1
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Harris HR, Davis CP, Terry KL. Epidemiologic Methods to Advance Our Understanding of Ovarian Cancer Risk. J Clin Oncol 2024; 42:2619-2621. [PMID: 38748943 DOI: 10.1200/jco.24.00602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 07/31/2024] Open
Affiliation(s)
- Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Colette P Davis
- Department of Public Health, University of West Florida, Pensacola, FL
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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2
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Watkins E, Chow CM, Lingohr-Smith M, Lin J, Yong C, Tangirala K, Collins K, Li J, Brooks R, Amico J. Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States. Ann Pharmacother 2024; 58:480-493. [PMID: 37589369 DOI: 10.1177/10600280231190701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is a highly prevalent vaginal infection. OBJECTIVES Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. METHODS Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. RESULTS An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. CONCLUSION AND RELEVANCE The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary.
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Affiliation(s)
| | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
| | | | | | | | | | - Roy Brooks
- Capital Women's Care Division 64, Laurel, MD, USA
- Holy Cross Hospital, Silver Spring, MD, USA
| | - Jennifer Amico
- Robert Wood Johnson Medical School, Rutgers, New Brunswick, NJ, USA
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Manjate A, Sergon G, Kenga D, Golparian D, Tyulenev Y, Loquilha O, Mausse F, Guschin A, Langa JC, Passanduca A, Sacarlal J, Unemo M. Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1323926. [PMID: 38706519 PMCID: PMC11067503 DOI: 10.3389/frph.2024.1323926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.
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Affiliation(s)
- Alice Manjate
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Gladys Sergon
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Darlenne Kenga
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yuriy Tyulenev
- Department of Healthcare, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Osvaldo Loquilha
- Departamento de Matemática e Informática, Faculdade de Ciências, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Fabião Mausse
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Alexander Guschin
- Department of Healthcare, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - José Carlos Langa
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Alfeu Passanduca
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jahit Sacarlal
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Magnus Unemo
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, United Kingdom
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Dhumal T, Rai P, Shah D, Murray PW, Kelly KM. Menstrual Products: Attitudes About Taxation and Safety. J Womens Health (Larchmt) 2024; 33:491-498. [PMID: 38407820 DOI: 10.1089/jwh.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.
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Affiliation(s)
- Trupti Dhumal
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Pragya Rai
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Drishti Shah
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Pamela W Murray
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly M Kelly
- Center for Innovation in Health Equity Research, Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Rodriguez VJ, Pan Y, Salazar AS, Nogueira NF, Raccamarich P, Klatt NR, Jones DL, Alcaide ML. Using unsupervised machine learning to classify behavioral risk markers of bacterial vaginosis. Arch Gynecol Obstet 2024; 309:1053-1063. [PMID: 38310145 DOI: 10.1007/s00404-023-07360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition. METHODS: Participants were 391 cisgender women in Miami, Florida, with a mean of 30.8 (SD = 7.81) years of age; 41.7% identified as Hispanic; 41.7% as Black and 44.8% as White. Participants completed measures of demographics, risk behaviors [sexual, medical, and reproductive history, substance use, and intravaginal practices (IVP)], and underwent collection of vaginal samples; 135 behavioral variables were analyzed. BV was diagnosed using Nugent criteria. RESULTS We identified four clusters, and variables were ranked by importance in distinguishing clusters: Cluster 1: nulliparous women who engaged in IVPs to clean themselves and please sexual partners, and used substances frequently [n = 118 (30.2%)]; Cluster 2: primiparous women who engaged in IVPs using vaginal douches to clean themselves (n = 112 (28.6%)]; Cluster 3: primiparous women who did not use IVPs or substances [n = 87 (22.3%)]; and Cluster 4: nulliparous women who did not use IVPs but used substances [n = 74 (18.9%)]. Clusters were related to BV (p < 0.001). Cluster 2, the cluster of women who used vaginal douches as IVPs, had the highest prevalence of BV (52.7%). CONCLUSIONS Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, in developing interventions intended to reduce BV and IVP, and ultimately in reducing the risk of HIV infection among women.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
- Department of Psychology, University of Georgia, Athens, USA
| | - Yue Pan
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Patricia Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA
| | - Nichole R Klatt
- Surgical Outcomes and Precision Medicine Research Division, Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1951 NW 10th Avenue, Suite 2300, Miami, FL, 33136, USA.
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Wireko S, Ofosu M, Agyemang F, Dankluvi HE, Cobbina AE. Vaginal douching and health risks among young women. Health Sci Rep 2024; 7:e1882. [PMID: 38357485 PMCID: PMC10865275 DOI: 10.1002/hsr2.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Vaginal douching is practiced by women for various reasons. Studies have shown that this practice can upset the normal vaginal flora, increasing susceptibility to certain sexually transmitted diseases (STIs). This study aimed to assess the health risks associated with this practice among women aged 15-54 years in a densely populated community in Kumasi, the second capital city of Ghana. Methods A cross-sectional survey was conducted to gather data on the prevalence of vaginal douching among young women and their beliefs, motivations, and knowledge about the practice. A structured questionnaire was used in recruiting participants. One-hundred and fifteen structured questionnaires were administered to women aged between 15 and 54 after their consent was sought. Results The study established that more than half of the participants (69.6%) engaged in douching with a midpoint of 19.5. The study indicated no significant difference between the age of participants and douching (p < 0.93). However, there was an indication of a significant association between educational status, marital status, and perception in relation to douching (p < 0.003, 0.0015, and 0.00, respectively), which also influenced the frequency of douching and contraction of STIs. Conclusion Most women in the study community recruited, regardless of their educational and marital status, believed that douching is necessary and considered part of feminine hygiene practices. Practicing douching may lead to most health complications including pelvic inflammatory disease and infertility which must be given serious attention by researchers, health personnel, and various women's groups.
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Affiliation(s)
- Solomon Wireko
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Mina Ofosu
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Florence Agyemang
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Herbert Ekoe Dankluvi
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
- Department of Medical DiagnosticsKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Andrews Evans Cobbina
- Department of Clinical MicrobiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
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Liptáková A, Čurová K, Záhumenský J, Visnyaiová K, Varga I. Microbiota of female genital tract – functional overview of microbial flora from vagina to uterine tubes and placenta. Physiol Res 2022. [DOI: 10.33549/physiolres.934960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Microorganisms and eukaryotic human cells coexist in synergistic relationships in nearly every niche of the human body. The female genital tract consisting of the vagina, uterus with its cervix and endometrium, uterine tubes and ovaries – harbors its own typical microbiota, which accounts for 9 % of the total bacterial population in females. To this organ system, we also assigned the microbiome of the placenta, which has not been studied much until now. Among the spectrum of microbial species, the female genital tract is mainly dominated by Lactobacillus species, which are considered to be one of the simplest yet most important microbial communities. However, this relationship between macro- and micro-organisms seems to have a number of physiological functions, e.g., the vaginal and cervical microbiota have unique impact on reproductive health. The aim of this review was to provide current view on female genital tract microbiota and its role in reproductive health. We describe in detail the association of vaginal or tubal epithelium with microbiota or the role of microbiota in normal placental function.
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Affiliation(s)
| | - K Čurová
- Department of Medical and Clinical Microbiology, Faculty of Medicine, University of P. J. Šafárik, Košice, Slovak Republic.
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8
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LIPTÁKOVÁ A, ČUROVÁ K, ZÁHUMENSKÝ J, VISNYAIOVÁ K, VARGA I. Microbiota of female genital tract - functional overview of microbial flora from vagina to uterine tubes and placenta. Physiol Res 2022; 71:S21-S33. [PMID: 36592438 PMCID: PMC9853993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Microorganisms and eukaryotic human cells coexist in synergistic relationships in nearly every niche of the human body. The female genital tract consisting of the vagina, uterus with its cervix and endometrium, uterine tubes and ovaries - harbors its own typical microbiota, which accounts for 9 % of the total bacterial population in females. To this organ system, we also assigned the microbiome of the placenta, which has not been studied much until now. Among the spectrum of microbial species, the female genital tract is mainly dominated by Lactobacillus species, which are considered to be one of the simplest yet most important microbial communities. However, this relationship between macro- and micro-organisms seems to have a number of physiological functions, e.g., the vaginal and cervical microbiota have unique impact on reproductive health. The aim of this review was to provide current view on female genital tract microbiota and its role in reproductive health. We describe in detail the association of vaginal or tubal epithelium with microbiota or the role of microbiota in normal placental function.
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Affiliation(s)
- Adriana LIPTÁKOVÁ
- Institute of Microbiology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
| | - Katarína ČUROVÁ
- Department of Medical and Clinical Microbiology, Faculty of Medicine, University of P. J. Šafárik in Košice, Slovak Republic
| | - Jozef ZÁHUMENSKÝ
- Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava and University Hospital Bratislava, Slovak Republic
| | - Kristína VISNYAIOVÁ
- Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava and University Hospital Bratislava, Slovak Republic
| | - Ivan VARGA
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic
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Salazar AS, Nogueira NF, Rodriguez VJ, Mantero A, Cherenack EM, Raccamarich P, Maddalon M, Brophy T, Montgomerie E, Klatt NR, Jones DL, Alcaide ML. A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis. AIDS Behav 2022; 26:3110-3118. [PMID: 35362906 PMCID: PMC9378611 DOI: 10.1007/s10461-022-03634-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.
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Affiliation(s)
- Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nicholas F Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Violeta J Rodriguez
- Department of Psychology, University of Georgia, Athens, Georgia
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alejandro Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Emily M Cherenack
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Patricia Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Marissa Maddalon
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Theodora Brophy
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Emily Montgomerie
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Nichole R Klatt
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, United States.
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States.
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10
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Font SA, Caniglia M, Kennedy R, Noll JG. Child Protection Intervention and the Sexual and Reproductive Health of Female Adolescents Ages 13 to 17 Years. JAMA Pediatr 2022; 176:461-469. [PMID: 35188543 PMCID: PMC8861893 DOI: 10.1001/jamapediatrics.2021.6605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022]
Abstract
Importance Child maltreatment adversely affects health and development, but evidence is needed regarding whether and how Child Protective Services (CPS) interventions may mitigate risks. Objective To assess whether different forms of CPS intervention are associated with sexual and reproductive health outcomes among female adolescents investigated by CPS for suspected exposure to maltreatment during childhood. Design, Setting, and Participants This cohort study used linked, longitudinal, statewide administrative data from Wisconsin, including medical assistance and CPS records, to examine the rates and correlates of sexual and reproductive health outcomes (sexual transmitted infections, pregnancies, births, and high-risk sexual behavior) among 9392 female adolescents tracked from age 13 through 17 years who were investigated by CPS for suspected exposure to maltreatment prior to their 13th birthday. The study assesses how these outcomes were associated with types and frequency of CPS involvement and intervention and with adolescent and family demographic characteristics. Participants were female adolescents born from 2000 through 2002 who were investigated by Wisconsin CPS for suspected exposure to maltreatment before 13 years of age and who were covered by medical assistance at least 85% of the time from 13 to 17 years of age. Exposures Varying levels and intensities of CPS interventions, ranging from a single investigation to adoption from foster care. Main Outcomes and Measures Dependent variables were pregnancy, birth, sexually transmitted infection, and an aggregate measure of sexual health concerns from 13 to 17 years of age. Primary explanatory variables were the intensity of CPS intervention (investigation only, in-home services, and foster care) and frequency of maltreatment concerns (number of investigations, continued involvement during adolescence). Logistic regression was used to assess the association of CPS measures with differences in sexual health outcomes. Data were analyzed from March 1 to October 12, 2021. Results This cohort study included 9392 female adolescents, among whom 3156 (33.6%) were born in 2000, 3064 (32.6%) in 2001, and 3173 (33.8%) in 2002; 2501 adolescents [26.6%] were Black, 1568 [16.7%] were Hispanic, 1024 [10.9%] were multiracial, 4024 [42.8%] were White, and 275 [2.9%] were listed as other [which included American Indian, Asian or Pacific Islander, or unknown race or ethnicity]). By 18 years of age, sizable proportions of maltreated female adolescents had at least 1 concerning sexual health outcome (23.5%), including diagnoses of gonorrhea, chlamydia, or trichomoniasis (8.4%), pregnancy (11.2%), and parenthood (6.1%). Compared with CPS investigation without formal intervention, foster care was associated with lower odds of pregnancy (adjusted odds ratio, 0.82; 95% C, 0.69-0.98) and live birth (adjusted odds ratio, 0.78; 95% CI, 0.61-0.99). Recurrent and ongoing CPS involvement was associated with adverse sexual health outcomes. Conclusions and Relevance This cohort study found that maltreated girls face increased risks of adverse sexual health outcomes in adolescence, but CPS interventions were associated with limited influence. More effective interventions are needed to help maltreated girls avoid teen pregnancy, sexually transmitted infections, and risky sexual behaviors in adolescence.
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Affiliation(s)
- Sarah A. Font
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
| | - Michael Caniglia
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
| | - Reeve Kennedy
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
| | - Jennie G. Noll
- Child Maltreatment Solutions Network, The Pennsylvania State University, University Park
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
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11
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Impact of vaginal douching products on vaginal Lactobacillus, Escherichia coli and epithelial immune responses. Sci Rep 2021; 11:23069. [PMID: 34845288 PMCID: PMC8629978 DOI: 10.1038/s41598-021-02426-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/09/2021] [Indexed: 11/08/2022] Open
Abstract
We compared the effect of commercial vaginal douching products on Lactobacillus crispatus, L. jensenii, L. gasseri, L. iners, E. coli, and immortalized vaginal epithelial cells (VK2). All studied douching products (vinegar, iodine and baking soda based) induced epithelial cell death, and all inhibited growth of E. coli. Co-culture of vaginal epithelial cells with any of the lactobacilli immediately following exposure to douching products resulted in a trend to less human cell death. However, co-culture of epithelial cells with L. iners was associated with higher production of IL6 and IL8, and lower IL1RA regardless of presence or type of douching solution. Co-culture with L. crispatus or L. jensenii decreased IL6 production in the absence of douches, but increased IL6 production after exposure to vinegar. Douching products may be associated with epithelial disruption and inflammation, and may reduce the anti-inflammatory effects of beneficial lactobacilli.
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Davis CP, Bandera EV, Bethea TN, Camacho F, Joslin CE, Wu AH, Beeghly-Fadiel A, Moorman PG, Myers ER, Ochs-Balcom HM, Peres LC, Rosenow WT, Setiawan VW, Rosenberg L, Schildkraut JM, Harris HR. Genital Powder Use and Risk of Epithelial Ovarian Cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Cancer Epidemiol Biomarkers Prev 2021; 30:1660-1668. [PMID: 34155063 PMCID: PMC8419086 DOI: 10.1158/1055-9965.epi-21-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genital powder use is more common among African-American women; however, studies of genital powder use and ovarian cancer risk have been conducted predominantly in White populations, and histotype-specific analyses among African-American populations are limited. METHODS We used data from five studies in the Ovarian Cancer in Women of African Ancestry consortium. Participants included 620 African-American cases, 1,146 African-American controls, 2,800 White cases, and 6,735 White controls who answered questions on genital powder use prior to 2014. The association between genital powder use and ovarian cancer risk by race was estimated using logistic regression. RESULTS The prevalence of ever genital powder use for cases was 35.8% among African-American women and 29.5% among White women. Ever use of genital powder was associated with higher odds of ovarian cancer among African-American women [OR = 1.22; 95% confidence interval (CI) = 0.97-1.53] and White women (OR = 1.36; 95% CI = 1.19-1.57). In African-American women, the positive association with risk was more pronounced among high-grade serous tumors (OR = 1.31; 95% CI = 1.01-1.71) than with all other histotypes (OR = 1.05; 95% CI = 0.75-1.47). In White women, a significant association was observed irrespective of histotype (OR = 1.33; 95% CI = 1.12-1.56 and OR = 1.38; 95% CI = 1.15-1.66, respectively). CONCLUSIONS While genital powder use was more prevalent among African-American women, the associations between genital powder use and ovarian cancer risk were similar across race and did not materially vary by histotype. IMPACT This is one of the largest studies to date to compare the associations between genital powder use and ovarian cancer risk, overall and by histotype, between African-American and White women.
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Affiliation(s)
- Colette P Davis
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, District of Columbia
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois
| | - Anna H Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patricia G Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Will T Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Veronica W Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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13
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Lewis FM, Diesel J. Intravaginal Practices Among Women Attending a Sexually Transmitted Disease Clinic-Philadelphia, 2017. Sex Transm Dis 2021; 48:e64-e67. [PMID: 32842046 PMCID: PMC10189515 DOI: 10.1097/olq.0000000000001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We conducted a survey among women attending an urban public sexually transmitted disease clinic to determine the type and frequency of intravaginal cleansing practices. Both intravaginal washing and douching were frequent, performed mostly for routine hygiene, and associated with self-report of sexually transmitted infection and bacterial vaginosis (douching and intravaginal washing).
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Affiliation(s)
- Felicia M.T. Lewis
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Jill Diesel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Michigan Department of Health and Human Services, Lansing, MI
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14
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Reynolds GL, Fisher DG, Erlyana E, Otterloo LV. Rectal douching in a community sample of men and women. Int J STD AIDS 2020; 31:1082-1092. [PMID: 32914687 DOI: 10.1177/0956462419837483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rectal douching (RD) may be a vector for sexually transmitted infection (STI) acquisition. The aim of this study was to describe the relationship between RD, and the prevalence of various STIs and sexual behaviors in a sample of women and men in Long Beach, California. Five hundred and forty-seven men (mean age 42.8 years) and 530 women (mean age 37 years) recruited from a community-based setting between April 2010 and August 2014 completed the Risk Behavior Assessment and a questionnaire eliciting information on use of lubricants and enemas for vaginal intercourse (VI) and anal intercourse (AI). Participants were screened for high-risk behaviors for human immunodeficiency virus infection including injection drug use. Bivariate analyses were conducted separately for women and men. Based on the empirical results, separate logistic regression models for women and men were constructed. Sensitivity analysis was conducted to assess model fit for reduced samples of only those men and women who reported AI. For men, RD was associated with a lower odds of being hepatitis C antibody positive, greater odds of being positive for hepatitis B virus surface antigen, syphilis, and using lubricants for receptive anal intercourse (RAI). RD in women was associated with higher odds of a positive test for syphilis, ever vaginally douching for VI, and using lubricants for RAI. Men and women who practice RD report positive syphilis test results and use of lubricants for RAI. RD should not be perceived as preventing STIs.
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Affiliation(s)
- Grace L Reynolds
- Department of Health Care Administration, Center for Behavioral Research and Services, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA
| | - Dennis G Fisher
- Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Department of Health Care Administration, California State University, Long Beach, CA, USA
| | - Erlyana Erlyana
- Department of Health Care Administration, Center for Behavioral Research and Services, California State University, Long Beach, CA, USA.,Center for Behavioral Research and Services, Psychology Department, California State University, Long Beach, CA, USA
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15
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Hung KJ, Hudson PL, Bergerat A, Hesham H, Choksi N, Mitchell C. Effect of commercial vaginal products on the growth of uropathogenic and commensal vaginal bacteria. Sci Rep 2020; 10:7625. [PMID: 32376907 PMCID: PMC7203152 DOI: 10.1038/s41598-020-63652-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/21/2020] [Indexed: 12/20/2022] Open
Abstract
Half of postmenopausal women experience genitourinary syndrome of menopause, for which many use lubricating vaginal products. The effect of vaginal products on uropathogenic and commensal vaginal bacteria is poorly understood. We evaluated the effect of five common vaginal products (KY Jelly, Replens Silky Smooth lubricant, coconut oil, Replens Long-Lasting moisturizer or Trimo-San) on growth and viability of Escherichia coli and Lactobacillus crispatus. Bacteria were co-cultured products alone and in the presence of both vaginal epithelial cells and selected products. Bacterial growth was compared between conditions using an unpaired t-test or ANOVA, as appropriate. All products except for coconut oil significantly inhibited growth of laboratory and clinical strains of Escherichia coli (p < 0.02). Only two products (Replens Long-Lasting moisturizer and Trimo-San) significantly inhibited growth of Lactobacillus crispatus (p < 0.01), while the product Replens Silky Smooth stimulated growth (p < 0.01). Co-culture of selected products in the presence of vaginal epithelial cells eliminated the inhibitory effects of the products on E. coli. In conclusion, in vitro exposure to vaginal moisturizing and lubricating products inhibited growth of Escherichia coli, though the inhibition was mitigated by the presence of vaginal epithelial cells. Lactobacillus crispatus demonstrated less growth inhibition than Escherichia coli.
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Affiliation(s)
- Kristin J Hung
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, United States.,Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA, United States
| | - Patricia L Hudson
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, United States.,Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Agnes Bergerat
- Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Helai Hesham
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, United States.,Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Namit Choksi
- Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Caroline Mitchell
- Vincent Center for Reproductive Biology, Vincent Obstetrics and Gynecology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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16
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O'Brien KM, D'Aloisio AA, Shi M, Murphy JD, Sandler DP, Weinberg CR. Perineal Talc Use, Douching, and the Risk of Uterine Cancer. Epidemiology 2019; 30:845-852. [PMID: 31584892 PMCID: PMC6779343 DOI: 10.1097/ede.0000000000001078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Perineal talc use and douching could affect the risk of uterine cancer through several possible pathways, including inflammation response, microbiota changes, or endocrine disruption. Two previous cohort studies of the association between talc use and uterine cancer have reported weak positive associations, but we know of no previous evaluations of the relationship between douching and uterine cancer. METHODS Using a large prospective cohort, we examined the relationship between incident uterine cancer and self-reported use of talc or douche using Cox proportional hazards models. RESULTS After excluding those with prior hysterectomy, 271 of 33,609 women reported incident uterine cancer (mean follow-up = 8.3 years in noncases; maximum 12.6 years). Overall, 26% of women reported ever using talc and 15% reported ever having douched. Ever talc use was associated with an increase in risk of uterine cancer (adjusted hazard ratio [HR] = 1.2; 95% confidence interval [CI] = 0.94, 1.6), with some evidence of a dose-response for frequency of talc use (P-for-trend = 0.07). Ever douching was not associated with uterine cancer risk (HR = 1.0; 95% CI = 0.72, 1.5), with no evidence of a frequency dose-response (P = 0.96). The estimates were similar when we restricted to invasive endometrial cancers, but not when we further restricted to endometroid adenocarcinomas. CONCLUSION The positive association we observed between talc use and uterine cancer risk is consistent with findings from previous prospective cohort studies of endometrial cancer. The relationships between uterine cancer and both douching and talc use merit further consideration, particularly as both exposures are preventable.
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Affiliation(s)
- Katie M O'Brien
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | | | - Min Shi
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - John D Murphy
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dale P Sandler
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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17
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Gabriel IM, Vitonis AF, Welch WR, Titus L, Cramer DW. Douching, Talc Use, and Risk for Ovarian Cancer and Conditions Related to Genital Tract Inflammation. Cancer Epidemiol Biomarkers Prev 2019; 28:1835-1844. [PMID: 31455671 DOI: 10.1158/1055-9965.epi-19-0375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/01/2019] [Accepted: 08/16/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Douching is associated with disorders involving genital tract inflammation and genital talc use with epithelial ovarian cancer (EOC), but their joint effects are infrequently considered. METHODS From 2,040 cases of EOC and 2,100 controls enrolled in eastern Massachusetts and New Hampshire, we used unconditional logistic regression to estimate risk for EOC associated with douching and/or talc use. In subsets of cases and controls, we also collected information about pelvic inflammatory disease (PID), ectopic pregnancy, and cervical neoplasia to estimate risk for these events from douching and/or talc use. RESULTS The adjusted OR and 95% confidence interval (CI) for all EOC was 0.94 (0.76-1.16) in women who douched but never used talc and 1.28 (1.09-1.51) in women who used talc but never douched. Compared with women who never regularly douched or used talc, ORs (95% CIs) were 0.83 (0.52-1.33) for women who both used talc and homemade douches and 1.53 (1.11-2.10) for women who both used talc and store-bought douches. Cases who both douched and used talc were more likely to have had PID compared with cases who had used neither [OR = 5.03 (95% CI, 1.61-15.7)]. CONCLUSIONS Douching is not an independent risk factor for ovarian cancer, but the combination of talc use and store-bought douches may modestly increase the risk for EOC beyond that for talc use alone. IMPACT The joint effect of talc use and douching, especially with commercial products, should be considered in evaluating risks associated with disorders involving genital tract inflammation or EOC.
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Affiliation(s)
- Iwona M Gabriel
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison F Vitonis
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - William R Welch
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Linda Titus
- Department of Epidemiology, University of Dartmouth, Geisel School of Medicine, Hanover, New Hampshire
| | - Daniel W Cramer
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
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18
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Ziba FA, Yakong VN, Asore RA, Frederickson K, Flynch M. Douching practices among women in the Bolgatanga municipality of the upper east region of Ghana. BMC WOMENS HEALTH 2019; 19:32. [PMID: 30736772 PMCID: PMC6368746 DOI: 10.1186/s12905-019-0720-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Vaginal douching is a common practice among women all over the world. Women douche for various reasons, despite evidence indicating the harmful health effects of the practice. There is lack of data on the practice in Ghana but health behaviors like vaginal douching may be influenced by differences in culture and geography. Therefore, this study sought to assess prevalence and predictors of vaginal douching practices among women of the Bolgatanga Municipality of Ghana. METHODS This cross-sectional study was conducted among 200 women from January to March 2016. RESULTS Sixty-seven percent of the women practiced vaginal douching, from which a similar proportion did it daily. Over two-thirds (67.7%) of the women used water for douching. The reasons for douching were cleansing the vagina (67.7%), therapeutic effects (12.8%) and tightening of the vaginal muscles (19.5%). The majority (87.2%) of women who douched were unaware of the harmful health effects associated with the practice. The educational level of the women (p = 0.025) and having knowledge of the dangers associated with douching (p < 0.001) were then significantly associated with douching practices. CONCLUSION Vaginal douching is commonly practiced by women in the Bolgatanga Municipality. Most of these women douche because they did not know that there are health problems associated with the practice. Health education on the issues of women health is very vital for the improvement of women's health.
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Affiliation(s)
| | - Vida Nyagre Yakong
- Department of Midwifery, University for Development Studies, Tamale, Ghana
| | | | | | - Michele Flynch
- Lienhard School of Nursing, Pace University, Pleasantville, New York City, USA
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19
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Stifani BM, Plagianos M, Vieira CS, Merkatz RB. Factors associated with nonadherence to instructions for using the Nestorone®/ethinyl estradiol contraceptive vaginal ring. Contraception 2017; 97:415-421. [PMID: 29269252 DOI: 10.1016/j.contraception.2017.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We sought to identify factors associated with nonadherence to instructions for using a novel contraceptive providing 1 year of protection. STUDY DESIGN Data from a multicountry Phase 3 trial of the Nestorone® (segesterone acetate)/ethinyl estradiol (NES/EE) contraceptive vaginal ring (CVR) were analyzed. Participants were instructed to use the CVR over 13 cycles and follow a 21/7 regimen. Their reports of CVR removals >2 h outside scheduled removal periods served as a proxy for nonadherence. We used multivariate logistic regression to determine factors associated with such use. RESULTS Of 905 participants, 120 (13%) reported CVR removals >2 h. Removals for washing [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.50-6.27] or sexual intercourse (OR 3.19, 95% CI 2.03-4.99), and finding CVR insertion difficult (OR 2.80, 95% CI 1.36-5.80) were factors associated with removals >2 h. Lower educational attainment also predicted ring removal >2 h (OR 3.23, 95% CI 1.55-6.75). Women residing in Europe or Australia were less likely to remove the ring for >2 h compared with women in the United States (OR 0.44, 95% CI 0.24-0.83 and OR 0.13, 95% CI 0.02-0.98, respectively). Participants who reported removals >2 h were more likely to discontinue CVR use (OR 1.93, 95% CI 1.24-2.95), report dissatisfaction (OR 2.20, 95% CI 1.32-3.69) and become pregnant during the study (OR 4.07, 95% CI 1.58-10.50). CONCLUSIONS Removing the CVR for washing and removing it before intercourse are factors associated with nonadherence to ring use. These are important topics for counseling women who are considering or using vaginal rings, including the NES/EE CVR. IMPLICATIONS Findings from this study may be useful in guiding counseling for current and prospective vaginal ring users. Anticipatory guidance should focus on how the ring feels in the vagina and during sex. Asking about ring removals may help identify women who are at increased risk for having an unplanned pregnancy.
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Affiliation(s)
- Bianca M Stifani
- Department of Obstetrics, Gynecology and Women's Health of Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA; Population Council, 1230 York Avenue, New York, NY, 10065, USA
| | | | - Carolina Sales Vieira
- Population Council, 1230 York Avenue, New York, NY, 10065, USA; Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, 3900-Campus Universitário-Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Ruth B Merkatz
- Population Council, 1230 York Avenue, New York, NY, 10065, USA.
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20
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Litman L, Williams MT, Rosen Z, Weinberger-Litman SL, Robinson J. Racial Disparities in Cleanliness Attitudes Mediate Purchasing Attitudes Toward Cleaning Products: a Serial Mediation Model. J Racial Ethn Health Disparities 2017; 5:838-846. [PMID: 28940177 DOI: 10.1007/s40615-017-0429-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/24/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
The present study has three objectives (1) to examine whether there are differences in cleanliness concerns between African Americans and European Americans toward kitchen items that are known to be vectors of disease, (2) to examine whether disparities in cleanliness attitudes have an impact on purchasing attitudes toward kitchen cleaning products, and (3) to explore the mechanisms that may account for these differences utilizing a serial mediation model. Five hundred participants, 50% African American and 50% European American were shown a picture of a sponge cleaning product and filled out multiple survey instruments relating to cleanliness attitudes. We found greater concern with cleanliness of kitchen items (d = .46) and a greater willingness to purchase cleaning products among African Americans compared to European Americans (17 vs 10%). A serial mediation analysis revealed that general cleanliness concerns account for the increased willingness to spend money on cleaning products among African Americans. These results suggest that African Americans are more sensitive to issues of cleanliness compared to European Americans and, in particular, are more sensitive to cleanliness of kitchen items such as sponges, which can be vectors of food-borne pathogens. Potential reasons for the observed racial disparities in cleanliness attitudes and the implications of these results for public health are discussed.
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Affiliation(s)
- Leib Litman
- Department of Psychology, Lander College, 75-31 150th Street, Flushing, NY, 11367, USA. .,Touro College and University System, New York, USA.
| | - Monnica T Williams
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Zohn Rosen
- Mailman School of Public Health, GRAPH Center, Columbia University, New York, USA
| | | | - Jonathan Robinson
- Department of Psychology, Lander College, 75-31 150th Street, Flushing, NY, 11367, USA.,Touro College and University System, New York, USA
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