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

Background: Decreasing primary care access and increasing emergency department (ED) usage is a potential contributor to declining cancer screening prevalences in those facing barriers to health care access. The ED is a non-traditional yet potentially high-yield setting for implementation of interventions to monitor and increase cancer screening.

Methods: An ED-administered survey in July 2022 gathered data on breast, cervical, and colorectal cancer screening, as well as human papillomavirus (HPV) vaccination status of females presenting to the ED for care. This was compared with electronic health record (EHR) data extraction of all ED patients during the same timeframe. Primary outcome was proportion of cancer screening and HPV vaccination not up to date in each group.

Results: ED survey was administered to 101 individuals; EHR data was extracted on 2934 patients. Survey versus EHR, respectively, found cervical cancer screening was not up to date in 6.2% vs. 77.6%, breast cancer screening in 14.3% vs. 73.4%, colorectal cancer screening in 22.9% vs. 56.5%, and HPV vaccination in 33.3% vs. 57.8%. p value was < 0.001 for all screening category comparisons between survey and EHR.

Discussion: Our data indicate significant discrepancies between self-reported screening history and EHR data. ED survey results were more in line with the observed screening rates in various surveillance systems and published in the literature. This suggests that point-of-care ED survey administration may be more effective in identifying those needing preventative cancer screening, especially in individuals with less access to routine health care.

Pregnancy is a hypercoagulable state. There is a lack of strong evidence-based guidance regarding management when anticoagulation is required to prevent or treat venous thromboembolism during pregnancy. In practice, some patients are prescribed enoxaparin and transitioned to heparin due to the shorter half-life in the setting of an unpredictable delivery despite less predictable pharmacokinetics of heparin compared with enoxaparin, while others are continued on enoxaparin with a scheduled delivery. This work retrospectively evaluates obstetrical and neonatal outcomes between these two practices for 194 live singleton deliveries from 179 patients in a single institution January 2017 through May 2022. A Bayesian regression was used to control for confounders including dosing regimens. This work found no statistically significant differences in blood loss at time of delivery or availability of neuraxial anesthesia. This suggests continuing enoxaparin is noninferior to transitioning to heparin when anticoagulation is indicated in pregnancy.

Purpose: In this study, we examined the relationship between health-related social needs (HRSNs) and screening mammography.

Methods: We gathered data from April 2020 to February 2021 among women ages 52-74 years at a federally qualified community health center network in the Chicago region. We measured HRSNs using a one-item screener, and among those screening positive, with an eight-item questionnaire. Screening mammography was measured as (1) ever having mammography and (2) mammography completed in the past 2 years. We examined the relationship between HRSNs in the one-item and multi-item questionnaires and both measures of screening mammography using logistic regression.

Results: Among 3711 women, mean age was 60 years, 68% were Hispanic/Latino, 62% were best served in Spanish, 39% had no insurance, and 71% had incomes <100% federal poverty level. In total, 32% reported an HRSN in the one-item screener. Of these, 74% completed the multi-item questionnaire; changes in income (60%) and inadequate access to food (46%) were the most common HRSNs reported. Overall, 65% reported prior mammography and 47% reported mammography in the past 2 years. There was an association between prior mammography and the one-item screener (odds ratio = 0.83, 95% confidence intervals = 0.70, 0.98), but no association between recent mammography and HRSNs reported in the one-item, specific HRSNs, or number of HRSNs.

Conclusions: We found an association between ever having a mammogram and a positive one-item screener, but not in relation to specific HRSNs. The findings of this study may inform future assessments of HRSNs and understanding their relationships with preventive health care.

Objectives: COVID-19 hit at the midpoint of Choose Well, a statewide contraceptive access initiative commenced in South Carolina (SC) in 2017. This study assessed whether the pandemic altered the trends in contraceptive use among SC Medicaid during the first half of Choose Well.

Methods: Contraception use among 333,253 women was analyzed from 2017 to 2022, divided into prepandemic (January 2017-February 2020) and pandemic (March 2020-December 2022) periods. Bivariate differences in contraceptive use were examined using Pearson's Chi square test across these periods, including the first, first two, and first three quarters of the pandemic. Interrupted time-series analysis assessed changes in trends for intrauterine devices (IUDs) and implants during pandemic compared with prepandemic levels.

Results: IUD and implant use dropped during the first two quarters of the pandemic. While IUD use matched the prepandemic levels by the end of the first three quarters, implant use slightly lagged. The use of injections and pills decreased from 16.6% and 26.2% during the prepandemic period to 13.6% and 21.7% during the pandemic period, respectively (p < 0.001). The trends in IUD and implant use in the pandemic period were higher by 0.01 (95% confidence interval [CI]: 0.01, 0.02) and 0.04 (95% CI: 0.03, 0.05) percentage points per month relative to the prepandemic trends, respectively.

Conclusions: The pandemic's initial impact quickly stabilized, and overall, the gains in contraceptive use among Medicaid beneficiaries associated with Choose Well remained largely unaffected, with some methods showing increased trends.

Background: Heavy menstrual bleeding (HMB) is common, and 20-30% of patients presenting with HMB are diagnosed with an inherited bleeding disorder (IBD). Despite the frequent association of HMB with bleeding disorders, specific learning objectives on this topic are lacking for Obstetrics and Gynecology (OBGYN) residents.

Objective: We sought to determine the exposure of OBGYN residents to didactics, clinical training, and confidence in evaluation and management of patients with HMB due to IBDs.

Methods: Prospective survey of OBGYN residents through email solicitation. Residents were invited to complete an anonymous 26-item survey, querying residents' confidence in evaluation and management of HMB in patients with and without IBDs.

Results: In total, 239 OBGYN residency programs were invited to participate and 20 programs responded. Among 388 residents, 84 completed the survey (21.6%). The majority reported didactics on HMB evaluation (n = 71, 85.5%) and treatment (n = 77, 92.8%); however, for HMB due to IBDs, only 35 residents (42.4%) reported didactics on evaluation and 28 (33.7%) reported didactics on treatment. Confidence in evaluation and management of HMB was high but decreased significantly with an IBD. Residents who received didactics on IBDs reported more confidence in their evaluation than residents who did not receive didactics (mean Likert scale score of 3.67 vs. 3.23, p = 0.002). Increasing postgraduate year level was associated with more confidence in treatment (p < 0.001) and did not differ based on type of training program (p = 0.825).

Conclusion: OBGYN residents have decreased confidence in evaluation and management of HMB due to IBDs. Resident confidence increases with didactics and training. Residents would benefit from curricula designed to address this deficit in training.

Background: Women are more at risk for developing long-term symptoms after a COVID-19 infection. Only limited data are available for patients with coexisting endometriosis and/or menstrual pain symptoms.

Study design: A total of 840 premenopausal women with menstrual pain and/or endometriosis were included in this observational cross-sectional study using an online survey platform.

Results: A total of 840 women with menstrual pain (mean age 30.7 ± 6.9, 15-54 years) were studied. Of these, 714 (84.2%) had a COVID-19 infection, 123 did not (14.5%). A total of 312 subjects had acute COVID-19 (AC) with symptoms ≤4 weeks (43.7%), 132 (18.5%) developed postacute COVID-19 syndrome (PC), and 88 (12.3%) had "long Covid" (LC). There were no statistical differences regarding number of vaccination shots between the three groups AC, PC, and LC. A total of 582 patients with surgically confirmed endometriosis (SCE) showed a twofold increased risk of LC [odds ratio (OR): 2.12, 2.18-3.84] in comparison with AC subjects. In SCE the comorbidity anxiety disorder (OR: 2.08, 1.14-3.81) and depression (OR: 2.02, 1.15-3.56) further increased the risk of LC. LC subjects had a significantly higher disturbance level of menstrual pain (p = 0.002), were more restricted in job (p < 0.001), leisure (p = 0.002), and family activities (p < 0.001), and had a higher number of endometriosis surgeries (p = 0.003).

Conclusion: Subjects with SCE had a twofold increased risk of LC (in comparison to subjects with nonconfirmed endometriosis menstrual pain). In patients with SCE concomitant diagnosis of depression or anxiety disorder further twice-fold increased risk of LC. Further studies are needed if it is possible to reduce LC risk by improving the treatment of those secondary diagnoses and whether the type of endometriosis treatment can reduce LC occurrence (holistic, coanalgetic, hormonal).

Aim: This study aimed to examine the level of work-family conflict and the factors affecting it among women academic and administrative staff working at the university.

Materials and methods: The study is descriptive and cross-sectional. We collected data online from women academic and administrative staff at two different universities from December 2022 to June 2023. The data for the study were collected by using the Personal Information Form, Work-Family Conflict Scale, and Family-Work Conflict Scale.

Results: The mean Work-Family and Family-Work Conflict Scale scores of the female university staff participating in the study were 15.40 ± 5.02 and 12.02 ± 4.76, respectively. Academic staff were found to have higher mean scores in the Work-Family Conflict Scale (U = 1942.5, p = 0.034) and the Family-Work Conflict Scale (U = 1972, p = 0.042) than administrative staff. The Work-Family Conflict Scale score was affected by the status of sharing domestic responsibilities with the spouse (χ² = 8.855, p = 0.012). Likewise, it was found that the Family-Work Conflict Scale score was affected by the presence of elderly and/or disabled individuals who were in need of help and support at home (U = 772, p = 0.030), family type (χ² = 8.013, p = 0.018), and having children (U = 2917, p = 0.028). There was a significant negative correlation between the Work-Family Conflict Scale and daily time allocated to oneself and their spouse (r = -0.163, p = 0.034; r = -0.189, p = 0.013), and a significant positive correlation between the Work-Family Conflict Scale and number of children (r = 0.185, p = 0.04), age of children (r = 0.204, p = 0.03), and daily time allocated to child/children (r = 0.250, p = 0.001).

Conclusions: Work-family conflict is affected by variables related to the work and family roles of university staff.

Background: This study investigated the potential associations between neighborhood characteristics, rurality, ethnicity/race, and breast cancer screening outcomes in designated Health Professional Shortage Areas in Central Texas. Limited access to preventive medical care can impact screening rates and outcomes. Previous research on the effects of factors such as rurality, neighborhood socioeconomic status, and education level on cancer prevention behaviors has yielded inconsistent results.

Materials and methods: We analyzed data from a state-funded breast and cervical cancer screening programs for disadvantaged and medically underserved individuals. A mixed-effects logistic regression model was used to assess the impact of residency characteristics (rurality, educational attainment, unemployment, and poverty) on abnormal breast cancer screening outcomes, with individual level (age, ethnicity, race, and education) as control variables.

Results: During the studied time, there were 1,139 women screened and 134 abnormal mammograms found. Residency characteristics were not significantly associated with abnormal mammography outcomes at 0.05. However, individual factors are strongly associated with abnormal screening results. Non-Hispanic or Latino white women had increased odds of abnormal clinical outcomes compared with Hispanic or Latino women (OR = 2.03, CI 1.25-3.28; p = 0.004). Additionally, women residing in counties with more than 30% of the population completing college had increased odds of abnormal mammogram outcomes compared with counties with less than 15% college attainment (OR = 2.89, CI 0.99-8.38; p = 0.051).

Conclusions: This study found a significant correlation between area-level educational characteristics and abnormal mammography outcomes. Future research should explore the contextual risk factors influencing breast cancer occurrence and develop targeted interventions for this population.

Background/objective: Women Veterans (WV) are exposed to unique risk factors for the development of autoimmune diseases (AID), which can increase risk of pregnancy complications. To characterize pregnancy outcomes in this population, our team performed a descriptive case series.

Methods: To identify WV with AID from the Center for Maternal and Infant Outcomes Research in Translation dataset, medical records were screened using diagnostic codes and medications. A protocolized chart review and extraction was performed.

Results: Twenty-five WV with AID were identified. The most frequently reported AID were inflammatory bowel disease (n = 4), psoriasis (n = 4), and undifferentiated connective tissue disease (n = 4). Forty-four percent of WV with AID experienced pregnancy complications, 32% utilized VA subspecialty care for AID management, and 40% did not seek health care at the VA during their pregnancy.

Conclusions: Identified pregnancies had a high frequency of complications with more than one in three Veterans lost to VA follow-up during pregnancy.

Introduction: Lifestyle change programs (LCPs) are effective in helping people adopt healthy lifestyles and maintain healthy weight for disease prevention. LCPs are known to be underutilized, but the nuances surrounding women's interest in using these programs for disease prevention need to be further explored so that enrollment and retention in these programs can be improved.

Methods: The purpose of this study was to explore women's interest in and knowledge of LCPs and identify their motivators and barriers to joining these types of programs through a survey. The survey was administered both online and in person. The survey had 22 questions and included demographics, medical and family history, knowledge and interest in LCPs, and barriers and motivators to participating in LCPs.

Results: Participants in this study included 1,606 women from 40 to 74 years of age. We found that respondents had limited knowledge about the benefits of LCPs in reducing risks of specific diseases, such as breast cancer and osteoarthritis. Respondents reported low-to-moderate interest in LCPs. We found that their interest in these programs was negatively associated with their weekly physical activity and positively associated with their body mass index (BMI) and the number of reported barriers to joining LCPs. The most common barriers cited were cost, location, time, and too many meetings. In addition, we found that respondents who had or were unsure about their family history of diabetes were more interested in LCPs compared with individuals who had no family history of diabetes. We did not find significant differences in respondent interest in LCPs across ethnicity.

Conclusions: Our study suggests that specific barriers to LCPs-including women's knowledge of such programs-will need to be addressed before enrollment and retention in LCPs are increased.