Journal of women's health & gender-based medicine最新文献

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.

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.

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.

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.

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.

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.

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.