Disabled women’s experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study

Background: Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.

Methods: The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers
impacting their access to care. Data were generated during 2013 using one-to-one interviews.

Results: Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.

Conclusions: Positive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

Doing Gendered Time: The Harms of Women's Imprisonment

This chapter focuses on women’s imprisonment in the context of gendered punishment inflicted by the State. It considers the gender-specific consequences of incarceration for women prisoners and the potential of gender-responsive alternatives to custodial sentences. Following a brief historical overview, it traces the rise and consolidation of women’s incarceration in UK jurisdictions, noting the significance of devolution on the prison systems of Scotland and Northern Ireland. In examining the impact of neo-liberal policies and globalisation on women’s imprisonment, it draws comparisons with other advanced democratic states. Analysing the rationale underpinning the disproportionate rise in women’s incarceration, particularly in the UK and the USA the chapter identifies the persistent tensions between retributivism/ incapacitation and reformism/rehabilitation. Drawing on international research demonstrating the complex needs and vulnerabilities of women and girl prisoners, the chapter reveals the gendered harm experienced within penal regimes and the recent development - and limitations - of official gender-specific policies and practices. The emergence of distinct but related political discourses on ‘risk’ and ‘responsibilisation’ as applied to women in conflict with the law, and their consequent criminalisation, is critiqued in the contexts of structural disadvantage, gender discrimination and institutionalised racism. Within these oppressive dynamics often severe deprivations are inflicted on women’s acts of resistance both inside prison and in their communities post-release, further confining the potential of individual and collective agency. Finally, the chapter proposes fundamental change through establishing women-centred alternatives to prison, alongside policies committed to decarceration, while working towards securing the abolition of women’s imprisonment.

Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

AIMS: To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes.

METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years.

RESULTS: Alanine aminotransferase level had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase value (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P=0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P=0.001). No relationship was found for gamma-glutamyltransferase.

CONCLUSIONS: The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health. This article is protected by copyright. All rights reserved.

Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12

Background: High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts. Methods: Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of ‘any’ (drugs prescribed at least once per year) and ‘long-term’ (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined. Results: While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12. Conclusions: High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.

Prevalence of cataract and pseudophakia/aphakia among adults in the United States.

OBJECTIVES:

To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020.

METHODS:

Summary prevalence estimates of cataract and of pseudophakia/aphakia were prepared separately for black, white, and Hispanic persons (for whom only cataract surgery data were available) in 5-year age intervals starting at 40 years for women and men. The estimates were based on a standardized definition of various types of cataract: cortical, greater than 25% of the lens involved; posterior subcapsular, present according to the grading system used in each study; and nuclear, greater than or equal to the penultimate grade in the system used. Data were collected from major population-based studies in the United States, and, where appropriate, Australia, Barbados, and Western Europe. The age-, gender-, and race/ethnicity-specific rates were applied to 2000 US Census data, and projected population figures for 2020, to obtain overall estimates.

RESULTS:

An estimated 20.5 million (17.2%) Americans older than 40 years have cataract in either eye, and 6.1 million (5.1%) have pseudophakia/aphakia. Women have a significantly (odds ratio = 1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract than men in the United States. The total number of persons who have cataract is estimated to rise to 30.1 million by 2020; and for those who are expected to have pseudophakia/aphakia, to 9.5 million.

CONCLUSION:

The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages.

Waiting time for cataract surgery and its influence on patient attitudes.

PURPOSE:

To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong.

METHODS:

This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status.

RESULTS:

Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more.

CONCLUSIONS:

Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.

Presbyopia and near-vision impairment in rural northern China.

PURPOSE: Presbyopia limits activities of daily living, but population-based data from rural China are scarce. METHODS: A population-based, cross-sectional study was conducted in 2009 among all persons aged 40+ years in a rural area near Shenyang, China. Distance and near VA were measured using logMAR E charts. Individuals with pinhole-corrected distance vision ≥20/63 underwent detailed eye examination and near refraction. RESULTS: A total of 1008 (91.5%) respondents were examined (mean age, 58.4 ± 10.7 years for men, 56.8 ± 9.89 years for women). Women and older subjects were more likely to participate. The prevalence of functional presbyopia (near vision <20/50 [N8] improved by ≥1 line with correction) was 67.3% (95% confidence interval [CI], 64.30%-70.09%), increasing from 27.6% at 40 to 49 years of age to 81.8% at 60 to 69 years. Multivariate analysis showed that older age (P < 0.001), but not gender or education, was significantly associated with a higher risk of presbyopia. Self-reported presbyopic spectacle correction coverage was 51.5%. In multivariate logistic regression models, worse presenting near vision (P = 0.013) and higher required spherical equivalent power (P < 0.001) were associated with having correction, while age, gender, education, and distance vision were unassociated. Major barriers reported by persons without near correction included poor quality of available glasses (33.1%) and lack of awareness of the condition and its treatment (28.8%). CONCLUSIONS: Presbyopia is highly prevalent in rural China, and nearly half of affected persons have no access to correction. Interventions should focus on education and improvement in the quality of refractive services.

Can group exercise programs improve health outcomes in pregnant women? A systematic review

Current scientific evidence supports the recommendation to initiate or continue the practice of physical exercise in healthy pregnant women. Group exercise programs have positive effects in improving health and well-being, as well as social support. In order to understand the scientific evidence in this field, and the outcomes in maternal health, it has generated wide interest in exploring the studies carried out with more relevant group exercise programs. The aim of this systematic review was to evaluate the available evidence on the effectiveness of group exercise programs in improving women’s and newborns health outcomes during pregnancy. Three databases were used to conduct literature searches and strict inclusion and exclusion criteria were employed. Seventeen studies were selected for analysis. All studies were randomized control trials conducted with pregnant women that evaluated the effect of group exercise programs on the health outcomes of mother and newborn. Most studies followed a supervised structured exercise program including a main aerobic part, resistance training, pelvic floor training and stretching and relaxation sections. The significant effects of the programs are related with improved maternal perception of health status, lower maternal weight gain, improved levels of maternal glucose tolerance, improved aerobic fitness and muscular strength, lower frequency of urinary incontinence, improved sick leave due to lumbopelvic pain, fewer cesarean and instrumental deliveries, higher newborn Apgar score and faster postpartum recovery. Exercise and health professionals should advise pregnant women that aerobic group exercise during pregnancy improves a wide range of health outcomes for the women and newborn

Life after Stroke: Coping mechanisms among African Caribbean Women

In the UK stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation, or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using Interpretative Phenomenological Analysis was adopted. Eight women were recruited into the study. Semi structured in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion and church based health promotion in post stroke recovery.

Pilot study of the utility and acceptability of tampon sampling for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infections by duplex realtime polymerase chain reaction in United Kingdom sex workers

We aimed to evaluate the acceptability of self-collected tampon samples for the screening of female sex workers for sexually transmitted infections. We recruited 65 sex workers, and 63 agreed to provide tampon samples. The tampon samples were processed by realtime polymerase chain reaction (PCR) targeting Neisseria gonorrhoeae and Chlamydia trachomatis. Urethral and endocervical swabs were also obtained from 61 of 63 participants and tested using culture (N. gonorrhoeae) and the BD ProbeTec strand displacement amplification (SDA) (C. trachomatis) assay. Tampon sampling was preferred by 95% of the women and all favoured being tested away from genitourinary medicine clinics; the most common reasons cited were avoidance of embarrassment (40%) and convenience (30%). Besides near-universal acceptability of tampon sampling, the tampon sampling-PCR approach described in this study appeared to have enhanced sensitivity compared with conventional testing, suggesting the possibility of a residual hidden burden of N. gonorrhoeae and/or C. trachomatis genital infections in UK female sex workers.

The relationship between dimensions of love, personality, and relationship length

The present study examined the associations among participant demographics, personality factors, love dimensions, and relationship length. In total, 16,030 participants completed an internet survey assessing Big Five personality factors, Sternberg’s three love dimensions (intimacy, passion, and commitment), and the length of time that they had been involved in a relationship. Results of structural equation modeling (SEM) showed that participant age was negatively associated with passion and positively associated with intimacy and commitment. In addition, the Big Five factor of Agreeableness was positively associated with all three love dimensions, whereas Conscientiousness was positively associated with intimacy and commitment. Finally, passion was negatively associated with relationship length, whereas commitment was positively correlated with relationship length. SEM results further showed that there were minor differences in these associations for women and men. Given the large sample size, our results reflect stable associations between personality factors and love dimensions. The present results may have important implications for relationship and marital counseling. Limitations of this study and further implications are discussed.

Translation and Psychometric Evaluation of a Standard Chinese Version of the Body Appreciation Scale-2

The present study examined the factorial and construct validity of a Standard Chinese translation of the Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015b). Participants were 191 women and 154 men from mainland China who were resident in Hong Kong at the time of recruitment. Results of confirmatory factor analysis indicated that the one-dimensional model of the BAS-2, in which all 10 items loaded onto the same factor, had adequate fit and was invariant across sex. Body appreciation scores had good internal consistency and were significantly correlated with self-esteem and life satisfaction, and, in women, with weight discrepancy and body mass index. There were no significant differences in body appreciation scores between women and men. The present findings suggest that the Standard Chinese translation of the BAS-2 has the same one-dimensional factor structure as its parent scale and may facilitate cross-cultural studies of positive body image.