Women’s Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21723
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Item Does Weight Relate to Mental Health Status in Females Ages 35-54?(2016-03-23) Hartos, Jessica; Bowden, Britney; Cherry, Merritt; Florez, Joshua; Ford, Angela; Meyer, KimPurpose: The purpose of this study was to assess the relationship between mental health and weight status for women during the transitional years from young adulthood to middle age. Methods: This cross-sectional analysis used data from the 2013 BRFSS for women ages 35-45 from the states of Mississippi, Oklahoma, Oregon, Utah, and West Virginia. Multiple linear regression analysis was used to determine whether weight status was related to mental health after controlling for psychosocial and demographic variables. Results: Participants reported relatively high numbers of days of good mental health in the past 30 days and relatively moderate levels of BMI. Mental health was not significantly related to weight status after controlling for psychosocial and demographic variables; however mental health was inversely related to the number of chronic health problems and positively related to working for wages and higher incomes. Conclusions: Mental health and weight status were not significantly related after controlling for demographic and psychosocial variables in the target population. These results imply weight status may not be as important as other factors for women 35-45 and, thus, healthcare providers should not disregard weight, but place more emphasis on treating comorbidities with mental health.Item Management of subcapsular hepatic hematoma in a post-partum female with pre-eclampsia with severe features(2016-03-23) Garda, Jacqueline; Zimmerman, Leah; Chinney, LaurenBackground: Subcapsular hematoma is a rare complication in patients with pre-eclampsia. The presence of this complication can be life-threatening. As this is a rare complication, this case report is designed to discuss the conservative management chosen for this case. Case: A 36 year old who was admitted for induction of labor for pre-gestational diabetes. She progressed to vaginal delivery complicated with some elevated blood pressures. She then developed pre-eclampsia with severe features with complications including: vision changes, hypotension and severe abdominal pain. Patient was found to have large subcapsular hematoma. She was managed conservatively without need for surgical intervention. Conclusion: Subcapsular hematoma is a rare complication in patients with pre-eclampsia. Management can include surgical, expectant or embolization. Without evidence of liver rupture, expectant management can be a reasonable approach to treatment.Item Gender Differences in Obstructive Sleep Apnea Treatment: A Retrospective Analysis(2016-03-23) Jouett, Noah; Watenpaugh, Donald; Smith, Michael PhD; Sanchez, AmaniIntroduction: Obstructive Sleep Apnea (OSA) affects four times as many men as women in the United States. However, nearly 5 million women have documented OSA, and there are likely many more due to historically high rates of OSA under-diagnosis. As a result of this documented gender difference, OSA treatment providers may not be sensitive to accommodate female patients undergoing positive airway pressure (PAP) therapy, which is the gold standard for OSA treatment and is notoriously obtrusive and uncomfortable. We hypothesized in a retrospective analysis of OSA patient records that (1) PAP treatment is less effective in women vs. men and (2) that women have lower compliance rates to PAP treatment than men. Methods: The University of North Texas Health Science Center Institutional Review Board approved this study. We studied the records of 619 patients (43% women, 57% men). Diagnosis of OSA was established by full night polysomnography (PSG) according to American Academy of Sleep Medicine (AASM) criteria. For this study, only patients prescribed for PAP machines that provide usage data, estimated apnea-hypopnea indices (AHIs), air leakage rates, recent detailed night-to-night data, and (if automated) mean and range of treatment pressures were considered. PAP data was downloaded from each patient’s machine during their office visit (see below) and was transferred into a database. Chi-square analysis assessed for gender differences in YFU vs. OFU treatment groups. Results: In comparing men and women and effectiveness of PAP treatment, there was a greater reduction in respiratory events in men than in women (P=0.037). Men initially had a greater number of baseline events, (P= Conclusions: The results indicate that PAP usage is substantially less in women compared to men, both in terms of 5 of sleep time and days/week, and women receive slightly less benefit from PAP use versus men. Furthermore, We contend that because women use PAP treatment less than men, they are more likely to receive inadequate treatment for their OSA.Item Trauma-Informed Care for Refugee Populations(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Thein, Emelda; Mudey, Halimo; Rudasingwa, Laurette; Subedi, Radhika; Qureshi, IramBackground: With the growing number of refugees resettled in the United States after fleeing war torn countries devastated by genocides, mass violence, and human rights abuses, it is increasingly likely that a healthcare provider will treat a patient who has experienced one or more traumatic events. When trauma is unaddressed, healthcare providers may unknowingly trigger re-traumatization, preventing refugees from seeking or receiving healthcare services. Refugee trauma survivors require a sensitive system of care. Western medicine is unfamiliar to many refugee groups, and some services, such as cervical cancer screening, may remind them of prior trauma. Trauma-informed care is an approach for assisting trauma survivors with evidence of benefit to vulnerable populations. Objectives: Introduce the trauma-informed care framework and key principles, provide examples of traumas experienced by refugees, and demonstrate how previous trauma can influence preventive health care utilization among women enrolled in the Building Bridges program. Methods: A literature review of trauma-informed care and trauma among refugees resettled in the United States was conducted. Additionally, qualitative data collected by Building Bridges Lay Health Educators as part of their education and navigation services was analyzed and grouped into themes. Results: Recurring themes of rape, torture and distrust towards healthcare providers was found in literature on refugee trauma. Similarly, Building Bridges data confirms rape and violence experienced by refugee women inhibit them from seeking preventive health services. Conclusions: This calls for more attention to the mental health needs of resettled refugees. Refugees need a linguistically and culturally appropriate form of care incorporating the trauma-informed framework.Item Trauma-Informed Care for Refugee Populations(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Thein, Emelda; Mudey, Halimo; Rudasingwa, Laurette; Subedi, Radhika; Qureshi, IramBackground: With the growing number of refugees resettled in the United States after fleeing war torn countries devastated by genocides, mass violence, and human rights abuses, it is increasingly likely that a healthcare provider will treat a patient who has experienced one or more traumatic events. When trauma is unaddressed, healthcare providers may unknowingly trigger re-traumatization, preventing refugees from seeking or receiving healthcare services. Refugee trauma survivors require a sensitive system of care. Western medicine is an unfamiliar concept to many refugee groups, and some services, such as cervical cancer screening, may remind them of prior trauma. Trauma-informed care is an approach for assisting trauma survivors with evidence of benefit to vulnerable populations. Objectives: Introduce the trauma-informed care framework and key principles, provide examples of traumas experienced by refugees, and demonstrate how previous trauma can influence preventive health care utilization among women enrolled in the Building Bridges program. Methods: A literature review of trauma-informed care and trauma among refugees resettled in the United States was conducted. Additionally, qualitative data collected by Building Bridges Lay Health Educators as part of their education and navigation services was analyzed and grouped into themes. Results: Recurring themes of rape, torture and distrust towards healthcare providers was found in existing literature on refugee trauma. Similarly, Building Bridges data confirms that rape and violence experienced by refugee women inhibit them from seeking preventive health services. Conclusions: This calls for more attention to the mental health needs of resettled refugees. Refugees need a linguistically and culturally appropriate form of care incorporating the trauma-informed framework.Item Crucial Barriers to Health Center Deliveries in Rural Western Kenya: Accessibility, Knowledge, or Values?(2016-03-23) Baker, Lisa; Abell, Troy; Ogolla, Habil; Otieno, Anne; Tingle, Jonathan; Damoiseaux, JoleneCrucial Barriers to Health Center Deliveries in Rural Western Kenya: Accessibility, Knowledge, or Values? I. Purpose Maternal health services play a vital role in optimizing pregnancy outcomes for high-risk women in developing countries. Despite increased services, Kenya in particular has made insufficient progress to reducing their maternal mortality and attaining Millennium Development Goal 5. In order to understand why few women utilize available services, this study identified and categorized the major determinants of health center deliveries into accessibility versus knowledge and values. II. Methods Extensive interviews were conducted on the Nyakach Plateau in rural western Kenya with 90 native Luo women (43 pregnant and 47 previously pregnant). Subjects were asked about accessibility barriers, pregnancy knowledge, their values concerning a health center delivery, as well as their intended versus actual delivery location. III. Results In this cross-sectional study, 98% of the pregnant women intended to deliver at a health center but only 45% of previously pregnant mothers actually did so. Almost 100% of the sample valued health center deliveries, but 92% reported a transportation barrier followed by financial problems (76%) and a lack of services (64%). 82% walked for an average of 3 miles to their prenatal care appointments, however 55% were unable to complete the journey over rough terrain when in labor. With the sample living almost four times closer to a traditional birth attendant than to a health center, these women faced significant structural barriers that left 38% with serious problems resulting from pregnancy (including HIV/AIDS, chronic physical consequences, and death). IV. Conclusions These conclusions direct significant intervention efforts toward accessibility barriers, particularly transportation aid, to increase the number of health center deliveries. Knowledge and values, although important, are irrelevant if structural barriers prevent access to health services. With these conclusions, a community-based program called Mothers On the Move (MOM) was started to provide expectant mothers with transportation to nearby health centers. To date, over 600 women have experienced positive birth outcomes at Sigoti Health Center and Nyabondo Hospital as a result of accessible maternal health services. Although specific to the Nyakach Plateau, these findings can be generalized to similar impoverished communities in the developing world.Item Does Access to Preventative Care Differ by Metropolitan Status for Women Aged 35-45?(2016-03-23) Staten, Christina; Brennan, Emily; Tithi, Hafiza; Chapados, Jayme; Powe, Joni; Hartos, Jessica PhDThe purpose of this study was to assess the relationship between metropolitan status and access to preventative care. Differences in access to preventive care by metropolitan status were assessed using 2013 BRFSS data for representative samples of women ages 35-45 in 6 states while controlling for demographic characteristics. The results indicated that metropolitan status was not significantly related to access to preventative care but healthcare coverage was in all 6 states. In addition, in 3 states of the 6 states, participants were significantly less likely to have access to preventative care when reported being white, non-Hispanic (Texas, New York, Ohio) and when cost precluded seeing a doctor (Georgia, California, Ohio). Overall, the findings indicate that metropolitan status was not significantly related to access to preventative care, and focus would be better placed on increasing healthcare coverage and providing free or low-cost routine checkups.Item Uterine Arteriovenous Malformations (AVM): A Rare Cause of Abnormal Uterine Bleeding(2016-03-23) DeLeon, Frank MD; Zimmerman, Leah; Allen, AshleyBACKGROUND: Uterine arteriovenous malformations are a very rare, but life-threatening cause of uterine bleeding. Difficulty recognizing the presentation likely leads to misdiagnosis and underreporting. CASE: A 20-year-old woman with a recent history of a spontaneous abortion presented to the ER for loss of consciousness and heavy vaginal bleeding. Doppler imaging reflected increased vascularity extending down to the endometrium. The patient underwent a unilateral uterine artery embolization. CONCLUSION: Uterine AVM should be considered in reproductive age women with a recent history of pregnancy that present with heavy vaginal bleeding. Doppler imaging is a useful screening tool. Angiography confirms the diagnosis, provides a method of definitive treatment, and should be used in patients when Doppler imaging cannot exclude the presence of an AVM.Item Refugee Women’s Breastfeeding Practices and Experiences Following Resettlement in Tarrant County(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Kwentua, Victoria; Thein, Emelda; Mudey, Halimo; Subedi, Radhika; Rudasingwa, Laurette; Durbin, KatherinePurpose Exclusive breastfeeding for the first 6 months of life ensures that infants obtain adequate nutrients needed to support healthy growth and development. While there is robust literature on factors influencing breastfeeding initiation and duration among sub-populations of women, there is little known about the breastfeeding practices of refugee women resettled in the United States. The limited studies and anecdotal reports suggest, however, that breastfeeding practices change following resettlement. This qualitative study aims to explore refugee women’s infant feeding experiences and practices to better inform culturally appropriate education, support, and maternity care for women resettled in Tarrant County, Texas. Methods Refugee women between the ages of 18 and 50, who had given birth to at least one live infant were recruited into the study. Participants completed a demographic survey and participated in a focus group discussion about their breastfeeding practices and experiences. The demographic survey addressed participant age, ethnicity, time and experience breastfeeding, etc., and descriptive statistics were complied to assess the characteristics/demographics of the study population. Bilingual research personnel conducted focus groups in their respective language using a semi-structured interview guide exploring infant feeding practices, experiences, sources of information, etc. The group discussions were audio-recorded, translated and transcribed. Systematic procedures of qualitative data analysis included intensive reading of the text and group discussion of full transcripts, followed by coding, displaying, reducing, and interpreting information. Results Refugee women representing different ethnic groups participated in the demographic surveys and focus groups. Conclusions Results of the focus groups suggest multiple influences on infant feeding practices of refugee women following resettlement in the United States. A culturally and linguistically multi-level approach to providing education and support services to refugee women is necessary to protect their breastfeeding practices. Findings from this study have implications for health providers, resettlement agencies, public health and others involved in serving this population.Item Breast Health - Guidelines and Misconceptions(2016-03-23) Chhetri, Shlesma; Spence-Almaguer, Emily; Paul, Marcy; Desai, Anjali; Wilder, Misty; Cantu, KatherineObjective: According to the Center for Disease Control (CDC, 2016), breast cancer is the second most common cancer among women. Due to the high incidence and prevalence of breast cancer, the CDC has proposed guidelines in place for self-assessment and early detection. It is crucial for women to understand risk factors and symptoms associated with breast cancer. Despite the wide spread efforts in publishing these guidelines, the level of awareness regarding breast health among women in unclear. This study aimed to assess the level of breast health knowledge among women of Tarrant County, Texas and to evaluate the effectiveness of a lay health breast educator training initiative. Methods: The initiative conducted “train-the-trainer” educational events, where women in the community completed a lay breast health educator training session. Pre and post surveys to assess changes in breast health awareness were administered during the training. The next component was to evaluate the knowledge of the women who received a screening at any one of the nine different breast cancer screening locations throughout Tarrant County. The lay breast health educators’ role was not to only share information about breast health, but also to promote attendance at the screening day. Results: A total of 134 women participated, 43 women completed pre and post survey at training and 91 women completed survey on the screening day. Over half of the participants were between the ages of 40-59, have had at least some college, and identified as either African American/Black or as Hispanic/Latina. A vast majority were aware of lump related symptoms of breast cancer. However, participants lacked awareness on other key symptoms. Conclusion: This study indicated a general lack of knowledge regarding breast cancer awareness, and a need to promote non-lump related symptoms along with other risk factors of breast cancer. Lay breast health educators’ knowledge of breast cancer signs increased immediately following the an hour long training session, suggesting that the knowledge learned is beneficial to their personal efficacy and ability to recognize breast cancer symptoms.Item Adverse Outcomes from vaginal delivery during immersion in water versus traditional vaginal delivery(2016-03-23) Combs, Shanna; Felini, Martha; Donaldson, Kathleen; Lopez, Tania; Hicks, Candis; Griffith, Lindsay; Cochrane, Cindy; Zimmerman, Leah; Shillington, AmelleHypothesis: There are no adverse events examining four years of hospital midwifery vaginal delivery during immersion in water versus traditional vaginal delivery. At our institution, our Certified Nurse Midwife practice has been practicing vaginaldeliveries via immersion in water since 2008. In light of the ACOG committee opinion 594, we conducted a matched-pair analysis to compare the frequency of adverse events during immersion in water vs traditional vaginal delivery. Materials and Methods: A retrospective chart review was conducted for deliveries occurring at a single urban hospital from 2010 – 2014. Deliveries were grouped into waterbirths and landbirths. Women who had a waterbirth were matched by parity and gestational age to women having a traditional vaginal delivery. Adverse outcomes assessed included lacerations, episiotomy, hemorrhage, APGAR score, shoulder dystocia, and NICU admission. Conditional logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (95% CI). Results: Of the 149 matched pairs assessed, the median age was 28; 71% were Caucasian and 20% were Hispanic. Women were similar across delivery groups in age, race, chronic conditions, and number of previous preterm births. The odds of a laceration during waterbirth delivery were observed to be 90% lower when compared with landbirth (AOR = 0.10, 95% CI: 0.01 – 0.78). Likewise, a poor 1 minute APGAR ( Conclusion: This study suggests that there were fewer lacerations and higher 1-minute APGAR scores among waterbirth deliveries.