Journal of women's health
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Journal of women's health · Apr 2020
Severe Maternal Morbidity Among a Cohort of Post-9/11 Women Veterans.
Background: Maternal morbidity and mortality are key indicators of women's health status and quality of care. Maternal morbidity and mortality are high and rising in the United States. There has been no evaluation of severe maternal morbidity and mortality among veteran women, although population characteristics suggest that they may be at risk. ⋯ High rates of mental health problems, obesity, rurality, maternal conditions, and racial discrepancies were noted among veterans who experienced severe maternal morbidity events. Conclusions: Severe maternal morbidity affects a significant number of veteran women. Systematic reporting of pregnancy outcomes and a multidisciplinary review committee would improve surveillance and case management at the VA. The VA is uniquely positioned to develop innovative comanagement strategies, especially in the area of perinatal mental health.
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Journal of women's health · Apr 2020
Implementing a Learning Collaborative Framework for States Working to Improve Outcomes for Vulnerable Populations: The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community.
The opioid crisis has impacted vulnerable populations, specifically pregnant and postpartum women, and infants prenatally exposed to substances, including infants with Neonatal Abstinence Syndrome. Lack of access to clinical and social services; potential stigma or discrimination; and lack of resources for provision of services, including screening and treatment, have impacted the health of these populations. In 2018, using a systems change approach, the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) convened an Opioid use disorder, Maternal outcomes, Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) that included other federal agencies, national clinical and nonclinical organizations, and 12 state leadership groups. ⋯ Four virtual learning sessions were conducted on the areas of focus identified by state teams, and ASTHO conducted three intensive TA opportunities, and five states were identified for temporary field placement. To successfully address the impact of the opioid crisis on pregnant and postpartum women and infants, states developed innovative strategies focused on increasing support, services, and resources. Moving forward, state teams will participate in two additional in-person meetings, continue to identify barriers to the work, refine and customize action plans, and set new goals, to effect broad-ranging systems change for these vulnerable populations.
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Journal of women's health · Apr 2020
Time to Cancer Diagnosis in Young Women Presenting to Surgeons with Breast-Related Symptoms: A Population-Based Cohort Study.
Background: Delay in diagnosis may be a contributing factor to the observed correlation between young age and advanced disease. We examined time to cancer diagnosis in young women presenting to surgeons with breast-related complaints. Materials and Methods: This population-based cohort study included all women aged 18-44 presenting to a surgeon with breast-related complaints between 2005 and 2015 in a large health care plan (n = 157,264). Data included demographics, diagnosis codes, and workup. ⋯ But nonspecific visit codes (other than breast mass) were associated with delays to imaging and biopsy. Among, women diagnosed with breast cancer, age under 40 years (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.9), being postpartum (OR: 2.6, 95% CI: 1.1-5.9), and a nonspecific visit code (OR: 8.3, 95% CI: 4.9-14.2) were associated with delay. Conclusions: Symptomatic women with lower a-priori likelihood of malignancy (younger age, postpartum, or nonspecific visit code) are at significantly greater risk of delayed diagnosis of cancer. Physicians should be aware of the diagnostic challenge in young women presenting with nonspecific symptoms.
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Journal of women's health · Apr 2020
A Prospective Study of Weight Gain in Women Diagnosed with Early-Stage Invasive Breast Cancer, Ductal Carcinoma In Situ, and Women Without Breast Cancer.
Background: Weight gain after breast cancer has been associated with recurrence and mortality. We therefore examined factors associated with ≥5% weight gain over 2-year follow-up of a cohort of newly diagnosed early-stage invasive breast cancer (EIBC) and ductal carcinoma in situ (DCIS) patients and age-matched controls without a breast cancer history. Materials and Methods: We interviewed participants 4-6 weeks after definitive surgical treatment (patients) or a negative/benign screening mammogram (controls). Multivariable logistic regression models were used to identify socioeconomic, psychosocial, and treatment factors associated with ≥5% weight gain over 2-year follow-up. Results: Overall, 88 (24%) of 362 EIBC patients, 31 (17%) of 178 DCIS patients, and 82 (15%) of 541 controls had ≥5% weight gain during follow-up. ⋯ Among DCIS patients, older patients (OR = 0.94; 95% CI = 0.89-0.99) were less likely to have ≥5% weight gain. Among controls, smokers were more likely to have ≥5% weight gain (OR = 3.03; 95% CI = 1.49-6.17). Conclusions: EIBC patients were more likely than DCIS patients and controls to experience ≥5% weight gain over follow-up. Studies are necessary to elucidate mechanisms of weight gain in early-stage breast cancer survivors.
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Journal of women's health · Apr 2020
The Consistency of Maternal Childhood Abuse Reporting in Pregnancy and the Postpartum Period.
Background: Toxic stress resulting from childhood abuse can lead to poorer physical and mental health for pregnant women and their unborn children. To provide a clinical response to these experiences, momentum to incorporate questionnaires about childhood adversity, including abuse, into patient care is building. Limiting factors to this initiative are concerns regarding the consistency of abuse reporting before age 18. ⋯ Higher postpartum social support was associated with less inconsistency overall, whereas higher depression was associated with increased inconsistency in physical abuse reporting (OR = 1.03, 95% CI = 1.01-1.06). Conclusions: Upon reevaluation, a questionnaire with clear adversity descriptions yielded greater retrospective reports of childhood abuse in the postpartum period. Women of higher psychosocial risk may be at greatest risk of inconsistent abuse reports. Thus, the questionnaire structure and individual characteristics of the reporter may play an important role in the report obtained.