Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persist

Background: Research in the US and UK shows lesbian women are less likely than their heterosexual peers to attend for routine Pap smear tests. This study examined Pap smear test rates among community-attached lesbian, bisexual and queer (LBQ) women in New South Wales, to investigate if rates had changed between 2002 and 2012, compare rates to the general NSW population and identify predictive factors for Pap smear test attendance. Method: Data was taken from the Sydney Women and Sexual Health (SWASH) survey, a self-completed biennial questionnaire of LBQ women’s health and wellbeing. Results: Of the 4083 respondents, 83% had ever had a Pap smear test. Recent attendance rates were slightly higher than the general population. Significant predictors for ever having attended for a Pap smear test were older age, post-year 12 education, ever having had an STI test, being out about sexuality to a regular doctor and ever having had sex with men. Conclusions: Pap smear rates for LBQ women are encouraging when compared to rates in similar countries. A significant proportion of LBQ women are never receiving Pap smear tests. Predictive factors suggest a continued perception that women who have not had sex with men are not at risk of HPV, and highlight the importance of health providers providing a safe and welcoming environment for LBQ women to openly discuss their health

Redefining freebirth as a self-care practice: findings from a systematic qualitative evidence synthesis.

This poster summarises the findings of a systematic qualitative evidence synthesis on freebirth - the act of giving birth intentionally without a qualified health care professional being present. The study found 22 publications and drew themes of formal healthcare systems being felt to threaten reproductive self-determination, whereas freebirth is seen as a way of protecting this and further as a form of self-care

Exploring women's motivations to freebirth and their experience of maternity care: protocol for a systematic qualitative evidence synthesis.

Freebirth is the deliberate choice to give birth at home without a regulated healthcare professional. It is also known as unassisted childbirth. While the choice to decline professional care refers mainly to the intrapartum period, women who freebirth may choose to accept all, some or no antenatal and postnatal care. The last decade has seen an apparently increased number of women opting to freebirth; however, as a choice outside of the boundaries of health systems, it is difficult to know its exact prevalence. It is likely that freebirth may represent just a small proportion of the already low numbers (<1%) of homebirths in high income countries. Given that freebirth happens at the margin of maternity services, the impact of this choice in maternal and neonatal outcomes is currently unknown. This is a protocol for a systematic review, the objective of which is to identify, appraise and synthesise the qualitative evidence on women's motivations to freebirth and their experience of maternity care when choosing freebirth, with special attention to their perceptions of maternity care provision. This qualitative evidence synthesis aims to answer the following questions: 1) What factors influence women's choice to freebirth?; 2) How do women who freebirth perceive maternity care?; 3) What is the care experience for women who choose to freebirth

Exploring women’s motivations to freebirth and their experience of maternity care: a systematic qualitative evidence synthesis.

Freebirth is currently defined as the deliberate choice to give birth without a regulated healthcare professional. Previous reviews have identified factors influencing women’s choice to freebirth, yet, there is limited evidence on what is the care experience for women who choose to freebirth. To synthesise the qualitative evidence on women’s motivations to freebirth and their experience of maternity care when choosing freebirth. The researchers' conducted a qualitative evidence synthesis using a sensitive search strategy in May 2022 and August 2023. Twenty-two publications between 2008 and 2023 and from ten different high-income countries were included. Thematic synthesis, underpinned by a feminist standpoint, was used to analyse the data. Three main analytical themes were developed in response to each of the review questions. a) A quest for a safer birth' describes the factors influencing women's decision to freebirth. b) Powerful and powerless midwives' describes women's perceptions of their care providers (mostly midwives) and how these perceptions influenced their choice to freebirth. c) Rites of self-protection' describes women's care experiences and self-care practices in the pregnancy leading to freebirth. Freebirth was rarely women's primary choice but the result of structural and relational barriers to access wanted care. Self-care in the form of freebirth helped women to achieve a positive birth experience and to protect their reproductive self-determination. A new woman-centred definition of freebirth is proposed as the practice to self-care during birth in contexts where emergency maternity care is readily available

Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persist

ACO

Adults with type 1 and 2 diabetes and healthcare professionals' experiences of household food insecurity management in high income countries: a systematic review. [Protocol]

Protocol for a review, aiming to address the following questions: 1) What are the experiences of household food security self-management among adults with type 1 and 2 diabetes? 2) What are the experiences of household food security management among healthcare professionals in high income countries? 3) What evidence is there around household food security management of diabetes

Inequality in the survival of patients with head and neck cancer in Scotland

Background: Socioeconomic inequalities impact on the survival of head and neck cancer patients, but there is limited understanding of the explanations of the inequality, particularly in long-term survival. Methods: Patients were recruited from the Scottish Audit of Head and Neck cancer from 1999 to 2001 and were linked to mortality data as at 30th September 2013. Socioeconomic status was determined using the area-based Carstairs 2001 index. Overall and disease-specific survival were calculated using the Kaplan-Meier method with 95% confidence intervals (CI’s) at one-, five- and 12-years. Cox proportional hazard models with 95% CIs were used to determine the explanations for the inequality in survival by all-cause mortality and disease-specific mortality with 95% CIs. Net survival at one-, five- and 12-years was also computed with 95% CIs. Results: Most patients were from the most deprived group, and were more likely to smoke, drink, have cancer of a higher stage and have a lower WHO Performance Status. A clear gradient across Carstairs fifths for unadjusted overall and disease-specific survival was observed at one-, five- and 12-years for patients with HNC. Multiple patient, tumour and treatment factors play a part in the inequality observed, particularly by five- and 12-years when the inequality could be explained in fully adjusted models. However, the inequality at one-year survival remained. The inequality in 12-year net survival was very small, suggesting that the inequality in the long-term may be partly attributable to background mortality. Conclusion: Explanations for the inequality in the survival of patients with HNC are not straightforward, and this study concludes that many factors play a part including multiple patient, tumour and treatment factors

No backstage: the relentless emotional management of acute nursing through the COVID-19 pandemic.

The COVID-19 pandemic disordered the routine delivery of health care. We explored nurses' experiences of working in COVID and non-COVID facing roles, focusing on staff in the acute sector of one Scottish health board. The study covered the period between April and July 2021, and was conducted through twenty in-depth interviews. Interactions between patients, family members and nurses changed due to inflection control measures. Staff experienced a range of conflicting emotions, e.g. fear of infection and transmission but a strong sense professional duty to contribute to the pandemic effort. Nurses were dissatisfied with the care they provided and experienced moral dilemmas, distress and injury from the emotional labour caused not only by working under the infection control measures, but also by the virulence and uncertainty of this new disease. We draw on earlier works - Goffman's (1967) presentation of self, Hochschild's (1983) work on emotional labour, and Bolton and Boyd's (2003) work furthering emotional labour - to illustrate that the usual rules and routines of interaction between patients, family and staff were abandoned. Nurses were able to mask their distress and injury, but were often unable to effectively deliver the correct emotional response due to infection control measures, such as protective clothing (PPE) and social distancing. The 'backstage' spaces, important for dealing with the emotion of front stage performances, were missing for those in COVID-facing roles. The isolating work, and the removal of spaces for the donning and doffing of PPE, resulted in limited or no opportunity for humour and the enacting of collective care. Their private space offered little reprieve with the constant media attention on infection levels, death and nursing 'heroes'

The effect of tonsillectomy on the morbidity from recurrent tonsillitis

Background Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year.1 Recurrent tonsillitis results in significant morbidity and impacts on individuals’ quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. Objectives To describe disease-specific and global quality of life for adults with recurrent tonsillitis 6 months after tonsillectomy, using two instruments: the health impact of throat problems (HITP) and EuroQol-visual analogue scale questionnaire. To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory (GBI). To assess potential predictors of tonsillectomy benefit. Design A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy.2 Setting Secondary care, teaching hospital. Participants Seventy patients (57 female), median age 20 years (range 13-41). Results Median preoperative HITP was 47 (range 15-67), compared to 4 (0-72), (P<.001) 6 months following surgery. Median HITP difference was 39.5 (range −20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (−3 to 100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before “achieving” tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years. Conclusions Recurrent tonsillitis causes a poor disease-specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease-specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue dela