Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration

INTRODUCTION: Uterine fibroids are the most common indication for hysterectomy. Minimally invasive hysterectomy (MIH) confers lower risk of complications and shorter recovery than open surgical procedures; however, it is more challenging to perform with larger fibroids. There are racialized differences in fibroid size and MIH rates. We examined the role of uterine size in black-white differences in MIH among Veterans in the Department of Veterans Affairs (VA). METHODS: Using VA clinical and administrative data, we conducted a cross-sectional study among black and white Veterans with fibroids who underwent hysterectomy between 2012 and 2014. We abstracted postoperative uterine weight from pathology reports as a proxy for uterine size. We used a generalized linear model to estimate the association between race and MIH and tested an interaction between race and postoperative uterine weight (≤250 g vs. \u3e250 g). We estimated adjusted marginal effects for racial differences in MIH by postoperative uterine weight. RESULTS: The sample included 732 Veterans (60% black, 40% white). Postoperative uterine weight modified the association of race and MIH (p for interaction=0.05). Black Veterans with postoperative uterine weight ≤250 g had a nearly 12-percentage point decrease in MIH compared to white Veterans (95% CI -23.1 to -0.5), with no difference by race among those with postoperative uterine weight \u3e250 g. DISCUSSION: The racial disparity among Veterans with small fibroids who should be candidates for MIH underscores the role of other determinants beyond uterine size. To eliminate disparities in MIH, research focused on experiences of black Veterans, including pathways to treatment and provider-patient interactions, is needed

Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India.

PURPOSE: Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity. METHODS: We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85th percentile. Exposure included maternal obesity, defined as >90th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects. RESULTS: We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58). CONCLUSION: We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India

State of Reproductive Health In Women Veterans – VA Reproductive Health Diagnoses and Organization of Care

Reproductive health (RH) is a critical part of health. For women, RH encompasses gynecological health throughout life, preconception care, maternity care, cancer care, and the interaction of RH with other mental and medical conditions. Reproductive Health is defined as a state of complete physical, mental, and social well-be­ing and not merely the absence of reproductive disease or infirmity. This definition highlights the importance of taking a health systems approach that integrates RH care issues and services with other aspects of care needed across the life course. The RH needs of women are shaped by their stages of life and life experiences. For women Veterans, their military experiences may influence their RH in important ways. Given the increasing numbers of women in the military and women Veterans, it is critical to understand key aspects of RH in this unique population of women. This first report of the State of Reproductive Health in Women Veterans provides an overview of the RH diagnoses of women Veterans utilizing the Department of Veterans Affairs (VA) health care services, VA delivery of RH care, and a vision for RH in VA

Reproductive health diagnoses of women veterans using department of veterans affairs health care

BACKGROUND: Little is known regarding the reproductive health needs of women Veterans using Department of Veterans Affairs (VA) health care. OBJECTIVE: To describe the reproductive health diagnoses of women Veterans using VA health care, how these diagnoses differ across age groups, and variations in sociodemographic and clinical characteristics by presence of reproductive health diagnoses. RESEARCH DESIGN: This study is a cross-sectional analysis of VA administrative and clinical data. SUBJECTS: The study included women Veterans using VA health care in FY10. MEASURES: Reproductive health diagnoses were identified through presence of International Classification of Disease, 9th Revision (ICD-9) codes in VA clinical and administrative records. The prevalence of specific diagnosis categories were examined by age group (18-44, 45-64, \u3e =65 y) and the most frequent diagnoses for each age group were identified. Sociodemographic and clinical characteristics were compared by presence of at least 1 reproductive health diagnosis. RESULTS: The most frequent reproductive health diagnoses were menstrual disorders and endometriosis among those aged 18-44 years (n = 16,658, 13%), menopausal disorders among those aged 45-64 years (n = 20,707, 15%), and osteoporosis among those aged \u3e =65 years (n = 8365, 22%). Compared with women without reproductive health diagnoses, those with such diagnoses were more likely to have concomitant mental health (46% vs. 37%, P \u3c 0.001) and medical conditions (75% vs. 63%, P \u3c 0.001). CONCLUSIONS: Women Veterans using VA health care have diverse reproductive health diagnoses. The high prevalence of comorbid medical and mental health conditions among women Veterans with reproductive health diagnoses highlights the importance of integrating reproductive health expertise into all areas of VA health care, including primary, mental health, and specialty care

Sexual maturation and metabolic profile among adolescents and children of the Health Worker Cohort Study in Mexico Madurez sexual y perfil metabólico de los adolescentes y niños del estudio de cohorte de trabajadores de la salud en México

OBJECTIVE:Our objective was to investigate the associations between level and timing of sexual development with metabolic profile in a cohort of Mexican adolescents in central Mexico. MATERIAL AND METHODS:Baseline data from children between the ages of 7 and 17 years (n= 582) who participated in the Health Worker Cohort Study, was used. The study participants included children of workers at the Mexican Institute of Social Security (IMSS) and the National Institute of Public Health, both located in Cuernavaca, in addition to children of workers at the Universidad Autónoma del Estado de México in Toluca who were enrolled between March 2004 and April 2006. Multiple linear regressions with robust estimates of variance, were used adjusting for specific covariates. RESULTS:Both pubertal boys and girls, compared to their pre-pubertal counterparts, had higher body mass index (girls: 4.59 kg/m², p<0.0001; boys: 1.12 kg/m², p= 0.05) and percent body fat (girls: 3.61, p<0.0001; boys: 1.48, p= 0.0001). A significant difference in level of insulin resistance (homeostasis model assessment, HOMA) was detectable among girls (0.92, p<0.0001). CONCLUSIONS:Timing and levels of sexual development were significantly associated with adverse differences in several critical anthropometric and metabolic parameters.<br>OBJETIVO:Investigar las asociaciones entre etapa y momento de inicio del desarrollo sexual y perfil metabólico en una cohorte de adolescentes mexicanos. MATERIAL Y MÉTODOS:Se usó la información basal de los jóvenes entre 7 y 17 años de edad (n= 582), que participaron en el Estudio de cohorte de trabajadores de la salud. Los participantes del estudio fueron los hijos e hijas de los trabajadores del Instituto Mexicano del Seguro Social (IMSS) y del Instituto Nacional de Salud Pública en Cuernavaca, Morelos, así como los hijos e hijas de los trabajadores de la Universidad Autónoma del Estado de México en Toluca. Se realizaron regresiones lineales múltiples con estimadores de varianza robustos, ajustando por covariables específicas. RESULTADOS:Se encontró un índice de masa corporal mayor en los niños y niñas en la etapa de pubertad, comparado con los de pre-pubertad (niñas: 4.59 kg/m², p<0.0001; niños: 1.12 kg/m², p= 0.05) y un mayor porcentaje de grasa corporal (niñas: 3.61, p<0.0001; niños: 1.48, p= 0.0001). Se encontró una diferencia significativa en el indicador de resistencia a la insulina (HOMA, por sus siglas en inglés) en las niñas (0.92, p<0.0001). CONCLUSIONES:La etapa y el momento de inicio del desarrollo sexual se asociaron significativamente con diferencias adversas en varios parámetros metabólicos y antropométricos críticos

Food and housing insecurity and health status among U.S. adults with and without prior military service

Food and housing insecurity may contribute to poorer mental and physical health. It is unclear as to whether those with prior military service, compared to those without, are more vulnerable to these current stressors. The objective of this study was to use U.S. population-based data to determine whether prior military service moderates the association of food and housing insecurity with poor mental and physical health.We analyzed data from nine states administering the Social Context module from the 2011 and 2012 Behavioral Risk Factor Surveillance System. Multivariable logistic regression was used to examine the associations of housing and food insecurity with poor mental and physical health and potential modification by military service. Compared with those with a history of military service, those without had higher prevalence of food insecurity (23.1% versus 13.7%) and housing insecurity (36.0% versus 22.5%). Food insecurity was associated with poor mental and physical health (mental health: odds ratio (OR)=3.47, 95% confidence interval (CI)=[3.18–3.77]; physical health: OR=3.21, 95% CI=[2.92–3.53]). Similar associations were observed between housing insecurity and poor mental and physical health. Prior military service was significantly associated with poor physical health. Interaction terms of prior military service with food and housing were not statistically significant. Food and housing insecurity does not appear to differentially impact mental and physical health among those with and without military service. Keywords: Food and housing insecurity, Mental and physical health, Military servic

Development of a Composite Risk Index of Reproductive Autonomy Using State Laws: Association With Maternal and Neonatal Outcomes

OBJECTIVE: We developed a composite index to quantify state legislation related to reproductive autonomy and examined its association with maternal and neonatal outcomes. We hypothesized that greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. DESIGN: A Delphi panel was used to inform development of the index. Restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data were used to conduct a cross-sectional study among all live births in the 50 U.S. states to people aged 15 to 44 between January 1, 2016, and December 31, 2018, to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. We used linear regression with state scores and quartiles, adjusted for state-level proportions of White, Black, and Hispanic live births; percent living in rural areas; percent of population foreign born; Health Resources and Services Administration spending on maternal and child health; and the Opportunity Index, a composite measure of indicators of the economy, education, and community. RESULTS: From 2016 to 2018, there were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM. The Delphi panel resulted in a summed state measure of 106 laws in 8 categories that could affect reproductive autonomy. In adjusted analyses, states in the most enabling (most reproductive autonomy) quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile (least reproductive autonomy). CONCLUSIONS: A composite policy index of reproductive autonomy was found to be associated with higher rates of SMM but lower rates of PRM and PTB. Further research is needed to understand how reproductive autonomy in the cumulative index may influence these and other maternal and birth outcomes