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

Although recurrent pregnancy loss is rare, it is a major health problem. Fewer than 50% of cases have definitive causes. Thrombophilias such as factor V Leiden mutation may be responsible for a portion of the unexplained cases. In recent years, a number of studies have reached conflicting conclusions about the role of factor V Leiden in recurrent pregnancy loss. This article reviews the current literature. It appears that factor V Leiden mutation may be associated with stillbirth as well as with some poor pregnancy outcomes. The mutation may also be linked to first-trimester loss. Prospective case-controlled studies to better answer many of the questions concerning the role of this mutation in recurrent pregnancy loss and to determine optimal treatment may not be feasible because it is so rare. At this point, treatment involves anticoagulation and is based on observational studies and expert opinion.

Objective: To describe positive and negative consequences of health care screening for intimate partner violence from the perspectives of female survivors.

Method: We conducted 7 semistructured focus group interviews with 41 women in battered women's shelters or intimate partner violence support groups.

Results: Positive consequences of screening included: recognizing that the violence was a problem, decreased isolation, and feeling that the medical provider cared. Negative consequences included: feeling judged by the provider, increased anxiety about the unknown, feeling that the intervention protocol was cumbersome or intrusive, and disappointment in the provider's response.

Conclusion: We found that both positive and negative consequences can result from screening for intimate partner violence and that they are related to provider behavior. The positive consequences described by the participants reflect changes in their attitudes, thoughts, and feelings that may precede help seeking. A better understanding of consequences can help providers tailor screening approaches and interventions for intimate partner violence.

Objectives: To estimate the prevalence of unexplained chronic vulvar pain (burning or sharp knife like pain or pain on contact) in an ethnically diverse population-based sample of women.

Methods: We used town census directories to identify 4915 women age 18 to 64 from 5 ethnically diverse Boston communities and asked them to complete a self-administered questionnaire pertaining to current and past chronic lower genital tract discomfort (response rate 68%). We calculated the cumulative incidence and 95% confidence intervals by demographic and reproductive characteristics. Approximately 16% of respondents reported histories of chronic burning, knife like pain, or pain on contact that lasted for at least 3 months or longer, and nearly 7% were experiencing the problem at the time of the survey. Chronic vulvar pain on contact decreased with increasing age, but the cumulative incidence of chronic burning and knife like pain was similar across all ages. Contrary to earlier clinical assessments, white and African American women reported similar lifetime prevalences. However, Hispanic women were 80% more likely to experience chronic vulvar pain than were white and African American women. Women with histories of chronic vulvar pain were 7 to 8 times more likely to report difficulty and great pain with their first tampon use than were women without such histories. Nearly 40% of women chose not to seek treatment, and of those who did, 60% saw 3 or more doctors, many of whom could not provide a diagnosis.

Conclusion: Chronic unexplained vulvar pain is a highly prevalent disorder that is often misdiagnosed.

Women have been underrepresented in both cardiac rehabilitation (CR) clinical care and research studies. This review summarizes the available data on women in CR, including referral and enrollment patterns, baseline characteristics, and sex-specific outcomes reported within each core component of care. Women in CR tend to be older than their male counterparts and to have a greater burden of comorbidities and coronary risk factors and lower functional status. Women and men seem to benefit equally from CR, with improvements in clinical, psychosocial, and behavioral outcomes, but sex-specific data are lacking for several of the core components of care. Future research needs to test single and multiple behavioral interventions in randomized controlled trials, paying particular attention to their sex specificity, feasibility, and cost-effectiveness within CR and secondary prevention programs.

Cardiovascular disease is currently the leading cause of death in women in the United States, but many women underestimate this risk. The treatment of coronary syndromes with percutaneous coronary intervention (PCI) has increased steadily in the past decade, but women referred for PCI have a different profile of demographic features and clinical presentation than do their male counterparts. Concern has been raised about sex discrepancy in referral of women for invasive cardiology procedures. This may have resulted from the outcomes of initial studies of balloon angioplasty, which demonstrated decreased success and increased risk of angioplasty in women compared with men. However, more recent data have shown no sex difference in outcomes with contemporary PCI practices. Additionally, primary PCI for acute myocardial infarction in women is associated with improved mortality in women when compared to thrombolytic therapy. This review will examine the sex differences in demographics and outcomes of women undergoing PCI.

Women age 70 and older have the highest incidence and mortality from breast cancer of any age group. Despite this increased burden of disease, studies show that older women are the least likely to be screened for breast cancer. Barriers to routine mammography in this population include transportation and logistical issues, psychosocial barriers, low literacy levels, and institutional barriers. A variety of interventions, such as community health educators and mobile mammography, have been effective at increasing screening mammography among older women. Although limited, studies have reported that screening mammography reduced breast cancer mortality among women age 65 and older. Research supports continued screening with mammography for elderly women as long as their health is not significantly compromised by comorbid illness, and most organizational guidelines support screening mammography in healthy elderly women. Ultimately, the decision to continue breast cancer screening should be made by the patient and her physician after carefully weighing the risks and benefits of the procedure, which generally become more favorable as women age.

Objectives: To comprehensively assess condom use errors and problems reported by women who apply condoms, given the lack of data on this aspect of condom use.

Methods: Data from a questionnaire survey, using a 3-month recall period, was analyzed for a convenience sample of 102 college women who put condoms on their male partner(s) for sex (vaginal, anal, or oral). The percentage of the sample reporting that an error or problem occurred at least once is presented.

Results: Fifty-one percent put the condom on after starting sex, and 15% took the condom off before ending sex. Forty-eight percent wanted a condom but didn't have one, 46% did not leave space at the tip, 30% put the condom on wrong side up and had to flip the condom over, 26% did not use a lubricant, and 15% wanted a water-based lubricant and did not have any available. Twenty-five percent reported that their partners lost erections in association with condom use. Twenty-eight percent reported breakage, slippage, or both. Higher error scores were found for those who reported: 1) breakage or slippage, 2) partner erection problems, 3) use of another form of contraception, and 4) not having received instruction in correct condom use.

Conclusion: Educating women as well as men about correct condom use, in addition to promoting consistent condom use, may be an important public health strategy.

Objectives: To identify the prevalence of cardiovascular disease risk factors among Mississippi women from 1991 to 1999, using data from the Behavior Risk Factor Surveillance Survey (BRFSS) and to examine the probability that certain risk factors would occur in certain groups of African American and white women in Mississippi.

Methods: We extracted self-reported data on 9690 women in Mississippi from the BRFSS for 1991 to 1999. We performed logistic regression analyses to examine the independent effects of age and race as relative risks for cardiovascular disease, controlling for socioeconomic status.

Results: Odds ratios for cigarette smoking for some African American women, for high blood pressure for some white women, and for diabetes in some white and African American women were significantly elevated. Prevalence data, however, showed that African American women had a higher prevalence of diabetes and overweight than white women did.

Conclusion: The prevalence of overweight among Mississippi women seemed to increase as they aged. Decreasing obesity should be a major public health priority, as obesity's association with several chronic diseases is well documented and it is very prevalent among Mississippi women. Implementing programs to address unhealthy behaviors is essential for maintaining good health and thus should be strongly encouraged.