Intimate Partner Violence During Pregnancy and Maternal and Neonatal Health Among Hispanic Women.

OBJECTIVE: To examine the prevalence and the effect of intimate partner violence (IPV) during pregnancy on maternal and neonatal health outcomes among Hispanics. STUDY DESIGN: A cross-sectional survey was conducted among Hispanic women who delivered at a Houston hospital between January 2011 and October 2012; 613 women completed self-administered questionnaires in the postpartum window prior to discharge. Indices of maternal and neonatal health were compared between women with and without reports of IPV during the most recent pregnancy. RESULTS: Approximately 11% of the surveyed population reported having experienced IPV during the most recent pregnancy. Among non-U.S. born participants, women who experienced IPV reported longer U.S. stay (11.4±7.3 years) as compared to women who did not (9.2±6.3 years). They were more likely to be unhappy about their pregnancy and to have evidence of depres-sion. Reported IPV was also associated with later initiation of prenatal care, a greater likelihood of delivery before 34 weeks' gestational age, lower infant birth weight, and lower likelihood of planning to breastfeed beyond 12 months (aOR 0.43, CI 0.21-0.83; p=0.02). CONCLUSION: IPV during pregnancy is associated with adverse maternal and neonatal health outcomes. Prenatal programs should assess Hispanic women for IPV during pregnancy with the goal of mitigating its long-term health consequences.

Assessment of factors impacting cervical cancer screening among low-income women living with HIV-AIDS.

Very little is currently known about factors impacting the prevalence of cervical cancer screening among women living with HIV-AIDS (WLHA). To better understand this issue, we surveyed low-income, medically underserved women receiving subsidized gynecologic care through an integrated HIV clinic. A self-administered questionnaire was completed by 209 women who self-identified as HIV positive. A total of 179 subjects (85.7%) reported having had a Pap test in the last three years. The majority of WLHA (95%) knew that the Pap test screens for cervical cancer. However, overall knowledge of cervical cancer risk factors, such as multiple sexual partners or sex with a man with multiple partners, was low (43% and 35%, respectively). Unscreened women were younger and more likely to be single with multiple current sexual partners. In multivariable analyses, the only factors associated with Pap testing were a woman's perception that her partner wants her to receive regular screening (aOR 4.64; 95% CI: 1.15-23.76; p = .04), number of clinic visits during the past year (aOR 1.36, 95% CI: 1.05-1.94; p = .04) and knowledge that the need for a Pap test does not depend on whether or not a woman is experiencing vaginal bleeding (aOR 6.52, 95% CI: 1.04-49.71; p = .05). We conclude that support from male partners in addition to effective contact with the health system and knowledge of cervical cancer risk factors influence Pap utilization among low-income WLHA. Future measures to improve the care for this population should increase knowledge of cervical cancer risk factors and encourage social support for cervical cancer screening among WLHA.

Elevated parathyroid hormone levels in older women treated for osteoporosis using denosumab.

PURPOSE: Primary care physicians (PCPs) often struggle with elevated serum intact parathyroid hormone (iPTH) in osteoporotic patients on antiresorptive treatment, specifically, denosumab. As iPTH and calcium levels need to be within normal ranges to receive the next dose of denosumab, continuously high serum iPTH may necessitate additional tests to rule out pathological causes. We aimed to determine factors associated with iPTH elevation in a cohort of postmenopausal women receiving osteoporosis treatment. METHOD: A cross-sectional analysis of electronic medical records of patients 50 years and older who visited a geriatric osteoporosis clinic between October 1, 2014 and December 31, 2019, was conducted. We divided patients into 3 categories: not currently on treatment, on bisphosphonates or on denosumab. Percentage change in iPTH levels from baseline to 1 year follow-up was the outcome measure. Other variables used are age, body mass index, chronic co-morbidities, 25OH-vitamin D, calcium, TSH, glomerular filtration rate and femoral neck BMD. Linear regression models were used to assess independent associations between treatment group and iPTH changes. RESULTS: Mean (SD) age of 173 participants in our study was 78 (± 10) years, and 71% were Caucasian. At follow-up, mean percent change of iPTH was 13.47 ± 62.76, 30.35 ± 61.17, and 39.60 ± 35.51 in the "no treatment", "bisphosphonate" and "denosumab" groups, respectively. Age was a predictor of elevated percent change of iPTH in the denosumab group. CONCLUSION: Increasing age is associated with iPTH elevations in osteoporotic patients on denosumab. In the absence of any pathology, continuation of denosumab may be safe in lowering fracture risk. However, a larger study may be required to confirm this.

Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia.

Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fracture risk in a national cohort of 360,015 male veterans aged 65 to 99 years with dementia but without prior fracture using Veterans Affairs (VA) hospital, Medicare, and pharmacy records from 2000 to 2010. Diagnosis of dementia, any clinical fracture (excluding facial and digital), comorbidities, and medications were identified using ICD-9 and drug class codes. Cox proportional hazard models considering AChEI use as a time-varying covariate and adjusting for fall and fracture risk factors compared the time-to-fracture in AChEI users versus non-AChEI users. Potential confounders included demographics (age, race, body mass index), comorbidities associated with fracture or falls (diabetes, lung disease, stroke, Parkinson's, seizures, etc.) and medications associated with fracture or falls (bisphosphonates, glucocorticoids, androgen deprivation therapy [ADT], proton pump inhibitors [PPIs], selective serotonin receptor inhibitors [SSRIs], etc.). Competing mortality risk was considered using the methods of Fine and Gray. To account for persistent effects on bone density or quality that might confer protection after stopping the medication, we completed a secondary analysis using the medication possession ratio (MPR) as a continuous variable in logistic regression models and also compared MPR increments of 10% to minimal/no use (MPR 0 to <0.10). Among older veterans with diagnosis of dementia, 20.1% suffered a fracture over an average of 4.6 years of follow-up. Overall, 42.3% of the cohort were prescribed AChEIs during the study period. The hazard of any fracture among AChEI users compared with those on other/no dementia medications was significantly lower in fully adjusted models (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.75-0.88). After considering competing mortality risk, fracture risk remained 18% lower in veterans using AChEIs (HR = 0.82; 95% CI 0.76-0.89). © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

Non-utilization of the Pap Test Among Women with Frequent Health System Contact.

Despite improvements in health access, many underserved women abstain from cervical cancer screening. A self-administered questionnaire was used to identify factors determining whether medically underserved women attending a safety net health system regularly are screened for cervical cancer. Approximately 11 % of study subjects had never received a Pap test despite an average of nearly four clinic visits in the preceding 12 months. Never screeners were significantly younger, more likely to be Hispanic, non-U.S. born and less likely to have healthcare continuity. In multivariable analysis, odds for never screening were independently lower among women with male partner support (aOR 0.29) and physician's recommendation for screening (aOR 0.34) and higher among women who believed screening visits are too long (aOR 2.53). Educating male partners of Hispanic and immigrant women in addition to addressing recognized situational barriers may help to improve cervical cancer screening rates.

The impact of multiple single day blood pressure readings on cardiovascular risk estimation: The Atherosclerosis Risk in Communities study.

AIMS: The aim of this study was to determine the magnitude of change in estimated cardiovascular disease risk when multiple same day blood pressure measurements are used in estimating coronary heart disease, heart failure and stroke risks. METHODS AND RESULTS: Black and White participants, N = 11,129, enrolled in the Atherosclerosis Risk in Communities study (mean age 53.9 ± 5.7 (SD) years) were included. Each participant had three sitting, five supine, and six standing blood pressure measures during one day. Main outcome measures were changes in estimated coronary heart disease, heart failure and stroke risk when using the different blood pressure measures. Mean sitting, standing and supine systolic blood pressure values of the study population were 120.8 ± 18.6, 124.9 ± 20 and 124.7 ± 19.6 mmHg, respectively. The substitution of the second sitting systolic blood pressure with the third sitting systolic blood pressure (taken ∼5 min later) in two separate coronary heart disease risk models reclassified 3.3% to 5.1% of study participants. Similar substitutions for heart failure and stroke risk prediction models led to reclassification of 1.9% and 2.7% of participants respectively. When mean sitting systolic blood pressure was replaced with mean standing systolic blood pressure 5.4% to 11.6% of the participants were reclassified. Maximum upward and downward change in an individual's estimated risk was 31% and 26% respectively. CONCLUSIONS: Estimated risks of coronary heart disease, heart failure, and stroke for an individual can change significantly within a day due to changes in systolic blood pressure. Given recommendations to use estimated risk for therapeutic decisions, our study has implications for the use of a single systolic blood pressure in cardiovascular risk estimation.