Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Professionalism, stigma, and willingness to provide patient-centered safe abortion counseling and care: a mixed methods study of Ethiopian midwives
Get PDFBackground:
Midwives are a large proportion of Ethiopia’s health care workforce, and their attitudes and practices shape the quality of reproductive health care, including safe abortion care (SAC) services. This study examines how midwives’ conceptions of their professional roles and views on women who have abortions relate to their willingness to provide respectful SAC.
Methods:
This study uses a cross-sectional, mixed methods design to conduct a regionally representative survey of midwives in Ethiopia’s five largest regions (Oromia; Amhara; Southern Nations, Nationalities, and Peoples [SNNP]; Tigray; and Addis Ababa) with a multistage, cluster sampling design (n = 944). The study reports survey-weighted population estimates and the results of multivariate logistic regression analyzing factors associated with midwives’ willingness to provide SAC. Survey data were triangulated with results from seven focus group discussions (FGDs) held with midwives in the five study regions. Deductive and inductive codes were used to thematically analyze these data.
Results:
The study surveyed 960 respondents. An estimated half of midwives believed that providing SAC was a professional duty. Slightly more than half were willing to provide SAC. A belief in right of refusal was common: two-thirds of respondents said that midwives should be able to refuse SAC provision on moral or religious grounds. Modifiable factors positively associated with willingness to provide SAC were SAC training (AOR 4.02; 95% CI 2.60, 6.20), agreeing that SAC refusal risked women’s lives (AOR 1.69; 95% CI 1.20, 2.37), and viewing SAC provision as a professional duty (AOR 1.72; 95% CI 1.23, 2.39). In line with survey findings, a substantial number of FGD participants stated they had the right to refuse SAC. Responses to client scenarios revealed “directive counseling” to be common: many midwives indicated that they would actively attempt to persuade clients to act as they (the midwives) thought was best, rather than support clients in making their own decisions.
Conclusion:
Findings suggest a need for new guidelines to clarify procedures surrounding conscientious objection and refusal to provide SAC, as well as initiatives to equip midwives to provide rights-based, patient-centered counseling and avoid directive counseling
Health issues in women and girls affected by haemophilia with a focus on nomenclature, heavy menstrual bleeding, and musculoskeletal issues
Get PDFIntroduction:
Women and girls affected by haemophilia, including haemophilia carriers (WGH) are at risk of bleeding symptoms that may go unrecognized, including heavy menstrual bleeding (HMB) and musculoskeletal bleeding. Terminology continues to evolve.
Aim:
To describe the current recommendations for nomenclature surrounding WGH, and the current understanding of HMB, iron deficiency, and musculoskeletal complaints in these patients.
Methods:
Literature was reviewed and summarized.
Results:
With regards to nomenclature, women with factor levels less than 50% should be classified as having haemophilia, while carriers with normal levels should be characterized accordingly to symptomatology. HMB and resultant iron deficiency are common among WGH, have a multitude of downstream effects, and maybe overlooked due to stigma around menstruation. Musculoskeletal bleeding and resultant joint changes are increasingly recognized in this population but do not necessarily correlate with factor levels.
Conclusion:
Although progress has been made in the care of WGH, much work remains to further improve their care
Assessment of long‐term sexual function of cervical cancer survivors after treatment: a cross‐sectional study
Get PDFObjectives:
This study aimed to investigate the long‐term sexual function of patients with cervical cancer who underwent treatment and to explore influential factors.
Methods:
This retrospective cross‐sectional study was conducted at Peking University First Hospital in (Beijing, China). A total of 207 patients, who were diagnosed with Stage IA‐IIA cervical cancer and had undergone surgical treatment (some patients had also been treated with adjuvant radiotherapy and chemotherapy) between January 2010 and August 2020, completed questionnaires via telephone. The median time since diagnosis was 54 (range, 13–138) months. Sexual function was assessed using the validated short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12). The multivariate logistic regression analysis was performed to determine factors influencing sexual function after treatment.
Results:
The mean preoperative PISQ‐12 score was 39.42 ± 3.922, and the mean postoperative PISQ‐12 score was 32.60 ± 6.592, indicating a significant decrease in postoperative PISQ‐12 score compared with preoperation (p < 0.001). In total, 49.8% of the patients had sexual dysfunction after treatment. According to the results of the multivariate logistic regression analysis, longer follow‐up (months), ovariectomy, lack of hormone replacement therapy after ovariectomy and adjuvant radiotherapy were significantly associated with sexual dysfunction after treatment (p < 0.05). There was no significant correlation among surgical method, tumor stage, adjuvant chemotherapy, and sexual dysfunction after treatment.
Conclusions:
The sexual function of cervical cancer survivors significantly decreased after treatment, which was related to the length of follow‐up, ovariectomy, and adjuvant radiotherapy. Hormone replacement therapy after ovariectomy can help patients to improve their sexual function
Estimation of genetic parameters for female fertility traits in the Polish Holstein-Friesian population
Get PDFThe objective of this study was to estimate genetic parameters for the analyzed fertility traits of Polish Holstein-Friesian primiparous and multiparous cows, as a step toward the incorporation of new traits into routine genetic evaluation. Lactation records of 116,836 Polish Holstein-Friesian cows were studied. The records cover the first three lactations of all cows. The cows, daughters of 2884 sires, were calved from 2006 to 2020. The conception rate for heifers (CRh) and for cows in the second (CR2) and third parity (CR3), the interval from first calving to first insemination (CTFI), the days open (DO), and the interval from first to successful insemination for heifers (FSh) and for cows in second (FS2) and third (FS3) parity were analyzed. The BLUPf90 package and a Bayesian method via Gibbs sampling were used to estimate (co)variance components. In general, all heritabilities were low and ranged from 0.013 (CTFI) to 0.038 (FS2). The heritability of conception rate and interval from first to successful insemination was slightly lower for heifers than for cows. Genetic correlations were moderate to high with two exceptions: correlation of CTFI with CRh (0.033) and with FSh (−0.051). The results indicate that a few analyzed traits could be used in genetic evaluation of Polish Holstein-Friesian cows. It is suggested to complement the selection index with traits for both heifers and cows, such as the interval from first to successful insemination (i.e., FSh, FS2 and FS3), in order to enable effective improvement of female fertility scores in the Polish Holstein-Friesian population
Prescribing as affective clinical practice: transformations in sexual health consultations through HIV pre‐exposure prophylaxis
Get PDFNew medicines can transform routines and priorities in clinical practice, but how do clinicians think and feel about these changes, and how does it affect their work? In Australia, the HIV prevention regimen pre‐exposure prophylaxis (PrEP) has been rapidly rolled out, transforming the sexual cultures and practices of users, but less attention has been given to the ways PrEP has reconfigured clinical practice. This paper draws on 28 qualitative semi‐structured interviews conducted between 2019 and 2020 with PrEP‐providing doctors and nurses in Australia to consider how they have affectively engaged with PrEP and put it into practice. Through a reflexive thematic analysis, we explore how clinicians adapted to PrEP, how the field of HIV prevention has been transformed, and how these developments have changed how clinicians approach patients. While the introduction of PrEP was initially received with uncertainty and shock, clinicians described PrEP as enjoyable to prescribe, and better aligned with the moral duties of sexual health consultations than existing HIV prevention strategies like condoms. Through approaching clinical work as an ‘affective practice’, we argue for attending not only to how new interventions change expectations and practices, but also how these changes are felt and valued by clinicians
Multispectral image under tissue classification algorithm in screening of cervical cancer
Get PDFThe objectives of this study were to improve the efficiency and accuracy of early clinical diagnosis of cervical cancer and to explore the application of tissue classification algorithm combined with multispectral imaging in screening of cervical cancer. 50 patients with suspected cervical cancer were selected. Firstly, the multispectral imaging technology was used to collect the multispectral images of the cervical tissues of 50 patients under the conventional white light waveband, the narrowband green light waveband, and the narrowband blue light waveband. Secondly, the collected multispectral images were fused, and then the tissue classification algorithm was used to segment the diseased area according to the difference between the cervical tissues without lesions and the cervical tissues with lesions. The difference in the contrast and other characteristics of the multiband spectrum fusion image would segment the diseased area, which was compared with the results of the disease examination. The average gradient, standard deviation (SD), and image entropy were adopted to evaluate the image quality, and the sensitivity and specificity were selected to evaluate the clinical application value of discussed method. The fused spectral image was compared with the image without lesions, it was found that there was a clear difference, and the fused multispectral image showed a contrast of 0.7549, which was also higher than that before fusion (0.4716), showing statistical difference (P < 0.05). The average gradient, SD, and image entropy of the multispectral image assisted by the tissue classification algorithm were 2.0765, 65.2579, and 4.974, respectively, showing statistical difference (P < 0.05). Compared with the three reported indicators, the values of the algorithm in this study were higher. The sensitivity and specificity of the multispectral image with the tissue classification algorithm were 85.3% and 70.8%, respectively, which were both greater than those of the image without the algorithm. It showed that the multispectral image assisted by tissue classification algorithm can effectively screen the cervical cancer and can quickly, efficiently, and safely segment the cervical tissue from the lesion area and the nonlesion area. The segmentation result was the same as that of the doctor's disease examination, indicating that it showed high clinical application value. This provided an effective reference for the clinical application of multispectral imaging technology assisted by tissue classification algorithm in the early screening and diagnosis of cervical cancer
Facilitators and barriers for clinical implementation of a 30-minute point-of-care test for Neisseria Gonorrhoeae and chlamydia trachomatis into clinical care: a qualitative study within sexual health services in England
Get PDFPoint-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as “change champions” for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff
Male sexual health implications of the 2022 global monkeypox outbreak
Get PDFThe 2022 global monkeypox (MPX) outbreak is the largest in history to occur outside of endemic African regions. Disease spread during this outbreak has been primarily through human-to-human transmission, with sexual contact being of particular concern. Clinical presentations have commonly featured genital, perianal, and oral lesions associated with sexual activity among men who have sex with men (MSM), who compose the vast majority of MPX cases. This review discusses the epidemiology, clinical features, and evaluation of MPX with regards to men’s sexual health. Comparisons were made between MPX and its relative from the Orthopoxvirus genus, smallpox, in order to make informed inferences on the potential effects of MPX on men’s sexual health. This review also discusses the role of men’s health specialists and urologists in addressing the current outbreak
Integrating preconception health into routine reproductive health services of Ghana: a qualitative study among university students
Get PDFObjective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students’ perspectives.
Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis.
Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students.
Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services
How Ohio's proposed abortion bans would impact travel distance to access abortion care
Get PDFContext:
Since March 2021, the Ohio legislature has been actively considering laws that would ban abortion if the United States Supreme Court overturns the Roe v. Wade decision that legalized abortion nationally in 1973.
Methods:
We used a national database of publicly advertised abortion facilities to calculate driving distances for Ohioans before and after the activation of proposed abortion bans. Using a legal analysis of abortion laws following the overturn of Roe, we determined which states surrounding Ohio would continue providing abortion care. We calculated distances from each Ohio county centroid to the nearest open abortion facility in three scenarios: (1) as of February 2022, (2) the best‐case post‐Roe scenario (two of the five surrounding states continue to offer abortion care), and (3) worst‐case post‐Roe scenario (no surrounding states continue to offer abortion care). We calculated population‐weighted distances using county‐level data about women aged 15–44 years from the 2019 American Community Survey.
Results:
In February 2022, all Ohio county centroids were at most 99 miles from an abortion facility (median = 50 miles). The best‐case post‐Roe scenario shows 62 of Ohio's 88 counties to be 115–279 miles away from the nearest facility (median = 146). The worst‐case shows 85 counties to be 191–339 miles away from the nearest facility (median = 264). The current average population‐weighted driving distance from county centroid to the nearest facility is 26 miles; the post‐Roe scenarios would increase this to 157 miles (best‐case) or 269 miles (worst‐case).
Conclusions:
Ohio's proposed abortion bans would substantially increase travel distances to abortion care, impacting over 2.2 million reproductive‐aged Ohioans