Journal of women's health
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Journal of women's health · May 2019
Predictors of More Effective Contraceptive Method Use at 12 Weeks Post-Abortion: A Prospective Cohort Study.
Background: Understanding factors associated with contraceptive use post-abortion can inform clinical practices to improve contraception uptake. Materials and Methods: This prospective cohort study included adult women who completed the survey before surgical abortion at an Atlanta, Georgia clinic, with an online survey 12 weeks later. Poisson regression models assessed associations between demographic and reproductive factors and use of more effective (contraceptive pill, ring, patch, injectables, intrauterine device [IUD], implant, sterilization) versus less effective (none, condoms, withdrawal, rhythm methods) contraception at follow-up. Results: Three hundred ninety three women completed the initial survey; 180 (46%) completed follow-up. ⋯ More effective contraception use was significantly associated with age over 30 (adjusted risk ratio, aRR 1.71, 95% confidence interval (CI): 1.14-2.57); nulliparity (aRR 1.70, 95% CI: 1.20-2.42); use of more effective methods at most recent conception (aRR 2.56, 95% CI: 1.73-3.79); interest in more effective methods at the time of the abortion (aRR 1.55, 95% CI: 1.11-2.18); and receiving a contraceptive/prescription at the time of abortion (aRR 1.97, 95% CI: 1.37-2.81). Conclusions: Over half of women use less effective contraception 3 months post-abortion, despite a high interest in more effective contraception. Additional research is needed to understand contraceptive decision making in the context of abortion care to inform interventions to increase contraceptive uptake.
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Journal of women's health · May 2019
The Clinical Utility of a Precision Medicine Blood Test Incorporating Age, Sex, and Gene Expression for Evaluating Women with Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Analysis from the PRESET Registry.
Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. ⋯ Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p < 0.0001, adjusted for patient demographics and clinical covariates). Across the score range, higher ASGES were associated with a higher likelihood of posttest cardiac referral. At 1-year follow-up, low ASGES women experienced fewer major adverse cardiac events than elevated ASGES women (1.3% vs. 4.2% respectively, p = 0.16). Conclusions: Incorporation of ASGES into the diagnostic workup demonstrated clinical utility by helping clinicians identify women less likely to benefit from further cardiac evaluation.
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Journal of women's health · May 2019
Quantifying Sex Differences in Cardiovascular Care Among Patients Evaluated for Suspected Ischemic Heart Disease.
Background: Cardiovascular care sex differences are controversial. We examined sex differences in management and clinical outcomes among patients undergoing noninvasive testing for ischemic heart disease (IHD). Methods: In a rural integrated healthcare system, we identified adults age 40-79 without diagnosed IHD who underwent initial evaluation with a cardiac stress test with imaging or coronary computed tomographic angiography (CTA), 2013-2014. We assessed sex differences in statin/aspirin therapy, revascularization, and adverse cardiovascular events. ⋯ There were no sex differences in revascularization after accounting for obstructive CAD or adverse cardiovascular outcomes during median follow-up of 33 months. Conclusion: In this contemporary cohort of patients with suspected IHD, women were less likely to receive lipid testing and aspirin therapy, but not statin therapy. Women did not experience worse outcomes. Sex differences in statin therapy reported by others may be due to inadequate accounting for baseline risk.
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Journal of women's health · May 2019
Preferred Product Attributes of Potential Multipurpose Prevention Technologies for Unintended Pregnancy and Sexually Transmitted Infections or HIV Among U.S. Women.
Background: Multipurpose prevention technologies (MPTs) are being developed to simultaneously protect women from unintended pregnancy and sexually transmitted infections (STIs) or human immunodeficiency virus. This study aims to determine MPT characteristics desired by young women in the United States (U. S.). Materials and Methods: This is a cross-sectional national survey administered online by MTurk. ⋯ Women desire safety and emphasize contraceptive efficacy over infection prevention. MPT preferences must be considered during product development to promote future acceptance among young women in the U. S.
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Journal of women's health · May 2019
Women with Preterm Birth Have Evidence of Subclinical Atherosclerosis a Decade After Delivery.
Background: Women with preterm birth (PTB) have excess risk of cardiovascular disease (CVD) and metabolic dysregulation after delivery, but vascular mechanisms are poorly understood. We considered that women with PTB may have evidence of subclinical atherosclerosis after delivery, perhaps related to cardiometabolic risk factors. Materials and Methods: The Pregnancy Outcomes and Community Health Moms (POUCHmoms) study followed women from pregnancy through 7 to 15 years after delivery (n = 678). Women underwent B-mode ultrasound to measure the average intima-media thickness (IMT) across the common carotid, bulb, and internal carotid artery segments at follow-up (n = 605). ⋯ Thicker mean bulb IMT in women with PTB was robust to cardiovascular risk factor adjustments (fully adjusted difference = +0.033, p = 0.029). Excluding cases of prepregnancy hypertension or preeclampsia did not change results. Conclusions: Mechanisms leading to subclinical atherosclerosis may link PTB with future CVD. PTB differences in maternal vessel remodeling in the carotid bulb, an arterial segment more prone to early development of atherosclerosis, were independent of traditional risk factors suggesting that novel processes may be involved.