Showing papers in "Journal of Womens Health in 2011"
TL;DR: Routine HIV testing is underused among women during their postreproductive years and HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.
Abstract: Objective and background: Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. Methods: Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50–64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. Results: More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50–54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those ...
429 citations
TL;DR: Overall, results confirm the profound impact of violence and victimization and how it is intertwined with poor decision making, increased risk taking and negative health consequences, particularly in the context of substance abuse.
Abstract: Women in the United States are increasingly affected by HIV/AIDS. The SAVA syndemic—synergistic epidemics of substance abuse, violence, and HIV/AIDS—is highly prevalent among impoverished urban women and potentially associated with poor HIV outcomes. A review of the existing literature found 45 articles that examine SAVA's impact on (1) HIV-associated risk-taking behaviors, (2) mental health, (3) healthcare utilization and medication adherence, and (4) the bidirectional relationship between violence and HIV status. Overall, results confirm the profound impact of violence and victimization and how it is intertwined with poor decision making, increased risk taking and negative health consequences, particularly in the context of substance abuse. Among current findings, there remain diverse and inconsistent definitions for substance abuse, violence, mental illness, adherence, and healthcare utilization that confound interpretation of data. Future studies require standardization and operationalization of definitions for these terms. Development and adaptation of evidence-based interventions that incorporate prevention of violence and management of victimization to target this vulnerable group of women and thereby promote better health outcomes are urgently needed.
293 citations
TL;DR: The current level of compliance with guidelines for the inclusion, analysis, and reporting of sex and race/ethnicity in federally funded randomized controlled trials (RCTs) is compared to that from 2004.
Abstract: Background: The National Institutes of Health (NIH) Revitalization Act of 1993 requires that NIH-funded clinical trials include women and minorities as participants; other federal agencies have adopted similar guidelines. The objective of this study is to determine the current level of compliance with these guidelines for the inclusion, analysis, and reporting of sex and race/ethnicity in federally funded randomized controlled trials (RCTs) and to compare the current level of compliance with that from 2004, which was reported previously. Methods: RCTs published in nine prominent medical journals in 2009 were identified by PubMed search. Studies where individuals were not the unit of analysis, those begun before 1994, and those not receiving federal funding were excluded. PubMed search located 512 published articles. After exclusion of ineligible articles, 86 (17%) remained for analysis. Results: Thirty studies were sex specific. The median enrollment of women in the 56 studies that included both ...
289 citations
TL;DR: Maternal depression is a major public health problem in the United States, with an estimated 1 in 10 children experiencing a depressed mother in any given year and professionals who work with mothers and children should be aware of its prevalence and its detrimental effects.
Abstract: Objectives: To examine the public health burden of major depressive disorder (MDD) among mothers: its prevalence and sociodemographic patterns; associated functioning, comorbidities, and adversities; and racial/ethnic disparities. Methods: This was a cross-sectional analysis of 8916 mothers in the National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative survey of the civilian U.S. population in 2001–2002. Past-year MDD was assessed with a structured interview protocol. Results: Ten percent of mothers experienced depression in the past year. White and Native American women, those with low education or income, and those not married had high rates of depression. Depression was not strongly patterned by number of or age of children. Depressed mothers experienced more adversities (poverty, separation or divorce, unemployment, financial difficulties) and had worse functioning. Half of depressed mothers received services for their depression. Black and Hispanic depres...
255 citations
TL;DR: Women's prepregnancy alcohol consumption and exposure to abuse or violence were consistently associated with drinking during pregnancy, and antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.
Abstract: Background: Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts. Methods: A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the woman's pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e.g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009. Results: Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were...
221 citations
TL;DR: Rural women experience higher rates of IPV and greater frequency and severity of physical abuse yet live much farther away from available resources, and more IPV resources and interventions targeting rural women are needed.
Abstract: Objective: Intimate partner violence (IPV) against women is a significant health issue in the United States and worldwide. The majority of studies on IPV have been conducted in urban populations. The objectives of this study are to determine if prevalence, frequency, and severity of IPV differ by rurality and to identify variance in geographic access to IPV resources. Methods: A cross-sectional clinic-based survey of 1478 women was conducted to measure the 1-year prevalence of physical, sexual, and psychologic IPV. IPV intervention programs in the state were inventoried and mapped, and the distance to the closest program was estimated for each participant based on an innovative algorithm developed for use when only ZIP code location is available. Results: Women in small rural and isolated areas reported the highest prevalence of IPV (22.5% and 17.9%, respectively) compared to 15.5% for urban women. Rural women reported significantly higher severity of physical abuse than their urban counterparts....
204 citations
TL;DR: Evaluated the relationship between maternal prepregnancy BMI, including comorbidities associated with overweight and obesity such as diabetes mellitus, and BF initiation and duration in overweight and obese women to better understand the role of race/ethnicity, gestational weight gain, and such comorbridities as diabetes in increasing risk for reduced BF initiation.
Abstract: Background: Previous studies have found an association between maternal obesity and overweight and breastfeeding (BF) difficulties, including delayed lactogenesis and shorter duration of BF. Biological, psychological, and mechanical causes have been linked with poor BF outcomes. Other review articles on this topic have included studies that measured maternal body mass index (BMI) in the postpartum period instead of prenatally, presenting difficulties in teasing out the role of gestational weight gain and prepregnancy BMI on BF success. My objective was to evaluate the relationship between maternal prepregnancy BMI, including comorbidites associated with overweight and obesity such as diabetes mellitus, and BF initiation and duration. Methods: Four PubMed searches were conducted, retrieving 13 articles. Results: Of the 12 studies reviewed that assessed the association between prepregnancy maternal BMI category and BF initiation, 9 found an association between maternal overweight or obesity and del...
192 citations
TL;DR: The Centers for Disease Control and Prevention has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions.
Abstract: unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception.
180 citations
TL;DR: This is the first community-based epidemiologic study demonstrating that DSM-IV-diagnosed antecedent depression and anxiety disorders influence the risk of vulvodynia and that vulVodynia increases therisk of both new and recurrent onset of psychopathology.
Abstract: Background: Studies have shown that women with vulvodynia are more psychologically distressed than women without vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and vulvodynia. Methods: The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 case-control pairs of women with and without vulvodynia. Interviews established age at first onset of diagnosed mood and anxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new or recurrent onset of mood or anxiety disorder. Results: After adjusting for education, race, age at menarche, age at first tampon ...
166 citations
TL;DR: Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care.
Abstract: Objectives: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. Methods: We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Results: Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg/m2 (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the vis...
156 citations
TL;DR: Accessibility of screening services could be improved through planning and implementation of screening programs involving community leaders and culturally appropriate messages and based on demographic factors, knowledge, beliefs, and attitudes that influence cervical screening.
Abstract: Aims: The aims of this study were (1) to estimate what proportion of rural females had received cervical screening, (2) to assess knowledge, beliefs, attitudes, and demographics that influence cervical screening, and (3) to predict cervical screening accessibility based on demographic factors, knowledge, beliefs, and attitudes that influence cervical screening. Methods: The study sample consisted of randomly selected, sexually active, rural females between 12 and 84 years of age. Five hundred fourteen females responded to an individually administered questionnaire. Results: Of the 514 participants, 91% had never had cervical screening and 81% had no previous knowledge of cervical screening tests; 80% of the group expressed positive beliefs about cervical screening tests after an educational intervention. Females who were financially independent were 6.61% more likely to access cervical screening compared with those who were dependent on their husbands. Females in mining villages were 4.47% more l...
TL;DR: This study provides one of the first descriptive profiles of allostatic load among a nationally representative sample of adult women in the United States and presents racial/ethnic trends in AL across age groups that are useful for identifying demographically and clinically important subgroups at risk of having high cumulative physiological dysregulation.
Abstract: Objective: This study provides a descriptive sociodemographic profile of allostatic load (AL) among adult women of all age groups, focusing on how age patterns of AL vary across racial/ethnic groups. Allostatic load, an index of cumulative physiological dysregulation, captures how the cumulative impact of physiological stress responses from person-environment interactions causes wear and tear on the body's regulatory systems, which in turn can lead to disease outcomes and health disparities. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, this study examines AL in a nationally representative sample of women ≥18 years of age (n=5765). Measures of AL using 10 biomarkers representing cardiovascular, inflammatory, and metabolic system functioning were created. Multivariate negative binomial regression models were used, and predicted AL scores were computed. Results: Black women had the highest predicted AL scores relative to other racial/ethnic groups...
TL;DR: Insomnia symptoms affected a significant proportion of the perinatal women in this sample, and are linked to symptoms of depression and anxiety in treatment-seeking pregnant and postpartum women.
Abstract: Background: Depression and anxiety symptoms are commonly experienced by women during the perinatal period. Changes in sleep and sleep quality are typical throughout pregnancy and early postpartum. However, little is known about relationships between insomnia symptoms and psychiatric symptoms in perinatal women. The objective of the present study is to characterize the burden of insomnia symptoms in perinatal women seeking outpatient psychiatric treatment and to examine relationships between insomnia and symptoms of depression and anxiety. Methods: Data from 257 pregnant or postpartum women who sought outpatient psychiatric treatment at a university hospital-affiliated clinic were extracted from an existing clinical management database. Data included validated self-report measures assessing insomnia (Insomnia Severity Index [ISI]), mood (Edinburgh Postnatal Depression Scale [EPDS]), and generalized anxiety (Penn State Worry Questionnaire [PSWQ]). Results: Fifty-two percent of women reported sympto...
TL;DR: Clinicians should be encouraged to provide timely and accurate advice to women about gestational weight gain and interventions to promote healthy gestationalWeight gain may benefit from targeting women's beliefs about ideal and expected gestational Weight gain.
Abstract: Background: The purpose of this study was to investigate receipt of gestational weight gain advice in prenatal care and ideal and expected gestational weight gain outcomes for normal weight and overweight/obese women. Methods: This was a cross-sectional study of normal weight (n = 203) and overweight/obese (n = 198) women in early (<16 weeks) pregnancy. Results: Less than half of participants (41.7%) reported receiving weight gain advice from a practitioner. In multivariate models, pregravid weight status was not significantly related to receiving advice. However, women with lower income (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.77, p = 0.01), younger age (OR 0.93, 95% CI 0.87-0.99, p = 0.02), and multiparity (OR 0.49, 95% CI 0.28-0.87, p = 0.02) were least likely to report receiving advice. Among those receiving advice, most (85%) received accurate advice; however, overweight/obese women were more likely to be advised to overgain compared with normal weight women (22.2% vs. 2.3%...
TL;DR: The results indicate that there may be some benefits of dietary counseling, an LGI diet advice, or an exercise program for prevention of GDM, but better-designed studies are required to generate higher quality evidence.
Abstract: Background: The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM is associated with increased risks for mother and child during pregnancy and in later life. The aim of this article is to systematically review literature on the effectiveness of interventions to prevent GDM. Methods: Controlled trials found in PubMed, EMBASE, or CENTRAL were selected. The primary outcome was GDM, and relevant secondary outcomes were maternal fasting blood glucose and large-for-gestational age (LGA) or macrosomia. Data were combined in meta-analyses, and the quality of evidence for the effectiveness of the interventions was assessed in a GRADE approach. Results: Nineteen studies evaluating six types of interventions were included. Dietary counseling significantly reduced GDM incidence compared to standard care. None of the interventions was effective in lowering maternal fasting blood glucose. Low glycemic index (LGI) diet advice and an exercise program significantly reduced the risk of macrosomia. The quality of evidence for these outcomes was low. Conclusions: The results indicate that there may be some benefits of dietary counseling, an LGI diet advice, or an exercise program. However, better-designed studies are required to generate higher quality evidence. At the moment, no strong conclusions can be drawn with regard to the best intervention for prevention of GDM. © 2011 Mary Ann Liebert, Inc.
TL;DR: Younger maternal age, poverty, lower education, and lack of social support were all significantly associated with increased maternal depression in multivariate regression models.
Abstract: Background: This longitudinal study examined maternal depression status from birth of a child to 36 months of age using data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development. Methods: Maternal depression was assessed using the Center of Epidemiological Studies Depression Scale (CES-D) and defined as a score of ≥16. For this study, early onset depression was defined as depression within the 6 months after birth, and late onset depression was depression onset when the child was ≥24 months old. Chronic depression was defined as depression that started within 6 months after birth and lasted until 24 months of age or longer. Results: The prevalence of maternal depression was 32.2% for early onset, 7.4% for late onset, and 13.4% for chronic depression. The prevalence of maternal depression was highest at 1 month, decreased at 6 months, and then remained fairly stable until 36 months. Mothers 18–24 years of age, of black race, unem...
TL;DR: Fully characterizing pregnancy intention and its relationship to psychosocial profiles may provide a basis for identifying women with highest risk during pregnancy and early motherhood.
Abstract: Objectives: We explore the psychosocial, demographic, and maternal characteristics across wanted, mistimed, and unwanted pregnancies. Methods: Data from 1321 women from a prospective cohort study of pregnant women in Durham, NC, are analyzed. Psychosocial correlates were obtained through prenatal surveys; electronic medical records were used to ascertain maternal health and pregnancy outcomes. Results: Sixty-two percent of the women indicated an unintended pregnancy, with 44% (578) mistimed and 18% (245) unwanted. Only 38% of the pregnancies were characterized as wanted. Women with unwanted and with mistimed pregnancies were similar demographically, but they differed significantly on psychosocial profiles and maternal characteristics. Women with mistimed and with wanted pregnancies differed in demographics and psychosocial profiles. Wanted pregnancies had the healthiest, mistimed an intermediate, and unwanted the poorest psychosocial profile. Women with unwanted pregnancies had the highest depres...
TL;DR: The findings of this study can guide future research aimed at ensuring high-quality, culturally appropriate, patient-centered healthcare for Muslim women in the United States and other western countries.
Abstract: Objective: The purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care. Methods: Using a cross-sectional study design, a written survey was administered to a convenience sample of healthcare providers (n = 80) and Muslim women (n = 27). Results: There was considerable congruence among patients and providers regarding healthcare needs of Muslim women. A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their healthcare provider did not understand their religious or cultural needs. Providers and patients outlined similar barriers/challenges and recommendations. Key challenges in...
TL;DR: A multifaceted approach with efficient identification of social, cultural, and environmental factors that give rise to obesity tolerance in blacks will provide potential targets for intervention, which may ameliorate weight misperception and the prevalence of excess weight in the black population.
Abstract: Background: The prevalence of obesity is higher in blacks than whites, especially in black women, and is known to be associated with major cardiovascular disease risk factors, which are also more prevalent in blacks than whites. Weight perception may contribute to these differences if blacks are more likely to underestimate their weight. We explored race and gender differences in underestimation of weight using body mass index (BMI) and waist circumference (WC), after adjusting for other cardiovascular risk factors. Methods and Results: We studied 219 white and 240 black women and men as part of the META-Health Study. Perceived weight was assessed over the phone and categorized into three categories: underweight or normal weight, overweight, or obesity. Height, weight, and WC were measured at a subsequent visit, and BMI was calculated. Logistic regression was used to compare the likelihood of underestimating actual weight category by race, before and after adjusting for sociodemographic, lifestyl...
TL;DR: Neither preexisting diabetes nor GDM was independently associated with increased risk of antenatal depression, and both were associated with similar odds for antenatal major depression.
Abstract: Background: Prior studies have reported inconsistent findings regarding the association of antenatal depression with pregnancy-related diabetes. This study examined the association of diabetes and antenatal depression. Methods: We conducted a cross-sectional analysis of baseline data from a prospective cohort study of pregnant women receiving prenatal care at a single University of Washington Medical Center clinic between January 2004 and January 2009. The primary exposure was diabetes in pregnancy (no diabetes, preexisting diabetes, or gestational diabetes [GDM]). Antenatal depression was defined by the Patient Health Questionnaire-9 (PHQ-9) score or current use of antidepressants. Antenatal depression was coded as (1) any depression (probable major or minor depression by PHQ-9 or current antidepressant use) and (2) major depression (probable major depression by PHQ-9 or current antidepressant use). Logistic regression was used to quantify the association between diabetes in pregnancy and antena...
TL;DR: Older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women, and some women who have been physically or sexually assaulted decades earlier in life continue to report significant levels of PTSD well into older adulthood.
Abstract: Background: This systematic review synthesizes the quantitative empirical literature concerning older women survivors of physical and sexual assault. Methods: A literature search was conducted using a range of scholarly databases. Information is presented here on the prevalence, correlates, and consequences of these types of interpersonal violence in older women. Additionally, age-related differences in prevalence, psychiatric distress, and characteristics of violence, including information on perpetrators, are reviewed. Results: Overall, older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women. Additionally, older women who experienced interpersonal violence report greater psychiatric distress, including posttraumatic stress disorder (PTSD), than older women who have not experienced such events. Conclusions: Some women who have been physically or sexually assaulted decades earli...
ALFA1
TL;DR: The findings suggest that boric acid is a safe, alternative, economic option for women with recurrent and chronic symptoms of vaginitis when conventional treatment fails because of the involvement of non-albicans Candida spp.
Abstract: Background: Recurrent vulvovaginal candidiasis (VVC) remains a challenge to manage in clinical practice. Recent epidemiologic studies indicate that non-albicans Candida spp. are more resistant to conventional antifungal treatment with azoles and are considered as causative pathogens of vulvovaginal candidiasis. Methods: We searched PubMed and Scopus for studies that reported clinical evidence on the intravaginal use of boric acid for vulvovaginal candidiasis. Results: We identified 14 studies (2 randomized clinical trials [RCTs], 9 case series, and 4 case reports) as eligible for inclusion in this review. Boric acid was compared with nystatin, terconazole, flucytosine, itraconazole, clotrimazole, ketoconazole, fluconazole, buconazole, and miconazole; as monotherapy, boric acid was studied in 7 studies. The mycologic cure rates varied from 40% to 100% in patients treated with boric acid; 4 of the 9 included case series reported statistically significant outcomes regarding cure (both mycologic and ...
TL;DR: The data suggest that the availability of microbicides in multiple dosage forms may increase acceptability, adherence, and, therefore, effectiveness in sexually active women.
Abstract: Background: Vaginal microbicides are in development for the prevention of HIV transmission to women via sexual intercourse. Acceptability of the microbicide delivery method in the targeted population is important to product adherence and, therefore, product effectiveness. It is anticipated that multiple delivery methods will be required to satisfy personal preferences among future microbicide users. Methods: A total of 526 sexually active women aged 18–30 years participated in a consumer product preference study in Burkina Faso, Tanzania, and Zambia. Screened women who had given consent were instructed to use each of the three products (placebo formulations of a vaginal tablet, film, and soft-gel capsule) once daily for 7 consecutive days for a total of 21 days. Women were interviewed about their impressions of the product at the completion of each 7-day trial period. Results: Over 80% of women reported they liked using each dosage form, and over 85% said they would definitely use it. The film an...
TL;DR: Family-friendly policies are pertinent to men and women, as both demonstrate interest and need, linked to increased career satisfaction, and are important to recruitment, retention, and career advancement.
Abstract: Background: Although women receive nearly half of all doctoral degrees and show a high interest in academic careers, the pipeline is leaky. The challenge of balancing life course events with career trajectory is an important determinant leading to premature dropout or slower career advancement. This report describes the findings of the first phase of a National Institute of Health Office of Research on Women's Health (NIH ORWH)-funded study using survey and academic data for exploring satisfaction and awareness of/intent to use specific career flexibility options at the University of California, Davis (UCD). Methods: All men and women faculty in the UCD's Schools of Medicine (SOM) and Veterinary Medicine (SVM) and College of Biological Science (CBS) were surveyed. Data also were obtained from deans' offices on use of family-friendly benefits by faculty. Results: Three hundred twenty-five total survey responses were received from the SOM, 83 from SVM, and 64 from CBS, representing 42%, 46%, and 52...
TL;DR: Proactive, ongoing use of two approaches to advancing women--the concept of a leadership continuum and a framework of practical approaches for moving toward gender equity at all ranks can promote reflective dialogue and provide direction and accountability for institutions working to advance women into leadership positions.
Abstract: Background: In the United States, women have attained near gender equity at the entry stages in academic medicine; however, progress has been much slower at senior leadership levels. The paucity of women leaders inhibits the ability of academic medicine to adequately meet the needs of an increasingly diverse body of students, faculty, staff, and patients. Research indicates that until a critical mass of women with sustained success as leaders is achieved, it is unlikely that this deficit will be corrected. Methods: To promote the attainment of a critical mass of women leaders, the authors integrate two approaches to advancing women—the concept of a leadership continuum and a framework of practical approaches for moving toward gender equity at all ranks. Results: An institutional guide is presented that can be used to promote dialogue about gender equity, noting areas of success and opportunities for additional improvement as well as an assessment of progress. A corresponding checklist has been de...
TL;DR: TMS appears to be a promising treatment option for pregnant women who do not wish to take antidepressant medications, and seven of ten subjects responded to treatment with transcranial magnetic stimulation.
Abstract: Objective: Despite the data that major depressive disorder (MDD) is common during pregnancy and that pregnant women prefer nonmedication treatment options, there is a paucity of research examining alternative treatments for this special population. We present the results of an open label pilot study examining treatment with transcranial magnetic stimulation (TMS) in pregnant women with MDD. Methods: Ten women with MDD in the second or third trimester of pregnancy were treated with 20 sessions of 1-Hz TMS at 100% of motor threshold (MT) to the right dorsolateral prefrontal cortex. The total study dose was 6000 pulses. Antenatal monitoring was performed during treatment sessions 1, 10, and 20. Results: Seven of ten (70%) subjects responded (decrease ≥50% in Hamilton Depression Rating Scale [HDRS-17] scores). No adverse pregnancy or fetal outcomes were observed. All infants were admitted to the well baby nursery and were discharged with the mother. Mild headache was the only common adverse event and...
TL;DR: This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters™ initiative, which will be implemented in four urban communities.
Abstract: Teen dating violence (TDV) is a preventable public health problem that has negative consequences for youth. Despite evidence that youth in urban communities with high crime and economic disadvantage may be at particularly high risk for TDV, little work has specifically addressed TDV in these communities. The Centers for Disease Control and Prevention (CDC) has developed a comprehensive approach to prevent TDV—Dating Matters™: Strategies to Promote Healthy Teen Relationships—that addresses gaps in research and practice. This Report from CDC describes the programmatic activities, implementation support, evaluation, and surveillance of the Dating Matters™ initiative, which will be implemented in four urban communities.
TL;DR: The results suggest that either extreme of maternal GWG may influence risk for early age at menarche in daughters, and may be a modifiable risk factor for early menarches.
Abstract: Background: Sexual development begins in utero and enters a dormant phase during infancy. The influence of maternal gestational weight gain (GWG) on daughter's age at menarche has not been explored. Methods: We investigated the association between maternal GWG and age at menarche ( 15 years of age) in a large cohort study of U.S. nurses, The Nurses' Health Study II (NHS II), and the Nurses' Mothers' Cohort Study. Results: Among 32,218 respondents, 7% reported age at menarche age 15. Compared with women whose mothers gained 20–29 lbs during pregnancy, those whose mothers reported 40 lbs of GWG were 30% more likely to report early onset menarche (<11 years of age) in logistic regression models adjusted for sociodemographic and maternal characteristics, and childhood body size and physical activity: adjusted odds ratio (OR) 1.31, 95% confidence interval (CI) 1.05-1.62, and 1.27, 95% CI 1.06-1.56. Maternal GWG was not associated ...
TL;DR: PTSD symptoms were associated with an increased frequency of consumption of fast food and soda as well as unhealthy dieting behaviors but not with increased body mass index (BMI).
Abstract: Objective: This study examines the association of posttraumatic stress disorder (PTSD) symptoms with fast food and soda consumption, unhealthy dieting behaviors, and body mass index (BMI)
TL;DR: Acceptance and clinical use of FRAX may help identify men and women at increased risk for osteoporotic fracture, but implementing the tool into clinical practice may be a challenge for busy physicians.
Abstract: Osteoporosis is a serious health concern affecting millions of Americans, with many patients going undiagnosed and untreated. Fractures due to osteoporosis and fracture-related complications are the most clinically relevant and costly consequences of this disorder. The Fracture Risk Assessment Tool (FRAX®), released by the World Health Organization (WHO) in February 2008, is a major achievement in helping determine which patients may be candidates for pharmacological therapy for osteoporosis. This Web-based algorithm, which has been incorporated into some dual x-ray absorptiometry (DXA) reporting software, calculates the 10-year probability of major osteoporotic fracture (clinical vertebral, hip, forearm, or humerus) and the 10-year probability of hip fracture in men and women based on easily obtained clinical risk factors and bone mineral density (BMD) of the femoral neck (optional). The National Osteoporosis Foundation updated its U.S. guidelines in February 2008 to incorporate FRAX and recommends that all postmenopausal women and men aged ≥50 years with a hip or vertebral fracture, a T-score ≤-2.5 at the femoral neck or spine (excluding secondary causes), or low bone mass (T-score between -1.0 and -2.5) and a 10-year probability of hip fracture ≥3% or of major osteoporosis-related fracture ≥20% (based on FRAX) should be considered candidates for drug therapy. Despite its demonstrated clinical utility, FRAX has limitations and should not be used in all situations. Acceptance and clinical use of FRAX may help identify men and women at increased risk for osteoporotic fracture, but implementing the tool into clinical practice may be a challenge for busy physicians.