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Biomedical subjects

Lori A Bastian

Publications and source records attributed to Lori A Bastian.

At least 19 recordsLinked to original sources
PubMed2006

Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

Delivery of Health Care↗
PubMed2005

Initiation and discontinuation of hormone therapy for menopausal symptoms: results from a community sample.

Factors related to initiation and discontinuation of hormonal therapy (HT) for treatment of menopausal symptoms were examined in a community sample of 533 peri/postmenopausal women aged 45-54 by telephone three times. Over 40 variables including: sociodemographic characteristics, clinical reasons to start HT use, HT contraindications, HT attitudes/knowledge, and health behaviors were examined in logistic regression models comparing women who discontinued HT to women who continued using HT over 9 months (discontinuers) and women who initiated HT versus women who never used HT over 9 months (initiators). Increased understanding of HT, confidence, mental health symptoms, perception that menopause is natural, and having gynecological surgery were related to decreased likelihood of HT discontinuation. Increased understanding about risks of HT, vasomotor symptoms, mood symptoms, and having gynecological surgery were related to increased likelihood of HT Initiation. These findings highlight the importance of physicians discussing HT with their patients, particularly because of recent clinical trial developments.

Communication↗
PubMed2005

Number of children and the risk of obesity in older women.

BACKGROUND: The purpose of this study is to examine number of live births, other reproductive factors, and health behaviors in relation to obesity risk among older women. METHODS: Data were collected during in-person and telephone-based interviews from a population-based cohort in Utah. RESULTS: A total of 2,035 women aged 66-102 are included in this report. Overall, 403 (20%) older women were determined to be obese. The rates of obesity were significantly higher with increasing numbers of children, demonstrating a dose-response relationship (P < 0.05). After adjustment for age, education, marital status, BMI at age 18, use of oral contraceptives, hysterectomy status, physical activity, current use of hormone therapy, and age at menarche, the risk of obesity increased 11% with each additional live birth. In additional analyses that excluded nulliparous women, after adjusting for cumulative months of breast-feeding, the risk of obesity increased 7% with each live birth. In this cohort of older women, we found higher rates of obesity with increasing number of children that was independent of socioeconomic status and other confounding factors. CONCLUSIONS: In a cohort of older women, higher rates of obesity were associated with increasing number of children that was independent of socioeconomic status and other confounding factors.

Aged↗
PubMed2005

Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy.

The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed follow-up surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had "caused" their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.

Adult↗
PubMed2005

Hormone therapy does not affect depression severity in older women.

OBJECTIVE: Although estrogens are thought to have a beneficial effect on menopausal symptoms, the role of estrogen in the etiology and treatment of depression in older women remains unclear. The authors examined the relationship between hormone therapy (HT) use and depressive symptom severity. METHODS: Authors report the findings from a cross-sectional analysis of baseline data from the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) Study, using data from 1,160 women age 60 years and older. RESULTS: Women who were taking HT were likely to be younger, White, married, and to have had at least some college education. They were also more likely to report good or better health and to have taken antidepressant medications in the past 3 months. Although HT use was associated with more severe depressive symptoms in the unadjusted analysis, it was not associated with depression severity in adjusted analyses. Although there was a trend for a differential effect of college education with HT use on depression scores, no significant interaction was found between HT and race. CONCLUSION: There was no evidence to suggest that women HT users differ from non-HT users in depressive symptom severity.

Aged↗
PubMed2004

The impact of environmental tobacco smoke on women's risk of dying from heart disease: a meta-analysis.

OBJECTIVE: To review systematically and analyze the association between environmental tobacco smoke (ETS) exposure and the risk of dying from heart disease in women. METHODS: We searched the English-language literature using MEDLINE (1966-April 2004), CINAHL, PsychInfo, and bibliographies of selected studies. We included studies that specifically addressed the association of ETS and heart disease mortality in women and had adequate controls and retrievable risk estimates. We looked for either cohort studies or randomized controlled trials. Studies were evaluated independently by two of the authors. Nine cohort studies were finally selected for analysis. We estimated the summary relative risk (RR) and associated 95% confidence intervals (95% CI) using a random-effects model. RESULTS: Mean follow-up periods for these cohorts ranged from 6 to 39 years. Among non-smoking women, exposure to ETS was associated with a 15% increase in the risk of dying from heart disease compared with nonsmoking women not exposed to ETS (RR = 1.15, 95% CI 1.03-1.28, p < 0.05). CONCLUSIONS: Among nonsmoking women, exposure to passive smoke increases the risk of dying from heart disease. In accordance with the newly developed guidelines by the American Heart Association for prevention of cardiovascular disease (CVD) in women, we recommend counseling women on reducing or avoiding ETS exposure.

Cohort Studies↗
PubMed2004

Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness.

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (CI)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI--particularly African-American veterans--have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.

Adult↗
PubMed2003

Is this woman perimenopausal?

CONTEXT: Perimenopause is a time of transition for women at midlife. Women want to know whether they are starting this change and physicians need to know the accuracy of a clinical examination in identifying perimenopausal women. These women should be counseled about alleviating climacteric symptoms, using contraception, and preventing diseases such as osteoporosis. OBJECTIVE: To systematically review the accuracy of self-assessment, symptoms, signs, and laboratory tests in diagnosing women in perimenopause. DATA SOURCES: English-language articles that presented data relevant to diagnosis of perimenopause were identified in a MEDLINE search from 1966 to 2001. References of these articles and other publications also were reviewed. STUDY SELECTION: Cross-sectional or longitudinal studies of women aged 40 years or older that used the definition of perimenopause as 3 to 11 months of amenorrhea or irregular periods, included a premenopausal control group, and reported a clinical examination finding. Of 1246 articles identified, 16 studies were included in the analysis. DATA EXTRACTION: Two authors independently reviewed articles for quality (L.A.B. and C.M.S.). Discrepancies were resolved by a third author (K.N.). DATA SYNTHESIS: The prior probability of perimenopause is directly related to a woman's age. After considering age, the following yielded the greatest positive likelihood ratios (LRs+): self assessment of going through the transition (LR+ range, 1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+ 1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range, 1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54), and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of perimenopausal status had the smallest negative LR (range, 0.18-0.36). CONCLUSIONS: No one symptom or test is accurate enough by itself to rule in or rule out perimenopause. Clinicians should diagnose perimenopause based on menstrual history and age without relying on laboratory test results.

Adult↗
PubMed2003

Daytime testing after laboratory or home-based polysomnography: comparisons of middle-aged insomnia sufferers and normal sleepers.

Many studies have shown only modest differences between insomnia sufferers and matched, non-complaining normal controls in regard to their levels of daytime sleepiness and diurnal performances. The current study was conducted to determine whether such daytime comparisons might be affected by the setting (home vs. sleep lab) in which study participants sleep on the nights before such testing. The study used a counter-balanced, matched-group design in which participants underwent three consecutive nocturnal polysomnographs (PSG) conducted either in the sleep lab or in their homes prior to undergoing daytime multiple sleep latency test (MSLT) and computer-administered performance testing. The study participants were 35 (18 women and 17 men) middle-aged (40-59 years) non-complaining normal sleepers and 33 middle-aged insomnia sufferers (17 women and 16 men) who met structured interview criteria for persistent primary insomnia. Use of a hierarchical linear statistical model showed only insomnia sufferers who underwent nocturnal home PSG were more alert on the MSLT than were normal sleepers who underwent lab PSG. However, these insomnia sufferers showed a greater propensity toward attention lapses on selected reaction time tests than did either of the two normal control groups (i.e. either those who slept in the lab or those who slept at home). The results suggest the nocturnal sleep setting (home vs. lab) may affect subsequent MSLT and performance test comparisons of insomnia sufferers and normal sleepers.

Adult↗
PubMed2003

Gender differences in hepatitis C infection and risks among persons with severe mental illness.

OBJECTIVES: The authors assessed gender differences in hepatitis C infection and associated risk behaviors among persons with severe mental illness. METHOD: S: The sample consisted of 777 patients (251 women and 526 men) from four sites. RESULTS: Across sites, the rate of hepatitis C infection among men was nearly twice that among women. Clear differences were noted in hepatitis C risk behaviors. Men had higher rates of lifetime drug-related risk behaviors: needle use (23.1 percent compared with 12.5 percent), needle sharing (17.6 percent compared with 7.7 percent), and crack cocaine use (45.2 percent compared with 30.8 percent). Women had significantly higher rates of lifetime sexual risk behaviors: unprotected sex in exchange for drugs (17.8 percent compared with 11.2 percent), unprotected sex in exchange for money or gifts (30.6 percent compared with 17 percent), unprotected vaginal sex (94 percent compared with 89.7 percent), and anal sex (33.7 percent compared with 22.6 percent). Gender appeared to modify some sex risks. Unprotected sex in exchange for drugs increased the risk of hepatitis C seropositivity for both men and women. In the multivariate model, gender was not significantly associated with hepatitis C seropositivity after adjustment for other risk factors. CONCLUSION: S: Gender differences in the lifetime rates of drug risks explain the higher rates of hepatitis C infection among men with severe mental illness.

Acute Disease↗
PubMed2002

Evaluating participants' use of a hormone replacement therapy decision-making intervention.

BACKGROUND: Associations between optimal use of a tailored decision-aid and levels of accuracy of perceived breast cancer risk, confidence in decision-making, and satisfaction with decisions about HRT were evaluated in a randomized intervention trial with a community sample of women aged 45-54. METHODS: Data are from 289 women randomized to receive a computer-tailored three-step decision-aid. RESULTS: Forty-seven percent of participants reported optimal use of the intervention materials. African American women and those with low confidence in decision-making were less likely to use the intervention optimally than white women and those with higher confidence (P<0.05). Optimal use of the decision-aid was associated with increased accuracy of perceived risk and confidence to make a decision. DISCUSSION: When used optimally, self-directed decision-aids can improve women's ability to make decisions about HRT. Additional refinement of these aids is needed. For some subgroups of women, adjuncts such as telephone counseling also might be considered.

Black or African American↗
PubMed2002

Behavioral medicine and aging.

A brief history of behavioral medicine and aging is followed by a series of perspectives that help to understand how age is used as a variable in this research, the relative importance of age to declines in cognitive functioning, and the impact of behavioral risk indicators on healthy survival. The authors discuss Alzheimer's disease and the role of age in clinical practice. Also discussed are potential problems in age-related research, ways to improve the knowledge base in behavioral medicine and aging, and thoughts about future challenges to enhance work in behavioral medicine and aging.

Age Factors↗
PubMed2002

Hormone replacement therapy and the risk of death from breast cancer: a systematic review.

OBJECTIVE: Recent studies have shown an increased relative risk of breast cancer with hormone replacement therapy for > or = 5 years. However, tumors in hormone replacement therapy users are more likely to be localized and of a favorable histologic condition. Our objective was to determine the effects of hormone replacement therapy on the risk of death from breast cancer. STUDY DESIGN: We searched the literature to identify studies that addressed hormone replacement therapy and breast cancer death among healthy hormone replacement therapy users compared with nonusers. We included randomized controlled trials and cohort and case-control studies with adequate controls and retrievable risk estimates. RESULTS: Ten observational studies met the inclusion criteria; these studies varied widely with regard to population, choice of control group, ascertainment of exposure and outcome, and adjustment for potential confounders. CONCLUSION: Most studies showed a reduced risk of death from breast cancer in hormone replacement therapy users compared with nonusers. In a few studies, this risk reduction was attenuated after prolonged use or prolonged duration of follow-up. Limited information on recency of use, dose, or use of combined hormone replacement therapy was available.

Breast Neoplasms↗
PubMedDate not supplied

Are women worrying about heart disease?

Women at risk for coronary artery disease (CAD) may not be worried about the disease. In this study, demographic, CAD-risk, and CAD-worry data collected from Durham Veterans' Affairs Medical Center women veterans were examined using bivariate and multivariate analysis with worry as the outcome. Excluding CAD patients (N = 64) and incomplete data (N = 17) of 328 women, 42% worried about CAD. Younger age, single marital status, obesity, family history, and hyperlipidemia were associated with worry. Of women with up to three risk factors, fewer than half worried about CAD. Higher-risk women were unconcerned about CAD. This could undermine prevention efforts.

Adult↗
PubMedDate not supplied

Coping styles and personality domains related to menopausal stress.

PURPOSE: Examine the role of coping styles and personality domains in relationship to stress associated with menopause. DATA/INFORMATION: Data are from 170 women ages 45 to 54 who completed a mailed questionnaire and a telephone interview that assessed women's stress associated with menopause, coping style, personality, menopausal symptoms, depressive symptoms, and use of hormone replacement therapy. RESULTS: Rating menopause as stressful was associated with higher levels of neuroticism, seeking social support, and avoidance, and lower levels of agreeableness in unadjusted analyses. In a multivariate model, menopausal symptoms, seeking social support, and neuroticism accounted for 21% of the variance in rating menopause as stressful. CONCLUSIONS: Health care providers treating women going through menopause should be aware that the stress response to the menopause transition is multifactorial and is associated with women's individual personalities and coping styles.

Adaptation, Psychological↗
PubMedDate not supplied

Provider characteristics and mammography recommendation among women in their 40s and 50s.

OBJECTIVES: Healthcare provider recommendation for mammography is one of the strongest predictors of women's mammography use, but few studies have examined the association of provider characteristics with mammography recommendations. We examined the relationship of provider gender, age, medical specialty, and duration of relationship with the patient to report mammography recommendation. METHODS: Participants were women ages 40-45 and 50-55 who were part of a larger intervention study of decision making about mammography. We examined the relationship of provider characteristics to patient-reported mammography recommendations at baseline and at 24-month follow-up. RESULTS: At baseline, 74% of women in their 40s and 79% of women in their 50s reported provider mammography recommendations within the prior 2 years. Proportions were similar at the 24-month follow-up. In multivariate logistic regression models including both patient and provider characteristics, women in their 40s who had female providers were more likely to report mammography recommendations than those with male providers at baseline (OR=1.83, p=0.01) and follow-up (OR=1.74, p=0.03). Among women in their 50s, participants whose regular providers were primary care physicians were more likely to report recommendations at baseline than those whose regular providers were obstetrician/gynecologists (OR=1.68, p=0.03). CONCLUSIONS: About one fourth of women in this study reported not having been advised by a healthcare provider to have a mammogram. All women in the study had health insurance. Among women in their 40s, for whom mammography guidelines were controversial at the time of data collection, provider gender was an important predictor of patient-reported mammography recommendation.

Adult↗
PubMedDate not supplied

Number of children associated with obesity in middle-aged women and men: results from the health and retirement study.

OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men. METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples). RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different. CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.

Adult↗