PDF(Pubmed)
Abstract：
UNASSIGNED: Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C specialist care.
UNASSIGNED: The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of \"specialist\" (as opposed to \"generalist\") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary.
UNASSIGNED: Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided.
UNASSIGNED: Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.
UNASSIGNED: The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of \"specialist\" (as opposed to \"generalist\") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary.
UNASSIGNED: Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided.
UNASSIGNED: Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.
摘要：
■全球北部女性生殖器切割/切割（FGM/C）妇女的医疗保健通常被描述为次优，重点是产妇保健。FGM/C专家服务已经出现，几乎没有经验证据表明提供服务。这项范围审查的目的是确定FGM/C专家护理的关键特征。
■审查是根据JBI方法进行的。参与者：提供专业FGM/C护理的组织。概念：专业服务的组成部分。背景：高收入经合组织国家。资格标准包括2012年至2022年任何设计的主要研究研究，提供专业服务的全面描述。检索了七个书目数据库(MEDLINE，EMBASE,CINAHL,WebofScience,Scopus,Cochrane图书馆和MIC）。定义了“专家”（而不是“通才”）服务的组成部分，然后将其应用于FGM/C专家护理的分析。FGM/C专业规定分为主要（基本）和次要特征。通过图表和叙述性总结，对数据进行描述性提取和分析。
25篇论文描述了11个高收入国家的20种独特的专业服务。用于识别FGM/C专家护理的主要特征是：-（i）指定为专家服务/诊所：11/20（55％）；（ii）确定的专家领导：13/20，（65％），要么是助产士,妇科医生,泌尿科医生,或整形外科医生；(iii)提供专科干预：外科(即，重建和/或去阴锁)和/或心理(即，创伤和/或性咨询）；（iv）提供多学科护理：14/20（70％）。11项服务（在西班牙，瑞典,瑞士,德国,意大利,荷兰,法国,比利时,和美国）提供了重建手术，通常与性心理支持相结合。在英国没有服务，挪威,澳大利亚提供了这个。六项服务（30％）仅提供创伤治疗；25％的性和创伤治疗；仅性治疗15％；30％没有提供咨询。专科护理的次要特征细分为（a）护理背景和（b）护理内容。与提供口译员等概念相关的背景，护理费用，社区参与以及是否描述了理论基础。内容指的是护理模式，是否进行了保护评估，并提供健康教育/信息。
■总的来说，FGM/C专家服务的功能和组成在两者之间差异很大，有时在内部，国家。全球指南主张，专科护理应包括获得脱音，心理健康支持,性咨询,教育和信息。审查发现，这些很少都可用。在一些高收入国家，妇女无法接受重建手术，尤其是，很少有针对非孕妇的服务提到保障措施。此外，为孕妇提供的综合创伤治疗或心理支持服务很少。审查强调需要将咨询（创伤和性心理）和文化上适当的敏感保障评估纳入非孕妇和孕妇的护理服务。需要进一步的研究来提取专家服务的特征到一个全面的框架，可以用来检查，比较,并评估FGM/C临床专科护理，以确定哪些临床特征可提供最佳结果。目前地理彩票似乎存在，不仅在英国，但也横跨全球北部。
■审查是根据JBI方法进行的。参与者：提供专业FGM/C护理的组织。概念：专业服务的组成部分。背景：高收入经合组织国家。资格标准包括2012年至2022年任何设计的主要研究研究，提供专业服务的全面描述。检索了七个书目数据库(MEDLINE，EMBASE,CINAHL,WebofScience,Scopus,Cochrane图书馆和MIC）。定义了“专家”（而不是“通才”）服务的组成部分，然后将其应用于FGM/C专家护理的分析。FGM/C专业规定分为主要（基本）和次要特征。通过图表和叙述性总结，对数据进行描述性提取和分析。
25篇论文描述了11个高收入国家的20种独特的专业服务。用于识别FGM/C专家护理的主要特征是：-（i）指定为专家服务/诊所：11/20（55％）；（ii）确定的专家领导：13/20，（65％），要么是助产士,妇科医生,泌尿科医生,或整形外科医生；(iii)提供专科干预：外科(即，重建和/或去阴锁)和/或心理(即，创伤和/或性咨询）；（iv）提供多学科护理：14/20（70％）。11项服务（在西班牙，瑞典,瑞士,德国,意大利,荷兰,法国,比利时,和美国）提供了重建手术，通常与性心理支持相结合。在英国没有服务，挪威,澳大利亚提供了这个。六项服务（30％）仅提供创伤治疗；25％的性和创伤治疗；仅性治疗15％；30％没有提供咨询。专科护理的次要特征细分为（a）护理背景和（b）护理内容。与提供口译员等概念相关的背景，护理费用，社区参与以及是否描述了理论基础。内容指的是护理模式，是否进行了保护评估，并提供健康教育/信息。
■总的来说，FGM/C专家服务的功能和组成在两者之间差异很大，有时在内部，国家。全球指南主张，专科护理应包括获得脱音，心理健康支持,性咨询,教育和信息。审查发现，这些很少都可用。在一些高收入国家，妇女无法接受重建手术，尤其是，很少有针对非孕妇的服务提到保障措施。此外，为孕妇提供的综合创伤治疗或心理支持服务很少。审查强调需要将咨询（创伤和性心理）和文化上适当的敏感保障评估纳入非孕妇和孕妇的护理服务。需要进一步的研究来提取专家服务的特征到一个全面的框架，可以用来检查，比较,并评估FGM/C临床专科护理，以确定哪些临床特征可提供最佳结果。目前地理彩票似乎存在，不仅在英国，但也横跨全球北部。
