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2.
PLoS One ; 15(12): e0244054, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326463

RESUMO

BACKGROUND: Immigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities. METHODS: In this systematic review, we searched the following databases from inception-May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work Abstracts (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included. FINDINGS: 6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women's and children's health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study. INTERPRETATION: Many punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Emigração e Imigração/legislação & jurisprudência , Nível de Saúde , Saúde da Criança/estatística & dados numéricos , Emigrantes e Imigrantes/legislação & jurisprudência , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estados Unidos , Saúde da Mulher/estatística & dados numéricos
3.
PLoS One ; 15(10): e0239894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035246

RESUMO

INTRODUCTION: Worldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014 and 97%, occurred in low-and-middle income countries. Abortion among adolescent girls and young women (15-24 years) is a major public health issue, especially in low-and middle-income countries, including Ghana. Using data from the 2017 Maternal Health Survey, we sought to examine the association between mass media exposure and adolescent girls and young women's self-efficacy in abortion decision making. MATERIALS AND METHODS: A sample of 5,664 adolescent girls and young women in Ghana was considered in this study. Both descriptive and inferential analytical approaches were employed to analyse the data. The descriptive analytical approach involved the use of proportions to illustrate the proportion of adolescent girls and young women who had self-efficacy in abortion decision-making. Self-efficacy in abortion decision-making was derived from the question 'Could you decide on your own to get an abortion?' Respondents who answered "Yes" to this question were considered as having self-efficacy in abortion decision making. At the inferential level, a chi-square test and bivariate and multivariable logistic regression models were employed with statistical significance pegged at p-value <0.05. The results of the bivariate and multivariable logistic regression analyses were presented using crude and adjusted odds ratios respectively. RESULTS: Less than a quarter of adolescent girls and young women (24%) in Ghana had self-efficacy in abortion decision-making. We further found that adolescent girls and young women who were exposed to mass media had higher odds in self-efficacy in abortion decision-making compared to those who were not exposed to the mass media [AOR = 1.55, CI = 1.14-2.11]. It was also found that adolescent girls and young women aged 20-24 [AOR = 1.45, CI = 1.25-1.68], those who were cohabiting [AOR = 1.40, CI = 1.02-1.93], and those from the Ashanti region [AOR = 2.39, CI = 1.85-3.07] had higher odds on self-efficacy in abortion decision-making. On the other hand, adolescent girls and young women from the Eastern Region [AOR = 0.52, CI = 0.36-0.73] and those belonging to the Ga-Adangbe ethnic group [AOR = 0.70, CI = 0.50-0.99] had lower odds in self-efficacy in abortion decision-making. CONCLUSION: Less than a quarter of adolescent girls and young women in Ghana have self-efficacy in abortion decision-making which can affect adolescent girls and young women's future abortion seeking behaviours. Exposure to mass media was strongly associated with self-efficacy in abortion decision making. We recommend that policy makers should promote mass media campaigns scheduled on regular intervals in order to inform the target audience about safe abortions in Ghana. This could go a long way to ensure that cases of unsafe abortions are reduced to the starkest minimum.


Assuntos
Aborto Induzido/psicologia , Tomada de Decisões , Meios de Comunicação de Massa/estatística & dados numéricos , Autoeficácia , Aborto Induzido/estatística & dados numéricos , Adolescente , Feminino , Gana , Inquéritos Epidemiológicos , Humanos , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
4.
PLoS One ; 15(10): e0238782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33021973

RESUMO

In 2015, UN member states committed to eliminate female genital mutilation (FGM) by 2030 as part of the Sustainable Development Agenda. To reach this goal, interventions need to be targeted and guided by the best available evidence. To date, however, estimates of the number of girls and women affected by FGM and their trends over time and geographic space have been limited by the availability, specificity and quality of population-level data. We present new estimates based on all publicly available nationally representative surveys collected since the 1990s that contain both information on FGM status and on the age at which FGM occurred. Using survival analysis, we generate estimates of FGM risk by single year of age for all countries with available data, and for rural and urban areas separately. The likelihood of experiencing FGM has decreased at the global level, but progress has been starkly uneven between countries. The available data indicate no progress in reducing FGM risk in Gambia, Guinea-Bissau, Mali and Guinea. In addition, rural and urban areas have diverged over the last two decades, with FGM declining more rapidly in urban areas. We describe limitations in the availability and quality of data on FGM occurrence and age-at-FGM. Based on current trends, the SDG goal of eliminating FGM by 2030 is out of reach, and the pace at which the practice is being abandoned would need to accelerate to eliminate FGM by 2030. The heterogeneity in trends between countries and rural vs urban areas offers an opportunity to contrast countries where FGM is in rapid decline and explore potential policy lessons and programmatic implications for countries where the practice of FGM appears to remain entrenched.


Assuntos
Circuncisão Feminina , Adolescente , Adulto , Criança , Pré-Escolar , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/estatística & dados numéricos , Circuncisão Feminina/tendências , Estudos de Coortes , Estudos Transversais , Feminino , Saúde Global/legislação & jurisprudência , Saúde Global/estatística & dados numéricos , Saúde Global/tendências , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Estudos Retrospectivos , Saúde da População Rural , Inquéritos e Questionários , Nações Unidas , Saúde da População Urbana , Saúde da Mulher/legislação & jurisprudência , Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/tendências , Adulto Jovem
5.
Medicine (Baltimore) ; 99(44): e22909, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126346

RESUMO

To analyze the prevalence of anemia and associated factors in primiparous parturient.Cross-sectional study conducted in a municipality of the Brazilian Western Amazon from July 2014 to December 2015. A convenience sample of 461 first-time pregnant women were interviewed. Data on their sociodemographic, clinical, obstetric, personal habits and nutritional status were collected. Anemia and iron depletion were measured by peripheral blood collection with hemoglobin, hematocrit, serum ferritin and transferrin saturation index. To test the association between the variables, the χ tests were applied and Poisson regression analysis with a 95% confidence interval was performed, and P < .05 values were considered significant. The Forward stepwise strategy was used to construct the adjusted model. These analyzes were performed using the STATA 14.0 program (College Station, TX, 2013).A higher risk of anemia was identified among adolescent; white; who had a partner; with unpaid occupation, with less than eight years of formal education. Residents in the countryside; smokers; who had more than six prenatal consultations and were overweight.Anemia was reported in 28.20% and iron depletion in 60.52% of parturient women. The variables studied did not have association with the anemia outcome, except alcohol consumption.


Assuntos
Anemia Ferropriva , Paridade , Complicações Hematológicas na Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Demografia , Escolaridade , Feminino , Humanos , Estado Nutricional , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Hematológicas na Gravidez/epidemiologia , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Saúde da Mulher/estatística & dados numéricos
6.
BMC Public Health ; 20(1): 1467, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993596

RESUMO

BACKGROUND: Breast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs. METHODS: The present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services. RESULTS: The utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85-84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67-14.96%) in American countries, and 14.29% (95% CI: 13.87-14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women. CONCLUSION: The utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Idoso , Ásia , Neoplasias da Mama/epidemiologia , Europa (Continente) , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos
8.
Int J Behav Nutr Phys Act ; 17(1): 88, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646435

RESUMO

BACKGROUND: Sedentary behavior (SB) is linked to negative health outcomes in older adults. Most studies use summary values, e.g., total sedentary minutes/day. Diurnal timing of SB accumulation may further elucidate SB-health associations. METHODS: Six thousand two hundred four US women (mean age = 79 ± 7; 50% White, 34% African-American) wore accelerometers for 7-days at baseline, yielding 41,356 person-days with > 600 min/day of data. Annual follow-up assessments of health, including physical functioning, were collected from participants for 6 years. A novel two-phase clustering procedure discriminated participants' diurnal SB patterns: phase I grouped day-level SB trajectories using longitudinal k-means; phase II determined diurnal SB patterns based on proportion of phase I trajectories using hierarchical clustering. Mixed models tested associations between SB patterns and longitudinal physical functioning, adjusted for covariates including total sedentary time. Effect modification by moderate-vigorous-physical activity (MVPA) was tested. RESULTS: Four diurnal SB patterns were identified: p1 = high-SB-throughout-the-day; p2 = moderate-SB-with-lower-morning-SB; p3 = moderate-SB-with-higher-morning-SB; p4 = low-SB-throughout-the-day. High MVPA mitigated physical functioning decline and correlated with better baseline and 6-year trajectory of physical functioning across patterns. In low MVPA, p2 had worse 6-year physical functioning decline compared to p1 and p4. In high MVPA, p2 had similar 6-year physical functioning decline compared to p1, p3, and p4. CONCLUSIONS: In a large cohort of older women, diurnal SB patterns were associated with rates of physical functioning decline, independent of total sedentary time. In particular, we identified a specific diurnal SB subtype defined by less SB earlier and more SB later in the day, which had the steepest decline in physical functioning among participants with low baseline MVPA. Thus, diurnal timing of SB, complementary to total sedentary time and MVPA, may offer additional insights into associations between SB and physical health, and provide physicians with early warning of patients at high-risk of physical function decline.


Assuntos
Ritmo Circadiano , Desempenho Físico Funcional , Comportamento Sedentário , Acelerometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Feminino , Humanos , Estudos Prospectivos , Dispositivos Eletrônicos Vestíveis , Saúde da Mulher/estatística & dados numéricos
9.
BMC Public Health ; 20(1): 1125, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680488

RESUMO

BACKGROUND: Anaemia is a global health problem and women in reproductive age (WRA) are amongst the most affected population. Its consequences include low birth weight and maternal mortality. This study aimed to assess the prevalence of anaemia and to identify its determinants in Sudanese women in reproductive age. METHODS: A population-based cross-sectional study was conducted in Sudan in 2016. A multi-stage stratified cluster sampling design was executed with consideration of rural population, urban population, and internally displaced persons/refugees camps residents. All women in reproductive age (15-49 years), classified by pregnancy status, in the targeted households were surveyed and personal characteristic data were collected. Their haemoglobin level and malaria infection (using rapid diagnostic test, RDT) were assessed. The World Health Organization (WHO) haemoglobin level cut-off for defining anaemia and severe anaemia in pregnant and non-pregnant women was used. Logistic regression analyses were performed. RESULTS: A total of 4271 women (WRA) of which 421 (9.9%) pregnant women (PW) were included in the study. The overall anaemia prevalence in WRA was 35.6%. It was 36.0 and 35.5% in PW and non-pregnant women (NPW), respectively. The average haemoglobin level was found to be 113.9 g/L (SD 16.3) and 123.2 g/L (SD 15.7) for PW and NPW respectively. Severe anaemia prevalence was 1.2% in each group. In the logistic regression model, anaemia was associated with malaria infection in PW (aOR 4.100, 95%CI 1.523-11.039, p = 0.003), NPW (aOR 2.776, 95%CI 1.889-4.080, p < 0.001), and WRA (aOR 2.885, 95%CI 2.021-4.119, p < 0.001). Other identified determinants of anaemia in NPW was living in camps (aOR 1.499, 95%CI 1.115-2.017, p = 0.007) and in WRA was being in the poorest economic class (aOR 1.436, 95%CI 1.065-1.936, p = 0.018). CONCLUSIONS: Anaemia is a public health problem in Sudan. The study supported the association between malaria infection and anaemia, but not with low and moderate malaria transmission areas. Resources need to be allocated for all anaemic populations with special attention for the populations in most need and interventions need to be implemented based on local variations. Malaria control interventions, specifically case management, may have a major impact in reducing anaemia prevalence in low to moderate malaria transmission areas.


Assuntos
Anemia/epidemiologia , Complicações na Gravidez/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Anemia/etiologia , Análise por Conglomerados , Estudos Transversais , Características da Família , Feminino , Hemoglobinas/análise , Humanos , Modelos Logísticos , Malária/epidemiologia , Pobreza/estatística & dados numéricos , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Refugiados/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , Sudão/epidemiologia , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
10.
PLoS One ; 15(7): e0235329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702035

RESUMO

INTRODUCTION: Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS: We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS: The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION: We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.


Assuntos
Aborto Induzido/psicologia , Saúde Reprodutiva/tendências , Saúde da Mulher/tendências , Adolescente , Adulto , África ao Sul do Saara , Benin/epidemiologia , Tomada de Decisão Clínica , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Feminino , Gabão/epidemiologia , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
11.
BMC Public Health ; 20(1): 1013, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590963

RESUMO

BACKGROUND: Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants. METHODS: We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework. RESULTS: We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10-60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management. CONCLUSIONS: While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Refugiados/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Feminino , Humanos , Qualidade da Assistência à Saúde , Isolamento Social/psicologia , Apoio Social , Serviços de Saúde da Mulher/organização & administração
12.
PLoS One ; 15(6): e0233904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479509

RESUMO

Racial and ethnic minorities are at higher risk for a variety of diseases. While sociodemographic and lifestyle factors contribute to racial/ethnic health disparities, the biological processes underlying these associations remain poorly understood. Stress and its biological consequences through the glucocorticoid receptor (GR) have been hypothesized to mediate adverse disease outcomes. In fasting morning samples of 503 control women from the San Francisco Bay Area Breast Cancer Study, we used a sensitive Chemical-Activated LUciferase gene eXpression (CALUX) assay to examine the association of sociodemographic and lifestyle factors with plasma glucocorticogenic (G) activity in three racial/ethnic groups. The G activity is a sensitive measure that reflects biological activity of total plasma glucocorticoids including cortisol and glucocorticoid-like compounds. Associations between G activity and sociodemographic and lifestyle factors were examined using multivariable linear regression models. Latina and non-Latina Black (NLB) women had 9% (P = 0.053) and 14% (P = 0.008) lower morning G activity than non-Latina White (NLW) women, respectively. Additionally, we replicated a previously reported association between G activity and alcohol intake (women who drank >10gms had 19% higher G activity than non-drinkers, P = 0.004) in Latina and NLB women. Further research should assess the association between G activity and health outcomes in a prospective cohort so as to characterize the relationship between total plasma G activity in pre-disease state and disease outcomes across different racial/ethnic populations.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Disparidades nos Níveis de Saúde , Estilo de Vida/etnologia , Receptores de Glucocorticoides/sangue , Saúde da Mulher/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Prospectivos , São Francisco/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos
13.
BMC Womens Health ; 20(1): 104, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410601

RESUMO

BACKGROUND: Quality of life (QoL) after menopause could be influenced by a host of personal and social factors. This study aimed to determine the factors associated with quality of life among postmenopausal women. METHODS: This cross-sectional study was conducted among 405 postmenopausal women selected using a multi-stage randomized sampling. The data-collection tools were the WHO Quality of Life-BREF (WHOQOL-BREF), the Menopause Rating Scale (MRS), and a researcher-designed questionnaire. The relationship between QoL and its potentially correlated factors was examined using t-test, ANOVA, Pearson's correlation, Spearman's correlation coefficient, and multiple linear regression. RESULTS: A negative correlation was found between the scores of QoL (total and all subscales) and the MRS total scores. The total scores of QoL were negatively correlated with duration of menopause (r = - 0.127, P = 0.010), gravida (r = - 0.177, P < 0.001), parity (r = - 0.165, P = 0.001), frequency of stillbirth (r = - 0.104, P = 0.037), vaginal delivery (r = - 0.161, P = 0.001), and waist-to-hip ratio (r = - 0.195, P < 0.001). The QoL total scores were positively correlated with the educational level of the participants (r = 0.207, P < 0.001) and that of their spouses (r = 0.160, P = 0.001) along with their level of monthly family income (r = 0.218, P < 0.001). Multiple-linear-regression analysis showed that the total score of QoL decreased with inadequate income, waist-to-hip ratio, and the total score of MRS. CONCLUSIONS: Personal and social factors along with the severity of menopausal symptoms affect QoL post-menopause. These factors need to have a bearing on any effort to improve QoL among postmenopausal women.


Assuntos
Menopausa/psicologia , Pós-Menopausa/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Renda , Irã (Geográfico) , Saúde Mental , Pessoa de Meia-Idade , Pós-Menopausa/etnologia , Inquéritos e Questionários , Saúde da Mulher/estatística & dados numéricos
14.
PLoS One ; 15(4): e0231757, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32339177

RESUMO

The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79-8.29), respiratory (OR = 5.04; 95% CI: 2.52-10.07), cardiovascular (OR = 6.07; 95% CI: 1.88-19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07-12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08-5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.


Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Biocombustíveis/efeitos adversos , Nível de Saúde , População Rural/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Biocombustíveis/estatística & dados numéricos , Culinária/métodos , Culinária/estatística & dados numéricos , Estudos Transversais , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Índia , Pessoa de Meia-Idade , Autorrelato/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
15.
Arch Sex Behav ; 49(5): 1443-1461, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32270401

RESUMO

As more longitudinal surveys collect information on sexual orientation, evaluating the quality of these data and understanding how sexual minorities engage with the survey process are increasingly important endeavors. This study constitutes the first systematic analysis of sexual orientation as a predictor of attrition from longitudinal surveys. Drawing upon the minority stress model, we developed testable hypotheses about how sexual identity and sexual identity change relate to panel attrition. These hypotheses were subsequently tested using data from two national cohorts of Australian women from the Australian Longitudinal Study on Women's Health (one born 1973-1978, n = 11,262, and one born 1989-1995, n = 16,689). In the older cohort, sexual minority women were more likely to attrit from the survey than exclusively heterosexual women-largely due to noncontact rather than noncooperation. The associations faded once sociodemographic and health-related covariates were included in the models. Further, higher rates of noncontact were observed among women who changed their sexual identity in a more same-sex-oriented direction, compared to women with a stable sexual identity. None of these associations were apparent in the younger cohort. Taken together, our results suggest that sexual minority status may be a risk factor for panel attrition among older but not younger cohorts of women and that improved efforts to locate and contact participants who are generally vulnerable could increase the retention of sexual minorities in longitudinal studies. Effect sizes were nevertheless small, suggesting that existing research on sexual orientation using longitudinal surveys is unlikely to be biased by non-random attrition of non-heterosexual individuals.


Assuntos
Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero , Feminino , Humanos , Estudos Longitudinais , Inquéritos e Questionários , Saúde da Mulher/estatística & dados numéricos
16.
PLoS One ; 15(4): e0230894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240207

RESUMO

Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.


Assuntos
Violência por Parceiro Íntimo/psicologia , Saúde Mental/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Violência de Gênero/estatística & dados numéricos , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Quênia/etnologia , Saúde Mental/tendências , Áreas de Pobreza , Saneamento/estatística & dados numéricos , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Saúde da Mulher/tendências , Adulto Jovem
17.
BJOG ; 127(6): 694-700, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32011073

RESUMO

BACKGROUND: Developing a shared agenda is an important step in ensuring future research has the necessary relevance. OBJECTIVE: To characterise research priority setting partnerships (PSPs) relevant to women's health. SEARCH STRATEGY: Included studies were identified by searching MEDLINE and the James Lind Alliance (JLA) database. SELECTION CRITERIA: Priority setting partnerships using formal consensus methods. DATA COLLECTION AND ANALYSIS: Descriptive narrative to describe the study characteristics, methods, and results. MAIN RESULTS: Ten national and two international PSPs were identified. All PSPs used the JLA method to identify research priorities. Nine PSPs had published a protocol. Potential research uncertainties were gathered from guidelines (two studies), Cochrane reviews (five studies), and surveys (12 studies). The number of healthcare professionals (31-287), patients (44-932), and others (33-139) who responded to the survey, and the number of uncertainties submitted (52-4767) varied. All PSPs entered confirmed research uncertainties (39-104) into interim priority setting surveys and healthcare professionals (31-287), patients (44-932), and others (33-139) responded. All PSPs entered a short list of research uncertainties into a consensus development meeting, which enabled healthcare professionals (six to 21), patients (eight to 14), and others (two to 13) to identify research priorities (ten to 15). Four PSPs have published their results. CONCLUSION: Future research priority setting studies should publish a protocol, use formal consensus development methods, and ensure their methods and results are comprehensively reported. TWEETABLE ABSTRACT: Research published in @BJOGtweets highlights future research priorities across women's health, including @FertilityTop10, @jamesmnduffy.


Assuntos
Pesquisa Biomédica/organização & administração , Pesquisa , Saúde da Mulher , Consenso , Feminino , Humanos , Projetos Piloto , Saúde da Mulher/estatística & dados numéricos
18.
Matern Child Health J ; 24(3): 267-274, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31916140

RESUMO

BACKGROUND: Reproductive health inequalities tend to be more marked in large cities because they include neighbourhoods with unequal social and community networks, resources and opportunities. The aim was to describe social inequalities in fertility patterns among women who gave birth between 2007 and 2016 in the city of Barcelona (Spain) by jointly evaluating the effect of individual and socioeconomic neighbourhood characteristics. METHODS: We conducted a multilevel study of women's individual characteristics (age, educational attainment, and country of origin) and neighbourhood characteristics (disposable household income, percentage of unemployment and percentage of foreigners). RESULTS: Multilevel modelling revealed significant variability in fertility across neighbourhoods after adjustment for individual explanatory variables. The fertility rate (FR) was higher in better educated women (adjusted relative risk: aRR 2.76), those aged 30-39 years (aRR 2.13), and in those born in Spain in relation to their respective reference groups. The FR was lowest in women with upper to post-secondary, non-tertiary education (aRR 0.86) who were born in high income countries (aRR 0.57). Women living in neighbourhoods with a low income (aRR 1.46) and with a higher unemployment (aRR 1.33) were more likely to have children. In contrast, women living in neighbourhoods with a lower percentage of foreigners had the lowest FR (aRR 0.81). CONCLUSIONS: The neighbourhood's characteristics played an important role in fertility patterns, independently of women's individual characteristics. At the contextual level, the highest FR was found in the poorest settings, highlighting inequalities. At the individual level, the FR was highest among women with higher education and in their thirties.


Assuntos
Coeficiente de Natalidade , Fertilidade , Classe Social , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Análise Multinível , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Espanha , População Urbana , Adulto Jovem
19.
PLoS One ; 15(1): e0228142, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971983

RESUMO

OBJECTIVE: To explore the role of clinical providers and mothers on young women's ability to have confidential, candid reproductive health conversations with their providers. METHODS: We conducted 14 focus groups with 48 women aged 15-28 years (n = 9), and 32 reproductive healthcare workers (n = 5). Focus groups were audio recorded and transcribed. Data were analyzed using inductive coding and thematic analyses. We examined findings through the lens of paternalism, a theory that illustrates adults' role in children's autonomy and wellbeing. RESULTS: Mothers have a substantial impact on young women's health values, knowledge, and empowerment. Young women reported bringing information from their mothers into patient-provider health discussions. Clinical best practices included intermingled components of office policies, state laws, and clinical guidelines, which supported health workers' actions to have confidential conversations. There were variations in how health workers engaged young women in a confidential conversation within the exam room. CONCLUSIONS: Both young women and health workers benefit from situations in which health workers firmly ask the parent to leave the exam room for a private conversation with the patient. Young women reported this improves their comfort in asking the questions they need to make the best decision for themselves. Clinic leadership needs to ensure that confidentiality surrounding young women's reproductive health is uniform throughout their practice and integrated into patient flow.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Mães , Saúde Reprodutiva/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Comunicação , Confidencialidade , Feminino , Pessoal de Saúde/legislação & jurisprudência , Humanos , Privacidade , Saúde Reprodutiva/legislação & jurisprudência , Saúde da Mulher/legislação & jurisprudência , Adulto Jovem
20.
Psychooncology ; 29(3): 550-556, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31823434

RESUMO

BACKGROUND: Increasingly complex genetics counseling requires guidance to facilitate counselees' psychosocial adjustment. We explored networks of inter-relationships among coping strategies and specific psychosocial difficulties in women tested for hereditary breast or ovarian cancer. METHODS: Of 752 counselees consecutively approached, 646 (86%) completed questionnaires addressing coping strategies (Brief-COPE) and psychosocial difficulties (PAHC) after the initial genetic consultation (T1), and 460 (61%) of them again after the test result (T2). We applied network analysis comparing partial correlations among these questionnaire scales, according to the type of genetic test - single gene-targeted or multigene panel, test result and, before and after testing. RESULTS: Overall, 98 (21.3%), 259 (56.3%), 59 (12.8%) and 44 (9.6%) women received a pathogenic variant, uninformative negative (panel testing), variant of uncertain significance (VUS) or true negative (targeted testing) result, respectively. In most networks, connections were strongest between avoidance and general negative emotions. Cognitive restructuring was inter-related to lower psychosocial difficulties. Avoidance and familial/social relationship difficulties were strongly related in women receiving a pathogenic variant. Stronger inter-relationships were also noticed between avoidance and worries about personal cancer and concerns about hereditary predisposition in women receiving a VUS result. Differences in the prominence of inter-relationships were observed by type of testing and assessment time. CONCLUSIONS: Network analysis may be fruitful to highlight prominent inter-relationships among coping strategies and psychosocial difficulties, in women tested for HBOC susceptibility, offering guidance for counseling.


Assuntos
Neoplasias da Mama/psicologia , Aconselhamento Genético/psicologia , Predisposição Genética para Doença/psicologia , Síndromes Neoplásicas Hereditárias/psicologia , Neoplasias Ovarianas/psicologia , Adulto , Ansiedade/psicologia , Neoplasias da Mama/diagnóstico , Feminino , Testes Genéticos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Qualidade de Vida/psicologia , Inquéritos e Questionários , Saúde da Mulher/estatística & dados numéricos
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