A 50-Year Commitment to American Indian and Alaska Native Women.

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.

Update on Syphilis for Women's Health Nurses.

After declining for many years, rates of syphilis in the United States are increasing. This article discusses possible reasons why women, and specifically pregnant women, are not getting tested properly. Lack of prenatal care, poor access to prenatal care, and improper prenatal care all have contributed to cases of congenital syphilis. Clinicians working in women's health care can address this issue by taking accurate sexual histories, remaining open to sexual fluidity among their patients, ensuring they are up to date on appropriate syphilis testing guidelines, and routinely offering screening to any woman at risk. Syphilis is a treatable and preventable sexually transmitted infection, and nurses, advanced practice nurses, and midwives can significantly contribute to reversing the current trend.

Temporal Trends Analysis of the Characteristics, Management, and Outcomes of Women With Acute Coronary Syndrome (ACS): ACS Israeli Survey Registry 2000-2016.

Background Cardiovascular disease remains a leading cause of death among women. Despite improvements in the management of patients with acute coronary syndrome (ACS), women with an ACS remain at higher risk. Methods and Results We performed a time-dependent analysis of the management and outcomes of women admitted with ACS who enrolled in the prospective biennial ACS Israeli Surveys between 2000 and 2016. Surveys were divided into 3 time periods (2000-2004, 2006-2010, and 2013-2016). Outcomes included 30-day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality. Overall, 3518 women were admitted with an ACS. Their mean age (70±12 years) was similar among the time periods. Over the time course of the study, more women were admitted with non-ST-elevation ACS (51.9%, 59.6%, and 66.1%, respectively; P<0.001), and statins and percutaneous coronary intervention were increasingly utilized (66%, 91%, 93%, and 42%, 60%, and 68%, respectively; P<0.001 for each). Among women with ST-segment-elevation myocardial infarction, more primary percutaneous coronary interventions were performed (48.5%, 84.7%, and 95.3%, respectively; P<0.001). The rate of 30-day major adverse cardiac events has significantly decreased over the years (24.6%, 18.6%, and 13.5%, respectively; P<0.001). However, 1-year mortality rates declined only from 2000 to 2004 (16.9%, 12.8%, and 12.3%; P=0.007 for the overall difference), and this change was not significant after propensity matching or multivariate analysis. Conclusions Over more than a decade, 30-day major adverse cardiac events have decreased among women with ACS. Advances in pharmacological treatments and an early invasive approach may have accounted for this improvement. However, the lack of further reduction in 1-year mortality rates among women suggests that more measures should be provided in this high-risk population.

Historias locas: Internaciones psiquiátricas durante el siglo XX

Compilación del trabajo de investigación desarrollado sobre un fondo documental de historias clínicas del período 1895-1987 del Archivo Intermedio del Archivo General de la Nación, provenientes del Hospital Neuropsiquiátrico de Mujeres José Esteves, de la Provincia de Buenos Aires (Argentina). La investigación tuvo el aval de la Universidad Nacional de Lanús (UNL) y el CONICET, y se centró en la trayectoria del hospital en ese período, y la atención a la salud/enfermedad mental, partiendo de una presentación socio-epidemiológica de las personas internadas, y situándolas en su contexto socio-histórico y cultural.

Shared Decision-Making With Choosing Wisely.

Choosing Wisely is a national health care improvement campaign promoting conversations between women and their health care professionals about selecting high-value health care practices. It disseminates lists of recommendations and downloadable educational materials from professional societies on its website. In November 2018, we searched for and categorized Choosing Wisely recommendations pertinent to women's health care. Of 78 recommendations, 28 (36%) were related to perinatal care, 22 (28%) were related to gynecologic care, and 28 (36%) were related to women's health and general care. Twelve recommendations (17.6%) were related to antenatal care, 10 (14.7%) to intrapartum and postpartum care, and 10 (14.7%) to cervical cancer screening. These free resources can help frame the shared decision-making process in clinical practice.

Breast Arterial Calcium: A Game Changer in Women's Cardiovascular Health?

In 2018, cardiovascular disease (CVD) was the leading cause of death among women, and current CVD prevention paradigms may not be sufficient in this group. In that context, it has recently been proposed that detection of calcification in breast arteries may help improve CVD risk screening and assessment in apparently healthy women. This review provides an overview of breast arterial anatomy; and the epidemiology, pathophysiology, and measurement of breast artery calcium (BAC); and discusses the features of the BAC-CVD link. The potential clinical applications that BAC may offer for CVD prevention in the context of current clinical practice guidelines and recommendations are also discussed. Finally, current gaps in evidence gaps are outlined, and future directions in the field are explored with a focus on the implementation of BAC mammography as a CVD risk-screening tool in routine clinical practice.

Fetal mortality and the challenges for women's health care in Brazil.

OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country's fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.

A Project to Improve Postpartum Depression Screening Practices Among Providers in a Community Women's Health Care Clinic.

OBJECTIVE: The purpose of this project was to improve health care providers' postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool. DESIGN: The plan-do-study-act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD. SETTING/LOCAL PROBLEM: Health care providers' screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women's health care clinic serving minority women of lower socioeconomic status. PARTICIPANTS: Health care providers at a community women's health care clinic. INTERVENTION/MEASUREMENTS: A single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews. RESULTS: PPD screening documentation rates increased from 56% to 92.7% (p < .5). CONCLUSION: PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women's health care clinic.

Fetal mortality and the challenges for women's health care in Brazil / Mortalidade fetal e os desafios para a atenção à saúde da mulher no Brasil

ABSTRACT OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country's fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.

RESUMO OBJETIVO: Traçar uma série histórica da mortalidade fetal no Brasil e regiões entre 1996 e 2015, identificando seu comportamento e tendência. MÉTODOS: Estudo descritivo sobre casos de óbitos fetais no Brasil e em cada região notificados de 1996 a 2015, registrados no Datasus e classificados pela CID-10. A idade e escolaridade da mãe, duração da gestação e tipo de parto foram considerados. Foi realizado o cálculo da taxa de mortalidade fetal entre 1996 e 2015 para construção das séries históricas. RESULTADOS: A série temporal apresenta um quadro estacionário na taxa de mortalidade fetal a partir de 2000 no Brasil e em todas as regiões. A taxa de mortalidade fetal do país passou de 8,19 em 1996 para 9,50 por 1.000 nascimentos em 2015. Houve tendência crescente dos óbitos fetais cuja causa básica consta no capítulo XVII da CID-10 no Brasil e em todas as regiões. Óbitos por causas do capítulo XVI apresentaram tendência de aumento somente na região Nordeste, enquanto outras causas básicas mostraram tendência de aumento nas regiões Sudeste e Sul. No âmbito brasileiro, houve tendência crescente de óbitos fetais em mães nas faixas etárias de 10-14 anos e 25-44 anos. No Brasil e em todas as regiões, houve aumento nas mulheres com mais de oito anos de escolaridade. Os óbitos fetais predominaram entre a 28ª e a 36ª semana de gestação, com tendência crescente no Brasil e todas as regiões, exceto no Sul (estacionário). O tipo de parto predominante foi vaginal, com tendência estacionária, enquanto as cesarianas apresentaram tendência crescente no Brasil e em todas as regiões. CONCLUSÕES: A qualidade da informação sobre os óbitos fetais, investimentos nos comitês de investigação e melhora na qualidade do pré-natal devem ser priorizados para possibilitar um enfrentamento mais efetivo e diminuir a taxa de mortalidade fetal no Brasil.

Naval Medicine's Involvement in Global Health: The Participation of Women's Healthcare Providers in Continuing Promise 2017.

INTRODUCTION: This is a retrospective review of information collected during operation Continuing Promise 2017 from the Wayuu population in Colombia, South America. MATERIALS AND METHODS: Team objective was to present an overview of women's health care needs in an isolated underserved population of Colombia by a humanitarian mission of health care providers from the U.S. Navy. We analyzed demographics, contraceptive selection, presenting complaint, diagnosis, and disposition of those female patients presenting for care. RESULTS: The acute care clinics of this mission saw patients for 10 full clinic days in each of the countries of Guatemala, Honduras, and Colombia. In the Wayuu clinic of Colombia, 356 patients were seen in the acute care women's clinic. These women averaged 36 years of age with an age range of 9-77 years of age and a gravidity of 3 ± 3.3 and a range of 0-18. Of the women less than the age of 50, not permanently sterilized, 186/220 (84.5%) were not using any form of contraception. The most common chief complaints were vaginal discharge and pelvic pain and the most common final diagnosis was bacterial vaginosis. The two most common secondary diagnoses of the pregnant women were urinary tract infection and anemia. Other significant diagnoses included uterine cancer, preterm labor, and fetal posterior urethral valve syndrome. CONCLUSIONS: A majority of Wayuu women presenting to an acute clinic setting in Colombia, South America were in their mid-thirties having had three pregnancies and the majority were not using any form of contraception. The most common diagnoses were straightforward diagnoses such as vaginal infections, urinary tract infections, and abnormal uterine bleeding. Our findings suggest a need for access to routine gynecologic care, general hygiene education, and increased availability of birth control among the Wayuu population.

Living with mutilation: A qualitative study on the consequences of female genital mutilation in women's health and the healthcare system in Spain.

INTRODUCTION: Female genital mutilation is a health and human rights issue which extends to western countries. It is estimated that there are some seventeen thousand women and girls living in Spain who have either been mutilated or are at risk of being so. Healthcare professionals face the challenge of providing adequate care in response to this emerging problem. AIM: To discover the repercussions of female genital mutilation on the health of sub-Saharan women residing in Spain, as well as the healthcare received. METHODS: A life-history qualitative research design was utilized. The study population included 14 genitally mutilated women residing in the Region of Murcia who had given birth in Spain and been attended to by the national public healthcare system. RESULTS: Women suffer physical, psychological, obstetric and sexual health issues as a result of female genital mutilation and despite having a favourable perception of the healthcare received during the pregnancy and the delivery, the provision of health education, detection and treatment of female genital mutilation by healthcare professionals was seen to be lacking. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Healthcare policy must address insufficiencies in delivering adequate care to immigrant women who have been the victim of female genital mutilation by implementing the necessary resources and training for professionals to effectively meet the specific healthcare needs of this population and prevent this cruel practice from being perpetuated.