A call to action for evidence‐based safer conception interventions for HIV‐affected couples desiring children in Sub‐Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135487/1/ijgo73.pd

Colorectal Cancer Screening Practices among Obstetrician/Gynecologists and Nurse Practitioners

Abstract Objective: Obstetrician/gynecologists (Ob/Gyn) and nurse practitioners (NP) are essential providers of primary and preventive care for their female patients. Therefore, colorectal cancer (CRC) screening should be part of their routine preventive practices. The purpose of our study is to evaluate the CRC screening practices of these providers. Methods: A self-administered survey was mailed to a national sample of 1130 Ob/Gyns and NPs to assess providers' demographics, current CRC screening practices, and familiarity with CRC guidelines. Results: Three hundred thirty-six providers (29.7%) returned our survey (54% Ob/Gyns and 46% NPs). Three fourths of providers routinely performed screening for CRC, compared with 95% for breast and cervical cancer. Routine CRC screening was more common among Ob/Gyns (87.2%) than NPs (61.7%) (p10 years (p<0.01), practicing in a multispecialty group (2.62 times more likely), and having an older patient population (p<0.001). Conclusions: Ob/Gyns and NPs underuse CRC screening compared with breast and cervical cancer screening and lack knowledge about appropriate use of CRC screening modalities. Opportunities to further educate Ob/Gyns and NPs should be sought to improve compliance with current CRC screening guidelines.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78151/1/jwh.2008.1117.pd

Discontinuation of long‐acting reversible contraception versus short‐term hormonal methods in urban Ghana: A pilot longitudinal study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/1/ijgo12518.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144677/2/ijgo12518_am.pd

Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act

Background: Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Methods: Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18?55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Results: Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03?0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17?0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10?0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35?0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12?32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Conclusions: Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140134/1/jwh.2014.5175.pd

Public perceptions of endometriosis: perspectives from both genders

Objective. Many women with endometriosis experience significant delay between the onset of symptoms and definitive diagnosis. Much is published on physician awareness of endometriosis and on the experiences of women with the condition. There is a paucity of data, however, surrounding perceptions of endometriosis in the general population. This study aims to assess knowledge of endometriosis among individuals of both genders. Design. Survey study. Setting. Family waiting room of a large university hospital. Population. A total of 543 men and women. Methods. Surveys were distributed to men and women over the age of 18 in the family waiting room of a large university hospital. Main outcome measures. A series of questions regarding the etiology, symptoms, and treatments for endometriosis were combined into a composite knowledge score. Results. Knowledge of endometriosis was positively correlated with female gender, education level, regular health care, and exposure to individuals with the disease. Women diagnosed with endometriosis were more likely to have discussed symptoms of the condition with their physicians than women without the diagnosis. Conclusions. Individuals of both genders have limited knowledge of the signs and symptoms of endometriosis, which may contribute to the delay in diagnosis of the condition.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79158/1/00016341003657900.pd

Pilot study outcomes from a resource‐limited setting for a low‐cost training program for laparoscopic surgical skills

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135455/1/ijgo186.pd

Moving Toward Patient‐Centered Care: Women's Decisions, Perceptions, and Experiences of the Induction of Labor Process

Background Patient preferences and clinician practices are possible causative factors to explain the increase in induction of labor, but scientific studies that demonstrate this link are limited. The purpose of this study is to identify factors that influence inductions from the perspective of women. Methods A qualitative investigation using grounded theory methodology was conducted. Women were interviewed preinduction and postinduction. Analysis of the interviews was conducted using constant comparison to identify codes, categories, and themes. Through this process the complex intersection between women, their clinician, and the application of evidence‐based care in clinical practice was explored. Results Five major themes from the preinduction interview were identified; safety of baby, women's trust in their clinician, relief of discomfort and/or anxiety, diminish potential or actual risk, and lack of informed decision making. Five major themes were identified from the postinduction interview; lack of informed decision making, induction as part of a checklist, women's trust in their clinician, happy with induction, and opportunities to improve the experience. Conclusions Lack of informed decision making was cited as a barrier to optimal care. This study has important implications for patient‐centered research and clinical care, requiring the inclusion of women and the salient concepts of care that they identify.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107354/1/birt12080.pd

Exploring the optimal allostatic load scoring method in women of reproductive age

AimsThe aim of this study was to determine the optimal allostatic load scoring method.DesignThis is a secondary analysis of data on women of reproductive age from the 2001-2006 National Health and Nutrition Examination Survey.MethodsWe created allostatic load summary scores using five scoring methods including the count-based, Z-Score, logistic regression, factor analysis and grade of membership methods. Then, we examined the predictive performance of each allostatic load summary measure in relation to three outcomes: general health status, diabetes and hypertension.ResultsWe found that the allostatic load summary measure by the logistic regression method had the highest predictive validity with respect to the three outcomes. The logistic regression method performed significantly better than the count-based and grade of membership methods for predicting diabetes as well as performed significantly better for predicting hypertension than all of the other methods. But the five scoring methods performed similarly for predicting poor health status.ConclusionWe recommended the logistic regression method when the outcome information is available, otherwise the frequently used simpler count-based method may be a good alternative.ImpactThe study compared different scoring methods and made recommendations for the optimal scoring approach. We found that allostatic load summary measure by the logistic regression method had the strongest predictive validity with respect to general health status, diabetes and hypertension. The study may provide empirical evidence for future research to use the recommended scoring approach to score allostatic load. The allostatic load index may serve as an -early warning- indicator for health risk.ç ®ç è¿ é¡¹ç  ç©¶ç ç ®ç å ¨äº ,ç¡®å® æ ä½³é åº è´ è ·è¯ å æ ¹æ³ ã è®¾è®¡è¿ æ ¯å¯¹2001å¹´è ³2006æ é ´å ¨å ½å ¥åº·å è ¥å »æ£ æ ¥è° æ ¥ä¸­è ²é¾ å¦ å¥³æ °æ ®ç äº æ¬¡å æ ã æ ¹æ³ æ ä»¬ä½¿ç ¨äº äº ç§ è¯ å æ ¹æ³ (å æ ¬å ºäº è®¡æ °æ³ ã Z计å æ³ ã é »è¾ å å½ æ³ ã å  å­ å æ æ³ å é ¶å± åº¦æ ¹æ³ )æ ¥å å»ºäº é åº è´ è ·æ± æ »å æ °ã ç ¶å ,æ ä»¬æ£ æ ¥äº ä¸ ä¸ ä¸ªç» æ ç ¸å ³ç å ç§ é åº è´ è ·æ± æ »æ °å ¼ç é¢ æµ æ §è ½:æ ´ä½ å ¥åº·ç ¶æ ã ç³ å°¿ç å é« è¡ å ã ç» æ æ 们å ç °,é »è¾ å å½ æ³ ç é åº è´ è ·æ± æ »å æ °å¯¹è¿ ä¸ ä¸ªç» æ å ·æ æ é« ç é¢ æµ æ 度ã é »è¾ å å½ æ³ å ¨é¢ æµ ç³ å°¿ç æ ¹é ¢ç è¡¨ç °æ æ ¾ä¼ äº å ºäº è®¡æ °æ³ å é ¶å± åº¦æ ¹æ³ ,å ¨é¢ æµ é« è¡ å æ ¹é ¢ç è¡¨ç °ä¹ æ æ ¾ä¼ äº æ æ å ¶ä» æ ¹æ³ ã ä½ è¿ äº ç§ è¯ å æ ¹æ³ å ¨é¢ æµ ä¸ è ¯å ¥åº·ç ¶æ æ ¹é ¢ç è¡¨ç °ç ¸ä¼¼ã ç» è®ºå½ ç» æ èµ æ å ¯ç ¨æ ¶,æ ä»¬æ ¨è é »è¾ å å½ æ³ ,å ¨å ¶ä» æ ¹é ¢,å¸¸ç ¨ä¸ æ ´ç® å ç å ºäº è®¡æ °æ³ å ¯è ½ä¹ æ ¯ä¸ ä¸ªä¸ é ç é æ ©ã å½±å è¯¥ç  ç©¶æ¯ è¾ äº ä¸ å ç è¯ å æ ¹æ³ ,并æ å ºäº æ ä½³è¯ å æ ¹æ³ ç 建议ã æ 们å ç °ç ¨é »è¾ å å½ æ³ è¿ è¡ ç é åº è´ è ·æ± æ »å æ °å¯¹æ ´ä½ å ¥åº·ç ¶æ ã ç³ å°¿ç å é« è¡ å å ·æ æ 强ç é¢ æµ æ æ æ §ã è¯¥ç  ç©¶å ¯ä»¥ä¸ºä» å ä½¿ç ¨æ ¨è ç è¯ å æ ¹æ³ å¯¹æ æ é åº è´ è ·è¯ å æ ä¾ å® éª æ §è¯ æ ®ã é åº è´ è ·æ æ °å ¯ä»¥ä½ ä¸ºå ¥åº·é£ é ©ç -é¢ è­¦-æ æ  ãPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151983/1/jan14014_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151983/2/jan14014.pd

Attitudes toward birth spacing among women in Eastern Uganda

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135383/1/ijgo194.pd

U.S. Women's Intended Sources for Reproductive Health Care

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd