Sexual Reproductive Health and Rights Repository (Aga Khan University)
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We are having a huge problem with compliance”: exploring preconception care utilization in South Africa
Get PDFBackground: Preconception care (PCC), a policy directive from the World Health Organisation (WHO), comprises all the health interventions offered to women and couples before conception and is intended to improve their overall health status and the pregnancy outcomes. Although PCC should be an essential part of maternal and child health services in most African countries, its provision and utilization are not widely documented. Hence, this study aimed to explore the factors influencing preconception care utilization among high-risk women in South Africa. Methods: A descriptive qualitative study of 29 purposively selected women and healthcare workers was conducted through individual in-depth interviews using a semi-structured interview guide. The interviews were transcribed verbatim, and the analyses were performed using Nvivo version 12. The Social-Ecological Model (SEM) guided the data analysis. Four levels of factors (the individual, the interpersonal, the community and social, and the policy and institutional) were used to assess what can influence PCC utilization. Findings: The availability of PCC services, the intrahospital referral of women, the referral practices of other healthcare workers, the underutilization of the PCC facility, and resources emerged at the institutional levels, while compliance with PCC appointments, socioeconomic factors, pregnancy planning, assumptions, and knowledge was at the individual levels. Conclusion: The utilization of the preconception care services was inadequate. The primary influencer of preconception care utilization was at the individual, policy, and institutional levels. The availability of preconception care services and the intrahospital referral of women at high risk of adverse pregnancy outcomes positively influenced the women’s PCC utilization, while poor pregnancy planning, and unavailability of PCC policies and guidelines negatively influenced preconception care utilization. Therefore, interventions to improve PCC utilization should focus on the four SEM levels for effectiveness. There is a need to raise PCC awareness and develop policy and guidelines to ensure consistent, standardized practice among healthcare workers
The comparative study for survival outcome of locally advanced cervical cancer treated by neoadjuvant arterial interventional chemotherapy or intravenous chemotherapy followed by surgery or concurrent chemoradiation
Get PDFObjective:
This study aimed to compare the survival outcome of 3 different treatment groups (arterial interventional chemotherapy or intravenous chemotherapy or concurrent chemoradiotherapy) for locally advanced cervical cancer.
Methods:
A total of 187 patients with pathological stage IB3–IIB cervical cancer (cervical squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma) hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2013 to May 2019 were included. Therefore, this article is a retrospective study. We collected data from all eligible patients. And all according to the treatment methods at that time, they were divided into three subgroups: (1) 40 patients who received neoadjuvant arterial interventional chemotherapy + surgery + postoperative chemotherapy (IA-NAC + RS), (2) 63 patients who received neoadjuvant intravenous chemotherapy + surgery + postoperative chemotherapy (IV-NAC + RS), (3) 84 patients who only received concurrent chemoradiotherapy (CCRT). Notably, 108 of these patients met the 5-year follow-up period, and 187 patients met the 3-year follow-up period only. Consequently, we compared 5-year survival and 3-year survival separately. The prognosis (5-year survival and 3-year survival) of the three groups and the chemotherapy efficacy, intraoperative blood loss, operation time, and postoperative pathological risk factors of different subgroups were compared.
Results:
(1) There were no significant differences in the 3-year overall survival (OS) rate, 3-year progression-free survival (PFS) rate, 5-year OS rate, and 5-year PFS rate among the three subgroups (p > 0.05). (2) The chemotherapy response rates of IA-NAC+RS group (37.5%) and IV-NAC+RS group (25.4%) were comparable (p > 0.05). (3) The intraoperative blood loss in the IA-NAC+RS group (average 92.13±84.09 mL) was significantly lower than that in the IV-NAC+RS group (average 127.2±82.36 mL) (p 0.05). (5) There were no significant differences between the IA-NAC+RS group and IV-NAC+RS group in pathological lymph node metastasis, parametrial invasion, and involvement of lymphovascular space (p > 0.05).
Conclusions:
Neoadjuvant chemotherapy combined with surgery had the same long-term survival benefit as concurrent chemoradiotherapy
Determining the status of preconception care model in pregnant woman of Gorgan city (North of Iran) using structural equation modeling (SEM)
Get PDFBACKGROUND:
Preconception reduces unplanned pregnancies and plays an important role in reducing maternal and infant mortality. Considering the importance of these care services, this study was conducted to determine the status of preconception care (PCC) model with Structural Equation Modeling (SEM).
MATERIALS AND METHODS:
This cross-sectional descriptive study was conducted on 394 pregnant women referring to Gorgan's health centers. Samples were selected by multi-stage stratified sampling method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted least square mean and variance method was used to fit the conceptual model and the significance level of the tests was considered 0.05.
RESULTS:
The results showed that PCC model was deemed appropriate as optimum conditions indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self-efficacy (SE), and SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS:
Facilities and SE as a key element of empowerment have an important role in promoting PCC. Identifying the factors associated with this care appears to help health policymakers to planning for these caregivers more precise and sensitive
Cluster analysis for symptomatic management of Neisseria gonorrhoea and Chlamydia trachomatis in sexually transmitted infections related clinics in China
Get PDFObjective:
This study aimed to perform a cluster analysis of symptoms linked with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and to identify which cluster of symptoms was associated with a higher risk of NG and CT.
Study design:
From 15 April to 16 May 2018, a cross-sectional study was conducted, and patients attending sexually transmitted infections (STI) related clinics were recruited from 22 medical institutions in six districts of Shenzhen city.
Methods:
A structured questionnaire was used to collect social-demographic information as well as STI symptoms, and urine samples were collected for nucleic acid detection. Cluster analysis and logistic regression were applied.
Results:
Among 8,207 participants, the prevalence of CT and NG infection was 9.04% (742/8,207) and 2.36% (194/8,207), respectively. Among male outpatients, four clusters with distinct symptomatic patterns were identified. Unmarried, having casual sexual partners in the past 6 months, cluster 2 (OR = 6.70, 95% CI = 3.36–13.35) and cluster 4 (OR = 24.53, 95% CI = 12.96–46.44) were risk factors associated with NG infection. Unmarried, cluster 2 (OR = 2.54, 95% CI = 1.83–3.53) and cluster 4 (OR = 3.31, 95% CI = 2.37–4.61) were risk factors associated with CT infection. Among female outpatients, five clusters with distinct symptomatic patterns were identified. Aged 24 years or below and cluster 3 (OR = 3.68, 95% CI = 1.61–8.39) were risk factors associated with NG infection. Aged 24 years or below, unmarried, having a high school/secondary technical school education, and having junior high school or below education were risk factors associated with CT infection.
Conclusion:
The cluster of symptoms integrated into risk assessment for CT and NG infections suggests a new strategy of symptomatic management. Healthcare providers in STI clinics and resource-limited places may use this strategy to identify more potential patients and deliver adequate, acceptable, and equitable STI care for outpatients with a high risk of STI
Female fertility and the zona pellucida
Get PDFFertility in female mammals, including mice and humans, is dependent on the presence of a zona pellucida (ZP) around growing oocytes and unfertilized eggs. A ZP is required to stabilize contacts between oocyte microvilli and follicle cell projections that traverse the ZP to form gap junctions that support the health of growing oocytes and developing follicles. In the absence of a ZP, due to inactivation or mutation of genes encoding ZP proteins, there is a loss of contacts between growing oocytes and neighboring follicle cells and a concomitant reduction in the production of ovulated eggs that results in female infertility
Destigmatizing and democratizing postpartum care: a “black woman-person first” approach
Get PDFOptimizing postpartum care highlights the need for care coordination, enhancement, and expansion of health care services after childbirth. Yet the prioritization of disease surveillance, management, and mitigation during birth and beyond within the American College of Obstetrics and Gynecology facilitates the medicalization and pathologization of Black bodies, voices, and power. Thus, we offer the Building and Bridging Black Futures Beyond Birth Model: A 12-Step Black Woman-Person First Approach, as a more humane and holistic model of culturally affirming and clinically responsive care. Destigmatizing and democratizing care bridges the gap between intent and impact in postpartum care optimization, particularly for Black women, girls, and gender expansive people and their communities
Associations among resilience, hope, social support, stress, and anxiety severity in Chinese women with abnormal cervical cancer screening results
Get PDFThis study was to explore the resilience level and its potential correlates and further to evaluate the influence of these resilience-centred variables on anxiety severity among Chinese women with abnormal cervical cancer screening results. One hundred and seventy-five subjects completed self-administered questionnaires to collect relevant variables. The level of resilience of our sample is moderate (70.57 ± 12.14). The data identified hope (β = 0.218), social support (β = 0.247) and perceived stress (β = -0.320) as independent associates for resilience. Finally, among variables, only perceived stress is found to have a direct and positive influence on anxiety severity. Interventions on these variables can be effective for resilience promotion in this population. In addition, anxiety should be preferentially intervened in through the alleviation of perceived stress
COVID‐19 impacts on abortion care‐seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States
Get PDFContext:
Many people wanted to avoid or delay childbearing during the COVID‐19 pandemic. This study sought to examine the extent COVID‐19 influenced abortion care‐seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion‐restrictive policies.
Methodology:
We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ 2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic‐related life changes by whether COVID‐19 influenced abortion care‐seeking.
Results:
Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID‐19 influenced their decision to have an abortion. These individuals were significantly more likely to report “not financially prepared” (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID‐19. They were also more likely to have lost or changed their health insurance due to pandemic‐related employment changes (15% vs. 2%), report substantial money difficulties due to COVID‐19 (59% vs. 33%), and report that paying for their abortion was “very difficult” (25% vs. 2%).
Conclusion:
COVID‐19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises
Laparoscopic radical hysterectomy combined with neoadjuvant chemotherapy for cervical cancer patients effectively improves immune function
Get PDFObjective:
To evaluate the clinical efficacy of neoadjuvant chemotherapy plus laparoscopic radical hysterectomy for cervical cancer and the effect on the immune function of patients.
Methods:
Between January 2021 and December 2021, 42 patients with cervical cancer diagnosed and treated at our hospital were recruited and randomly assigned at a 1 : 1 ratio to receive neoadjuvant chemotherapy plus open radical hysterectomy (control group) or neoadjuvant chemotherapy plus laparoscopic radical hysterectomy (treatment group) (study group). Outcome measures included surgical indices, clinical outcomes, and immunological function.
Results:
There were no significant differences in the operative time between the two groups (P > 0.05). Patients receiving laparoscopic surgery had significantly less intraoperative bleeding and shorter time lapse before postoperative anal exhaustion, time lapse before out-of-bed activities, and hospital stay versus patients receiving open surgery (P 0.05). The study group showed a significantly lower incidence of complications (19.05%) than the control group (71.43%) (P < 0.05). Patients in the study group had a lower reoperation rate and a higher survival rate (0.00%, 95.24%) than those in the control group (19.05%, 66.67%) (P < 0.05).
Conclusion:
Neoadjuvant chemotherapy plus laparoscopic radical hysterectomy effectively improves clinical efficacy, lowers cancer marker levels, improves patients' immune function, reduces the risk of adverse events, and improves patients' prognosis with less intraoperative bleeding, less trauma, faster postoperative recovery, and shorter hospital stay for cervical cancer patients
Influences on the uptake of a population health approach to sexual health programs in Ontario public health units: a qualitative descriptive study
Get PDFAim:
Population-level prevention initiatives are the cornerstone of public health practice. However, despite this normative practice, sexual health programming within public health has not utilized this approach to the same extent as other public health programs. Understanding requirements to put a population-level approach into practice is needed. The objective of this study was to explore the barriers and facilitators experienced by sexual health programs and services within public health when implementing a population health approach.
Subject design and methods:
The principles of qualitative description guided all sampling, data collection and analysis decisions. Data collection involved in-depth semi-structured interviews with 12 sexual health managers and/or supervisors from ten Ontario public health units. Directed content analysis was used to code and synthesize the data. Data collection and analysis was guided using constructs from the Consolidated Framework for Implementation Research.
Results:
Factors that served as either barriers and facilitators to implementing a population health approach, were mainly in the inner and outer setting domains of the Consolidated Framework for Implementation Research. Participants identified the presence of community partnerships, adequate staff training on population health, and access to data on population health served as facilitators. In comparison, barriers to implementation included a lack of resources (human, financial) and clinicians’ value of and preferences for delivering services at the individual clinic level.
Conclusion:
Some clear barriers and facilitators influenced if staff in sexual health programs and services could implement a population health approach. Results indicate where public health resources need to be enhanced to move toward a population health approach and provide insight into what worked and should be considered by public health organizations