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Women’s Health

The next FDA commissioner must address health disparities and barriers to care

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As a practicing obstetrician and gynecologist and an advocate for improving access to reproductive and sexual health and resources, I have seen firsthand how our health systems all too often fail those with the greatest barriers to accessing health care and services.

The Biden government has a unique opportunity to appoint a Commissioner for the Food and Drug Administration (FDA) who boldly addresses systemic biases and obstacles in health care, advocates evidence-based science, and promotes health equity. The next FDA commissioner will play a vital role in setting the direction of our country’s health care. Administration must take into account the needs of people and communities and their opportunities to access health care. The pandemic has shown the importance of having leaders who are science-driven and committed to justice. however, these principles are also important in ameliorating long-standing, recalcitrant health inequalities.

For example, despite advances driven by the Affordable Care Act and advances in contraception technology, access to contraception remains a major challenge for far too many Americans. The FDA commissioner will have the opportunity to make a huge leap forward in women’s health and access to contraception by ensuring that birth control methods that have been proven to meet the same requirements as other over-the-counter drugs are available over the counter. It’s been 60 years since the FDA approved birth control for everyone, but people continue to face medically unnecessary prescribing barriers. Access to birth control pills without a prescription would provide a safe and inexpensive method of birth control.

It is also important that the FDA commissioner commit to an evidence-based and timely review of the proposed switch from prescription to over-the-counter (OTC). For years, medical associations and doctors across the country have urged the FDA to investigate the possibility of OTC access to the pill. In fact, the American College of Obstetricians and Gynecologists has officially approved such access for all ages.

In addition, every candidate for FDA commissioner must have a clear understanding of the inequalities in our health care system and how they affect the reproductive health of people of color, people struggling to survive, and people from rural areas. In fact, people with limited resources who receive medical care through Medicaid are more likely to have gaps in their ability to access contraception. Black women and girls – regardless of their income – are also more likely to have gaps in access to contraceptives. It is important that the Commissioner understand the role of the FDA in addressing these inequalities.

Additionally, women of childbearing potential have been excluded or underrepresented in clinical trials for studies of conditions such as diabetes and heart disease in the past – and that exclusion was even worse for women of color. The lack of inclusion is reflected in incomplete data sets that prevent some people from making informed decisions about their health care. Therefore, each potential candidate must have a plan on how the FDA can improve and modernize clinical trials and ensure the equitable inclusion of people of color and reproductive capabilities.

A potential candidate must trust that people will make their own decisions about their reproductive health – 70 percent of women of childbearing age prefer having the pill on the store shelf. It is long time for the FDA to take the lead and remove unnecessary barriers. We look forward to working with a Commissioner who is ready to face the challenges of all people – especially those who have been inadequately cared for by our health system for far too long.

Raegan McDonald-Mosley, MD, MPH, FACOG, is the CEO of Power to Decide, Senior Medical Advisor to the Contraceptive Access Initiative, and a practicing obstetrician and gynecologist. Follow her on Twitter @DrRaegan.

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Women’s Health

Do official vital records of maternal death detect specific effects of new pandemic viruses?

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Using a statistical technique called interrupted time series (ITS), the researchers identified a sustained decline in the maternal mortality rate (MMR) from 1980 to 2009 (blue dots), the year of the H1N1 pandemic. During this event, the MMR rose exponentially (red point) and then resumed an even more accelerated downward trend from 2010 (sky points). Photo credit: MELISA Institute

New viruses can affect women’s health and lead to an increase in complications and deaths during pregnancy, childbirth and the puerperium. This is shown by a population-based nature experiment on the 2009 H1N1 flu pandemic conducted on the basis of Argentine national vital records of maternal mortality. The research was published in The Lancet Regional Health — Americas.

In this joint study – led by Dr. Elard Koch, Senior Epidemiologist at the MELISA Institute (Chile) and conducted by a team of researchers affiliated with academic centers in Argentina, Peru and Chile – a 38-year time series of Argentine vital records was used to assess the trend in maternal mortality (the Ratio between the number of maternal mortality and live births at the national level multiplied by 100,000 per year) for specific causes to be assessed before, during and after the global outbreak of the pandemic H1N1 influenza virus in 2009.

According to Dr. Koch, knowing the sensitivity of vital signs of live births and maternal mortality is of vital importance in order to investigate the potential harmful effects of a new pathogen on particular organs or systems, stages of pregnancy, comorbidities and ultimately on the offspring. “Vital records have improved over the past few decades, confirming a decrease in maternal mortality in most Latin American countries. However, it is not clear whether this improvement led to an increased sensitivity in the detection of specific effects of new virus-induced pandemics, ”the epidemiologist emphasizes.

Unlike randomized experiments or clinical trials, where researchers have full control over an intervention, natural population experiments use long discontinuous time series (ITS) to measure the effect of a causal factor by looking at the underlying mortality trends before and after the introduction of one exogenous event that affects an entire population. This type of design is therefore ideal for quantifying the impact of new public guidelines or natural disasters such as epidemics caused by new viruses.

In terms of the methodology used, the 2009 H1N1 influenza pandemic provides the latest epidemiological for Maria Elena Critto, PhD student at MELISA Institute and lead author of the article, ahead of the current public health crisis triggered by SARS-CoV-2 Experiences to assess whether the official Argentine Ministry of Health records are sensitive enough to identify specific maternal health consequences of a newly emerging pathogen. “The results obtained not only showed a significant and transient impact of a pandemic virus on maternal health, but also confirm that Argentine vital records can be used to assess specific effects of the current SARS-CoV-2 outbreak and other emerging pathogens in to investigate the region’s future, “added the researcher.

The study confirmed the so-called “obstetric transition”, which is mainly characterized by changes in the dominance of deaths from direct obstetric causes to indirect causes. In fact, there was a 58.6% decrease in all-cause maternal mortality over the 38 years studied. The main causes of maternal mortality that contributed to this decline were bleeding (10.2 to 2.3 per 100,000 live births, 77.7%) and miscarriages (from 24.5 to 4.3 per 100,000 live births, 82.6%). However, there was an increase in indirect causes (2.6 to 7.7 per 100,000 live births, 197%) due to comorbid conditions outside of pregnancy, including cardiovascular disease, diabetes, cancer, kidney failure, and other chronic conditions.

The Argentine data are in line with recent studies in Chile, Mexico and Brazil, making them an excellent example of the progress made in reducing maternal mortality in Latin America over the past few decades. The challenge now is to prevent deaths from chronic diseases, which can complicate pregnancy and which are increasingly common in the region due to the postponement and accelerated aging of motherhood.

For Adolfo Etchegaray, specialist researcher in maternal and fetal medicine at the University of Austral (Universidad Austral), the research clearly shows a change in the scenario with regard to the specific causes and challenges of maternal morbidity and mortality. “It is important that this information is taken into account by decision-makers as a starting point for the prioritization of strategies and policies in the area of ​​public health for the primary prevention of this population group for the next few years,” emphasized the Argentine specialist.

Specific but temporary fatal effects

One of the most relevant results of the study is to illustrate how a pandemic pathogen can have very specific, abrupt and temporarily fatal effects on the historical evolution of a country’s maternal mortality.

During the period under review (from 1980 to 2017), the 2009 H1N1 flu pandemic recorded a peak in the Argentine maternal mortality rate, which then quickly fell. “Overall maternal mortality declined at a constant rate of -0.94 per 100,000 live births, reversed abruptly in 2009 with an increase of 12.74 per 100,000 live births, and then resumed a downward trend,” said Yordanis Enriquez, Ph.D. and researcher at Sedes Sapientiae Catholic University (Peru) who carried out the statistical analyzes of the ITS.

When analyzing the specific causes of death, researchers found that the increase in maternal mortality was almost entirely limited to respiratory complications and sepsis, with no other causes of death affected. Dr. Koch explained that maternal death from sepsis during pregnancy is becoming rarer thanks to the advancement and development of antibiotics, but the pandemic H1N1 virus had a distinct and significant regressive effect on these types of complications. “During pregnancy, physiological and immunological changes predispose the pregnant woman to systemic infections, which can be exacerbated by influenza, which is more common and at higher risk during pregnancy,” noted the epidemiologist.

Regarding the importance of the study for the epidemiological surveillance of the current SARS-CoV-2 pandemic virus, the researchers agree that it is important to investigate the specific harms this coronavirus has on maternal health. “It is important to determine whether the new pandemic coronavirus may also increase maternal mortality from sepsis and other chronic non-respiratory comorbidities, and to know whether these complications are susceptible to endemic variants over time,” said researcher Ruth Weinberg, OB / GYN medical doctor from the University of Buenos Aires.

There are already reports of spikes in maternal mortality in Mexico and Brazil, apparently related to the ongoing COVID-19 pandemic. “In contrast to the H1N1 pandemic virus, the new SARS-CoV-2 pandemic coronavirus does not appear to be restricted to the respiratory tract only; new studies may let us know more about its specific consequences during pregnancy, childbirth and the puerperium, ”says Dr. Koch emphasizes.

Finally, María Elena Critto noted that early organized health care needs a major effort to prevent maternal deaths and to monitor the effects of emerging pandemic viruses on women during pregnancy. “In the case of Argentina, the maternal mortality record was of acceptable quality to reflect very specific changes in MMR caused by an emerging outbreak of infection, and therefore this record may be useful in assessing specific effects of the ongoing SARS-CoV-2 pandemic and evaluate any other emerging outbreak of infection in the future, “concluded the researcher.

The COVID-19 pandemic has dramatically increased maternal mortality in Mexico

More information:
María Elena Critto et al., Impact of emerging viral pandemics on causal time series of maternal mortality: a population-based natural experiment with national vital statistics, Argentina 1980-2017, The Lancet Regional Health – Americas (2021). DOI: 10.1016 / j.lana.2021.100116

Provided by the MELISA Institute

Quote: Do Official Maternal Death Data Detect Specific Effects of New Pandemic Viruses? (2021, November 29) Retrieved November 29, 2021 from https://medicalxpress.com/news/2021-11-vital-maternal-death-specific-effects.html

This document is subject to copyright. Except for fair trade for private study or research purposes, no part may be reproduced without written permission. The content is provided for informational purposes only.

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The Royal strives for ‘hospital without walls’ to address mental health issues, substance use — and stigma

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Canadians from all walks of life experience mental health problems and substance use. And in Ottawa, The Royal is at the forefront of building what its CEO calls the “hospital without walls” to address those challenges – and the stigma – wherever people are.

It is a mission that makes fundraising critical to The Royal’s ambitious approach to service delivery.

“The silos of mental illness and drug use end at The Royal because we believe there should be no limits to treatment,” said Joanne Bezzubetz, president and CEO of The Royal, the Carling Avenue facility that Ottawa’s primary treatment for mental health and capital research is region.

Bezzubetz stated that every year thousands of people in and around Ottawa receive services from The Royal without ever entering the complex on Carling. The Royal works with other mental health professionals, health care providers and social services to care for people in shelters, long-term care facilities and at home.

“The Royal is there to provide this type of care,” said Tracey Welsh, community building director for the Royal Ottawa Foundation for Mental Health. “The Royal’s mental health community component is a really integral part. Sometimes people think it’s just that great building on Carling Avenue. But it’s so much more. “

One in five Canadians experiences mental health problems each year, according to the Canadian Mental Health Commission. Susan Farrell, vice president of patient care and community psychiatry for the Royal Ottawa Health Care Group, said the number is rising.

The pandemic is really difficult for everyone. With this, we see both the deterioration in people’s mental health and the development of new mental health problems, including substance use.

– Susan Farrell, vice president of patient care and community mental health at The Royal

“The pandemic is really difficult for everyone,” she said. “With this we see both the deterioration in people’s mental health and the development of new mental problems, including substance use.”

A report from Public Health Ontario found that “Ontarians have a high burden of disease associated with mental illness and addiction.” The report concluded that while effective treatment options are available, only a small proportion of those affected receive them.

The Welshwoman said she saw a sharp surge in demand for mental health services in her 15 years at The Royal. She said the center lacks the capacity to provide assistance to everyone in need.

She said this underscores the importance of awareness raising, as well as funding for mental health care and research. And the Welshwoman added that she hoped the situation will continue to improve.

“People are really taking solace in supporting the Royal’s events and mental health in general,” she said. “Watching events grow – our fundraising increases – are real signals that people are becoming much more aware, much more open to donations and much more open to support.”

The Royal is expanding its services to be more accessible, and this is where things like a recent fundraising breakfast come in very handy, Welsh said.

“Sometimes people think it’s just that great building on Carling Avenue, but it’s so much more.”

– Tracey Welsh, The Royal

The Royal’s most recent 14th annual Leaders for Mental Health Breakfast raised $ 733,411, and rising in the weeks following the virtual event.

The proceeds from breakfast will be distributed among several mental health services at The Royal, including the Rapid Access Addiction Medicine Clinic and the Prompt Care Clinic.

The Royal Ottawa Hospital is expanding its services to meet the increased demand for mental health care in the community. [Photo © Krystin Ptaszkiewicz]

Virtual services

Alternative ways of accessing psychosocial support have become increasingly important in recent years when physical going to a clinic was not an option. Virtual care via video conferences or by telephone has also been extended to existing and new patients.

The high demand for services related to substance use has prompted the federal government to open RAAM clinics across the country.

The clinics provide immediate help for people who consume substances or who suffer from substance use disorders. They have adapted to be more accessible by offering the ability to check in through “virtual front doors”.

The Royal recognized the limits of technology and specifically for people who may not have a mobile phone or have no access to the internet. The institution is now making telephones and data tariffs – donated by TELUS – available to the people who need them.

The Prompt Care Clinic was originally implemented in response to the increased demand for immediate mental health services during the first wave of the pandemic. It offered short-term virtual care, including assessment, medication, and psychotherapy.

“We’re trying to improve access to our services by making the service delivery model as flexible as possible,” said Farrell. “Another barrier is making sure the services are appropriate for the person and what they need … so that we can meet people where they are in their communities and in recovery or access to medical care Care.”

The Prompt Care Clinic received 1,000 referrals within the first six months of opening.

The Royal recently announced the launch of a version of the Prompt Care Clinic that will include additional personal services in addition to its virtual platform.

Part of the funding for this project comes from this year’s Women’s Mental Health Run. Farrell said more than two-thirds of people who presented themselves at the Prompt Care Clinic were women – a high percentage of whom had never used mental health services before.

Run for women

“In Ottawa, we have a very proud tradition of running for the mental health of women. The run is both an opportunity for conversation and a sense of community, ”said Farrell.

The annual run is the organization’s “largest fundraiser” to support the services for women at The Royal. This includes the Women’s Mental Health Program – a community-based outreach service for hospitals and women’s shelters.

In 10 years the number has grown from 600 to 6,000 in 18 cities across Canada. She stressed the importance of having programs tailored to women’s specific needs and the psychological care they receive.

To date, the Run for Women has raised more than $ 1.7 million for women’s mental health. The official date for the Women’s Mental Health Run 2022 has not yet been set, but The Royal is already encouraging the community to get involved.

Words are important

A major focus of The Royal’s fundraising campaign, including the recent breakfast event, has been on the power of words used when talking about mental health.

“We still have too much stigma surrounding access to care in our community. I am confident that a silver lining in the increased rates of mental health problems during COVID is that the conversation is much more frequent and people understand the need to have access to medical care, ”Farrell said. “I hope it will reduce stigma.”

Farrell highlighted the stigmatizing effect that the words we choose can have on people with mental health problems or illnesses, including people who use substances or have a substance disorder. The most recent breakfast focused on using the person’s first language more consciously.

The person’s first language focuses on the individual, not the condition.

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Women’s Health

Serena Williams Flaunts Her Legs In A Swimsuit In New IG Photos

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  • Serena Williams is vacationing in a tropical place and shares snippets of her fans on Instagram.
  • Tennis GOAT, 40, posted a series of underwater images in a new post, and they are everything.
  • Serena recently told Women’s Health that she is following a plant-based diet and is trying to view food as fuel.

    Serena Williams is vacationing in a tropical place and shares snippets of her fans on Instagram. The latest: Serena totally whips the model poses while snorkeling.

    Tennis GOAT, 40, posted a series of underwater images in a new post, and they are everything. There’s Serena showing off her toned legs as she stretches out in a snakeskin print one-piece, Serena swimming in the ocean with her hand under her head, Serena flashing peace signs over a pile of fish, and one final shot of just Serena’s well-toned legs and bum.

    “If you ask how I got that ball … it’s underwater training :)” she joked in the caption.

    People were in the comments about it. “Stop intimidating the sharks!” Wrote one person. “Legs,” said another.

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    Obviously, Serena gets a lot of that jaw-dropping tone from logging hours on the tennis court. But that’s not all she does.

    Last year Serena posted a modified yoga-inspired workout routine (which she calls a “warm up”) on Instagram. In it, Serena and her sister, her fellow tennis legend Venus Williams, worked a series of stretches and strengthening exercises for 30 minutes.

    “I like to call [this] a warm up, but it’s a bit intense, ”said Serena at the beginning. Afterward, Serena said to her sister, “I’m going to do cardio,” because of course she did.

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    As for that cardio, Serena also shared a video on TikTok last July doing a weighted HIIT workout. She tossed a bit of everything into the mix, including interval ladder training, some ab exercises with a resistance band, weighted jump squats, box jumps, a number of plank variations, and more.

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    But Serena doesn’t just train hard: she also eats well. She recently told Women’s Health that she followed a plant-based diet and tried to use food as fuel. “Eat to live. Don’t live to eat,” she said. “I want to have a healthy lifestyle and you know [I’m eating] a lot of green and lately mostly vegetable, just super healthy stuff. “

    Serena said she doesn’t like to eat first – “When I roll out of bed, I’m just not hungry” – so lunch, which usually contains vegetables and protein, is often her first meal of the day.

    When a tournament comes up, however, she will switch to pasta.

    “I only eat pasta when I’m playing or training. Usually you never see me eating pasta. Because I feel like I’ve had to eat it so often in my career. It’s just like that, I never want to see pasta again, ”she said.

    Shortly before a competition, she sticks to a certain menu. “I usually like to eat a lot of greens before my game and then actually fruit, a little carbohydrates and some kind of protein,” she said.

    But Serena also describes her eating habits as “moody”.

    “I can have a smoothie for six months and then I think I don’t want to see a smoothie for the next six months,” she said. “And then I say, okay, I’m back to the smoothie. My food is very moody. “

    .


    Korin Miller is a freelance writer specializing in general wellbeing, sexual health and relationships, and lifestyle trends, with work on men’s health, women’s health, self, glamor, and more.

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