Associations of Coffee and Tea Consumption With Survival to Age 90 Years Among Older Women.

BACKGROUND: Coffee and tea are two of the most widely consumed beverages worldwide and have been associated with reduced risk of mortality in some studies. However, it is unknown whether consumption of these beverages is associated with survival to an advanced age. OBJECTIVE: To examine associations of coffee and tea consumption with survival to age 90 years. DESIGN: Prospective cohort study among participants from the Women's Health Initiative, recruited during 1993 to 1998 and followed up until March 31, 2018. SETTING: The setting included 40 US clinical centers. PARTICIPANTS: A racially and ethnically diverse cohort of 27,480 older women, aged 65 to 81 years at baseline. MEASUREMENTS: Women were classified as having either survived to age 90 years or died before this age. Consumption of caffeinated and decaffeinated coffee and caffeinated tea was assessed at baseline and categorized as 0, 1, 2 to 3, or 4 or more cups/day. Associations of coffee and tea consumption with survival to age 90 years were examined using logistic regression models adjusted for sociodemographic characteristics, lifestyle behaviors, dietary quality, and chronic disease history. RESULTS: A total of 14,659 (53.3%) women survived to age 90 years during follow-up. Caffeinated coffee, decaffeinated coffee, or caffeinated tea consumption was not significantly associated with survival to age 90 years after adjusting for confounders. Findings did not significantly vary by smoking, body mass index, or race/ethnicity. CONCLUSION: No amount of coffee or tea consumption was associated with late-age survival among older women. These findings may be reassuring to older women who consume coffee and tea as part of their daily diets but do not support drinking these beverages to achieve longevity.

Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period.

Importance: Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. Methods: We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. Interventions: An online conversational agent, called "Gabby", assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. Results: After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). Conclusion: The scalability of Gabby has the potential to improve women's nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01827215.

Postmenopausal health interventions: Time to move on from the Women's Health Initiative?

Menopause is a critical period during which, without timely interventions, increased risks of cardiovascular and metabolic diseases, osteoporosis, sexual dysfunction and premature cognitive decline will contribute to diminished quality-of-life in women. Hormone therapy (HT) used to be the standard of care for managing vasomotor symptoms and prevention of chronic diseases until publication of the Women's Health Initiative (WHI) in 2002. Concerned about risks highlighted in WHI publications, many symptomatic women promptly ceased HT which resulted in increased vasomotor symptoms, osteoporosis-related-fractures and insomnia. Data from post-hoc WHI analyses and newer clinical trials consistently show reductions in coronary heart disease and mortality when estrogen therapy is initiated soon after menopause, whereas administration in later years and/or in combination with progesterone carries increased risks. However, no validated primary preventive strategies are available for younger postmenopausal women (<60 years), highlighting the need to re-evaluate the use of estrogen alone for which the risk-benefit balance appears positive. In contrast, in older women (>60 years), risks associated with oral HT exceed benefits; however transdermal estrogen may offer a safer alternative and should be further evaluated. Alternative therapies such as phytoestrogens and non-hormonal prescriptions may be beneficial for older women or those who are unsuitable for HT. Long-term head-to-head comparisons of HT with alternative interventions are warranted to confirm their efficacy for chronic disease prevention.

La mujer ante el envejecimiento en un centro para adultos mayores / Women towards aging in elderly center

Estudio cualitativo, descriptivo y analítico, que describe la visión de la mujer mayor acerca del envejecimiento saludable y analiza su vivencia sobre la asistencia en un Centro de Convivencia para Adultos Mayores. El escenario fue el Programa de Asistencia Integral a Personas Mayores del Instituto de Atención de Salud São Francisco de Assis, en la ciudad de Rio de Janeiro, Brasil. Los datos fueron recolectados mediante la técnica de grupo focal, con preguntas abiertas, permitiendo un carácter interactivo y multiplicidad de puntos de vista. Se concluyó que la mayoría de las ancianas entiende el envejecimiento como un proceso saludable, con experiencias buenas y provechosas. Las actividades del Centro, integradas con la atención para promoción y prevención de salud y con apoyo social, proporcionaron una fase saludable en el proceso de envejecimiento

Qualitative, descriptive and analytical research, which describes the view of the elderly woman on healthy aging and analyzes their experience on the assistance received in a Community Center for the Elderly. The setting was the Program of Comprehensive Care for the Elderly at the Institute for Health Care São Francisco de Assis, in the city of Rio de Janeiro, Brazil. Data was collected through focus group technique, with open questions, enabling an interactive quality and multiplicity of views. The study concluded that the majority of the elderly women understand aging as a healthy process with good and fruitful experiences. The activities in the Center, integrated with promotion and prevention health care and social support, provided a salutary phase in the aging process

La matrona en la gestión de la salud materno-infantil y de la salud sexual y reproductiva / No disponible

No disponible

The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions.

Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.

The challenge of preconception counseling: Using reproductive life planning in primary care.

PURPOSE: A case study is used to explore barriers and challenges in the delivery of preconception care, and to highlight the future role of reproductive life planning in primary practice settings. DATA SOURCES: Peer-reviewed journal articles and clinical practice guidelines pertaining to preconception care. CONCLUSIONS: Because of the high rate of unintended pregnancy, preconception care should be incorporated into routine primary care for women of reproductive age. Reproductive life plans are tools that help formalize contraceptive and preconception care for women across the life span. They may prove particularly useful for women with chronic diseases and for young, low-income, and minority women. IMPLICATIONS FOR PRACTICE: With their emphasis on holistic care and patient education, nurse practitioners are well suited to incorporate elements of preconception care into the routine care they provide patients. Clinicians can modify reproductive life plans to fit the unique needs of an individual, patient population, or clinical practice.

Biologic therapies and personalized medicine in gynecologic malignancies.

Through advances in human genomic sequencing, the unique molecular biology that predisposes certain individuals to either health or disease has now been illuminated. Although many malignancies behave similarly on a phenotypic level, biologically there exist multiple layers of interconnected molecular and cellular pathways that may make each patient's disease significantly more unique than previously appreciated. In gynecologic oncology, the most progress in developing targeted biologics has been in the treatment of ovarian cancers. Future investigations will see further development in endometrial and cervical cancers. Technology such as whole genome sequencing can theoretically identify the individual tumor's genetic profile; however, identifying the priority pathways for therapeutic interventions and subsequent complex interactions remains a significant challenge. New therapeutic technologies such as siRNA and immune modulators will also play a promising role in the movement toward individualized therapies. It is hoped that the identification and use of targeted agents will lead to individualized care that in turn will lead to significantly improved outcomes manifested by more cures and better quality of life through amelioration of toxicities.