Journal of women's health
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Journal of women's health · Dec 2020
Adherence to Recommended Practices for Provision of Long-Acting Reversible Contraception Among Providers in a Large U.S. Health Care System.
Background: There is little research examining adherence to practice guidelines for long-acting reversible contraception (LARC). We assessed same-day LARC provision and adherence to other guideline-recommended practices among providers in a large academic health care system. Materials and Methods: We surveyed 363 providers who had billed using LARC-related codes within the prior 12 months. ⋯ Among IUD providers, 73% schedule routine follow-up after insertion. Conclusions: Same-day LARC provision is low among providers in a large academic health care system. Provider-identified barriers suggest interventions to improve LARC access, including incentivizing device stocking and billing and insurance education.
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Journal of women's health · Dec 2020
Concomitant Bilateral Salpingo-Oophorectomy at Hysterectomy: Differences by Race and Menopausal Status in the Veterans Affairs Health Care System, 2007-2014.
Background: Hysterectomy can be performed with concomitant bilateral salpingo-oophorectomy (BSO) to treat symptomatic pathology of the ovary (e.g., endometriosis) or to prevent ovarian cancer. Our objective was to examine the relationship between race and concomitant BSO by menopausal status in the Veterans Affairs (VA) health care system. Methods: This is a longitudinal study utilizing VA administrative data to identify hysterectomies provided or paid for by VA (i.e., source of care) between 2007 and 2014. ⋯ Conclusions: Premenopausal Black Veterans are less likely to undergo BSO even after adjustment for salient characteristics. Our findings may have implications for equitable gynecological care for Veterans. Additional research is needed to better understand the role of differential preferences or cancer risk in these racial differences.
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Journal of women's health · Dec 2020
Comparative StudyPreconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study.
Background: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. ⋯ Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. Conclusion: Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.
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Background: Screening for diabetes in early pregnancy is recommended for high-risk women, however, the optimal test for the diagnosis of early gestational diabetes mellitus (GDM) is unknown. Thus, the objective of this study was to evaluate hemoglobin A1c (HbA1c) as a diagnostic test for early GDM compared with two-step testing. Materials and Methods: Retrospective cohort of women with prior GDM or obesity who had HbA1c and two-step testing <21 weeks' gestation. Early GDM was diagnosed by 1 hour, 50 g oral glucose challenge test (GCT) ≥135 mg/dL and ≥2 abnormal values on 3 hour, 100 g oral glucose tolerance test or GCT >200 mg/dL. ⋯ Median HbA1c levels were higher among women with GDM versus those without GDM (5.8% vs. 5.3%, p < 0.001). The AUC for HbA1c compared with two-step testing was 0.80 (95% CI 0.69-0.91). The optimal HbA1c threshold was 5.6% (64% sensitivity, 84% specificity). Conclusions: HbA1c is moderately predictive of early GDM compared with two-step testing, and a threshold lower than that used for diabetes diagnosis among nonpregnant adults is justified.
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Journal of women's health · Dec 2020
From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities.
Background: Research is needed to improve understanding of work-life integration issues in academic medicine and to guide the implementation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS), a national initiative offering financial support to physician-scientists facing caregiving challenges. Materials and Methods: In 2018, as part of a prospective program evaluation, the authors conducted a qualitative study to examine FRCS program participants' initial impressions, solicit descriptions of their career and caregiving experiences, and inquire how such factors might influence their professional advancement. The authors invited all 33 awardees who had been granted FRCS funding in the first year of the program to participate in the study, of whom 28 agreed to complete an interview. ⋯ Their comments indicated that the FRCS has the potential to influence culture if institutional leadership simultaneously fosters a community that validates individuals both as caregivers and as scientists. Conclusions: Insights garnered from this qualitative study suggest that there is a pressing need for institutional leaders to implement programs that can foster awareness and normalization of caregiving challenges. In addition to providing funding and other tangible resources, interventions should strive to reinforce a broader culture that affirms the presence of work-life integration challenges and openly embraces solutions.