Journal of women's health
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Journal of women's health · May 2019
Preterm Delivery and Maternal Cardiovascular Disease Risk Factors: The Nurses' Health Study II.
Background: Preterm delivery has been linked to future maternal cardiovascular disease (CVD); however, research investigating clinical CVD risk factors is limited. We evaluated whether women who have delivered an infant preterm are at higher risk of developing CVD risk factors after adjustment for prepregnancy confounders. Materials and Methods: We examined the association between preterm delivery and incident chronic hypertension, type 2 diabetes mellitus (T2DM), and hypercholesterolemia among 57,904 parous women in the Nurses' Health Study II. ⋯ The cumulative incidence of each risk factor was highest in women who delivered very preterm. Conclusions: Women with a history of preterm delivery are at higher risk of developing chronic hypertension, T2DM, and hypercholesterolemia in the years after pregnancy. This increased risk was particularly pronounced in the first 10 years after a preterm delivery, indicating that it may be an important time period to implement lifestyle interventions.
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Journal of women's health · May 2019
Representation of Women Physician Deans in U.S. Medical Schools.
Background: Among U. S. medical school deans, there is a wide gender gap, most prominent at the highest levels. We aimed to discover how well women physicians were represented within the pool of women deans compared with the pool of men deans. Materials and Methods: A cross-sectional study was performed on 149 allopathic medical schools in the United States. ⋯ This difference was most profound at the lower tier (assistant) dean level. A lower tier physician dean was 1.25 times more likely to be a man than a woman, and a higher tier (dean of medical school, senior associate, vice, or associate) physician dean was 1.16 times more likely to be a man. Conclusions: Women physicians were under-represented among medical school deans compared with men. This disparity held among lower tier and higher tier deans.
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Journal of women's health · May 2019
Predictors of More Effective Contraceptive Method Use at 12 Weeks Post-Abortion: A Prospective Cohort Study.
Background: Understanding factors associated with contraceptive use post-abortion can inform clinical practices to improve contraception uptake. Materials and Methods: This prospective cohort study included adult women who completed the survey before surgical abortion at an Atlanta, Georgia clinic, with an online survey 12 weeks later. Poisson regression models assessed associations between demographic and reproductive factors and use of more effective (contraceptive pill, ring, patch, injectables, intrauterine device [IUD], implant, sterilization) versus less effective (none, condoms, withdrawal, rhythm methods) contraception at follow-up. Results: Three hundred ninety three women completed the initial survey; 180 (46%) completed follow-up. ⋯ More effective contraception use was significantly associated with age over 30 (adjusted risk ratio, aRR 1.71, 95% confidence interval (CI): 1.14-2.57); nulliparity (aRR 1.70, 95% CI: 1.20-2.42); use of more effective methods at most recent conception (aRR 2.56, 95% CI: 1.73-3.79); interest in more effective methods at the time of the abortion (aRR 1.55, 95% CI: 1.11-2.18); and receiving a contraceptive/prescription at the time of abortion (aRR 1.97, 95% CI: 1.37-2.81). Conclusions: Over half of women use less effective contraception 3 months post-abortion, despite a high interest in more effective contraception. Additional research is needed to understand contraceptive decision making in the context of abortion care to inform interventions to increase contraceptive uptake.
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Journal of women's health · May 2019
The Clinical Utility of a Precision Medicine Blood Test Incorporating Age, Sex, and Gene Expression for Evaluating Women with Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Analysis from the PRESET Registry.
Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. ⋯ Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p < 0.0001, adjusted for patient demographics and clinical covariates). Across the score range, higher ASGES were associated with a higher likelihood of posttest cardiac referral. At 1-year follow-up, low ASGES women experienced fewer major adverse cardiac events than elevated ASGES women (1.3% vs. 4.2% respectively, p = 0.16). Conclusions: Incorporation of ASGES into the diagnostic workup demonstrated clinical utility by helping clinicians identify women less likely to benefit from further cardiac evaluation.