Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study.

BACKGROUND: Young adult sex workers may benefit from sexual and reproductive health care services; however, little research has examined their access experiences. This study aimed to assess barriers to and facilitators of access to sexual and reproductive health care among young adult sex workers, and identify practices suggested by participants to improve services. METHODS: This was a community-based mixed-methods study of adults aged 18-29 years who were currently or had previously been engaged in sex work, conducted in Toronto in 2017-2018. The study was guided by a Youth Advisory Committee of 4 youth with lived experience of sex work. Participants completed an online survey, or participated in a focus group or a one-on-one interview; all 3 modalities included parallel questions about barriers to and facilitators of access to sexual and reproductive health care. We summarized quantitative data using descriptive statistics and identified qualitative themes using thematic analysis, followed by triangulation of the 2 strands. RESULTS: There were 54 survey respondents (response rate 48%) and 17 participants in the qualitative phase (14 in focus groups and 3 in interviews), for a total sample size of 71. Survey respondents reported suboptimal access to sexual and reproductive health care, with 8 (15%) reporting no regular source of care, and only 6 (11%) reporting that they disclose their sex work experience to providers. Actual or expected stigma regarding sex work on the part of providers was the dominant barrier to care, whereas nonjudgmental providers, particularly those who themselves have sex work experience, was a key facilitator. Participants suggested 7 practices to improve access to sexual and reproductive health care. INTERPRETATION: Young adult sex workers face many barriers to accessing sexual and reproductive health care. Including people with sex work experience in the development of solutions will maximize the capacity to address the needs of this underserved population.

A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age

More women postpone childbearing nowadays while female fertility begins to decline with advancing age. Furthermore, with the rolling out of the two­child policy, there is a huge demand for a second child for Chinese aged women. There are various assisted reproductive technology (ART) strategies applied for age­related infertility without solid evidence. On behalf of the Society of Reproductive Medicine, Chinese Medical Association, we would like to develop a Chinese guideline of ART strategies for age­related infertility. This guideline was produced following the recommendations for standard guidelines described in the 2012 WHO Handbook for guideline development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. A protocol was formulated and a Guideline Development Group was formed with specialists of reproductive medicine, methodologists from Chinese GRADE working group, and patient representative. Questions regarding the ART strategies for aged infertility were formulated and 8 most important ones were chosen to be structured in PICO format (Population, Intervention, Comparison, Outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria and be categorized as high, moderate, low, or very low. Twenty­five recommendations were formulated among members of the Guidelines Development Group (Delphi method) basing on the overall quality of the evidence, in addition to the balance between benefits and harms, values and preferences, and resource implications. The final recommendations were agreed on by consensus during face­to­face meetings. This is the first Chinese practice guideline in reproductive medicine developed following the standard and scientific method.

Is there an association between spatial accessibility of outpatient care and utilization? Analysis of gynecological and general care.

BACKGROUND: In rural regions with a low population density, distances to health care providers as well as insufficient public transport may be barriers for the accessibility of health care. In this analysis it was examined whether the accessibility of gynecologists and GPs, measured as travel time both by car and public transport has an influence on the utilization of health care in the rural region of Western Pomerania in Northern Germany. METHODS: Utilization data was obtained from the population based Study of Health in Pomerania (SHIP). Utilization was operationalized by the parameter "at least one physician visit during the last 12 months". To determine travel times by car and by public transport, network analyses were conducted in a Geographic Information System (GIS). Multivariate logistic regression models were calculated to identify determinants for the utilization of gynecologists and GPs. RESULTS: There is no significant association between the accessibility by car or public transport and the utilization of gynecologists and GPs. Significant predictors for the utilization of gynecologists in the regression model including public transport are age (OR 0.960, 95% CI 0.950-0.971, p < 0.0001), social class (OR 1.137, 95% CI 1.084-1.193, p < 0.0001) and having persons ≥18 years in the household (OR 2.315, 95% CI 1.116-4.800, p = 0.0241). CONCLUSIONS: In the examined region less utilization of gynecologists is not explainable with long travel times by car or public transport.

Rural women and violence situation: access and accessibility limits to the healthcare network. / Mulheres rurais e situações de violência: fatores que limitam o acesso e a acessibilidade à rede de atenção à saúde.

OBJECTIVE: To analyze the access and accessibility to the healthcare network of women dwelling in rural contexts undergoing violence situation, as seen from the professionals' speeches. METHOD: A qualitative, exploratory, descriptive study with professionals from the healthcare network services about coping with violence in four municipalities in the northern region of Rio Grande do Sul. The information derived from interviews, which have been analyzed by thematic modality. RESULTS: (Lack of) information of women, distance, restricted access to transportation, dependence on the partner and (lack of) attention by professionals to welcome women undergoing violence situation and (non)-articulation of the network are factors that limit the access and, as a consequence, they result in the lack of confrontation of this problem. CONCLUSION: To bring closer the services which integrate the confrontation network of violence against women and to qualify professionals to welcome these situations are factors that can facilitate the access and adhesion of rural women to the services.

Mulheres rurais e situações de violência: fatores que limitam o acesso e a acessibilidade à rede de atenção à saúde / Mujeres rurales y situaciones de violencia: límites de acceso y accesibilidad a la red de atención de salud / Rural women and violence situation: access and accessibility limits to the healthcare network

RESUMO Objetivo Analisar o acesso e a acessibilidade à rede de atenção às mulheres em situação de violência, residentes em contextos rurais, a partir dos discursos de profissionais. Métodos Estudo qualitativo, exploratório descritivo, com profissionais dos serviços da rede de atenção à violência de quatro municípios da região norte do Rio Grande do Sul. As informações foram geradas por meio de entrevistas realizadas entre agosto e dezembro de 2014 e analisadas pela modalidade temática. Resultados (Des)informação das mulheres, distância, acesso restrito ao transporte, dependência do companheiro, (des)atenção dos profissionais para acolher as mulheres em situação de violência e (des)articulação da rede são fatores limitantes do acesso e têm como consequência o não enfrentamento dessa problemática. Conclusão Aproximar os serviços que integram a rede de atenção à violência contra a mulher e qualificar os profissionais para acolher essas situações pode facilitar o acesso e a adesão das mulheres rurais a esses serviços.

RESUMEN Objetivo Analizar el acceso y la accesibilidad a la red de atención de las mujeres en situación de violencia, residentes en contextos rurales, desde los discursos de los profesionales. Método Estudio cualitativo, exploratorio descriptivo, con profesionales de los servicios de la red de atención en el enfrentamiento a la violencia en cuatro municipalidades de la región norte de Rio Grande do Sul. Se generaron las informaciones por medio de entrevista que fueron analizadas según la modalidad temática. Resultados (Des)información de las mujeres, distancia, acceso restricto a transporte, dependencia del compañero, (des)atención de los profesionales para acoger a las mujeres en situación de violencia así como (des)articulación de la red son factores que limitan el acceso y, a consecuencia, resultan en la falta de enfrentamiento de esa problemática. Conclusión Aproximar los servicios que integran la red de enfrentamiento de la violencia contra la mujer y calificar a los profesionales para acoger desde la perspectiva de género pueden facilitar el acceso y la adhesión de las mujeres rurales a los servicios.

ABSTRACT Objective To analyze the access and accessibility to the healthcare network of women dwelling in rural contexts undergoing violence situation, as seen from the professionals' speeches. Method A qualitative, exploratory, descriptive study with professionals from the healthcare network services about coping with violence in four municipalities in the northern region of Rio Grande do Sul. The information derived from interviews, which have been analyzed by thematic modality. Results (Lack of) information of women, distance, restricted access to transportation, dependence on the partner and (lack of) attention by professionals to welcome women undergoing violence situation and (non)-articulation of the network are factors that limit the access and, as a consequence, they result in the lack of confrontation of this problem. Conclusion To bring closer the services which integrate the confrontation network of violence against women and to qualify professionals to welcome these situations are factors that can facilitate the access and adhesion of rural women to the services.

ACOG Committee Opinion No. 649: Racial and Ethnic Disparities in Obstetrics and Gynecology.

Projections suggest that people of color will represent most of the U.S. population by 2050, and yet significant racial and ethnic disparities persist in women's health and health care. Although socioeconomic status accounts for some of these disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women's health outcomes. The American College of Obstetricians and Gynecologists is committed to the elimination of racial and ethnic disparities in the health and health care of women and encourages obstetrician-gynecologists and other health care providers to engage in activities to help achieve this goal.

The health of women and girls: how can we address gender equality and gender equity?

This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. Various strategies to address the health of women and girls have been developed at intergovernmental, regional, and national level, and by international nongovernmental organizations. These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policy arenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy.

What happens the morning after? The costs and benefits of expanding access to emergency contraception.

Emergency contraception (EC) can prevent pregnancy after sex, but only if taken within 72 hours of intercourse. Over the past 15 years, access to EC has been expanded at both the state and federal level. This paper studies the impact of those policies. We find that expanded access to EC has had no statistically significant effect on birth or abortion rates. Expansions of access, however, have changed the venue in which the drug is obtained, shifting its provision from hospital emergency departments to pharmacies. We find evidence that this shift may have led to a decrease in reports of sexual assault.

Medición de calidad de vida: en pacientes con cáncer de mama avanzado. Servicio de Medicina Paliativa y Oncología Hospital San Roque de Córdoba

Este trabajo se inicia a partir de mi vivencia diaria como oncóloga, en un grupo de pacientes con características tan diversas en cuanto a personalidad, entorno familiar, nivel cultural y socioeconómico; pero con algo en común: su dolencia por un cáncer avanzado y la necesidad de ser atendidos. El objetivo es advertir la importancia de la calidad de vida de pacientes con cáncer de mama metastásico. Se realizó un estudio observacional transversal de pacientes del Hospital San Roque de Córdoba con datos aportados por entrevistas a través de un cuestionario de calidad de vida diseñado ad hoc. Se realizaron observaciones referidas a la consulta del paciente, el control del dolor y el acompañamiento familiar, las cuales son determinantes en el control de los síntomas.La investigación permitió identificar individuos más vulnerables respecto a condiciones de calidad de vida. Estos se asociaron con menor acompañamiento familiar, falta de consulta con profesionales en Salud Mental, no así con su equipo médico con las que todas manifestaron conformidad y seguridad.

This report is based on my daily experience as an oncologist doctor, with a group of patients with many differences, in their personalities, family structures, education and culture, and economic and social characteristics; but, they all have something in common: their pain caused by and advanced cancer and the need for attention. The target is to warm the importance of a life quality in metastatic breast cancer patient´s health. A cross- observational study was accomplished in Cordoba´s Hospital San Roque patients with information collected from interviews based on a life quality questionnaire ad hoc. The patient´s consultations, the control of the pain, and the family accompaniment were observed, as determinant factors in the control of the symptoms. This investigation allowed identifying the most vulnerable individuals in respect of life quality conditions. These were associated with lower family accompaniment, lack of professional consultations in mental health. In opposition, they showed themselves satisfied and safe with the medical team.

[Effective coverage to manage domestic violence against women in Mexican municipalities: limits of metrics]. / Cobertura efectiva del manejo de la violencia contra mujeres en municipios Mexicanos: límites de la métrica.

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

Assessing the health care needs of women in rural British Columbia: development and validation of a survey tool.

OBJECTIVE: To design reliable survey instruments to evaluate needs and expectations for provision of women's health services in rural communities in British Columbia (BC). These tools will aim to plan programming for, and evaluate effectiveness of, a women's health enhanced skills residency program at the University of British Columbia. DESIGN: A qualitative design that included administration of written surveys and on-site interviews in several rural communities. SETTING: Three communities participated in initial questionnaire and interview administration. A fourth community participated in the second interview iteration. Participating communities did not have obstetrician-gynecologists but did have hospitals capable of supporting outpatient specialized women's health procedural care. PARTICIPANTS: Community physicians, leaders of community groups serving women, and allied health providers, in Vancouver Island, Southeast Interior BC, and Northern BC. METHODS: Two preliminary questionnaires were developed to assess local specialized women's health services based on the curriculum of the enhanced skills training program; one was designed for physicians and the other for women's community group leaders and aboriginal health and community group leaders. Interview questions were designed to ensure the survey could be understood and to identify important areas of women's health not included on the initial questionnaires. Results were analyzed using quantitative and qualitative methods, and a second draft of the questionnaires was developed for a second iteration of interviews. MAIN FINDINGS: Clarity and comprehension of questionnaires were good; however, nonphysician participants answered that they were unsure on many questions pertaining to specific services. Topics identified as important and missing from questionnaires included violence and mental health. A second version of the questionnaires was shown to have addressed these concerns. CONCLUSION: Through iterations of pilot testing, we created 2 validated survey instruments for implementation as a component of program evaluation. Testing in remote locations highlighted unique rural concerns, such that University of British Columbia health care professional training will now better serve BC community needs.

'Patience, hormone replacement therapy and rain!' Women, ageing and drought in Australia: narratives from the mid-age cohort of the Australian Longitudinal Study on Women's Health.

OBJECTIVE: This paper explores women's experiences of drought in Australia. Despite the significance of drought for rural life in Australia, there is little research seeking to understand its psychological consequences. There is also a need to recognise gendered experiences of drought and for research that addresses its long-term effects as people age in prolonged drought-affected areas. DESIGN: The study explores longitudinal qualitative data collected by the Australian Longitudinal Study on Women's Health. Free-text comments (n = 217), collected via mailed survey at five time points (1996, 1998, 2001, 2004, 2007) from the same 77 women, were subjected to a narrative analysis. PARTICIPANTS: Participants from the Australian Longitudinal Study on Women's Health who were aged 45-50 when the study began in 1996. RESULTS: Findings indicate that drought has an impact on women as they age, particularly in reference to menopause, access to support systems and retirement. CONCLUSION: This study concludes that the experience of drought cannot be disentangled from the realities of gender and ageing.

The percentage of family physicians attending to women's gender-specific health needs is declining.

As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing women's health care, especially in rural and underserved areas. The proportion of family physicians who are attending to women is declining. Policy intervention may be needed to help family physicians maintain the comprehensiveness of care necessary to address the wide range of medical problems of women they encounter within their practices.