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A study of secret shoppers sheds light on barriers to opioid treatment in women

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After a 2020 study at Vanderbilt University Medical Center showed women had difficulty accessing treatment for opioid use disorder (OUD), researchers analyzed the comments from participants in the study. Other barriers to care have been exposed, including everything from long hold times. For difficult interactions with the clinic front desk during a phone call requesting a reservation. Credits: Vanderbilt University Medical Center

After a 2020 study at Vanderbilt University Medical Center showed women had difficulty accessing treatment for opioid use disorder (OUD), researchers analyzed the comments from participants in the study. Other barriers to care have been exposed, including everything from long hold times. For difficult interactions with the clinic reception during a phone call requesting a reservation.

A study of “Secret Shopper” published on the JAMA network in 2020 attempted to seek treatment from a trained actor in 10 states in the United States. Over 10,000 individual “patients” are randomly assigned during pregnancy or non-pregnancy and have private or Medicaid-based insurance to assess differences in access experience.

The results revealed many challenges in planning the first appointment for treatment for OUD, including finding a healthcare provider who would get insurance instead of cash. Access to treatment was even more difficult to receive treatment than women who are not pregnant.

Trained actors left around 18,000 comments explaining what happened during the call, and pregnant callers and those using Medicaid are the hardest to book. I recorded a problem. The qualitative survey is published in the following journals. Women’s health problems.

“These trained callers didn’t really have opioid use disorders and weren’t desperate for help for themselves or their babies, but they were still stigmatized during those calls. “I felt,” said lead author Dr. Julia Filippi. D., CNM, Midwife and Academic Director of the Midwifery Program at Vanderbilt University School of Nursing. “They were treated for better or worse, so emotions often overwhelmed them. That really speaks to something. “

Many callers did not welcome the answer from the person who answered the call and often stigmatized them. A secret buyer told the receptionist, “People don’t usually show up on promises because they want the last drink before they come.”

In many cases, the caller has repeatedly put on hold or transferred. One caller commented, “It’s strange how long it takes to speak to someone,” and another said, “I’m being treated for an addiction and I’m four months pregnant.” They put it on a typical instant stop. “

Not all interactions were negative. One caller reported that “everyone who spoke during the call, including the receptionist, was deeply compassionate, knowledgeable, and friendly”.

As the opioid crisis worsened in the United States, women became more and more affected. From 1999 to 2016, the drug-related death rate for women rose from 3.9 to 13.4 per 1,000, according to the National Center for Health Statistics.

Treatment with Opioid Use Disorder Drugs (MOUD) is very effective in reducing overdose deaths and improving quality of life. For pregnant women, MOUD improves pregnancy outcomes. Premature birth ..

“Overdose deaths have hit record levels in the United States that the COVID-19 pandemic may have made worse,” said Dr. Stephen Patrick, Director of the Center for Pediatrics Health Policy at Vanderbilt University School of Medicine and Associate Professor of Pediatrics. Is very expensive. “And a neonatologist at Health Policy and Vanderbilt University Medical Center. “We know that drugs used to treat opioid use disorders reduce the risk of death from maternal overdose and increase the chances of giving birth to a higher birth weight. We have easy access to treatment. You need to. It’s not difficult at all. “

The authors recommend interventions to improve access to OUD treatment for women of childbearing potential, including increasing the number of US clinics offering MOUD with or without pregnancy and insurance. More training for clinic phone responders. Address this problem nationwide through political reform.

Cumbersome access to opioid treatment for patients

For more informations:
Julia C. Phillippi et al., Experience of Women of Childbearing Potential Who Have Access to Treatment for Opioid Use Disorders: “We’re Not Doing It Here,” Women’s Health Problems (2021). DOI: 10.1016 / j.whi.2021.03.010

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Vanderbilt University Medical Center

Quote: A study among secret shoppers sheds light on the barriers to opioid treatment in women (June 3, 2021) https://medicalxpress.com/news/2021-06-secret-shopper-barriers-opioid-Behlungs. Received from html on June 3, 2021

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Women’s Health

Fatigue and headache aren’t part of ‘being a woman’. They can be signs of low iron

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The World Health Organization (WHO) estimates that a third of all women of childbearing age are anemic, and 40 percent of pregnant women are also iron deficient.

Without enough iron, our bodies cannot produce enough hemoglobin in red blood cells to carry oxygen around the body. As a result, an iron deficiency can lead to quality of life-impairing symptoms such as tiredness, headache, dizziness, poor concentration and shortness of breath. While some may show signs of iron deficiency, others may show no symptoms depending on the degree of the deficiency. These symptoms can significantly affect a person’s daily life, with greater risks for pregnant women.

Realizing the dangers, frequency, and symptoms associated with iron deficiency is one factor in addressing the iron deficiency problem, which is often dismissed as a problem by women. A study recently published in Blood Advances found that half of the participants were low in iron, with one in four being severely iron deficient. However, the study, which enrolled 44,552 pregnant women, found that 40 percent of participants never had their iron levels checked, while women with a lower socioeconomic background were less likely to be tested or treated. Symptoms of fatigue, headaches, and shortness of breath are often introspectively dismissed as problems simply related to the territory of pregnancy or “being a woman”. If left untreated, however, iron deficiency can lead to complications that could otherwise be easily prevented and treated.

“Iron deficiency and anemia during pregnancy are associated with adverse maternal and fetal outcomes, including neurocognitive deficits in children born to mothers with iron deficiency,” says Dr. Aoibhe O’Driscoll of Blackrock Medical Center, Women’s Health Clinic and Menopause Specialist in Cork. “Iron deficiency during pregnancy is associated with several complications. Most developed countries have a national iron screening program for pregnant women to ensure early detection and intervention to reduce risks associated with iron deficiency. Unfortunately, iron screening is not routinely performed in the general population, mainly for reasons of cost. “

The need for iron in pregnancy to support the developing fetus, the growing placenta, and the increased blood supply needed to maintain the pregnancy requires better access to regular screenings during and after pregnancy.

While it is an easily treatable condition, it is not uncommon for women to accept the symptoms of iron deficiency and live with them for years before seeking treatment

“Regardless of the national iron screening programs during pregnancy, an ideal opportunity to repeat the screening is the six-week routine exam to find out how the pregnancy or breastfeeding affected iron levels,” says Dr. O’Driscoll. “This would be invaluable in assessing who needs iron supplementation, which could help avoid iron level issues in subsequent pregnancies.

“Once a woman has inadequate iron levels during pregnancy, the dietary sources of iron are insufficient to replenish the level and oral iron supplementation is required. Therefore, I would suggest that women focus on iron to reduce the risks associated with inadequate iron levels associated with folic acid supplementation, as both play key roles during pregnancy. “

Since iron deficiency has been identified as a result of the challenges of pregnancy, it is often also due to menstrual loss, with an estimated 2.1 billion people living with iron deficiency as a result. It is the leading cause of anemia in women of childbearing age worldwide. While it is an easily treatable condition, it is not uncommon for women to accept the symptoms of iron deficiency and live with them for years before seeking treatment. As such, women enter pregnancy already with an iron deficiency.

The most common symptoms of anemia

New data suggests that 64 percent of women have heavy periods and are more likely to experience symptoms such as fatigue and exhaustion due to iron deficiency as a result. However, since only 33 percent of the participants are of the opinion that too little iron contributes to tiredness and exhaustion, the knowledge gap regarding the importance of iron intake becomes clear. Iron deficiency anemia due to heavy menstruation is common in a third of menstruating women. According to a survey of 2,400 women commissioned by the makers of Active Iron, 71 percent of participants recognized fatigue and exhaustion as a symptom caused by the menstrual cycle. Surprisingly, however, a third believe that “it can’t do anything to make a difference” about the symptoms resulting from their periods and the potential for iron deficiency.

“Women of childbearing potential are at greater risk of inadequate iron levels due to monthly menstrual blood loss. Pregnant women and women with a restricted diet, endurance athletes and those with oral iron intolerance also belong to the higher risk category. These common lifestyle factors contribute to inadequate iron levels and so would indicate that the prevalence of iron deficiency is much higher in women, ”says O’Driscoll.

The average woman spends nearly ten years of her life menstruating

“People present in primary care with symptoms of inadequate iron levels such as TATT,“ always tired ”, low energy, or frequent heavy periods or restricted diets on a daily basis, and then it is clinically appropriate to test for them. Inadequate iron levels are often treated with high-dose oral iron, which can cause gastrointestinal side effects such as constipation and nausea in most women. For many, this intolerance leads to poor adherence and unsuccessful treatment. When choosing an iron supplement, it is important that it is stomach-friendly and yet highly absorbable. “

Dr. O’Driscoll says she is surprised to learn that so many Irish women are suffering symptoms of iron deficiency. “I’ve seen firsthand in my practice that treating inadequate iron levels has alleviated symptoms. The average woman spends nearly ten years of her life menstruating, which is a considerable amount of time during which she feels less than at her best. That really has to change. “

Fatigue and exhaustion are the symptoms of menstruation that women are most likely to accept as part of life. Dr. However, O’Driscoll recognizes that simple lifestyle and diet changes as well as routine supplementation can help replenish iron levels, provide sustained energy, and alleviate the common side effects of iron deficiency that can include extreme fatigue.

With iron deficiency anemia remaining a globally underrated condition affecting women, growing awareness of the causes, risks, and options available will encourage women to seek advice and help in managing low iron levels. When health care professionals support efforts to close the awareness gap, iron deficiency anemia can be targeted, resulting in better outcomes for women.

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Women’s Health

Ellen Noble: Fostering inclusivity, opportunity and health awareness in cycling

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Ellen Noble is stepping down from professional cycling indefinitely to make her health a priority, but she will continue her mission of promoting inclusivity, opportunity and health awareness in the sport.

In an interview with Cyclingnews, Noble said she wanted to provide opportunities for girls and young women through ENCXQuest and Noble Racing Mentorship Program Grant initiatives.

“It is possible to still be inclusive and create community, be it in person or remotely. I love this connection. I didn’t always fit in when I was in school, so it really means having a group of people we can all fit into. ”A lot to me, and I want to keep finding ways to do that. I don’t want to stop doing my initiatives outside of racing and I hope I can do more of them now that I have more time. I intend to stay in the sport even if it’s not on the track, “said Noble.

Noble has ongoing health problems after being diagnosed with Hashimoto’s disease in 2018, an autoimmune disease that affects thyroid function.

Noble told Cyclingnews that it took some time to find ways to relieve her symptoms through visits to different doctors, but that she was slowly putting together treatments and lifestyle adjustments that work for her.

“In the last two years since my diagnosis, I’ve had a lot of small wins. Every time you work with someone new, you learn a little and I take small pieces from each practitioner and I slowly build a solid foundation for health, which is my goal, ”said Noble, who uses acupuncture to provide symptom relief has found .

“Practitioners in many circles believe that autoimmune diseases and chronic diseases can be hibernated, they can never be cured, but they can be let dormant. The ultimate goal for me is to put it into hibernation and not struggle with flare-ups. “

Noble said her health was in delicate but good shape when she suffered a fall earlier this year that broke her spine in three places. Although she was now almost completely healed, the injury opened a void in her health that was difficult to fill.

“I still have back pain, my back is healed, but it didn’t just go away. I don’t think injuries, be it a broken bone or illness, aren’t always linear, ”she said.

“I think this is how my autoimmune disease changed after I broke my back. When I broke my back in April, I was doing pretty well. I felt healthy, my symptoms were regulated, and I felt pretty good. I just wasn’t in my best shape and my results weren’t great, but I felt good.

“That was a bridge too far for me. My health was still fragile and the physical trauma of breaking my back shook my health as we were in a delicate balancing act. I came back and rode and worked at the gym and then hit a wall in August. Physically I couldn’t anymore and my nervous system was at its limit. “

Noble hasn’t ruled out the possibility of a return to professional racing; However, she has not set a schedule for her sabbatical. Instead, it focuses on other goals within the sport that offer rewards beyond performance and results.

“I’m still trying to find out everything. I take my time and I feel like this is a great opportunity for me and I feel grateful in this room where I can do something new. I still want to be involved in the sport because I love cycling, I love bikes and most of all I love what bikes can do for people, from racing to commuting to rides around your neighborhood with friends of kids. I want to pass this message on. I also think bikes are a great platform to talk about physical and mental health, ”said Noble.

Connection and acceptance

Noble launched ENCXQuest in 2017, which accommodates 12 to 18 girls and young women ages 15 to 23 to experience an all-women cycling camp that includes training, technique building, yoga, and education on nutrition, sponsorship, and the sport in general.

“The camp started as an answer to my question: What did I want and need in sports when I was 15? When I was in high school, sport opportunities were lacking for women my age. There were many junior camps and, despite my requests, I was never admitted. When there weren’t any options for the next generation, I decided to do it myself, “said Noble.

Camp has been postponed in 2020 and 2021 due to Covid-19, but Noble is preparing to host its fourth edition in 2022. Noble stated that ENCXQuest relies on donations and industry partners. It’s also an application-based program that offers places for women of all backgrounds, whether they can afford it or not.

“We want to make sure that the athletes who are eligible for the camp regardless of their financial status can participate. I’m delighted that space has been created for these athletes that might otherwise not have been created, ”said Noble.

“People are very supportive and so we can operate through donations from very generous people who also have the mission to get more girls and young women on bikes and to create a space for young women to have fellowship. Yes, it’s about bikes, but it’s also about 12 to 18 girls who spend the week together and find that having more women in your circle is pretty cool. “

While the ENCXQuest took a break due to Covid-19, Noble launched a virtual platform in 2021 to create opportunities for women in cycling. The Noble Racing Mentorship Program Grant Fundraiser is an attempt to support and mentor the next generation of young women in cycling. It offers seven athletes monthly group and one-on-one meetings, as well as financial grants to cover their entry fees, travel expenses, and coaching.

Noble wants to continue both initiatives while finding new ways to promote inclusion and opportunities for women in cycling.

When asked where she sees herself in the future in sport, especially in terms of her initiatives, Noble said, “I don’t think I’m alone in this, but I hope the sport continues. We see these little advances in different areas. We’re seeing more colored riders in the results, on the start lists and on the podium and it’s amazing. The same goes for transporters. Seeing acceptance grow wider, which is amazing to see, has been my mission since the beginning of the quest to promote that inclusivity.

“I hope more people understand that bikes are powerful and can change lives. The more people from all backgrounds – no matter where you come from or who you are – the more people we can bring on bikes mission. If you have love in your heart and want to ride a bike then you are friends of mine. It’s a great way to connect. “

Noble will take the time it takes to get better and one day we may see her at the highest level of racing again, but even if we don’t she’s sure she has a place in cycling .

“My comeback to cycling is not guaranteed. I won’t be racing again if I don’t fix my health, but my goal is to fix that and if I can I’ll be back at the track. Anyway, I’m not done with cycling yet, “said Noble.

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Women’s Health

New York electeds rally around Planned Parenthood, assure NYC as safe haven for abortion seekers

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As the right to abortion is threatened in states across the country, elected officials from New York gathered in Lower Manhattan on Monday to discuss planned parenting.

With abortion fast becoming one of the most controversial issues of the year and fear of losing the right to vote, a bevy of city and state officials assure New Yorkers that they will not lose access to these health services.

While touring Planned Parenthood at 26 Bleecker Street, Congressman Carolyn Maloney, Senator Brian Kavanagh, councilor Carlina Rivera, famous journalist and activist Gloria Steinem, and more brought the facility’s importance to the fore today more than ever. Maloney said the site is already seeing an influx of patients from overseas.

Congressman Carolyn Maloney. Photo by Dean Moses

“We just visited Planned Parenthood and they are already telling us that people are flying in from Texas for treatment. I am so proud that Planned Parenthood is in the district I represent and that it does such a good and wonderful job helping women and girls, ”said Maloney.

“Reproduction rights are no longer chopped off. They were thrown away the entire time I was in Congress. Vote here and vote there. They no longer scratch our rights. They ram them into the ground, ”she added.

That influx coincides with the case of the Dobbs Supreme Court over the 15-week abortion ban in Mississippi, the ongoing litigation over the six-week abortion ban in Texas, and efforts to escalate denials of health care, including abortion and contraception. In the Dobbs v Jackson case, the state of Mississippi argues that the power to regulate abortions should be a state issue, not a state issue. As the court battle continues with a verdict due by the summer of this year, 21 states are on the verge of making abortions illegal or extremely difficult due to strict guidelines such as the “Heartbeat Laws”.

Chair of the Oversight and Reform Committee alongside her work in Congress, Maloney is pushing for a five-part plan to tackle the attack on women’s rights. Citing discussions she had with incestants aged 10 and over who became pregnant, she called abortion abolition “cruel” and “inhuman”.

Maloney’s initiative sees the constitutional change in equality through the passage of the Women’s Health Protection Act, which would establish a legal right to abortion across the country while cracking down on contraceptive restrictions.

Gloria Steinem is all too familiar with this fight. Steinem, who fought for women’s rights for decades, called this latest controversy an attack on democracy.

Journalist and activist Gloria Steinem. Photo by Dean Moses

“If we cannot control ourselves, there is no democracy. When Hitler was elected and he was elected, the first thing he did the very next day was padlock the family planning clinics and declare abortion a crime against the state. Mussolini did the same. Dictators know that they have to control reproduction, ”Steinem said.

While this is extremely worrying for those living in the affected states, many in attendance reassured New Yorkers as well.

“New Yorkers need to know that their right to abortion is safe here in this state. Regardless of what happens in the Supreme Court, ”said Sonia Ossorio, President of NOW-NYC.

Tiffany Caban. Photo by Dean Moses

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