Women veterans and menopause: Knowledge and preferences

The increasing number and older age of women Veterans receiving care at Veterans Health Administration (VHA) requires health-care providers to adjust to their changing patient population. We explored women Veterans’ self-reported knowledge of menopause, current/preferred sources of menopausal health information, and perceptions/barriers regarding treatment of menopausal symptoms. Three focus groups were conducted at two South Florida VHA facilities in 2014, which included 30 women Veterans (aged 45–60 years) who visited VHA primary care clinics at least once in the past year. Participants reported using various sources to obtain general and menopausal health information, particularly family, friends, and the internet. Some women also had discussions with their health-care providers, but believed not all VHA providers were knowledgeable about menopause. Most preferred older female providers, thinking they were better informed about menopausal issues. Women favored complementary/alternative therapies and were against using hormone therapy (HT) for symptom relief, although they felt they were insufficiently informed about HT. Menopausal-age women are the fastest growing group at VHA. To provide better care and enhance their experiences, the VHA must educate all primary care providers about menopausal care and strive to address women Veterans’ menopausal concerns and preferences.     

Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.

OBJECTIVES: To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country. DESIGN: A prospective study with patient follow-up until the 30th postoperative day. SETTING: A general surgical ward of a public hospital in Santa Cruz, Bolivia. PATIENTS: Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed. RESULTS: Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a "local" risk index constructed with the above cutoff points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3. CONCLUSIONS: SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.     

Duodenoscopic Management in Biliary Ascariasis

Abstract: Ascaris lumbricoides is spreading throughout the entire world. In its adult form it usually lives in the human intestine, but biliary or pancreatic complications due to the worn's infestation are not uncommon in endemic areas like Bolivia and have become a significant problem. Many authors recommended surgical treatment for the removal of the worn. In this paper we present our experiences with the endoscopic management of bilialy ascariasis. From June 1985 to August 1991, 38 patients were diagnosed as having biliary ascuriasis by means of an endoscopic retrograde cholungiography. In the duodenoscopic treatment, all of the procedures were performed under fluoroscopic control. These Ascaris lumbricoides were located in the choledocus and common hepatic ducts in 33 patients (86.8%), 3. patients had them in the gallbladder (7.9%) and 2 patients had them (5.3%) in the intrahepatic ducts. Endoscopic extractions were successful in 17 out of 20 (85.0%) non-jaundice patients, in the other 3 cases the woms were removed surgically. In the jaundice cases, 3 of the 6 patients with woms (50.0%) were successfully treated by endoscopic extractions with simultaneous stones prior to an endoscopic sphincterotomy and the rest were treated surgically. Since no significant complications were observed after this endoscopic treatment method we recommend endoscopic extractions of biliary ascariasis.     

Health Literacy,Numeracy, and Graphical Literacy Among Veterans in Primary Care and Their Effect on Shared Decision Making and Trust in Physicians

Studies reveal high levels of inadequate health literacy and numeracy in African Americans and older veterans. The authors aimed to investigate the distribution of health literacy, numeracy, and graph literacy in these populations. They conducted a cross-sectional survey of veterans receiving outpatient care and measured health literacy, numeracy, graph literacy, shared decision making, and trust in physicians. In addition, the authors compared subgroups of veterans using analyses of covariance. Participants were 502 veterans (22–82 years). Low, marginal, and adequate health literacy were found in, respectively, 29%, 26%, and 45% of the veterans. The authors found a significant main effect of race qualified by an age and race interaction. Inadequate health literacy was more common in African Americans than in Whites. Younger African Americans had lower health literacy (p <.001), graph literacy (p <.001), and numeracy (p <.001) than did Whites, even after the authors adjusted for covariates. Older and younger participants did not differ in health literacy, objective numeracy, or graph literacy after adjustment. The authors found no health literacy or age-related differences regarding preferences for shared decision making. African Americans expressed dissatisfaction with their current role in decision making (p =.03). Older participants trusted their physicians more than younger participants (p =.01). In conclusion, African Americans may be at a disadvantage when reviewing patient education materials, potentially affecting health care outcomes.     

Tripartite control of growth hormone secretion in women during controlled estradiol repletion

CONTEXT: Studies of how aging attenuates GH secretion are confounded by differences in sex-steroid milieus, abdominal visceral fat mass (AVF), and IGF-I concentrations and limited in interpretability by the use of pharmacological doses of secretagogues. HYPOTHESIS: In a controlled estrogenic milieu, near-physiological secretagogue drive will unmask distinct influences of age, AVF, and IGF-I on GH secretion. LOCATION: The study was conducted at an academic medical center. SUBJECTS: Subjects included 10 healthy pre- (PRE) and 10 postmenopausal (POST) women. PROCEDURE: In a defined estradiol (E(2)) milieu, we compared GH secretion after submaximal stimulation with GH-releasing peptide (GHRP)-2 (ghrelin analog), GHRH, and l-arginine (an inhibitor of somatostatin outflow). ANALYSIS: We related GH responses to age stratum (dichotomous variable) and AVF and IGF-I concentrations (continuous variables). RESULTS: In the face of comparable concentrations of E(2), testosterone, and SHBG: 1) age (P < 0.001) and secretagogue type (P < 0.001) independently determined GH secretion; 2) GH responses in POST subjects were only 26-33% of those in PRE (P < or = 0.002) across all secretagogues; 3) POST women lost the PRE order of secretagogue potency (GHRP-2 > GHRH = l-arginine); and 4) in the combined cohorts, higher AVF predicted reduced l-arginine-stimulated GH secretion (R(2) = 0.46, P = 0.0013), whereas higher IGF-I concentrations forecast increased GHRP-2 and GHRH drive (R(2) > or = 0.52, P < or = 0.013). CONCLUSION: A paradigm of near-physiological secretagogue drive in an E(2)-clamped milieu unmasks tripartite deficits in peptide-signaling pathways in healthy POST, compared with PRE, women. Post hoc analyses indicate that both greater visceral adiposity and lower IGF-I concentrations mark this triple regulatory defect.