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Tanaka Y, Murashima A, Atsumi T, Dobashi H, Murakawa Y, Momohara S, Kawaguchi H, Tanigaki S, Makino S, Saito S. The management of women of child-bearing age with rheumatoid arthritis: an expert report. Expert Rev Clin Immunol 2023; 19:655-669. [PMID: 37022668 DOI: 10.1080/1744666x.2023.2197212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
INTRODUCTION The introduction of biologic therapies and a treat-to-target approach has transformed the management of rheumatoid arthritis (RA), which has led to improved outcomes for women with RA who wish to become pregnant. However, guidelines for the management of reproductive health in female patients with RA are still lacking. AREAS COVERED A task force (Women of Childbearing Age [WoCBA]-Rheumatoid Arthritis in Japan) comprising 10 experts in the fields of rheumatology, obstetrics and orthopedic surgery developed 10 clinical questions (CQ) related to the management of WoCBA with RA. For each CQ, a systematic literature review was conducted to identify relevant evidence. Based on this evidence, a set of recommendations for each CQ were drafted and evaluated using the modified Delphi method. This article describes the agreed recommendations along with the supporting evidence. EXPERT OPINION There are many ongoing challenges associated with the provision of reproductive healthcare in WoCBA with RA. It is hoped that the consensus-based recommendations provided here can be implemented in clinical practice in order to increase collaboration between rheumatologists and obstetricians/gynecologists and to improve reproductive health outcomes for WoCBA with RA.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Kitakyushu 807-8555, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yohko Murakawa
- Department of Medical Education and Research, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Shigeki Momohara
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Haruna Kawaguchi
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, 840, Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Shinji Tanigaki
- Department of Obstetrics and Gynecology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Urayasu Hospital, 2-1-1, Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Sugitani 2630, Toyama 930-0194, Japan
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Smith PB. Social determinants of health and their relationships to reproductive outcomes. Bull Menninger Clin 2023; 87:189-208. [PMID: 37260327 DOI: 10.1521/bumc.2023.87.2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The medical community has begun to focus on factors that impact not only health but also wellness for both mainstream and disadvantaged communities. Public health initiatives have evaluated nonmedical factors to determine whether they have a broader influence on physical health than traditional medicine, especially in reproductive care. These factors, referred to as social determinants of health (SDOH), affect a variety of medical conditions, have an impact on medical strategies, and suggest that traditional medicine may be more limited than commonly thought. The purpose of this article, therefore, is threefold: First, it will offer a general review of selected components of current SDOH that act as nonmedical factors in health and behavioral wellness. Second, it will present specific SODH and their impact on contraceptive and prenatal care. Finally, it will highlight SODH policies that either enhance or impede the ability of health systems to deliver innovative reproductive services to underserved populations.
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Affiliation(s)
- Peggy B Smith
- Professor and CEO, Population Program, Baylor College of Medicine, Houston, Texas
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Eysenbach G, Leung T, Callegari LS, Kazmerski TM, Borrero S. A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States. J Med Internet Res 2022; 24:e36338. [PMID: 35482371 PMCID: PMC9100540 DOI: 10.2196/36338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 01/21/2023] Open
Abstract
The United States has abysmal reproductive health indices that, in part, reflect stark inequities experienced by people of color and those with preexisting medical conditions. The growth of "femtech," or technology-based solutions to women's health issues, in the public and private sectors is promising, yet these solutions are often geared toward health-literate, socioeconomically privileged, and/or relatively healthy white cis-women. In this viewpoint, we propose a set of guiding principles for building technologies that proactively identify and address these critical gaps in health care for people from socially and economically marginalized populations that are capable of pregnancy, as well as people with serious chronic medical conditions. These guiding principles require that such technologies: (1) include community stakeholders in the design, development, and deployment of the technology; (2) are grounded in person-centered frameworks; and (3) address health disparities as a strategy to advance health equity and improve health outcomes.
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Affiliation(s)
| | | | - Lisa S Callegari
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States.,Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Traci M Kazmerski
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Health Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Abstract
Medical tourism is an emerging industry that facilitates travel to another country for people who seek medical, surgical, or dental care that is unavailable or more affordable than in their home countries. Rapid advances in electronic communication and the ease of international travel have fueled the growth of this industry. More than half of medical travelers are women, especially for services related to cosmetic or reproductive conditions. Medical tourism creates both opportunities and challenges for nurses and other health care providers. Consumers' increased access to the global health care market necessitates the development of a structure that shapes the medical tourism industry and addresses evolving ethical, political, and human rights concerns related to this industry.
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Stankovic B. Situated technology in reproductive health care: Do we need a new theory of the subject to promote person-centred care? Nurs Philos 2016; 18. [PMID: 27882655 DOI: 10.1111/nup.12159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/30/2016] [Indexed: 11/29/2022]
Abstract
Going through reproductive experiences (especially pregnancy and childbirth) in contemporary Western societies almost inevitably involves interaction with medical practitioners and various medical technologies in institutional context. This has important consequences for women as embodied subjects. A critical appraisal of these consequences-coming dominantly from feminist scholarship-relied on a problematic theory of both technology and the subject, which are in contemporary approaches no longer considered as given, coherent and well individualized wholes, but as complex constellations that are locally situated and that can only be described empirically. In this study, we will be relying on the developments in phenomenological theory to reconceptualize women as technologically mediated embodied subjects and on the new paradigms in philosophy of technology and STS to reconstruct medical technology as situated-with the aim of reconceptualizing their relationship and exploring different possibilities for the mediating role of medical technology. It will be argued that technologization of female reproductive processes and alienating consequences for women are not necessary or directly interrelated. The role of technology varies from case to case and depends mainly on the nontechnological and relational aspects of institutional context, in which medical practitioners play a decisive role.
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Affiliation(s)
- Biljana Stankovic
- Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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Rimawi BH, Smith SL, Badell ML, Zahedi-Spung LD, Sheth AN, Haddad L, Chakraborty R. HIV and reproductive healthcare in pregnant and postpartum HIV-infected women: adapting successful strategies. Future Virol 2016; 11:577-581. [PMID: 28348636 PMCID: PMC5365084 DOI: 10.2217/fvl-2016-0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Linkage and retention in care for many HIV-infected women in the postpartum period is suboptimal, which compromises long-term virologic suppression and the HIV Care Continuum. Efforts are needed to improve individual outcomes by addressing transitions in care. We summarize some successful strategies to engage and retain HIV-infected women in care during the postpartum period.
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Affiliation(s)
- Bassam H Rimawi
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Emory University School of Medicine, 550 Peachtree Street, 8th Floor, Atlanta, GA 30303, USA
| | - Somer L Smith
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, 5th Floor, Atlanta, GA 30322, USA
| | - Martina L Badell
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Emory University School of Medicine, 550 Peachtree Street, 8th Floor, Atlanta, GA 30303, USA
| | - Leilah D Zahedi-Spung
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Emory University School of Medicine, 550 Peachtree Street, 8th Floor, Atlanta, GA 30303, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, USA
| | - Lisa Haddad
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Emory University School of Medicine, 550 Peachtree Street, 8th Floor, Atlanta, GA 30303, USA
| | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, 5th Floor, Atlanta, GA 30322, USA
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