Browsing by Subject "women's health"
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Item At The Heart of the Matter: An Atypical Case of Spontaneous Coronary Artery Dissection(2022-03) Thamba, Aish; Patel, Bhumi; Vander Missen, Marissa; Frey, JulianneCASE: A 51-year-old female with a history of hypertension and ADHD presented to the emergency department with sharp substernal pain and nausea. Initial EKG showed anterior ST-segment elevation. Patient vitals were 53 bpm, 170/110 mmHg, and 90% O2 saturation on room air. The patient was on a prescribed amphetamine for ADHD and propanol. She was given nitroglycerin by EMS; and carvedilol, heparin, and ticagrelor at the hospital. Echocardiogram found diffusely hypokinetic to akinetic apex, distal anteroseptal wall, and mid to distal anterior/anterolateral walls, suggestive of ischemia or stress-induced cardiomyopathy. Subsequent coronary angiography demonstrated 95% stenosis in the left anterior descending artery with ulceration, type 4 dissection segment, and thrombosis. Two drug-eluting stents were placed successfully; lisinopril and carvedilol were increased, and atorvastatin and ticagrelor were initiated. CONCLUSION: This patient presented with multiple risks for SCAD: female, hypertension, use of dextroamphetamine-amphetamine, family cardiac history, and middle-age. However, the consult differential did not include SCAD. Instead, the leading diagnosis was stress-induced cardiomyopathy due to EKG presentation. SCAD was discovered after initial stent placement. SCAD is a rare vascular emergency where a tear spontaneously forms in a coronary artery and can precipitate myocardial infarction by occluding perfusion, potentially resulting in sudden death. Confounding factors in the presentation were newly increased dextroamphetamine-amphetamine and alcohol use, indicating that typical SCAD presentations, as taught, may not be inclusive of all cases. CLINICAL SIGNIFICANCE: Broadening differentials or diagnostic criteria for SCAD could improve SCAD screening and diagnosis. Additionally, providers have been shown in the literature to underdiagnose cardiac events and undertreat pain in females relative to male patients experiencing the same events. This case exemplifies the importance of a more inclusive differential to provide comprehensive care for female patients.Item Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans(Elsevier, 2015-01) Bergman, Alicia A.; Frankel, Richard M.; Hamilton, Alison B.; Yano, Elizabeth M.; Department of Medicine, IU School of MedicineBackground The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services. Methods We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics. Results Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. Conclusion Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.Item "Fitter Families, Better Babies, and Reproductive Control"(2005-10-10) Stern, AlexandraItem Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women’s health(Elsevier, 2019-04) Steel, Amie; Munk, Niki; Wardle, Jon; Adams, Jon; Sibbritt, David; Lauche, Romy; Health Sciences, School of Health and Rehabilitation SciencesObjective Examine the generational differences in complementary medicine (CM) utilisation between young women from the X and Millennial generations. Design Secondary analysis of two cross-sectional surveys from the Australian Longitudinal Study on Women’s Health (ALSWH). Setting Australia. Main outcome measures Differences between young Generation X women (surveyed 1996; aged 18–23 years), and Millennial women (surveyed 2014; aged 19–24 years) regarding consultations with CM practitioners, sociodemographic characteristics, and health. Predictors for CM consultations were analysed via logistic regression analyses. Results Of the 14,247 Generation X women, 19.4% reported consulting CM, compared to 26.8% of the 11,344 Millennial women. CM consultations was predicted in both cohorts by higher age, education beyond primary school, non-urban (vs. urban) residence, and frequent back pain or headaches. Obesity and regular smoking predicted non-use in both. Significant cohort differences were found in physical activity levels (moderate/high levels associated with increased CM consultations in Millennial, but not Generation X women), and health status (Generation X women reporting fair-poor health were more likely to consult CM practitioners, while Millennial women reporting good health were less likely to do so, compared to women with very good/excellent health). Conclusions The increase in CM utilization among young Australian women from Generation X compared to the Millennial generation could indicate different health consumer patterns for future middle-aged and older adult Australian women. Further increases in CM usage may be observed as current young women age into characteristics traditionally linked with higher CM use such as worsening health status and increased disposable income.Item Impact of the COVID-19 Pandemic on Women's Health Care Access: A Cross-Sectional Study(Mary Ann Liebert, 2022-12-13) Turner, Kea; Brownstein, Naomi C.; Whiting, Junmin; Arevalo, Mariana; Islam, Jessica Y.; Vadaparampil, Susan T.; Meade, Cathy D.; Gwede, Clement K.; Kasting, Monica L.; Head, Katharine J.; Christy, Shannon M.; Communication Studies, School of Liberal ArtsBackground: There has been limited study of how the COVID-19 pandemic has affected women's health care access. Our study aims to examine the prevalence and correlates of COVID-19-related disruptions to (1) primary care; (2) gynecologic care; and (3) preventive health care among women. Materials and Methods: We recruited 4,000 participants from a probability-based online panel. We conducted four multinomial logistic regression models, one for each of the study outcomes: (1) primary care access; (2) gynecologic care access; (3) patient-initiated disruptions to preventive visits; and (4) provider-initiated disruptions to preventive visits. Results: The sample included 1,285 women. One in four women (28.5%) reported that the pandemic affected their primary care access. Sexual minority women (SMW) (odds ratios [OR]: 1.67; 95% confidence intervals [CI]: 1.19–2.33) had higher odds of reporting pandemic-related effects on primary care access compared to women identifying as heterosexual. Cancer survivors (OR: 2.07; 95% CI: 1.25–3.42) had higher odds of reporting pandemic-related effects on primary care access compared to women without a cancer history. About 16% of women reported that the pandemic affected their gynecologic care access. Women with a cancer history (OR: 2.34; 95% CI: 1.35–4.08) had higher odds of reporting pandemic-related effects on gynecologic care compared to women without a cancer history. SMW were more likely to report patient- and provider-initiated delays in preventive health care. Other factors that affected health care access included income, insurance status, and having a usual source of care. Conclusions: The COVID-19 pandemic disrupted women's health care access and disproportionately affected access among SMW and women with a cancer history, suggesting that targeted interventions may be needed to ensure adequate health care access during the COVID-19 pandemic.Item Low-Income Women Describe Fertility-Related Expectations: Descriptive Norms, Injunctive Norms, and Behavior(2010-12) Bute, Jennifer J.; Jensen, Robin E.Social norms surrounding sexuality, pregnancy, and childbearing may help guide women's health-related behaviors. In this study, we explore low-income women's perceptions of fertility-related norms by allowing women to describe their experiences with normative expectations. Semistructured interviews (n = 30) suggested that women in low-income subject positions articulate descriptive norms that generally correspond with mainstream descriptive norms, identify two major sources of injunctive norms concerning fertility and sexuality— authoritative and peer-oriented—and often align their behaviors according to subgroup expectations communicated in the form of peer-oriented injunctive norms. We discuss these results in light of the extant literature on social norms.Item Managing Life's Anxieties(Indiana University, 2019-07-19) Oruche, Ukamaka M.Item Menorrhagia: The Importance of Treatment in Women with Disorders of Hemostasis(2021-03-25) Essex, Amanda; Sommers, Kit; Colomb, Elaine; Watters, MelissaCase A 37 yo female was admitted to the hospital for potential Immune Thrombocytopenic Purpura after laboratory findings noted a platelet count of 12k and mild anemia. Her history revealed new onset petechiae, gingival bleeding and recently worsening menorrhagia. Treatment began with IVIG, prednisone and iron and she was ultimately discharged with instructions to follow up. Within 2.5 months of her initial presentation of ITP, the patient had a recurrence of petechiae and a platelet count of 4k. Upon readmission, IVIG and steroids were restarted. At this time, she was also experiencing cramping, fatigue, and heavy menstrual bleeding that led to another drop in hemoglobin. Discussions about outpatient management of menorrhagia were started. After 5 days, she was discharged and began Tranexamic Acid to address excessive menstrual losses at home. In follow up, she expressed significant anxiety about her diagnosis of ITP and felt that her ongoing menorrhagia was causing her ITP to recur. Conclusions Finding the best treatment option for patients experiencing menorrhagia requires consideration of numerous factors including the patient’s medical history, cause and severity of menorrhagia, future childbearing plans, patient preference and more. Without proper management, menorrhagia has been linked to decreased quality of life in terms of physical, mental, and social health. Anxiety surrounding menorrhagia can be compounded when patients do not have a clear understanding of the etiology of their condition. Clinical Significance Managing disorders of hemostasis like ITP can be complex especially in cases of early relapse. Menorrhagia in the setting of a bleeding disorder can further complicate management and can lead to worsening physical and psychosocial consequences. While prompt recognition and treatment of menorrhagia in patients with disorders of hemostasis is important for improving physical outcomes, it also plays a critical role in improving quality of life for patients.Item Neonatal Abstinence Syndrome Screening for Newborn Girl with Prenatal Maternal History of Substance Use Disorder(2020-03) Arnaudo, Camila; Chiu, Megan; Essex, Amanda; D'Arnaud, LindseyBackground: Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome of newborns with prenatal exposure to opioids and other substances. Incidence of NAS has increased significantly in the last decade and remains a current issue. Untreated NAS can lead to adverse outcomes including infant death. All newborns with known opioid exposure are screened for NAS using the Finnegan Scoring System or now more popular Eat Sleep Console (ESC) method. Treatment ranges from supportive care to pharmacological management, dependent on assessment scoring and clinical signs. Case: A 3.48kg female newborn was born at 40-week,2-day gestation from spontaneous vaginal delivery with no meconium and Apgar scores of 8 and 9. Prenatal maternal history was significant for hepatitis C, heroin use and buprenorphine (BUP) mono-product as medication assisted treatment (MAT) and maternal urine drug screen positive for BUP and benzodiazepines at delivery. The newborn’s urine drug screen was positive only for BUP. During her 4-day hospital course, she was eating and voiding well with some need for caregiver support for consoling and no need for pharmacological intervention per ESC. She was discharged home with mother and supportive extended family and has been developing well without major complications. Clinical Significance: Several barriers (social stigma, provider bias and legal policies) discourage mothers from seeking prenatal care and MAT, thus precluding NAS screening and treatment. Studies show that increased access and earlier initiation to maternal MAT improves outcomes for both mother and baby. Decreasing stigma and bias, implementing non-punitive policies and using ESC have also been shown to improve outcomes. This case provides a positive example of early initiation maternal MAT and use of ESC for a newborn with concern for NAS. We hope these cases will continue to help decrease stigma and help us advocate for non-punitive state policies regarding substance use during pregnancy.Item Online Information on Dysmenorrhea: An Evaluation of Readability, Credibility, Quality, and Usability(Wiley, 2019-10) Lovett, Jordan; Gordon, Candice; Patton, Shelby; Chen, Chen X.; School of NursingAims and objectives To evaluate online information on dysmenorrhoea, including readability, credibility, quality and usability. Background Menstrual pain impacts 45%–95% of women of reproductive age globally and is the leading cause of school and work absences among women. Women often seek online information on dysmenorrhoea; however, little is known about the information quality. Design This was a descriptive study to evaluate online information on dysmenorrhoea. Methods We imitated search strategies of the general public. Specifically, we employed the three most popular search engines worldwide—Google, Yahoo and Bing—and used lay search terms, “period pain” and “menstrual cramps.” We screened 60 web pages. Following removal of duplicates and irrelevant web pages, 25 met the eligibility criteria. Two team members independently evaluated the included web pages using standardised tools. Readability was evaluated with the Flesch–Kincaid Reading Ease and Flesch–Kincaid Grade formulas; credibility, quality and usability were evaluated with established tools. We followed the STROBE checklist for reporting this study. Results For readability, the mean Flesch–Kincaid level was 10th grade. For credibility, 8% of web pages referenced scientific literature and 28% stated the author's name and qualifications. For quality, no web page employed user‐driven content production; 8% of web pages referenced evidence‐based guidelines, 32% of web pages had accurate content, and 4% of web pages recommended shared decision‐making. Most web pages were interactive and included nontextual information. Some nontextual information was inaccurate. Conclusion Online information on dysmenorrhoea has generally low readability, mixed credibility and variable quality. Relevance to clinical practice Strategies to improve health information on dysmenorrhoea include avoiding complex terms, incorporating visual aids, presenting evidence‐based information and developing a decision aid to support shared decision‐making. Healthcare providers should be aware of the problematic health information that individuals are exposed to and provide education about how to navigate online health information.