Many chronic diseases may have their seeds early in life. Observations from the Dutch famine have taught us that the intrauterine environment is an important determinant of adult health. Birth weight has been related to cardiovascular disease (CVD), hypertension, diabetes, and cancer. Critical phases for adult obesity development include time periods between conception and adolescence. A life course approach to chronic disease prevention includes the study of maternal diet during pregnancy, intrauterine exposures, postnatal growth, and the adolescent period.
BACKGROUND:As we enter the 21st century, AIDS and breast cancer are two pressing issues in women's health. The spread of AIDS continues unabated. More than 21.8 million people have died of AIDS, and it is estimated that as of December 2000 an additional 36.1 million people, mostly in sub-Saharan Africa, were infected with the human immunodeficiency virus. In addition, women now constitute almost one half of all AIDS cases. With the widespread use of highly active antiretroviral therapy in the United States, the overall health and survival of HIV(+) individuals has improved dramatically. Thus, as the HIV(+) population matures, we will be called on to diagnose and treat more cases of breast cancer in seropositive women. What can we expect as the incidence of these two diseases begins to overlap?METHODS:Medline search, and review of the relevant literature.RESULTS:Forty-six published cases of breast cancer in HIV(+) individuals identified.CONCLUSIONS:Based on epidemiologic data from Western countries and Africa, HIV infection is not permissive for breast cancer. This is reflected in the paucity of available data. Early reports consisted of case reports, describing advanced cancers with unusual presentations and uniformly poor prognoses. Recent series describe more favorable prognoses and long-term survivors. It appears that hormonal therapy is well tolerated and effective, even in cases of locally advanced disease, and the toxicity from standard chemotherapy regimens is unacceptably high.
BACKGROUND:Injury to the anterior cruciate ligament (ACL) often requires surgery and extensive rehabilitation. Women who participate in collegiate sports and military drills are more likely to injure their ACL than are men participating in similar activities. The influence of the normal fluctuation of sex hormones on the physical properties of the ACL is one potential cause for this disparity. The purpose of this study was to report the correlation between estradiol, estrone, estriol, progesterone, and sex hormone binding globulin (SHBG) and ACL stiffness during three phases of the menstrual cycle in normally cycling, healthy females.METHODS:We tested ACL stiffness and collected blood from 20 female subjects who were not using oral contraception during three phases of their menstrual cycle. Ligament stiffness was tested with the KT-2000 trade mark knee arthrometer (MEDmetric, San Diego, CA). Concentrations of estradiol and SHBG were assessed via radioimmunoassay (RIA). Progesterone, estriol, and estrone concentrations were determined via enzyme-linked immunoassay.RESULTS:Spearman rank correlation analysis indicated a significant correlation between estradiol concentration and ACL stiffness (-0.70, p < 0.001) and estrone concentration and ACL stiffness near ovulation (0.46, p = 0.040). With the effects of the other variables controlled, there was a significant partial correlation between estradiol (-0.80, p < 0.001), estriol (0.70, p = 0.003), and progesterone (0.66, p = 0.005) and ACL stiffness near ovulation.CONCLUSIONS:Our results indicate that there is a significant correlation between estradiol, estriol, and progesterone and ACL stiffness suggesting that fluctuating levels of sex hormones may influence the stiffness of the ACL near ovulation. Future studies that examine the relationship between sex hormones and the physical properties of the ACL should be focused near the ovulation phase of the menstrual cycle.
Objectives: The purpose of this prospective study was to investigate the impact of the gender of physicians and patients on the accuracy of diagnosing coronary artery disease (CAD) based on the patient history only.Methods: Screening involved 1082 consecutive patients undergoing coronary angiography for suspected CAD. Known CAD was an exclusion criterion. The inclusion criteria were met by 144 patients (47 females). All patients were inverviewed by both an experienced male cardiologist (n=6) and an experienced female cardiologist (n=5), who had to state before coronary angiography if CAD was present relying solely on the patient interview. Eligible subjects also answered a questionnaire. Diagnostic performance to assess the presence or absence of CAD by history taking by male and female cardiologists, exercise testing, patient self-assessment, and the questionnaire were compared.Results: Coronary angiography showed significant CAD in 20 females (43%) and 70 males (72%). Diagnostic accuracy was not different between male (79%) and female (79%) cardiologists and comparable to the results of exercise testing (74%) but better than self-assessment by the patients (65%, p=0.01) or a questionnaire (68%, p=0.01). The accuracy of female physicians was better in men than in women (85% vs. 66%, p=0.01). The specificity of male physicians tended to be better in women than in men (74% vs. 59%, p=0.25). Female cardiologists overestimated the presence of CAD in women (specificity 48% vs. 74%, p=0.04).Conclusions: The female cardiologists did not assess women more accurately than did their male colleagues. The diagnostic accuracy of these male and female cardiologists was quite good. However, both tend to assess patients of the opposite gender more specifically. There may be an impact of the gender of the physician on the accuracy of diagnosis of CAD by history taking.
OBJECTIVE To determine women physicians' rates of pro bono work and nonmedical volunteerism. We examined data from the Women Physician's Health Study (WPHS), a cross-sectional survey conducted in 1993-1994 of 4501 U.S. women physicians aged 30-70 years. RESULTS Of this group, 71% participated in either pro bono work (among those participating, a median of 4 hours/week), nonmedical volunteering (2 hours/week), or both. Predictors of pro bono work were subspecialty training, practice site, practice location, on-call nights, work hours, and hours nonmedical volunteering. Predictors of nonmedical volunteering were age, ethnicity, marital status, number of children, religion, practice site, practice location, work hours, political identification, and the performance of pro bono services. CONCLUSIONS A substantial majority of women physicians volunteer their time. These data on characteristics of volunteers can help us understand and motivate physicians giving behaviors.
Background: This study examined the factors that motivate women to seek cosmetic breast augmentation surgery.Methods: Twenty-five breast augmentation surgery candidates completed measures of body image dissatisfaction, sociocultual influences on physical appearance, marital and sexual satisfaction, and self-report questionnaires that assessed other motivations for surgery. Thirty physically similar women who were not interested in breast augmentation also completed the measures.Results: Replicating previous studies, breast augmentation candidates, compared with controls, reported greater dissatisfaction with their breasts. The two groups, however, did not differ on overall body image dissatisfaction or greater awareness or internalization of sociocultural influences on physical appearance. Breast augmentation patients reported more positive sexual functioning compared with controls.Conclusions: Overall, breast augmentation patients appeared to be motivated by their feelings about their breasts rather than direct or indirect influence from external sources, such as romantic partners or sociocultural representations of beauty. These findings provide new information on the motivations behind breast augmentation and dispute several stereotypes about the factors that influence the pursuit of this surgery.
Purpose: The October 2001 publication of a meta-analysis questioning the scientific basis for recommending screening mammography sparked yet a new flame of controversy about this issue. We conducted a national survey in March 2002 to provide information about women's perspectives on the issues, including the evidence regarding the efficacy of mammography and, ultimately, their intentions to continue screening.Methods: We added 12 questions to a national telephone omnibus survey in March 2002 to assess women's reactions to the ongoing debate. Responses were collected over three waves of the twice-weekly survey to obtain data from 733 women between the ages of 40 and 69. The sample was weighted to the U.S. population for census region, age, race, ethnicity, and educational attainment.Results: Consistent with prior studies, most women were getting regular mammograms (78%) (95% confidence interval [CI] 75%-81%), >90% believed that mammography is effective in detecting breast cancer (95%) (95% CI 93%-97%) and in reducing breast cancer mortality (93%) (95% CI 91%-96%), and only about 22% (95% CI 19%-25%) said they were confused. Logistic regression analyses revealed sociodemographic differences among women who had heard about the controversy and who reported some confusion about mammograms. Women with lower levels of education, younger women, and those residing in nonmetropolitan areas were significantly less likely to be aware of the controversy. Although a majority of women said they were not confused about mammography, minority women and women with lower education levels were more likely to report being confused. There were no significant demographic differences in intentions to get future mammograms. Women who were concerned about getting breast cancer were much more likely to be planning to have future mammograms than women who were not at all concerned (odds ratio [OR] 3.63; 95% CI 2.37, 5.56). Likewise, respondents who said that they had enough information to make decisions whether to get future mammograms were much more likely to plan on getting screened than women who said they did not have enough information (OR 2.47; 95% CI 1.14, 5.40).Conclusions: These results do not suggest that controversy leads to lower rates of adherence. They do indicate that some women lack the information needed to make informed decisions about mammography.
Colorectal cancer is the second leading cause of cancer death in the United States, and the number of new cases annually is approximately equal for men and women. Several nutritional factors are likely to have a major influence on risk of this cancer. Physical inactivity and excessive adiposity, especially if centrally distributed, clearly increase the risk of colon cancer. Hyperinsulinemia may be an important underlying risk factor. In conjunction with obesity and physical inactivity, which induce a state of insulin resistance, certain dietary patterns that stimulate insulin secretion, including high intakes of red and processed meats, saturated and trans-fats, and highly processed carbohydrates and sugars, may increase the risk of colon cancer. There is evidence suggesting that some component of red meat may independently increase the risk of colorectal cancer, and some micronutrients may be important as protective agents. Currently, the evidence is strongest for folate and calcium. Folate may be especially important in alcohol drinkers because alcohol appears to increase the risk, particularly when folate intake is low. This interaction may be related to the antifolate properties of alcohol. In contrast to earlier studies, more recent epidemiologic studies have generally not supported a strong influence of dietary fiber or fruits and vegetables, although these have other health benefits, and their consumption should be encouraged. The majority of colon cancers, as well as many other conditions, may be prevented by lifestyle alterations in the intake of these nutritional factors, in addition to other factors, such as smoking.
Approximately 25% of women over the age of 50 in the United States will suffer one or more vertebral compression fractures (VCFs) related to osteoporosis. VCFs are the most common of all osteoporotic fractures, with an incidence of approximately 700,000 annually. Such a fracture may cause significant pain, disability, and loss of general health and mobility and may lead to a progressive decline in quality of life. This is a review of the clinical literature on VCFs, including patient presentation, methods of diagnosis, and current rehabilitation and medical management. Much of the pain and disability that follow a VCF may be minimized by addressing the psychological impact of such a fracture, using current medications to help limit bone loss and preserve bone mass, adhering to a well-planned rehabilitation program, and consideration of vertebroplasty or kyphoplasty in appropriate patients. A multifaceted approach will help to optimize recovery from a VCF related to osteoporosis.
BACKGROUND The issuance in 2002 of new guidelines recommending universal screening for group B Streptococcus (GBS), a leading cause of neonatal sepsis in the United States, has created a new opportunity to educate women of childbearing age to be active partners in prevention. METHODS To assess baseline levels of awareness about perinatal GBS, we analyzed responses to a question included in a health communications/social marketing survey in 1999 and 2002. RESULTS Among the 2917 women under 50 who responded, 47% reported ever having heard of perinatal GBS. Among women pregnant at the time of the survey, awareness was 66%. Women with a high school education or less (OR = 0.60, 95% CI 0.50-0.73), household income <25,000 US dollars (OR 0.65, 95% CI 0.54-0.79), or reporting black, Asian/Pacific Islander, or other race (ORs [95% CI] 0.70 [0.57-0.87], 0.61 [0.41-0.90], 0.41 [0.20-0.85], respectively) had lower awareness of perinatal GBS than other women. Women currently pregnant (OR 2.2, 95% CI 1.5-3.3) had higher awareness. CONCLUSIONS Awareness of perinatal GBS is high among currently pregnant women, for whom this issue is most important. Efforts to raise awareness should be targeted to women from traditionally underserved populations, such as those who are of nonwhite race or who have lower educational attainment or household income.
BACKGROUND:Lymphangioleiomyomatosis (LAM) is a rare pulmonary disease of women of unknown etiology. Diffuse cystic changes associated with multifocal clusters of smooth muscle-like cells (LAM cells) replace normal lung parenchyma, leading to progressive loss of lung function. Reports of exacerbations of LAM with the use of exogenous estrogens and during pregnancy suggest an association between hormones and clinical deterioration.OBJECTIVES:To conduct the largest case series to date in order to characterize the demographics of a living cohort of patients with LAM. To evaluate the effect of oral contraceptive pill (OCPs) use on the age at onset of symptoms in a large population of women with LAM.METHODS:The study population was drawn from the University of Miami (UM) LAM database consisting of 91 living women previously diagnosed with LAM by a physician. A self-administered questionnaire was mailed to the participants.RESULTS:The final response rate was 91.2% (83 of 91), and the study participants were 96.4% white, 1.2% Asian, 1.2% African American, and 1.2% American Indian; 68.4% identified their ethnicity as European and 14.5% as Jewish. Of the women surveyed, 73 were still menstruating at the time of LAM diagnosis. Among these women, the rate of use of OCPs was approximately 27%, similar to the rate in the general population. There was a significant difference between the age at onset of symptoms in women using OCPs vs. women not using OCPs (29.2 +/- 4.7 vs. 32.9 +/- 8.0, p = 0.0397).CONCLUSIONS:The present study suggests that OCPs may serve as catalysts to promote an earlier occurrence of LAM.
BACKGROUND The diagnosis of atypical squamous cells of undetermined significance (ASCUS) during cervical screening indicates cellular abnormality but is not sufficient for a definitive diagnosis of a squamous intraepithelial lesion (SIL). Before the 2001 consensus guidelines for the management of women with cervical cytological abnormalities are introduced, follow-up management of ASCUS women by colposcopic biopsy is done at patient and physician discretion. METHODS In this study, we examined variables associated with the method of follow-up (colposcopic biopsy, repeat Pap smear) in a sample of 651 women(ages 18-82 years) who were diagnosed with ASCUS and were then referred for either a colposcopic biopsy or a repeat Pap smear at their next follow-up appointment. RESULTS In a multivariate logistic regression analysis (outcome variable = follow-up by colposcopic biopsy or by repeat Pap smear), we found that the odds of follow-up by colposcopic biopsy were 8-fold (OR 8.5, 95% CI 4.4-16.3) higher for high-income (>47,117 US dollars vs. <24,767 US dollars) women, 2-fold higher (OR 2.8, 95% CI 1.5-5.1 ) for women with private insurance (relative to Medicaid), and 3-fold higher (OR 3.1, 95% CI 1.3-7.4) for middle-aged women (ages 36-45 vs. > 55 y). CONCLUSIONS In stratified analyses, we found that high income was positively associated with odds of colposcopic biopsy in all strata of health coverage and that among those in the highest income category, private insurance remained an indicator of colposcopic biopsy use. Our findings raise the possibility that among women with ASCUS, there is an overuse of colposcopic biopsy by high-income and privately insured women who are likely to be at low risk of cervical malignancies.
OBJECTIVES:Healthcare provider recommendation for mammography is one of the strongest predictors of women's mammography use, but few studies have examined the association of provider characteristics with mammography recommendations. We examined the relationship of provider gender, age, medical specialty, and duration of relationship with the patient to report mammography recommendation.METHODS:Participants were women ages 40-45 and 50-55 who were part of a larger intervention study of decision making about mammography. We examined the relationship of provider characteristics to patient-reported mammography recommendations at baseline and at 24-month follow-up.RESULTS:At baseline, 74% of women in their 40s and 79% of women in their 50s reported provider mammography recommendations within the prior 2 years. Proportions were similar at the 24-month follow-up. In multivariate logistic regression models including both patient and provider characteristics, women in their 40s who had female providers were more likely to report mammography recommendations than those with male providers at baseline (OR=1.83, p=0.01) and follow-up (OR=1.74, p=0.03). Among women in their 50s, participants whose regular providers were primary care physicians were more likely to report recommendations at baseline than those whose regular providers were obstetrician/gynecologists (OR=1.68, p=0.03).CONCLUSIONS:About one fourth of women in this study reported not having been advised by a healthcare provider to have a mammogram. All women in the study had health insurance. Among women in their 40s, for whom mammography guidelines were controversial at the time of data collection, provider gender was an important predictor of patient-reported mammography recommendation.
Background: Studies of the effects of physician gender on patient care have been limited by selected samples, examining a narrow spectrum of care, or not controlling for important confounders. We sought to examine the role of physician and patient gender across the spectrum of primary care in a nationally representative sample, large enough to examine the role of gender concordance and adjust for confounding variables. Methods: We examined the relationships between physician and patient gender using nationally representative samples (the U. S. National Ambulatory Medical Care Surveys from 1985 to 1992) of encounters of 41,292 adult patients with 1470 primary care physicians (internists, family physicians, and obstetrician/gynecologists). Factors examined included physician (age, gender, region, rural location), patient (age, gender, race, insurance), and visit characteristics (diagnoses, gender-specific and nonspecific prevention, duration, continuity, and disposition). Results: After multivariate adjustment, female physicians were more likely to see female patients, had longer visit durations, and were more likely to perform female prevention procedures and make some follow-up arrangements and referrals. Female physicians were slightly more likely to check patients blood pressure, but there were no significant differences in other nongender-specific prevention procedures or use of psychiatric diagnoses. Among encounters without breast or pelvic examinations, visit length was not related to physician gender, but length was longer in gender concordant visits than gender-discordant visits. Conclusions: Female physicians were more likely to deliver female prevention procedures, but few other physician gender differences in primary care were observed. Physician-patient gender concordance was a key determinant of encounters.
OBJECTIVE:To develop a simple, sensitive screening tool for lifetime intimate partner violence (IPV) in women.METHODS:In the emergency department (ED) of an urban teaching hospital, 75 English-speaking women between 18 and 64 years old were tested. The sensitivity and specificity of 43 dichotomous response-option, IPV screening questions were compared. The reference standard was lifetime IPV, determined by a semistructured interview, using preset criteria of specific violence acts or emotional control or both by an intimate partner. Questions with high sensitivity (>70%) were tested together against the reference standard. Answering yes to any question scored 1 point. Content area and the area under receiver-operator curve (AUROC) of the screening questions determined the final tool.RESULTS:Sixty-three percent of women reported lifetime IPV. Eight of the 43 screening questions had a sensitivity of >70%. After testing possible combinations, the final three-question screen, STaT had the highest AUROC. The STaT questions are: "Have you ever been in a relationship where your partner has pushed or Slapped you?" "Have you ever been in a relationship where your partner Threatened you with violence?" and "Have you ever been in a relationship where your partner has thrown, broken or punched Things?" The sensitivity (95% confidence intervals [95% CI]) of STaT for lifetime IPV is 96% (90%, 100%), 89% (81%, 98%), and 64% (50%, 78%) for a score of >/=1, >/=2, and 3, respectively. The corresponding specificity is 75% (59%-91%), 100%, and 100%.CONCLUSIONS:Three simple questions when used together can effectively identify lifetime IPV and will aid clinicians' efforts to identify abuse in women.
OBJECTIVE:To assess the health status of Afghan women and attitudes of these women and their male relatives during the period of Taliban rule toward women's rights and community development needs in Afghanistan.METHODS:In household residences in two regions in Afghanistan (one Taliban controlled and the other not under the Taliban) and a refugee camp and repatriation center in Pakistan, structured interviews were conducted among a random sample of women and men exposed to Taliban policy and women living in a non-Taliban controlled area (724 Afghan women and 553 male relatives).RESULTS:Major depression was far more prevalent among women exposed to Taliban policies (73%-78%) than among women living in a non-Taliban controlled area (28%). Sixty-five percent of women living in a Taliban-controlled area and 73% of women in Pakistan exposed to Taliban policies expressed suicidal ideation at the time of the study, compared with 18% of those in a non-Taliban controlled area. More than 90% of both women and men expressed support for equal work and educational opportunities, free expression, protection of women's rights, participation of women in government, and the inclusion of women's human rights concerns in peace talks. A majority of both women and men believed that guaranteeing civil and political rights (69%) and meeting basic needs (90%) were important for the health and development of their communities.CONCLUSIONS:In Afghanistan under the Taliban, policies restricting women's rights were not the product of years of tradition or of social and economic deprivation. Instead, they were man-made policies as easily and swiftly revoked as they were instituted. Depression rates among women in Afghanistan, especially in Taliban-controlled areas, were extraordinarily high. Current efforts to rebuild Afghanistan must address these high rates of depression and other mental health problems to ensure women's full participation in development.
Journal of Women's HealthVol. 12, No. 1 Conversation with the ExpertsToward Optimal Health: The Experts Discuss Gastrointestinal DysfunctionJodi Godfrey MeislerJodi Godfrey MeislerSearch for more papers by this authorPublished Online:7 Jul 2004https://doi.org/10.1089/154099903321154095AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetails Volume 12Issue 1Jan 2003 To cite this article:Jodi Godfrey Meisler.Toward Optimal Health: The Experts Discuss Gastrointestinal Dysfunction.Journal of Women's Health.Jan 2003.11-16.http://doi.org/10.1089/154099903321154095Published in Volume: 12 Issue 1: July 7, 2004PDF download
OBJECTIVE:Unrealistic perceptions of personal susceptibility to the health hazards of smoking may be an important determinant of cigarette smoking and a barrier to smoking cessation. This study was undertaken to assess perceptions of smoking-related health risks among women smokers.METHODS:A secondary analysis was conducted using cross-sectional data collected from 1184 (response rate 61%) perimenopausal women patients from one university-affiliated health system.RESULTS:The majority of respondents were white and college-educated and had an annual household income of over $60,000. Twelve percent of respondents were current smokers, 37% were former smokers, and 51% were never smokers. Sixty percent of current smokers rated their lifetime risk for developing heart disease or lung cancer as average or below average, and 75% of current smokers rated their lifetime risk for developing osteoporosis as average or below average. Multivariable logistic regression analysis revealed that any smoking history (past or current) was associated with perception of above average risk for developing lung cancer, but only heavier smoking (> or =10 cigarettes per day) was associated with perception of above average risk for developing heart disease. No level of smoking was associated with perception of above average risk for developing osteoporosis.CONCLUSIONS:The majority of women smokers surveyed perceived their lifetime risk for developing heart disease, lung cancer, and osteoporosis as average or below average. It appears that women smokers are more aware of their increased risk for developing lung cancer than their increased risk for developing heart disease or osteoporosis.
OBJECTIVES:This study examined the baseline health-related quality of life (HRQL) of 301 postmenopausal women with heart disease enrolled in the Estrogen Replacement and Atherosclerosis (ERA) trial.METHODS:The primary measure of HRQL was the Medical Outcomes Study Short Form-36 (MOS SF-36). The SF-36 was augmented with secondary assessments, including measures of depressive symptoms, life satisfaction, urinary incontinence, sleep disturbance, and physical symptoms. Multiple regression analyses were used to test hypotheses regarding the contribution of positive (social support) and negative (social strain) aspects of social relations after accounting for other correlates of HRQL and heart disease.RESULTS:Results indicate that social support was positively associated with better functioning for all measured outcomes (all p < 0.05) except symptom frequency and severity. Social strain was negatively associated with HRQL functioning (all p < 0.05) except overall physical functioning, sleep disturbance, and urinary incontinence. In addition, several comorbid conditions were negatively associated with HRQL outcomes. In particular, chest pain was significantly associated with worse functioning on all HRQL outcomes except urinary incontinence.CONCLUSIONS:These data suggest that both clinical status variables (particularly chest pain) and the psychosocial context (represented by dimensions of relationship quality) influenced HRQL in this cohort. Thus, interventions that combine medical treatments with psychosocially based interventions may be most effective for women at risk for impaired HRQL.
BACKGROUND:A woman's risk for cervical cancer has been used by physicians to guide the initiation and frequency of a Pap smear. The aim of this study was to determine family physicians' knowledge of risk factors for cervical cancer and perceived importance of risk in screening women.METHODS:The self-administered questionnaire was mailed to 5000 randomly selected active members of the American Academy of Family Physicians (AAFP).RESULTS:Data from 2748 usable questionnaires indicated the mean number of risks considered for cervical cancer was 4.5. Physician's age and the number of reported risks were inversely correlated (p = 0.0001). Female physicians reported significantly more risk factors than male physicians (p = 0.05). The number of Pap smears performed per month was positively correlated with the number of risk factors reported (p = 0.001). Only 10% of the physicians indicated that they perform a Pap smear at the same interval regardless of the risk of the woman.CONCLUSIONS:This sample of family physicians has a limited understanding of the risk factors for cervical cancer. This was true regardless of the age, gender, training, race, geographic location, or practice setting of the responding physician. Yet the usual practice of screening for cervical cancer reported by these physicians would suggest that knowledge and use of risk factors would be a critical aspect of screening for cervical cancer.
