Journal of women's health最新文献

Objectives: Although women have comprised at least 50% of medical school classes for decades, women remain underrepresented in leadership positions. Although the proportion of women division chiefs in the U.S. academic medical centers is small, it is growing. Division chief positions can be a precursor to more senior level leadership positions. Our objective was to explore the lived experience of women division chiefs across specialties. Materials and Methods: We conducted a qualitative study using semi-structured interviews of women division chiefs from medical and surgical subspecialties in 2023 at a major academic medical center in the northeastern United States. We used the grounded theory approach and the constant comparative method until thematic sufficiency was reached. Results: We interviewed 18 of a total of 29 women division chiefs (62%). The following major themes emerged: (1) Most women are externally motivated to seek out the division chief role, (2) formal preparation or leadership development prior to taking on the section chief role is lacking, (3) leaders (both men and women) who sponsor and mentor women facilitate their success, and (4) women leaders face specific challenges including promotion delays and lack of recognition of their authentic leadership styles. We found the following minor themes: (1) Lack of formal onboarding to the division chief role; (b) positive influence of women in senior leadership roles within the institution; and (c) barriers to leadership roles include feeling undervalued in preceding leadership roles, navigating parenthood, and need for broader sponsorship. Conclusion: Opportunities to support the continued growth of women division heads include more deliberate recruitment and succession planning; a structured, formal onboarding process; acceptance of authentic leadership styles; and more practical ways to support parenting.

Introduction: Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. Methods: We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023. We excluded people with a hospital stay >6 days (n = 29). Results: In this cohort of 6,041 birthing people, 11.3% had ≥1 outpatient encounters (range 0-6) and 3.2% had ≥1 hospital readmissions (range 0-4) within 12 weeks of discharge from the birth hospitalization. Median time to first outpatient PACU was 10 days post-discharge and 6 days for first hospital readmission. Among encounters for the top five medical indications, time to first postpartum acute care encounter varied by medical indication (log-rank test of equality over strata Chi-square = 69.93, degrees of freedom = 4, p < 0.0001). Complications specified during the puerperium (n = 234) and hypertension and hypertensive-related conditions complicating the puerperium (n = 87) were the two most frequent indications. Conclusion: These findings can inform efforts to direct health resources to improve postpartum health care and health outcomes.

Background: Women veterans who experience certain conditions during pregnancy, such as gestational hypertension, pre-eclampsia, and gestational diabetes, are at increased risk of developing cardiovascular disease (CVD) later in life. Many women are unaware of this risk. Furthermore, women often face financial, socioeconomic, or physical challenges when trying to make healthy behavior modifications to reduce CVD risk. Objective: To examine Veterans' pregnancy-related cardiovascular (CV) risk conditions, risk identification, and risk communication with primary care providers. Research Design: Telephone/video interviews were conducted with female Veterans who had experienced at least one sex-specific CV risk condition during pregnancy. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived. Results: Twenty-eight women Veterans participated in the study, conducted between October and December 2023. A majority of participants were racial/ethnic minorities, and the average age was 38. Four themes arose: (1) Veterans Affairs (VA) medical records may contain limited information regarding CV risk factors experienced during pregnancy; (2) strong relationships between Veterans and their VA primary care providers can facilitate management of CV risk factors following pregnancy; (3) some Veterans receive vague and/or conflicting recommendations for CV risk reduction following pregnancy; and (4) social determinants of health may play a key role in Veterans' ability to follow recommended CV risk reduction behaviors. Conclusions: Women Veterans with pregnancy-related CV risk conditions may not know that they are at increased risk of developing future CVD conditions, often because VA providers receive limited records from outside providers. Those who are aware often receive conflicting or vague recommendations to address these risk factors. When trying to follow CV health recommendations, many women have difficulty due to lack of finances, childcare, or safe areas. Future interventions should be aimed at improving access to medical records between outside and VA providers, patient education, and access to heart-healthy resources.

Background: People diagnosed with pelvic organ prolapse (POP) face preference-sensitive treatment decisions. We conducted a systematic review, meta-analysis, and narrative synthesis to determine the effect of decision-making interventions for prolapse on patient-reported outcomes. To gain a more complete understanding of all potentially accessed resources, we also conducted an environmental scan to determine the quantity and quality of online interventions for prolapse decision-making. Methods: We searched Ovid MEDLINE, Cochrane Trials, and Scopus from inception to August 2022, trial registries, and reference lists of included articles. For the systematic review, we included studies that compared a decision-making intervention to usual care among patients with prolapse. We calculated mean difference (MD), 95% confidence intervals (CIs), and statistical heterogeneity (I²). For the environmental scan, we also searched Google, app stores, and clinical society websites. We assessed intervention quality using DISCERN, the International Patient Decision Aid Standards checklist, and readability metrics. Results: We identified eight publications in the systematic review, including 512 patients across three countries. The average patient age was 60. In the meta-analysis and narrative synthesis, there were no differences in decisional conflict (MD 0.09, 95% CI: -2.91, 3.09; I² = 0%), decision regret (MD 0.00, 95% CI: -0.22, 0.22; I² = 0%), satisfaction (MD -0.10, 95% CI: -0.23, 0.03; I² = 0%), knowledge, or shared decision-making. Study quality was low to moderate. We included 32 interventions in the environmental scan analysis. Most (22/32) were not interactive. Overall quality was low with a mean DISCERN of 48.2/80, and the mean reading grade level was 10.0. Conclusions: Existing decision-making interventions for prolapse did not improve patient-reported outcomes, and interventions were not tested in younger populations. The quality of online interventions is generally low with poor readability. Future research should address these gaps through the user-centered design of digital interventions with younger patients.

Background: Research on the association between age at menarche and menopause, reproductive lifespan, and the risk of obesity in China is unclear and requires further clarification. Materials and Methods: Data were obtained from the China Hypertension Survey, a cross-sectional study using a stratified multistage random sampling method, conducted from October 2012 to December 2016, with a total of 187,162 women included in the analysis. Logistic regression models and restricted cubic spines were used to estimate the relationship between obesity and age at menarche, age at menopause, and reproductive lifespan. Results: The mean (standard deviation) age at menarche and menopause, and reproductive lifespan were 15.5 (1.8), 48.7 (3.5), and 33.2 (3.9) years, respectively. Age at menarche was negatively related to the risk of obesity (odds ratio [OR]: 0.968; 95% confidence interval [CI]: 0.961-0.975). There was a positive association between age at menopause and the risk of obesity in postmenopausal women (OR: 1.019; 95% CI: 1.014-1.023). Reproductive lifespan was positively related to obesity (OR: 1.020; 95% CI: 1.017-1.025). The restricted cubic spines showed the association between age at menarche, age at menopause, reproductive lifespan, and obesity was nonlinear when fully adjusted. Conclusions: Based on the large nationally representative sample, Chinese women with earlier age at menarche, later age at menopause, and longer reproductive lifespan have a higher risk of obesity.

Hypertension in pregnancy, which includes both chronic hypertension and pregnancy-associated hypertension, is on the rise in the United States and is associated with an increased incidence of maternal and neonatal complications and future cardiovascular disease. Recent clinical recommendations suggest a lower blood pressure threshold for initiating treatment of chronic hypertension in pregnancy. Here we present a new quality improvement resource for outpatient clinicians to support changes to care processes for managing chronic hypertension in pregnancy and the postpartum period.

Cardiovascular disease (CVD) is the leading cause of death among Black women. When compared with their non-Hispanic White counterparts, Black women are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review examined the updated literature on the efficacy of primary prevention self-management interventions for Black women with CVD risk factors. Searches were run on PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases based on the following inclusion criteria: papers published from September 22, 2018; English language; U.S. studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices for primary prevention; comorbid conditions without a cardiovascular event; at least one patient-level outcome; and Black women at least 18 years of age. Twelve papers met the inclusion criteria. Health practices targeted included physical activity, nutrition, weight loss, health knowledge, and BP control. Nine of the 12 papers reported statistically significant improvements on at least one CVD risk factor including weight loss, physical activity, BP control, waist circumference, and depression. Culturally tailored self-management interventions appear to be feasible with weak to moderately high evidence of efficacy for reducing CVD risk factors in Black women. Further research should focus on the influence that social determinants of health, including mental health, may have on self-management and CVD risk in this population.

Objective: To assess whether depression, anxiety, and post-traumatic stress disorder (PTSD) are associated with serum anti-Müllerian hormone (AMH) levels. Study Design: We used data from a sample of women firefighters from the Fire Fighter Cancer Cohort Study. Participant demographics, reproductive history, and self-reported clinical diagnosis of anxiety, depression, and PTSD were collected with serum for AMH analysis at enrollment. Main Outcome Measure: Linear regression models were used to estimate the association between anxiety, depression, and PTSD and log transformed AMH levels adjusted for age years (continuous and squared) and body mass index. Percent difference in AMH was calculated by [exp(β) - 1] × 100. Results: Among 372 participants, with mean ± standard deviation age 32.54 ± 6.32, clinical diagnoses were reported as follows: depression (15%), anxiety (18.2%), or PTSD (8.7%). No statistically significant association was observed between depression and AMH levels (-22%Δ, 95% confidence interval [CI]: -47.3, 14.5). Women firefighters with a history of anxiety (-33%Δ, 95% CI: -53.5, -4.2) and PTSD (-66%Δ, 95% CI: -79.1, -44.6) had lower serum AMH compared with participants without those conditions. When individuals with concurrent PTSD were excluded, the association between anxiety ceased to be statistically significant (26.7%Δ, 95% CI: -17.9, 92.6). Conclusion: A history of clinically diagnosed anxiety or PTSD was associated with statistically significantly lower AMH levels. This association offers insight into the potential biological mechanisms through which mental health conditions may influence reproductive health.