression (n = 612), arterial hypertension (n = 873), and healthy women (n = 9731) formed the study population. The importance of and satisfaction with sex life were measured by a self-report questionnaire modified from the Schover's and colleagues' Sexual History Form. RESULTS: Women with BC considered sex life less important than did healthy women (p < 0.001). They were significantly less satisfied with their sex life than healthy women (p = 0.01) and women with arterial hypertension (p = 0.04). Living single or educational level did not explain the differences between the groups. CONCLUSIONS: BC survivors depreciate their sex life and experience dissatisfaction with it. Sexuality can be a critical issue for the quality of life of women surviving from BC, and hence, the area deserves major attention in BC survivorship care. Health care professionals should regularly include sexual functions in the assessment of BC survivors' wellbeing.


Asunto(s)
Neoplasias de la Mama/psicología , Supervivientes de Cáncer/psicología , Depresión/psicología , Hipertensión/psicología , Calidad de Vida/psicología , Salud de la Mujer/normas , Anciano , Estudios de Casos y Controles , Estudios de Cohortes , Estudios Transversales , Femenino , Finlandia , Humanos , Orgasmo/fisiología , Satisfacción Personal , Estudios Prospectivos , Autoinforme
19.
Curr Pharm Teach Learn ; 11(11): 1167-1171, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31783964

RESUMEN

BACKGROUND: While pharmacists should be aware of gender and sex-related differences in treatment related decisions, this is not a required doctor of pharmacy curricular component. A regional pilot study demonstrated that approximately half of pharmacy practice faculty discussed these differences in their content area. The aim of this study was to evaluate the extent of inclusion of gender and sex-related differences on a national level in doctor of pharmacy curricula and to determine if faculty are comfortable teaching the topic. METHODS: An electronic message with a link to an online survey was distributed to 7250 faculty members at 139 colleges of pharmacy. The survey remained open for three weeks and potential participants received weekly email reminders. The survey was voluntary, and responses were de-identified. RESULTS: Overall, 641 faculty participated in the survey (8.8% response rate). Most respondents indicated that they do not teach about gender or sex-related differences (54.9%). Of those faculty reporting teaching gender and/or sex-related differences, 28% indicated that it was addressed in one clinical topic, while some (7.7%) indicated that the content was included in up to five topics. Half of faculty (53.6%) indicated that they believe this topic is somewhat important. CONCLUSIONS: Results of this study suggest that gender and sex-related differences are not adequately addressed in current pharmacy curricula.


Asunto(s)
Curriculum/estadística & datos numéricos , Docentes de Farmacia/educación , Docentes/normas , Farmacéuticos/estadística & datos numéricos , Concienciación , Curriculum/tendencias , Educación en Farmacia/métodos , Femenino , Identidad de Género , Empleos en Salud/ética , Humanos , Masculino , Proyectos Piloto , Facultades de Farmacia/estadística & datos numéricos , Caracteres Sexuales , Estudiantes de Farmacia/estadística & datos numéricos , Encuestas y Cuestionarios , Enseñanza/tendencias , Universidades , Salud de la Mujer/normas
20.
Med Anthropol ; 38(8): 695-709, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31821057

RESUMEN

In Salvador-Bahia, many Black lesbians are deeply concerned about how gynecologists dismiss or demean their sexuality, which often leads to prolonged lapses in gynecological care. Black lesbians who identify as virgins in particular are confronted with challenges that reveal entrenched normativity within the gynecological clinic. In this article, I examine Black lesbian virginity as a site of vivência Negra (Black woman's existence or lived experience) during the gynecological encounter. In response to such encounters, Black lesbians assess their inhumane treatment by way of anti-racist knowledge production. The resulting anti-racist evaluations serve to identify and decenter white heteronormativity in gynecology.


Asunto(s)
Grupo de Ascendencia Continental Africana , Minorías Sexuales y de Género , Salud de la Mujer/normas , Antropología Médica , Brasil , Femenino , Examen Ginecologíco , Ginecología , Homosexualidad Femenina , Humanos , Estilo de Vida , Prejuicio , Salud Sexual , Percepción Social
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