Women's health issues : official publication of the Jacobs Institute of Women's Health
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Womens Health Issues · Jan 2010
Impact of patient adherence and test performance on the cost-effectiveness of cervical cancer screening in developing countries: the case of Honduras.
We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis. ⋯ In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.
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Womens Health Issues · Jan 2010
Maternal mortality ratio and predictors of maternal deaths in selected desert districts in rajasthan a community-based survey and case control study.
Reduction in maternal and child mortality has been a top priority in India, especially in light of the commitment on the part of the national government to the reach the Millennium Development Goals. Despite massive program efforts and availability of technology needed to avert maternal deaths, the maternal mortality ratio (MMR) in India continues to be high. Population-based estimates of MMR are lacking, and reliable evidence of role of socioeconomic determinants and program-related factors that mediate medical causes is not available. The present study was conducted to develop population-based estimates of MMR, and to evaluate the primary causes of maternal deaths and factors associated with excess risk of maternal mortality. ⋯ MMR was estimated to be 519 (95% confidence interval [CI], 477-561). Hemorrhage was the chief cause (31%) of maternal deaths; the other causes were obstructed labor, severe anemia, puerperal sepsis, and abortion. Young age at child birth (odds ratio [OR], 2.6; 95% CI, 1.9-3.2) and poverty (OR, 2.5; 95% CI, 1.6-3.4) were independently associated with increased risk of maternal death. Presence of complications during antenatal period was an important predictor of maternal death (OR, 7.8; 95% CI, 6.8-8.8). Childbirth at home (OR, 4.4; 95% CI, 3.3-5.5) was associated with increased risk of maternal death. The study provides clear evidence for renewed program efforts and strategies for reducing complications and maternal deaths.
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Womens Health Issues · Jan 2010
The role of Medicaid in promoting access to high-quality, high-value maternity care.
One of the most challenging aspects of health care improvement and reform is ensuring that individuals, particularly those who are vulnerable and low income, have access to care. Just as challenging is the imperative to ensure that the care accessed is of the highest quality possible. The Institute of Medicine (IOM) report, Crossing the Quality Chasm, identified the primary goal of any high-quality heath care system: The ability to furnish the right care, in the right setting, at the right time. ⋯ All reforms, including Medicaid reforms, should seek to support the IOM-identified aims. Much of the emphasis in Medicaid policy development has been focused on access to care and great need for reform remains in the area of quality assurance and improvement, and disparity reduction because the program can play a significant role in this regard as well. More broadly, health care reform may provide an opportunity to revisit key issues around access to and quality of maternity care, including the benefit package, the content of services covered in the package, the frequency with which these services should be furnished, and the development of meaningful measures to capture whether women of childbearing age, including pregnant women, regardless of insurance status, indeed receive efficient, timely, effective, safe, accessible, and woman-centered maternity care.
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Womens Health Issues · Nov 2009
Screening mammography: a cross-sectional study to compare characteristics of women aged 40 and older from the deep South who are current, overdue, and never screeners.
We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. ⋯ Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.