Women's health reports (New Rochelle, N.Y.)最新文献

Purpose: To estimate the 1-year continuation rate of low-dose levonorgestrel-releasing intrauterine systems (LNG-IUS) in Spanish women and elucidate potential factors impacting continuation.

Materials and methods: A prospective, multicenter, noninterventional study with a 1-year follow-up was conducted in Spain. Participants were 18-35-year-old women using low-dose LNG-IUS. Clinical and demographic data were collected, and the association between baseline characteristics and discontinuation rate was analyzed.

Results: A total of 289 women (9.3% using 13.5 mg LNG-IUS and 90.6% using 19.5 mg LNG-IUS) completed the study, and 9% discontinued prematurely after 12 months. A statistically significant association was found between LNG-IUS discontinuation and educational level (odds ratio [OR] = 2.63; 95% confidence interval [CI]: 1.07-6.48), previous pregnancies (OR = 3.44; 95% CI: 1.40-8.46), and baseline intensity of menstrual pain (OR = 1.03; 95% CI: 1-1.04). In addition, both the change in the menstrual bleeding's interference with daily life activities between the final and basal visit and the change in the pain associated with the intensity of menstrual bleeding showed a significant association with discontinuation.

Conclusions: When recommending LNG-IUS, a patient's baseline characteristics such as educational level, previous pregnancies, intensity of menstrual pain, and menstrual bleeding's interference with daily life activities have to be considered. By doing so, health care providers can improve contraceptive counseling, reduce discontinuation rates, and enhance women's satisfaction.

Background: Unintended pregnancies are associated with unsafe abortions and maternal deaths. Undergraduates are at risk of unexpected pregnancy due to changes in their lives. Adequate knowledge and attitudes toward contraceptive uses are essential to help prevent pregnancy.

Objective: To assess sex activity, knowledge, attitudes, and practices of contraception methods among female undergraduates at Chiang Mai University, Thailand.

Methods: Self-administered anonymous questionnaires were answered by female undergraduate students via an online platform. The questionnaire consisted of four parts (sociodemographic and contraception use, knowledge of contraceptive methods, attitudes, and sources of information.).

Results: A total of 475 women responded to the questionnaire. Of them, 29.2% had sex experience, with significantly lower prevalence among the students in health sciences faculties, when compared with those of nonhealth sciences (20.6% vs. 40.2%; p-value <0.001). The mean ± standard deviation scores of knowledge of contraceptive methods was 12.84 ± 4.59 (range, 0-24), indicating a medium level. There were only 15.1% of participants who were categorized as a high level, while many participants (86.9%) had a positive attitude toward contraceptive methods. Most participants gained contraceptive knowledge from online content from the internet and social media.

Conclusion: Nearly 30% of the female university students had sex experience, lower than that in most previous studies, with significantly lower prevalence in the group of health sciences faculties. Most female university students had a positive attitude toward contraception uses; however, their knowledge about contraception was relatively limited. Finally, most contraceptive methods used were relatively less effective and theoretically at risk for unintended pregnancy.

Background: American Indian and Alaska Native (AI/AN) women experience higher rates of mortality from many cancers than their non-Native counterparts.

Objective: To examine recent data on gynecological cancers (cervical, ovarian, and uterine) among AI/AN women living in the Upper Midwest (Iowa, Montana, Nebraska, North Dakota, South Dakota, and Wyoming) for any improvement in equity.

Methods: We used data from the North American Association for Central Cancer Registries Cancer in North America database (1995-2019). We used descriptive statistics, including incidence mortality rates, trends, and time to treatment. Analyses were restricted to non-Hispanic individuals living in a purchased/referred care delivery area (PRCDA) at the time of diagnosis; sensitivity analyses included all AI/AN people, regardless of PRCDA residence or ethnicity.

Results: From 1995 to 2019, there were 647 gynecological cancers diagnosed among AI/AN women living in PRCDA counties in the Upper Midwest (cervical n = 194, ovarian n = 142, uterine n = 311). Incidence and mortality rates for ovarian and uterine cancers were similar between AI/AN and non-Hispanic White (NHW) women; however, the incidence of cervical cancer was 1.87 (95% confidence interval [CI]: 1.60, 2.17) times higher, and mortality was 2.92 (95% CI: 2.29, 3.68) times higher among AI/AN compared to NHW women. The majority of AI/AN women diagnosed with gynecological cancer initiated treatment within 1 month (cervical = 67.2%, ovarian = 80.6%, uterine = 63.1%), which was similar to NHW women.

Conclusions: Differences exist in incidence and mortality for cervical cancer between AI/AN and NHW women in the Upper Midwest, with AI/AN facing continued inequity.

Aim: The present study aims to investigate thyroid disorders (TDs) in women with diabetes mellitus (DM) and the correlation, if any, between TDs and development of hypertension in this group of patients.

Methods: The present study is a retrospective cross-sectional study that was conducted in the United Arab Emirates. Women with DM were randomly selected from the electronic medical records database, and 429 patients were included in the study. The investigation included age, diabetes duration, body mass index, blood pressure, hemoglobin A1c, fasting and random glucose, lipid profile, thyroid function test, and levels of thyroid-stimulating hormone. In addition, the antidiabetic medications used by patients with DM were analyzed.

Results: The majority of the studied population (90%, n = 386) had type 2 DM and 33% (n = 142) had TDs; 42% participants with thyroid dysfunction had hypertension compared with 57% participants with normal thyroid function (odds ratio 0.57; 95% confidence interval 0.33-0.97; p = 0.039). It was also found that a smaller number of patients with DM who use pioglitazone as a main antidiabetic medication had thyroid dysfunction (1.4%), whereas participants who used liraglutide were more vulnerable to develop TDs (16.9%).

Conclusions: Two-thirds of women with DM and TDs had hypothyroidism; 42% of women with DM and TDs had hypertension. Liraglutide was seen more in patients with TDs compared with pioglitazone suggesting a potential correlation between TDs and the use of Glucagon-Like Peptide (GLP-1) analogues.

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the United States with an increased risk for hospital readmission and cardiovascular disease. The American College of Obstetricians and Gynecologists recommends that women with severe HDP follow-up within 72-hours post-discharge after childbirth. The purpose of this study is to evaluate if a postpartum hypertension (PPHTN) clinic improves follow-up and management.

Methods: Retrospective chart review of a referred cohort in a single-center, tertiary care hospital in Hartford, Connecticut. This study included women with severe HDP who were referred to the PPHTN clinic between March 2022 to February 2023. Primary outcomes were the percentage of patients seen within 72-hours postdischarge of hospitalization, percentage of patients achieving goal blood pressure (BP) (<130/80) at first and last follow-up visits, and hospital readmission rate. Secondary outcomes included the percentage of patients receiving HDP education materials, automatic BP cuff upon discharge from hospitalization, and antihypertensive medications prescribed postpartum.

Results: Our cohort had 157 women with a mean age of 32 years old (19-44), mean body mass index (BMI) 32 kg/m² (16-49), and were 39% White, 24% African American, and 33% Hispanic. Comorbidities included 41% nulliparity, 19% gestational diabetes, 23% HTN, 28% gestational HTN and 10% prior preeclampsia. Among the women seen in the clinic, 53% were observed within 72 hours, 28% achieved their goal BP at first visit, and 58% achieved their goal BP at subsequent visits. Hospital readmission occurred in 5% of women. Overall, 86% received HDP education and 89% had or were prescribed a BP cuff upon discharge. Lastly, 85% were discharged on antihypertensives and 60% required antihypertensive modification postpartum.

Conclusion: Our initiative significantly improved the percentage of patients observed within 72 hours of discharge and facilitated longitudinal follow-up. Future analysis is needed to evaluate readmission rate reduction and the cost-effectiveness of the PPHTN clinic.

Background: Endometriosis is a chronic inflammatory gynecological disease affecting many women worldwide. In Gabon, data on this disease has never been published. Created in 1978, the laboratory of the Department of Pathological Anatomy at the University of Health Sciences was the only laboratory for histological analysis throughout all the country until 2009.

Methods: A descriptive and analytical retrospective study was conducted using data from the medical records of women whose operation specimen samples were examined between 1987 and 2022.

Results: A total of 6666 files were collected for the period between 1987 and 2022. The mean age of the patients was 38.0 ± 10.8 years. The proportion of endometriosis between 1987 and 2022 was 7.3% [6.7-7.9]. The year 2004 had the highest prevalence (23.2%). Endometriosis was significantly elevated in patients aged 36 to 50 years (10.8%), followed by those aged 51 years and over (9.6%) (p < 0.001). The uterus was the most resected surgical part (40.3%) and the most affected organ (72.6%). Malignant (23.9%) and benign (51.4% including 29.6% leiomyomas) tumors were the most common pathologies. In the final model, age, in particular the groups of [35-50 years] (OR = 11.4 (95% CI [2.8-46.5]) and [51-89 years] (OR = 11.2 (95% CI [2.7-46.1]), salpingitis (OR = 2.6 (95% CI [2.1-3.3]), and benign tumors (OR = 1.3 (95% CI [1.1-1.6]) were risk factors for the occurrence of endometriosis.

Conclusion: This study is the first published study, which reveals that endometriosis is a health issue in Gabon. In order to better characterize this pathology in the country, it would be wise to conduct prospective studies, including Knowlege Attitude and Pratice's (KAP) studies.

Purpose: The human papillomavirus (HPV) vaccine was recently approved for 27-45-year-olds. We examined the association between HPV vaccination status and having an up-to-date Papanicolaou (Pap) test for 27-45-year-old women across racial/ethnic groups.

Methods: We conducted a cross-sectional analysis using 2019-2022 Behavioral Risk Factor Surveillance System data. We performed weighted multivariable logistic regressions to examine the association between being unvaccinated, initiating, and completing the HPV vaccine series and Pap test uptake.

Results: Among 7,052 women, non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (14.0%). Non-Hispanic Black (NHB) had the lowest rate of HPV vaccine series completion (9.2%) and the highest rate of up-to-date Pap tests (71.2%). Non-Hispanic Other (NHO) women had the lowest rate of up-to-date Pap tests (52.1%). Completing the HPV vaccine series was associated with increased odds of having an up-to-date Pap test (odds ratio [OR]: 1.66 95% confidence interval [CI]: 1.23-2.24). Among Hispanic and NHW women, HPV vaccine series completion was associated with increased odds of up-to-date Pap testing (Hispanic: OR: 2.16, 95% CI: 1.02-4.58; NHW: OR: 1.49, 95% CI: 1.01-2.21). HPV vaccine series initiation was associated with up-to-date Pap tests for NHB (OR: 2.75, 95% CI: 1.19-6.34) and NHO women (OR: 3.15, 95% CI: 1.56-6.37).

Conclusions: Unvaccinated women had decreased odds of up-to-date Pap testing. Shared clinical decision-making should be utilized to help 27-45-year-old women decide if they want to receive the HPV vaccine; culturally tailored efforts should be made to improve utilization of Pap testing across racial/ethnic groups.

Objective: To assess the specific barriers and facilitators for pregnant individuals who have an opioid use disorder (OUD) receiving perinatal care.

Methods: We conducted key informant interviews with patients who received care from obstetric clinicians who had been trained to provide medication for opioid use disorder (n = 16). We asked patients about the care they received for their OUD, the quality of communication with their perinatal care team, and any recommendations for improving OUD care. Two staff independently coded transcripts, and we used content analysis to identify themes.

Results: Our analysis resulted in three main facilitators that support participants receiving care from their obstetric clinician: (1) positive relationship with supportive and nonjudgmental clinician; (2) access to medication for opioid use disorder (MOUD); and (3) access to therapeutic and peer supports. Patients noted that nonjudgmental clinicians provided a care environment where they felt safe, did not experience stigma, and felt they could be active participants in their care. Patients also expressed that access to MOUD and clinical and supportive services were beneficial components of perinatal care. The main barriers identified included lack of access to transportation, long wait times for treatment programs, and difficulty accessing MOUD.

Conclusions: The results of this study suggest that increased obstetric provider education about OUDs and providing trauma-informed care for pregnant individuals who have an OUD may help reduce barriers to accessing care and increase satisfaction with care for this population. Furthermore, the present study suggests obstetricians provide in-house access to MOUD, if possible, or assist patients with referrals to care, as these may reduce the structural barriers patients face.

Background: Prior studies have suggested gender differences in COVID-related outcomes that have the potential to impact cardiovascular risk. We aimed to investigate gender differences on short- and long-term effects of COVID-19 infection.

Methods: Patients hospitalized with COVID-19 infection were enrolled in an ongoing prospective registry across NY-Presbyterian networks, which encompassed same-day echocardiogram, cardiac magnetic resonance (CMR), 6-minute walk test, and quality of life assessment 1 year following acute COVID hospitalization.

Results: In this prospective cohort of 213 hospitalized patients with COVID-19 infection, males were more likely to require intensive care unit (ICU) stay (13.6 vs. 3.6%; p = 0.009) and oxygen supplementation (40.8 vs. 26.4%; p = 0.026), paralleling higher rates of elevated troponin, C-reactive protein, ferritin, and D-dimer (p < 0.05 for all). In contrast, 1 year following COVID hospitalization, females reported worse physical function and fatigue on Patient-Reported Outcomes Measurement Information System (PROMIS) scale (p < 0.05 for all). Additionally, 6-minute walk distance was less in females than males (383.0 ± 98.0 vs. 428.6 ± 78.6 m; p = 0.006), and Borg dyspnea score was nearly twofold higher in females vs. males (2.0 ± 2.3 vs. 1.0 ± 1.5; p < 0.001). With respect to imaging parameters, females had higher left ventricle and right ventricle ejection fraction (p < 0.05 for all) with smaller infarct size (p = 0.042) on CMR.

Conclusion: Whereas males have greater morbidity during acute COVID hospitalization, females are disproportionately impacted by post-COVID impaired functional status despite higher biventricular ejection fraction and smaller infarct size.

Objective: Determine if diagnosis of gestational diabetes mellitus (GDM) increases the incidence of postpartum depression (PPD) in rural Appalachian Ohio.

Methods: A retrospective chart review was conducted to review pregnancies between February 2020 and March 2023 to look for diagnoses of gestational diabetes and PPD.

Results: The population studied showed that 5.41% of pregnancies were affected by gestational diabetes, 7.76% of pregnancies had associated PPD, and 1.26% had both. Hypertension incidence that was a secondary data point in this study showed that 20.4% of pregnancies were affected by a form of hypertension.

Conclusions: Incidence of gestational diabetes and PPD were similar in this population to the rest of the United States and occurred together at low rates. Hypertension was a more common condition that affected pregnancies in this population.