Journal of the American Medical Women's Association (1972)最新文献

Objectives: We investigated associations between various dimensions of women's status and self-rated health. We hypothesized that women living in states with lower levels of women's status would be at greater risk of reporting poor health than women living in states with higher levels of women's status, even when controlling for individual and state characteristics.

Methods: We used individual self-rated health and sociodemographic characteristics for 87 848 female respondents to the Behavioral Risk Factor Surveillance System (BRFSS) 2000. Women's status indices and indicators were obtained from the Status of Women in the States 2000. State median income and income inequality were included as state-level contextual variables. We examined data using a multilevel logistic regression method.

Results: Women living in states scoring in the lowest quintile on women's political and economic indices (political participation, employment and earnings, and economic autonomy) were more likely to report poor health, odds ratio (OR) 1.14 (95% confidence interval [CI] 1.01, 1.28), OR 1.29 (CI 1.08,1.55); OR 1.30 (CI 1.09, 1.56), respectively, after controlling for individual characteristics and other state-level variables than were women living in the highest-performing 20% of states.

Conclusions: The status of women at the state level has an independent association with the risk of reporting poor health over and above women's individual characteristics. This finding suggests a contextual effect of women's societal status on health status.

Objective: Research has shown that intimate partner violence (IPV) affects the physical and mental health of victims. It can also compromise work performance, leading to job loss. We explored the potential link between job loss and IPV as part of a larger study on IPV and health care.

Methods: Thirty-two mothers in Midwestern IPV shelters or support groups were interviewed to gather information about their abuse histories, health care experiences, and demographic characteristics. Interviews were audio taped, transcribed, and reviewed for themes.

Results: Half of participants had lost jobs because of IPV. Reasons included: the abuser told the victim to quit, in order to be safe, excessive absences because of covering up the abuse, and health issues exacerbated by IPV.

Conclusion: Job instability was common among IPV victims in this study. Although this study did not address cause and effect, evidence of job instability may be another "red flag symptom" indicating that providers should screen for IPV.

Although less prevalent than breast cancer, cervical cancer has a lower 5-year survival rate. Cervical cancer is nearly always due to human papillomavirus (HPV). Increased screening and DNA typing for oncogenic HPV have begun to reduce the number of cases. Interpretation of Papanicolaou test results and disease management decisions require a comprehensive grasp of recent revisions in classification and management practice. This article reviews the recommendations of the multidisciplinary Bethesda 2001 Workshop and the American Society for Colposcopy and Cervical Pathology. Practice changes include: new criteria for using liquid-based collection, a streamlined borderline category of atypical squamous cells (ASC), and a new category of ASC-cannot exclude high-grade lesion (ASC-H). Management includes colposcopy for all categories suspicious for epithelial abnormality and clearer guidelines for diagnostic colposcopy and endocervical sampling for glandular cell abnormalities (AGC, AGC-favor neoplasia). Adolescents and postmenopausal women have some variations from the recommended protocol. Reflex HPV DNA typing reflects the advances in research regarding risks for progression to cervical cancer. Treatment options include surgical removal of the lesions via laser, cryosurgery, loop excision, or cold-knife conization. Medical options include local treatments of cervical condyloma with tricloroacetic acid or 5-fluorouracil. Visible and sometimes functional cervical changes may result. Clinicians now have clearer guidelines with which to manage abnormal Papanicolaou test results, using the latest technology and research. Discussing abnormal results with patients requires great sensitivity.

The 4 currently recognized eating disorders are among the most common of psychiatric disorders to affect women in this country and are associated with chronic health impairments, although anorexia nervosa still carries a high mortality rate, including death by suicide. This review will focus primarily on the treatment of anorexia and bulimia nervosa and discuss interventions focused on engaging the patient, normalizing weight and nutritional status, changing dysfunctional attitudes and behaviors, and managing comorbid disorders such as major depression.

Objective: We evaluated the effects of hormone replacement therapy (HRT) alone and in combination with a selective serotonin reuptake inhibitor on mood, cognition, and neuroendocrine parameters in peri- and postmenopausal women.

Methods: We measured neuroendocrine variations in peri- and postmenopausal depressed patients (DP) and postmenopausal normal control (NC) women (45 to 72 years old) before and after treatment with HRT alone and HRT combined with antidepressant medication. All subjects were without significant medical illness and off psychoactive or other medication that would interfere with neuroendocrine measures.

Results: Menopausal DP women reported greater severity of hot flashes, were less likely to be "morning" types, and had relatively good neuropsychological function compared with NC. DP and NC had comparable levels of reproductive hormones, with the exception of elevated prolactin levels, which increased, as did thyroid-stimulating hormone levels, in response to estradiol treatment. DP had poor sleep quality as measured both by subjective ratings and objective polysomnographic measures compared with NC. In DP estradiol did not enhance the effect of antidepressant alone on mood ratings.

Conclusion: These findings may differ from other reports in the literature as a function of diagnoses of major depressive episode, randomized controlled trials, or dose and preparation of HRT. Further work is needed on the differential effect of treatment regimens in these disturbances that are evident primarily in baseline neuroendocrine function.

Objective: Risk of falling increases as people age, and decreased leg strength and poor balance have been implicated as contributors. Our aims were to:1) assess the efficacy of a fall-prevention exercise program on balance and leg strength in women aged 65 to 89 years and 2) conduct a 1-year follow-up to determine the effect of exercise on fall rates.

Methods: Forty women were classified by falling history and fear of falling and assigned to exercise and control groups using stratified randomization. We used the Berg Balance Scale, Get-up and Go, Functional Reach, and Wall-Sit Tests to evaluate changes in balance and leg strength before and after a supervised 15-week exercise program (31-hr sessions/week). We conducted 1-year follow-up telephone interviews and compared the number of falls reported by exercise and control groups.The study used a 2 x 2 (exercise/control by pretest/post-test) factorial design with the testing times being a repeated factor, so we used analysis of variance (ANOVA) to evaluate differences between the 2 groups across testing times. Power analysis computed a priori with STPLAN software (Version 4.2) showed that a sample size of 40 was necessary to determine statistical differences in balance and leg strength.

Results: Exercise subjects showed significant improvement on 5 of 14 items (5.2%, p < or = 05 to 34.4%, p < or = .01) in the Berg Balance Scale and on the total score (6.8%, p < or = .05). Leg strength increased significantly (p < or = .05) on post-test as measured by the Wall-Sit Test. Control subjects reported 6 falls and exercise subjects no falls during the follow-up year, but this difference was not significant using Fischer's exact test (p=.106).

Conclusion: The exercise program resulted in increased balance and leg strength, but did not result in a significant difference in falls during the follow-up period. Further research with a larger and possibly older sample is needed to more adequately investigate this question. Health care providers who work with older women should provide exercise programs in which balance and leg strength are emphasized.