Journal of women's health最新文献

Background: Latinas with mammographic dense breasts are at increased risk of breast cancer. This randomized controlled trial tests the effectiveness of three breast density (BD) educational approaches on adherence to subsequent mammography screening among Latinas receiving care at a Federally Qualified Health Center (FQHC). Measure(s): Adherence was ascertained using electronic health record and survey responses. Kaplan-Meier estimates of the time to subsequent mammogram were used to obtain adherence rates at 1- and 2-years post baseline mammogram. Cox modeling assessed whether adherence differed by patient characteristics or group assignment. Results: This analysis was limited to Latinas enrolled between October 27, 2016, and December 21, 2018 (n = 946; 66.1% <50 years of age, 53.5% with dense breasts). Adherence rates at 1 year was 24.8% increasing to 51.7% by year 2. Latinas randomized to the Promotora + brochure + letter arm (hazard ratio [HR]: 1.09 [95% confidence interval [95% CI] 0.87 to 1.36]) or brochure + letter (HR: 1.03 [95% CI 0.82 to 1.29]) arm were not more likely to be adherent to subsequent mammography compared to the letter only arm (p = 0.76). Adjusting for age and study group, having more prior mammograms, being "extremely likely" to get an annual mammogram, and having more confidence to get an annual mammogram at baseline were significant drivers of subsequent adherence. Conclusion: Informational interventions targeting BD education alone are unlikely to significantly improve adherence to subsequent mammography among Latinas receiving care in FQHCs.

Background: Females are the fastest-growing group in the veteran population, yet there is a paucity in the literature of sex-specific results from studies of chronic disease in veterans that limit our understanding of their health issues. This study provides nationally representative estimates of the physical and mental health of females and males from the Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) veteran population. Methods: Data from the 2018 Comparative Health Assessment Interview Research Study (CHAI), a cross-sectional nationwide survey of the health and well-being of OEF/OIF/OND veterans and a comparison sample of U.S. nonveterans, were analyzed to provide sex-stratified and deployment-stratified lifetime prevalence estimates and adjusted relative odds of physical and mental health conditions in a large population-based study of OEF/OIF/OND veterans. Results: Overall, female veterans were significantly more likely to report cancer, respiratory disease, irritable bowel syndrome/colitis, bladder infections, vision loss, arthritis, back/neck pain, chronic fatigue syndrome, migraine, posttraumatic stress disorder, and depression. Male veterans were significantly more likely to report obesity, diabetes, heart conditions, hypertension, high cholesterol, hearing loss, fractures, spinal cord injury, sleep apnea, and traumatic brain injury. Both males and females who deployed were significantly more likely to report adverse health outcomes than those who did not deploy. Conclusion: This article reports sex-stratified and deployment-stratified lifetime prevalence estimates and adjusted relative odds of physical and mental health conditions in a large population-based study of OEF/OIF/OND veterans. This study demonstrates the value of epidemiological research on female veterans and its importance in understanding the burden of disease in the female veteran population.

Background: To advance existing knowledge, this study examined mechanisms that may link retrospectively reported adverse childhood family environment (ACFE) to lower urinary tract symptoms and their impact (LUTS/impact), a composite variable with four levels (bladder health and mild, moderate, or severe LUTS/impact), among women (n = 1,026) in the Coronary Artery Risk Development in Young Adults cohort study. A prior study demonstrated that ACFE was associated with greater LUTS/impact. Materials and Methods: In 2000-01, the frequency of ACFE events was retrospectively assessed. In 2012-13, data on LUTS/impact were collected. Between 1985-86 and 2010-11, data on proposed mediators were collected at varying time points and averaged to form composite variables. A series of proportional odds ordinal logistic regression analyses were conducted. LUTS/impact was regressed on ACFE, adjusting for age, race, education, and parity. A single proposed mediator was added to the model at one time to determine whether the strength of the association between ACFE and LUTS/impact was attenuated. Results: When entered into regression models individually, life stressors, low levels of emotional support, and depressive symptoms each significantly attenuated the association between ACFE and LUTS/impact, with the association becoming nonsignificant when depressive symptoms were entered. Remaining proposed mediators (social network extensiveness, health behaviors, physiological health, cognitive function) did not mediate the association. Conclusions: ACFE may place women at risk for repeated or chronic episodes of experiencing life stressors, low support, and depressive symptoms during early and midlife adulthood, which in turn may place women at risk for more LUTS and impact during midlife adulthood.

Rationale: Obstructive sleep apnea (OSA) during pregnancy is linked to negative maternal and neonatal outcomes. Diagnosing OSA in this population is particularly challenging. Portable monitoring devices (PMD) present a potential alternative to polysomnography (PSG), but their effectiveness in pregnant women is uncertain. Objective: To evaluate diagnostic accuracy of a PMD to detect OSA in pregnant women. Methods: A prospective study of 136 middle-aged pregnant women (34 ± 4 years) in their third trimester of pregnancy (34 ± 3 weeks) who underwent laboratory type III PMD and PSG simultaneously. Results: Using an apnea-hypopnea index (AHI) ≥5 event/h by PSG, OSA was diagnosed in 10.3% of women (mild OSA: 86%; moderate OSA: 14%). An acceptable positive correlation was found between both tests in the AHI (r = 0.787; p < 0.001) and oxygen desaturation index (ODI) (r = 0.806; p < 0.001). The agreement limits between PSG and type III PMD were -4.1 to 5.4 for AHI and -6.0 to 4.5 for ODI. The sensitivity and specificity of type III PMD for an AHI ≥5 events/h were 57.1% and 99.2%, respectively, with a positive predictive value (PPV) of 88.9% and a negative predictive value (NPV) of 95.3%. On a receiver operating characteristic curve, the best cutoff point of AHI by type III PMD to identify OSA according to PSG criteria was 2.25 events/h. The sensibility and specificity for this point were 85.7% and 88.5%, respectively, with a PPV of 46.2% and NPV of 98.2%. Conclusions: A type III PMD with an AHI cutoff of 5 events/h could be a good alternative for OSA diagnosis in pregnant women. Additionally, an AHI ≥2.25 event/h demonstrates good diagnostic performance, but its low positive predictive value suggests that it is more appropriate as a screening tool. Further studies are needed to validate this sleep study tool in pregnant women, particularly in home settings.

Objective: Vulvodynia is a condition characterized by chronic pain and discomfort in the vulvar region often accompanied with physical and psychological comorbidities. Interstitial cystitis (IC)/bladder pain syndrome (BPS), a chronic condition characterized by bladder pain and urinary urgency, has repeatedly been shown to comorbidly be present in a large proportion of women with vulvodynia. However, recent studies have shown that women with vulvodynia experienced additional bladder-related symptoms beyond that of just IC/BPS. Materials and Methods: Using Swedish National Registry data, we assessed the association between urological symptoms in the presence and absence of IC/BPS in women with vulvodynia/vaginismus relative to women with no vulvar pain history. Results: After adjustment for birth year, parity, education, and residential location, women with vulvar pain had a 2.2-fold greater risk of cystitis or urethritis as expected (95% confidence interval [CI] 1.9-2.6). However, when women with cystitis codes were excluded, those with urethra disorders or other urinary symptoms codes were 1.9 times more likely to be vulvar pain cases (95% CI 1.7-2.1). Conclusions: These findings support the belief that vulvodynia is not limited to being comorbid with IC/BPS but may also likely be associated with a wide range of urological disorders.

Background: Data regarding pregnancy and perinatal outcomes of oocyte donation (OD) recipients older than age 45 are limited. Materials and Methods: A total of 459,528 singleton pregnancies with 946 OD pregnancies and 458,582 spontaneous pregnancies were grouped according to maternal age ≥45 years and <45 years. Results: The mean maternal age of the OD recipients was 47.6 for patients >45 and 40.7 for patients ≤45 (p < 0.001). Among the spontaneous conceptions, the mean maternal age was 47.8 years for patients >45 and 31.1 for patients ≤45 (p < 0.001). Multivariable logistic regression for preterm birth (PTB) <37 weeks and for small gestational age (SGA) among the OD recipients demonstrated that age >45 is a protective factor for PTB <37 weeks (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.4-0.9, p = 0.03) and for SGA (OR: 0.3, 95% CI: 0.1-0.7, p = 0.006, respectively). Among the spontaneous group, age >45 is a risk factor for PTB <37 weeks (OR: 3.2, 95% CI: 2.7-3.9, p < 0.001), PTB <34 weeks (OR: 4.7, 95% CI: 3.4-6.4, p < 0.001), SGA (OR: 1.6, 95% CI: 1.2-2.1, p < 0.001), and pregnancy-induced hypertension (OR: 3.1, 95% CI: 2.1-4.7, p < 0.001). Other obstetric complications were comparable between the age-groups of the oocyte recipients but were higher among patients >45 years who conceived spontaneously. Conclusions: As opposed to spontaneous pregnancies, OD pregnancies of recipients >45 are not associated with higher rates of obstetric or perinatal morbidity compared with younger recipients.

Background: There is growing awareness that the experiences of neurodivergent people during menopause are not well understood. Menopause may be particularly challenging for autistic people due to common co-occurring conditions such as depression and differences in sensory processing. The few (mostly qualitative) studies to explore autism and menopause suggest that autistic traits may be exacerbated. Methods: In an online cross-sectional survey, we examined self-reported menopause symptoms of 342 people (autistic, n = 242 and non-autistic, n = 100) at different stages of their reproductive life (premenopausal [∼20% of sample], menopausal [∼30%], postmenopausal [∼50%]). Results: Autistic people reported significantly higher rates of bothersome psychological and somatic menopause symptoms than non-autistic people, but no differences were observed for vasomotor symptoms. Results indicated different patterns of psychological, somatic, and vasomotor symptoms between the autistic and non-autistic groups. People in the menopause and postmenopause groups reported negative changes in symptoms, but non-autistic women reported these as more negative than autistic women. Whether this finding is related to the observation that autistic people report more bothersome psychological and somatic symptoms before the menopause requires further investigation. Conclusion: This cross-sectional analysis suggests that autistic people may experience more bothersome symptoms during menopause compared with non-autistic people. Longitudinal studies examining change are required to fully understand the variables that impact individual experiences for autistic people.

Objectives: Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. Materials and Methods: We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (n = 54) or nonabortion gynecological care (n = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics. Results: This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is "morally acceptable and should be legal." Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (p < 0.001), with no differences by appointment type. Educational attainment (p = 0.03) and Democratic party affiliation (p = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, p = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, p < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care. Conclusions: Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.