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1.
Background
Scant research has examined the relationship between exercise behavior and weight status in pregnant women.Methods
A prospective study was conducted in which pregnant women (N = 332) completed self-report measures at each trimester. Repeated measures multivariate analysis of covariance (controlling for race, education, and parity) examined changes in the motivational determinants of exercise over time and by weight status. Regression analyses were conducted to understand how the motivational determinants predicted exercise behavior and to examine the impact of prepregnancy weight status.Results
A significant main effect for time was observed, with an increase in early pregnancy followed by a decrease in late pregnancy for the motivational determinants of exercise and exercise behavior. A significant main effect for weight status was observed such that normal weight pregnant women had significantly greater attitude and intention for exercise when compared with pregnant women with overweight/obesity. The primary predictors of intention were perceived behavioral control (first to second trimester) and attitude (second to third trimester). The primary predictor of exercise behavior was intention. Prepregnancy weight status provided no unique contributions.Conclusions
Findings from this study suggest that interventions designed to promote exercise in pregnancy should consider targeting perceived behavioral control in early pregnancy and attitude in later pregnancy. Improving exercise attitude in women with overweight or obesity may further strengthen their motivation to be active in pregnancy. Customized interventions may need to be designed to address the unique needs of women because their motivational determinants change over the course of pregnancy. 相似文献2.
Aims
Researchers at the U.S. Centers for Disease Control and Prevention (CDC) recently estimated the number of women at risk for alcohol-exposed pregnancies (AEPs) as 3.3 million per month. The number of women at risk was widely interpreted as the actual number of AEPs. The actual number of AEPs may be easier to interpret and may be more a more relevant public health metric for evaluating efforts to reduce AEPs. We estimated the expected actual number of AEPs among U.S. women 15–44 years of age and the expected actual number of alcohol-exposed births (AEBs).Methods
Like the CDC researchers, we used data about women aged 15–44 years who were neither pregnant nor sterile from the 2011–2013 National Survey of Family Growth. We identified women who had had sex without contraception in the last 4 weeks and reported binge drinking or drinking on more than 7 of the last 30 days. We then estimated the expected actual number of AEPs and AEBs, accounting for the chances of becoming pregnant and for pregnancy outcomes (birth, miscarriage, and abortion). We also conducted sensitivity analyses with varying assumptions.Results
Estimated prevalences of AEPs and AEBs were 1.2% (95% confidence interval, 0.9–1.7) and 0.8% (95% confidence interval, 0.5–1.2), respectively. During a 1-month period, we estimate 731,000 U.S. women had AEPs and 481,000 resulted in AEBs. Sensitivity analyses indicate expected actual AEP estimates ranging from 104,000 to 1,242,000 and AEBs from 79,000 to 816,000.Conclusions
Under our assumptions, the estimated expected actual number of AEPs is 2.5 million less than the CDC estimate of the number at risk of an AEP. By using evidence-informed assumptions for the chances of becoming pregnant and common pregnancy outcomes, our estimate of the expected actual number of AEPs is only 22% as large as the CDC's estimate of number at risk, and our estimate of expected actual number of AEBs only 15% as large. The evidence-informed assumptions used here should inform future efforts to estimate expected actual numbers of AEPs and AEBs. 相似文献3.
4.
Eliza Hartley Briony Hill Cate Bailey Matthew Fuller-Tyszkiewicz Helen Skouteris 《Women's health issues》2018,28(6):530-538
Background
Postpartum depression and anxiety are prevalent in the first year after giving birth and can have problematic health outcomes for the mother and infant, although further research is required about the factors that contribute to their development. This study explored the trajectory of depressive and anxiety symptoms across the first postpartum year and their associations with body attitudes, body mass index, and weight retention.Methods
Participants were 467 women recruited during pregnancy via online forums, in parenting magazines, and at baby and children's markets, or from a large tertiary Australian hospital. Participants reported retrospectively on the prepregnancy period and provided data in early pregnancy (Baseline; M = 17.1 weeks pregnant), at 3 months postpartum (T1; M = 13.1 weeks after birth), 6 months postpartum (T2; M = 26.6 weeks after birth), and 12 months postpartum (T3; M = 52.8 weeks after birth).Results
Latent growth curve modelling revealed that, from T1 to T3, depressive symptoms significantly decreased, whereas anxiety symptoms did not change significantly. Demographic factors, weight retention, body mass index, and body attitudes at T1 did not significantly predict the course of depression and anxiety over time; however, greater postpartum weight retention and negative body attitudes at T1 predicted a more severe experience of both depression and anxiety at T3.Conclusions
These findings emphasize the need to assess and monitor the risk factors that can have an adverse impact on postpartum women's psychological health. This finding is particularly important for women deemed to be at risk of problematic body image or weight issues so that health professionals can intervene, and better ensure the health of new mothers in the longer term. 相似文献5.
Background
Breast cancer is a leading cause of death in the United States. Continuing medical education programs such as the American Board of Internal Medicine's Maintenance of Certification (MOC) program can increase early detection of cancers by educating physicians about the benefits of screening. Did the imposition of American Board of Internal Medicine's MOC requirement affect guideline-compliant mammography screening?Method
To address this question, we took advantage of a natural experiment that occurred when one group of general internists was required to complete MOC by 2001 because they initially certified in 1991 (MOC required) and another group was grandfathered out of this requirement because they initially certified in 1989 (MOC grandfathers). To measure associations with the MOC requirement, we compared mammography screening in the 2 years before and the 3 years after the 2001 MOC requirement among beneficiaries treated by the MOC-required physicians and compared this difference with the same difference in mammography screening among a control group of beneficiaries treated by the MOC-grandfathered physicians.Results
We found that the MOC requirement was associated with a regression adjusted 2.8% increase (p < .001) in annual screening and 1.7% increase (p < .001) in biennial screening. When we limited the sample to beneficiaries with no screening at baseline (1999 and 2000), these figures increased to 8.5% (p = .02) and 6.4% (p = .01), respectively.Conclusions
The MOC requirement was associated with an improvement in guideline-compliant mammography screening with the most pronounced improvements among women who were the least adherent at baseline and therefore might have benefited the most from screening. 相似文献6.
Emily M. Johnston Andrea E. Strahan Peter Joski Anne L. Dunlop E. Kathleen Adams 《Women's health issues》2018,28(2):122-129
Introduction
We use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Act's (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19–44).Methods
We use two-way fixed effects difference-in-differences models to estimate the effects of Medicaid expansions on low-income (<100% of the Federal Poverty Level) women of reproductive age. Additional models are stratified to estimate effects based on women's parental status, pre-ACA state Medicaid eligibility levels, and the presence of a state Medicaid family planning waiver.Results
ACA Medicaid expansions decreased uninsurance among low-income women of reproductive age by 13.2 percentage points. This decrease was driven by a decrease of 27.4 percentage points for women without dependent children, who also experienced a decrease in the likelihood of not having a personal doctor (13.3 percentage points). We find a 3.8-percentage point reduction in the likelihood of experiencing a cost barrier to care among all women, but no significant effects for other access measures or subgroups. When stratified by state policies, decreases in uninsurance were greater in states expanding from pre-ACA eligibility levels of less than 50% of Federal Poverty Level (19.4 percentage points) and in states without a Medicaid family planning waiver (17.6 percentage points).Conclusions
The ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA. 相似文献7.
Jennifer K. Straughen Shawnita Sealy-Jefferson Michael Bazydlo Laura Helmkamp Dawn P. Misra 《Women's health issues》2018,28(6):488-494
Background
Few studies have identified modifiable risk factors that are associated with the prevention of preterm delivery (PTD). This study examined the relationship between PTD and physical activity during pregnancy.Methods
Data were obtained by medical record review and postpartum questionnaires from a cohort of African American women (N = 1,410) delivering singleton infants. Physical activity was self-reported and analyses compared any and none. Additional analyses classified leisure time physical activity (LTPA) and walking for a purpose as 0, 1 to 19, 20 to 39, and 40 minutes per day or more and stair climbing as 0, 1 to 5, 6 to 9, and 10 or more times per day. Log-Poisson models adjusted for previous PTD, pregnancy complications, and income were used to examine the association between PTD and physical activity during pregnancy across body mass index categories.Results
Overall, 16.4% of deliveries were preterm. LTPA was associated with a decreased prevalence of PTD (prevalence ratio [PR], 0.73; 95% confidence interval [CI], 0.55–0.96), but stratification by maternal prepregnancy body mass index suggested that LTPA was only protective against PTD among women with normal weight (PR, 0.43; 95% CI, 0.23–0.79). Stair climbing 10 or more times per day was associated with a decreased prevalence of PTD among women with normal weight (PR, 0.32; 95% CI, 0.11–0.94) and women with overweight (PR, 0.24; 95% CI, 0.07–0.80) only. Walking for a purpose (e.g., to the store, the bus stop, or to work) was not associated with PTD.Conclusions
African American women who participate in either LTPA or stair climbing during pregnancy have a decreased prevalence of PTD, but the protective effect varied by maternal body mass index. 相似文献8.
Ian Waldman Stephen Wagner Audrey S. Kulaylat Timothy A. Deimling 《Women's health issues》2018,28(5):456-461
Objectives
We sought to determine if there is an association between preoperative risk factors as defined by the American Society of Anesthesiologists (ASA) physical status score and the route of hysterectomy for benign indications.Methods
In this retrospective cohort study, the American College of Surgeons National Surgical Quality Improvement Project database was used to determine the route of hysterectomy, using Current Procedural Terminology codes, and associated ASA class. The analysis included abdominal, vaginal, total laparoscopic, and laparoscopic assisted vaginal routes of hysterectomy. Routes of hysterectomy were also grouped as either abdominal or minimally invasive for analysis. Multinomial logistic regression was used to model route of hysterectomy as a function of patient covariates, including ASA class, age, race and ethnicity, and body mass index.Results
The analysis included 117,919 patients from the National Surgical Quality Improvement Project database. Patients with ASA classification of III or IV to V had significantly decreased odds of undergoing a minimally invasive approach for hysterectomy (odds ratio [OR], 0.81 [95% confidence interval (CI)], 0.77–0.85; and OR, 0.42 [95% CI, 0.37–0.48], respectively). Secondary outcome analysis revealed that a body mass index of more than 30 kg/m2 was associated with significantly lower odds of undergoing a minimally invasive hysterectomy (OR, 0.87; 95% CI, 0.85–0.89). With respect to race/ethnicity, all non-White groups had decreased odds of undergoing a hysterectomy via a minimally invasive approach. Age 75 years or older was correlated with an increased likelihood of minimally invasive hysterectomy (OR, 1.18; 95% CI, 1.10–1.26).Conclusions
Patients with increased preoperative risk as defined by a high ASA classification are less likely to undergo a hysterectomy using a minimally invasive route for benign indications. 相似文献9.
Financial Strain and Contraceptive Use Among Women in the United States: Differential Effects by Age
Sophie Lyons Jennet Arcara Julianna Deardorff Anu Manchikanti Gomez 《Women's health issues》2019,29(2):153-160
Introduction
Low-income and young women experience disproportionately high rates of unintended pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators of financial status, particularly during emerging adulthood. This study investigates the relationship between financial strain and contraceptive use, focusing on the differential effects by age group.Methods
Multinomial logistic regression analyses assessed the relationship between financial strain and contraceptive use in a national sample of U.S. women ages 18–39 years (N = 932). Models were adjusted for income, employment status, and other sociodemographic characteristics and tested the interaction of financial strain and age group.Results
Women with high financial strain were less likely to use short-acting methods (compared with using no method) in the adjusted model; when the age and financial strain interaction was included, associations held only for women ages 18–24 and 25–29 years of age. Relative to contraceptive nonuse, women ages 18–24 years with high financial strain were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95% confidence interval [CI], 0.01–0.99) and short-acting hormonal (RRR, 0.03; 95% CI, 0.00–0.18) methods. Women ages 25–29 with high financial strain were less likely to use short-acting hormonal (RRR, 0.20; 95% CI, 0.05–0.87) and coital-specific (RRR, 0.11; 95% CI, 0.02–0.51) methods.Implications for Practice and/or Policy
Young women may be vulnerable to the effect of high financial strain on contraceptive nonuse. Providers working with this group should consider incorporating financial strain into screening tools to identify patients who may need extra attention in contraceptive decision-making conversations. Antipoverty programs could also have a positive effect on effective contraceptive use. 相似文献10.
Sarah F. Gallups Mary C. Connolly Catherine M. Bender Margaret Q. Rosenzweig 《Women's health issues》2018,28(6):553-558
Background
Recognition of potential explanations for nonadherence or treatment delays is crucial to improving survival, particularly among African American women, for whom there is limited research assessing patient factors that influence adherence to breast cancer chemotherapy.Objective
This study sought to examine the association of patient factors such as age, income, employment, and partner status with adherence (full dose/on time) to prescribed breast cancer adjuvant chemotherapy and delays in treatment among African American women.Methods
This observational, prospective study used baseline data from the Adherence, Communication, Treatment, and Support Intervention Study that included African American women with early stage breast cancer who were recommended to receive chemotherapy. Eleven baseline demographic variables measured by a sociodemographic questionnaire were analyzed against the outcome variables of 85% adherence to chemotherapy, dichotomized as yes or no, and chemotherapy treatment delays measured as number of days.Results
For the 121 African American women included in this study, only employment status and number of comorbidities were significant predictors for total treatment delays (incidence rate ratio [IRR] = 2.175 [p = .000]; IRR = 1.234 [p = .003]) in the adjusted models.Implications
Employment status and number of comorbidities are predictors of the ability to receive timely breast cancer chemotherapy among African American women. This knowledge allows identification of patients in need of tailored supportive care to encourage adherence and prevent treatment delays. 相似文献11.
Jill Theresa Messing Michelle Patch Janet Sullivan Wilson Gabor D. Kelen Jacquelyn Campbell 《Women's health issues》2018,28(1):104-111
Purpose
Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV.Methods
Trained researchers conducted semistructured interviews with women survivors of IPV referred by police. Multinomial logistic regression examined differential correlates of attempted, completed, and multiple strangulation.Results
Interviews were conducted with 71.14% of eligible women contacted by researchers. A high proportion (79.66%) of the women interviewed experienced attempted (11.70%), completed (30.16%), or multiple (37.80%) strangulation. Each form of strangulation was independently significantly associated with sexual violence when compared with no strangulation. African American women were at increased risk of attempted (adjusted relative risk ratio [ARR], 2.02; p < .05), completed (ARR, 1.79; p < .05), and multiple strangulation (ARR, 2.62; p < .001). Compared with no strangulation, multiple strangulation was associated with more IPV injury and risk factors for homicide, including loss of consciousness (ARR, 2.95; p < .05) and miscarriage (ARR, 5.08; p < .05). Women who had lost consciousness owing to strangulation were more likely to seek medical care than those who had been strangled but had not lost consciousness (p < .01).Conclusions
Strangulation is a prevalent form of IPV that presents significant health risks to women. Women's health practitioners are optimally positioned to identify subtle signs and symptoms of strangulation, help women to understand the delayed sequelae and potential future fatality associated with strangulation, and connect them with appropriate resources to reduce the risk of morbidity and mortality. 相似文献12.
Purpose
To examine the concordance of labor induction measures derived from birth certificate and hospital discharge data with each other and with maternal report.Methods
Birth certificate data were linked with hospital discharge data and structured interviews of 2,851 mothers conducted 1 month after first childbirth. Those who reported that a doctor or nurse tried to cause their labor to begin, and were not in labor before that event, were classified as undergoing labor induction. The mothers were aged 18 to 35 years at study entry and delivered at 78 hospitals (76 in Pennsylvania and 2 out of state) from 2009 to 2011.Results
The labor induction rate was 34.3% measured by maternal report, 29.4% by birth certificate data, and 26.2% by hospital discharge data. More than one-third of the women who reported labor induction were not reported as having been induced in the birth certificate data (33.6%), with similar results for the hospital discharge data (36.5%). The rate of underreporting of labor induction in the birth certificate data was higher for inductions occurring before 39 weeks of gestation (43.9%) than for inductions at 39 weeks or later (29.9%; p < .0001). Agreement between birth certificate and hospital discharge data was relatively low (kappa = 0.56), as was agreement between maternal report and birth certificate data (kappa = 0.58), and maternal report and hospital discharge data (kappa = 0.60).Conclusions
Both the birth certificate and hospital discharge data exhibit relatively poor agreement with maternal report of labor induction and seem to miss a substantial portion of labor inductions. 相似文献13.
Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women
Hye Chong Hong Carol Estwing Ferrans Chang Park Hyeonkyeong Lee Lauretta Quinn Eileen G. Collins 《Women's health issues》2018,28(2):188-196
Objective
Korean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women.Methods
Surveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence.Results
Ninety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust.Conclusions
The breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions. 相似文献14.
Naleen Raj Bhandari Kanesha D. Day Nalin Payakachat Amy M. Franks Keith R. McCain Denise Ragland 《Women's health issues》2018,28(3):251-257
Introduction
Given the rapid rise in availability and use, understanding the perception of electronic nicotine delivery systems (ENDS) products in pregnant women is vital. As more women of reproductive age use these products, it is likely that their use during pregnancy is also increasing. This study investigated the use of ENDS and tobacco cigarettes, along with knowledge and perceptions of associated health risks in pregnant women.Methods
A cross-sectional survey was conducted at a university-based obstetrical clinic. A 32-item self-administered survey was used to collect participants' knowledge, use, and risk perceptions of ENDS and tobacco smoking. Bivariate associations of demographics and ENDS user status were explored using Chi-square or Fisher's exact tests. Average differences in agreement with perception statements across ENDS user status were tested using ANOVA with Tukey's tests for multiple comparisons.Results
Of 382 participants, 57.9% were 21-29 years old and 60.1% had some college or higher education. 30.3% reported using both ENDS and tobacco cigarettes and 11.9% were current ENDS users. The majority of participants had adequate knowledge about the facts and safety of ENDS and there was no difference across three ENDS user status groups. ENDS users perceived significantly lower risk of ENDS and higher benefit of using ENDS to aid quitting tobacco smoking, compared to non-ENDS users. The majority of participants reported that their healthcare providers less frequently assessed ENDS use during their prenatal visits, compared to tobacco cigarette use.Conclusions
There is critical need for healthcare providers to increase the screening for ENDS use during pregnancy and promote awareness of risks and benefits of ENDS in pregnant women. 相似文献15.
Veronica X. Vela Elizabeth W. Patton Darshak Sanghavi Susan F. Wood Peter Shin Sara Rosenbaum 《Women's health issues》2018,28(2):137-143