RESUMEN
BACKGROUND: Use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) has been postulated to reduce cancer risk by inhibition of tumor progression, vascularization, and metastasis. The renin-angiotensin system is upregulated in colorectal cancers; however, the association of ACEi and ARB use with colorectal cancer risk is not well understood. METHODS: The study population was 142,812 Women's Health Initiative participants free of colorectal cancer who reported on ACEi and ARB use at baseline; 2,216 incident colorectal cancers were diagnosed during 10 years of follow-up. Cox regression models estimated adjusted HRs and 95% confidence intervals for associations relative to nonuse among normotensive women, untreated hypertensive women, and hypertensive women treated with other antihypertensive medications. RESULTS: HRs among women who used any ACEi or ARB compared with nonuse in the three referent groups ranged between 0.97 and 1.01. Findings were similar for increased ACEi/ARB duration and for medications examined as separate classes or individually. CONCLUSIONS: In this large prospective study of women, no associations of ACEi or ARB use with colorectal cancer risk were observed. IMPACT: Choice of drug in the large population of aging women who will be prescribed ACEi and ARB should be made without factoring in any benefit on colorectal cancer risk.
Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Neoplasias Colorrectales/epidemiología , Hipertensión/tratamiento farmacológico , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Medición de RiesgoRESUMEN
Objective: To provide updated prevalence estimates of asthma and asthma medication use for women of childbearing age in the United States.Methods: Using data from 11,383 women aged 18-44, including a subset of 1,245 pregnant women, enrolled in the National Health and Nutrition Examination Survey (2001-2016), we assessed the age-adjusted prevalence of self-reported diagnosed asthma. For women aged 18-44, we stratified by year, demographics, and other characteristics. Furthermore, we assessed asthma medication use among women aged 18-44 with asthma.Results: After age-adjustment, 9.9% (95% confidence interval (CI) 9.2%, 10.7%) of women aged 18-44 and 10.9% (95% CI 7.2%, 14.6%) of pregnant women reported having asthma. Asthma prevalence was highest in 2015-2016 (12.0% 95% CI 9.8%, 14.3%) and lowest in 2003-2004 (8.6% 95% CI 6.4%, 10.8%). Women aged 18-44 with Medicaid or State Children's Health Insurance Program insurance coverage (16.8% 95% CI 14.5%, 19.2%), obesity (14.4% 95% CI 12.9%, 15.8%), diabetes (18.7% 95% CI 12.1%, 25.2%), hypertension (16.6% 95% CI 14.2%, 19.0%), and current smokers (12.8% 95% CI 11.4%, 14.2%) had the highest asthma prevalence. Of women with asthma, 38.3% (95% CI 34.5%, 42.1%) reported using asthma medications in the past 30 days.Conclusions: Among women of childbearing ages, asthma burden varies across demographic and clinical characteristics and has increased in recent years.
Asunto(s)
Asma/epidemiología , Costo de Enfermedad , Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Femenino , Geografía , Humanos , Encuestas Nutricionales/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Prevalencia , Autoinforme/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To identify frequently reported prescription medications and supplements among couples planning pregnancy because there is a lack of descriptive information on these agents in women and men who are trying to conceive. METHODS: Five hundred one couples enrolled in the Longitudinal Study of Infertility and the Environment, which took place between 2005 and 2009. Participants reported prescription medications as well as prescription and over-the-counter supplements used through interviews at study enrollment and through daily dairies during the 12-month follow-up. We identified prescription medications and supplements prospectively reported by ≥1% of women and men at baseline and from daily journal information grouped into 3-month preconception follow-up intervals while couples tried for pregnancy. RESULTS: The 5 most reported prescription medications among women were levothyroxine (5.8%), cetirizine (2.6%), fluticasone (2.4%), escitalopram (1.8%), and fluoxetine (1.8%) and for men were lisinopril (2.0%), mometasone (2.0%), fexofenadine (1.8%), atorvastatin (1.6%), and montelukast (1.6%). The most reported supplements were multivitamins (63.3%, 43.5%) and fish oil (13.2%, 9.4%) for women and men, respectively, and prenatal vitamins (22.0%) for women. For women during the first 3 months of follow-up, prenatal vitamins (6.0%) and antibiotics (1.2%-2.6%) were among the most frequently started medications. During the next 3 months, clomiphene (4.5%) was the most frequently initiated medication. CONCLUSIONS: Couples trying for pregnancy reported a variety of prescription medications and supplements, and they differed by gender. Preconception guidance should address medication and supplement use to avoid potential exposures associated with adverse reproductive and perinatal outcomes.
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Suplementos Dietéticos , Medicamentos sin Prescripción , Atención Preconceptiva , Medicamentos bajo Prescripción , Adulto , Femenino , Fertilización , Humanos , Masculino , Embarazo , Estudios ProspectivosRESUMEN
BACKGROUND: Covariate selection to reduce bias in observational data analysis has primarily relied upon statistical criteria to guide researchers. This approach may lead researchers to condition on variables that ultimately increase bias in the effect estimates. The use of directed acyclic graphs (DAGs) aids researchers in constructing thoughtful models based on hypothesised biologic mechanisms to produce the least biased effect estimates possible. METHODS: After providing an overview of different relations in DAGs and the prevailing mechanisms by which conditioning on variables increases or reduces bias in a model, we illustrate examples of DAGs for maternal antidepressants in pregnancy and four separate perinatal outcomes. RESULTS: By comparing and contrasting the diagrams for maternal antidepressant use in pregnancy and spontaneous abortion, major malformations, preterm birth, and postnatal growth, we illustrate the different conditioning sets required for each model. Moreover, we illustrate why it is not appropriate to condition on the same set of covariates for the same exposure and different perinatal outcomes. We further discuss potential selection biases, overadjustment of mediators on the causal path, and sufficient sets of conditioning variables. CONCLUSION: In our efforts to construct parsimonious models that minimise confounding and selection biases, we must rely upon our scientific knowledge of the causal mechanism. By structuring data collection and analysis around hypothesised DAGs, we ultimately aim to validly estimate the causal effect of interest.
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Antidepresivos/efectos adversos , Modelos Estadísticos , Resultado del Embarazo , Embarazo/efectos de los fármacos , Anomalías Inducidas por Medicamentos/etiología , Aborto Espontáneo/inducido químicamente , Femenino , Crecimiento/efectos de los fármacos , Humanos , Nacimiento Prematuro/inducido químicamenteRESUMEN
BACKGROUND: Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care. METHODS: Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ(2) tests. Differences in postpartum mean total score by group were assessed via multiple linear regression. RESULTS: Women in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001). CONCLUSIONS: Although intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.
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Negro o Afroamericano/educación , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Embarazo/etnología , Mujeres Embarazadas/psicología , Atención Prenatal/métodos , Salud Reproductiva/educación , Adulto , Negro o Afroamericano/psicología , Depresión/etnología , Depresión/prevención & control , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/prevención & control , Trastorno Depresivo/terapia , District of Columbia , Femenino , Humanos , Periodo Posparto , Embarazo/psicología , Mujeres Embarazadas/etnología , Atención Primaria de Salud/métodos , Conducta de Reducción del Riesgo , Fumar/etnología , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Maltrato Conyugal/etnología , Maltrato Conyugal/prevención & control , Resultado del TratamientoRESUMEN
OBJECTIVE: The present study identified and compared the coping strategies of Chinese American, Korean American, and Mexican American breast cancer survivors (BCS). METHODS: Six focus groups were conducted with Chinese American (n = 21), Korean American (n = 11), and Mexican American (n = 9) BCS. Interviews were audio-recorded, transcribed, and translated for thematic content analysis of coping experiences and strategies. RESULTS: Women reported the use of 8 coping strategies (religious/spiritual, benefit finding, fatalism, optimism, fighting spirit, information seeking, denial, and self-distraction). Among Chinese American BCS, benefit finding was the most referenced coping strategy, whereas religious/spiritual coping was most frequently reported among Korean American and Mexican American BCS. Denial and self-distraction were the least cited strategies. CONCLUSIONS: Survivors draw upon new found inner strength to successfully integrate their cancer experience into their lives. Coping models must consider the diversity of cancer survivors and the variability in coping strategies among cultural ethnic minority BCS.
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Adaptación Psicológica , Asiático/psicología , Neoplasias de la Mama/psicología , Americanos Mexicanos/psicología , Sobrevivientes/psicología , Adulto , Asiático/estadística & datos numéricos , Neoplasias de la Mama/terapia , Femenino , Grupos Focales , Humanos , Americanos Mexicanos/estadística & datos numéricos , Persona de Mediana Edad , Investigación Cualitativa , Sobrevivientes/estadística & datos numéricosRESUMEN
PURPOSE: To examine whether maternal asthma contributes to racial/ethnic differences in obstetrical and neonatal complications. METHODS: Data on white (n = 110,603), black (n = 50,284), and Hispanic (n = 38,831) singleton deliveries came from the Consortium on Safe Labor. Multilevel logistic regression models, with an interaction term for asthma and race/ethnicity, estimated within-group adjusted odds ratios (aORs) for gestational diabetes, gestational hypertension, pre-eclampsia, placental abruption, premature rupture of membranes, preterm delivery, maternal hemorrhage, neonatal intensive care unit admissions, small for gestational age, apnea, respiratory distress syndrome, transient tachypnea of the newborn, anemia, and hyperbilirubinemia after adjustment for clinical and demographic confounders. Nonasthmatics of the same racial/ethnic group were the reference group. RESULTS: Compared with nonasthmatics, white asthmatics had increased odds of pre-eclampsia (aOR, 1.28; 95% confidence interval [CI], 1.15-1.43) and maternal hemorrhage (aOR, 1.14; 95% CI, 1.04-1.23). White and Hispanic infants were more likely to have neonatal intensive care unit admissions (aOR, 1.19; 95% CI, 1.11-1.28; aOR, 1.16; 95% CI, 1.02-1.32, respectively) and be small for gestational age (aOR, 1.11; 95% CI, 1.02-1.20; aOR, 1.26; 95% CI, 1.10-1.44, respectively), and Hispanic infants were more likely to have apnea (aOR, 1.32; 95% CI, 1.02-1.69). CONCLUSIONS: Maternal asthma did not affect most obstetrical and neonatal complication risks within racial/ethnic groups. Despite their increased risk for both asthma and many complications, our findings for black women were null. Asthma did not contribute to racial/ethnic disparities in complications.
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Asma/etnología , Disparidades en el Estado de Salud , Enfermedades del Recién Nacido/etnología , Complicaciones del Embarazo/etnología , Desprendimiento Prematuro de la Placenta/etnología , Adulto , Apnea/etnología , Asma/complicaciones , Población Negra , Parto Obstétrico , Diabetes Gestacional/etnología , Etnicidad , Femenino , Rotura Prematura de Membranas Fetales/etnología , Hispánicos o Latinos , Humanos , Hiperbilirrubinemia/etnología , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Hemorragia Posparto/etnología , Preeclampsia/etnología , Embarazo , Nacimiento Prematuro/etnología , Síndrome de Dificultad Respiratoria del Recién Nacido/etnología , Estudios Retrospectivos , Taquipnea/etnología , Estados Unidos , Población Blanca , Adulto JovenRESUMEN
This study examined causal attribution beliefs about breast cancer and the influence that these beliefs exert on health behavior change among breast cancer survivors (BCS). Focus groups with Chinese (n = 21), Korean (n = 11), and Mexican American (n = 9) BCS recruited through community- and hospital-based support groups were conducted. Interviews were audio-recorded, transcribed verbatim, and translated into English for thematic content analysis. Three themes concerning beliefs about breast cancer cause common to all three groups included (a) stress, (b) diet, and (c) fatalism. Causal beliefs corresponded to behavioral changes with women describing efforts to improve their diet and manage their stress. Ethnic minority BCS adhere to beliefs about what caused their cancer that influence their health behaviors. Providing quality health care to ethnically diverse cancer survivors requires cultural sensitivity to patients' beliefs about the causes of their cancer and awareness of how beliefs influence patients' health behaviors post diagnosis.