Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone.

The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.

Maternal morbidity and mortality associated with mode of delivery in sickle cell disease.

This retrospective observational study compared pregnancy outcomes based on mode of delivery in women with homozygous sickle cell disease (HbSS) to women without (HbAA) using delivery records of 48,600 parturients between January 1992 and January 2020. Fisher's exact tests and Mann-Whitney's test were used to analyse variables based on sickle cell status. Vaginal delivery and HbSS were more associated with labour induction/augmentation (AOR = 2.4, (0.7-7.8)), intrapartum complications (AOR = 2.6, (0.5-14)), postpartum haemorrhage (AOR = 2.8 (0.5-15.2)) and postpartum infections (AOR = 9.6 (1.7-54.4)). Caesarean delivery resulted in more postpartum infections in the HbSS group (AOR = 23.6 (0.9-638.4)). Vaginal delivery in HbSS resulted in more intrapartum complications and postpartum haemorrhage but caesarean delivery greatly increased the risk of postpartum infections and hypertensive disorders. Sickle cell disease (SCD) did not confer increased risk of adverse perinatal outcomes regardless of mode of delivery.Impact StatementWhat is already known on this subject? Women with homozygous sickle cell disease (SCD) are at an increased risk of postpartum infections, undergoing caesarean delivery, admission to the neonatal intensive care unit and overall perinatal mortality when compared to women with normal haemoglobin genotype. Comparisons have been made between homozygous SS disease and haemoglobin SC disease revealing higher rates of maternal and foetal morbidity in both groups.What do the results of this study add? Studies comparing maternal and foetal morbidity based on mode of delivery are lacking. To our knowledge, this study is the first examine maternal and perinatal outcomes in women with SCD undergoing vaginal and abdominal delivery compared to women with normal haemoglobin. We found that vaginal delivery in SCD is associated with more postpartum haemorrhage and caesarean delivery was linked to more hypertensive disorders and postpartum infections then compared to women with normal haemoglobin. Converse to other reports, there was no difference in perinatal outcomes based on mode of delivery.What are the implications of these findings for clinical practice and/or further research? Caesarean delivery and SCD greatly increased the risk of postpartum infections and hypertensive disorders but did not confer a higher risk of postpartum haemorrhage. There were more maternal deaths in SCD women who underwent caesarean vs. vaginal delivery and this requires further study to determine the pregestational predictors of adverse outcomes. Women with SCD who achieve a successful primary vaginal delivery may have reduced risk of complications in subsequent pregnancies, possibly comparable to women without the disease.

Social distancing, community stigma, and implications for psychological distress in the aftermath of Ebola virus disease.

BACKGROUND: The 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities. METHODS: Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen's κ = 0.80 or higher. FINDINGS: Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws. INTERPRETATION: This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.

Profile of women with pelvic organ prolapse at the University Hospital of the West Indies risk factors and presentation.

POP affected 40% of participants in the WHI trial. Risk factors include parity, vaginal delivery, large babies, advancing age, obesity, hysterectomy and lifting. Data suggest African-American women have a lower prevalence of symptomatic POP than other racial groups. Literature review did not show a study of risk factors and symptoms in a black population. Cross-sectional study of women with POP attending urogynaecology clinic at the UHWI from May to October 2013, using an interviewer administered questionnaire was performed and analysed using SPSS version 19 program (SPSS Inc., Chicago, IL). One hundred and eight participants were included: 94.7% postmenopausal (mean 65.08 years) and 94.5% parous (mean 4). Risk factors included obesity (mean BMI 28.82 kg/m2), hysterectomy (28.7%), heavy lifting (51.9%) and chronic cough (13.9%). Symptoms included stress incontinence (40.7%), stranguria (16.7%), faecal incontinence (13.9%), constipation (31.5%), coital urinary and faecal incontinence (6.3%, 12.6%). We concluded risk factors for POP in this population correlates with other studies. Stress urinary incontinence and constipation most frequently reported symptoms in this population.Impact StatementWhat is already known on this subject? Pelvic organ prolapse (POP) is a common condition with multifactorial aetiology. As seen in systematic reviews (Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. 2015. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. International Urogynecology Journal 26(11):1559-1573). Study shows white women appeared to have more overall symptoms both from prolapse, as well as urinary symptoms, as compared with black women (Ford AT, Eto CU, Smith M, Northington GM. 2019. Racial differences in pelvic organ prolapse symptoms among women undergoing pelvic reconstructive surgery for prolapse. Female Pelvic Medicine & Reconstructive Surgery 25:130-133).What do the results of this study add? The result highlights the fact that Black women are exposed to similar risk factors and have similar symptoms to other racial groups for POP.What are the implications of these findings for clinical practice and/or further research? These findings can be used to educate women with risk factors about the possibility of developing symptomatic POP. Further research is needed to ascertain the prevalence of POP and to assess knowledge and attitude in this population as we hypothesise that there is generalised assumption in that being black is protective from POP.

Getting to zero HIV/AIDS in sub-Saharan Africa: Understanding perceptions of locals using the social determinants of health framework.

This study explored a community perception of the facilitators and inhibitors of Getting to Zero (GTZ) in rural Zambia, sub-Saharan Africa. Data were collected in 2017. We use the Social Determinants of Health framework to guide organisation of key themes emerging from semistructured, focus group interviews with community members (N = 52). Data were analysed through an iterative descriptive/thematic approach which allowed for the highlighting of key themes. Emerging themes point to the significance of (a) individual, (b) sociocultural, (c) environmental and (d) economic factors, for example, treatment adherence, gender norms, food security and access to health care as important in GTZ. Implications for policy, practise and scholarship are suggested.

Mind the gap: primary care physicians and gynecologists' knowledge about menopause and their attitudes to hormone therapy use in Jamaica.

OBJECTIVES: The study objective was to evaluate physicians' knowledge, attitude, and practices toward menopause and hormone therapy. METHODS: This study was a cross-sectional study using a stratified sample of physicians across the four health regions in Jamaica, between September and October 2017. A total of 145 physicians (75% response rate) completed a questionnaire to assess knowledge and attitudes toward menopause and prescribing hormonal therapy. Univariate and bivariate analyses were used to describe and compare the knowledge, attitudes, and practices in participants. RESULTS: The majority of physicians (66%) self-reported a moderate level of knowledge of menopausal treatment options. Self-reported knowledge was associated with years in practice (P < 0.0001) and level of experience (P < 0.0001). Those who identified as having good and moderate knowledge were likely to discuss treatment options with patients (P < 0.005), while physicians with good knowledge were more likely to prescribe hormone therapy (P < 0.05). Correct responses regarding common menopause symptoms were noted in >60% physicians; however, there was a precipitous fall in correct responses regarding findings related to the Women's Health Initiative (<45%). More consultant grade physicians were confident and less confused about prescribing hormone therapy (P < 0.05) compared to junior grade physicians. When stratified by level of experience, knowledge level was the factor that discouraged physicians from seeing symptomatic menopausal patients (P < 0.05). CONCLUSIONS: This study highlights the gaps in knowledge and practices and a need for carefully designed curricula to provide individualized, risk-mitigated training in menopause healthcare.

Video Summary:http://links.lww.com/MENO/A814 .

Contraceptive practices in women with chronic medical conditions.

Contraception in women with severe medical conditions is a potential measure to reduce maternal mortality. We sought to determine the contraceptive use in women with medical conditions at the University Hospital of the West Indies (UHWI) in Jamaica to determine if there is room for improvement in contraceptive use. Participants were identified from the medical out-patient departments and questionnaires administered. Two hundred and sixty females between 18 and 44 years with varied chronic medical conditions were included. Those included were systemic lupus erythematosus (SLE), diabetes, hypertension (HTN), thyroid disease, cardiac and renal disease. The total current use of contraception was 58.4%, while 41.6% were not on contraceptives. The use of barrier methods and long-acting reversible contraceptives (LARCs) was 71% and 10%, respectively. The current use of contraception in patients with sickle cell disease (SCD) was 84% (p=.004) and in rheumatoid arthritis (RA), 14% (p=.028). Fifty-eight (58, 24.2%) of the women were using two or more methods of contraception. There is a role for improving contraceptive use among women with medical conditions as they are at increased risk of pregnancy complications.IMPACT STATEMENTWhat is already known on this subject? Women with medical comorbidities significantly contribute to both direct and indirect causes of maternal mortality. Contraception may play an integral role in reducing the risk of dying in chronically ill women; however, the use of contraception in this group is often suboptimal.What the results of this study add? This study adds to the literature that in this high-risk group, there is an underuse of long-acting reversible contraceptives, which is ideal for this population.What the implications are of these findings for clinical practice or further research? The results will provide evidence that this high-risk group of women should be targeted and counselled regarding their risk of morbidity and mortality in pregnancy as well as contraception use while their condition is optimised. From this evidence, services may be put in place in institutions, especially in low-resource settings.

Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial.

OBJECTIVE: To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN: Randomised, phase III, double blinded international, multicentre clinical trial. SETTING: 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). PARTICIPANTS: 2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses. INTERVENTION: Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16 of gestation until delivery. Clinicians, participants, adjudicators, and study staff were masked to study treatment allocation. MAIN OUTCOME MEASURE: The primary outcome was pre-eclampsia, defined as hypertension presenting after 20 weeks' gestation with major proteinuria or HELLP syndrome (haemolysis, elevated liver enzymes, low platelets). RESULTS: Pre-eclampsia occurred in 169/1144 (14.8%) women in the folic acid group and 156/1157 (13.5%) in the placebo group (relative risk 1.10, 95% confidence interval 0.90 to 1.34; P=0.37). There was no evidence of differences between the groups for any other adverse maternal or neonatal outcomes. CONCLUSION: Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition. TRIAL REGISTRATION: Current Controlled Trials ISRCTN23781770 and ClinicalTrials.gov NCT01355159.

Comparison of ultrasonographic estimated fetal weight and actual birthweight performed by residents in training at the University Hospital of the West Indies / Comparación del peso fetal estimado por ultrasonografía y el peso real al nacer realizada por los residentes en formación en el Hospital Universitario de West Indies

OBJECTIVE: To determine the correlation of ultrasonographic estimation of fetal weight and actual birthweight and the impact of the level of resident s training on the results. METHODS: This was a prospective study of 90 women with term pregnancies. Ultrasound estimated fetal weight (EFW) was calculated by a pre-programmed Hadlock formula. Days from ultrasound to delivery were less than seven. The EFW was compared to the actual birthweight at delivery. The year of training of the resident that performed the ultrasound was recorded. Exclusion criteria included diabetes mellitus and known fetal anomalies. RESULTS: Mean age was 28 years, parity was 0 to 4 and mean gestational age was 38 weeks. There was an average over-estimation of 64.8 grams. The difference between mean EFW and mean birthweight was not significant (p = 0.067). The difference between mean EFW and mean birthweight when calculated according to year of residency was not significant, p = 0.075 and 0.402for junior and senior residents, respectively. CONCLUSION: There is good correlation between residents' ultrasonographic estimation of fetal weight and actual birthweight at the UHWI. There was no significant difference in correlation between senior and junior residents. Developments in computer technology might contribute to decrease in the learning curve.

OBJETIVO: Determinar la correlación de la estimación ultrasonográfica del peso fetal y el peso real al nacer, y el impacto del nivel de formación del residente en los resultados. MÉTODOS: Se trató de un estudio prospectivo de 90 mujeres con embarazos a término. El peso fetal estimado (PFE) por ultrasonido fue calculado mediante una fórmula de Hadlock preprogramada. Los días transcurridos desde el ultrasonido hasta el parto fueron menos de siete. Se comparó el PFE con el peso real en el parto. Se registró el año de formación del residente que realizó el ultrasonido. Los criterios de exclusión criterios incluyeron diabetes mellitus y anomalías fetales conocidas. RESULTADOS: La edad promedio fue 28 años; la paridad fue de 0 a 4; la edad gestacional fue de 38 semanas. Hubo una sobreestimación promedio de 64.8 gramos. La diferencia entre el PFE promedio y el peso promedio al nacer no fue significativa (p = 0.067). La diferencia entre el PFE promedio y el peso promedio al nacer calculada según el año de residencia no fue significativa, siendo p = 0.075 y 0.402 para médicos en la primera y última etapa de su residencia, respectivamente. CONCLUSIÓN: Existe una buena correlación entre la estimación ultrasonográfica del peso fetal, realizada por los residentes, y el peso real al nacer en el HUWI. No hubo ninguna diferencia significativa en la correlación entre los residentes en sus primeras y últimas etapas. Los desarrollos en la tecnología informática pueden contribuir a la disminución de la curva de aprendizaje.

Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Densidad mineral osea en mujeres negras jamaicanas después de histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD: We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS: There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION: Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

OBJETIVO: Determinar si mujeres negras jamaicanas postmenopáusicas sometidas a histerectomía corrían mayor riesgo de osteoporosis. Evaluar el riesgo de osteoporosis en pacientes jamaicanas postmenopáusicas histerectomizadas. MÉTODO: Se examinaron 809 mujeres (403 histerectomizadas y 406 controles) para evaluar el riesgo de enfermedad cardiovascular. Hicimos una historia demográfica y un examen para obtener información sobre la presión arterial, el índice cintura/cadera ratio, y el índice de masa corporal. Asimismo, realizamos investigaciones que incluyeron pruebas de glucemia en ayunas, colesterol total, y colesterol de lipoproteínas de alta densidad (HDL). También medimos la densidad ósea en el talón de todas las mujeres, usando el densitómetro óseo ultrasónico modelo Achilles para obtener el T-score y el Z-score. RESULTADOS: Hubo una asociación significativa entre el estado de histerectomía y el estado de la densidad mineral ósea (DMO) con una proporción de mujeres con osteoporosis en el grupo de histerectomía (χ2 = 18.4; p = 0,001) más pequeña de lo esperada. El T-score promedio fue significativamente mayor en las mujeres histerectomizadas, ajustando por edad, circunferencia de la cintura y factores sociodemográficos. La relación entre los distintos factores predictivos y DMO fue explorada mediante regresión gradual stepwise modelado. Los factores que estuvieron significativamente relacionados con baja DMO fueron estado histerectomía, edad, circunferencia de la cintura y siendo empleado. CONCLUSIÓN: Se halló que la histerectomía no es un factor de riesgo significativo para la osteoporosis. El riesgo de osteoporosis entre las mujeres menopáusicas de Jamaica parece deberse a otros factores de riesgo que probablemente existían antes de la operación.

A review of molar pregnancy at the university hospital of the West Indies over a 16-year period.

There is a wide variation in reported incidence, risk factors and presentation of molar pregnancy. This necessitates population-based studies to determine these parameters at the University Hospital of the West Indies, which is a referral centre for these conditions. The incidence of molar pregnancy at the University Hospital of the West Indies was found to be 2.81 per 1,000, which fell in the range of worldwide values. Partial moles made up 61.1% and complete moles 31.0%. The mean age of the patients was 28.49 years old with 85% of patients aged between 20 and 40 years old. The median gestational age by dates was 12 weeks and vaginal bleeding was the most common presenting symptom (77%). A significant number of cases (52.2%) of molar pregnancy were diagnosed by routine histopathology for failed pregnancy and not by pre-evacuation ultrasound. The practice of routine assessment of tissue from failed pregnancy should therefore be encouraged in our population.

Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study.

OBJECTIVE: To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD: We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS: There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION: Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

Comparison of ultrasonographic estimated fetal weight and actual birthweight performed by residents in training at the university hospital of the west indies.

OBJECTIVE: To determine the correlation of ultrasonographic estimation of fetal weight and actual birthweight and the impact of the level of resident's training on the results. METHODS: A prospective study of 90 women with term pregnancies. Ultrasound estimated fetal weight (EFW) was calculated by a preprogrammed Hadlock formula. Days from ultrasound to delivery were less than seven. The EFW was compared to the actual birthweight at delivery. The year of training of the resident that performed the ultrasound was recorded. Exclusion criteria included Diabetes mellitus and known fetal anomalies. RESULTS: Mean age was 28 years, parity zero to four, mean gestational age 38 weeks. There was an average over-estimation of 64.8 grams. The difference between mean EFW and mean BWT was not significant (p = 0.067). The difference between mean EFW and mean BWT when calculated according to year of residency was not significant, p = 0.075 and 0.402 for junior and senior residents, respectively. CONCLUSION: There is good correlation between resident's ultrasonographic estimation of fetal weight and actual birthweight at the UHWI. There was no significant difference in correlation between senior and junior residents. Development in computer technology might contribute to decrease in the learning curve.

Counselling patients with uterine fibroids: a review of the management and complications.

Fibroids are very common in Afro-Caribbean women. They can cause severe complications. The treatment modalities are not without risk and should be weighed against the complications of the fibroids.

Improvement in HDL cholesterol in postmenopausal women supplemented with pumpkin seed oil: pilot study.

OBJECTIVE: Pumpkin seed oil is rich in phytoestrogens and animal studies suggest that there is some benefit to supplementation in low estrogen conditions. This study is the first to evaluate the benefit of pumpkin seed oil in postmenopausal women. METHODS: This pilot study was randomized, double-blinded and placebo-controlled. Study participants included 35 women who had undergone natural menopause or had iatrogenically entered the climacteric due to surgery for benign pathology. Wheat germ oil (placebo; n = 14) and pumpkin seed oil (n = 21) were administered to eligible participants over a 12-week period at a dose of 2 g per day. Serum lipids, fasting plasma glucose and blood pressure were measured and an 18-point questionnaire regarding menopausal symptoms was administered; the atherogenic index was also calculated. Differences between groups, as well as before and after the period of supplementation, were evaluated with Student's t-test, Wilcoxon matched-pair signed-ranked test and Mann-Whitney test, as appropriate (Stata version 10.1). RESULTS: Women receiving pumpkin seed oil showed a significant increase in high density lipoprotein cholesterol concentrations (0.92 ± 0.23 mmol/l vs. 1.07 ± 0.27 mmol/l; p = 0.029) and decrease in diastolic blood pressure (81.1 ± 7.94 mmHg vs. 75.67 ± 11.93 mmHg; p < 0.046). There was also a significant improvement in the menopausal symptom scores (18.1 ± 9.0 vs. 13.2 ± 6.7; p < 0.030), with a decrease in severity of hot flushes, less headaches and less joint pains being the main contributors. Women in the group receiving wheat germ oil reported being more depressed and having more unloved feeling. CONCLUSION: This pilot study showed pumpkin seed oil had some benefits for postmenopausal women and provided strong evidence to support further studies.

Cardiovascular disease risk factors in menopausal Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Factores de riesgo de la enfermedad cardiovascular en mujeres negras jamaicanas en la menopausia tras histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To determine differences in prevalence of cardiovascular risks and diseases in black Jamaican postmenopausal women who had hysterectomy (hysgroup) compared with those without (control). METHOD: Eight hundred and nine (809) women (hysterectomized (HYSGRP) = 403; non-hysterectomized (controls) = 406) were enrolled. Sociodemographic information and lifestyle history, measured blood pressure, waist hip ratio, body mass index, fasting blood glucose, total and HDL cholesterol were obtained. RESULTS: Of the 809 women, complete cardiovascular risk data were available in 341 controls and 328 in the HYSGRP group. There was no difference in mean age, blood pressure and body mass indices between the subjects excluded and the subjects in the data analytical sample. A significantly lower proportion ofwomen in the control group exercised, attained post-secondary education and were of higher parity. Systolic (mean difference with 95% CI; 6 (3, 9) mmHg and diastolic (3 (1, 5) mmHg) blood pressure were lower in the HYSGRP compared with controls but total cholesterol (0.2 (0.07 to 0.4) mmol/L was greater. HDL cholesterol was not different between both groups 1.3 mmol/L (SD 0.3) vs 1.3 mmol/L [SD 0.4] (p = 0.8435). There was no difference in the prevalence of diabetes, hypertension and high waist-hip ratio in hysterectomized women compared with controls adjusting for hormone replacement therapy usage, cigarette smoking, exercise and educational status. Within the HYSGRP, there was also no difference in cardiovascular disease or risk in women who had bilateral oophorectomy compared with women who had at least an ovary preserved at time ofoperation. CONCLUSION: Hysterectomy was not associated with an increased risk of cardiovascular disease. This must be taken cautiously since data did not allow for analysis on duration of menopause.

OBJETIVO: Determinar las diferencias en la prevalencia de riesgos y enfermedades cardiovasculares en mujeres negras jamaicanas menopáusicas con histerectomía, en comparación con las que no tuvieron esta operación (control). MÉTODO: Se enrolaron ochocientas nueve (809) mujeres (histerectomizadas (HYSGRP) = 403; no histerectomizadas (controles) = 406). Se obtuvo información sobre datos demográficos e historia del estilo de vida, mediciones de la presión arterial, índice cintura/cadera, glucemia en ayunas, así como el colesterol total y HDL. RESULTADOS: De 809 mujeres, había disponible datos completos sobre el riesgo cardiovascular en 341 controles, y 328 en el grupo HYSGRP. No hubo diferencias significativas en relación con la edad promedio, la presión arterial, y el índice de masa corporal entre los sujetos excluidos y los sujetos en las muestras del análisis de datos. Una proporción significativamente menor de mujeres en el grupo de control practicado, tuvo educación post-secundaria y fueron de paridad más alta. La presión arterial sistólica (diferencia promedio con 95% CI; 6 (3 a 9 mmHg)) y la presión arterial diastólica (3 (1 a 5 mmHg)) fueron más bajas en el grupo de la histerectomía HYSGRP en comparación con el grupo de control, pero el colesterol (0.2 (0.07 a 0.4)) fue mayor. El colesterol HDL no fue diferente entre los dos grupos: 1.3 mmol/L (SD 0.3) frente a 1.3 mmol/L [SD 0.4] (p = 0.8435). No hubo diferencia en cuanto a laprevalencia de la diabetes, la hipertensión, y el alto índice cintura/cadera en las mujeres histerectomizadas, en comparación con los controles ajustándose en relación con el uso de la terapia de reemplazo hormonal, el hábito defumar, el ejercicio, y el nivel educacional. Dentro del grupo HYSGRP tampoco hubo diferencias con respecto a las enfermedades cardiovasculares o riesgos en mujeres operadas de ooforectomía bilateral, en comparación con las mujeres a las que se les preservó por lo menos un ovario en el momento de la operación. CONCLUSIÓN: La histerectomía no estuvo asociada con un aumento de riesgo de la enfermedad cardiovascular. No obstante, esta conclusión debe tomarse con cautela, ya que los datos no permitieron el análisis en el período de duración de la menopausia.

Cardiovascular disease risk factors in menopausal Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study.

OBJECTIVE: To determine differences in prevalence of cardiovascular risks and diseases in black Jamaican postmenopausal women who had hysterectomy (hysgroup) compared with those without (control). METHOD: Eight hundred and nine (809) women (hysterectomized (HYSGRP) = 403; non-hysterectomized (controls) = 406) were enrolled. Sociodemographic information and lifestyle history, measured blood pressure, waist hip ratio, body mass index, fasting blood glucose, total and HDL cholesterol were obtained. RESULTS: Of the 809 women, complete cardiovascular risk data were available in 341 controls and 328 in the HYSGRP group. There was no difference in mean age, blood pressure and body mass indices between the subjects excluded and the subjects in the data analytical sample. A significantly lower proportion of women in the control group exercised, attained post-secondary education and were of higher parity. Systolic (mean diference with 95% CI; 6 (3, 9) mmHg and diastolic (3 (1, 5) mmHg) blood pressure were lower in the HYSGRP compared with controls but total cholesterol (0.2 (0.07 to 0.4) mmol/L was greater HDL cholesterol was not different between both groups 1.3 mmol/L (SD 0.3) vs 1.3 mmol/L [SD 0.4] (p = 0.8435). There was no difference in the prevalence of diabetes, hypertension and high waist-hip ratio in hysterectomized women compared with controls adjusting for hormone replacement therapy usage, cigarette smoking, exercise and educational status. Within the HYSGRP there was also no diference in cardiovascular disease or risk in women who had bilateral oophorectomy compared with women who had at least an ovary preserved at time of operation. CONCLUSION: Hysterectomy was not associated with an increased risk of cardiovascular disease. This must be taken cautiously since data did not allow for analysis on duration of menopause.

Retained placenta in homozygous sickle cell disease.

OBJECTIVE: To document an increased prevalence of retained placenta in mothers with homozygous sickle cell disease. METHODS: A retrospective review (January 1, 1992, to December 31, 2005) at the University Hospital of the West Indies revealed 174 singleton deliveries in women with sickle cell disease who were matched by delivery date and age 1:1 with 174 mothers with normal hemoglobin phenotype. Cesarean delivery in 62 mothers (36%) with sickle cell and in 41 women with normal hemoglobin (24%) left 112 sickle cell and 133 normal hemoglobin pregnancies with spontaneous deliveries. Retained placenta was defined by an interval of at least 30 minutes. Duration and details of the third stage of delivery were obtained by review of records. Duration of delivery stages was assessed by Kaplan-Meier survival charts and tested using the log rank test. Known risk factors were sought by logistic regression or exact logistic regression when the number of outcomes was small. RESULTS: First-stage duration was similar in maternal genotypes (sickle cell 470 minutes [median] compared with normal hemoglobin 335 minutes [median]), but in sickle cell disease, the second stage was slightly delayed (sickle cell 16 minutes compared with normal hemoglobin 15 minutes) and the third stage (sickle cell 7 minutes compared with normal hemoglobin 6 minutes). Retained placenta occurred in 20 mothers (17.9%) with sickle cell (interval 30-340 minutes) compared with four among the women in the control group (3.0%, 30-107 minutes). Apart from a weak association with combined oxytocin and misoprostol, there were no significant associations with known risk factors or with hematologic indices within sickle cell disease. CONCLUSION: Retained placenta is common among mothers with sickle cell disease, and the lack of association with known risk factors suggests that maternal sickle cell disease may be a risk factor. LEVEL OF EVIDENCE: II.