Biomedical subjects

Victoria L Holt

Publications and source records attributed to Victoria L Holt.

34 records · Page 2Linked to original sources

PubMed2003

Recreational physical activity and endometrioma risk.

Endometriosis, defined by implantation of endometrial tissue outside the uterus, is commonly found on the ovaries and is characterized by a range of symptoms and severity, including chronic pelvic pain and infertility. The role of modifiable exogenous factors such as exercise in the development of this disease is not well understood. The authors conducted a 1990-1994 case-control study (77 cases, 735 controls) to evaluate the risk of cystic ovarian endometriosis (endometrioma) associated with recreational physical activity among females aged 18-39 years enrolled in the Group Health Cooperative of Puget Sound, Washington. Physical activity was evaluated according to its duration, frequency, and intensity during two periods of exposure: 2 years prior to the reference date and at ages 12-21 years. Women who reported frequent, high-intensity activity during the 2 years prior to the reference date had a 76% reduced endometrioma risk (odds ratio = 0.24, 95% confidence interval: 0.08, 0.71) compared with women who engaged in no high-intensity activity. A nonsignificant 53% reduction in risk was observed for women who reported such activity at ages 12-21 years (odds ratio = 0.47, 95% confidence interval: 0.18, 2.23). Activities of lower intensity, frequency, and duration were not associated with a woman's risk of endometrioma.

Adolescent↗

PubMed2003

Behavioral problems among children whose mothers are abused by an intimate partner.

OBJECTIVES: To determine the association between children's exposure to maternal intimate partner violence (IPV) and behavior problems as measured by the parent report version of the Child Behavior Checklist (CBCL). METHODS: The study population was comprised of 167 2- to 17-year-old children of Seattle women with police-reported or court-reported intimate partner abuse. The CBCL normative population served as the comparison group. Risk of behavior problems was calculated among the exposed children, in the presence and absence of a history of reported child maltreatment, relative to the normative population. Multiple logistic regression served as the primary method of analysis. RESULTS: Children exposed to maternal IPV were more likely to have borderline to clinical level scores on externalizing (i.e., aggressive, delinquent) behavior (RR=1.6, 95% CI: 1.2, 2.1) and total behavioral problems (RR=1.4, 95% CI: 1.1, 1.9) compared to the CBCL normative sample after adjusting for age and sex. Children who were exposed to maternal IPV and were victims of child maltreatment were more likely to receive borderline to clinical level scores on internalizing (i.e., anxious, depressed) behaviors (RR=2.6, 95% CI: 1.5, 3.6), externalizing (i.e., aggressive, delinquent) behaviors (RR=3.0, 95% CI: 1.9, 4.0) and total behavioral problems (RR=2.1, 95% CI: 1.2, 3.2) compared to the CBCL normative sample after adjusting for age and sex. CONCLUSIONS: Exposure to maternal IPV is significantly associated with child behavioral problems both in the presence and absence of co-occurring child maltreatment. Appropriate attention to the mental health of children living in households with IPV is needed.

Adolescent↗

PubMed2003

Oral contraceptives, tubal sterilization, and functional ovarian cyst risk.

OBJECTIVE: To determine whether current contraceptive method affects functional ovarian cyst risk, with emphasis on oral contraceptives (OCs) and tubal sterilization. METHODS: We conducted a case-control study of 18-39-year-old health maintenance organization enrollees with a functional ovarian cyst diagnosed between January 1, and June 30, 1994, and age-matched female controls randomly selected from enrollment files. In-person interviews as well as medical and pharmacy records were obtained for 78% of cases and 82% of controls; these analyses were based on 392 cases and 623 controls. Odds ratios (ORs) calculated with unconditional logistic regression were used to estimate the risk of a functional ovarian cyst diagnosis associated with current contraceptive method. RESULTS: In multivariable analyses adjusting for age, education, number of live births, and reference year, the overall OR was 0.72 (95% confidence interval [CI] 0.53, 0.99) for current OC use, compared with use of nonsurgical nonhormonal contraception or no contraception. The risk associated with use of 35 microg ethinyl estradiol monophasic OCs (OR 0.69; 95% CI 0.44, 1.10) was slightly lower than that associated with less than 35 microg ethinyl estradiol monophasic (OR 0.79; 95% CI 0.43, 1.47) or multiphasic OCs (OR 0.76; 95% CI 0.49, 1.19). Women with tubal sterilization had a substantially increased risk of a functional ovarian cyst diagnosis (OR 1.70; 95% CI 1.05, 2.75) compared with women using nonhormonal or no contraception. CONCLUSION: Our findings suggest that low-dose OC use has little or no effect on functional ovarian cyst likelihood. The increased risks we found associated with tubal sterilization merit further investigation.

Adolescent↗

PubMed2003

Impact of police-reported intimate partner violence during pregnancy on birth outcomes.

OBJECTIVE: To examine the relationship of police-reported intimate partner violence during pregnancy and adverse birth outcomes. METHODS: We conducted a population-based, retrospective, cohort study in Seattle, Washington, using Seattle police data and Washington State birth certificate files from January 1995 through September 1999. Exposed subjects were women with an intimate partner violence incident reported to police during pregnancy and who subsequently had a singleton live birth or fetal death registered in the state of Washington. Unexposed subjects were randomly selected Seattle residents with a singleton live birth or fetal death in the same time period and who did not report an incident. The main outcome measures were low birth weight (LBW less than 2500 g), very LBW (VLBW less than 1500 g), preterm birth (20-36 weeks' gestation), very preterm birth (20-31 weeks), and neonatal death (before discharge). RESULTS: Women reporting any partner violence during pregnancy were significantly more likely to have a LBW infant (adjusted odds ratio [aOR] 1.70; 95% confidence interval [CI] 1.20, 2.40), a VLBW infant (aOR 2.54; 95% CI 1.32, 4.91), a preterm birth (aOR 1.61; 95% CI 1.14, 2.28), a very preterm birth (aOR 3.71; 95% CI 1.80, 7.63), and a neonatal death (aOR 3.49; 95% CI 1.43, 8.50). CONCLUSION: Police-reported partner violence during pregnancy is significantly associated with an increased risk of adverse birth outcomes. There is a critical need to identify pregnancy among women with reported incidents and to provide women health and social service information and referrals, particularly referrals to high-risk pregnancy programs.

Adolescent↗

PubMed2003

Do protection orders affect the likelihood of future partner violence and injury?

BACKGROUND: Approximately 20% of U.S. women who experience intimate partner violence (IPV) annually obtain a civil protection order (CPO). The effect of these orders on future abuse has been estimated in only a few studies, with mixed results. The objective of this study was to assess the effect of a CPO on the risk of future self-reported IPV and injury. METHODS: In this prospective cohort study of 448 adult female Seattle WA residents with IPV between October 1997 and December 1998, interviews were conducted at baseline, 5 months, and 9 months after the index incident. Odds ratios (ORs) estimated risks of contact; unwelcome calls or visits; threats; weapon threats; psychological, sexual, or physical abuse or injury; and abuse-related medical care among women who obtained a CPO after the index incident, compared with those who did not. RESULTS: Women who obtained a CPO following the index IPV incident had significantly decreased risk of contact by the abuser (OR=0.4); weapon threats (OR=0.03); injury (OR=0.3); and abuse-related medical care (OR=0.2) between the first and second follow-up interviews. Stronger decreases in risk were seen among women who had maintained the CPO throughout follow-up, which were significant for contact by the abuser (OR=0.2); weapon threats (OR=0.02); psychological abuse (OR=0.4); sexual abuse (OR=0.2); physical abuse (OR=0.3); injury (OR=0.1); and abuse-related medical care (OR=0.1) between first and second follow-up interviews. CONCLUSIONS: CPOs are associated with decreased likelihood of subsequent physical and nonphysical IPV.

Adult↗

PubMed2003

Intimate partner violence and adverse pregnancy outcomes: a population-based study.

OBJECTIVES: The purpose of this study was to measure the prevalence of exposure to intimate partner violence during pregnancy and to determine whether such exposure is associated with adverse pregnancy outcomes. STUDY DESIGN: We measured the prevalence of exposure to intimate partner violence and fear of a partner during pregnancy among 4750 residents of Vancouver, British Columbia, who gave birth between January 1999 and December 2000. We undertook a multivariate analysis to examine the associations with second- or third-trimester hemorrhage, preterm labor and delivery, intrauterine growth restriction, and perinatal death. RESULTS: We report a prevalence rate of 1.2% for exposure to physical violence by an intimate partner during pregnancy and 1.5% for fear of a partner. Physical violence was associated with an increased risk of antepartum hemorrhage (adjusted odds ratio [OR]: 3.79, 95% CI 1.38-10.40), intrauterine growth restriction (OR: 3.06, 95% CI 1.02-9.14), and perinatal death (OR: 8.06, 95% CI 1.42-45.63). Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse pregnancy outcomes. CONCLUSION: Our study confirms prior work reporting an association of physical abuse during pregnancy with intrauterine growth retardation and, in addition, reports an association with antepartum hemorrhage and perinatal death.

Fear↗

PubMed2003

Contextualizing depression and physical functioning in battered women: adding vulnerability and resources to the analysis.

This investigation examined the relationships between physical, psychological, and sexual abuse along with vulnerability appraisals, positive and negative social relations, and socioeconomic resources on battered women's depression symptomatology and physical functioning. Women were recruited following an incident of partner violence that resulted in a police-report or the filing of a protection order. Participants were surveyed using a standardized questionnaire. Bivariate correlations and multiple regressions were used to examine the relationships between predictors as well as the cumulative and unique contributions of each variable set in explaining depression and physical functioning. Findings indicate that vulnerability appraisals, social relations, and socioeconomic resources significantly explain women's depression and physical functioning over and above the unique effect of specific types of partner violence. Given that women's physical and mental health are important aspects of assisting women with safety planning and violence cessation strategies, implications for assessment and interventions for battered women are discussed.

Adaptation, Psychological↗

PubMed2003

Resolution of depression among victims of intimate partner violence: is cessation of violence enough?

The objective of this article is to assess the effect of abuse cessation on depressive symptoms among women abused by a male intimate partner. This prospective cohort study of Seattle women with a history of intimate partner violence (IPV) who were classified by history of abuse and abuse status at 3 month, 9 month, and 2 year follow-up interviews. Relative risks (RR) were calculated using generalized estimating equations. Among subjects with a history of psychological abuse only, cessation of abuse was associated with a nonsignificant reduction in the likelihood of depression compared to subjects whose abuse continued (aRR = 0.88; 95%CI: 0.75,1.03). Among subjects with a history of physical/sexual abuse and psychological abuse, cessation of physical/sexual abuse only was associated with a 27% decline, and cessation of both types of abuse was associated with a 35% decline in the likelihood of depression (aRR = 0.73, 95%CI: 0.63,0.86; and aRR = 0.65; 95%CI: 0.55,0.76; respectively). Cessation of abuse among victims of IPV is associated with a decreased prevalence of depression.

Adolescent↗

PubMed2002

Civil protection orders and risk of subsequent police-reported violence.

CONTEXT: Approximately 1.5 million US women experience intimate partner violence annually. Approximately 20% of these women obtain civil protection orders, but the effectiveness of such orders in preventing future violence is unclear. OBJECTIVE: To assess associations between obtaining a protection order and risk of subsequent police-reported intimate partner violence. DESIGN, SETTING, AND SUBJECTS: Retrospective cohort study of 2691 adult female residents of Seattle, Wash, with an incident of male intimate partner violence reported to the Seattle Police Department between August 1, 1998, and December 31, 1999. MAIN OUTCOME MEASURE: Relative risk (RR) of police-reported physical and psychological abuse in the 12 months following the index incident according to protection order status (temporary protection order, usually in effect for 2 weeks; permanent protection order, usually in effect for 12 months; or no protection order). RESULTS: Overall rates of police-reported physical and psychological abuse in the 12 months of follow-up were 13.5 per 100 person-years and 12.3 per 100 person-years, respectively. After controlling for cohabitation at time of index incident and index incident offense type, women with temporary protection orders in effect were more likely than women without protection orders to be psychologically abused (RR in the first 6 months after the index incident, 4.0; 95% confidence interval [CI], 2.2-7.2; RR in the entire 12 months after the index incident, 4.9; 95% CI, 2.8-8.6), while women with permanent protection orders in effect were less likely than those without orders to be physically abused (RR in the first 6 months, 0.4; 95% CI, 0.1-1.1; RR in the entire 12 months, 0.2; 95% CI, 0.1-0.8). CONCLUSIONS: Permanent, but not temporary, protection orders are associated with a significant decrease in risk of police-reported violence against women by their male intimate partners.

Adult↗

PubMed2002

Academic and school health issues among children exposed to maternal intimate partner abuse.

OBJECTIVE: To determine the association between children's exposure to maternal intimate partner violence (IPV) and academic problems and school health concerns. DESIGN: The study population consisted of 153 children aged 5 to 16 years who attended public school and whose mothers experienced police- or court-reported IPV. The comparison group consisted of public school peers of the exposed children. Generalized linear modeling using a binomial distribution and log-link function served as the primary method of analysis. SETTING: Urban public school district. MAIN OUTCOME MEASURES: The occurrence of academic problems and type-specific school nurse visits during the 1-year study period. RESULTS: Children whose mothers experienced IPV were more likely to be suspended from school (relative risk [RR], 1.8; 95% confidence interval [CI], 1.2-1.7) and to have had frequent non-suspension-related absences (RR, 1.6; 95% CI, 1.0-2.3) than comparison children after adjusting for relevant confounders. Intimate partner violence-exposed children were more likely to have a school nurse visit for social or emotional complaints (RR, 2.2; 95% CI, 1.3-3.9), a visit that resulted in being sent home from school (RR, 1.6; 95% CI, 1.1-2.3), or a visit that led to referral to the school speech pathologist (RR, 7.5; 95% CI, 1.9-29.6) relative to comparison schoolchildren after adjusting for relevant confounders. CONCLUSIONS: Children's exposure to maternal IPV is significantly associated with the occurrence of academic problems and school health concerns. Describing the increased risk of the academic and health problems exhibited by IPV-exposed children relative to nonexposed children offers the possibility of improving the likelihood that clinicians will identify the woman who experienced abuse and her children, and promote referral to appropriate resources.

Adolescent↗

PubMed2002

Talipes equinovarus and maternal smoking: a population-based case-control study in Washington state.

BACKGROUND: Talipes equinovarus (TEV), also called congenital idiopathic clubfoot, true clubfoot and common clubfoot, is one of the most common major birth defects. Its correction is often difficult and expensive. Its etiology is poorly understood and few analytic epidemiological studies have been devoted to exploring specific risk factors for TEV. METHODS: Our population-based study consists of 239 documented cases of idiopathic TEV obtained from hospital and outpatient sources and 365 controls identified via random digit dialing from five Western Washington counties. Structured maternal interviews were conducted by trained interviewers and multiple logistic regression used to evaluate associations between maternal smoking and birth of a child with TEV. RESULTS: Our study shows strong associations between maternal smoking and idiopathic TEV. Case mothers were more likely to have smoked during pregnancy (OR = 2.2; 95% CI = 1.5, 3.3). Increased TEV risk was seen with increased smoking and estimates ranged from 1.5 for the lightest smokers to 3.9 for the heaviest smokers. Gender specific differences in risk were also noted with risk estimates of 1.8 (95% CI = 1.2, 3.0) for boys whose mothers smoked during pregnancy and 2.8 (95% CI = 1.4, 5.4) for girls. Trends for increased risk with higher numbers of cigarettes were noted for both genders. For isolated TEV, the overall odds ratio (OR) for smoking was 2.4 (95% CI = 1.6, 3.6) with a range from 1.4-4.6. No confounders were noted. CONCLUSIONS: As postulated, maternal smoking during pregnancy appears to increase the risk of having a child with idiopathic clubfoot and the number of cigarettes smoked influence that risk. Further delineation of dose-response is warranted as are continued efforts to decrease maternal smoking during pregnancy.

Adult↗

PubMed2002

Body weight and risk of oral contraceptive failure.

OBJECTIVE: To examine the hypothesis that higher body weight increases the risk of oral contraceptive (OC) failure. METHODS: We conducted a retrospective cohort analysis of data from 755 randomly selected female enrollees of Group Health Cooperative of Puget Sound who completed an in-person interview and dietary questionnaire between 1990 and 1994 as control subjects for a case-control study of ovarian cysts. Among the 618 women who were OC ever-users, we used Cox proportional hazards regression models to estimate the relative risk (RR) of pregnancy while using OCs associated with body weight quartile. RESULTS: During 2822 person-years of OC use, 106 confirmed pregnancies occurred (3.8 per 100 person-years of exposure). After controlling for parity, women in the highest body weight quartile (70.5 kg or more) had a significantly increased risk of OC failure (RR 1.6, 95% confidence interval [CI] 1.1, 2.4) compared with women of lower weight. Higher elevations of risk associated with the highest weight quartile were seen among very low-dose OC users (RR 4.5, 95% CI 1.4, 14.4) and low-dose OC users (RR 2.6, 95% CI 1.2, 5.9), controlling for parity, race, religion, and menstrual cycle regularity. CONCLUSION: Our findings suggest that body habitus may affect metabolism sufficiently to compromise contraceptive effectiveness. Consideration of a woman's weight may be an important element of OC prescription.

Absorption↗

PubMed2002

Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery.

OBJECTIVE: We examined the associations between psychiatric and substance use diagnoses and low birth weight (LBW), very low birth weight (VLBW), and preterm delivery among all women delivering in California hospitals during 1995. METHODS: This population-based retrospective cohort analysis used linked hospital discharge and birth certificate data for 521,490 deliveries. Logistic regression analyses were conducted to assess the associations between maternal psychiatric and substance use hospital discharge diagnoses and LBW, VLBW, and preterm delivery while controlling for maternal demographic and medical characteristics. RESULTS: Women with psychiatric diagnoses had a significantly higher risk of LBW (adjusted odds ratio [OR] 2.0; 95% confidence interval [CI] 1.7, 2.3), VLBW (OR 2.9; 95% CI 2.1, 3.9), and preterm delivery (OR 1.6; 95% CI 1.4, 1.9) compared with women without those diagnoses. Substance use diagnoses were also associated with higher risk of LBW (OR 3.7; 95% CI 3.4, 4.0), VLBW (OR 2.8; 95% CI 2.3, 3.3), and preterm delivery (OR 2.4; 95% CI 2.3, 2.6). CONCLUSION: Maternal psychiatric and substance use diagnoses were independently associated with low birth weight and preterm delivery in the population of women delivering in California in 1995. Identifying pregnant women with current psychiatric disorders and increased monitoring for preterm and low birth weight delivery among this population may be indicated.

Adolescent↗

PubMed2002

Introducing domestic violence assessment in a postpartum clinical setting.

OBJECTIVES: Attempts to introduce assessment for exposure to domestic violence in health care settings have met with limited success, in spite of widespread knowledge of the prevalence of spousal abuse and its implications for women's health. We assessed the utility of Rogers' model of institutional change for the implementation of a universal screening program for domestic violence in postpartum clinical settings. METHODS: We adapted Rogers' innovation-diffusion model to develop and implement a protocol for domestic violence assessment among 300 nurses working in two hospitals that together provide obstetrical care to the City of Vancouver, British Columbia, Canada. Our education sessions introduced new knowledge and addressed attitudes and beliefs. They were followed by "hands-on" demonstration and supervision of assessments. Our "Let's Talk" visual aids program added visibility to our initiative and provided cues as to how to undertake screening and response. Screening rates were monitored along with a process evaluation based on anecdotal reporting by nursing staff. RESULTS: Following the initiation of educational sessions and supervision of assessment, the screening rate was 42%. Within 6 months, the screening rate had climbed to 60% and was sustained at that level. Major barriers to screening include difficulty in finding the opportunity to screen in privacy and overcoming language barriers. CONCLUSIONS: Application of Rogers' principles of diffusion of innovation in the implementation of a universal program for a domestic violence in two obstetrical care settings resulted in a screening rate of 60% which has been sustained for the first 18 months of the program.

British Columbia↗

PubMed2002

Maternal and infant outcomes after injury during pregnancy in Washington State from 1989 to 1997.

BACKGROUND: Few population-based studies have assessed maternal and infant outcomes after nonfatal injuries occurring during pregnancy. METHODS: We performed a retrospective cohort study to assess outcomes of pregnant women hospitalized for injury in Washington State from 1989 to 1997. We used the Injury Severity Score (ISS) to classify 266 nonseverely injured (ISS of 1-8) and 28 severely injured (ISS > 9) pregnant women who delivered at their injury hospitalization. We compared these women to 12,578 pregnant women randomly selected from Washington State birth and fetal death certificates who had no injury hospitalization during pregnancy. RESULTS: Nonseverely injured pregnant women were at increased risk of placental abruption and their infants were at increased risk of hypoxia and fetal death. Severely injured pregnant women were at a 17-fold (95% confidence interval, 6.2-46.8) increased risk of placental abruption and their infants were at increased risk of prematurity, low birth weight, and fetal distress, and a 30-fold (95% confidence interval, 9.4-97.1) increased risk of fetal death. CONCLUSION: Nonsevere as well as severe injuries resulting in hospitalization during pregnancy can result in adverse maternal and infant outcomes.

Adult↗

PubMed2002

The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death.

BACKGROUND: The Injury Severity Score (ISS) is the national standard for injury severity assessment but has been rarely validated in the pregnant population. METHODS: We evaluated 294 pregnant women who were hospitalized for injury in Washington State from 1989 to 1997. We used ICDMAP-90 computer software to assign an ISS to all women. We identified injured pregnant women who experienced a placental abruption or a fetal death using the Washington State delivery hospitalization data and the birth certificate or fetal death records. We evaluated the accuracy of the ISS in predicting these adverse outcomes using sensitivity analysis. RESULTS: We found that the ISS was not accurate in predicting placental abruption and fetal death. We also found that relatively minor injuries were associated with adverse pregnancy outcomes. CONCLUSION: A more comprehensive injury assessment tool is needed to accurately predict adverse outcomes in the pregnant trauma population.

Abruptio Placentae↗