Journal of women's health最新文献

Objective: To determine subclinical cardiovascular disease (sCVD) in middle-aged women with clinically manifested hand osteoarthritis (HOA) and to improve the characterization of cardiovascular risk in this population. Design: We cross-sectionally evaluated the relationship between HOA and sCVD in 1,803 volunteers from the Mexican Teachers' Cohort. From 2012 to 2016, a subsample from Mexico City, the Northern state Nuevo León, and the Southern states Chiapas and Yucatán was invited for clinical evaluations, during which neurologists examined carotid arteries using ultrasound, and a standardized HOA questionnaire was also administered. HOA was defined as age ≥45 years, hand joint pain, and morning stiffness that lasted no longer than 30 minutes. sCVD was assessed using the intima-media thickness (IMT) and atherosclerotic plaques. Results: Among participants with a mean age of 51 years (±4), 18.4% met the criteria for HOA, and the prevalence of carotid atherosclerosis was 23.1%. After multivariable adjustment, women diagnosed with HOA had a 1.8% (95% confidence interval [CI] 0.3, 3.3) greater mean IMT than those without this joint disease. Similarly, women with HOA had 36% (95% CI 1.01, 1.84) higher odds of carotid atherosclerosis. Conclusions: HOA is associated with sCVD in middle-aged women. This relationship might be due to low-grade chronic inflammation; however, further research is required to clarify the underlying mechanisms.

Background: Physician burnout disproportionately affects women and contributes to attrition from the workforce, a costly problem that likely begins in training. Female physicians leave the workforce significantly earlier than male counterparts. The association between burnout and attrition intent in women physician trainees is unknown. Methods: This is a cross-sectional analysis of baseline data from a national sample of female physician trainees in a randomized controlled trial testing a well-being program in 2022. Participants completed surveys on burnout and intent to leave. Associations were analyzed using chi-square testing and univariable linear regression. Results: A total of 1,017 trainees responded. The average standard deviation (SD) age was 30.8 (4.0) years, 959 (94.3%) self-identified as a woman, and 540 (53.1%) as White. One-fifth (207, 20.7%) were in postgraduate year (PGY)-1, 198 (19.8%) PGY-2, and 595 (59.5%) ≥ PGY-3. Most scored positively for burnout; 77.5% experienced high emotional exhaustion (EE). One-fifth (20.6%) reported some intent to leave their program before graduation, and 32.7% reported intent to leave their specialty within 2 years. There was a strong association between EE scores and intent to leave: trainees reporting a high likelihood to leave before graduation had a 22.27 higher EE point average than those reporting no likelihood (95% confidence interval [CI]: 7.80, 36.74, p = 0.003). Conclusions: Attrition intent was associated with burnout. Addressing burnout during training will not only benefit trainees but could impact the retention of women physicians.

Urinary tract infection (UTI) is a pervasive, costly, and dangerous cause of morbidity and mortality worldwide, which can lead to further complications if they become recurrent or progress to urosepsis. Recurrent UTI is a particular concern among postmenopausal females because of increased risk factors and decreased estrogen levels, leading to changes in the urogenital epithelium and subsequently causing alterations in the urogenital microbiome. Prevention strategies for recurrent UTIs are often incorporated into patient-centered care plans, but finding the right management can be difficult for older women since many of the common treatment options have contraindications and adverse side effects. This review aims to describe the diagnosis, treatment, and special considerations for the treatment and prevention of recurrent UTIs in women over 65. Current prevention strategies include both antibiotic and nonantibiotic options. The antibiotic choice for older women presents a few unique challenges, including frequent allergy or intolerance of side effects, renal or liver dysfunction, and polypharmacy or drug interactions. Nonantibiotic options range from readily accessible drugstore remedies to experimental vaccines, which all are accompanied by certain advantages and disadvantages. Appropriate management plans can help to reduce symptoms and poor outcomes among older females. In addition, we hope future studies continue to investigate the proper dosing and routes for optimal management in this aging female population.

Objective: Attrition of women health care professionals is high, threatening patient care and advances in health care sciences. Women health care professionals have often reported experiencing challenges in the workplace that lower their sense of belonging and may precipitate their attrition. The current study sought to identify dimensions of workplace belonging in women health care professionals and to determine the relative strength of association of these belonging dimensions with intent to leave (ITL) their institution. Methods: Attendees of a continuing education course on women's leadership skills in health care were surveyed about their ITL and workplace belonging experiences. Dimensions of workplace belonging were identified by factor analysis. The strength of association between ITL and each workplace belonging dimension, as well as their relative strengths of association, were assessed in ordinal regression analyses. Results: Women comprised 99% of survey participants. Three dimensions of workplace belonging were identified: "institutional culture," "interactions with supervisor," and "interpersonal relationships." More frequent experiences of support in any of the three belonging dimensions associated strongly with lower ITL. When all three belonging dimensions were considered simultaneously, ITL remained strongly related with experiences of a supportive "institutional culture" (odds ratio 0.41, p < 0.0001), while it became much less strongly related with supportive experiences in the other two dimensions. Conclusions: These findings suggest a dominant role of institutional culture in attrition risk in women health care professionals. Interventions that foster an institutional culture of diversity, opportunities for career advancement, and inclusivity might be effective in improving retention of women health care professionals.

Background: Veterans who use VA pregnancy benefits may be at high risk for adverse pregnancy outcomes; however, little is known about rates of adverse pregnancy events or pregnancy-associated death among Veterans. Methods: We conducted a retrospective cohort study using VA national administrative data for Veterans ages 18-45 with at least one pregnancy outcome between October 2009 and September 2016 and a VA primary care visit within one year prior to pregnancy. We identified adverse events during pregnancy and up to 42 days after pregnancy and all-cause mortality within one year of pregnancy and compared prevalence of adverse events by Veteran race/ethnicity using adjusted logistic regression. Results: Pregnancies among Black Veterans had 69% higher odds of any adverse event than those among White Veterans (aOR = 1.69, 95% CI: 1.43, 2.00). All-cause mortality during pregnancy or within one year of pregnancy was recorded for 18 pregnancies, resulting in an estimated overall pregnancy-associated mortality rate of 76 deaths per 100,000 live births. Conclusions: We identified high overall rates of adverse pregnancy events and pregnancy-associated death among Veterans using VA benefits. As in non-VA populations, there were stark racial disparities in adverse pregnancy events among Veterans.