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issn:1931-843
1.  Gender Analysis of Moxifloxacin Clinical Trials 
Journal of Women's Health  2014;23(1):77-104.
Abstract
Purpose: To determine the inclusion of women and the sex-stratification of results in moxifloxacin Clinical Trials (CTs), and to establish whether these CTs considered issues that specifically affect women, such as pregnancy and use of hormonal therapies. Previous publications about women's inclusion in CTs have not specifically studied therapeutic drugs. Although this type of drug is taken by men and women at a similar rate, adverse effects occur more frequently in the latter.
Methods: We reviewed 158 published moxifloxacin trials on humans, retrieved from MedLine and the Cochrane Library (1998–2010), to determine whether they complied with the gender recommendations published by U.S. Food and Drug Administration Guideline.
Results: Of a total of 80,417 subjects included in the moxifloxacin CTs, only 33.7% were women in phase I, in contrast to phase II, where women accounted for 45%, phase III, where they represented 38.3% and phase IV, where 51.3% were women. About 40.9% (n=52) of trials were stratified by sex and 15.3% (n=13) and 9% (n=7) provided data by sex on efficacy and adverse effects, respectively. We found little information about the influence of issues that specifically affect women. Only 3 of the 59 journals that published the moxifloxacin CTs stated that authors should stratify their results by sex.
Conclusions: Women are under-represented in the published moxifloxacin trials, and this trend is more marked in phase I, as they comprise a higher proportion in the other phases. Data by sex on efficacy and adverse effects are scarce in moxifloxacin trials. These facts, together with the lack of data on women-specific issues, suggest that the therapeutic drug moxifloxacin is only a partially evidence-based medicine.
doi:10.1089/jwh.2012.4171
PMCID: PMC3881443  PMID: 24180298
2.  Relationship Between Poor Physical Function, Inflammatory Markers, and Comorbidities in HIV-Infected Women on Antiretroviral Therapy 
Journal of Women's Health  2014;23(1):69-76.
Abstract
Background: HIV-infected individuals may be at increased risk of poor physical function. Chronic inflammation has been associated with decreased physical function in the elderly and may also influence physical function in HIV-infected individuals.
Methods: This cross-sectional study assessed physical function in 65 HIV-infected women aged 40 and older on stable antiretroviral treatment using the Short Physical Performance Battery (SPPB): a standardized test of balance, walking speed, and lower- extremity strength developed for elderly populations. The relationship between low SPPB score, selected demographic and medical characteristics, and high inflammatory biomarker profile was analyzed using Fisher's exact test and Wilcoxon rank sum test.
Results: The median age of subjects was 49 years (interquartile range [IQR] 45–55), and the median CD4 T-cell count was 675 cells/mm3 (IQR 436–828). Thirteen subjects (20%) had a low SPPB score. Subjects with a low SPPB score were more likely to be cigarette smokers (p=0.03), had more medical comorbidities (p=0.01), and had higher levels of interleukin-6 (IL-6) (p<0.05). They also tended to be older (median age 55 vs. 48, p=0.06), more likely to have diabetes (p=0.07), and have higher levels of soluble tumor necrosis factor-1 (p=0.09).
Conclusions: Twenty percent of women aged 40 and older with well-treated HIV had poor physical-function performance, which was associated with the high burden of comorbidities in this population and with increased IL-6. However, it is unclear from this cross-sectional study whether increased inflammation was related to poor physical function or to other factors, such as age and medical comorbidities.
doi:10.1089/jwh.2013.4367
PMCID: PMC3880911  PMID: 24219874
3.  Weight and Body Composition Changes During Oral Contraceptive Use in Obese and Normal Weight Women 
Journal of Women's Health  2014;23(1):38-43.
Abstract
Background: Oral contraceptive (OC) use seems to have little effect on weight change in normal weight women. Most previous studies have excluded obese women, so the effect of OC use on weight change in obese women is unknown.
Methods: This analysis evaluates weight and body composition change with OC use among obese (body mass index [BMI] 30.0–39.9) and normal weight (BMI 19.0–24.9) women who were randomly assigned to two OC doses: 20 μg ethinyl estradiol (EE) and 100 μg levonorgestrel (LNG) OCs or 30 μg EE and 150 μg LNG OCs. Follow-up occurred after three to four OC cycles. Weight and body composition were measured at baseline and at follow-up using a bioelectrical impedance analyzer.
Results: Among 150 women (54 obese and 96 normal weight) who used OCs for 3 to 4 months, there were no clinically or statistically significant weight or body composition changes in the overall group or by BMI or OC formulation group.
Conclusions: These findings add to evidence that EE/LNG OCs are not associated with short term weight or body composition change for normal weight women and suggest that OCs are also are not associated with short term weight or body composition change in obese women.
doi:10.1089/jwh.2012.4241
PMCID: PMC3880912  PMID: 24156617
4.  Maternal Mortality and Morbidity in the United States: Where Are We Now? 
Journal of Women's Health  2014;23(1):3-9.
Abstract
This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.
doi:10.1089/jwh.2013.4617
PMCID: PMC3880915  PMID: 24383493
5.  Maternal Depression Mediates the Association Between Intimate Partner Violence and Food Insecurity 
Journal of Women's Health  2014;23(1):29-37.
Abstract
Background: Examination of maternal experiences of intimate partner violence (IPV) and depression as risk factors for food insecurity can provide a more nuanced understanding of the role that the family environment and women's health plays in the lives of families with young children that experience food insecurity. We investigated the longitudinal association between mothers' experiences of IPV and household food insecurity, and whether maternal depression mediated the relationship.
Methods: IPV, depression, and food insecurity were assessed among 1,690 socioeconomically disadvantaged mothers of young children who participated in the Fragile Families and Child Wellbeing study. Longitudinal multivariate logistic regression models were used to examine the association between IPV measured 3 years after the child's birth and increase in food insecurity from child's third to fifth birthday, as well as the mediating role of maternal depression, controlling for a number of maternal and household characteristics.
Results: Mothers who reside in food insecure households and those who experience IPV share similar characteristics of socioeconomic disadvantage and a greater propensity for depression compared to their counterparts. Mothers' experiences of IPV predicted an increased risk of household food insecurity two years later, and the relationship was mediated by maternal depression.
Conclusions: Food insecure mothers may benefit from widespread assistance. Targeting issues central to women's health must become a priority in combating food insecurity. Having IPV and mental health screenings coincide with food assistance applications may help identify women who would benefit from resources designed to increase physical safety, psychological well-being, and food security.
doi:10.1089/jwh.2012.4224
PMCID: PMC3880922  PMID: 24131321
6.  Subclinical Impairment of Ovarian Reserve in Systemic Lupus Erythematosus Patients with Normal Menstruation Not Using Alkylating Therapy 
Journal of Women's Health  2013;22(12):1023-1027.
Abstract
Background
Disease activity is a major factor in menstrual disorders in systemic lupus erythematosus (SLE) patients not receiving alkylating therapy. However, the ovarian reserve of SLE women with normal menstruation is still unclear.
Methods
Twenty-three SLE patients naïve to cytotoxic agents (SLE group) and nineteen SLE patients receiving current or previous cyclophosphamide (CTX) therapy (without other cytotoxic agents; SLE-CTX group) were enrolled. Twenty-one age-matched healthy women served as controls. All patients and controls had a regular menstrual cycle. Basal hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), and antral follicle count (AFC) were analyzed in the two study groups and compared with the control group.
Results
No significant differences were found between the SLE, SLE-CTX, and control groups in age, body mass index (BMI), and basal FSH and LH levels. The E2 (P=0.023) levels were high and the AMH (P=0.000) values and AFC (P=0.001) were significantly lower in the SLE and SLE-CTX groups compared to control. However, these values were similar between the SLE and SLE-CTX groups.
Conclusion
SLE patients not receiving alkylating therapy who had normal menstruation and short illness duration still had an impaired ovarian reserve.
doi:10.1089/jwh.2013.4255
PMCID: PMC3852339  PMID: 24283710
7.  Glycemic Control and Urinary Incontinence in Women with Diabetes Mellitus 
Journal of Women's Health  2013;22(12):1049-1055.
Abstract
Background
Although many studies have shown that diabetes increases the risk for urinary incontinence, it is unclear whether poor glycemic control in women with diabetes is associated with incontinence. This study aims to determine the relationship between the hemoglobin A1c (HbA1c) level and urinary incontinence in a large, diverse cohort of older women.
Methods
We examined 6026 older women who responded to a survey (62% response rate) and were enrolled in the Diabetes and Aging Study, an ethnically stratified random sample of patients with diabetes enrolled in Kaiser Permanente Northern California. Our primary independent variable was the mean of all HbA1c measurements in the year preceding the survey. Outcomes included the presence/absence of incontinence and limitations in daily activities due to incontinence. We used modified Poisson regression and ordinal logistic regression models to account for age, race, body mass index, parity, diabetes treatment, duration of diabetes, and comorbidity.
Results
Sixty-five percent of women reported incontinence (mean age 59±10 years). After adjustment, HbA1c levels were not associated with the presence or absence of incontinence. However, among women reporting incontinence, HbA1c ≥9% was associated with more limitations due to incontinence than HbA1c <6% (adjusted odds ratio 1.67, 95% confidence interval: 1.09–2.57).
Conclusion
In this cross-sectional analysis, HbA1c level is not associated with the presence or absence of incontinence. However, for women with incontinence, poor glycemic control (HbA1c ≥9%) is associated with more limitations in daily activities due to incontinence. Longitudinal studies are needed to determine whether improving glycemic control to HbA1c <9% leads to fewer limitations in daily activities due to incontinence.
doi:10.1089/jwh.2012.4093
PMCID: PMC3852603  PMID: 24032999
8.  Association Between Body Mass Index, Sexually Transmitted Infections, and Contraceptive Compliance 
Journal of Women's Health  2013;22(12):1062-1068.
Abstract
Background
Recent studies have examined the relationship between body mass index (BMI) and sexual behaviors, but little information exists on this relationship among racially diverse, low-income women using objectively measured clinical data. The purpose of this study was to examine the association between BMI and sexual behaviors, rates of sexually transmitted infections (STIs) and unintended pregnancy, and contraceptive adherence among adolescent and young adult women.
Methods
As part of a larger study, 1,015 Hispanic (54.2%), Black (18.6%) and White (24.8%) women aged 16 to 24 years seeking family planning services at publicly funded reproductive health clinics provided data on their baseline sexual behaviors, and contraceptive use and pregnancy history over 12 months. Objective clinical data were available from medical records at baseline (i.e., height, weight, and Papanicolaou [Pap] smear results), and over a 12-month period (i.e., STI results). Multivariable analyses were used to compare sexual behaviors, STI rates, contraceptive compliance, and unintended pregnancy rates between obese, overweight, and normal weight participants after adjusting for age, race/ethnicity, and other confounders.
Results
Overall, 423 (36.6%), 304 (26.3%), and 288 (24.9%) participants were classified as normal weight, overweight, and obese, respectively. No statistically significant association was observed between BMI and sexual behaviors, STI rates (overweight odds ratio [OR] 0.67; 95% confidence interval [95% CI] [0.4, 1.08]; obese OR 0.68; 95% CI [0.42, 1.10]); contraceptive compliance (overweight OR 0.89; 95% CI [0.69, 1.16]; obese OR 0.89; 95% CI 0.68, 1.16]), or unintended pregnancy (overweight OR 1.08 95% CI [0.73, 1.60]; obese OR 1.09; 95% CI [0.72, 1.63]).
Conclusion
STI history and contraceptive compliance did not vary by BMI. Therefore, all women should receive equal contraceptive counseling (including condoms) to reduce the risk of unplanned pregnancy and STIs.
doi:10.1089/jwh.2012.4116
PMCID: PMC3852604  PMID: 24093760
9.  Physical Activity and Musculoskeletal Injuries in Women: The Women's Injury Study 
Journal of Women's Health  2013;22(12):1038-1042.
Abstract
Background
Increased injury rates have been associated with physical activity (PA). The differences in musculoskeletal injury (MSI) characteristics resulting from PA, versus those unrelated to PA, are unknown. We describe the pattern of PA and non-PA MSI incurred by community-dwelling women.
Methods
Data were extracted from the Women's Injury Study, a web-based observational study that tracked weekly PA behaviors and self-reported MSI of 909 community-dwelling women ages 20–83 years. The primary outcome was self-reported MSI that interrupted daily activities ≥2 days and/or required treatment from a health care provider. Follow-up telephone reporting of MSIs allowed further description of injuries. Mixed effects logistic regression was used to identify injury sites associated with PA, controlling for age, body mass index, previous injury, and use of alcohol.
Results
Incidence of PA and non-PA MSIs were comparable; some differences in injury characteristics were evident across 83,241 person-weeks of reporting. Non-PA MSIs were more likely to come on “suddenly” (54% vs. 8%) and commonly involved head/jaw/neck injuries. Reported PA-related MSIs were less likely to require health care provider treatment (60% vs. 80%) and resulted in less missed days of work/school (11%) versus non-PA MSIs (17%). Compared to non-PA related injuries, PA-related injuries were more likely to involve the lower (odds ratio [OR]=3.10, p=0.002) or upper limbs (OR=2.54, p=0.01) and less likely to involve the head/jaw/neck (OR=0.21, p=0.002).
Conclusion
There are some differences in mechanisms of injury, the distribution of injuries by anatomical location, and the treatment of injuries depending on aerobic activity participation, although absolute rates of MSI were comparable.
doi:10.1089/jwh.2013.4287
PMCID: PMC3852605  PMID: 24117001
10.  The Status of HIV Prevention Efforts for Women in Correctional Facilities 
Journal of Women's Health  2013;22(12):1005-1008.
Abstract
In the United States, women are a significant proportion of the correctional population. Women also account for an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) cases. When compared with white women, black women have higher incarceration rates and represent more of the newly diagnosed HIV cases. Correctional facilities offer an opportunity to provide women with HIV testing and prevention services so that they will know their status and receive HIV/sexually transmitted disease (STD) risk-reduction counseling and other preventive services. In this report, we describe incarcerated population statistics and HIV surveillance epidemiology for women. We also describe HIV prevention activities undertaken by the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Additional research, program development, and implementation are needed to improve HIV prevention efforts for high-risk women.
doi:10.1089/jwh.2013.4522
PMCID: PMC3852606  PMID: 24116966
11.  Endogenous Estradiol Is Not Associated with Poor Physical Health in Postmenopausal Breast Cancer Survivors 
Journal of Women's Health  2013;22(12):1043-1048.
Abstract
Background
Among postmenopausal breast cancer survivors, poor physical health has been associated with higher risks of breast cancer events. Obesity and physical inactivity are known risk factors for poor physical health, while circulating estrogen is an additional potential risk factor. We tested the hypothesis that the relationship between poor physical health and worse breast cancer outcomes is mediated by higher estrogen concentrations associated with body size and physical inactivity.
Methods
We used data from 1030 postmenopausal breast cancer survivors to examine the association between serum estradiol levels, body mass index (BMI), physical activity, and RAND-36-item Health Survey (SF-36) physical health.
Results
In univariate analysis, poor physical health was associated with higher estradiol levels, in addition to obesity and low physical activity. Higher estradiol levels were significantly associated with higher odds of poor physical health (odds ratio, OR, 1.20 [95% confidence interval 1.03–1.39]) in a multivariable model adjusting for age, cancer stage and treatment, alcohol use, and physical activity. However, the relationship between estradiol levels and poor physical health was no longer significant (OR 1.06 [0.91–1.24]) after adding BMI in the model. In multivariate analysis, only poor physical health resulted in higher risks of recurrence (hazard ratio 1.33 [95% CI 1.08–1.64]).
Conclusions
These findings indicate that estradiol is related to poor physical health, but is not an independent risk factor from body size or inactivity. While obesity and physical activity in survivorship are potential targets for improving physical health, other biological processes that impact physical health, e.g. inflammation, remain to be identified.
doi:10.1089/jwh.2013.4375
PMCID: PMC3852607  PMID: 24111813
12.  Low Papanicolaou Smear Screening Rate of Women with HIV Infection: A Nationwide Population-Based Study in Taiwan, 2000–2010 
Journal of Women's Health  2013;22(12):1016-1022.
Abstract
Background
Women infected by human immunodeficiency virus (HIV) have a higher risk of contracting cervical cancer. Recent guidelines recommend that all HIV-positive women should receive two Pap smears in the first year after their HIV diagnosis.
Methods
This was a population-based cohort study, and the National Health Insurance Research Database (NHIRD) in Taiwan was used to estimate the Pap smear screening rate for 1449 HIV-infected women aged 18 years and over from 2000 to 2010. A multiple logistic regression analysis was used to identify factors associated with HIV-infected women who had received Pap smears.
Results
Of 1449 women, 618 (43%) women received at least one Pap smear. Only 14.7% of the HIV-infected women received Pap smears within one year after being diagnosed with HIV. A logistic regression analysis showed that the factors associated with receiving at least one Pap smear after HIV diagnosis were increasing age (AOR 1.04, 95% CI 1.03–1.05), high monthly income (AOR 1.83, 95% CI 1.51–2.23), any history of antiretroviral therapy (AOR 1.78, 95% CI 1.38–2.29), retention in HIV care (AOR 1.36, 95% CI 1.04–1.77), a history of sexually transmitted diseases (AOR 1.96, 95% CI 1.50–2.56), and any history of treatment for opportunistic infections (AOR 2.46, 95% CI 1.91–3.16).
Conclusions
A great need exists to develop strategies for promoting receipt of Pap smear screening services that specifically target severely disadvantaged women with HIV, particularly younger, lower income women and those in an asymptomatic phase.
doi:10.1089/jwh.2012.4127
PMCID: PMC3852610  PMID: 23992102
13.  Prevalence of Sleep Deficiency in Early Gestation and its Associations with Stress and Depressive Symptoms 
Journal of Women's Health  2013;22(12):1028-1037.
Abstract
Objective
Sleep deficiency is an emerging concept denoting a deficit in the quantity or quality of sleep. This may be particularly salient for pregnant women since they report considerable sleep complaints. Sleep deficiency is linked with morbidity, including degradations in psychosocial functioning, (e.g., depression and stress), which are recognized risk factors for adverse pregnancy outcomes. We sought to describe the frequency of sleep deficiency across early gestation (10–20 weeks) and whether sleep deficiency is associated with reports of more depressive symptoms and stress.
Methods
Pregnant women (N=160) with no self-reported sleep or psychological disorder provided sleep data collected via diary and actigraphy during early pregnancy: 10–12, 14–16, and 18–20 weeks' gestation. Sleep deficiency was defined as short sleep duration, insufficient sleep, or insomnia. Symptoms of depression and stress were collected at the same three time points. Linear mixed effects models were used to analyze the data.
Results
Approximately 28%–38% met criteria for sleep deficiency for at least one time point in early gestation. Women who were sleep deficient across all time points reported more perceived stress than those who were not sleep deficient (p<0.01). Depressive symptoms were higher among women with diary-defined sleep deficiency across all time points (p=0.02).
Discussion
Sleep deficiency is a useful concept to describe sleep recognized to be disturbed in pregnancy. Women with persistent sleep deficiency appear to be at greater risk for impairments in psychosocial functioning during early gestation. These associations are important since psychosocial functioning is a recognized correlate of adverse pregnancy outcomes. Sleep deficiency may be another important risk factor for adverse pregnancy outcomes.
doi:10.1089/jwh.2013.4331
PMCID: PMC3852611  PMID: 24117003
14.  Congress on Women's Health Trudy Bush Lecture 2014: New Insights into Sex Hormones and Cardiovascular Disease 
Journal of Women's Health  2014;23(12):997-1004.
Summary
Many basic, mechanistic studies of how sex steroids alter vascular function proceeded from Dr. Bush's seminal epidemiologic observations that noncontraceptive use of estrogen reduced all-cause and cardiovascular mortality. However, translating findings from these basic science studies into clinical trials and clinical guidelines has been controversial. This commentary reviews the development of sex steroid vascular research, identifies mechanisms by which sex steroids affect vascular function, reviews findings from recent clinical hormone trials, and identifies challenges and the need for continued funding of such investigations.
doi:10.1089/jwh.2014.4995
PMCID: PMC4267120  PMID: 25495365
15.  Abnormal Uterine Bleeding, Health Status, and Usual Source of Medical Care: Analyses Using the Medical Expenditures Panel Survey 
Journal of Women's Health  2013;22(11):959-965.
Abstract
Background
Traditionally, research on abnormal uterine bleeding (AUB) focused on measured menstrual blood loss. However, the main burden of this symptom from the patient perspective is its impact on quality of life. Better describing the demographic characteristics, quality of life, and utilization of medical care of women with AUB could assist with health resource planning for this population.
Methods
We analyzed data from the Medical Expenditures Panel Survey from 2002 to 2010. AUB was identified by International Classification of Diseases, ninth edition (ICD-9) code group 626, disorders of menstruation and other abnormal bleeding from the female genital tract. Health-related quality of life was assessed by the Short-form 12 Health Survey (SF-12, QualityMetric) physical and mental component summary scores (PCS and MCS). Poorer health-related quality of life was defined as PCS or MCS <50. Odds ratios (OR) and 95% confidence intervals (CI) for the association of AUB with poorer SF-12 scores and having a usual source of care were estimated by multivariable logistic regression models.
Results
Data analyzed represented an annual average of 56.2 million nonpregnant women between ages 18 and 50 years. We estimate that 1.4 million women per year (95% CI: 1.3–1.5 million) reported AUB. Women with AUB were more likely to be younger, Caucasian, and obese than women without AUB. Compared to women without AUB, women with AUB had greater odds of a poorer PCS score (OR=1.30, 95% CI: 1.10–1.55), a poorer MCS score (OR=1.28, 95% CI: 1.10–1.51), and a usual source of care (OR=1.85, 95% CI: 1.44–2.38).
Conclusions
AUB is associated with diminished physical and mental health status and having a usual source of medical care.
doi:10.1089/jwh.2013.4288
PMCID: PMC3820123  PMID: 24050455
16.  Maternal Screening for Hypothyroidism and Thyroiditis Using Filter Paper Specimens 
Journal of Women's Health  2013;22(11):991-996.
Abstract
Background and Objective
Hypothyroidism and autoimmune thyroiditis are more prevalent than previously considered in women during pregnancy and the postpartum, and are associated with adverse effects on the mother and her fetus. We determined the efficacy and accuracy of screening women for primary hypothyroidism and autoimmune thyroiditis by testing TSH and two thyroid antibodies (TAb): thyroperoxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), in eluates of filter paper specimens collected during early pregnancy and the postpartum.
Methods
We enrolled 494 first-trimester pregnant women with no exclusion criteria into a prospective study to detect primary hypothyroidism and autoimmune thyroiditis. Finger stick blood was applied to filter paper, dried in room air, eluted, and promptly tested for TSH and TAb. A total of 178 of the pregnant women (36%) were tested in the early postpartum. Women with abnormal results had confirmatory serum tests.
Results
It was found that 91 pregnant women (18.4%) and 43 postpartum women (24.2%) had abnormal TSH values (>4.0 mU/L) and/or positive TAb; 140 pregnant women (28.3%) had TSH values >2.5 mU/L. All subjects with TSH values >4.0 mU/L tested positive for TAb. Eighteen women (3.6%) who tested normal during pregnancy tested abnormal in the postpartum.
Conclusions
This study confirms that TSH and TPOAb measured in eluates of blood-spotted filter paper specimens are excellent screening tests to detect primary hypothyroidism and autoimmune thyroiditis in pregnant and postpartum women. Results are very comparable to serum data in this population published in the literature.
doi:10.1089/jwh.2013.4393
PMCID: PMC3820125  PMID: 24025107
17.  Do Differences in Risk Factors Explain the Lower Rates of Coronary Heart Disease in Japanese Versus U.S. Women? 
Journal of Women's Health  2013;22(11):966-977.
Abstract
Background
Mortality from coronary heart disease (CHD) in women in Japan is one of the lowest in developed countries. In an attempt to shed some light on possible reasons of lower CHD in women in Japan compared with the United States, we extensively reviewed and analyzed existing national data and recent literature.
Methods
We searched recent epidemiological studies that reported incidence of acute myocardial infarction (AMI) and examined risk factors for CHD in women in Japan. Then, we compared trends in risk factors between women currently aged 50–69 years in Japan and the United States, using national statistics and other available resources.
Results
Recent epidemiological studies have clearly shown that AMI incidence in women in Japan is lower than that reported from other countries, and that lipids, blood pressure (BP), diabetes, smoking, and early menopause are independent risk factors. Comparing trends in risk factors between women in Japan and the United States, current levels of serum total cholesterol are higher in women in Japan and levels have been similar at least since 1990. Levels of BP have been higher in in Japan for the past 3 decades. Prevalence of type 2 diabetes has been similar in Japanese and white women currently aged 60–69 for the past 2 decades. In contrast, rates of cigarette smoking, although low in women in both countries, have been lower in women in Japan.
Conclusions
Differences in risk factors and their trends are unlikely to explain the difference in CHD rates in women in Japan and the United States. Determining the currently unknown factors responsible for low CHD mortality in women in Japan may lead to new strategy for CHD prevention.
doi:10.1089/jwh.2012.4087
PMCID: PMC3820126  PMID: 24073782
18.  Practices That Reduce the Latina Survival Disparity After Breast Cancer 
Journal of Women's Health  2013;22(11):938-946.
Abstract
Objectives
Latina breast cancer patients are 20 percent more likely to die within 5 years after diagnosis compared with white women, even though they have a lower incidence of breast cancer, lower general mortality rates, and some better health behaviors. Existing data only examine disparities in the utilization of breast cancer care; this research expands the study question to which utilization factors drive the shorter survival in Latina women compared with white women.
Methods
This longitudinal linked Surveillance Epidemiology and End Results (SEER)-Medicare cohort study examined early stage breast cancer patients diagnosed between 1992 and 2000 and followed for 5–11 years after diagnosis (N=44,999). Modifiable utilization factors included consistent visits to primary care providers and to specialists after diagnosis, consistent post-diagnosis mammograms, and receipt of initial care consistent with current standards of care.
Results
Of the four utilization factors potentially driving this disparity, a lack of consistent post-diagnosis mammograms was the strongest driver of the Latina breast cancer survival disparity. Consistent mammograms attenuated the hazard of death from 23% [hazard ratio, HR, (95% confidence interval, 95%CI)=1.23 (1.1,1.4)] to a nonsignificant 12% [HR (95%CI)=1.12 (0.7,1.3)] and reduced the excess hazard of death in Latina women by 55%. Effect modification identified that visits to primary care providers have a greater protective impact on the survival of Latina compared to white women [HR (95%CI)=0.9 (0.9,0.9)].
Conclusions
We provide evidence that undetected new or recurrent breast cancers due to less consistent post-diagnosis mammograms contribute substantially to the long-observed Latina survival disadvantage. Interventions involving primary care providers may be especially beneficial to this population.
doi:10.1089/jwh.2012.4235
PMCID: PMC3820127  PMID: 24106867
19.  The Impact of Menopausal Symptoms on Quality of Life, Productivity, and Economic Outcomes 
Journal of Women's Health  2013;22(11):983-990.
Abstract
Background
The aim of this study was to investigate the impact of menopausal symptoms and menopausal symptom severity on health-related quality of life (HRQoL), work impairment, healthcare utilization, and costs.
Methods
Data from the 2005 United States National Health and Wellness Survey were used, with only women 40–64 years without a history of cancer included in the analyses (N=8,811). Women who reported experiencing menopausal symptoms (n=4,116) were compared with women not experiencing menopausal symptoms (n=4,695) on HRQoL, work impairment, and healthcare utilization using regression modeling (and controlling for demographics and health characteristic differences). Additionally, individual menopausal symptoms were used as predictors of outcomes in a separate set of regression models.
Results
The mean age of women in the analysis was 49.8 years (standard deviation,±5.9). Women experiencing menopausal symptoms reported significantly lower levels of HRQoL and significantly higher work impairment, and healthcare utilization than women without menopausal symptoms. Depression, anxiety, and joint stiffness were symptoms with the strongest associations with health outcomes.
Conclusions
Menopausal symptoms can be a significant humanistic and economic burden on women in middle age.
doi:10.1089/jwh.2012.3719
PMCID: PMC3820128  PMID: 24083674
20.  Calcium: Too Much of a Good Thing? 
Journal of Women's Health  2013;22(11):997-999.
doi:10.1089/jwh.2013.4596
PMCID: PMC3820141  PMID: 24192309
21.  Association of Physical Activity and Sedentary Behavior with Biological Markers Among U.S. Pregnant Women 
Journal of Women's Health  2013;22(11):953-958.
Abstract
Background
To examine the association between objectively measured light-intensity and moderate-to-vigorous-intensity physical activity (MVPA), sedentary behaviors, and biological markers in a national sample of U.S. pregnant women, as few studies have examined these relationships among this population.
Methods
The sample of noninstitutionalized U.S. civilians was selected by a complex, multistage probability design. Data from the 2003–2006 National Health and Examination Survey were used. Two hundred six pregnant women were included in the data analysis. Physical activity and sedentary data were objectively measured via accelerometry (ActiGraph 7164). Biomarker data was obtained in the mobile examination center from urine, blood samples, blood pressure, and anthropometric measurements. Urine and blood samples were obtained to determine pregnancy status, C-reactive protein (CRP), high-density lipoprotein (HDL) cholesterol, total cholesterol, and cotinine as well as fasting glucose, fasting triglycerides, and fasting low-density lipoprotein (LDL) cholesterol data. Multivariable regression was employed to examine the association between physical activity, sedentary behavior, and biomarker levels.
Results
There was a positive association between sedentary behavior and CRP levels (beta coefficient [b]=0.001, p=0.02) and LDL cholesterol (b=0.12, p=0.02). There was an inverse association between light-intensity physical activity and CRP (b=−0.003; p=0.008) and diastolic blood pressure (b=−0.03; p=0.02), with those engaging in higher levels of MVPA having higher HDL cholesterol (b=6.7; p=0.01).
Conclusion
Physical activity and sedentary behavior were favorably associated with various biomarkers among pregnant women, suggesting that healthcare providers should encourage pregnant women to participate in safe forms of physical activity behaviors while also reducing their amount of time spent in sedentary behaviors.
doi:10.1089/jwh.2013.4394
PMCID: PMC3820143  PMID: 23968237
22.  Calcium Plus Vitamin D Supplementation and Health Outcomes Five Years After Active Intervention Ended: The Women's Health Initiative 
Journal of Women's Health  2013;22(11):915-929.
Abstract
Background
Clinical outcomes of the Women's Health Initiative (WHI) calcium plus vitamin D supplementation trial have been reported during 7.0 years of active intervention. We now report outcomes 4.9 years after the intervention stopped and cumulative findings.
Methods
Postmenopausal women (N=36,282) were randomized; postintervention follow-up continued among 29,862 (86%) of surviving participants. Primary outcomes were hip fracture and colorectal cancer. Breast cancer, all cancers, cardiovascular disease (CVD), and total mortality were predetermined major study outcomes.
Results
Hip fracture incidence was comparable in the supplement and the placebo groups, postintervention hazard ratio (HR)=0.95, 95% confidence interval (95% CI: 0.78, 1.15) and overall HR=0.91 (95% CI: 0.79, 1.05). Overall, colorectal cancer incidence did not differ between randomization groups, HR=0.95 (95% CI: 0.80, 1.13). Throughout, there also was no difference in invasive breast cancer, CVD, and all-cause mortality between groups. In subgroup analyses, the invasive breast cancer effect varied by baseline vitamin D intake (p=0.03 for interaction). Women with vitamin D intakes >600 IU/d, had an increased risk of invasive breast cancer, HR=1.28 (95% CI; 1.03, 1.60). Over the entire study period, in post hoc analyses, the incidence of vertebral fractures, HR=0.87 (95% CI: 0.76, 0.98) and in situ breast cancers, HR=0.82 (95% CI: 0.68, 0.99) were lower among women randomized to supplementation.
Conclusion
After an average of 11 years, calcium and vitamin D supplementation did not decrease hip fracture or colorectal cancer incidence. Exploratory analyses found lower vertebral fracture and in situ breast cancer incidence in the supplement users. There was no effect on CVD or all-cause mortality.
doi:10.1089/jwh.2013.4270
PMCID: PMC3882746  PMID: 24131320
23.  Effects of Sex and Gender on Adaptation to Space: Musculoskeletal Health 
Journal of Women's Health  2014;23(11):963-966.
Abstract
There is considerable variability among individuals in musculoskeletal response to long-duration spaceflight. The specific origin of the individual variability is unknown but is almost certainly influenced by the details of other mission conditions such as individual differences in exercise countermeasures, particularly intensity of exercise, dietary intake, medication use, stress, sleep, psychological profiles, and actual mission task demands. In addition to variations in mission conditions, genetic differences may account for some aspect of individual variability. Generally, this individual variability exceeds the variability between sexes that adds to the complexity of understanding sex differences alone. Research specifically related to sex differences of the musculoskeletal system during unloading is presented and discussed.
doi:10.1089/jwh.2014.4910
PMCID: PMC4235589  PMID: 25401942
24.  Effects of Sex and Gender on Adaptations to Space: Reproductive Health 
Journal of Women's Health  2014;23(11):967-974.
Abstract
In this report, sex/gender research relevant to reproduction on Earth, in conjunction with the extant human and animal observations in space, was used to identify knowledge gaps and prioritize recommendations for future sex- and gender-specific surveillance and monitoring of male and female astronauts. With overall increased durations of contemporary space missions, a deeper understanding of sex/gender effects on reproduction-related responses and adaptations to the space environment is warranted to minimize risks and insure healthy aging of the men and women who travel into space.
doi:10.1089/jwh.2014.4915
PMCID: PMC4235591  PMID: 25401943
25.  Effects of Sex and Gender on Adaptation to Space: Behavioral Health 
Journal of Women's Health  2014;23(11):975-986.
Abstract
This article is part of a larger body of work entitled, “The Impact of Sex and Gender on Adaptation to Space.” It was developed in response to a recommendation from the 2011 National Academy of Sciences Decadal Survey, “Recapturing a Future for Space Exploration: Life and Physical Sciences for a New Era,” which emphasized the need to fully understand sex and gender differences. In this article, our workgroup—consisting of expert scientists and clinicians from academia and the private sector—investigated and summarized the current body of published and unpublished human research performed to date related to sex- and gender-based differences in behavioral adaptations to human spaceflight. This review identifies sex-related differences in: (1) sleep, circadian rhythms, and neurobehavioral measures; (2) personality, group interactions, and work performance and satisfaction; and (3) stress and clinical disorders. Differences in these areas substantially impact the risks and optimal medical care required by space-faring women. To ensure the health and safety of male and female astronauts during long-duration space missions, it is imperative to understand the influences that sex and gender have on behavioral health changes occurring during spaceflight.
doi:10.1089/jwh.2014.4911
PMCID: PMC4235984  PMID: 25259837

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