Showing papers in "Journal of Womens Health in 2012"
TL;DR: Preventive care utilization was found to be higher in women than in men, and the gender disparity issue needs to be explored in greater detail to understand these differences.
Abstract: Background: The utilization of preventive care services in the United States remains low, despite health-care costs being as high as $2.3 trillion. While gender disparities have been known to exist for utilization of overall health-care services, the same issue has not been probed for preventive care utilization. Methods: A retrospective, cross-sectional study using the 2008 Medical Expenditure Panel Survey (MEPS). Preventive care services common to both genders were included (blood pressure checkup, cholesterol checkup, sigmoidoscopy/colonoscopy, flu shot, and dental checkup). Guideline adherence was determined using clinically accepted guidelines such as Joint National Committee 7 and the American Cancer Society. Descriptive statistics were used to describe the population, and chi-square analysis was used to determine the within group differences between the two genders. A multivariate logistic regression was built to determine the likelihood of guideline adherence based on gender while adjusti...
276 citations
TL;DR: Pregnant women with MDE were no more likely than other women to be diagnosed with or treated for their depression, and treatment barriers did not differ by pregnancy status.
Abstract: Background: Depression is often undiagnosed and untreated. It is not clear if differences exist in the diagnosis and treatment of depression among pregnant and nonpregnant women. We sought to estimate the prevalence of undiagnosed depression, treatment by modality, and treatment barriers by pregnancy status among U.S. reproductive-aged women. Methods: We identified 375 pregnant and 8,657 nonpregnant women 18–44 years of age who met criteria for past-year major depressive episode (MDE) from 2005–2009 nationally representative data. Chi-square statistics and adjusted prevalence ratios (aPR) were calculated. Results: MDE in pregnant women (65.9%) went undiagnosed more often than in nonpregnant women (58.6%) (aPR 1.1, 95% confidence interval [CI] 1.0-1.3). Half of depressed pregnant (49.6%) and nonpregnant (53.7%) women received treatment (aPR 1.0, 95% CI 0.90-1.1), with prescription medication the most common form for both pregnant (39.6%) and nonpregnant (47.4%) women. Treatment barriers did not di...
260 citations
TL;DR: Although marked reductions in the overall and race-specific incidence rates of invasive cervical cancer have been achieved, they mask important variation by histologic subtype and suggest that alternatives to Pap smear-based screening, such as human papillomavirus testing and HPV vaccination, need to be prioritized if adenocarcinomas of the cervix are to be controlled.
Abstract: Purpose: To analyze trends in invasive cervical cancer incidence by age, histology, and race over a 35-year period (1973–2007) in order to gain insight into changes in the presentation of cervical cancer. Methods: Data from the nine Surveillance, Epidemiology, and End Results (SEER) registries that continuously collected information on invasive cervical cancer were analyzed for trends. Standardized to the 2000 U.S population, annual age-adjusted incidence rates were estimated by race and histologic subtype. Histologic subtype was classified into squamous, adenocarcinoma, and adenosquamous. Results: Overall incidence rates for invasive cervical cancer decreased by 54% over the 35 years, from 13.07/100,000 (1973–1975) to 6.01/100,000 (2006–2007), and the incidence rates declined by 51% and 70.2%, respectively, among whites and blacks. The incidence rates for squamous carcinoma decreased by 61.1% from 10.2/100,000 (1973–1975) to 3.97/100,000 (2006–2007). Incidence rates for adenosquamous cell carcin...
245 citations
TL;DR: An interdisciplinary roundtable of experts from academia, clinical medicine, industry, and the government was convened to discuss the state of the science in sex and gender differences in AD.
Abstract: Alzheimer's disease (AD) disproportionately affects women in both prevalence and severity; however, the biologic mechanisms underlying these sex differences are not fully understood. Sex differences in the brain, such as in brain anatomy, age-related declines in brain volume, and brain glucose metabolism, have been documented and may be important in understanding AD etiology. The full impact of sex as a basic biologic variable on this neurodegenerative disease remains elusive. To address the evidence for sex differences in AD, the Society for Women's Health Research (SWHR) convened an interdisciplinary roundtable of experts from academia, clinical medicine, industry, and the government to discuss the state-of-the-science in sex and gender differences in AD. Roundtable participants were asked to address gaps in our knowledge and identify specific sex-based research questions for future areas of study.
183 citations
TL;DR: The major findings discussed at the 2-day meeting on diversifying clinical trials about female and minority patients and physicians and their willingness to participate in clinical trials and the barriers that sponsors face in recruiting a diverse trial population are presented.
Abstract: There is mounting scientific evidence pointing to genetic or physiologic distinctions between genders and among racial and ethnic groups that influence disease risk and severity and response to treatment. The diverse enrollment of subjects engaged in clinical trials research is, thus, critical to developing safer and more effective drugs and medical devices. However, in the United States, there are striking disparities in clinical trial participation. To address this problem, the Food and Drug Administration (FDA) Office of Women's Health and the Society for Women's Health Research (SWHR) together convened the 2-day meeting, Dialogues on Diversifying Clinical Trials. The conference was held in Washington, DC, on September 22–23, 2011, and brought together a wide range of speakers from clinical research, industry, and regulatory agencies. Here, we present the major findings discussed at this meeting about female and minority patients and physicians and their willingness to participate in clinical ...
149 citations
TL;DR: Depression is a significant health concern for breast cancer survivors and is associated with lower HRQOL and the need to monitor women with breast cancer for depression and provide resources for treating depression during the survival period is suggested.
Abstract: Background: Breast cancer diagnosis and treatment can have a profound influence on a woman's physical, psychosocial, and overall well-being. We examined the prevalence of depressive symptoms and its association with health-related quality of life (HRQOL) in women who are survivors of breast cancer. We also assessed if factors, including metastasis, cancer recurrence, diagnosis of new primary cancers, and comorbid conditions, are associated with depressive symptoms. Methods: The Patient Health Questionnaire (PHQ-8) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 were mailed to assess depressive symptoms and HRQOL, respectively, in breast cancer patients who received cancer treatment in a large tertiary cancer center. Results: Two hundred forty patients participated (56% response rate and 6–13 years since treatment). The mean score on the PHQ-8 scale was 4 points (standard deviation [SD] 4.8, median 2.0). Sixteen percent had PHQ-8 score ≥10 and w...
142 citations
TL;DR: It is hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders.
Abstract: In the early postpartum period, mother and infant navigate a critical neuroendocrine transition from pregnancy to lactation. Two major clinical problems that occur during this transition are failed lactation and perinatal mood disorders. These disorders often overlap in clinical settings. Failed lactation is common. Although all major medical organizations recommend 6 months of exclusive breastfeeding, only 13% of women in the United States achieve this recommendation. Perinatal mood disorders affect 10% of mothers, with substantial morbidity for mother and child. We hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders. In this hypothesis article, we discuss data from both animal models and clinical studies that suggest neuroendocrine mechanisms that may underlie these two disorders. Research to elucidate the role of these underlying mechanisms may identify treatment strategies both to relieve perinatal depression and to enable women t...
114 citations
TL;DR: Findings from the review of the Division of Violence Prevention's research and programmatic portfolio from 2000 to 2010 are summarized by highlighting DVP's key activities and accomplishments during this period and identifying remaining gaps in the field and future directions for SV prevention.
Abstract: In 2011, the Division of Violence Prevention (DVP) within CDC's Injury Center engaged an external panel of experts to review and evaluate its research and programmatic portfolio for sexual violence (SV) prevention from 2000 to 2010. This article summarizes findings from the review by highlighting DVP's key activities and accomplishments during this period and identifying remaining gaps in the field and future directions for SV prevention. DVP's SV prevention work in the 2000s included (1) raising the profile of SV as a public health problem, (2) shifting the field toward a focus on the primary prevention of SV perpetration, and (3) applying the public health model to SV research and programmatic activities. The panel recommended that DVP continue to draw attention to the importance of sexual violence prevention as a public health issue, build on prior investments in the Rape Prevention and Education Program, support high-quality surveillance and research activities, and enhance communication to improve the link between research and practice. Current DVP projects and priorities provide a foundation to actively address these recommendations. In addition, DVP continues to provide leadership and guidance to the research and practice fields, with the goal of achieving significant reductions in SV perpetration and allowing individuals to live to their full potential.
109 citations
TL;DR: White women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available.
Abstract: Background: Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. Methods: We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. Results: Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imagin...
106 citations
TL;DR: Significant differences appear to exist between oral and transdermal estrogens in terms of hormonal bioavailability and metabolism, with implications for clinical efficacy, potential side effects, and risk profile of different hormone therapy options, but neither results nor study designs are uniform.
Abstract: Background: To compare oral and transdermal delivery systems in domains of lipid effects; cardiovascular, inflammatory, and thrombotic effects; effect on insulin-like growth factor, insulin resistance, and metabolic syndrome; sexual effects; metabolic effects including weight; and effects on target organs bone, breast, and uterus. Methods: Review of the literature 1990–2010. Studies selected on basis of applicability, quality of data, and relationship to topic. Results: Data applicable to the comparisons of oral versus transdermal delivery systems for postmenopausal estrogen therapy were utilized to perform a review and formulate conclusions. Conclusions: Significant differences appear to exist between oral and transdermal estrogens in terms of hormonal bioavailability and metabolism, with implications for clinical efficacy, potential side effects, and risk profile of different hormone therapy options, but neither results nor study designs are uniform. Bypassing hepatic metabolism appears to resu...
102 citations
TL;DR: Primary prevention efforts should be established to empower girls to make informed and autonomous decisions about sexual debut and personalized contraceptive counseling should be offered to all women, with particular focus on women who report an early age at first intercourse or other factors associated with inconsistent contraceptive use.
Abstract: Background: Sexual debut before age 15 years has been associated with increased sexual risk behaviors among teens, but little is known about its effects beyond adolescence. This study examines the relationship between the age at first intercourse and subsequent contraceptive gaps. Methods: We identified 3538 sexually active, fertile women participants from the 2006–2008 National Survey of Family Growth. Women were classified as consistent contraceptive users or inconsistent/nonusers. Age at first intercourse with a man was determined by self-report and categorized as <15, 15–17, and ≥18 years. Results: Twenty-three percent reported gaps in contraceptive use in the year prior to interview. Compared with women who were 18 or older at first intercourse, women who were <15 years of age at the time of first intercourse were nearly two times as likely to report a gap in contraceptive use (adjusted odds ratio: 1.93; 95% confidence interval: 1.23–3.00). Conclusions: Age at first intercourse is associated...
TL;DR: The findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer, and underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.
Abstract: Background: Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women. Methods: Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18–80 years inclusively, who reported either a male (n=136,174) or female (n=693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model. Results: Women in same-sex couples, compared to women in different-sex r...
TL;DR: This is the first trial to show beneficial effects of a 10-mg natural S-(-)equol supplement consumed daily for 12 weeks on major menopausal symptoms, specifically, hot flushes and neck or shoulder muscle stiffness, in postmenopausal Japanese women.
Abstract: Objective: The objective of this clinical trial was to examine the efficacy of a supplement containing natural S-(−)equol, a daidzein metabolite, in reducing menopausal symptoms. Methods: In this multicenter, double-blind placebo-controlled trial, 160 equol nonproducing, postmenopausal Japanese women who experienced at least 1 hot flush/day were randomly assigned to consume 10 mg/day S-(−)equol (n=77 women) or placebo (n=83 women) for 12 weeks. Participants completed a standardized menopausal symptom checklist and rated five common menopause symptoms by a visual analog scale at baseline, week 12, and week 18 (6-week postintervention). Physical, blood, and urine examinations were conducted. One hundred twenty-six women completed the study. Results: At baseline, daily hot flush frequency was 2.9±2.1 for the S-(−)equol group and 3.2±2.4 for the placebo group. After the 12-week intervention, the S-(−)equol group had a greater decrease from baseline in hot flush frequency compared with the placebo gro...
TL;DR: Gender concordance in female patient-female physician dyads demonstrated significantly more PCC, highlighting the influence of gender in the process of care and provision of PCC.
Abstract: Background: Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC. Methods: Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code. Results: No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC ...
TL;DR: This review outlines the current literature on sex hormones and QT interval, including the endogenous effects of estrogen, progesterone, and testosterone and the exogenous effects of hormones in the forms of MHT and hormone contraception and reviews the potential mechanisms and pathophysiology of sex hormones on the QT intervals.
Abstract: A prolonged QT interval is a marker for an increased risk of ventricular tachyarrhythmias. Both endogenous and exogenous sex hormones have been shown to affect the QT interval. Endogenous testosterone and progesterone shorten the action potential, and estrogen lengthens the QT interval. During a single menstrual cycle, progesterone levels, but not estrogen levels, have the dominant effect on ventricular repolarization in women. Studies of menopausal hormone therapy (MHT) in the form of estrogen-alone therapy (ET) and estrogen plus progesterone therapy (EPT) have suggested a counterbalancing effect of exogenous estrogen and progesterone on the QT. Specifically, ET lengthens the QT, whereas EPT has no effect. To date, there are no studies on oral contraception (OC) and the QT interval, and future research is needed. This review outlines the current literature on sex hormones and QT interval, including the endogenous effects of estrogen, progesterone, and testosterone and the exogenous effects of estrogen and progesterone therapy in the forms of MHT and hormone contraception. Further, we review the potential mechanisms and pathophysiology of sex hormones on the QT interval.
TL;DR: More than a quarter of women studied had acne, which peaked in the teens but continued to be prevalent through the fifth decade, and smokers had more, primarily comedonal, acne than nonsmokers.
Abstract: Background: Acne vulgaris is a common skin disease with a large quality of life impact, characterized by comedones, inflammatory lesions, secondary dyspigmentation, and scarring. Although traditionally considered a disease of adolescence, reports suggest it is also a disease of adults, especially adult women. Our objectives were to determine acne prevalence in a large, diverse group of women and to examine acne by subtype and in relation to other skin findings, measurements, and lifestyle factors. Methods: We recruited 2895 women aged 10–70 from the general population. Photographs were graded for acne lesions, scars, and dyspigmentation. Measurements were taken of sebum excretion and pore size, and survey data were collected. Results: Of the women studied, 55% had some form of acne: 28% had mild acne, and 27% had clinical acne, 14% of which was primarily inflammatory and 13% of which was primarily comedonal. Acne peaked in the teenage years, but 45% of women aged 21–30, 26% aged 31–40, and 12% ag...
TL;DR: Poverty, loss of status and support linked to declining marriage participation, and female-headed single-parent household structure are discussed-all of which influence sexual risks for black women.
Abstract: Recent epidemiologic reports show that black women are at risk for HIV infection and other sexually transmitted diseases (STDs). In this report, we go beyond race and consider a number of social and economic trends that have changed the way many black women experience life. We discuss poverty, loss of status and support linked to declining marriage participation, and female-headed single-parent household structure—all of which influence sexual risks. We also discuss the Centers for Disease Control and Prevention-led national efforts to advance consideration of social determinants of health (SDH) and promotion of health equity in public health activities that may have impact on black and other women.
TL;DR: Eating less healthy foods and being less physically active put overweight and obese women at risk of gaining more weight after a pregnancy.
Abstract: Background: The postpartum period may be critical for the development of midlife obesity. Identifying factors associated with postpartum weight change could aid in targeting women for healthy lifestyle interventions. Methods: Data from Active Mothers Postpartum (AMP), a study of overweight and obese postpartum women (n=450), were analyzed to determine the effect of baseline characteristics, breastfeeding, diet, physical activity, and contraception on weight change from 6 weeks to 12, 18, and 24 months postpartum. The repeated measures mixed model was used to test the association of these effects with weight change. Results: Although mean weight loss was modest (0.49 kg by 24 months), the range of weight change was striking (+21.5 kg to −24.5 kg, standard deviation [SD] 7.4). Controlling only for baseline weight, weight loss was associated with breastfeeding, hormonal contraception, lower junk food and greater healthy food intake, and greater physical activity. Only junk food intake and physical a...
TL;DR: The strength of evidence supporting specific IPV screening interventions has improved, but the optimal implementation and dissemination strategies are not clear and implementation science, which seeks to close the evidence to program gap, is a useful framework for improving screening and intervention uptake.
Abstract: Background: Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine's Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women's preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale. Methods: To foster dialogue about implementing effective interventions, we convened a symposium entitled “Responding to Violence Against Women: Emerging Evidence, Implementation Science, and Innovative Interventions,” on May 21, 2012. Drawing on multidisciplinary expertise, the agenda integrated data on the prevalence and health impact of IPV violence, with an overview of the implementation science framework, and a panel of innovative IPV scree...
TL;DR: It is indicated that infidelity concerns, a specific form of jealousy, were the immediate trigger for both the acute violent episode and resulting injuries to victims and were persistently raised by both perpetrators and victims as an ongoing relationship stressor.
Abstract: Background: We conducted a qualitative study to examine acute, situational factors and chronic stressors that triggered severe intimate partner violence (IPV) in women. Methods: Our sample consisted of 17 heterosexual couples, where the male was in detention for IPV and made telephone calls to his female victim. We used up to 4 hours of telephone conversational data for each couple to examine the couple's understanding of (1) acute triggers for the violent event and (2) chronic stressors that created the underlying context for violence. Grounded theory guided our robust, iterative data analysis involving audiotape review, narrative summation, and thematic organization. Results: Consistently across couples, violence was acutely triggered by accusations of infidelity, typically within the context of alcohol or drug use. Victims sustained significant injury, including severe head trauma (some resulting in hospitalization/surgery), bite wounds, strangulation complications, and lost pregnancy. Chronic...
TL;DR: The development and evaluation of community-level approaches to SV prevention represent a vital and logical next step toward the implementation of effective, multilevel prevention efforts and a population-level reduction in the prevalence of SV.
Abstract: The Division of Violence Prevention within CDC's National Center for Injury Prevention and Control recently undertook a systematic review of primary prevention strategies for sexual violence (SV) perpetration. This review identified the lack of community-level strategies to prevent SV as a critical gap in the literature. Community-level strategies function by modifying the characteristics of settings (e.g., schools, workplaces, neighborhoods) that increase the risk for violence victimization and perpetration. Identification of evidence-based strategies at the community level would allow implementation of ecologic approaches to SV prevention with a greater potential for reducing the prevalence of SV perpetration. The field will face several challenges in identifying and evaluating the effectiveness of promising community-level strategies to prevent SV. These challenges include limited knowledge of community-level and societal-level risk factors for SV, a lack of theoretical or empirical guidance in the SV literature for identification of promising community-level approaches, and challenges in evaluating SV outcomes at the community level. Recognition of these challenges should guide future research and foster dialogue within the SV prevention field. The development and evaluation of community-level approaches to SV prevention represent a vital and logical next step toward the implementation of effective, multilevel prevention efforts and a population-level reduction in the prevalence of SV.
TL;DR: Yoga may be an efficacious complementary therapy for smoking cessation among women and shows reduced anxiety and improvements in perceived health and well-being when compared with controls.
Abstract: Background: Tobacco smoking remains the leading preventable cause of death among American women. Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms. Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect. Methods: This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation. Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were randomized to a twice-weekly program of Vinyasa yoga or a general health and wellness program (contact control). The primary outcome measure was 7-day point prevalence abstinence at the end of treatment validated by saliva cotinine testing. Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up. We examined the effects of the intervention...
TL;DR: A desire for both comprehensive and targeted mentoring to address gaps that varied by faculty rank, research focus, parenting, and work time status was identified.
Abstract: Background: Although women comprise an increasing proportion of US medical school faculty, they are underrepresented at higher ranks. Lack of effective mentoring may contribute to this disparity. We examined the role of academic rank, research focus, parenting, and part-time work on mentoring importance, needs, and gaps. Methods: In 2009, women faculty members of Harvard Medical School and Harvard School of Dental Medicine were invited by e-mail to participate in a 28-item structured questionnaire. Descriptive statistics and adjusted logistic regressions were used to identify relevant themes. Results: Of the 1179 women faculty who responded, 54% had a mentor, and 72% without a mentor desired mentoring. The most important mentor characteristic identified was availability. Respondents endorsed most mentoring areas as important (range 51%–99%); 52% of respondents identified mentoring gaps (area important and unmet) in developing and achieving career goals and negotiation skills. Interest in mentorsh...
TL;DR: The findings confirm that breast cancer prevalence is elevated among female orthopaedic surgeons, and suggest that the orthopedic community consider educating current practitioners of the use of protective shielding and other modifiable breast cancer risk factors.
Abstract: Background: As a result of low-dose ionizing radiation exposure during clinical practice, female orthopaedic surgeons may be at increased risk for breast cancer. Methods: The 2009 American Academy of Orthopaedic Surgeons (AAOS) membership directory was used to mail a survey to all female AAOS fellows. Survey responses were collected between June 2009 and June 2010 among 505 (69.7%) of the eligible women. We calculated standardized prevalence ratios (SPRs) and 95% confidence intervals (CIs) by dividing the observed number of cancers among female orthopaedic surgeons by the expected number, based on the gender-specific, age-specific, and race-specific cancer prevalence statistics in the general U.S. population. We compared the distribution of breast cancer risk factors in our study population to that of the women in the 2007 California Health Interview Survey (CHIS, n=30,541). Results: Twenty-four women reported a prior diagnosis of invasive cancer. Female orthopaedic surgeons had a prevalence of c...
TL;DR: Group-based promotora-led interventions supporting social involvement are recommended as a more cost-effective approach to achieving cancer screening among Latina women.
Abstract: Objectives: Inadequate screening adherence for breast, cervical, and colorectal cancer among Latinas places them at greater risk for poor survival rates, once diagnosed. The purpose of this study was to examine two delivery methods of lay health educators (promotoras de salud) to increase screening behavior and evaluate costs. Methods: This community-based group randomized trial assigned Latinas due for breast, cervical, or colorectal cancer screening (n=1006) to promotora-taught cancer screening/prevention classes delivered individually (IND) or in social support groups (SSG) over 8 weeks. Screening behaviors were assessed immediately after and 3 and 15 months after intervention. Intervention costs per study arm were compared. Results: Screening and maintenance behaviors were not significantly different between SSG and IND for any one type of cancer screening, but with a study entry requirement that participants were either never screened or due for screening, postintervention screening rates (t...
TL;DR: Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD, and all veterans with comorbid PTSD had higher use in almost all areas.
Abstract: Background: Little is known about gender differences in healthcare use among newly returning veterans with posttraumatic stress disorder (PTSD). We investigated gender differences in Veterans Affairs (VA) medical center health service use among Iraq and Afghanistan veterans with PTSD with and without comorbid depression and alcohol use disorders (AUD). Methods: Using VA administrative data, bivariate and multivariate statistics were used to examine gender differences in health service use among 159,705 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD seeking VA healthcare from October 7, 2001, to December 31, 2010. Results: Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD. Men were more likely to have higher mental health inpatient use compared to women. Women and men with comorbid PTSD and depression or comorbid PTSD and AUD were more likely to have hig...
TL;DR: Significant gender-related differences in the perception of COPD healthcare delivery exist, revealing an opportunity to better understand what influences these attitudes and to improve care for both men and women.
Abstract: Background: Morbidity and mortality for women with chronic obstructive pulmonary disease (COPD) are increasing, and little is known about gender differences in perception of COPD care. Methods: Surveys were administered to a convenience sample of COPD patients to evaluate perceptions about symptoms, barriers to care, and sources of information about COPD. Results: Data on 295 female and 273 male participants were analyzed. With similar frequencies, women and men reported dyspnea and rated their health as poor/very poor. Although more women than men reported annual household income <$30,000, no significant gender differences in frequency of health insurance, physician visits, or ever having had spirometry were detected. In adjusted models (1) women were more likely to report COPD diagnostic delay (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.13-2.45, p =0.01), although anxiety (OR 1.83, 95% CI 1.10-3.06, p =0.02) and history of exacerbations (OR 1.60, 95% CI 1.08-2.37, p =0.01) were also significant predictors, (2) female gender was associated with difficulty reaching one’s physician (OR 2.54, 95% CI 1.33-4.86, p =0.004), as was prior history of exacerbations (OR 2.25, 95% CI 1.21-4.20, p =0.01), and (3) female gender (OR 2.15, 95% CI 1.10-4.21, p =0.02) was the only significant predictor for finding time spent with their physician as insufficient. Conclusions: Significant gender-related differences in the perception of COPD healthcare delivery exist, revealing an opportunity to better understand what influences these attitudes and to improve care for both men and women.
TL;DR: Depression and anxiety can be detected using very few items, which makes assessment feasible in surveillance systems, such as PRAMS, and in primary care settings that have severe limits on time for depression and anxiety screening.
Abstract: Background: Depressive and anxiety disorders in the postpartum period cause significant suffering for women. State public health officials across the country use the Centers for Disease Control and Prevention (CDC)-sponsored Pregnancy Risk Assessment Monitoring System (PRAMS) to assess health behaviors and conditions, including depression and anxiety, that occur around the time of pregnancy. The purpose of the present study was to validate two to three items that could be included on the PRAMS questionnaire to detect depression and anxiety among postpartum women in a surveillance system. Methods: A comprehensive set of 16 depression and anxiety items was developed and tested in a final sample of 1077 postpartum women, 353 of whom completed Structured Clinical Interview for DSM-IV (SCID) interviews to determine the presence of a major depressive episode (MDE) and generalized anxiety disorder (GAD). Regression analyses reduced candidate items to 5 each for MDE and GAD. Responses were scored on a 5-...
TL;DR: The ADHD symptom score appears to be associated with some risky sexual behaviors and deserves further attention and a brief ADHD screening can identify this high-risk group for timely evaluation and safe sex counseling.
Abstract: Background: This study was undertaken to assess the association between adult attention deficit/hyperactivity disorder (ADHD) symptoms and high-risk sexual behavior. Methods: This cross-sectional study interviewed 462 low-income women aged 18–30 years. We used the 18-item Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist to assess ADHD symptoms. Risky sexual behaviors included sex before 15 years of age, risky sex partners in lifetime, number of sex partners in the last 12 months, condom use in the last 12 months, alcohol use before sex in the last 12 months, traded sex in lifetime, and diagnosed with sexually transmitted infection (STI) in lifetime. Results: Mean ADHD symptom score was 19.8 (SD±12.9), and summary index of all risky sexual behavior was 1.77 (SD±1.37). Using unadjusted odds ratios (OR), women who endorsed more ADHD symptoms reported engaging in more risky sexual behaviors of all types. However, when multivariable logistic regression was applied adjusting for various socio...
TL;DR: Examination of correlates of HPV vaccine series initiation and completion among low-income and minority adolescents receiving primary care at one of seven medical centers found provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination.
Abstract: Background: Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence. Methods: Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11–21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care. Results: Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11–<13 (46%) and 13–<18 (47%) initiated vaccination than ...