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Lindau ST, Pinkerton EA, Abramsohn EM, Fuller CM, Grubb D, Mendoza T, Siston AK. Importance of Breast Sensation After Mastectomy: Evidence from Three Sources. Womens Health Rep (New Rochelle) 2023; 4:594-602. [PMID: 38099078 PMCID: PMC10719638 DOI: 10.1089/whr.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/17/2023]
Abstract
Background Every year, more than 90,000 U.S. women undergo mastectomy. More than 40% have reconstruction. Following reconstruction, most women experience persistent partial or complete numbness of the reconstructed breasts, and many experience pain. Yet, breast reconstruction procedures focus largely on esthetic outcomes with mixed impact on sensory outcomes and little attention to pain. This study examines whether and how breast sensation is important to women. Materials and Methods Conventional content analysis of extant qualitative data from a clinical registry (29 women with prior breast surgery for cancer, 2008-2022), a volunteer community sample (qualitative interviews with 6 women with and 5 without breast cancer, 2019), and from a Twitter social media survey (N = 32, 2022). Results Functions of the breast identified by women with and without cancer include breastfeeding, sexual function, and femininity. Five interrelated themes on the importance of breast sensation emerged among women with breast cancer history: sexual function, experience of partnered sex or relationship with one's sexual partner, breast embodiment, effect of breast pain on sexual function, and importance to psychological wellbeing. Women, advocates, and clinicians described a lack of patient-physician communication in this domain that exacerbates the negative impact of breast sensation loss on health and wellbeing. Conclusions Breast sensation is important to women following mastectomy, yet a gap exists in patient-physician communication about the impact of mastectomy and reconstruction on breast sensory function. Lessons for physicians, scientists, and skeptics are conveyed about why the basic integrity of women's bodies matters for practice and science.
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Affiliation(s)
- Stacy T. Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
| | - El A. Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Charles M. Fuller
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Danielle Grubb
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Tania Mendoza
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Amy K. Siston
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Lindau ST, Jagai JS, Abramsohn EM, Fuller CM, Wroblewski KE, Pinkerton EA, Makelarski JA. Unwanted sexual activity among United States women early in the COVID-19 pandemic. Am J Obstet Gynecol 2023; 228:209.e1-209.e16. [PMID: 36241078 PMCID: PMC9553968 DOI: 10.1016/j.ajog.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 09/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security. OBJECTIVE This study aimed to describe patterns and correlates of unwanted sex, defined as having sex more frequently than desired, among US women early in the COVID-19 pandemic. STUDY DESIGN The National US Women's Health COVID-19 Study was conducted in April 2020, using a nested quota sample design to enroll 3200 English-speaking women (88% cooperation rate) aged 18 to 90 years recruited from a research panel. The quota strata ensured sufficient sample sizes in sociodemographic groups of interest, namely, racial and ethnic subgroups. Patterns of sexual activity, including unwanted sex early in the pandemic, were described. To further elucidate the experiences of women reporting unwanted sex, open-ended responses to an item querying "how the coronavirus pandemic is affecting your sex life" were assessed using conventional content analysis. Logistic regression analyses-adjusting for sociodemographic characteristics, self-reported health, and prepandemic health-related socioeconomic risk factors, including food insecurity, housing instability, utilities and transportation difficulties, and interpersonal violence-were used to model the odds of unwanted sex by a pandemic-related change in health-related socioeconomic risk factors. RESULTS The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having "more sex," fear or worry about the transmission of the virus because of sex, and having sex to meet the partner's needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4-10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7-4.3). CONCLUSION More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.
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Affiliation(s)
- Stacy T Lindau
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL; Medicine Geriatrics, The University of Chicago, Chicago, IL.
| | - Jyotsna S Jagai
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Charles M Fuller
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | | | - El A Pinkerton
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Jennifer A Makelarski
- Departments of Obstetrics and Gynecology, The University of Chicago, Chicago, IL; College of Science and Health, Benedictine University, Lisle, IL
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3
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Moorhead JB, Herbert BM, Abebe KZ, Harrington C, Miller E, Lindau ST, Magnani JW, Johnson AE. Internet access and cardiovascular death in the United States. Am Heart J Plus 2022; 21:100200. [PMID: 37077665 PMCID: PMC10112670 DOI: 10.1016/j.ahjo.2022.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 04/21/2023]
Abstract
As high-speed internet becomes increasingly important as a resource for cardiovascular disease (CVD) prevention and management services, gaps in digital infrastructure may have detrimental impact on health outcomes. Using national census and CDC data from 2018 we evaluated state-level rates of household internet access and age-adjusted cardiac mortality. After adjusting for state level demographic variables, and rates of education, income, and health insurance, internet access rates were inversely associated with age adjusted CVD mortality, showing that the potential for internet access to affect CVD management deserves further study.
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Affiliation(s)
| | - Brandon M. Herbert
- University of Pittsburgh, School of Public Health, United States of America
| | - Kaleab Z. Abebe
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of General Internal Medicine, United States of America
| | - Christina Harrington
- Carnegie Mellon University, Human-Computer Interaction Institute, United States of America
| | - Elizabeth Miller
- University of Pittsburgh, School of Medicine, United States of America
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, United States of America
| | - Stacy T. Lindau
- The University of Chicago, Departments of Ob/Gyn and Medicine-Geriatrics and Palliative Medicine, United States of America
| | - Jared W. Magnani
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of Cardiology, United States of America
| | - Amber E. Johnson
- University of Pittsburgh, School of Medicine, United States of America
- University of Pittsburgh, Department of Medicine, Division of Cardiology, United States of America
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4
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Kunst N, Long JB, Xu X, Busch SH, Kyanko KA, Lindau ST, Richman IB, Gross CP. Understanding Regional Variation in the Cost of Breast Cancer Screening Among Privately Insured Women in the United States. Med Care 2021; 59:437-443. [PMID: 33560712 PMCID: PMC8611614 DOI: 10.1097/mlr.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Breast cancer screening for women aged 40-49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs. METHODS We used Blue Cross Blue Shield Axis, a large US commercial claims database accessed through secure portal, to assess regional variation in screening utilization and costs. We included screening mammography±digital breast tomosynthesis (DBT), screening ultrasound, diagnostic mammography±DBT, diagnostic ultrasound, magnetic resonance imaging and biopsy, and evaluated their utilization and costs. We assessed regional variation in annual per-screened-beneficiary costs and examined potential savings from reducing regional variation. RESULTS Of the 2,257,393 privately insured women, 41.2% received screening mammography in 2017 (range: 26.6%-54.2% across regions). Wide regional variation was found in the DBT proportion (0.7%-91.1%) and mean costs of DBT ($299; range: $113-714) and 2-dimensional (D) mammograms ($213; range: $107-471). In one-fourth of the regions, the mean DBT cost was lower than the mean 2D mammography cost in the full sample. Regional variation in the per-screened-beneficiary cost (mean: $353; range: $151-751) was mainly attributable to variation in the cost of DBT (accounting for 23.4% of regional variation) and 2D mammography (23.0%). Reducing regional variation by decreasing the highest values to the national mean was projected to save $79-335 million annually. CONCLUSIONS The mean mammogram cost for privately insured women ages 40-49 varies 7-fold across regions, driving substantial variation in breast cancer screening costs. Reducing this regional variation would substantially decrease the screening costs.
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Affiliation(s)
- Natalia Kunst
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
- Public Health Modeling Unit, Yale University School of Public Health, New Haven, Connecticut
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jessica B. Long
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Susan H. Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Kelly A. Kyanko
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Stacy T. Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, the University of Chicago, Chicago, IL, USA
| | - Ilana B. Richman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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Abstract
Mastectomy often leads to a complete desensitization of the chest, which in turn can give rise to diminished sexual function and to disembodiment of the breasts. One approach to mitigate the sensory consequences of mastectomy is to leverage technology that has been developed for the restoration of sensation in bionic hands. Specifically, sensors embedded under the skin of the nipple-areolar complex can be used to detect touches. The output of the sensors then drives electrical stimulation of the residual intercostal nerves, delivered through chronically implanted electrode arrays, thereby eliciting tactile sensations experienced on the nipple-areolar complex. The hope is that the bionic breast will restore a woman's sense that her breast belongs to her body so she can experience the pleasure of an embrace and derive the benefit of the sensual touch of her partner.
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Affiliation(s)
- Stacy T. Lindau
- Department of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, IL, United States
| | - Sliman J. Bensmaia
- Department of Organismal Biology and Anatomy, Division of Biological Sciences, The University of Chicago, Chicago, IL, United States
- Grossman Institute for Neuroscience, Quantitative Biology, and Human Behavior, Division of Biological Sciences, The University of Chicago, Chicago, IL, United States
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Lindau ST, Makelarski J, Abramsohn E, Beiser DG, Escamilla V, Jerome J, Johnson D, Kho AN, Lee KK, Long T, Miller DC. CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities. Health Aff (Millwood) 2018; 35:2020-2029. [PMID: 27834242 DOI: 10.1377/hlthaff.2016.0694] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to generate an inventory of 14,914 health-promoting resources; and a health information technology (IT) platform that was integrated with three electronic health record systems at thirty-three clinical sites. By mapping thirty-seven prevalent social and medical conditions to community resources, CommunityRx generated 253,479 personalized HealtheRx prescriptions for more than 113,000 participants. Eighty-three percent of the recipients found the HealtheRx very useful, and 19 percent went to a place they learned about from the HealtheRx. All but one organization continued using the CommunityRx system after the study period ended. This study demonstrates the feasibility of using health IT and workforce innovation to bridge the gap between clinical and other health-promoting sectors.
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Affiliation(s)
- Stacy T Lindau
- Stacy T. Lindau is an associate professor in the Departments of Obstetrics and Gynecology and of Medicine-Geriatrics and director of research and innovation at the Urban Health Initiative of University of Chicago Medicine, all at the University of Chicago, in Illinois
| | - Jennifer Makelarski
- Jennifer Makelarski is director of epidemiology and research training in the Lindau Laboratory in the Department of Obstetrics and Gynecology, University of Chicago
| | - Emily Abramsohn
- Emily Abramsohn is a researcher and director of quality assurance and data governance in the Lindau Laboratory in the Department of Obstetrics and Gynecology, University of Chicago
| | - David G Beiser
- David G. Beiser is an associate professor of medicine and pediatrics in the Section of Emergency Medicine at the University of Chicago
| | - Veronica Escamilla
- Veronica Escamilla is a senior researcher in the Lindau Laboratory in the Department of Obstetrics and Gynecology, University of Chicago
| | - Jessica Jerome
- Jessica Jerome is an assistant professor in the Department of Health Sciences at DePaul University, in Chicago, and a medical anthropologist in the Lindau Laboratory in the Department of Obstetrics and Gynecology, University of Chicago
| | - Daniel Johnson
- Daniel Johnson is chief of the Section of Academic Pediatrics, a professor in the Department of Pediatrics, and director of community science for the Urban Health Initiative of University of Chicago Medicine
| | - Abel N Kho
- Abel N. Kho is an associate professor of medicine at Northwestern University and director of the Center for Health Information Partnerships, both in Chicago
| | - Karen K Lee
- Karen K. Lee is director of fundraising and special programs in the Section of Pediatric Infectious Diseases and Section of Academic Pediatrics, University of Chicago
| | - Timothy Long
- Timothy Long is director of performance improvement, health information technology, and research at the Near North Health Service Corporation and chief clinical officer at Alliance of Community Health Services, both in Chicago
| | - Doriane C Miller
- Doriane C. Miller is an associate professor in the Department of Medicine and director of the Center of Community Health and Vitality at the Urban Health Initiative of University of Chicago Medicine
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7
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Flynn KE, Carter J, Lin L, Lindau ST, Jeffery DD, Reese JB, Schlosser BJ, Weinfurt KP. Assessment of vulvar discomfort with sexual activity among women in the United States. Am J Obstet Gynecol 2017; 216:391.e1-391.e8. [PMID: 27988269 DOI: 10.1016/j.ajog.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Multidimensional self-report measures of sexual function for women do not include the assessment of vulvar discomfort, limiting our understanding of its prevalence. In an effort to improve the measurement of patient-reported health, the National Institutes of Health funded the creation of the Patient Reported Outcomes Measurement Information System (PROMIS). This included the development of the PROMIS Sexual Function and Satisfaction measure, and version 2.0 of the Sexual Function and Satisfaction measure included 2 scales to measure vulvar discomfort with sexual activity. OBJECTIVES The objectives of the study were to describe the development of 2 self-reported measures of vulvar discomfort with sexual activity, describe the relationships between these scales and scales for lubrication and vaginal discomfort, and report the prevalence of vulvar discomfort with sexual activity in a large, nationally representative sample of US women. STUDY DESIGN We followed PROMIS measure development standards, including qualitative development work with patients and clinicians and psychometric evaluation of candidate items based on item response theory, in a probability sample of 1686 English-speaking US adult women. We tested 16 candidate items on vulvar discomfort. We present descriptive statistics for these items, correlation coefficients among the vulvar and vaginal scales, and mean PROMIS scores with 95% confidence intervals separately by menopausal status for the 1046 women who reported sexual activity in the past 30 days. RESULTS Based on the psychometric evaluation of the candidate items, we created 2 separate 4 item scales, one to measure labial discomfort and pain and one to measure clitoral discomfort and pain. Additional items not included in the scales assess pain quality, numbness, and bleeding. The correlations between the lubrication, vaginal discomfort, and the 2 vulvar discomfort measures ranged from 0.46 to 0.77, suggesting that these measures represent related yet distinct concepts. In our nationally representative sample, 1 in 5 US women endorsed some degree of vulvar discomfort with sexual activity in the past 30 days. Menopausal status was associated with lower lubrication and higher vaginal discomfort but not with vulvar discomfort. CONCLUSION The PROMIS Vulvar Discomfort with Sexual Activity-Labial and Vulvar Discomfort with Sexual Activity-Clitoral scales are publicly available for use in research and clinical settings. There is limited overlap between vulvar discomfort and lubrication or vaginal discomfort. The importance of measuring vulvar discomfort as part of a comprehensive assessment of sexual function is underscored by its prevalence.
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Affiliation(s)
- Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
| | - Jeanne Carter
- Departments of Surgery and Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Li Lin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Stacy T Lindau
- Departments of Obstetrics-Gynecology and Medicine-Geriatrics, University of Chicago, Chicago, IL
| | - Diana D Jeffery
- Defense Health Agency, Department of Defense-Health Affairs, Falls Church, VA
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Bethanee J Schlosser
- Departments of Dermatology and Obstetrics-Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kevin P Weinfurt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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8
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Abstract
OBJECTIVES Ectopic pregnancy is an important cause of maternal morbidity and mortality. Women who experience fragmented care may undergo unnecessary delays to diagnosis and treatment. Based on ectopic pregnancy cases observed in clinical practice that raised our concern about fragmentation of care, we designed an exploratory study to describe the number, characteristics, and outcomes of fragmented care among patients with ectopic pregnancy at one urban academic hospital. METHODS Chart review with descriptive statistics. Fragmented care was defined as a patient being evaluated at an outside facility for possible ectopic pregnancy and transferred, referred, or discharged before receiving care at the study institution. RESULTS Of 191 women seen for possible or definite ectopic pregnancy during the study period, 42 (22 %) met the study definition of fragmented care. The study was under-powered to observe statistically significant differences across groups, but we found concerning, non-significant trends: patients with fragmented care were more likely to be Medicaid recipients (65.9 vs. 58.8 %) and to experience a complication (23.8 vs. 18.1 %) compared to those with non-fragmented care. Most patients (n = 37) received no identifiable treatment prior to transfer and arrived to the study hospital with no communication to the receiving hospital from the outside provider (n = 34). Nine patients (21 %) presented with ruptured ectopic pregnancies. The fragmentation we observed in our study may contribute to previously identified socio-economic disparities in ectopic pregnancy outcomes. CONCLUSION If future research confirms these findings, health information exchanges and regional coordination of care may be important strategies for reducing maternal mortality.
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Affiliation(s)
- Debra B Stulberg
- Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA. .,Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA. .,Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.
| | - Irma Dahlquist
- Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA
| | - Christina Jarosch
- Psychiatry Residency Program, University of Minnesota, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA
| | - Stacy T Lindau
- Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA.,Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.,Department of Medicine - Geriatrics, The University of Chicago, Chicago, IL, USA
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9
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Bucholz EM, Strait KM, Dreyer RP, Lindau ST, D'Onofrio G, Geda M, Spatz ES, Beltrame JF, Lichtman JH, Lorenze NP, Bueno H, Krumholz HM. Editor's Choice-Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis. Eur Heart J Acute Cardiovasc Care 2016; 6:610-622. [PMID: 27485141 DOI: 10.1177/2048872616661847] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Young women with acute myocardial infarction (AMI) have a higher risk of adverse outcomes than men. However, it is unclear how young women with AMI are different from young men across a spectrum of characteristics. We sought to compare young women and men at the time of AMI on six domains of demographic and clinical factors in order to determine whether they have distinct profiles. METHODS AND RESULTS Using data from Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO), a prospective cohort study of women and men aged ⩽55 years hospitalized for AMI ( n = 3501) in the United States and Spain, we evaluated sex differences in demographics, healthcare access, cardiovascular risk and psychosocial factors, symptoms and pre-hospital delay, clinical presentation, and hospital management for AMI. The study sample included 2349 (67%) women and 1152 (33%) men with a mean age of 47 years. Young women with AMI had higher rates of cardiovascular risk factors and comorbidities than men, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, renal failure, and morbid obesity. They also exhibited higher levels of depression and stress, poorer physical and mental health status, and lower quality of life at baseline. Women had more delays in presentation and presented with higher clinical risk scores on average than men; however, men presented with higher levels of cardiac biomarkers and more classic electrocardiogram findings. Women were less likely to undergo revascularization procedures during hospitalization, and women with ST segment elevation myocardial infarction were less likely to receive timely primary reperfusion. CONCLUSIONS Young women with AMI represent a distinct, higher-risk population that is different from young men.
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Affiliation(s)
- Emily M Bucholz
- 1 Yale School of Medicine, New Haven, CT, USA.,2 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,3 Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kelly M Strait
- 4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Rachel P Dreyer
- 4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,5 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Stacy T Lindau
- 6 Department of Obstetrics and Gynecology Program in Integrative Sexual Medicine, Department of Medicine - Geriatrics, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
| | - Gail D'Onofrio
- 7 Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Mary Geda
- 8 Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Erica S Spatz
- 4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,5 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John F Beltrame
- 9 Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Australia
| | - Judith H Lichtman
- 2 Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nancy P Lorenze
- 4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Hector Bueno
- 10 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Investigacion i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Harlan M Krumholz
- 4 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,5 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,11 Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,12 Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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10
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Lindau ST, Abramsohn E, Chan P, Garavalia B, Garavalia L, Krumholz HM, Spatz E, Spertus JA, Decker C. Abstract P147: Sexual Problems Experienced by Women After an MI. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Describe sexual problems experienced by female patients following an MI to inform best practices for prevention and treatment.
Methods:
Women in the U.S. TRIUMPH MI registry who reported being sexually active before and 12 months after their MI were randomly selected. In-depth telephone interviews 18-24 months post-MI were conducted until thematic saturation occurred. Transcripts were coded and content analyzed by a multidisciplinary team including a nurse, psychologist, public health researcher, anthropologist, and gynecologist.
Findings:
Mean age was 58 years (range 43 to 75). Most subjects (13/17) said sexual activity was important before and after the MI. Although frequency of sexual activity was generally lower, the majority had resumed sexual activity by 6 months post-MI. Three women had resumed sexual activity within 3 weeks of the MI. Common, bothersome sexual problems after MI included: 1) low desire and arousal: “Since I had my heart attack the desire is not there anymore, not like it was. And I don't get the same feeling that I used to get from it.”, 2) vaginal dryness: “It's so bad. But I don't know what to do with that.” and 3) fear or worry that sex will trigger another MI: “My first experience, I was trying so hard, I had a real heart palpitation. You know, real strong and my heart beat real fast and it scared me.” Patients described their own and their partner's fear about sex as a hindrance: “I had to convince my husband that I wasn't going to die in bed.” Women indicated that physician-initiated attention to sexual concerns following an MI is lacking. Some attributed their sexual problems to medications that were initiated after the MI. Despite sexual problems experienced by MI patients and their partners, several women reported pleasure, physical closeness, normalcy, and “living life to the fullest” in the face of a life-threatening condition as motivations for continued sexual activity.
Conclusions:
Many women continue to be sexually active following an MI, in spite of bothersome sexual problems and worry about MI recurrence triggered by sex. Sexual activity, including fear of recurrent MI, should be addressed during post-MI care. These findings are being used to develop an intervention to improve sexual outcomes in women following MI.
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Affiliation(s)
| | | | - Paul Chan
- Mid America Heart Institute, Kansas City, MO
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11
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Boesveldt S, Lindau ST, McClintock MK, Hummel T, Lundstrom JN, Lindstrom JN. Gustatory and olfactory dysfunction in older adults: a national probability study. Rhinology 2011; 49:324-30. [PMID: 21858264 DOI: 10.4193/rhino10.155] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Olfactory and gustatory functions have not been well characterized in older adults in the US. Consequently, their relationships to sociodemographic characteristics, as well as physical and mental health, were studied in a large national probability sample using brief validated tests of chemosensory function. METHODS A five-odour identification test and taste-impregnated strips of filter paper (sweet, sour, bitter, and salty) assessed the ability to identify chemosensory stimuli. RESULTS Severe gustatory dysfunction was more prevalent than severe olfactory dysfunction. Age, education and sex were independently associated with performance on both the olfactory and gustatory identification tasks. Higher scores were associated with female sex, higher level of education, and lower age. Odour identification scores exhibited a positive, albeit weak, correlation with BMI, and food-related odours were better identified than non-food odours. In addition, odour identification performance was also negatively associated with depressive symptoms. CONCLUSIONS These data demonstrate a high prevalence of severe gustatory and, to a somewhat lesser extent, olfactory dysfunction in a population-based sample and demonstrate that even brief tests are capable of detecting correlations between both chemical senses and relevant health measures outside a clinical setting.
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Affiliation(s)
- S Boesveldt
- Monell Chemical Senses Center, Philadelphia, PA, USA.
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12
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Abstract
In July 2009, an international committee announced a new diagnostic criterion for diabetes based on hemoglobin Alc (HbA1c) values. Our objective was to estimate how the new diabetes diagnostic criterion will affect the prevalence of diabetes among different race, age, and gender subpopulations, compared to the previously used fasting plasma glucose (FPG) criterion. We analyzed nationally representative data from The National Health and Nutrition Examination Survey (NHANES), aggregated from 1999 to 2006. We estimated the prevalence of known diabetes (prevalence static across either diagnostic criterion), unknown, and no diabetes (prevalence variable by criterion). We tested statistical significance of prevalence differences for unknown diabetes between the prior diagnostic criterion--FPG of at least 126 mg/dL--and the new diagnostic criterion--HbA1c of at least 6.5%--using conditional logistic regression. We further tested the association of these differences with demographic factors. The new HbA1c diagnostic criterion differentially affects different racial/ethnic groups. For non-Hispanic whites, the prevalence of undiagnosed diabetes was more than halved from 2.6% (95% confidence interval [CI], 2.2-3.1) with FPG diagnosis to 1.3% (95% CI, 1.0-1.7), P<.001 with HbAic diagnosis. For Hispanics and non-Hispanic blacks, the differences in prevalence by the 2 criteria were smaller and nonsignificant. Racial differences by diagnostic criteria were most pronounced among people aged over 55 years. Overall, the new definition of diabetes differentially affects ethnic groups, especially for older people. If the new criterion is widely adopted, over time, we may see an apparent widening of racial/ethnic disparities in diabetes prevalence.
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Affiliation(s)
- Anusha M Vable
- Diabetes Research and Training Center, and Department of Medicine, The University of Chicago, 5841 S. Maryland Ave, MC 2007, Chicago, IL 60637, USA
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13
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Lichtman JH, Lorenze NP, D'Onofrio G, Spertus JA, Lindau ST, Morgan TM, Herrin J, Bueno H, Mattera JA, Ridker PM, Krumholz HM. Variation in recovery: Role of gender on outcomes of young AMI patients (VIRGO) study design. Circ Cardiovasc Qual Outcomes 2011; 3:684-93. [PMID: 21081748 DOI: 10.1161/circoutcomes.109.928713] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Among individuals with ischemic heart disease, young women with an acute myocardial infarction (AMI) represent an extreme phenotype associated with an excess mortality risk. Although women younger than 55 years of age account for less than 5% of hospitalized AMI events, almost 16 000 deaths are reported annually in this group, making heart disease a leading killer of young women. Despite a higher risk of mortality compared with similarly aged men, young women have been the subject of few studies. METHODS AND RESULTS Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) is a large, observational study of the presentation, treatment, and outcomes of young women and men with AMI. VIRGO will enroll 2000 women, 18 to 55 years of age, with AMI and a comparison cohort of 1000 men with AMI from more than 100 participating hospitals. The aims of the study are to determine sex differences in the distribution and prognostic importance of biological, demographic, clinical, and psychosocial risk factors; to determine whether there are sex differences in the quality of care received by young AMI patients; and to determine how these factors contribute to sex differences in outcomes (including mortality, hospitalization, and health status). Blood serum and DNA for consenting participants will be stored for future studies. CONCLUSIONS VIRGO will seek to identify novel and prognostic factors that contribute to outcomes in this young AMI population. Results from the study will be used to develop clinically useful risk-stratification models for young AMI patients, explain sex differences in outcomes, and identify targets for intervention.
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Affiliation(s)
- Judith H Lichtman
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
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14
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Hill EK, Sandbo S, Abramsohn E, Makelarski J, Wroblewski K, Wenrich ER, McCoy S, Temkin SM, Yamada SD, Lindau ST. Assessing gynecologic and breast cancer survivors' sexual health care needs. Cancer 2010; 117:2643-51. [PMID: 21656742 DOI: 10.1002/cncr.25832] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/31/2010] [Accepted: 11/08/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to identify patterns of interest in receiving care for sexual concerns among women who were survivors of gynecologic and breast cancers. METHODS Survey and medical records data were collected from June 2008 to March 2009 from 261 gynecologic and breast cancer patients. Logistic regression was used to estimate the effect of age and months since treatment on interest in receiving sexual healthcare. RESULTS The mean participant age was 55 years (range, 21-88 years). Only 7% of women had recently sought medical help for sexual issues, yet 41.6% were interested in receiving care. Greater than 30% responded that they would be likely to see a physician to address sexual matters, and 35% of all women were willing to be contacted if a formal program was offered. Compared with older women (aged >65 years), younger women (ages 18-47 years) were significantly more likely to report interest in receiving care to address sexual issues (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.14-7.54) and to see a physician to address sexual matters (OR, 4.51; 95% CI, 1.51-13.43), and they were more willing to be contacted for a formal program (adjusted OR [AOR], 5.00; 95% CI, 1.63-15.28). Compared with women who were currently in treatment, women who last received treatment >12 months previously were significantly more interested in receiving care (AOR, 2.02; 95% CI, 1.02-4.01) and were more willing to be contacted (AOR, 2.49; 95% CI, 1.18-5.26). CONCLUSIONS Greater than 40% of survivors expressed interest in receiving sexual healthcare, but few had ever sought such care. The current results indicated that there is an unmet need for attention to sexual concerns among women with gynecologic and breast cancers.
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Affiliation(s)
- Emily K Hill
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois 60637, USA.
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15
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Lindau ST, Hoffmann JN, Lundeen K, Jaszczak A, McClintock MK, Jordan JA. Vaginal self-swab specimen collection in a home-based survey of older women: methods and applications. J Gerontol B Psychol Sci Soc Sci 2009; 64 Suppl 1:i106-18. [PMID: 19204072 PMCID: PMC2763518 DOI: 10.1093/geronb/gbn021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 10/28/2008] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe the methods used for, cooperation with, assays conducted on, and applications of vaginal specimens collected by older women in their homes. METHODS Community-residing women (N = 1,550), ages 57-85 years, participated in a nationally representative probability survey. Vaginal self-swab specimen collection and in-home interviews were conducted between 2005 and 2006. Specimens were analyzed for bacterial vaginosis (BV), vaginal candidiasis (VC), high-risk human papillomavirus (HR-HPV), and cytological characteristics. Field methods, consent procedures, the swab protocol, laboratory procedures, and results reporting are described. RESULTS One thousand twenty-eight respondents (67.5% weighted) agreed to provide a vaginal specimen; 99.1% were successful. The specimen adequacy rates were BV and VC, 94.1%; HR-HPV, 99.7%; and cytology, 85.5%. The most common recorded reason for nonparticipation was a physical or health problem (38% of nonresponders). Responders were significantly more likely than nonresponders to be younger and more educated, and were more likely to report a recent pelvic examination, menopausal hormone use, and recent sexual activity. DISCUSSION Collection of vaginal self-swab specimens from older women in a population-based study is feasible and provides novel data on microenvironmental characteristics of the female genital tract relevant to analyses of gynecologic health, sexual activity and problems, and immune and inflammatory function.
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Affiliation(s)
- Stacy T Lindau
- Department of Obstetrics and Gynecology and Medicine-Geriatrics, University of Chicago, 5841 S. Maryland Avenue, MC2050, Chicago, IL 60637, USA.
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16
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Drum ML, Shiovitz-Ezra S, Gaumer E, Lindau ST. Assessment of smoking behaviors and alcohol use in the national social life, health, and aging project. J Gerontol B Psychol Sci Soc Sci 2009; 64 Suppl 1:i119-30. [PMID: 19181686 DOI: 10.1093/geronb/gbn017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The National Social Life, Health, and Aging Project (NSHAP) assessed smoking behaviors and alcohol use as factors directly related to physical health, well-being, and social relationships. We describe self-report measures of tobacco and alcohol use, as well as an established biological marker of tobacco exposure, cotinine, collected in Wave 1 of NSHAP. METHODS We compare smoking behaviors and alcohol use by gender and age group. We report on derived measures of alcohol consumption and tobacco exposure widely used in medical and substance use literature, compare current and past users, and describe associations between self-reported smoking status and cotinine. RESULTS Men are more likely than women to report alcohol use, potential problem drinking, and ever smoking. Alcohol use and smoking are lower among older age groups. Although current smoking is less prevalent than in the general U.S. adult population, 50% of current and 29% of past smokers have lifetime exposure of 40 pack-years or more. Cotinine is directly related to number of cigarettes per day but with considerable unexplained variation. Cotinine levels contradict self-report in fewer than 4% of nonsmokers. CONCLUSION NSHAP provides data useful for investigation of smoking and alcohol use and their association with health and social factors.
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Affiliation(s)
- Melinda L Drum
- Department of Health Studies, The University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
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17
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Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P. The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women. Am J Obstet Gynecol 2002; 186:938-43. [PMID: 12015518 DOI: 10.1067/mob.2002.122091] [Citation(s) in RCA: 357] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to describe the relationship between health literacy, ethnicity, and cervical cancer screening practices and to evaluate physician recognition of low literacy. STUDY DESIGN We studied a prospective cohort of English-speaking patients > or =18 years (n = 529) in ambulatory women's clinics. Univariate and multivariate analyses were used to evaluate demographics, health practices and beliefs, and knowledge regarding cervical cancer screening and prevention. Physicians' assessments of patient reading skills were obtained. RESULTS Low health literacy (<9th grade) was found among 40% of participants. Minority women were half as likely to know the purpose of the Papanicolaou test (9% vs 21%; P <.03) and were significantly more likely to have low literacy levels compared with white women (46% vs 15%; P <.05). Literacy was the only factor independently associated with knowledge related to cervical cancer screening (adjusted odds ratio, 2.25; 95% CI, 1.05-4.80). Physicians detected only 20% of the lowest readers. CONCLUSION Poor health literacy was a better predictor of cervical cancer screening knowledge than ethnicity or education, yet physicians infrequently recognized low literacy. Improved physician awareness and development of low literacy interventions may improve cervical cancer screening, particularly for the most vulnerable women.
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Affiliation(s)
- Stacy T Lindau
- Department of Obstetrics and Gynecology, Northwestern University Medical School, the University of Chicago Robert Wood Johnson Clinical Scholars Program, Ill 60637, USA
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18
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Lindau ST, Tomori C, McCarville MA, Bennett CL. Improving rates of cervical cancer screening and Pap smear follow-up for low-income women with limited health literacy. Cancer Invest 2001; 19:316-23. [PMID: 11338888 DOI: 10.1081/cnv-100102558] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Adult literacy is an independent and important predictor of health behavior. In 1993, the National Adult Literacy Survey conducted by the U.S. Department of Education demonstrated that one-third of the U.S. population over age 16 (44 million adults) is functionally illiterate. Several studies link low health literacy to self-reported poor health status, poor health behavior, and inadequate knowledge about disease. Epidemiologic studies of cancer prevention have not detected strong racial and ethnic disparities in disease detection and progression, resulting in an emphasis on behavioral and intervention-based research. Low literacy presents a wide-reaching barrier to disease prevention that, unlike race/ethnicity, is potentially modifiable. Here, we explore the relationship between health literacy and health behaviors related to cervical cancer prevention in an effort to address concerns about low rates of screening and follow-up in vulnerable populations. Our goal is to improve our understanding of the health impact of low literacy among urban women and to inspire interventions that will promote disease prevention behaviors in this population, particularly with regard to cervical cancer.
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Affiliation(s)
- S T Lindau
- University of Chicago, Robert Wood Johnson Clinical Scholars Program, Chicago, Illinois, USA.
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19
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Abstract
We describe a structured and uniform resident experience in operative endoscopy and analyze the costs of implementing such a program at an urban academic medical center. The residency curriculum at Northwestern Memorial Hospital incorporates a five-part approach to endoscopy training: weekly endoscopy rounds, an annual animal laboratory for residents, an individual animal laboratory, supervision by skilled endoscopic surgeons, and a laparoscopic training facility. Thirty-two residents have completed the training over 4 years. The annual cost of the entire program is $34,500, which can be offset partially by vendor support. A comprehensive and continuous endoscopic training program is an important and affordable part of resident education.
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Affiliation(s)
- M P Milad
- Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois 60611, USA.
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