24 research outputs found
Cash Transfers to Increase Antenatal Care Utilization in Kisoro, Uganda: A Pilot Study
The World Health Organization recommends four antenatal visits for pregnant women in developing countries. Cash transfers have been used to incentivize participation in health services. We examined whether modest cash transfers for participation in antenatal care would increase antenatal care attendance and delivery in a health facility in Kisoro, Uganda. Twenty-three villages were randomized into four groups: 1) no cash; 2) 0.20 United States Dollars (USD) for each of four visits; 3) 0.40 USD for a single first trimester visit only; 4) 0.40 USD for each of four visits. Outcomes were three or more antenatal visits and delivery in a health facility. Chi-square, analysis of variance, and generalized estimating equation analyses were performed to detect differences in outcomes. Women in the 0.40 USD/visit group had higher odds of three or more antenatal visits than the control group (OR 1.70, 95% CI: 1.13-2.57). The odds of delivering in a health facility did not differ between groups. However, women with more antenatal visits had higher odds of delivering in a health facility (OR 1.21, 95% CI: 1.03-1.42). These findings are important in an area where maternal mortality is high, utilization of health services is low, and resources are scarce. (Afr J Reprod Health 2015; 19[3]: 144-150). Keywords: Maternal mortality; conditional cash transfers; prenatal care; delivery location sub-sharan Africa L'Organisation mondiale de la SantĂ© recommande quatre consultations prĂ©natales pour les femmes enceintes dans les pays en dĂ©veloppement. Les transferts de fonds ont Ă©tĂ© utilisĂ©s pour encourager la participation Ă des services de santĂ©. Nous avons examinĂ© si les transferts de fonds modestes pour la participation Ă des soins prĂ©natals pourraient augmenter la frĂ©quentation aux services des soins prĂ©natals et d'accouchement dans un Ă©tablissement de santĂ© Ă Kisoro, en Ouganda. Vingt-trois villages ont Ă©tĂ© randomisĂ©s en quatre groupes: 1) pas d'argent; 2) 0,20 dollars amĂ©ricains (DA) pour chacune des quatre visites; 3) 0,40 DA pour une seule visite du premiĂšre trimestre seulement; 4) 0,40 DA pour chacune des quatre visites. Les rĂ©sultats Ă©taient trois consultations prĂ©natales ou plus et lâaccouchement dans un Ă©tablissement de santĂ©. Nous avons menĂ© une analyse de la variance Chi-carrĂ© et d'Ă©quations d'estimation gĂ©nĂ©ralisĂ©es pour dĂ©tecter les diffĂ©rences dans les rĂ©sultats. Les femmes du groupe de visite de 0,40 DA Ă©taient plus susceptibles de trois consultations prĂ©natales ou plus que le groupe de tĂ©moin (OR 1,70, IC Ă 95%: 1,13 Ă 2,57). Les chances de lâaccouchement dans un Ă©tablissement de santĂ© ne sont pas diffĂ©rentes parmi les groupes. Cependant, les femmes avec plus de visites prĂ©natales Ă©taient plus susceptibles dâaccoucher dans un Ă©tablissement de santĂ© (OR 1,21, IC Ă 95%: 1,03 Ă 1,42). Ces rĂ©sultats sont importants dans une rĂ©gion oĂč la mortalitĂ© maternelle est Ă©levĂ©e, oĂč l'utilisation des services de santĂ© est faible, et les ressources sont rares. (Afr J Reprod Health 2015; 19[3]: 144-150). Mots-clĂ©s: mortalitĂ© maternelle; transferts monĂ©taires conditionnels; soins prĂ©natals; lieu dâaccouchement, Afrique sub-saharienne
Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients
Background: Laboratory blood testing incurs financial costs and the blood draws can increase discomfort, yet minimal data exists regarding routine testing in gynecologic oncology surgical patients. Additionally, an increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. An increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. Objective: The aims of this study were (1) to evaluate the frequency and etiology of perioperative laboratory test abnormalities in patients undergoing laparoscopic and laparotomy surgery in a gynecologic oncology service, and (2) to establish an evidence-based algorithm to reduce unnecessary laboratory testing. Materials and Methods: A single-institution retrospective study was completed, investigating laparoscopic and laparotomic surgeries over 4 years. Information on preoperative and postoperative laboratory data, surgical parameters, perioperative interventions, and patient demographics was collected. Quality-assurance data were reviewed. Data were tabulated and analyzed using Statistical Product and Service Solutions (SPSS) version 22. A Student's t-test was used to test for group differences for continuous variables with equal variance, the Mann-Whitney?U test for continuous variables when unequal variance was detected, and Pearson's ?2 was used to investigate categorical variables of interest. p-Values 98% of patients underwent at least one preoperative and postoperative laboratory test, totaling 8060 preoperative and 5784 postoperative results. The laparoscopy group was significantly less likely to have postoperative metabolic abnormalities or to undergo perioperative blood transfusion. Patients taking an angiotensin-converting-enzyme inhibitor, angiotensin-II?receptor blocker, or diuretic were significantly more likely to have elevated creatinine preoperatively (odds ratio [OR]: 5.0; p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140101/1/gyn.2015.0106.pd
Mapping Geographic Areas of High and Low Drug Adherence in Patients Prescribed Continuing Treatment for Acute Coronary Syndrome After Discharge
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90283/1/phco.31.10.927.pd
Depot Medroxyprogesterone Acetate Use and Periodontal Health in 15â to 44âYearâOld US Females
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141038/1/jper1008.pd
Periodontal health in breast cancer patients on aromatase inhibitors versus postmenopausal controls: a longitudinal analysis
AimThis study was conducted to determine periodontal changes in postmenopausal breast cancer (BCa) survivors using aromatase inhibitors (AI) as compared to postmenopausal women without BCa.MethodsAn 18âmonth prospective examination of periodontal health in postmenopausal women (29 receiving AI therapy; 29 women without BCa) was conducted at University of Michigan. Comprehensive periodontal examinations including alveolar bone height (ABH) were conducted at baseline, 6, 12, and 18 months. Bisphosphonate, vitamin D, and calcium supplementation were collected via chart review. Linear mixed models were utilized to investigate the relationship between AI and periodontal measures.ResultsAromatase inhibitor users had significantly deeper probing depths, more dental plaque and clinical attachment loss as compared to controls at the 6, 12, and 18 month study visits (p < 0.05). ABH loss was seen over time within the AI group. The linear mixed model showed a significant effect of time as well as an interaction between aromatase inhibitor use and calcium supplement status. AI users taking calcium experienced less ABH loss over the study than AI users not taking calcium (p = 0.005).ConclusionAromatase inhibitor therapy has a negative impact on the periodontal health of postmenopausal BCa patients. Calcium supplementation appears to mitigate ABH loss in women on AI.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133559/1/jcpe12562_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133559/2/jcpe12562.pd
Periodontal Health in Women With EarlyâStage Postmenopausal Breast Cancer Newly on Aromatase Inhibitors: A Pilot Study
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141857/1/jper0906.pd
Recommended from our members
Trends in Birth Rates After Elimination of Cost Sharing for Contraception by the Patient Protection and Affordable Care Act
ImportanceReducing out-of-pocket costs is associated with improved patterns of contraception use. It is unknown whether reducing out-of-pocket costs is associated with fewer births.ObjectiveTo evaluate changes in birth rates by income level among commercially insured women before (2008-2013) and after (2014-2018) the elimination of cost sharing for contraception under the Patient Protection and Affordable Care Act (ACA).Design, setting, and participantsThis cross-sectional study used data from Clinformatics Data Mart database from January 1, 2008, to December 31, 2018, for women aged 15 to 45 years who were enrolled in an employer-based health plan and had pregnancy benefits for at least 1 year. Women without household income information and women with evidence of having undergone a hysterectomy were excluded.ExposureSection 2713 of the ACA.Main outcomes and measuresThe primary outcome was the proportion of reproductive-aged women with a live birth by year (measured yearly from 2008 to 2018 [11 time points]) within 3 income categories. The secondary outcome was the distribution of contraceptive method fills in 3 categories by year: (1) most effective methods (long-acting reversible contraception or sterilization), (2) moderately effective methods (pill, patch, ring, and injectable), and (3) no prescription or surgical method.ResultsThe analytic sample included 4âŻ590âŻ989 women (mean [SD] age; 30.8 [9.1] years in 2013; 3âŻ069âŻ053 White [66.9%]) enrolled in 47âŻ721 health plans. A total of 500âŻ898 participants (40.8%) resided in households with incomes less than 400% of the federal poverty level in 2013. In all 3 years (2008, 2013, and 2018), women in the lowest income category were younger than women in the other income groups (median range, 21-22 years vs 30-34 years) and in households with a higher median number of dependents (9-10 vs 2-4). There was an associated decrease in births in all income groups in the period after the elimination of out-of-pocket costs. The estimated probability of birth decreased most precipitously among women in the lowest income group from 8.0% (95% CI, 7.4%-8.5%) in 2014 to 6.2% (95% CI, 5.7%-6.7%) in 2018, representing a 22.2% decrease (Pâ<â.001). The estimated probability decreased in the middle income group by 9.4%, from 6.4% (95% CI, 6.3%-6.4%) to 5.8% (95% CI, 5.7%-5.8%) (Pâ<â.001), and in the highest income group by 1.8%, from 5.6% (95% CI, 5.6%-5.7%) to 5.5% (95% CI, 5.4%-5.5%) (Pâ<â.001) in the period after the elimination of cost sharing.Conclusions and relevanceIn this cross-sectional study, the elimination of cost sharing for contraception under the ACA was associated with improvements in contraceptive method prescription fills and a decrease in births among commercially insured women. Women with low income had more precipitous decreases than women with higher income, suggesting that enhanced access to contraception may address well-documented income-related disparities in unintended birth rates