RESUMEN
OBJECTIVES: This study aimed to evaluate occupational exposures and menstrual cycle characteristics among nurses. METHODS: Using cross-sectional data collected in 2010-2012 from 6309 nurses aged 21-45 years, we investigated nurses' menstrual function in the Nurses' Health Study 3. We used multivariable regression modeling to analyze the associations between occupational exposures and prevalence of irregular cycles and long and short cycle lengths. RESULTS: The cohort reported cycle length as <21 (1.5%), 21-25 (15.6%), 26-31 (69.7%), and 32-50 (13.2%) days. In addition, 19% of participants reported irregular cycles. Working ≥41 hours/week was associated with a 16% [95% confidence interval (95% CI): 4-29%] higher prevalence of irregular cycles and a higher prevalence of very short (<21-day) cycles [prevalence odds ratio (OR) 1.93, 95% CI 1.24-3.01] in adjusted models. Irregular menstrual cycles were more prevalent among women working nights only (32% higher; 95% CI 15-51%) or rotating nights (27% higher, 95% CI 10-47%), and was associated with the number of night shifts per month (P for trend <0.0001). Rotating night schedule was associated with long (32-50 day) cycles (OR 1.28, 95% CI 1.03-1.61). Heavy lifting was associated with a higher prevalence of irregular cycles (34% higher), and the prevalence of cycles <21 days and 21-25 day cycles increased with increasing heavy lifting at work (P for trend <0.02 for each endpoint). CONCLUSION: Night work, long hours, and physically demanding work might relate to menstrual disturbances.
Asunto(s)
Ciclo Menstrual/fisiología , Trastornos de la Menstruación/etiología , Personal de Enfermería en Hospital , Exposición Profesional , Estrés Psicológico/complicaciones , Tolerancia al Trabajo Programado , Adulto , Estudios Transversales , Femenino , Fertilidad/fisiología , Humanos , Trastornos de la Menstruación/fisiopatología , Persona de Mediana Edad , Personal de Enfermería en Hospital/estadística & datos numéricos , Salud Laboral , Adulto JovenRESUMEN
OBJECTIVE: We sought to estimate the association between intimate partner violence, a prevalent psychosocial stressor, and the incidence of type 2 diabetes in women. RESEARCH DESIGN AND METHODS: In 2001, 68,376 Nurses' Health Study II participants answered questions on physical, sexual, and psychological intimate partner violence in adulthood (age ≥18 years) and reported the years in which any abuse occurred. We used Cox proportional hazards models to estimate the associations between intimate partner violence exposures and incidence of type 2 diabetes from 2001 to 2007. We also estimated effects of duration and time since intimate partner violence on type 2 diabetes incidence. RESULTS: Of 68,376 respondents, 64,732 met inclusion criteria at the 2001 baseline; of these, 23% reported lifetime physical intimate partner violence, 11% reported lifetime sexual intimate partner violence, and 8% reported moderate and <2% reported severe psychological intimate partner violence. Hazard ratios (HRs) and 95% CIs for type 2 diabetes, adjusted for potential confounders, were 1.18 (1.00-1.39) and 1.08 (0.86-1.35) for more than one lifetime episode of physical and sexual intimate partner violence, respectively, and 1.78 (1.21-2.61) for severe psychological abuse. Addition of updated BMI and other diabetes risk factors reduced the physical intimate partner violence HR to 1.12 (0.94-1.33) and the psychological intimate partner violence HR to 1.61 (1.09-2.38). CONCLUSIONS: Physical intimate partner violence is modestly associated with incidence of type 2 diabetes in this population. Severe psychological violence may substantially increase type 2 diabetes risk.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Maltrato Conyugal/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adulto , Femenino , Humanos , Incidencia , Factores de Riesgo , Delitos Sexuales/estadística & datos numéricos , Parejas SexualesRESUMEN
PURPOSE: Intimate partner violence, a prevalent stressor for women, may influence the risk of cardiovascular disease. We estimated the association between intimate partner violence and the development of hypertension, an important risk factor for cardiovascular disease, in the Nurses' Health Study II cohort. METHODS: Intimate partner violence measures included adult lifetime physical and sexual partner violence and the Women's Experiences with Battering Scale, which ascertained women's subjective experience of recent emotional abuse. Physician-diagnosed hypertension was self-reported on biennial questionnaires. We used Cox proportional hazards models to estimate the association between report of intimate partner violence in 2001 and incidence of hypertension from 2001 through 2007. RESULTS: Of 51,434 included respondents, 22% reported being physically hurt, and 10% reported being forced into sexual activities at some point in adulthood by an intimate partner. After adjustment for confounders, physical and sexual abuse were not associated with hypertension. However, women reporting the most severe emotional abuse had a 24% increased rate of hypertension (hazard ratio 1.24; 95% confidence interval: 1.02-1.53) compared with women unexposed to emotional abuse. CONCLUSIONS: The risk of hypertension appears to be increased in the small number of women recently exposed to severe emotional abuse.
Asunto(s)
Mujeres Maltratadas/estadística & datos numéricos , Violencia Doméstica/estadística & datos numéricos , Hipertensión/epidemiología , Delitos Sexuales/estadística & datos numéricos , Maltrato Conyugal/estadística & datos numéricos , Salud de la Mujer , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Modelos de Riesgos Proporcionales , Factores de Riesgo , Parejas Sexuales , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: We investigated self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays and the risk of spontaneous abortion in US nurses. STUDY DESIGN: Pregnancy outcome and occupational exposures were collected retrospectively from 8461 participants of the Nurses' Health Study II. Of these, 7482 were eligible for analysis using logistic regression. RESULTS: Participants reported 6707 live births, and 775 (10%) spontaneous abortions (<20 weeks). After adjusting for age, parity, shift work, and hours worked, antineoplastic drug exposure was associated with a 2-fold increased risk of spontaneous abortion, particularly with early spontaneous abortion before the 12th week, and 3.5-fold increased risk among nulliparous women. Exposure to sterilizing agents was associated with a 2-fold increased risk of late spontaneous abortion (12-20 weeks), but not with early spontaneous abortion. CONCLUSION: This study suggests that certain occupational exposures common to nurses are related to risks of spontaneous abortion.
Asunto(s)
Aborto Espontáneo/etiología , Enfermeras y Enfermeros/estadística & datos numéricos , Exposición Profesional/efectos adversos , Aborto Espontáneo/epidemiología , Adulto , Anestésicos por Inhalación/efectos adversos , Antineoplásicos/efectos adversos , Antivirales/efectos adversos , Desinfectantes/efectos adversos , Femenino , Humanos , Exposición Profesional/estadística & datos numéricos , Embarazo , Resultado del Embarazo , Prevalencia , Estudios Retrospectivos , Riesgo , Rayos X/efectos adversosRESUMEN
BACKGROUND: Shift workers who experience sleep disturbances and exposure to light at night could be at increased risk for alterations in physiologic functions that are circadian in nature. METHODS: We investigated rotating shift work and menstrual cycle patterns in the Nurses' Health Study II using cross-sectional data collected in 1993 from 71,077 nurses aged 28-45 years who were having menstrual periods and were not using oral contraceptives. Log-binomial regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Eight percent of participants reported working rotating night shifts for 1-9 months, 4% for 10-19 months, and 7% for 20+ months during the previous 2 years. Irregular cycles (>7 days variability) were reported by 10% of participants. Seventy percent of women reported menstrual cycles of 26-31 days, 1% less than 21 days, 16% 21-25 days, 11% 32-39 days, and 1% 40+ days. Women with 20+ months of rotating shift work were more likely to have irregular cycles (adjusted RR = 1.23 [CI = 1.14-1.33]); they were also more likely to have cycle length <21 days (1.27 [0.99-1.62]) or 40+ days (1.49 [1.19-1.87]) (both compared with 26-31 days). For irregular patterns and for 40+ day cycles, there was evidence of a dose response with increasing months of rotating shift work. Moderately short (21-25 days) or long (32-39 days) cycle lengths were not associated with rotating shift work. CONCLUSIONS: Shift work was modestly associated with menstrual function, with possible implications for fertility and other cycle-related aspects of women's health.
Asunto(s)
Trastornos Cronobiológicos/epidemiología , Ciclo Menstrual/fisiología , Trastornos de la Menstruación/epidemiología , Enfermeras y Enfermeros/estadística & datos numéricos , Tolerancia al Trabajo Programado , Adaptación Fisiológica , Adulto , Factores de Edad , Trastornos Cronobiológicos/etiología , Trastornos Cronobiológicos/fisiopatología , Intervalos de Confianza , Estudios Transversales , Femenino , Humanos , Incidencia , Modelos Lineales , Trastornos de la Menstruación/etiología , Trastornos de la Menstruación/fisiopatología , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Childhood adversities are associated with adult health. We hypothesize that exposure to physical and sexual abuse in childhood and adolescence will be associated with incidence of clinically symptomatic uterine leiomyomas (fibroids) through influences on health behaviors and reproductive hormone regulation. METHODS: Participants included 68,505 women enrolled in the Nurses' Health Study II, an ongoing prospective cohort study of premenopausal women from 14 US states aged 25-42 years at enrollment (1989), who completed a retrospective questionnaire on childhood violence exposure (2001). A cumulative indicator of severity and chronicity of child/teen violence exposure was derived using factor analysis. We used a Cox proportional-hazards model to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: During the 728,865 woman-years of follow-up (1989-2005), 9823 incident diagnoses of ultrasound- or hysterectomy-confirmed uterine leiomyomas were reported; 65% reported any physical or sexual abuse. A dose-response association between cumulative abuse and fibroid risk was found. Compared with those who reported no abuse, multivariable IRRs for ultrasound or hysterectomy-confirmed uterine leiomyomas were 1.08 (95% CI = 1.03-1.13), 1.17 (1.10-1.24), 1.23 (1.14-1.33), 1.24 (1.10-1.39), and 1.36 (1.18-1.54), for cumulative exposures ranging from mildest to most severe. Increased emotional support in childhood also attenuated associations. CONCLUSIONS: Severity and chronicity of child/teen sexual and physical abuse was associated with increasing risk of clinically detected fibroids among premenopausal women.
Asunto(s)
Maltrato a los Niños , Leiomioma/epidemiología , Delitos Sexuales , Apoyo Social , Neoplasias Uterinas/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Intervalos de Confianza , Femenino , Hormonas Esteroides Gonadales/metabolismo , Conductas Relacionadas con la Salud , Humanos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Although child abuse is associated with obesity, it is not known whether early abuse increases risk of type 2 diabetes. PURPOSE: To investigate associations of child and adolescent abuse with adult diabetes. METHODS: Proportional hazards models were used to examine associations of lifetime abuse reported in 2001 with risk of diabetes from 1989 to 2005 among 67,853 women in the Nurses' Health Study II. Data were analyzed in 2009. RESULTS: Child or teen physical abuse was reported by 54% and sexual abuse by 34% of participants. Models were adjusted for age, race, body type at age 5 years, and parental education and history of diabetes. Compared to women who reported no physical abuse, the hazards ratio (HR) was 1.03 (95% CI=0.91, 1.17) for mild physical abuse; 1.26 (1.14, 1.40) for moderate physical abuse; and 1.54 (1.34, 1.77) for severe physical abuse. Compared with women reporting no sexual abuse in childhood or adolescence, the HR was 1.16 (95% CI=1.05, 1.29) for unwanted sexual touching; 1.34 (1.13, 1.59) for one episode of forced sexual activity; and 1.69 (1.45, 1.97) for repeated forced sex. Adult BMI accounted for 60% (95% CI=32%, 87%) of the association of child and adolescent physical abuse and 64% (95% CI=38%, 91%) of the association of sexual abuse with diabetes. CONCLUSIONS: Moderate to severe physical and sexual abuse in childhood and adolescence have dose-response associations with risk of type 2 diabetes among adult women. This excess risk is partially explained by the higher BMI of women with a history of early abuse.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños/psicología , Abuso Sexual Infantil/psicología , Maltrato a los Niños/psicología , Diabetes Mellitus Tipo 2/etiología , Adolescente , Adulto , Índice de Masa Corporal , Niño , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Obesidad/complicaciones , Obesidad/psicología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Riesgo , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: We evaluated first-trimester exposures and the risk of preterm birth in the most recent pregnancy of participants of the Nurses' Health Study II. STUDY DESIGN: Log binomial regression was used to estimate the relative risk (RR) for preterm birth in relation to occupational risk factors, such as work schedule, physical factors, and exposures to chemicals and x-rays, adjusted for age and parity. RESULTS: Part-time work (Asunto(s)
Enfermeras y Enfermeros
, Enfermedades Profesionales/etiología
, Exposición Profesional/efectos adversos
, Nacimiento Prematuro/etiología
, Adulto
, Estudios de Cohortes
, Femenino
, Humanos
, Oportunidad Relativa
, Embarazo
, Primer Trimestre del Embarazo
, Factores de Riesgo
RESUMEN
BACKGROUND: There is inconsistent evidence as to whether work schedule (including rotating shifts and night work) can affect reproductive outcomes. METHODS: We investigated the association between work schedule and risk of spontaneous abortion in U.S. nurses. The Nurses' Health Study II is a prospective cohort study established in 1989. In 2001, information about occupational activities and exposures during pregnancy was collected from female nurses for the most recent pregnancy since 1993. Of 11,178 eligible respondents, 9547 (85%) indicated willingness to participate in the occupational study, and 8461 of those (89%) returned the questionnaire, for an overall participation rate of 76%. Of these, 7688 women had pregnancies that were eligible for analysis. RESULTS: Participants reported 6902 live births and 786 (10%) spontaneous abortions. Compared with women who reported usually working "days only" during their first trimester, women who reported usually working "nights only" had a 60% increased risk of spontaneous abortion (RR = 1.6; 95% confidence interval [CI] = 1.3-1.9). A rotating schedule, with or without night shifts, was not associated with an increase in risk (RR = 1.2 [CI = 0.9-1.5] and 1.0 [CI = 0.8-1.2], respectively). Women who reported working more than 40 hours per week during the first trimester were also at increased risk of spontaneous abortion (1.5; 1.3-1.7) compared with women working 21-40 hours, even after adjustment for work schedule. CONCLUSIONS: Nightwork and long work hours may be associated with an increased risk of spontaneous abortion. Further studies are needed to determine whether hormonal disturbances attributed to night work affect pregnancy outcome.
Asunto(s)
Aborto Espontáneo/epidemiología , Enfermeras y Enfermeros , Enfermedades Profesionales/epidemiología , Resultado del Embarazo/epidemiología , Tolerancia al Trabajo Programado , Adulto , Factores de Edad , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVES: To determine whether birth weight and adult body size interact to predict coronary heart disease in women, as has been observed for men. To determine whether birth weight and adult body size interact to predict risk of stroke. DESIGN: Longitudinal cohort study. SETTING AND PARTICIPANTS: 66,111 female nurses followed since 1976 who were born of singleton, term pregnancies and reported their birth weight in 1992. MAIN OUTCOME MEASURES: 1504 events of coronary heart disease (myocardial infarction or sudden cardiac death) and 1164 strokes. RESULTS: For each kilogram of higher birth weight, age adjusted hazard ratios from prospective analysis were 0.77 (95% confidence interval 0.69 to 0.87) for coronary heart disease and 0.89 (0.78 to 1.01) for total stroke. In combined prospective and retrospective analysis, hazard ratios were 0.84 (0.76 to 0.93) for total stroke, 0.83 (0.71 to 0.96) for ischaemic stroke, and 0.86 (0.66 to 1.11) for haemorrhagic stroke. Exclusion of macrosomic infants (> 4536 g) yielded stronger estimates. Risk of coronary heart disease was especially high for women who crossed from a low centile of weight at birth to a high centile of body mass index in adulthood. The association of lower birth weight with increased risk of stroke was apparent across categories of body mass index in adults and was not especially strong among heavier women. CONCLUSIONS: Higher body mass index in adulthood is an especially strong risk factor for coronary heart disease among women who were small at birth. In this large cohort of women, size at birth and adiposity in adulthood interacted to predict events of coronary heart disease but not stroke events.