Pregnancy,Prenatal Care,and Delivery of Mothers with Disabilities in Korea

The aim of this study was to investigate the whole picture regarding pregnancy, prenatal care, obstetrical complications, and delivery among disabled pregnant women in Korea. Using the data of National Health Insurance Corporation, we extracted the data of women who terminated pregnancy including delivery and abortion from January 1, 2010 to December 31, 2010. Pearson''s chi-square test and Student-t test were conducted to examine the difference between disabled women and non-disabled women. Also, to define the factors affecting inadequate prenatal care, logistic regression was performed. The total number of pregnancy were 463,847; disabled women was 2,968 (0.6%) and 460,879 (99.4%) were by non-disabled women. Abortion rates (27.6%), Cesarean section rate (54.5%), and the rate of receiving inadequate prenatal care (17.0%), and the rate of being experienced at least one obstetrical complication (11.3%) among disabled women were higher than those among non-disabled women (P < 0.001). Beneficiaries of Medical Aid (OR, 2.21) (P < 0.001) and severe disabled women (OR, 1.46) (P = 0.002) were more likely to receive inadequate prenatal care. In conclusion, disabled women are more vulnerable in pregnancy, prenatal care and delivery. Therefore, the government and society should pay more attention to disabled pregnant women to ensure they have a safe pregnancy period up until the delivery.

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Triglyceride-Rich Lipoprotein Cholesterol,Small Dense LDL Cholesterol,and Incident Cardiovascular Disease

BackgroundElevated triglyceride-rich lipoprotein (TRL) and small-dense low-density lipoprotein (sdLDL) particles are hallmarks of atherogenic dyslipidemia, and their cholesterol content is hypothesized to drive atherosclerotic risk. Prospective epidemiological data pertaining to cholesterol content of TRLs and sdLDL in primary prevention populations are mostly limited to coronary heart disease.ObjectivesThe purpose of this study was to prospectively evaluate whether triglyceride-rich lipoprotein cholesterol (TRL-C) and small-dense low-density lipoprotein cholesterol (sdLDL-C) concentrations associate with composite and individual incident cardiovascular disease (CVD) outcomes including myocardial infarction (MI), ischemic stroke (IS), and peripheral artery disease (PAD).MethodsIn a prospective case-cohort study within the Women’s Health Study, TRL-C and sdLDL-C (mg/dl) were directly measured in baseline blood specimens of case subjects (n = 480) and the reference subcohort (n = 496). Risk associations were evaluated for total CVD (MI, IS, PAD, and CVD death), coronary and cerebrovascular disease (MI, IS, CVD death), and individual outcomes (MI, IS, and PAD). Models were adjusted for traditional risk factors, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein.ResultsThe risk of both composite outcomes significantly increased across quartiles of TRL-C and sdLDL-C. TRL-C was significantly associated with MI and PAD (MI hazard ratio [HR]_Q4: 3.05 [95% confidence interval (CI): 1.46 to 6.39]; p_trend = 0.002; PAD HR_Q4: 2.58 [95% CI: 1.18 to 5.63]; p_trend = 0.019), whereas sdLDL-C was significantly associated with MI alone (HR_Q4: 3.71 [95% CI: 1.59 to 8.63]; p_trend < 0.001). Both markers weakly associated with IS. Association patterns were similar for continuous exposures and, for TRL-C, among subjects with low atherogenic particle concentrations (apolipoprotein B <100 mg/dl).ConclusionsTRL-C strongly associates with future MI and PAD events, whereas sdLDL-C strongly associates with MI alone. These findings signal that the cholesterol content of TRLs and sdLDL influence atherogenesis independently of low-density lipoprotein cholesterol, and high sensitivity C-reactive protein, with potentially different potency across vascular beds. (Women’s Health Study; NCT00000479)     

Genetic and environmental influences on the rate of progression to alcohol dependence in young women

Background: The development of alcohol dependence (AD) involves transitions through multiple stages of drinking behaviors and is shaped by both heritable and environmental influences. We attempted to capture this dynamic process by characterizing genetic and environmental contributions to the rate at which women progressed through 3 significant transitions along the pathway to AD: nonuse to initiation, initiation to onset of first alcohol‐related problem, and first problem to onset of AD. Methods: The sample consisted of 3,546 female twins from the Missouri Adolescent Female Twin Study. Participants ranged in age from 18 to 29 years. Retrospective reports of alcohol use histories were collected by telephone diagnostic interview and transition times between drinking milestones were coded ordinally. Standard genetic analyses were conducted in Mx to derive a trivariate model that provided estimates of genetic and environmental influences that were common as well as specific to the 3 transition times. Results: Heritable influences were found for rate of progression across all 3 transitions, accounting for 30 to 47% of the variance in transition times. Shared environmental contributions were evident only in rate of progression from nonuse to initiation (i.e., age at first drink). Heritable contributions to the rate of movement through successive drinking milestones were attributable to a common factor, whereas environmental influences were transition‐specific. Conclusions: The current study is unique in its use of a genetically informative design to document the rate of movement between drinking milestones in a female sample and to examine genetic contributions to multiple transition times over the course of AD development. Results indicate that an earlier report of heritability for males in rate of progression from regular drinking to AD generalizes to women and to other alcohol stage transitions. Findings also suggest the need to consider stage‐specific environmental contributions to alcohol outcomes in developing interventions.     

端粒酶与女性生殖功能

端粒酶是细胞中负责端粒延长的一种酶,通过合成染色体末端的DNA赋予细胞复制的永生性。其在保持端粒稳定、基因组完整、细胞长期的活性和潜在的继续增殖能力等方面有重要作用,端粒/端粒酶复合物的结构和功能的改变将会导致不同的疾病,尤其是癌症的发生。在人类正常生殖细胞、早期胚胎、干细胞、高度增殖体细胞和许多癌细胞中均有不同程度的端粒酶活性表达,并受到严密的调控。在女性生殖功能调控下,端粒酶活性表达在卵泡的发育及闭锁、子宫内膜的周期性变化、卵巢储备功能及性激素调节等方面发挥着重要的作用,并可在一定程度上预测卵巢储备功能及体外受精妊娠结局。     

Prevention of perinatal hepatitis B transmission in Haimen City,China: Results of a community public health initiative

In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8 × 10⁶ copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG.     

Reproductive decision-making in women living with human immunodeficiency virus: A systematic review

ObjectivesAnalyze and synthesize the research evidence to understand the reproductive decisions made by women living with HIV from the beginning of the epidemic to the present. Evaluate the barriers and the facilitators for reproductive decision-making. Identify areas of strength, improvement, and those requiring further research.Design and data sourcesSystematic review following the PRISMA guideline. PubMed, CINAHL, PsycINFO, Cochrane Library, SocINDEX, Embase, and Scopus databases were searched from 1985 to 2016 using the following Keywords: HIV, AIDS, pregnancy, reproduction, and decision-making.Study selectionA total of 42 research papers were included in this review. Initially, 1563 papers were identified for the review by database (n = 1544) and hand (n = 19) searches. With three review levels, 1521 papers were excluded (title review, n = 1272; abstract review, n = 136; and full paper review, n = 113). Studies published in English in peer-reviewed journals using both quantitative and qualitative methods and addressing reproductive decisions in women living with HIV were included. Thirdly, inclusion eligibility was assessed by title, abstract, and full text.Review methodsRandom allocation conducted by the primary researcher assigned an equal number of papers to each researcher for review, including detailed instructions with an abstraction form. Discrepancies were resolved by two researchers. Research quality was assessed using the NCHBL Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, the Critical Appraisal Skills Programme for the qualitative studies and its version for systematic reviewsResultsThe review included 42 papers, both quantitative (n = 24) and qualitative methods (n = 14). Most studies were completed by physicians (n = 16) or nurses (n = 15). More than two-thirds of the studies were performed in urban settings with predominantly African-American women (n = 27). Eight factors were identified as influencing the reproductive decision-making process in women living with HIV: ‘Socio-demographic, Health status and Pregnancy’, ‘Religion and spirituality’, ‘Beliefs and Attitudes about Antiretroviral Therapy’, ‘Healthcare providers’, ‘Significant others’, ‘Motherhood and fulfillment’, ‘Fear of perinatal infection and infection of partner(s)’, ‘Birth control and pregnancy management’.ConclusionsHealth care providers are not providing patient-centered care by applying scientific evidence to their practice when advising women with HIV in making reproductive decisions. Despite the strong evidence indicating pregnancy for women with HIV results in a safe birthing trajectory, one not likely to jeopardize the health of the either the mother or fetus, providers continue to recommend the women with HIV avoid pregnancy and neglect to invite partners to participate in the discussion.     

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The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women.     

Social support,acculturation stress,and parenting stress among marriage-migrant women

Purpose

The purpose of this study was to identify the relationships between social support, acculturation stress, and the parenting stress of marriage-migrant women.

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.