National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 121 Research Studies DisplayedXu X, Lin H, Wright JD
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, the investigators aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy was associated with increased mortality risk in women with occult uterine cancer.
AHRQ-funded; HS024702.
Citation: Xu X, Lin H, Wright JD .
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
J Clin Oncol 2019 Dec 10;37(35):3412-24. doi: 10.1200/jco.19.00562..
Keywords: Cancer, Mortality, Women, Surgery, Risk, Adverse Events
Tilden EL, Phillippi JC, Ahlberg M
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase.
AHRQ-funded; HS024733.
Citation: Tilden EL, Phillippi JC, Ahlberg M .
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Birth 2019 Dec;46(4):592-601. doi: 10.1111/birt.12428..
Keywords: Labor and Delivery, Pregnancy, Women
Fitzsimmons-Craft EE, Eichen DM, Kass AE
Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset.
This study examined short-term reciprocal longitudinal relations between weight/shape concern and comorbid symptoms and behaviors over the course of 24 months using cross-lagged panel models. Subjects were women 18-25 years old at high risk for onset of an eating disorder (ED), randomized to an online ED preventive intervention or waitlist control. Results supported focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change.
AHRQ-funded; HS00078.
Citation: Fitzsimmons-Craft EE, Eichen DM, Kass AE .
Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset.
Eat Weight Disord 2019 Dec;24(6):1189-98. doi: 10.1007/s40519-017-0469-7..
Keywords: Obesity, Obesity: Weight Management, Women, Risk, Behavioral Health, Young Adults
Neal JL, Carlson NS, Phillippi JC
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
This study compared labor care and birth outcomes between medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). A retrospective cohort study was conducted using Consortium on Safe labor data from low-risk nulliparous women who birthed in interprofessional (7393) or noninterprofessional (6982). Women at interprofessional medical centers were 74% less likely to undergo labor induction and 75% less likely to have oxytocin augmentation. In addition, the cesarean rate was 12% lower.
AHRQ-funded; HS024733.
Citation: Neal JL, Carlson NS, Phillippi JC .
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
Birth 2019 Nov 11;46(3):475-86. doi: 10.1111/birt.12407..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Grant MC, Gibbons MM, Ko CY
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
This paper is an evidence review of enhanced recovery after surgery (ERAS) protocols for gynecologic surgery that will be used as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. This initiative was developed in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The authors conducted a literature review of the various anesthesia components which may influence outcomes and facilitate recovery after gynecological surgery. They included interventions for preoperative, intraoperative, and postoperative phases of care and then summarized the best available evidence for ERAS for gynecological surgery. The best evidence was summarized for recommendations to be used in the initiative.
Citation: Grant MC, Gibbons MM, Ko CY .
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
AHRQ-funded; 233201500020I..
Keywords: Patient Safety, Surgery, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Women
Mills J, Day B
AHRQ Author: Mills J
Interventions to prevent perinatal depression.
This case study relates to interventions to prevent perinatal depression. It includes a case description as well as follow up questions and answers.
AHRQ-authored.
Citation: Mills J, Day B .
Interventions to prevent perinatal depression.
Am Fam Physician 2019 Sep 15;100(6):365-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Pregnancy, Depression, Behavioral Health, Prevention, Women, Case Study
Kissler K, Thumm EB, Smith DC
Perinatal telehealth: meeting patients where they are.
This qualitative study’s objective was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities. The study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. The authors conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. Six themes were identified: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients mentioned that they appreciated the increased ease and reduced cost of accessing visits led to fewer missed appointments.
AHRQ-funded; HS028085.
Citation: Kissler K, Thumm EB, Smith DC .
Perinatal telehealth: meeting patients where they are.
J Midwifery Womens Health 2024 Jan-Feb; 69(1):9-16. doi: 10.1111/jmwh.13560..
Keywords: Telehealth, Maternal Care, Health Information Technology (HIT), Women
Lewkowitz AK, Rosenbloom JI, Keller M
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
This study analyzed whether women experiencing a stillbirth had a higher risk of psychiatric morbidity and/or substance misuse within 1 year of delivery compared to women having a live birth. Higher risk was found for both using data from the Florida State Inpatient and State Emergency Department databases from 2005-2014. Women with an ICD-9 classification of stillbirth at or greater than 23 weeks gestation were included. Emergency department encounters or admissions with a diagnosis code of a psychiatric disorder were used.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Keller M .
Association between stillbirth >/=23 weeks gestation and acute psychiatric illness within 1 year of delivery.
Am J Obstet Gynecol 2019 Nov;221(5):491.e1-91.e22. doi: 10.1016/j.ajog.2019.06.027..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Women, Labor and Delivery
Lewkowitz AK, Rosenbloom JI, Lopez JD
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Researchers conducted this retrospective cohort study to estimate whether stillbirth at 23 weeks of gestation or more is associated with increased risk of severe maternal morbidity compared with live birth, when stratified by maternal comorbidities. Data from HCUP’s Florida State Inpatient Database was used. The researchers found that, although severe maternal morbidity is overall uncommon, delivering a stillborn fetus at 23 weeks of gestation or greater is associated with increased likelihood of severe maternal morbidity, particularly among women with comorbidities. They conclude that health care providers must be vigilant about severe maternal morbidity during stillbirth delivery.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI, Lopez JD .
Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity.
Obstet Gynecol 2019 Nov;134(5):964-73. doi: 10.1097/aog.0000000000003528..
Keywords: Healthcare Cost and Utilization Project (HCUP), Pregnancy, Maternal Care, Women, Adverse Events
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE .
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Li J, Pesko MF, Unruh MA
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
The purpose of this study was to evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity. The investigators concluded that the Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. They suggest that policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
AHRQ-funded; HS024357.
Citation: Li J, Pesko MF, Unruh MA .
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
Matern Child Health J 2019 Nov;23(11):1564-72. doi: 10.1007/s10995-019-02804-6..
Keywords: Medicaid, Primary Care, Maternal Care, Pregnancy, Women, Healthcare Utilization, Racial and Ethnic Minorities, Disparities
Marcum ZA, Vasan S, Tom S
Self-reported barriers to medication use in older women: findings from the Women's Health Initiative.
This study examined barriers to medication use in older women, using self-reported data from the Women’s Health Initiative from 2005-2010. The prevalence of one or more barriers was measured for women taking chronic medication in these 3 target classes: antilipemics, antihypertensives, and oral hypoglycemic. Criteria also included that they took the medication for at least 1 month and then answered questions about barriers at year 4. Among older women, approximately 20% reported at least 1 barrier to medication use, and 7% reporting multiple barriers. Barriers including concerns about adverse effects, not liking to take medications, and medication costs. Women with multiple barriers were more likely to have at least one of these characteristics: a lower age, Black race, Hispanic ethnicity, or have a poorer quality of health overall.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Vasan S, Tom S .
Self-reported barriers to medication use in older women: findings from the Women's Health Initiative.
J Am Pharm Assoc 2019 Nov - Dec;59(6):842-47. doi: 10.1016/j.japh.2019.07.003..
Keywords: Medication, Women, Elderly, Patient Adherence/Compliance
Vanderlaan J, Dunlop A, Rochat R
Methodology for sampling women at high maternal risk in administrative data.
This study compared the net benefits of using the Obstetric Comorbidity Index (OCI) to identify women at high maternal risk compared to conventional risk identification methods. Hospitalization discharge and vital records data for women experience singleton births in George from 2008 to 2012 was used. Results found there was a small but positive net benefit in using the OCI and conventional risk identification methods actually performed worse than using no risk identification methods at all. The researchers suggest that using OCI helps reduce misclassification.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Dunlop A, Rochat R .
Methodology for sampling women at high maternal risk in administrative data.
BMC Pregnancy Childbirth 2019 Oct 21;19(1):364. doi: 10.1186/s12884-019-2500-7..
Keywords: Research Methodologies, Health Services Research (HSR), Pregnancy, Maternal Care, Risk, Women
Lewkowitz AK, Rosenbloom JI , Keller M
Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery.
The purpose of this study was to estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year after delivery hospital discharge. Results showed that although absolute numbers were modest, severe maternal morbidity was associated with increased risk of severe postpartum psychiatric morbidity and substance use disorder. The highest period of risk extended to 4 months after hospital discharge.
AHRQ-funded; HS019455.
Citation: Lewkowitz AK, Rosenbloom JI , Keller M .
Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery.
Obstet Gynecol 2019 Oct;134(4):695-707. doi: 10.1097/aog.0000000000003434..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Hospital Discharge, Risk, Women
O'Leary ST, Narwaney KJ, Wagner NM
Efficacy of a web-based intervention to increase uptake of maternal vaccines: an RCT.
Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. The investigators concluded that Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake.
AHRQ-funded; HS021492.
Citation: O'Leary ST, Narwaney KJ, Wagner NM .
Efficacy of a web-based intervention to increase uptake of maternal vaccines: an RCT.
Am J Prev Med 2019 Oct;57(4):e125-e33. doi: 10.1016/j.amepre.2019.05.018..
Keywords: Vaccination, Pregnancy, Women, Health Information Technology (HIT), Social Media, Influenza
Jefferson UT, Zachary I, Majee W
Employing a user-centered design to engage mothers in the development of a mHealth breastfeeding application.
The Mother's Milk Connection mHealth application was designed to improve breastfeeding duration and access to support. This article describes a user-centered design process to engage mothers in the development of the Mother's Milk Connection application. Stakeholder and user engagement indicated the integration of four distinct features acceptable for use as a comprehensive mHealth intervention to improve access to breastfeeding support. Further, mHealth has the potential to be a useful strategy for providing breastfeeding support, and a clinical trial regarding the efficacy of the Mother's Milk Connection application is needed.
AHRQ-funded; HS022140.
Citation: Jefferson UT, Zachary I, Majee W .
Employing a user-centered design to engage mothers in the development of a mHealth breastfeeding application.
Comput Inform Nurs 2019 Oct;37(10):522-31. doi: 10.1097/cin.0000000000000549..
Keywords: Breast Feeding, Maternal Care, Pregnancy, Women, Health Information Technology (HIT), Patient and Family Engagement, Patient Adherence/Compliance, Health Promotion, Education: Patient and Caregiver, Caregiving
Purnell TS, Luo X, Crews DC
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. The investigators concluded that given their findings that poverty was more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Crews DC .
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Transplantation 2019 Oct;103(10):2183-89. doi: 10.1097/tp.0000000000002654.
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Keywords: Transplantation, Kidney Disease and Health, Patient-Centered Outcomes Research, Disparities, Women, Sex Factors, Low-Income, Outcomes
Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
This study examined data on utilization of in-facility second-trimester abortion services in Mexico. Data from Mexico’s Automated Hospital Discharge System (SAEH) from 2007-2015 was used to identify second-trimester abortions in public hospitals across Mexico’s 32 states. A total 145,956 second-trimester abortion services or 13.4% of total documented hospitalizations for abortion were identified. The rate remained constant for women aged 15-44 years. Women living in poorer socioeconomic conditions or highly marginalized municipalities were most likely to have second-trimester abortions compared to women in higher socioeconomic conditions who were able to utilize services in their first trimester.
AHRQ-funded; HS025155; HS022981.
Citation: Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B .
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
BMJ Sex Reprod Health 2019 Oct;45(4):283-89. doi: 10.1136/bmjsrh-2018-200300..
Keywords: Pregnancy, Women, Healthcare Utilization, Hospitals, Healthcare Delivery
Van Gerwen OT, Muzny CA
Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection.
Trichomonas vaginalis is the most common, curable non-viral sexually transmitted infection (STI) worldwide. Despite this burden of disease, it is not currently a reportable disease in the United States. Recent advances in the epidemiology, diagnosis, and management of T. vaginalis infection are described in this article.
AHRQ-funded; HS013852.
Citation: Van Gerwen OT, Muzny CA .
Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection.
F1000Res 2019 Sep 20;8. doi: 10.12688/f1000research.19972.1..
Keywords: Sexual Health, Women
Carlson NS, Neal JL, Tilden EL
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
The authors analyzed the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. They found that parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and a lower likelihood of labor induction when cared for in centers with midwives. They concluded that their findings support integrated, team-based models of perinatal care to improve maternal outcomes.
AHRQ-funded; HS024733.
Citation: Carlson NS, Neal JL, Tilden EL .
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
Birth 2019 Sep;46(3):487-99. doi: 10.1111/birt.12405..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women, Outcomes
Carter EB, Cahill AG, Olsen MA
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
This study examined whether early initiation and compliance with use of 17-OHPC can reduce the risk of preterm birth (PTB) risk more than later medication initiation. A retrospective cohort study was conducted using MarketScan® data. Rates of PTB were compared for women with medication initiation at 16-21 weeks versus 21-29 weeks. Women with an early 17-OHPC start were less likely to delivery preterm than those with a later start. Less compliant patients also had a higher PTB rate.
AHRQ-funded; HS019455.
Citation: Carter EB, Cahill AG, Olsen MA .
Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?
J Perinatol 2019 Sep;39(9):1182-89. doi: 10.1038/s41372-019-0401-2..
Keywords: Pregnancy, Labor and Delivery, Women, Medication, Patient Adherence/Compliance
Gance-Cleveland B, Leiferman J, Aldrich H
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening. Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement.
AHRQ-funded; HS024738.
Citation: Gance-Cleveland B, Leiferman J, Aldrich H .
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
J Midwifery Womens Health 2019 Sep;64(5):630-40. doi: 10.1111/jmwh.13009..
Keywords: Health Information Technology (HIT), Domestic Violence, Clinical Decision Support (CDS), Shared Decision Making, Pregnancy, Women, Evidence-Based Practice, Screening, Prevention
Burnett-Zeigler I, Satyshur MD, Hong S
Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: a qualitative study.
The authors examined the acceptability and feasibility of a mindfulness-based group intervention for socio-economically disadvantaged women in an urban community health center. Participants reported benefits to the intervention as well as barriers to session attendance. The authors concluded that the mindfulness-based intervention for depression was acceptable, reduced stress, and improved coping and functioning among women in a community health center.
AHRQ-funded; HS023011.
Citation: Burnett-Zeigler I, Satyshur MD, Hong S .
Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: a qualitative study.
Complement Ther Med 2019 Aug;45:19-24. doi: 10.1016/j.ctim.2019.05.012..
Keywords: Community-Based Practice, Depression, Behavioral Health, Racial and Ethnic Minorities, Women
Balk EM, Adam GP, Corsi K
Adverse events associated with nonsurgical treatments for urinary incontinence in women: a systematic review.
Investigators systematically reviewed nonsurgical interventions for urgency, stress, or mixed urinary incontinence (UI) in women, focusing on adverse events (AEs). They found that behavioral therapies and neuromodulation have a low risk of adverse events, while anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. Further, onabotulinum toxin A (BTX) is associated with UTIs and voiding dysfunction, and periurethral bulking agents are associated with erosion and voiding dysfunction. They concluded that these AEs should be considered when selecting appropriate UI treatment options, noting that AE reporting is inconsistent and that AE rates across studies tended to vary widely.
AHRQ-funded; 290201500002.
Citation: Balk EM, Adam GP, Corsi K .
Adverse events associated with nonsurgical treatments for urinary incontinence in women: a systematic review.
J Gen Intern Med 2019 Aug;34(8):1615-25. doi: 10.1007/s11606-019-05028-0.
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Keywords: Adverse Events, Patient Safety, Women, Evidence-Based Practice, Patient-Centered Outcomes Research
Birru Talabi M, Cllowse MEB, Blalock SJ
Contraception use among reproductive-age women with rheumatic diseases.
The purpose of this study was to determine contraception use among a cohort of reproductive-age women with rheumatic diseases. Women who had one of 21 possible rheumatic disease diagnoses, and had at least two outpatient rheumatology visits, were included. Findings revealed low use of prescription contraception, and the authors recommended urgent efforts to improve contraceptive care and access for some women with rheumatic diseases.
AHRQ-funded; HS022989.
Citation: Birru Talabi M, Cllowse MEB, Blalock SJ .
Contraception use among reproductive-age women with rheumatic diseases.
Arthritis Care Res 2019 Aug;71(8):1132-40. doi: 10.1002/acr.23724..
Keywords: Arthritis, Chronic Conditions, Women, Sexual Health