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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.
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
3.
BMC Womens Health ; 20(1): 21, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028952

RESUMO

BACKGROUND: The Dominican Republic (DR) ranks among nations with the highest burden of HIV in the Caribbean. Cultural and gender roles in rural areas of the DR may place women at increased HIV risk. However, little is known about sexual health and HIV testing behaviors among women in the rural DR. METHODS: We conducted a needs assessment among a systematic sample of adult women in a rural DR community in 2016. Demographic and behavioral attributes related to HIV testing, sexual health, and healthcare utilization were evaluated. Poisson regression analysis was used to identify demographics and behaviors associated with having had a previous HIV test. Significance was defined as a p-value < 0.05. RESULTS: Among 105 women evaluated, 77% knew someone with HIV and 73% of women reported that they would be very or extremely likely to take an HIV test if offered. Only 68% reported a previous HIV test, including 47% who were tested over 2 years prior. Barriers to HIV testing included low risk perception (23%), distance or requisite travel (13%), and discomfort being tested (11%). Women who had never been tested for HIV were more likely than those who had been tested to be older (p = 0.03), to have a lower level of education (p = 0.04), and to have never been tested for other sexually transmitted infections (STI; p <  0.01). In the Poisson multiple regression model, the only significant predictor of having had an HIV test was having had an STI test (p = 0.03). CONCLUSIONS: In the rural DR, numerous barriers contribute to low prevalence of HIV testing among women. Most women report willingness to have an HIV test and many engage in routine health care, indicating that this population may benefit from incorporating HIV testing and other sexual health promotion activities into routine medical care.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , República Dominicana/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários , Adulto Jovem
4.
Nurs Outlook ; 68(2): 242-251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31526520

RESUMO

BACKGROUND: It is widely acknowledged that experiences of poor treatment during health care encounters can adversely impact how individuals and communities engage with the health care system. Hence, understanding the health care seeking experiences of diverse patient populations is central to identifying ways to effectively engage with marginalized patients and provide optimal care for all patients, particularly those with marginalized identities. PURPOSE: Drawing on the narratives of 24 undocumented African immigrant women, this qualitative study aimed to understand their experiences seeking health care. METHODS: Our study was undergirded by a postcolonial feminist perspective which aims to situate participants' experiences within their given, broader societal context. Data were analyzed using the principles of thematic analysis. FINDINGS: Our findings indicate that women experienced insensitivity during health care encounters and harbored a mistrust of health care staff. DISCUSSION: Findings uncover the need for health care providers to provide culturally safe care and to identify ways to create safe spaces for undocumented patients within the health care setting.


Assuntos
Assistência à Saúde/etnologia , Assistência à Saúde/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Imigrantes Indocumentados/psicologia , Imigrantes Indocumentados/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , África , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos/etnologia
5.
Cad Saude Publica ; 35(9): e00081718, 2019 09 09.
Artigo em Português | MEDLINE | ID: mdl-31508694

RESUMO

The study analyzed the life and healthcare stories of women living in the Northwest Zone of the city of Santos, São Paulo State, Brazil, who had experienced neonatal deaths between January 2015 and July 2016. The study used triangulation of data from documents from the surveillance division, field diaries from visits to services, and interviews with the women. The interviews provided the main body of empirical data, based on narratives of the women's sexual and reproductive history, prenatal care, childbirth, and the experience of neonatal death. Of the 15 eligible cases, 8 women were interviewed, 6 of whom over 30 years of age and 2 under 30 years, all African-Brazilians, natives of Santos, and working in unskilled occupations. The data yielded the following results: (1) histories of unplanned pregnancies with various gestational risk factors; (2) the women's acknowledgment that they had experienced good access to health services; (3) questions concerning the need for tests and test results, understanding of complications, explanation of treatment approaches, and referrals; (4) prematurity, present in all the cases; (5) pain during labor, abandonment, and transfer to other services due to lack of beds in the neonatal ICU; (6) lack of integration between levels of care; and (7) after the infant's death, limited approaches and little orientation on comprehensive care related to the neonatal death. In conclusion, although the prenatal care was positively rated by the women, there was no comprehensive care for them in relation to the experience of neonatal death, with dialogue and an offer of more adequate contraceptive methods given their health history, as well as counseling on the emotional distress resulting from these experiences.


Assuntos
Morte Perinatal , Serviços de Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Parto Obstétrico , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Fatores de Risco , Populações Vulneráveis , Serviços de Saúde da Mulher/organização & administração
7.
BMJ Open ; 9(5): e027452, 2019 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-31147364

RESUMO

OBJECTIVE: To explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C. DESIGN: A systematic review of qualitative research studies using a thematic synthesis approach. METHODS: Inclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS: Fifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls' experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of 'culturally safe care' are identified. CONCLUSIONS: This review has highlighted key knowledge gaps, especially around (1) girls'/unmarried women's experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training. PROSPERO REGISTRATION NUMBER: CRD420150300012015.


Assuntos
Circuncisão Feminina/psicologia , Assistência à Saúde Culturalmente Competente , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autocuidado , Adolescente , Adulto , Imagem Corporal , Circuncisão Feminina/reabilitação , Comunicação , Barreiras de Comunicação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interpessoais , Poder Psicológico , Parceiros Sexuais/psicologia , Identificação Social , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
9.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 620-626, abr.-maio 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-994787

RESUMO

Objective: The study's goal has been to know the guidelines provided to women about the puerperal period during the immediate puerperium. Methods: It is an exploratory research with a qualitative approach where the scenario was a Basic Health Unit located in the South of the Rio Grande do Sul State, Brazil. Six mothers participated in the study, and the data collection was performed through semi-structured individual interviews during September 2014. Regarding the data analysis, it was chosen Minayo's operational proposal. Results: Based on the findings, the results were grouped into the two following categories: the guidelines with regards to the physiological changes and the care towards women during the immediate puerperium; and, the guidelines with regards to the emotional alterations during the immediate puerperium. Conclusion: The professionals are committed to guide women in relation to breastfeeding during the puerperal period, but there are issues related to both the health education actions and the guidelines concerning the physiological changes that take place over the puerperal period


Objetivo: Conhecer as orientações sobre período puerperal, fornecidas à mulher no puerpério imediato. Método: Trata-se de um estudo de caráter qualitativo e exploratório, cujo cenário de investigação foi uma Unidade Básica de Saúde do Sul do Rio Grande do Sul. Participaram seis puérperas vinculadas à essa Unidade Básica, e a coleta dos dados foi realizada em setembro de 2014 através de entrevistas individuais semiestruturadas. Para análise dos dados, optou-se pela análise temática, seguindo as etapas descritas por Minayo (2013): ordenação, classificação e análise. Resultados: Foram classificados em duas categorias: orientações quanto às modificações fisiológicas e os cuidados em relação à mulher no puerpério imediato, e quanto às alterações emocionais nesse período. Conclusão: Os profissionais estão comprometidos em orientar à amamentação no período puerperal, mas existem deficiências relacionadas às ações de educação em saúde, além de orientações tangentes às mudanças fisiológicas do período puerperal


Objetivo: Conocer orientaciones sobre el periodo puerperal fornecidas a mujeres en el puerperio inmediato. Método: Se trata de un estudio de carácter cualitativo y exploratorio, cuyo escenario de investigación fue una Unidad Básica de Salud, del Sul del Rio Grande do Sul. Participaron seis puérperas, y la recolecta de datos fue realizada en septiembre de 2014 por medio de entrevistas individuales semiestructuradas. Para análisis de datos, se optó por la propuesta operativa de Minayo. Resultados: Fueron clasificados en dos categorías: orientaciones cuanto a las modificaciones fisiológicas, y los cuidados a las mujeres en puerperio inmediato, y cuanto a las alteraciones emocionales en el puerperio inmediato. Concluyón: Los profesionales están comprometidos a la orientación con la lactancia materna en el periodo puerperal, pero hay deficiencias relacionadas a las acciones de educación en salud y orientaciones tangentes a los cambios fisiológicos del periodo puerperal


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Educação em Saúde/estatística & dados numéricos , Período Pós-Parto , Promoção da Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos
10.
Prim Health Care Res Dev ; 20: e119, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32323643

RESUMO

AIM: To investigate the changes in the provision of preventive health services in terms of woman and child health after reorganization of the primary health care services. BACKGROUND: The primary care system in Turkey has undergone fundamental changes as a part of Health Transformation Program during last decade. But there was no community-based study to evaluate these changes. METHOD: This community-based and cross-sectional study was conducted in 2010, just before the reorganization of primary care services and in 2015, five year after the reforms. The 30×7 cluster sampling method was used in Zümrütevler quarter of Maltepe District. The socio-demographic characteristics of the participants, the presence of the physician who can be consulted for any health problem, the presence of smokers at home were questioned. The women aged 18 years or older and gave consent provided information about history of pregnancy and birth, the number of follow-ups during pregnancy, family planning method usage, cervical and breast cancer screening, breastfeeding duration, vaccinations, and prophylactic iron and vitamin D supplementation for their children. FINDINGS: After the reorganization of primary care, more people stated that they had physicians to whom they could consult for all kinds of health problems (27.8 versus 44.7%; P<0.001) and that physician was the primary care physician (30.2 versus 64.7%; P<0.001). The reported frequency of at least one smoker at home was decreased after reorganization of primary care (63.6 versus 53.1%; P=0.034). There were no significant differences in terms unplanned pregnancy, the use of family planning method, the number of pregnancy follow-ups and the frequency of Pap smears and mammography. There are no significant differences in terms of healthy children follow-ups, vaccination, vitamin D and iron supplementation (P>0.05). It was found that the duration of total breastfeeding increased after reorganization of primary care (P<0.001).


Assuntos
Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/organização & administração , Inovação Organizacional , Serviços Preventivos de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Serviços de Saúde da Mulher/organização & administração , Adolescente , Adulto , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Turquia , Serviços de Saúde da Mulher/estatística & dados numéricos
11.
Mil Med ; 184(3-4): e135-e138, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30169662

RESUMO

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


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Medicina Militar/métodos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Colômbia , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Saúde Global , Guatemala , Honduras , Humanos , Pessoa de Meia-Idade , Medicina Militar/estatística & dados numéricos , Estudos Retrospectivos , Serviços de Saúde da Mulher/tendências
12.
Issue Brief (Commonw Fund) ; 2018: 1-10, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30458586

RESUMO

Issue: Immigrant women of reproductive age in the U.S. face significant challenges obtaining comprehensive and affordable health insurance coverage and care--including sexual and reproductive health services--compared with U.S.-born women, because of myriad policy and systemic factors. Goals: Synthesize recent evidence on immigrant women's access to sexual and reproductive health coverage and care and provide recommendations for policymaking and research. Methods: A rapid literature review to identify and summarize evidence from peer-reviewed and select grey literature published since 2011 on health insurance coverage and sexual and reproductive health care services use among immigrant women in the U.S. Where available, evidence is compared to U.S.-born women. Findings and Conclusions: Immigrant women are less likely to have coverage and use sexual and reproductive health services than U.S.-born women, which may increase their risk of negative outcomes. Federal and state policymakers could take actions to advance immigrant women's sexual and reproductive health, including expanding eligibility for coverage and shoring up the nation's health care safety net. Further research is needed to understand the needs, use of services, and outcomes of immigrant women, as well as the factors that contribute to differences between immigrant and U.S.-born women, and among groups of immigrant women.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Feminino , Humanos , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Gravidez , Provedores de Redes de Segurança , Estados Unidos , Mulheres
13.
BMC Med Res Methodol ; 18(1): 150, 2018 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-30466391

RESUMO

BACKGROUND: Integrated knowledge translation (IKT) is a research approach in which knowledge users (KUs) co-produce research. The rationale for IKT is that it leads to research that is more relevant and useful to KUs, thereby accelerating uptake of findings. The aim of the current study was to evaluate IKT activities within a cancer health services research network in Ontario, Canada. METHODS: An embedded multiple case study design was used. The cases were 5 individual studies within an overarching cancer health services research network. These studies focused on one of the following topics: case costing of cancer treatment, lung cancer surgery policy analysis, patient and provider-reported outcomes, colorectal cancer screening, and a team approach to women's survivorship. We conducted document reviews and held semi-structured interviews with researchers, KUs, and other stakeholders within a cancer system organization. The analysis examined patterns across and within cases. RESULTS: Researchers and their respective knowledge users from 4 of the 5 cases agreed to participate. Eighteen individuals from 4 cases were interviewed. In 3 of 4 cases, there were mismatched expectations between researchers and KUs regarding KU role; participants recommended that expectations be made explicit from the beginning of the collaboration. KUs perceived that frequent KU turnover may have affected both KU engagement and the uptake of study results within the organization. Researchers and KUs found that sharing research results was challenging because the organization lacked a framework for knowledge translation. Uptake of research findings appeared to be related to the researcher having an embedded role in the cancer system organization and/or close alignment of the study with organizational priorities. Document reviews found evidence of planned IKT strategies in 3 of 4 cases; however, actual KU role/engagement on research teams was variable. CONCLUSIONS: Barriers to KU co-production of cancer health services research include mismatched expectations of KU role and frequent KU turnover. When a research study directly aligns with organizational priorities, it appears more likely that results will be considered in programming. Research teams that take an IKT approach should consider specific strategies to address barriers to KU engagement.


Assuntos
Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Neoplasias/terapia , Pesquisa Médica Translacional/métodos , Comportamento Cooperativo , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Feminino , Serviços de Saúde/normas , Pesquisa sobre Serviços de Saúde/normas , Humanos , Neoplasias/diagnóstico , Ontário , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Formulação de Políticas , Projetos de Pesquisa/normas , Pesquisadores/psicologia , Pesquisadores/normas , Pesquisadores/estatística & dados numéricos , Serviços de Saúde da Mulher/normas , Serviços de Saúde da Mulher/estatística & dados numéricos
14.
Womens Health Issues ; 28(6): 546-552, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30279054

RESUMO

INTRODUCTION: Little is known about women veterans' experiences accessing and using Department of Veterans Affairs (VA) maternity care, which is nearly all purchased from non-VA providers. OBJECTIVE: To understand women veterans' experiences, preferences, and challenges using VA maternity care. METHODS: We conducted 27 semistructured interviews with women veterans who used VA maternity care during fiscal year 2016. To capture a wide variety of experiences, we randomly sampled veterans from urban and rural VA facilities with higher and lower volumes of VA paid deliveries. All interviews were recorded and transcribed verbatim. Transcripts were analyzed using inductive and deductive content analysis. RESULTS: Themes included experiences initiating prenatal care, obtaining prenatal and lactation classes, the role of maternity care coordinators, mental health care, and satisfaction with care. Women described challenges obtaining authorization for care and establishing care with non-VA providers. First-time mothers appreciated the availability of prenatal and lactation classes. VA maternity care coordinators helped women veterans to navigate the challenges related to VA maternity care, ranging from finding non-VA providers to billing. The majority of participants were engaged with mental health care before pregnancy and continued this care during pregnancy. Women's satisfaction with VA maternity care was impacted by access to supportive, knowledgeable providers; care coordinators; woman-centered labor and delivery experiences; and billing issues. CONCLUSIONS: Our findings provide a portrait of the current state of VA maternity care from the perspectives of women veterans and highlight areas, such as care coordination and woman-centered models for labor and delivery, that can improve satisfaction with care.


Assuntos
Maternidades/organização & administração , Hospitais de Veteranos/organização & administração , Mães/psicologia , Cuidado Pré-Natal , United States Department of Veterans Affairs/organização & administração , Veteranos/psicologia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , Aleitamento Materno , Parto Obstétrico , Feminino , Humanos , Gravidez , Estados Unidos , Veteranos/estatística & dados numéricos , Saúde da Mulher
15.
N C Med J ; 79(4): 205-209, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991607

RESUMO

BACKGROUND In 2015, North Carolina became the 5th state to pass legislation requiring women to undergo state-mandated counseling 72 hours prior to abortion. Whether this legislation has changed the timing of abortion decision-making or receipt of care is not known.METHODS This is a cross-sectional study using anonymous survey data from women presenting for abortion at a hospital-based abortion clinic in North Carolina. Data were collected for 8 weeks immediately before and after implementation of the new waiting period.RESULTS 26/48 (54%) of eligible patients participated. More than half (56%) of women made their abortion decision relatively quickly (less than or equal to 3 days), but had a median time-to-care of almost a week.LIMITATIONS This small study is the 1st recent evaluation of abortion decision-making and receipt of care immediately before and after implementation of a 72-hour waiting period in a Southern state. Only women presenting for care at a single hospital-based clinic were surveyed. Data were self-reported.CONCLUSION In our clinical setting, most women decided to have an abortion quickly but still waited 10-15 days before receiving care. Extended waiting periods provide no medical benefits and the potential for harm and delay of care remains.


Assuntos
Aborto Induzido/estatística & dados numéricos , Tomada de Decisões , Listas de Espera , Aborto Induzido/legislação & jurisprudência , Instituições de Assistência Ambulatorial/legislação & jurisprudência , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Aconselhamento , Estudos Transversais , Feminino , Idade Gestacional , Humanos , North Carolina , Gravidez , Inquéritos e Questionários , Serviços de Saúde da Mulher/legislação & jurisprudência , Serviços de Saúde da Mulher/estatística & dados numéricos
16.
Aten. prim. (Barc., Ed. impr.) ; 50(6): 368-376, jun.-jul. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-179052

RESUMO

OBJETIVO: Explorar la percepción de las profesionales sanitarias que trabajan en centros sanitarios alternativos sobre las barreras y los facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos generales y de salud sexual y reproductiva en el País Vasco. Emplazamiento: País Vasco. DISEÑO: Análisis de contenido cualitativo basado en 11 entrevistas individuales. PARTICIPANTES: Profesionales sanitarias que trabajan en centros sanitarios alternativos de atención primaria y salud sexual y reproductiva. MÉTODO: La recolección de datos se realizó entre septiembre y diciembre de 2015 en cuatro centros sanitarios alternativos. Tras su transcripción, se identificaron unidades de significado, códigos y categorías. RESULTADOS: Del análisis emergieron cuatro categorías que representan cómo las características de las mujeres inmigrantes (Dime cómo eres y te diré cómo accedes), la actitud del personal administrativo y sanitario ("Cuando ya les atienden, estupendamente. El problema está con los administrativos"), el funcionamiento del sistema sanitario (Sistema de salud inflexible, pasivo y receptor de necesidades) y las políticas sanitarias ("Si no cumples los requisitos, pues no entras. La ley es la ley") influyen en el acceso a los servicios sanitarios públicos de las mujeres inmigrantes. CONCLUSIONES: Este estudio indica que hay un considerable número de barreras y pocos facilitadores en el acceso de las mujeres inmigrantes a los servicios sanitarios públicos y de salud sexual y reproductiva en el País Vasco. Los centros sanitarios alternativos se presentaron como favorecedores en la mejora de la salud de la población inmigrante y en su acceso


OBJECTIVE: To determine the perception of health professionals working in alternative health centres on the barriers and facilitators in the access by immigrant women to general public health services and sexual and reproductive health in the Basque Country. LOCATION: Basque Country. DESIGN: Analysis of qualitative content based on 11 individual interviews. PARTICIPANTS: Health professionals working in alternative health centres of Primary Care and sexual and reproductive health. METHOD: Data collection was performed between September and December 2015 in four alternative health centres. After transcription, the units of meaning, codes and categories were identified. RESULTS: Four categories emerged from the analysis, which represented how the characteristics of immigrant women (Tell me how you are and I will tell you how to access), the attitude of the administrative and health staff ("When they are already taken care of"), the functioning of the health system (Inflexible, passive and needs-responsive health system), and health policies ("If you do not meet the requirements, you do not go in. The law is the law") influence access to health services of immigrant women. CONCLUSIONS: This study shows that there are a considerable number of barriers and few facilitators to the access by immigrant women to public health and sexual and reproductive health services in the Basque Country. The alternative health centres were presented as favouring the improvement of the health of the immigrant population and in their access


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Entrevistas como Assunto , 25783 , Percepção , Espanha
17.
Cad Saude Publica ; 34(6): e00168116, 2018 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-29952404

RESUMO

Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.


Assuntos
Aborto Induzido/efeitos adversos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Complicações na Gravidez/terapia , Tempo para o Tratamento/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Gravidez , Fatores de Risco , Estigma Social , Fatores de Tempo , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
18.
Trop Med Int Health ; 23(7): 774-784, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29752836

RESUMO

OBJECTIVES: To enhance uptake of sexual and reproductive health (SRH) services by female sex workers (FSWs), we conducted an implementation study in which we piloted and tested context-specific 'diagonal' interventions, combining vertical, targeted interventions with horizontally improved access to the general health services, in three cities in sub-Saharan Africa. METHODS: We collected indicators of SRH service uptake through face-to-face interviews with approximately 400 FSWs, pre- and post-intervention, in Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, recruited by respondent-driven sampling. Changes in uptake were tested for their statistical significance using multivariate logistic regression models. RESULTS: In all cities, overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete and 70.9% to 87.6% in Mombasa. In Tete and Mombasa, rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilisation of general health services. CONCLUSION: SRH service utilisation improved in the short-term in three different sub-Saharan African contexts, primarily through vertical, targeted components. The long-term effectiveness of diagonal approaches, in particular on the use of general, horizontal health services, needs further investigation.


Assuntos
Infecções por HIV/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Profissionais do Sexo , Doenças Sexualmente Transmissíveis/epidemiologia , Adulto , África ao Sul do Saara/epidemiologia , Cidades , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/transmissão , Serviços de Saúde da Mulher/estatística & dados numéricos
19.
Rev Saude Publica ; 52: 54, 2018.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29791527

RESUMO

OBJECTIVE To analyze the prevalence of not consulting a doctor within a year. METHODS Cross-sectional population-based study, including women aged 20-60 years, living in the urban area of São Leopoldo, state of Rio Grande do Sul, in 2015. The association between variables and outcome was assessed using prevalence ratios and 95% confidence intervals (95%CI). The adjusted analysis was performed using Poisson regression with robust variance. RESULTS Among the 1,127 women participating in the study, 954 (84.6%, 95%CI 82.5-86.7) reported having consulted a physician in the year prior to the interview, 173 (15.4%, 95%CI 13.2-17.5) did not. Women belonging to lower income classes D and E, younger, and smokers had higher prevalences of no medical visits. The participants with hypertension had a higher prevalence of consultations. CONCLUSIONS There was no expected evolution in the local health system, despite the emergence of the policies implemented in this period. It is necessary to provide care for those in less favored socioeconomic conditions and for younger women.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto , Fatores Etários , Brasil , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , População Urbana , Saúde da Mulher , Adulto Jovem
20.
Mil Med ; 183(suppl_1): 538-546, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635613

RESUMO

The health concerns for military women who serve in austere environments include feminine hygiene, risk of infection, and limited knowledge of gynecologic conditions, symptoms, and prevention. The purpose of this study is to evaluate the effectiveness of the Women's Health Promotion Program (WHPP) for Austere Environments that was implemented in the military community setting of a large operational military unit on a southeastern U.S. military base. The WHPP is a pilot-tested program designed to educate women to recognize and prepare for environments that require alteration of feminine hygiene behaviors, with the goal of maintaining genitourinary health. Evaluation of the WHPP was designed according to the RE-AIM framework, which measures the Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance of a health promotion program. The WHPP was offered to 49 military units (none of which declined) and presented to 443 military women in those units. One year after the implementation of the WHPP, the rates of urinary tract infections, vaginal candidiasis infections, and menstrual disorders decreased among the units that participated in the WHPP. These findings lay the foundation for an Army-wide adoption of this WHPP that could enhance readiness in military women.


Assuntos
Promoção da Saúde/métodos , Desenvolvimento de Programas/métodos , Serviços de Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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