Journal of women's health
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Journal of women's health · Jan 2025
An Analysis of Opioid Consumption and Patient Recovery after Hysterectomy by Surgical Approach.
Background: Minimally invasive hysterectomy is preferred to open hysterectomy due to lower morbidity, but recent data regarding the association of surgical approach with patient recovery and opioid consumption are lacking. Objective: To analyze how postoperative opioid use and return to baseline activity vary by surgical approach for hysterectomy. Study design: This was a retrospective cohort study including hysterectomy patients from the Michigan Surgical Quality Collaborative registry that was linked to the State of Michigan's prescription drug monitoring program. ⋯ Other covariates associated with lower opioid consumption included older age and year of surgery in 2019 versus 2018. Predicted probability of return to baseline activities >4 weeks after surgery was 51% (44-57%), 43% (40-45%), and 64% (60-69%) for vaginal, laparoscopic, and open hysterectomy, respectively. Conclusion: Minimally invasive approaches to hysterectomy are associated with lower postoperative opioid consumption and a more rapid recovery relative to open hysterectomy.
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Introduction: Many Americans are not using the contraceptive method they prefer, but there has been limited study of how this may be related to health system barriers. We evaluated how such barriers to contraceptive care are related to unmet contraceptive preference in Mississippi and which contraceptive methods are preferred by those who report an unmet preference. Materials and Methods: Between September 2020 and February 2021, we used social media advertisements to recruit Mississippi residents 18-45 years of age, who were assigned female at birth, for an online survey. ⋯ Among respondents with unmet preference, short-acting hormonal, long-acting reversible, and permanent methods were most desired. Conclusion: We find that nearly two-fifths of reproductive-aged Mississippians with capacity for pregnancy are not using their preferred contraceptive method. Structural barriers to care are very common and are significantly associated with experiencing unmet contraceptive preference, undermining reproductive autonomy.
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Journal of women's health · Jan 2025
Abortion After Pregnancy Occurrence with Contraceptive Use Among Veterans.
Objective: Many people report becoming pregnant while using contraception. Understanding more about this phenomenon may provide insight into pregnant people's responses to and healthcare needs for these pregnancies. This study explores the outcome (e.g., birth, miscarriage, abortion) of pregnancies among Veterans in which conception occurred in the month of contraceptive use. ⋯ In adjusted models, pregnancies occurring in the month of contraceptive use were significantly more likely to end in abortion (aOR: 1.76, 95% CI: 1.42-2.18) than live birth. Conclusions: Pregnancy while using contraception is common among Veterans; these pregnancies are more likely to end in abortion than live birth. Given widespread restrictions to reproductive health services across much of the United States, ensuring Veterans' access to comprehensive care, including abortion, is critical to supporting reproductive autonomy and whole health.
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Journal of women's health · Dec 2024
"No One Really Prepares You": Lived Experiences of Women Division Chiefs in Academic Medicine.
Objectives: Although women have comprised at least 50% of medical school classes for decades, women remain underrepresented in leadership positions. Although the proportion of women division chiefs in the U. S. academic medical centers is small, it is growing. ⋯ The following major themes emerged: (1) Most women are externally motivated to seek out the division chief role, (2) formal preparation or leadership development prior to taking on the section chief role is lacking, (3) leaders (both men and women) who sponsor and mentor women facilitate their success, and (4) women leaders face specific challenges including promotion delays and lack of recognition of their authentic leadership styles. We found the following minor themes: (1) Lack of formal onboarding to the division chief role; (b) positive influence of women in senior leadership roles within the institution; and (c) barriers to leadership roles include feeling undervalued in preceding leadership roles, navigating parenthood, and need for broader sponsorship. Conclusion: Opportunities to support the continued growth of women division heads include more deliberate recruitment and succession planning; a structured, formal onboarding process; acceptance of authentic leadership styles; and more practical ways to support parenting.
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Journal of women's health · Dec 2024
Change in Postpartum Visit and Contraception Rates Pre-COVID-19 to Post-Lockdown in Six U.S. Federally Qualified Health Centers.
Background: Postpartum care, including contraception, benefits maternal health and decreases mortality, which increased in the United States with COVID-19. Pandemic disruptions to postpartum health care access in vulnerable populations are not well understood. We utilize electronic health record (EHR) data for prenatal patients (n = 2,265) at six urban Federally Qualified Health Centers (FQHCs) from one year prepandemic (January 1, 2019) through one year after the first stay-at-home orders ("lockdown") (March 31, 2021). ⋯ After adjustment, PPV and contraception decreased by 9.3 percentage points (-13.1, -5.4), while PPV only was stable (-0.4 [-4.3, 3.6]). Conclusions: These findings suggest a substantial impact of the COVID-19 pandemic on postpartum care in FQHCs and community health centers. Supply and demand drivers require further examination to inform strategies to improve postpartum care access and subsequent maternal health outcomes.