Women's health issues : official publication of the Jacobs Institute of Women's Health
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Womens Health Issues · Nov 2017
When Guidelines Conflict: A Case Study of Mammography Screening Initiation in the 1990s.
Cancer screening guidelines communicate important information to patients and physicians regarding the costs and benefits of screening. Currently, guideline recommendations from major organizations conflict regarding the age of mammography screening initiation. To understand current and future U.S. mammography screening patterns we study age-mammography patterns from the 1990s, another period of conflicting guideline recommendations. ⋯ Physicians and patients converged primarily on the age 40 mammography screening threshold during the 1990s. Prices, along with guidelines, were key determinants of the age of screening initiation, with the insured responding to age 40 coverage and cost-sharing reductions and the uninsured affected by guidelines and public funding tied to the age 50 threshold. The policy factors underlying these results, recent ACA coverage increases, and ACA cost-sharing requirements imply that a substantial number of women will continue to receive mammography screening in their 40s.
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Womens Health Issues · Nov 2017
Perinatal Depression, Adverse Life Events, and Hypothalamic-Adrenal-Pituitary Axis Response to Cold Pressor Stress in Latinas: An Exploratory Study.
Latinas are disproportionately affected by perinatal depression (PND) as well as by adverse life events (ALEs), an independent predictor of PND. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been seen both in women with PND and with a history of ALEs in non-Latinas. Although some evidence suggests that HPA axis dysregulation may mediate the link between ALEs and PND, this hypothesis has received little attention and there are no studies that have examined these pathways in Latinas. The primary aim of the present study was to explore, in a Latina sample, associations between ALEs, PND, and HPA axis stress reactivity to a physical stressor, the cold pressor test (CPT). The secondary aim was to explore whether HPA axis reactivity and PND were associated with pain sensitivity to the CPT. ⋯ Given the associations between ALEs and PND and their individual effect on HPA axis stress reactivity, future studies on PND should include a larger sample of Latinas to test the mediating effects of HPA axis reactivity on associations between ALEs and PND.
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Womens Health Issues · Sep 2017
Observational StudyQuality and Content of Patient-Provider Communication About Contraception: Differences by Race/Ethnicity and Socioeconomic Status.
Research in family planning has shown that contraceptive counseling has an influence on women's family planning outcomes, but also that women are often dissatisfied with the counseling they receive. Little is known about how contraceptive counseling is conducted in the United States. We describe both the content and interpersonal quality of provider communication during family planning visits, as well as assess whether disparities in counseling exist by patient race/ethnicity and socioeconomic status. ⋯ Several deficiencies in contraceptive counseling were found, suggesting areas for further emphasis in training. Differences by race/ethnicity and socioeconomic states were not marked.
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Womens Health Issues · Sep 2017
Examining the Gap: Compensation Disparities between Male and Female Physician Assistants.
Compensation disparities between men and women have been problematic for decades, and there is considerable evidence that the gap cannot be entirely explained by nongender factors. The current study examined the compensation gap in the physician assistant (PA) profession. ⋯ There remain challenges to ensuring pay equality in the PA profession. Even when compensation-relevant factors such as experience, hours worked, specialty, postgraduate training, region, and call are controlled for, there is still a substantial gender disparity in PA compensation. Remedies that may address this pay inequality include raising awareness of compensation disparities, teaching effective negotiation skills, assisting employers as they develop equitable compensation plans, having less reliance on past salary in position negotiation, and professional associations advocating for policies that support equal wages and opportunities, regardless of personal characteristics.
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Womens Health Issues · Jul 2017
Do 72-Hour Waiting Periods and Two-Visit Requirements for Abortion Affect Women's Certainty? A Prospective Cohort Study.
This paper examines how Utah's two-visit requirement and 72-hour waiting period influence women's certainty about their decision to have an abortion. ⋯ Most women were certain of their decision to have an abortion when they presented for their abortion information visit and their certainty remained unchanged despite the information visit and 72-hour waiting period. Changes in certainty were largely concentrated in the minority of women who expressed uncertainty about their decision before the beginning of the information visit. Thus, individualized counseling for the minority who are conflicted when they first present for care seems more appropriate than universal requirements.