Pub Date : 2002-07-01DOI: 10.1089/152460902760277895
Pascal James Imperato, Jerry Waisman, Marcia Wallen, Christine C Llewellyn, Veronica Pryor
Objective: Information in pathology reports of breast cancer specimens is of critical importance to treating physicians for selection of local regional treatment and adjuvant therapy, evaluation of therapy, estimation of prognosis, and analysis of outcomes. This information is also of great importance to patients and their families. The Cancer Committee of the College of American Pathologists (CAP) and the Association of Directors of Anatomic and Surgical Pathology (ADASP) have published protocols for reporting the findings on breast cancer specimens to encourage adequate specimen examination and promote the reporting of findings in standardized formats and to provide treating physicians and their patients with vital information.
Methods: To assess the quality of breast cancer pathology practices and the degree to which they agree with published guidelines, we undertook a retrospective analysis among Medicare patients in New York State. Our random sample consisted of 748 (43.5%) of the 1718 cases of unilateral extended simple mastectomy, also referred to as total mastectomy with lymph node dissection (ICD-9-CM procedure code 85.43), for calendar year 1999. Of these, 555 (74.2%) were available for study, whereas the rest did not satisfy inclusion criteria. Among the 555 cases, 545 (98.2%) were women, and 10 (1.8%) were men. The gender distribution was proportionately the same at 98.2% and 1.8% for all 1718 cases.
Results: We examined the 555 hospital records for 16 elements (quality indicators). Aggregate performance on 7 of these was > or =83.7%, and performance was < or = 69.4% on 9 others. There were significant interhospital disparities in performance levels for a number of quality indicators. Although some hospitals always recorded certain indicators, others never did.
Conclusions: The issues with breast cancer pathology reports identified in this study are amenable to improvement to better serve patients, especially women, and their treating physicians in making adjuvant decisions, estimating prognosis, and evaluating outcomes.
目的:乳腺癌标本病理报告中的信息对治疗医师选择局部治疗和辅助治疗、评价治疗、估计预后和分析结果具有重要意义。这些信息对患者及其家属也非常重要。美国病理学家学会癌症委员会(CAP)和解剖与外科病理学主任协会(ADASP)发布了报告乳腺癌标本结果的协议,以鼓励充分的标本检查,促进以标准化格式报告结果,并为治疗医生及其患者提供重要信息。方法:为了评估乳腺癌病理实践的质量及其与已发表指南的一致程度,我们对纽约州的医疗保险患者进行了回顾性分析。我们的随机样本包括1999年1718例单侧扩大单侧乳房切除术中的748例(43.5%),也称为淋巴结清扫全乳切除术(ICD-9-CM程序代码85.43)。其中555例(74.2%)可用于研究,其余未满足纳入标准。555例中,女性545例(98.2%),男性10例(1.8%)。在所有1718例中,性别分布比例相同,分别为98.2%和1.8%。结果:对555份医院病历的16个要素(质量指标)进行了检查。其中7个项目的总绩效> or =83.7%,另外9个项目的绩效< or = 69.4%。在一些质量指标的表现水平上,医院间存在显著差异。虽然一些医院总是记录某些指标,但其他医院从未记录。结论:在本研究中发现的乳腺癌病理报告的问题是可以改进的,以便更好地为患者,特别是妇女,及其治疗医生做出辅助决策,估计预后和评估结果。
{"title":"Breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy.","authors":"Pascal James Imperato, Jerry Waisman, Marcia Wallen, Christine C Llewellyn, Veronica Pryor","doi":"10.1089/152460902760277895","DOIUrl":"https://doi.org/10.1089/152460902760277895","url":null,"abstract":"<p><strong>Objective: </strong>Information in pathology reports of breast cancer specimens is of critical importance to treating physicians for selection of local regional treatment and adjuvant therapy, evaluation of therapy, estimation of prognosis, and analysis of outcomes. This information is also of great importance to patients and their families. The Cancer Committee of the College of American Pathologists (CAP) and the Association of Directors of Anatomic and Surgical Pathology (ADASP) have published protocols for reporting the findings on breast cancer specimens to encourage adequate specimen examination and promote the reporting of findings in standardized formats and to provide treating physicians and their patients with vital information.</p><p><strong>Methods: </strong>To assess the quality of breast cancer pathology practices and the degree to which they agree with published guidelines, we undertook a retrospective analysis among Medicare patients in New York State. Our random sample consisted of 748 (43.5%) of the 1718 cases of unilateral extended simple mastectomy, also referred to as total mastectomy with lymph node dissection (ICD-9-CM procedure code 85.43), for calendar year 1999. Of these, 555 (74.2%) were available for study, whereas the rest did not satisfy inclusion criteria. Among the 555 cases, 545 (98.2%) were women, and 10 (1.8%) were men. The gender distribution was proportionately the same at 98.2% and 1.8% for all 1718 cases.</p><p><strong>Results: </strong>We examined the 555 hospital records for 16 elements (quality indicators). Aggregate performance on 7 of these was > or =83.7%, and performance was < or = 69.4% on 9 others. There were significant interhospital disparities in performance levels for a number of quality indicators. Although some hospitals always recorded certain indicators, others never did.</p><p><strong>Conclusions: </strong>The issues with breast cancer pathology reports identified in this study are amenable to improvement to better serve patients, especially women, and their treating physicians in making adjuvant decisions, estimating prognosis, and evaluating outcomes.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"537-47"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277868
Denise Von Mühlen, Deborah Morton, Carlos A Von Mühlen, Elizabeth Barrett-Connor
Objective: We examined postmenopausal estrogen (PME) use and prevalence of clinical osteoarthritis (OA) at the hand, knee, and hip in 1001 community-dwelling postmenopausal women aged 43-97 years (mean age 72).
Methods: OA at the hip, hand, and knee was defined by validated and standardized criteria based on pain history plus a clinical examination performed by a specially trained nurse.
Results: PME, validated by examination of pills and prescriptions, had been used for at least 1 year by 638 women (63.4%) for an average duration of 14.6 (+/-10.6) years. OA prevalence was 34.5% among women who had used PME for at least 1 year and 30.9% among women who did not use PME (age adjusted p = 0.02). Knee OA prevalence did not differ by PME use (p > 0.05). A significantly larger proportion of women who used PME for at least 1 year had hip and hand OA compared with women not using PME (4.1% vs. 1.1%, age-adjusted p = 0.002, and 15.8% vs. 13.5%, age-adjusted p = 0.02, respectively). In analyses adjusted for the potential confounding effects of age, body mass index (BMI), smoking, exercise, and type of menopause, women who used PME still were more likely to have hip OA (odds ratio [OR] = 5.03, confidence interval [CI] = 1.70-14.84, p = 0.003) and hand OA ([OR] = 1.57, CI = 1.05-2.33, p = 0.03). Among estrogen users, duration of PME use was longer for women with OA than for women without OA (16 vs. 11 median years, p = 0.01).
Conclusions: PME is associated with a higher prevalence of clinical OA.
目的:我们研究了1001名43-97岁(平均年龄72岁)的社区绝经后妇女绝经后雌激素(PME)的使用和临床手、膝和髋关节骨关节炎(OA)的患病率。方法:髋关节、手部和膝关节的骨关节炎由经过验证和标准化的标准定义,该标准基于疼痛史和经过专门培训的护士进行的临床检查。结果:638名妇女(63.4%)使用PME至少1年,平均持续时间14.6(+/-10.6)年。在使用PME至少1年的女性中,OA患病率为34.5%,在未使用PME的女性中为30.9%(年龄调整p = 0.02)。膝关节OA患病率与PME使用无显著性差异(p > 0.05)。与未使用PME的女性相比,使用PME至少1年的女性患髋部和手部OA的比例明显更大(分别为4.1%对1.1%,年龄调整p = 0.002, 15.8%对13.5%,年龄调整p = 0.02)。在校正了年龄、体重指数(BMI)、吸烟、运动和更年期类型等潜在混杂效应的分析中,使用PME的女性仍然更容易患髋部OA(优势比[OR] = 5.03,可信区间[CI] = 1.70-14.84, p = 0.003)和手部OA ([OR] = 1.57, CI = 1.05-2.33, p = 0.03)。在雌激素使用者中,患有OA的女性使用PME的时间比没有OA的女性更长(16年比11年,p = 0.01)。结论:PME与临床OA患病率较高有关。
{"title":"Postmenopausal estrogen and increased risk of clinical osteoarthritis at the hip, hand, and knee in older women.","authors":"Denise Von Mühlen, Deborah Morton, Carlos A Von Mühlen, Elizabeth Barrett-Connor","doi":"10.1089/152460902760277868","DOIUrl":"https://doi.org/10.1089/152460902760277868","url":null,"abstract":"<p><strong>Objective: </strong>We examined postmenopausal estrogen (PME) use and prevalence of clinical osteoarthritis (OA) at the hand, knee, and hip in 1001 community-dwelling postmenopausal women aged 43-97 years (mean age 72).</p><p><strong>Methods: </strong>OA at the hip, hand, and knee was defined by validated and standardized criteria based on pain history plus a clinical examination performed by a specially trained nurse.</p><p><strong>Results: </strong>PME, validated by examination of pills and prescriptions, had been used for at least 1 year by 638 women (63.4%) for an average duration of 14.6 (+/-10.6) years. OA prevalence was 34.5% among women who had used PME for at least 1 year and 30.9% among women who did not use PME (age adjusted p = 0.02). Knee OA prevalence did not differ by PME use (p > 0.05). A significantly larger proportion of women who used PME for at least 1 year had hip and hand OA compared with women not using PME (4.1% vs. 1.1%, age-adjusted p = 0.002, and 15.8% vs. 13.5%, age-adjusted p = 0.02, respectively). In analyses adjusted for the potential confounding effects of age, body mass index (BMI), smoking, exercise, and type of menopause, women who used PME still were more likely to have hip OA (odds ratio [OR] = 5.03, confidence interval [CI] = 1.70-14.84, p = 0.003) and hand OA ([OR] = 1.57, CI = 1.05-2.33, p = 0.03). Among estrogen users, duration of PME use was longer for women with OA than for women without OA (16 vs. 11 median years, p = 0.01).</p><p><strong>Conclusions: </strong>PME is associated with a higher prevalence of clinical OA.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"511-8"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277822
R M K Adanu
{"title":"Cervical cancer knowledge and screening in Accra, Ghana.","authors":"R M K Adanu","doi":"10.1089/152460902760277822","DOIUrl":"https://doi.org/10.1089/152460902760277822","url":null,"abstract":"","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"487-8"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277886
Yadong Cui, Maura K Whiteman, Patricia Langenberg, Mary Sexton, Katherine H Tkaczuk, Jodi A Flaws, Trudy L Bush
Objective: Black women are more likely to be diagnosed at a more advanced stage of breast cancer than are white women. Traditionally, this has been attributed in part to social or cultural factors. Given that black women are more likely to be obese than white women and that being obese is associated with a more advanced stage at diagnosis, this study aims to assess to what extent the racial difference in stage at diagnosis can be explained by racial differences in obesity.
Methods: Incident cases of breast cancer between 1991 and 1997 (white, n = 585; black, n = 381) were identified from hospitals in the Baltimore metropolitan area. Information, including age, race, weight, height, and pathology reports, was obtained from hospital medical records.
Results: Black women were more likely than white women to be diagnosed with breast cancer at tumor-node-metastasis (TNM) stage II or greater (age-adjusted odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.15-1.99). Further, black women were more likely than white women to be overweight or obese. A high body mass index (BMI) was significantly associated with an advanced stage of breast cancer at diagnosis. Adjustment for the higher prevalence of obesity in black women attenuated the risk estimate of more advanced stage of breast cancer at diagnosis in black women compared with white women by approximately 30%.
Conclusions: Our results suggest that the higher prevalence of obesity among black women plays an important role in explaining their relative disadvantage in stage at diagnosis of breast cancer. Nonetheless, a racial difference in stage of breast cancer at diagnosis persists after adjustment for obesity.
{"title":"Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women?","authors":"Yadong Cui, Maura K Whiteman, Patricia Langenberg, Mary Sexton, Katherine H Tkaczuk, Jodi A Flaws, Trudy L Bush","doi":"10.1089/152460902760277886","DOIUrl":"https://doi.org/10.1089/152460902760277886","url":null,"abstract":"<p><strong>Objective: </strong>Black women are more likely to be diagnosed at a more advanced stage of breast cancer than are white women. Traditionally, this has been attributed in part to social or cultural factors. Given that black women are more likely to be obese than white women and that being obese is associated with a more advanced stage at diagnosis, this study aims to assess to what extent the racial difference in stage at diagnosis can be explained by racial differences in obesity.</p><p><strong>Methods: </strong>Incident cases of breast cancer between 1991 and 1997 (white, n = 585; black, n = 381) were identified from hospitals in the Baltimore metropolitan area. Information, including age, race, weight, height, and pathology reports, was obtained from hospital medical records.</p><p><strong>Results: </strong>Black women were more likely than white women to be diagnosed with breast cancer at tumor-node-metastasis (TNM) stage II or greater (age-adjusted odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.15-1.99). Further, black women were more likely than white women to be overweight or obese. A high body mass index (BMI) was significantly associated with an advanced stage of breast cancer at diagnosis. Adjustment for the higher prevalence of obesity in black women attenuated the risk estimate of more advanced stage of breast cancer at diagnosis in black women compared with white women by approximately 30%.</p><p><strong>Conclusions: </strong>Our results suggest that the higher prevalence of obesity among black women plays an important role in explaining their relative disadvantage in stage at diagnosis of breast cancer. Nonetheless, a racial difference in stage of breast cancer at diagnosis persists after adjustment for obesity.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"527-36"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277912
Stephenie C Lemon, Wendy Verhoek-Oftedahl, Edward F Donnelly
Objective: Intimate partner violence (IPV) poses major health threats to women, including increased risk for several chronic health conditions. The impact of IPV on use of preventive health services is not well understood. Although several studies indicate that female victims of IPV have higher rates of alcohol abuse, this has not been replicated in population-based studies. The association of IPV with smoking has not been a major research focus. The purpose of this study was to examine the association between physical and psychological IPV in the past 12 months and preventive healthcare use, smoking, and alcohol use among women.
Methods: Data on 1643 women aged 18-54 from the 1999 Rhode Island Behavioral Risk Factor Surveillance System were analyzed. Logistic regression, controlling for age, race, marital status, education, insurance status, and functional disability, was used to model the associations of IPV with (1) checkups, (2) clinical breast examinations (CBEs), (3) Pap smear screening, (4) cigarette smoking, and (5) high-risk alcohol use.
Results: Prevalence of physical IPV was 4.1%. The prevalence of psychological IPV, in the absence of physical IPV was 4.5%. Physical IPV was associated with receiving regular Pap smears odds ratio ([OR] = 2.39, 95% confidence interval [CI] 1.01-5.70), current smoking (OR = 2.07, 95% CI 1.03-4.18), and high-risk alcohol use (OR = 4.85, 95% CI 2.02-11.60). Psychological IPV was associated with high-risk alcohol use (OR = 3.22, 95% CI 1.46-7.09).
Conclusions: Women experiencing IPV regularly access preventive healthcare, providing healthcare providers with opportunities to assess and counsel women for IPV in addition to smoking and high-risk alcohol use.
目标:亲密伴侣暴力对妇女的健康构成重大威胁,包括增加患几种慢性疾病的风险。IPV对使用预防性保健服务的影响尚不清楚。虽然几项研究表明,IPV的女性受害者有较高的酒精滥用率,但这在基于人群的研究中尚未得到证实。IPV与吸烟的关系一直不是主要的研究焦点。本研究的目的是研究过去12个月内女性的生理和心理IPV与预防性保健使用、吸烟和饮酒之间的关系。方法:对1999年罗德岛州行为危险因素监测系统中1643名18-54岁女性的数据进行分析。采用Logistic回归,控制年龄、种族、婚姻状况、教育程度、保险状况和功能障碍,对IPV与(1)体检、(2)临床乳房检查(CBEs)、(3)子宫颈抹片检查、(4)吸烟和(5)高危饮酒的关系进行建模。结果:物理IPV患病率为4.1%。在没有物理IPV的情况下,心理IPV的患病率为4.5%。物理IPV与定期接受子宫颈抹片检查的优势比([OR] = 2.39, 95%可信区间[CI] 1.01-5.70)、当前吸烟(OR = 2.07, 95% CI 1.03-4.18)和高危饮酒(OR = 4.85, 95% CI 2.02-11.60)相关。心理IPV与高危酒精使用相关(OR = 3.22, 95% CI 1.46-7.09)。结论:经历IPV的妇女定期获得预防性保健,为医疗保健提供者提供了评估和咨询妇女IPV的机会,除了吸烟和高风险饮酒。
{"title":"Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner violence.","authors":"Stephenie C Lemon, Wendy Verhoek-Oftedahl, Edward F Donnelly","doi":"10.1089/152460902760277912","DOIUrl":"https://doi.org/10.1089/152460902760277912","url":null,"abstract":"<p><strong>Objective: </strong>Intimate partner violence (IPV) poses major health threats to women, including increased risk for several chronic health conditions. The impact of IPV on use of preventive health services is not well understood. Although several studies indicate that female victims of IPV have higher rates of alcohol abuse, this has not been replicated in population-based studies. The association of IPV with smoking has not been a major research focus. The purpose of this study was to examine the association between physical and psychological IPV in the past 12 months and preventive healthcare use, smoking, and alcohol use among women.</p><p><strong>Methods: </strong>Data on 1643 women aged 18-54 from the 1999 Rhode Island Behavioral Risk Factor Surveillance System were analyzed. Logistic regression, controlling for age, race, marital status, education, insurance status, and functional disability, was used to model the associations of IPV with (1) checkups, (2) clinical breast examinations (CBEs), (3) Pap smear screening, (4) cigarette smoking, and (5) high-risk alcohol use.</p><p><strong>Results: </strong>Prevalence of physical IPV was 4.1%. The prevalence of psychological IPV, in the absence of physical IPV was 4.5%. Physical IPV was associated with receiving regular Pap smears odds ratio ([OR] = 2.39, 95% confidence interval [CI] 1.01-5.70), current smoking (OR = 2.07, 95% CI 1.03-4.18), and high-risk alcohol use (OR = 4.85, 95% CI 2.02-11.60). Psychological IPV was associated with high-risk alcohol use (OR = 3.22, 95% CI 1.46-7.09).</p><p><strong>Conclusions: </strong>Women experiencing IPV regularly access preventive healthcare, providing healthcare providers with opportunities to assess and counsel women for IPV in addition to smoking and high-risk alcohol use.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"555-62"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277859
Sherry A Marts
Progress in sex-based biology, the study of biological and behavioral differences between males and females, and the impact of those differences on health and disease will require collaboration across research disciplines and medical specialties and among all research approaches, from molecular biology to epidemiology. The importance of sex-based biology to healthcare necessitates a bench-to-bedside approach that is built on integration of research findings from studies at the cellular level, in animals, and in human subjects. Barriers to interdisciplinary collaborations are being addressed in a variety of ways by public and private funders. The J.D. and C.T. MacArthur Foundation supports interdisciplinary research networks that address broad questions in health and behavior. The National Institute of Mental Health supports cross-disciplinary research networks investigating the hypothalamic-pituitary-adrenal network. The National Institute of Child Health and Human Development offers grants for Building Interdisciplinary Research Careers in Women's Health. The National Science Foundation Directorate for Biological Sciences sponsors Research Coordination Networks in Biological Sciences. Among the challenges faced by interdisciplinary research programs are appropriate peer review, career advancement for young investigators with interdisciplinary training, and acceptance of interdisciplinary research reports by high-quality scientific publications.
{"title":"Interdisciplinary research is key to understanding sex differences: report from the Society for Women's Health Research Meeting on understanding the biology of sex differences.","authors":"Sherry A Marts","doi":"10.1089/152460902760277859","DOIUrl":"https://doi.org/10.1089/152460902760277859","url":null,"abstract":"<p><p>Progress in sex-based biology, the study of biological and behavioral differences between males and females, and the impact of those differences on health and disease will require collaboration across research disciplines and medical specialties and among all research approaches, from molecular biology to epidemiology. The importance of sex-based biology to healthcare necessitates a bench-to-bedside approach that is built on integration of research findings from studies at the cellular level, in animals, and in human subjects. Barriers to interdisciplinary collaborations are being addressed in a variety of ways by public and private funders. The J.D. and C.T. MacArthur Foundation supports interdisciplinary research networks that address broad questions in health and behavior. The National Institute of Mental Health supports cross-disciplinary research networks investigating the hypothalamic-pituitary-adrenal network. The National Institute of Child Health and Human Development offers grants for Building Interdisciplinary Research Careers in Women's Health. The National Science Foundation Directorate for Biological Sciences sponsors Research Coordination Networks in Biological Sciences. Among the challenges faced by interdisciplinary research programs are appropriate peer review, career advancement for young investigators with interdisciplinary training, and acceptance of interdisciplinary research reports by high-quality scientific publications.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"501-9"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277840
Stuart B Levy, Jack B Anon
{"title":"Toward optimal health: the experts discuss antibiotic therapy in primary care. Interview by Jodi Godfrey Meisler.","authors":"Stuart B Levy, Jack B Anon","doi":"10.1089/152460902760277840","DOIUrl":"https://doi.org/10.1089/152460902760277840","url":null,"abstract":"","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"493-9"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277903
Grace Wyshak
Objective: Diabetes has been increasing in incidence and prevalence in the United States. Physical activity and exercise have been shown to lower the risk of noninsulin-dependent diabetes (NIDD), and family history and genetic factors are associated with both insulin-dependent diabetes (IDD) (type 1) and NIDD. The objective of this paper is to examine risk factors for diabetes in female college graduates as part of a study designed to determine the long-term health of former college athletes compared with nonathletes. The study was first conducted in 1981-1982, and a follow-up study was conducted in 1996-1997.
Methods: The subjects for this paper are 3940 college alumnae (1945 former athletes and 1995 nonathletes), who participated in the follow-up study by responding to a self-administered questionnaire on medical history, health, family history, and behavioral practices.
Results: About 1.3% of the women reported physician-diagnosed diabetes, 0.9% of the former athletes, and 1.7% of the nonathletes. Former athletes had a significantly lower risk of NIDD, with an age-adjusted odds ratio (OR) of 0.41, 95% confidence level (CL) 0.2, 0.9. IDD was associated with a history of paternal diabetes (OR = 4.7, 95% CL 1.5, 14.9) and also with a history of diabetes in siblings (OR = 6.7, 95% CL 1.5, 30.1). NIDD was associated with a history of maternal diabetes (OR = 8.0, 95% CL 3.6, 17.8). Behavioral factors showed no association with IDD but were inversely associated with NIDD. The OR for being an athlete was 0.4, 95% CL 0.2, 0.9; for current regular exercise, OR = 0.4, 95% CL 0.2, 0.9; low body mass index (BMI) compared to high BMI, OR = 0.2, 95% CL 0.05, 0.60.
Conclusions: The findings that IDD is associated with paternal diabetes and that NIDD may be maternally transmitted are not widely known, although the mode of transmission of diabetes is receiving increasing attention in the medical and genetic literature. This study confirms that modifiable behavioral practices, such as physical activity and weight control (i.e., optimal BMI), reduce the risk of NIDD.
{"title":"Behavior, heredity, and diabetes in college alumnae.","authors":"Grace Wyshak","doi":"10.1089/152460902760277903","DOIUrl":"https://doi.org/10.1089/152460902760277903","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes has been increasing in incidence and prevalence in the United States. Physical activity and exercise have been shown to lower the risk of noninsulin-dependent diabetes (NIDD), and family history and genetic factors are associated with both insulin-dependent diabetes (IDD) (type 1) and NIDD. The objective of this paper is to examine risk factors for diabetes in female college graduates as part of a study designed to determine the long-term health of former college athletes compared with nonathletes. The study was first conducted in 1981-1982, and a follow-up study was conducted in 1996-1997.</p><p><strong>Methods: </strong>The subjects for this paper are 3940 college alumnae (1945 former athletes and 1995 nonathletes), who participated in the follow-up study by responding to a self-administered questionnaire on medical history, health, family history, and behavioral practices.</p><p><strong>Results: </strong>About 1.3% of the women reported physician-diagnosed diabetes, 0.9% of the former athletes, and 1.7% of the nonathletes. Former athletes had a significantly lower risk of NIDD, with an age-adjusted odds ratio (OR) of 0.41, 95% confidence level (CL) 0.2, 0.9. IDD was associated with a history of paternal diabetes (OR = 4.7, 95% CL 1.5, 14.9) and also with a history of diabetes in siblings (OR = 6.7, 95% CL 1.5, 30.1). NIDD was associated with a history of maternal diabetes (OR = 8.0, 95% CL 3.6, 17.8). Behavioral factors showed no association with IDD but were inversely associated with NIDD. The OR for being an athlete was 0.4, 95% CL 0.2, 0.9; for current regular exercise, OR = 0.4, 95% CL 0.2, 0.9; low body mass index (BMI) compared to high BMI, OR = 0.2, 95% CL 0.05, 0.60.</p><p><strong>Conclusions: </strong>The findings that IDD is associated with paternal diabetes and that NIDD may be maternally transmitted are not widely known, although the mode of transmission of diabetes is receiving increasing attention in the medical and genetic literature. This study confirms that modifiable behavioral practices, such as physical activity and weight control (i.e., optimal BMI), reduce the risk of NIDD.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"549-54"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277903","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21985832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1089/152460902760277877
Eric A Finkelstein, Philip J Troped, Julie C Will, Ruth Palombo
Objective: The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk reduction program targeting older uninsured and underinsured women. The cost-effectiveness of providing CVD screening and enhanced lifestyle interventions (EI), compared with providing CVD screening and a minimum intervention (MI), was assessed at five El and six MI healthcare sites.
Methods: Cost calculations were based on data collected during screenings and intervention activities conducted with 1586 women in 1996. Risk factor data, including cholesterol and blood pressure measures, were used to create a summary effectiveness outcome, the 10-year probability of developing coronary heart disease (CHD). The cost-effectiveness ratio of the EI, compared with the MI, was calculated by dividing the incremental cost of the EI by the incremental effectiveness of the EI.
Results: The incremental cost of the EI was $191. During the 1-year study period, the 10-year probability of CHD decreased from 9.4% to 9.2% in the MI group and from 10.3% to 9.8%in the El group. Based on these results, it would cost $637 to achieve a 1 percentage point larger decrease in the 10-year probability of CHD for women enrolled in the El. However, because differences between groups were not statistically significant, we cannot reject the hypothesis that the El results in no greater reductions in CHD risk.
Conclusions: Although women enrolled in both the MI and El showed decreases in CHD risk during the study period, future research is needed to assess the impact of lifestyle interventions targeting financially disadvantaged women.
{"title":"Cost-effectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: the Massachusetts WISEWOMAN project.","authors":"Eric A Finkelstein, Philip J Troped, Julie C Will, Ruth Palombo","doi":"10.1089/152460902760277877","DOIUrl":"https://doi.org/10.1089/152460902760277877","url":null,"abstract":"<p><strong>Objective: </strong>The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk reduction program targeting older uninsured and underinsured women. The cost-effectiveness of providing CVD screening and enhanced lifestyle interventions (EI), compared with providing CVD screening and a minimum intervention (MI), was assessed at five El and six MI healthcare sites.</p><p><strong>Methods: </strong>Cost calculations were based on data collected during screenings and intervention activities conducted with 1586 women in 1996. Risk factor data, including cholesterol and blood pressure measures, were used to create a summary effectiveness outcome, the 10-year probability of developing coronary heart disease (CHD). The cost-effectiveness ratio of the EI, compared with the MI, was calculated by dividing the incremental cost of the EI by the incremental effectiveness of the EI.</p><p><strong>Results: </strong>The incremental cost of the EI was $191. During the 1-year study period, the 10-year probability of CHD decreased from 9.4% to 9.2% in the MI group and from 10.3% to 9.8%in the El group. Based on these results, it would cost $637 to achieve a 1 percentage point larger decrease in the 10-year probability of CHD for women enrolled in the El. However, because differences between groups were not statistically significant, we cannot reject the hypothesis that the El results in no greater reductions in CHD risk.</p><p><strong>Conclusions: </strong>Although women enrolled in both the MI and El showed decreases in CHD risk during the study period, future research is needed to assess the impact of lifestyle interventions targeting financially disadvantaged women.</p>","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"11 6","pages":"519-26"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/152460902760277877","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22001570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1089/15246090260137644
A. Coker, P. Smith, M. Thompson, R. Mckeown, L. Bethea, K. Davis
OBJECTIVES Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women. METHODS A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview. RESULTS IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9). CONCLUSIONS Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.
对受虐待妇女的社会支持可能会减少虐待对心理健康的影响,但很少有研究涉及这一问题。我们希望确定亲密伴侣暴力(IPV)与心理健康结果之间的关联,并评估披露虐待行为和提供支持对受虐待妇女心理健康的保护作用。方法对1997 - 1999年从家庭诊所招募的1152名年龄在18-65岁的妇女进行横断面调查。在简短的门诊访谈中对他们进行IPV筛查,并在后续访谈中评估身体和心理健康状况。结果tsipv被定义为性、身体或心理虐待,与感知的精神和身体健康状况不佳、药物滥用、创伤后应激障碍(PTSD)症状、当前抑郁、焦虑和自杀意念/行为有关。在经历IPV并控制IPV频率的女性中,较高的社会支持评分与感知心理健康不良(调整相对风险[aRR] 0.5, 95%置信区间[CI] 0.3, 0.6)和身体健康(aRR 0.6, 95% CI 0.5, 0.8)、焦虑(aRR 0.3, 95% CI 0.2, 0.4)、当前抑郁(aRR 0.6, 95% CI 0.5, 0.8)、创伤后应激障碍症状(aRR 0.5, 95% CI 0.4, 0.8)和自杀企图(aRR 0.6, 95% CI 0.4, 0.9)的风险显著降低相关。结论医疗服务提供者可以在识别IPV和帮助妇女发展技能、资源和支持网络解决IPV方面发挥重要作用。医生、家人或朋友可以提供所需的社会支持。
{"title":"Social support protects against the negative effects of partner violence on mental health.","authors":"A. Coker, P. Smith, M. Thompson, R. Mckeown, L. Bethea, K. Davis","doi":"10.1089/15246090260137644","DOIUrl":"https://doi.org/10.1089/15246090260137644","url":null,"abstract":"OBJECTIVES\u0000Social support for abused women may reduce the impact of abuse on mental health, yet few studies have addressed this issue. We wish to determine associations between intimate partner violence (IPV) and mental health outcomes and to assess the protective role of abuse disclosure and support on mental health among abused women.\u0000\u0000\u0000METHODS\u0000A cross-sectional survey was conducted of 1152 women, ages 18-65, recruited from family practice clinics from 1997 through 1999. They were screened for IPV during a brief in-clinic interview, and physical and mental health status was assessed in a follow-up interview.\u0000\u0000\u0000RESULTS\u0000IPV, defined as sexual, physical, or psychological abuse, was associated with poor perceived mental and physical health, substance abuse, symptoms of posttraumatic stress disorder (PTSD), current depression, anxiety, and suicide ideation/actions. Among women experiencing IPV and controlling for IPV frequency, higher social support scores were associated with a significantly reduced risk of poor perceived mental health (adjusted relative risk [aRR] 0.5, 95% confidence interval [CI] 0.3, 0.6) and physical health (aRR 0.6, 95% CI 0.5, 0.8), anxiety (aRR 0.3, 95% CI 0.2, 0.4), current depression (aRR 0.6, 95% CI 0.5, 0.8), PTSD symptoms (aRR 0.5, 95% CI 0.4, 0.8), and suicide attempts (aRR 0.6, 95% CI 0.4, 0.9).\u0000\u0000\u0000CONCLUSIONS\u0000Healthcare providers can be instrumental in identifying IPV and helping women develop skills, resources, and support networks to address IPV. Physicians, family, or friends may provide needed social support.","PeriodicalId":80044,"journal":{"name":"Journal of women's health & gender-based medicine","volume":"8 1","pages":"465-76"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75798670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}