Journal of women's health最新文献

Objectives: Distress, including posttraumatic stress disorder (PTSD) and depression, is associated with lower cognitive function and higher use of medications, including sleep aids, opiate pain relievers, and minor tranquilizers. Whether use of these medications is linked to lower cognitive function, and whether such medication use might partially explain the relationship between distress and cognition remains unclear. Using data from 10,653 women in the Nurses' Health Study II, we assessed associations between distress and past-month medication use; medication use and cognitive function; and whether medication use mediates the distress-cognitive function relationship. Methods: Distress was defined using validated measures of PTSD and depression. To consider possible joint effects of experiencing both forms of distress, we derived a continuous, standardized distress score including symptoms of both PTSD and depression, and a six-level categorical variable indicating the presence/absence of trauma, PTSD, and depression. Past-month medication use was self-reported. Cognitive function was measured with the Cogstate Brief Battery, yielding composite score measures of psychomotor speed/attention and learning/working memory. We fit linear regression models for continuous outcomes, logistic regression for dichotomous outcomes, and conducted causal mediation analysis using a counterfactual framework. Results: Higher distress was associated with use of all three medications (e.g., a 1-standard-deviation higher continuous distress score was associated with 1.5 times the adjusted odds of past-month opiate use [95% confidence interval: 1.40, 1.60]). Associations between past-month medication use and cognitive function were mixed. Conclusion: We did not find clear evidence of mediation by medication use, suggesting that distress may influence cognitive function via other pathways.

Purpose: Post-stroke health care is crucial for recovery and preventing complications. This study explored the association between perceived racism and health care utilization among post-stroke women, highlighting the disparate utilization patterns of marginalized racial/ethnic women. Methods: The 2022 Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Survey was used to characterize health care utilization among women with stroke diagnoses across different racial groups: White, Black, Hispanic, and Asian/Asian, Islander, Alaska Native/Other/Multiracial. Logistic regression analysis characterized the association between three types of health care utilizations-having a health insurance plan, a health care provider, and receiving a routine checkup-and perceived race-based treatment in the medical sector. Results: The sample included 10,184 post-stroke women: 75.01% White, 12.42% Black, 6.77% Hispanic, and 5.80% Asian/AIAN/Other/multiracial. Only 2.95% of White women reported worse treatment, compared with 10.74% of Black, 13.19% of Asian/AIAN/Other/multiracial, and 8.85% of Hispanic women. Regression analysis revealed that Hispanic women (odds ratio [OR] = 0.61, confidence interval [CI] = 0.17, 0.84) were less likely to have a health plan, though those receiving similar or better treatment had higher odds (OR = 1.55, CI = 1.62, 3.90). Black women were less likely to have a routine checkup (OR = 0.51, CI = 0.14, 0.77), but those receiving similar or better treatment had higher odds (OR = 2.72, CI = 1.64, 11.63). Women from other racial/ethnic groups, Black, and Hispanic women had lower odds of having a personal provider (ORs ranging from 0.17 to 0.69), though those receiving similar or better treatment had higher odds (ORs ranging from 1.79 to 3.39). Conclusions: Perceived differences in treatment in the medical sector among marginalized post-stroke women were significantly associated with lower health care utilization.

Background: Contemporary risk calculators underestimate coronary artery disease (CAD) risk in women. Breast arterial calcification (BAC) associates with CAD. Low breast density (BD) (greater breast adipose tissue) associates with cardiometabolic disease. Both are readily identifiable on screening mammography. We sought to evaluate the association between the combined features of BD, BAC, and CAD. Methods: We retrospectively studied women with clinically indicated mammography and contemporaneous coronary computed tomography angiography. CAD risk was estimated by CAD Consortium Scoring (CCS;>15% high risk). BD was visually assessed by four-level Breast Imaging-Reporting and Data System (BI-RADS) (low:BI-RADS A-B, high:BI-RADS C-D). BAC was visually assessed as present/absent. CAD was categorized as presence/absence of coronary artery plaque. Results are presented with odds ratio (OR) and [95% confidence intervals], and area under the curve (AUC). Results: In 153 patients (age 62 ± 10), low BD (67%) and BAC presence (24%) were both associated with CAD, respectively: OR: 3.21 [1.58-6.60], p = 0.001, and OR: 4.36 [1.58-12.00], p = 0.004. CAD proportion in low BD (68.9%) and BAC (42.9%) was lower than with combined low BD+BAC positive (89.7%). Compared with (high BD+BAC negative), the presence of (low BD+BAC positive) associated with CAD independent of modifiable (OR: 9.12 [2.44-45.83], p = 0.002) and nonmodifiable (OR: 4.87 [1.22-25.02], p = 0.035) risk factors. CCS >15% was seen in 33%. Significant incremental value was seen with the addition of BD/BAC status to CCS (AUC 0.64 versus 0.73, p = 0.004). Conclusions: Mammographic BAC and low BD, both alone and combined, associate with CAD, and improve risk prediction beyond standard coronary risk estimation. Standardized reporting of these features may provide benefit and should be tested in prospective screening studies.

Changes in the U.S. laws, particularly the Dobbs decision in 2022, altered access to abortions. Fetal potassium chloride (KCl) injections can be used for second- and third-trimester abortions. This descriptive study aims to present the characteristics of patients who received KCl injections in a state with protective laws (Colorado), including pre- and post-Dobbs. Patients undergoing KCl injection at our institution between January 2014 and December 2023 were included. Records were reviewed for demographic data, parity, and procedure details. Distance traveled and area deprivation index (ADI) were determined based on residence data. Group differences pre- and post-Dobbs were analyzed using Chi-squared and Mann-Whitney U tests. Subanalyses were performed to compare in-state and out-of-state (OOS) patients. One hundred and nineteen patients were included: 56 pre-Dobbs and 63 post-Dobbs, representing a 6.4-fold increase in volume post-Dobbs. Patients were from 10 states of residence pre-Dobbs and 17 post-Dobbs. Median distance traveled significantly increased post-Dobbs, 29.8 versus 383.9 miles (p = 0.004). The maximum distance traveled was 855 miles pre-Dobbs and 1,201 miles post-Dobbs. ADI did not vary pre- or post-Dobbs. Singleton procedures increased post-Dobbs for all patients. There was no change in gestational duration at the time of procedure across any comparison. Procedure volume and distance traveled increased for both in-state and OOS patients with minimal change in patient characteristics pre- and post-Dobbs. Our data indicate an increased need for these procedures, even in a state with protective laws.

Importance: Despite increased initiatives and funding to improve access to evidence-based treatments for opioid use disorder (OUD), including medications for OUD (mOUD), pregnant/postpartum individuals have significant obstacles to accessing these life-saving medications. Observations: Current legislation, specifically the Comprehensive Addiction and Recovery Act (CARA), mandates that the Governor of each state has systems in place to identify and address the needs of substance-exposed infants. However, this legislation removed the word "illegal" when defining substance use and left other important words in the law up to each individual state to define. These changes resulted in pregnant/postpartum individuals with OUD who were receiving legally prescribed mOUD, being subject to legal actions. In many states, such notifications result in investigation and punitive actions, which may include the removal of children from the care of postpartum individuals. These state policies have created additional barriers to accessing mOUD for pregnant and/or postpartum individuals. Research has demonstrated that pregnant individuals delay and/or avoid recommended prenatal care or decide to stop taking mOUD altogether, to prevent potential legal and child welfare-related consequences. This situation is problematic as it places individuals at risk of overdose and death and infants at risk of health complications. Importantly, such policies are subject to bias and disproportionately impact individuals of color and those from lower socioeconomic backgrounds. Conclusions and Relevance: The need to address and change the criminalization of pregnant/postpartum substance use laws to not penalize individuals adhering to the recommended standard of evidence-based care is urgent. Specific recommendations include: not relying on toxicology testing, reinstating "illegal/non-prescribed" language in legislation, implementing Plans of Safe Care, use of a two "track" reporting system, and federal support for states complying with Child Abuse Prevention and Treatment Act Reauthorization of 2010 (CAPTA) laws, increasing resources to improve outcomes for infants/postpartum individuals with OUD, and additional mandated training to educate key individuals, such as hospital/outpatient clinic providers and child-welfare workers.

Background: People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. Methods: We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. Results: Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. Conclusions: Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.

Background: Postpartum care, including contraception, benefits maternal health and decreases mortality, which increased in the United States with COVID-19. Pandemic disruptions to postpartum health care access in vulnerable populations are not well understood. We utilize electronic health record (EHR) data for prenatal patients (n = 2,265) at six urban Federally Qualified Health Centers (FQHCs) from one year prepandemic (January 1, 2019) through one year after the first stay-at-home orders ("lockdown") (March 31, 2021). Objective: We investigated (1) changes in rates of postpartum visit (PPV) and postpartum contraception receipt in the post-lockdown versus prepandemic periods and (2) characteristics predictive of differential changes in PPV and contraception rates. Materials and Methods: Visit and prescription records from EHR were used to classify if patients received PPV and most/moderately effective contraception within 60 days postpartum, analyzed separately and as a composite variable: PPV and contraception, PPV only, or no PPV. Risk differences comparing post-lockdown with pre-COVID-19 pandemic were estimated using binomial regression and generalized logistic regression models adjusted for age, race/ethnicity, language, and clinical site. Effect modification by sociodemographic and clinical covariates was examined. Results: Total patient volume fell 21% in the post-lockdown versus pre-COVID-19 period. Rates of PPV decreased in absolute terms by 9.6 (95% confidence interval: -13.6, -5.6) and contraception by 8.1 (-13.3, -2.8) percentage points. After adjustment, PPV and contraception decreased by 9.3 percentage points (-13.1, -5.4), while PPV only was stable (-0.4 [-4.3, 3.6]). Conclusions: These findings suggest a substantial impact of the COVID-19 pandemic on postpartum care in FQHCs and community health centers. Supply and demand drivers require further examination to inform strategies to improve postpartum care access and subsequent maternal health outcomes.

Objective: To examine and compare the knowledge related to the female athlete triad and the signs and symptoms of low energy availability (LEA) and disordered eating (DE) in competitive (CO) and recreationally active (RA) females. Methods: Premenopausal females (n = 631, age 25 ± 7 years) completed an electronic survey that assessed female athlete triad knowledge and risk for LEA and DE. Participants self-selected as CO (n = 123) or RA (n = 508). Logistic regression examined the associations between membership in RA versus CO (reference group) and knowledge related to the female athlete triad. Linear regression assessed the association of group membership as predictor variables with LEA and DE risk scores. Results: Only 22% of participants were familiar with the female athlete triad term and almost half the total participants were at risk for LEA (45%) and/or DE (45%). The RA group was less likely to be familiar with the female athlete triad than CO (odds ratio = 0.34, confidence interval [CI]: 0.22, 0.53, p < 0.001), yet group membership did not predict risk for LEA (β = -0.57, CI: -1.42, 0.28, p = 0.19) or DE (β = 1.34, CI: -1.72, 4.39, p = 0.39). Conclusion: There is a lack of knowledge related to the female athlete triad, coupled with a relatively high prevalence of LEA and DE risk among physically active females, regardless of athletic status (CO vs. RA). Given the high prevalence of LEA and DE risk found in our study, expanding nutrition education and awareness of the health consequences of the female athlete triad to all physically active females is warranted.

Background: Bacterial vaginosis (BV), a common gynecological infection characterized by reduced lactic acid-producing bacteria and increased anerobic bacteria in the vaginal microbiome, is associated with adverse health outcomes. Methods: A PubMed search for English-language articles about BV in the USA and factors contributing to disparities in BV risk, with an emphasis on the role of the vaginal microbiome, published from August 2012 to August 2022, identified 760 articles. Results: Among the 52 articles meeting the prespecified criteria, BV prevalence varied among different populations and disproportionately impacted Black women (49-51%), Hispanic ethnicity (32-43%), and women of reproductive age (30%). Differences in microbial ecology and host genetics were important factors underlying these disparities. Colonization of BV-associated bacteria was more common in women of color than in non-Hispanic White women. Other factors linked with disproportionate burden included multiple/same-sex partners, obesity, immunosuppression, and C-section birth. Conclusions: BV prevalence was multifactorial, with some populations having higher prevalence rates and distinctive microbiome profiles that may predispose them to the condition. BV treatment and recurrence prevention were challenging due to the complex interplay of biological, clinical, and sociobehavioral factors. Understanding these disparate risk factors is critical to reducing BV burden.

Introduction: Toileting behaviors are recognized as potential contributors to lower urinary tract symptoms (LUTS) in women. This study examines the association between toileting behaviors and LUTS among community-dwelling women and whether age modifies these associations. Methods: Cross-sectional analyses were conducted using baseline data from a population-based cohort study, RISE FOR HEALTH (RISE). Women completed validated questionnaires assessing toileting behaviors (Toileting Behaviors-Women's Elimination Behaviors scale) and LUTS (10-item Lower Urinary Tract Dysfunction Research Network-Symptom Index [LURN SI-10]). Toileting behaviors included place preference for voiding, premature voiding, delayed voiding, straining to void, and toileting position. LUTS items included urine storage, emptying, and postmicturition symptoms. Associations were analyzed by proportional odds logistic regression. Analyses were stratified by seven age groupings. Results: Data from 2,327 women (mean age 51.1 years, standard deviation = 18.2) were analyzed. Delayed voiding was most strongly associated with the LURN SI-10 composite score (odds ratio [OR] 1.89; 95% confidence interval [CI]: 1.72, 2.09) and urgency incontinence (OR 1.87; 95% CI: 1.66, 2.10). Premature voiding showed the strongest association with urgency (OR 1.82; 95% CI: 1.68, 2.04). Straining was strongly associated with emptying symptoms, including delay before urine starts (OR 2.28; 95% CI: 2.05, 2.54) and slow stream (OR 2.28; 95% CI: 2.05, 2.53). Age modified associations between delayed voiding and LUTS, with strongest associations among 18- to 25 year-old women. Conclusions: Premature voiding, delayed voiding, and straining showed the strongest associations with LUTS in this cross-sectional analysis. Longitudinal studies are needed to clarify the directionality of these associations. Educating young women on healthy toileting habits may mitigate potential effects of unhealthy toileting behaviors on bladder health.