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

Introduction: In women, cardiovascular disease accounts for 35% of annual deaths, with ischemic heart disease being the leading cause. There are knowledge gaps in research, prevention, treatment, and access to cardiovascular care in women.

Objectives: To describe the clinical and epidemiological profiles of women with acute coronary syndrome (ACS) admitted to an Acute Cardiac Care Unit (ACCU) and to study their association with the development of complications.

Methods: This descriptive study included women admitted to the ACCU of a tertiary hospital for ACS. Sociodemographic, anthropometric, and clinical variables were assessed. Descriptive and inferential statistical analyses were performed using the SPSS v25 software.

Results: Eighty women (mean age, 68 ± 13 years) with a high prevalence of cardiovascular risk factors were included, and 66.2% presented ST-segment elevation ACS. The prevailing symptom was chest pain in 96.3% of patients, followed by associated symptoms such as sweating, nausea, and dyspnea (86.3%). The etiology was secondary to obstructive coronary artery disease in 81.3%, and the therapeutic strategy was percutaneous coronary intervention in 72.5% of patients. Among the women, 64.1% attributed their symptoms to non-cardiac causes, 60% did not perceive severity, and 35.2% presented complications of ACS, particularly cardiac arrest and arrhythmias. A reduced ejection fraction and being alone at the onset of symptoms were associated with a higher risk of complications.

Conclusions: Despite severe clinical presentations and complications, women have a low perception of severity and attribute cardiovascular symptoms to non-cardiac causes. Increasing awareness of ACS and its complications in women is needed among the population in order to improve health outcomes.

Background: The periodicity of births and the factors that influence them have not been thoroughly investigated in Ethiopia. Hence, this study aimed to assess birth seasonality patterns in Ethiopia using data collected from Demographic and Health Surveys over the past two decades (2000-2019).

Methods: A descriptive cross-sectional study was employed to record Ethiopian birth seasonality in greater detail than has previously been accomplished. The Demographic and Health Survey birth data were used to systematically document, evaluate, and compare the birth seasonality in Ethiopia.

Results: Nationally, there was an early peak in the year, followed by a gradual decline. Regarding regional variation, in Afar and Somalia, the birth patterns show high variation, and Tigray, Amhara, Addis Ababa, and South Nation Nationality and Peoples Region exhibit relatively low variation in birth patterns, respectively.

Conclusions: The birth pattern is not uniform and varies seasonally and with different locations as well as maternal demographics. This finding could assist in the prediction of seasonal birth rates, guide contraception campaigns, distribute vaccinations strategically, and design a proactive measure against childhood diseases using mathematical modeling.

Objectives: This study identified factors associated with COVID-19 vaccine acceptance and willingness to receive the vaccine among postpartum women in the United Kingdom, Thailand, Taiwan, Brazil, and South Korea.

Methods: An online cross-sectional survey was designed and conducted from July to November 2021. Data from 3,253 women who were up to 6 months postpartum in the United Kingdom, Thailand, Taiwan, Brazil, and South Korea were analyzed. Simple and multiple logistic regression analyses were performed.

Results: Approximately 72% of women had received at least one dose of the vaccine with a range from 97.0% in Brazil to 25.2% in South Korea. Among five countries, positive attitudes and beliefs toward the COVID-19 vaccine were associated with COVID-19 vaccine acceptance (odds ratio [OR]: 1.41; 95% confidence interval [CI]: 1.35, 1.47). Higher education, paid employee status, and urban residence were associated with COVID-19 vaccine acceptance. The country-specific analysis results showed that attitudes and beliefs toward the COVID-19 vaccine were a strong predictors of COVID-19 vaccine acceptance and willingness to receive it among postpartum women.

Conclusion: Positive attitudes and beliefs toward the COVID-19 vaccine and better COVID-19-related knowledge, attitudes, and practices are important for acceptance of the vaccine in postpartum women. Therefore, there is a need for sufficient and clear communication on the novel vaccine's safety and efficacy to improve awareness and attitudes among postpartum women.

Objective: This study aimed to evaluate the joint associations of maternal hyperglycemic and hypertensive disorders with adverse pregnancy outcomes across the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This retrospective study included 110,447 Louisiana Medicaid pregnant women with first-time delivery from January 1, 2016, to December 31, 2021. Associations between hyperglycemic as well as hypertensive disorders and adverse pregnancy outcomes in pregnancy during prepandemic, early pandemic, and late pandemic were assessed by binary logistic regression.

Results: The odds ratios of above adverse pregnancy outcomes were significantly higher during the early and late COVID-19 pandemic than those before the pandemic. Maternal gestational diabetes mellitus and diabetes before pregnancy were associated with higher risks of preterm birth, primary cesarean section, large for gestational age (LGA), macrosomia, neonatal hypoglycemia, neonatal jaundice, and neonatal respiratory distress syndrome (NRDS; all p < 0.05), respectively, compared with women with normal glucose during pregnancy. Maternal gestational hypertension, preeclampsia or eclampsia, and pre-existing hypertension were associated with higher risks of preterm birth, primary cesarean section, low birth weight (exception for gestational hypertension), small for gestational age, LGA (exception for preeclampsia or eclampsia), macrosomia (exception for preeclampsia or eclampsia), neonatal hypoglycemia, neonatal jaundice, and NRDS (all p < 0.05), respectively, compared with women with normal blood pressure during pregnancy. Most of these associations during the early and late pandemic were consistent with those before the COVID-19 pandemic.

Conclusions: Maternal hyperglycemic and hypertensive disorders during pregnancy, compared with maternal normal glucose or blood pressure during pregnancy, were associated with higher risks of adverse maternal and neonatal outcomes. Interventions should be taken to help individuals achieve glycemic and blood pressure control to decrease the risk of adverse perinatal outcomes regardless of the COVID-19 pandemic.

Background: Currently, the majority of pediatricians are female. However, it is unknown if that general representation is seen along the academic continuum. This study aimed to describe the sex distribution, position duration, and program size of pediatric residency program directors (PDs) and compare female PD representation to other roles along the academic continuum.

Methods: Data from all 213 U.S. pediatric residency programs were obtained from publicly available sources. Female representation along the professional academic continuum is obtained from publicly available sources. PD position duration was divided into three groups: short (<5 years), medium (5-10 years), and long (>10 years). Program size was based on the total resident count: small (<31 residents), medium (31-60 residents), and large (<60 residents).

Results: The majority of PDs, 153 (72%), were classified as female. Within each duration grouping, there were significantly more females than males. There was no significant difference in the within-sex distribution of duration grouping in the current PD position between female and male PDs. There were significantly more females than males in each program size group. The within-sex distribution of the program size grouping was not statistically different between female and male PDs. Females are less represented in academic positions with greater authority, such as pediatrics department chairs (33.3%) or medical school permanent deans (27%), compared to 72% of PDs.

Conclusion: Females are well-represented as pediatric PDs, but underrepresented in medical school positions with greater authority. Understanding the reasons for this is needed to ensure diverse and representative medical school leadership.

Background: Polycystic Ovary Syndrome (PCOS) affects 8%-13% of reproductive-age women globally, with comorbidities including obesity, insulin resistance, type 2 diabetes, and psychological disorders. Socioeconomic status (SES) significantly impacts health outcomes.

Methods: A community-based, pilot study was conducted in Trinidad among females aged 18-45 years, representing diverse ethnicities and SES. Participants underwent a standardized history and physical exam. Clinical hyperandrogenism (HIR) was assessed using the modified Ferriman-Gallwey scale (HIR ≥6), menstrual dysfunction (MD) as <9 cycles/year, depression via Beck's Inventory, overall health using SF-12 v1, and daytime somnolence with the Epworth Sleepiness Scale. Data analysis included descriptive statistics, analysis of variance, and multinomial logistic regression adjusting for confounders.

Results: Among 250 participants (mean age 31.6 ± 7.9 years), we classified 200 with clinical presentations, which included: no MD or HIR (56.7%), MD only (14.4%), HIR only (21.9%), and MD+HIR (7%). Age, income, and education were significantly correlated with clinical presentation. Older age reduced the risk of HIR (mean difference = 4.507, p = 0.004) and MD+HIR (mean difference = 9.063, p < 0.001). Income (OR = 0.37, 95% CI: 0.16-0.87, p = 0.022) reduced MD odds. Self-reported infertility was associated with MD (odds ratio [OR] = 0.27, 95% confidence interval [CI]: 0.11-0.65, p = 0.006). MD+HIR correlated with severe depression (OR = 5.96, 95% CI: 1.62-21.90, p = 0.007). Mental health scores (SF-12 MCS) were lower in women with MD+HIR (mean difference = -11.477, p = 0.005).

Conclusion: Seven percent of women in this sample showed probable PCOS based on clinical manifestations, with SES impacting quality of life, mental health, and sleep. Higher income reduced MD and MD+HIR risk, while infertility increased MD risk and severe depression was linked to MD+HIR.

Background: Food and housing insecurity have been identified as modifiable risks for poor mental health and perceived self-rated health among people with HIV. This study examined the associations of food and housing insecurity with perceived overall health, depression and anxiety symptoms, and the potential moderating effect of social support.

Methods: We conducted a cross-sectional study of 561 low-income women with HIV (WHIV) in the Miami-Dade County Ryan White Part A Program. Data were collected from June 2021 to March 2022. Food and housing insecurity were categorized into three groups: no food/housing insecurity, any food/housing insecurity, and concurrent food/housing insecurity. Multivariable logistic regression analyses were performed for each outcome variable.

Results: Compared to no food/housing insecurity, significant depressive symptoms were associated with any food/housing insecurity (aOR: 2.99, 95% confidence interval [CI]: 1.81-4.91) and concurrent food/housing insecurity (aOR: 17.11, 95% CI: 7.83-37.38). Significant anxiety symptoms were associated with any food/housing insecurity (aOR: 3.50, 95% CI: 1.68-7.30) and concurrent food/housing insecurity (aOR: 15.97, 95% CI: 6.92-36.87). Although social support was significantly related to depressive and anxiety symptoms, it did not moderate the relationship between these unmet needs and any of the health outcomes.

Conclusion: Our findings revealed significant associations between unmet food and housing needs, poor social support, and significant depressive and anxiety symptoms among WHIV. Continuous, multifaceted support is essential to mitigate the negative impact of unmet food and housing needs and ensure the physical and mental well-being of WHIV.

Introduction: U.S. maternal mortality rates are two to three times higher than other high-income countries, with most deaths occurring postpartum. Fragmented care, exacerbated by health insurance gaps and workforce shortages, underscores systemic deficiencies. Although patients' and clinicians' perspectives are well-documented, little is known about payors' and purchasers' perspectives. Given their influence in coverage decisions, payment rates, and service reimbursement, the objective was to explore their perspectives and identify challenges and opportunities in improving postpartum care in California, currently engaged in reshaping maternal health pathways.

Methods: We conducted a qualitative study using semi-structured interviews with high-level administrators from major California health insurance providers and purchasers between June and October 2023. Participants, recruited through professional connections, were selected through purposive sampling based on their involvement in maternal and child health coverage decisions. A hybrid inductive-deductive approach was employed to identify major themes.

Results: Participants (n = 11) identified barriers including limited insurance coverage, lack of clinical provider incentives, reimbursement concerns, and misaligned measures and metrics. Opportunities to improve postpartum care focused on visit timing and frequency, alternative payment models, and improving continuity of care between birth and the transition to primary care.

Conclusions: Insurance payors and purchasers identified postpartum care barriers and suggested solutions well-supported by the literature. These solutions-including reimagining global bundle payment models, updating Healthcare Effectiveness Data and Information Set measures, and promoting dyadic models-could address barriers, improve outcomes, and inform California's ongoing maternal health transformation and those happening around the United States.

Background: Chicago sustained substantial COVID-19 morbidity and mortality with greatest burdens among low-income communities of color. We sought to determine the prevalence and predictors of vaccine uptake and refusal over 3 years among a long-term cohort of Chicago women with/without HIV (WWH/WWoH).

Methods: Research staff provided outreach and collected data on COVID-19 knowledge, vaccine intent, uptake, and refusal quarterly during 2020 and then semiannually through 2023. 146 women (102 WWH and 44 WWoH) participated.

Results: Among 146 women, mean age was 54.4 years, 70% were WWH; predominantly Black (63%), unemployed (73%), 58% had ≤$18,000 annual household income, 63% had a high school education or less, and 65% had one or more comorbidities. Initially, 46% of women reported no intent to be vaccinated and were more likely to be employed, report medical mistrust and not living with HIV. By September 2023, 88% of women received at least one vaccination and 86% received the full series of doses. Vaccine uptake was lowest among those who were younger, less educated, heavier drinkers and marijuana users, and had fewer comorbidities including lower BMI and diabetes.

Conclusions: While initial vaccination non-intent was high, we observed higher-than-expected and more rapid COVID-19 vaccine uptake among vulnerable women of color engaged in a long-term research initiative relative to Chicago residents overall. Lower education, higher alcohol and marijuana use, and lower COVID morbidity and mortality risks were predictors of not receiving COVID vaccination. Understanding and addressing factors associated with vaccine refusal should be a key component of future pandemic preparedness initiatives.

Background: Polycystic ovarian syndrome (PCOS) is associated with the metabolic health of racially and ethnically diverse women globally, but limited research exists on the association of PCOS and metabolic syndrome (MetS) among women in the United States.

Objective: To examine the association of PCOS features and MetS in a racially/ethnically diverse population of reproductive-aged women in the United States.

Methods: Cross-sectional data from 2,172 women (12-49 years) from the 2011-2016 National Health and Nutrition Examination Survey were analyzed. Univariate logistic regression models determined unadjusted associations of MetS and its components (elevated central obesity, glucose, blood pressure and triglyceride, and low high-density lipoprotein cholesterol) with PCOS features (log-transformed total testosterone (LTT), sex-hormone binding globulin (LSHBG), amenorrhea, and oral contraceptive pills (OCP) use). Multivariable logistic models examined age-adjusted associations stratified by race and ethnicity.

Results: The analytical sample (mean age = 30.3 years, 59% non-Hispanic White, 12.4% non-Hispanic Black, 18.7% Hispanic/Latina, 6.2% non-Hispanic Asian, 3.7% Other/multi-race) had a MetS prevalence of 14.5%. Overall, MetS was associated with age, body mass index, race/ethnicity, LTT and LSHBG concentrations, amenorrhea, and OCP use (p < 0.01 for all), and many of the PCOS features were protective against individual MetS components. Most race/ethnicities showed significantly lower odds of MetS with an increase in LSHBG, with varying impacts on individual MetS features.

Conclusions: Findings suggest significant associations between PCOS features and MetS among a racially and ethnically diverse population of reproductive-aged women in the United States. More robust and longitudinal studies are needed to further understand the underlying mechanism linking PCOS and MetS.