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1.
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495

RESUMO

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-32859017

RESUMO

Cases of sexually transmitted infections (STIs) are underreported in Bangladesh. Women in general suffer from poor sexual health outcomes due to a lack of access to sexual health services. mHealth, a digital approach to STI services, is an easier and cheaper way to disseminate health information in Bangladesh. However, women have less autonomy in accessing STI services and it is important to learn if, how and/or why women use mHealth. A qualitative study was conducted with 26 medical doctors to explore their perceptions of the mHealth STI services used by Bangladeshi women. Themes were grouped under four categories: (1) provider perceptions of mHealth for sexual healthcare; (2) the health literacy of women clients; (3) cost and maintaining timeliness in providing mHealth services; (4) mHealth service accessibility. Data suggest that mHealth can play a significant role in improving the awareness and utilization of STI services in Bangladeshi women. Successful opportunities for STI service expansion using mHealth were identified, depending on the quality and type of service delivery options, awareness of challenges related to health literacy framework, cost, accessibility to information and availability of culturally competent health experts to disseminate health information. We identify the need to increase access and use of mHealth services for sexual health, as it provides an innovative platform to bridge the health communication gaps in sexual health for Bangladeshi women.


Assuntos
Assistência à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual , Telemedicina/métodos , Adulto , Bangladesh , Feminino , Letramento em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Doenças Sexualmente Transmissíveis
3.
Obstet Gynecol ; 136(3): 591-596, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769637

RESUMO

OBJECTIVE: To explore the role of reproductive travel (travel to another state or country for reproductive services) for intended parents at the time of delivery of gestational carrier pregnancies and to analyze the sociodemographic characteristics of those who build families through gestational surrogacy. METHODS: We conducted a cross-sectional study of births involving gestational surrogacy in Utah from 2009 to 2018. Data were obtained from birth certificates. State and country of residence were collected for intended parents, and the legal climates of these locations were assessed by reviewing laws at the time. Sociodemographic characteristics were compared among intended parents, parents with pregnancies resulting from assisted reproductive technology (ART) without gestational surrogacy, and parents with spontaneous pregnancies. RESULTS: A total of 361 gestational carrier pregnancies resulted in the birth of at least one liveborn neonate during the study period, involving 715 intended parents. Additionally, 50,434 parents delivered children after nonsurrogacy ART, and 950,460 parents delivered children after spontaneous fertilization. Many intended parents (17.2%) lived in countries outside of the United States, the majority of which (69.9%) had laws against surrogacy. Of those who lived within the United States, 57.4% lived outside of Utah, but only 15.9% lived in states that banned compensated surrogacy. Statutes in Utah support compensated and uncompensated gestational surrogacy. Intended parents were significantly older than parents with both nonsurrogacy ART pregnancies and spontaneous pregnancies (median age 38, 31, and 29 years, respectively) and had higher levels of education; 70.2% of intended parents had a bachelor's degree or above, compared with 48.2% of parents with nonsurrogacy ART pregnancies and 33.1% of parents with spontaneous pregnancies. DISCUSSION: A majority of intended parents live outside of Utah, which may be an important consideration for health care professionals caring for women with gestational carrier pregnancies. However, most intended parents live in places that do not have laws banning surrogacy, suggesting that there may be other reasons that intended parents travel for delivery.


Assuntos
Parto Obstétrico , Turismo Médico , Serviços de Saúde Reprodutiva , Mães Substitutas , Adulto , Estudos Transversais , Feminino , Humanos , Turismo Médico/estatística & dados numéricos , Gravidez , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Mães Substitutas/estatística & dados numéricos , Utah
4.
Obstet Gynecol ; 136(3): 518-523, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769650

RESUMO

OBJECTIVE: To estimate receipt of recommended gynecologic care, including cancer screening and menstrual care, among women with Down syndrome in the United States. METHODS: We conducted a retrospective cohort study of women participating in DS-Connect, the National Institute of Health's registry of women with Down syndrome. Using 2013-2019 survey data, we estimated the proportion of women receiving recommended age-appropriate well-woman care (Pap tests, mammogram, breast examination, pelvic examination) and compared receipt of gynecologic care to receipt of other preventive health care. We also estimated proportion receiving care for menstrual regulation. RESULTS: Of 70 participants with Down syndrome, 23% (95% CI 13-33) of women received all recommended gynecologic components of a well-woman examination. Forty-four percent (95% CI 32-56) of women aged 18 years and older reported ever having a gynecologic examination, and 26% (95% CI 15-37) reported ever having a Pap test. Of women aged 40 years or older, 50% (95% CI 22-78) had had a mammogram. Fifty-two percent (95% CI 41-65) had tried medication for menstrual regulation, and 89% (95% CI 81-96) received all recommended components of nongynecologic routine health care. CONCLUSION: Women with Down syndrome received gynecologic care, including cancer screening, at lower-than-recommended rates and at substantially lower rates than other forms of health care. Efforts to improve gynecologic care in this vulnerable population are needed.


Assuntos
Síndrome de Down , Doenças dos Genitais Femininos/prevenção & controle , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Pessoas com Deficiência/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adulto , Idoso , Estudos de Coortes , Síndrome de Down/complicações , Feminino , Doenças dos Genitais Femininos/complicações , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
5.
Buenos Aires; s.n; ago. 2020. 75 p. graf, tab.
Não convencional em Espanhol | LILACS, InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1119087

RESUMO

Actualización de los avances ocurridos durante el año 2019, relacionados con las acciones de la Coordinación Salud Sexual, Sida e ITS, del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, destinada principalmente al equipo de salud involucrado en la política de salud sexual y reproductiva de la Ciudad. Continúa el modelo de análisis del informe 2016-2018, basado en las dimensiones: Determinantes (elementos que dan cuenta del contexto en el que se desarrolla la respuesta ), Población (indicadores que permiten caracterizar la población objetivo de la política pública), Acciones Programáticas (desarrollo institucional del Programa), y Utilización de los servicios (encuentro entre el sistema de salud y las personas usuarias). Incluye un documento anexo que presenta, a modo de Resumen Ejecutivo, una tabla que permite observar el comportamiento de algunos indicadores seleccionados para los años 2016-2019.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/epidemiologia , Coeficiente de Natalidade , Dispositivos Anticoncepcionais/provisão & distribução , Serviços de Saúde Reprodutiva/provisão & distribução , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Direitos Sexuais e Reprodutivos , Saúde Sexual e Reprodutiva , Serviços Públicos de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos
6.
Artigo em Inglês | MEDLINE | ID: mdl-32722563

RESUMO

Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Migrantes , Atitude do Pessoal de Saúde , Anticoncepção , Comportamento Contraceptivo/etnologia , Discriminação Psicológica , Feminino , Grupos Focais , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Malásia , Gravidez , Pesquisa Qualitativa , Refugiados/psicologia , Saúde Reprodutiva , Comportamento Sexual , Saúde Sexual
7.
Cent Eur J Public Health ; 28(2): 143-148, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32592560

RESUMO

OBJECTIVE: In most indicators of the way of life, the Roma community is generally different from the majority population and dominant culture. The objective of the study was to describe factors affecting the health of the Roma living in Slovakia, with an emphasis on the sexual and reproductive health of Roma women, and report on the results of analysis of high-risk pregnancies of Roma women in the district of Rimavská Sobota, Slovakia. METHODS: A retrospective study of medical documentation was used. The results were analyzed using the absolute and relative frequencies. Statistical methods were used. RESULTS: A total of 1,256 high-risk pregnancies were analyzed, of which 622 (49.52%) were in Roma women. The average age of Roma respondents was lower by 5 years compared to non-Roma. The age of Roma women at the first pregnancy was statistically significantly lower compared to non-Roma (p < 0.001). The Roma respondents achieved statistically significantly lower levels of education than non-Roma. There was a demonstrably higher number of pregnancies as well as a higher number of artificial and spontaneous abortions per Roma woman. These results were statistically significant. For Roma women, pregnancy began to be risky demonstrably earlier than for non-Roma (p < 0.001). There was a statistically significant difference in attending prenatal counselling. Roma women attended prenatal counselling statistically significantly less frequently than non-Roma (p < 0.001). A significant statistical dependence was found between attending prenatal counselling and the onset of pregnancy problems in Roma women. There was no significant difference in the incidence of other diseases associated with high-risk pregnancy among Roma and non-Roma respondents. CONCLUSION: The findings indicate that Roma women are exposed to health problems in the area of sexual and reproductive health in Slovakia. In the approach to the Roma, it is essential to focus on improving accessibility to health care, prevention, knowledgeableness and effectively preventing, eradicating and strongly penalizing all forms of discrimination in access to health care, especially for Roma women, who are more likely to receive health care.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/etnologia , Gravidez de Alto Risco/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/etnologia , Roma/etnologia , Adolescente , Adulto , Feminino , Humanos , Paridade , Gravidez , Complicações na Gravidez/etnologia , Estudos Retrospectivos , Fatores de Risco , Eslováquia/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Adulto Jovem
8.
BMC Public Health ; 20(1): 747, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448236

RESUMO

BACKGROUND: Youth friendly services (YFS) was established in pilot areas in China. This study aimed to explore the promoting level on the awareness and utilization of YFS after the implementing of a multi-sectoral cooperation mechanism (MSCM) supported by social network theory (SNT) among multiple sectors related to young people reproductive health (YRH) closely. METHODS: A cross-sectional study with two separate self-administered questionnaire surveys was conducted before and after the implementing of a MSCM supported by SNT in both in-school and out-school unmarried young people aged 12-24 year-old in pilot areas in China. Both pre- and post- implementation surveys were conducted between December, 2008 and January, 2009, and between October, 2010 and January, 2011 respectively. The collected categorical data about the awareness on YFS in young people was described in percentage (%). χ 2 test was used to compare the differences between interventional and control areas, pre and after intervention, and changes in investigated areas after the intervention respectively. Binary logistic regression was used to analyze interventional effects after adjusting gender, in-school or out-school, and other factors. Significance level α was 0.05. RESULTS: The percentages of young people in interventional areas who could receive YRH education including that about YFS in schools, working sites and communities increased (OR = 15.485, 6.166, 3.723; 95% CI: 2.939~4.715, 4.014~9.473, 11.421~20.994 respectively) statistically significantly (P < 0.05). The percentages of young people in interventional areas who "have heard of YFS clinic" and "know that YFS clinic has been established in local area" (OR = 9.325, 11.244; 95% CI: 7.433~11.699, 8.780~14.399 respectively), and knowledge rates on YFS manner and contents also increased (OR = 14.830, 8.676; 95% CI: 9.728~22.607, 5.175~14.548 respectively) statistically significantly (P < 0.05). The increments of knowledge rates on YFS price, time, hotline number, contents on contraception, pregnancy and sexual harass/violence were statistically significant (P < 0.05). The satisfaction degree on this service has also increased (OR = 6.394, 95% CI: 2.789~14.655) statistically significantly (P < 0.05). CONCLUSIONS: SNT is a helpful tool to facilitate the construction of an effective multi-sectoral cooperation mechanism to promote the awareness and satisfactory degree of YRH services.


Assuntos
Assistência à Saúde/organização & administração , Promoção da Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/organização & administração , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Atitude Frente a Saúde , Criança , China , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Promoção da Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Projetos Piloto , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
BMC Public Health ; 20(1): 666, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398129

RESUMO

BACKGROUND: Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, particularly for young people. Young people facing humanitarian crises are also at higher risk for mental health problems, which can further exacerbate poor SRH outcomes. This review aimed to explore, describe and evaluate SRH interventions for young people in LMIC and humanitarian settings to better understand both SRH and psychosocial components of interventions that demonstrate effectiveness for improving SRH outcomes. METHODS: We conducted a systematic review of studies examining interventions to improve SRH in young people in LMIC and humanitarian settings following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Peer-reviewed journals and grey literature from January 1, 2000 to December 31, 2018 were included. Two authors performed title, abstract and full-text screening independently. Data was extracted and analyzed using a narrative synthesis approach and the practice-wise clinical coding system. RESULTS: The search yielded 813 results, of which 55 met inclusion criteria for full-text screening and thematic analysis. Primary SRH outcomes of effective interventions included: contraception and condom use skills, HIV/STI prevention/education, SRH knowledge/education, gender-based violence education and sexual self-efficacy. Common psychosocial intervention components included: assertiveness training, communication skills, and problem-solving. CONCLUSIONS: Findings suggest that several evidence-based SRH interventions may be effective for young people in humanitarian and LMIC settings. Studies that use double blind designs, include fidelity monitoring, and focus on implementation and sustainability are needed to further contribute to this evidence-base.


Assuntos
Pobreza , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Sexo Seguro , Comportamento Sexual , Saúde Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Altruísmo , Método Duplo-Cego , Feminino , Humanos , Masculino , Adulto Jovem
10.
PLoS One ; 15(4): e0231960, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343713

RESUMO

BACKGROUND: The Global Gag Rule (GGR), reinstated by President Trump in January 2017, makes non-U.S. non-governmental organizations ineligible for U.S. foreign assistance if they provide access to or information about abortion. While evidence suggests previous iterations of the GGR negatively impacted sexual and reproductive health outcomes, no studies have quantitatively assessed the impacts of the Trump administration's GGR. METHODS: We constructed a panel dataset of facilities (76% public) using 2017/2018 Performance Monitoring and Accountability 2020 service delivery point (SDP) surveys in Uganda. Based on information from stakeholder meetings, we classified districts as more or less exposed to the GGR; 45% (N = 34) of study districts were classified as "more exposed", which corresponded to 145 "more exposed" and 142 "less exposed" health facilities in our sample. We assessed changes in provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, engagement with community health workers (CHWs), service integration, and quality of care from 2017 (pre-GGR) to 2018 (post-GGR). Multivariable regression models were estimated, and difference-in-differences impact estimators were determined by calculating predicted probabilities from interaction terms for exposure and survey round. FINDINGS: We observed no immediate impact of the GGR on the provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, service integration, or quality of care. We did observe a significant impact of the policy on the average number of CHWs, with "more exposed" facilities engaging 3.8 fewer CHWs post-GGR (95% CI:-7.31,-0.32). CONCLUSIONS: The reduction in CHWs could reduce contraceptive use and increase unintended pregnancies in Uganda. The lack of other significant findings may not be surprising given the short post-GGR observation window. Rapid organizational responses and stopgap funding from foreign governments may have mitigated any immediate impacts on service delivery in the short term. The true impact may not be felt for many years, as stopgap funding potentially ebbs and service providers adapt to new funding environments.


Assuntos
Serviços de Planejamento Familiar , Serviços de Saúde Reprodutiva , Agentes Comunitários de Saúde/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Saúde Global , Administração de Instituições de Saúde , Humanos , Análise Multivariada , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Inquéritos e Questionários , Uganda
11.
BMC Public Health ; 20(1): 549, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326928

RESUMO

BACKGROUND: Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored. METHODS: We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis. RESULTS: The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90-3.39) and in Ghana (OR = 1.257, 95% CI: 0.77-2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081-2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services. CONCLUSIONS: These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Análise por Conglomerados , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Gana , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Nigéria , Gravidez , População Rural/estatística & dados numéricos , Classe Social , População Urbana/estatística & dados numéricos
12.
Afr J AIDS Res ; 19(1): 24-33, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32200723

RESUMO

Background: Despite the availability of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) services, many factors and reasons prevent mothers from accessing these services. HIV prevalence is still high among South African women of reproductive age and mother-to-child-transmission (MTCT) is a concern. This study ascertained the perspectives of healthcare workers regarding availability and accessibility of the PMTCT programme.Objective: To explore and describe the perspectives of healthcare workers regarding availability and accessibility of the PMTCT programme.Method: Qualitative research with exploratory-descriptive design was utilised. Data were collected from 21 healthcare workers using three focus-group discussions. The participants were selected based on rendering the PMTCT programme services for more than two years. Moreover, the participants had undergone training, formal education and continuous support on the PMTCT programme. Three large clinics were selected as the main clusters of the sub-district. Tesch's method was used to analyse the qualitative data.Results: Healthcare workers indicated ineffective utilisation of the PMTCT programme services by HIV-positive pregnant women. Most women had challenges with child feeding owing to limited knowledge. Another challenge indicated by healthcare workers was lack of resources. It is important that recommendations be implemented to assist with availability and accessibility of the PMTCT programme.Conclusion: Availability and accessibility of PMTCT programme services are still problematic. The study has the potential to inform development of strategies that may facilitate access to care for PMTCT programme clients.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por HIV/prevenção & controle , Pessoal de Saúde/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Feminino , Grupos Focais , Soropositividade para HIV , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Mães , Gravidez , Complicações Infecciosas na Gravidez/virologia , Pesquisa Qualitativa , Serviços de Saúde Reprodutiva/estatística & dados numéricos , África do Sul/epidemiologia
13.
Int J Equity Health ; 19(1): 44, 2020 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-32220250

RESUMO

BACKGROUND: Family planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services. METHODS: Using the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women. RESULTS: Our study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section. CONCLUSIONS: There is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , África Ocidental , Cesárea/estatística & dados numéricos , Comportamento Contraceptivo/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Cuidado Pré-Natal/estatística & dados numéricos , Características de Residência , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
14.
Obstet Gynecol ; 135(2): 361-369, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923070

RESUMO

OBJECTIVE: To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS: We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment. Descriptive statistics were calculated. RESULTS: The final sample consisted of 260 participants. About half (51.5%) had ever had an abnormal Pap test result, and 57.3% had ever tested positive for a sexually transmitted infection. Unintended pregnancy was common (61.2%), as was substance use during pregnancy (74.2%). Nearly half (46.5%) were not currently using a method of contraception, and only 28.5% were using a highly effective method. Common barriers to accessing reproductive health services included fear of being treated poorly or judged because of substance use, fear of child protective services, and structural barriers such as cost and lack of transportation. Most participants (80.4%) indicated interest in receiving sexual and reproductive health services on site or by referral from their substance use disorder treatment programs. CONCLUSION: Women in treatment for opioid use disorder in Michigan have high rates of adverse sexual and reproductive health experiences and face barriers to accessing care.


Assuntos
Acesso aos Serviços de Saúde/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Anticoncepção , Estudos Transversais , Feminino , Humanos , Michigan/epidemiologia , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada , Doenças Sexualmente Transmissíveis/prevenção & controle , Adulto Jovem
15.
BMJ Sex Reprod Health ; 46(3): 210-217, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31964779

RESUMO

OBJECTIVES: Sexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a health advisor and (iii) artificial intelligence (AI)-enabled chatbots, as potential platforms for SRH advice. METHODS: A pencil-and-paper 33-item survey was distributed in three clinics in Hampshire, UK for patients attending SRH services. Logistic regressions were performed to identify the correlates of acceptability. RESULTS: In total, 257 patients (57% women, 50% aged <25 years) completed the survey. As the first point of contact, 70% preferred face-to-face consultations, 17% telephone consultation, 10% webchats and 3% video consultations. Most would be willing to use video consultations (58%) and webchat facilities (73%) for ongoing care, but only 40% found AI chatbots acceptable. Younger age (<25 years) (OR 2.43, 95% CI 1.35 to 4.38), White ethnicity (OR 2.87, 95% CI 1.30 to 6.34), past sexually transmitted infection (STI) diagnosis (OR 2.05, 95% CI 1.07 to 3.95), self-reported STI symptoms (OR 0.58, 95% CI 0.34 to 0.97), smartphone ownership (OR 16.0, 95% CI 3.64 to 70.5) and the preference for a SRH smartphone application (OR 1.95, 95% CI 1.13 to 3.35) were associated with video consultations, webchats or chatbots acceptability. CONCLUSIONS: Although video consultations and webchat services appear acceptable, there is currently little support for SRH chatbots. The findings demonstrate a preference for human interaction in SRH services. Policymakers and intervention developers need to ensure that digital transformation is not only cost-effective but also acceptable to users, easily accessible and equitable to all populations using SRH services.


Assuntos
Inteligência Artificial/normas , Linhas Diretas/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Serviços de Saúde Reprodutiva/normas , Adolescente , Adulto , Idoso , Inteligência Artificial/estatística & dados numéricos , Estudos Transversais , Feminino , Linhas Diretas/estatística & dados numéricos , Humanos , Internet , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido
16.
JAMA Netw Open ; 3(1): e1920053, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995216

RESUMO

Importance: Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. Objective: To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. Design, Setting, and Participants: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. Main Outcomes and Measures: The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. Results: The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. Conclusions and Relevance: In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/provisão & distribução , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Catolicismo , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
17.
Public Health ; 180: 136-140, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31901574

RESUMO

OBJECTIVES: To investigate patient demographics and venue type preferences within community settings associated with re-attendance for chlamydia testing. STUDY DESIGN: Data used for this analysis were obtained from the English National Chlamydia Screening Programme (NCSP) which focuses on prevention, control and treatment of chlamydia in sexually active under-25 year olds. A greater understanding of how young adults attend services helps to inform commissioners regarding where to focus resources within community settings. METHODS: Data from the Chlamydia surveillance system (CTAD) were used to count patient attendances at non-specialist sexual health services (SHSs) among 15-24-year-olds and monitor re-attendance for chlamydia testing within and between community services between 6 and 18 months of their first visit. RESULTS: From January 2013 to December 2016, 866,847 young people underwent 1,041,245 tests for chlamydia. Re-attendance for chlamydia testing was 20.1% (174,398/866,847). Re-attendance rate was 28.5% after a positive test and 19.5% after a negative test. For re-attenders, 64.2% used the same venue type for both visits. General practice (GP) and sexual and reproductive health services (SRH) were the most commonly re-attended services (31.0% and 30.6% respectively). CONCLUSIONS: Only one in five re-attended for chlamydia testing. Re-attendance was associated with having a positive result, accessibility and convenience. Patients are likely to return for testing to services they know. This should be considered by commissioners implementing new re-attendance guidance based on the NCSP.


Assuntos
Infecções por Chlamydia/prevenção & controle , Serviços de Saúde Comunitária/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Infecções por Chlamydia/epidemiologia , Inglaterra/epidemiologia , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adulto Jovem
18.
J Obstet Gynaecol ; 40(2): 252-259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31392913

RESUMO

This service evaluation aimed to appraise the delivery of a fertility preservation service for women with cancer which was established in 2005 as part of an Assisted Conception Unit. First, the ACU-database was interrogated between 08/2005 and 01/2017; revealing 174 women received referrals over the 12-year period with a steady referral increase each year. Demographic analyses revealed factors, such as being partnered, to be strong indicators of whether women would seek FP or not. To improve service provision, women who had consented to be contacted for audit, administrative and research purposes, received questionnaires to ascertain their perspectives on the FP decision-making process, their outcomes and ACU after-care. The majority perceived their experience as excellent due to the care they received from ACU staff, speed and efficiency in service delivery. The increasing number of referrals since 2005 is reassuring. However, this audit also highlighted shortcomings of the service, such as limited awareness of the fertility counselling service and lack of after-care.IMPACT STATEMENTWhat is already known on this subject? There has been an increase in women diagnosed with cancer undergoing fertility preservation (FP) before starting potential gonadotoxic treatment. Offering FP to these women is essential as the ability to have future children is often perceived as equally as important as survivorship, and a source of hope for the future.What do the results of this study add? This study presents a service evaluation, across a 12-year period, of delivering FP services to women with cancer in one UK Assisted Conception Unit (ACU). Women's experiences of the service were evaluated to enhance service delivery and make recommendations for clinical practice.What are the implications of these findings for clinical practice and/or future research? The current service evaluation demonstrated increased rates of FP referral over a 12-year period for women with cancer. While this increasing number is reassuring and reflecting increased awareness among professionals and patients; shortcomings in the care pathway were also found: women reported limited opportunity to see fertility counsellors and desired better after care. This information may also be of benefit to other ACUs seeking to enhance and improve service provision in the care of women with cancer, contemplating fertility preservation.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Preservação da Fertilidade/estatística & dados numéricos , Neoplasias/terapia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adulto , Aconselhamento , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Reino Unido
19.
BMJ Sex Reprod Health ; 46(2): 132-138, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31722934

RESUMO

BACKGROUND: Mycoplasma genitalium (Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment. METHODS: Demographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic. RESULTS: There were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens. CONCLUSIONS: Treatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge.


Assuntos
Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium/efeitos dos fármacos , Resultado do Tratamento , Uretrite/etiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Infecções por Mycoplasma/epidemiologia , Mycoplasma genitalium/patogenicidade , Serviços de Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Uretrite/epidemiologia , Uretrite/terapia
20.
Womens Health Issues ; 30(1): 49-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31796346

RESUMO

BACKGROUND: Research on the physical and mental health profiles and patterns of health care use among women veterans receiving health care from the Department of Veterans Affairs (VA) on the island of Puerto Rico is lacking. METHODS: This cross-sectional study examines differences in physical and mental health conditions, and patterns of VA health care use, between women veterans of the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) era who were using VA facilities in Puerto Rico (n = 897) and those using U.S.-based VA facilities (n = 117,216) from 2002 to 2015. RESULTS: Results of fully adjusted logistic regression models revealed that OIF/OEF women in Puerto Rico had heightened risk for global pain-related disorders (i.e., any pain) (adjusted odds ratio [AOR], 1.45; 95% confidence interval [CI], 1.22-1.71), back pain (AOR, 1.83; 95% CI, 1.56-2.14), diabetes (AOR, 1.42; 95% CI, 1.03-1.95), hyperlipidemia (AOR, 3.34; 95% CI, 2.80-3.98), major depression (AOR, 1.78; 95% CI, 1.53-2.06), and bipolar depression (AOR, 1.66; 95% CI, 1.34-2.04). They also evidenced greater risk for a host of reproductive health conditions and had higher average annual use of VA health care than their U.S. counterparts. CONCLUSIONS: OIF/OEF women receiving VA health care in Puerto Rico evidenced a greater burden of physical illness, depression, and heightened use of VA health care services relative to their U.S. counterparts. Providers' increased awareness of the physical and mental health care needs of this population is warranted. Research efforts that help to identify efficient and effective strategies to provide culturally tailored and/or personalized health care for this population could also be useful.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Doença Crônica/epidemiologia , Doenças Transmissíveis/epidemiologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Guerra do Iraque 2003-2011 , Masculino , Transtornos Mentais/psicologia , Saúde Mental , Pessoa de Meia-Idade , Porto Rico , Estados Unidos , Veteranos/estatística & dados numéricos , Adulto Jovem
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