Journal of women's health
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Journal of women's health · Nov 2019
Breast Screening Utilization and Cost Sharing Among Employed Insured Women Following the Affordable Care Act: Impact of Race and Income.
Introduction: We assessed changes in screening mammography cost sharing and utilization before and after the Affordable Care Act (ACA) and the revised U. S. Preventive Services Task Force (USPSTF) recommendations by race and income. Methods: We used Optum™© Clinformatics™® Data Mart deidentified patient-level analytic files between 2004 and 2014. ⋯ However, screening utilization plateaued or showed a significant decline after the 2009 USPSTF recommendation revision in all income and racial groups except for African Americans in whom screening rates continued to increase after 2009. Conclusions: Impact of ACA cost-sharing elimination did not differ among various racial and income groups. Among our population of employer-based insured women, the racial gap in screening mammography use appeared to have closed and potentially reversed among African American women. Continued monitoring of screening utilization as health care policies and recommendations evolve is required, as these changes may affect race- and income-based disparities.
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Journal of women's health · Nov 2019
Characteristics of Immigrants Obtaining Abortions and Comparison with U.S.-Born Individuals.
Background: Little information exists about individuals born outside of the United States who seek abortion services from U. S.-based providers. Baseline data are necessary to identify future changes in the profile of this population. Materials and Methods: Using the Guttmacher Institute's Abortion Patient Survey, we pooled two national samples of individuals obtaining abortions from 2008-2009 to 2013-2014 to provide data on 17,873 respondents, 16% of whom were immigrants. ⋯ S.-born respondents, a larger proportion of immigrants were older, uninsured, and had not completed high school. A smaller proportion of immigrants compared with nonimmigrants had their abortions after 12 weeks (8% vs. 11%) or traveled over 50 miles to obtain their abortion (9% vs. 16%). Conclusions: Particularly with the continued rise in both restrictive abortion and immigration policies in the United States, it is critical to monitor how immigrants' use of and access to abortion services are impacted in the changing environment. Ensuring that policies and clinical practices facilitate abortion access for immigrants will serve to better support the reproductive health needs of all women.
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Journal of women's health · Nov 2019
Maternal History of Cervical Surgery and Preterm Delivery: A Retrospective Cohort Study.
Introduction: Our aim was to investigate whether cervical conization and/or loop electrosurgical excision procedure (LEEP) increases the risk of preterm delivery. Materials and Methods: We conducted a retrospective cohort study of singleton deliveries at our institution from 2010 to 2015. Women aged 16-49 years were included in our study. Univariate and logistic regression were used for statistical analyses. ⋯ In multivariable analysis, history of cervical surgery remained associated with preterm delivery (OR = 1.75, 95% CI: 1.31-2.33). There was no interaction (p = 0.91) between maternal HPV status and history of cervical conization or LEEP. Discussion and Conclusions: Maternal history of cervical conization and/or LEEP increases the risk of preterm delivery irrespective of concurrent maternal HPV positivity within the 3 years preceding delivery. Maternal HPV status does not modify the effect of history of cervical conization and/or LEEP on preterm delivery.
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Journal of women's health · Nov 2019
Gynecologic Health Care Providers' Willingness to Provide Routine Care and Papanicolaou Tests for Transmasculine Individuals.
Background: Transmasculine individuals who have a cervix may be at risk of cervical cancer, but they face a number of barriers to accessing care, including difficulty finding knowledgable and culturally sensitive providers who are willing to care for transgender patients. We examined gynecologic health care providers' willingness to provide routine care and Papanicolaou tests (Pap tests) to transmasculine individuals, including the role of personal, clinical, and professional factors. Materials and Methods: We surveyed attending physicians, advanced practitioners, and residents in the Women's Health department of a large, integrated Midwest health system (n = 60, 74.1% response rate). Results: A majority of participants were female (68.3%) and white (73.3%). Most had met a transgender person before (79.7%), and 40.7% had cared for a transgender patient in the past 5 years. ⋯ Bivariate analysis suggests that having met a transgender person (p = 0.028), higher empathy scores (p = 0.015), political views (p = 0.0130), and lower transphobia (p = 0.012) were associated with willingness to provide routine care to transmasculine individuals. Lower transphobia (p = 0.034) and political views (p < 0.001) were also associated with willingness to provide Pap tests to transmasculine people. Conclusions: Providers' willingness was not associated with barriers related to training or knowledge-only with personal biases and experiences. Transgender-inclusive health care training that addresses personal attitudes should be a routine part of training for all health professionals.
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Journal of women's health · Nov 2019
Natural Conception is Safe for HIV-Serodiscordant Couples with Persistent Suppressive Antiretroviral Therapy for the Infected Partner.
Background: Sustained use of antiretroviral treatment to achieve a suppressed viral load in persons living with HIV is associated with zero or near-zero risk of sexual and vertical HIV transmission. This has led to an increasing number of HIV-serodiscordant couples (SDCs) who wish to have children. The aim of this study was to describe the most recent results of a protocol for reproductive counseling directed at HIV-SDCs who desire natural conception and to identify some of the factors influencing reproductive success. Methods: Two hundred fourteen couples were enrolled. ⋯ CD4+ lymphocyte count, HIV viral load, serology/viral load of hepatitis B/C viruses, syphilis serology, and other sexually transmitted infection diagnosis in both members of couple; spermiogram in men, HIV proviral and viral load in semen of male HIV-infected partners, and urine luteinizing hormone qualitative test in women were performed. Unprotected vaginal intercourses, pregnancies achieved, and their outcomes were recorded. Results: After almost 10,000 sexual relations, a total of 188 pregnancies was achieved, 62% of couples became pregnant once or several times with no HIV transmission to either the partner or the offspring. Younger age of woman, no fertility disorders in both members of couple, and no treatment with efavirenz in men were factors related with reproductive success. Conclusions: Natural conception, under controlled conditions, can be offered to SDCs who wish to have children as a safe method of conception and its effectiveness seems to be related to factors not different from those of the general population.