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The article presents a study of pharmacological treatment of Parkinson disease patients diagnosed with anxiety disorders at community-based neurology practices. It is noted that the anxiety disorders were diagnosed by geriatric psychiatry and movement disorder specialists. The results indicated that patients with comorbidities such as depression or motor impairment were much more likely to receive antianxiety medication than those experiencing anxiety alone.

Purpose: Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. The purpose of this study was to describe contraceptive use by diabetic and overweight/obese women compared with women without these conditions. Methods: Using cross-sectional data from the 11 states participating in the optional Family Planning Module of the Behavioral Risk Factor Surveillance System in 2000, we analyzed contraceptive use among 7,943 sexually active women of reproductive age (18–44) who were not trying to conceive. Using logistic regression techniques, we modeled the effect of diabetes and overweight/obesity on contraceptive nonuse, controlling for age, race/ethnicity, marital status, education, income, and health insurance coverage. Main Findings: Contraceptive nonuse was reported by 1,500 (18.9%) of the total sample, 31 (25.8%) diabetic women, 371 (20.0%) overweight women, and 385 (23.4%) obese women. In the multivariable model, obesity was significantly associated with contraceptive nonuse (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.16–1.55), but there were no significant differences in contraceptive nonuse for diabetic women (adjusted OR 1.23, 95% CI 0.80–1.87) or overweight women (adjusted OR 1.14, 95% CI 0.99–1.31). Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse. Conclusion: Among women with need for contraception, obese women were more likely to report contraceptive nonuse than normal weight women. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority. [Copyright &y& Elsevier]

Purpose: This study examines nonpregnant women’s beliefs about whether or not they can influence their future birth outcomes with respect to the baby’s health and factors associated with internal locus of control for birth outcomes. Perceived internal control of birth outcomes could be a predisposing factor for use of preconception care, which is recommended for all women of childbearing age by the Centers for Disease Control and Prevention. The overall hypothesis is that internal control of birth outcomes is a function of prior pregnancy experiences, current health status and stress levels, access to health care, and sociodemographics. Methods: Data are from the Central Pennsylvania Women’s Health Study random digit dial telephone survey of 2,002 women ages 18–45; the analytic sample is 614 nonpregnant women with current reproductive capacity who reported that they are considering a future pregnancy. Internal control of birth outcomes is measured using 1) a 4-item Internal Control of Birth Outcomes Scale, 2) a single-item measure of Preconceptional Control, and 3) a score reflecting high internal control on both of these measures. Findings: In multiple logistic regression analyses, internal control of birth outcomes is positively associated with older age (35–45 vs. 18–34 years), higher education (some college or more), marital status (currently married or living with a partner), and higher self-rated physical health status on the SF-12v2 (but not mental health status or psychosocial stress). Previous adverse pregnancy outcomes and current access to health care have no association with internal control for birth outcomes. Conclusion: Variables associated with internal control of birth outcomes among women contemplating a future pregnancy are primarily sociodemographic and physical health related. Educational and social marketing efforts to increase women’s use of preconception care may be particularly important for women who are likely to have lower internal control, including younger, less educated, unmarried, and less healthy women. [Copyright &y& Elsevier]

This study used population-based data to examine how health status and risks vary by reproductive life stage, with particular focus on the proximal risks for preterm birth and low birthweight (LBW) infants in preconceptional and interconceptional women. Data are from the Central Pennsylvania Women’s Health Study (CePAWHS), which included a telephone survey of a representative sample of 2,002 women ages 18–45 years residing in largely rural central Pennsylvania. Women were classified according to reproductive stage—preconceptional, interconceptional, and postconceptional—on the basis of pregnancy history and reproductive capacity. Multiple indicators of health status and health risks were examined by reproductive stage, stratified by age group (ages 18–34 and ages 35–45). Results show that many risk factors varied significantly by reproductive stage and by age group within reproductive stage. Preconceptional and interconceptional women exhibited several unhealthy behaviors (e.g., binge drinking, nutritional deficits, physical inactivity). Younger pre- and interconceptional women (ages 18–34) had more gynecologic infections, some less favorable health behaviors, and more psychosocial stress than older women (ages 35–45) in the same reproductive stages. Older preconceptional women were more likely to have chronic conditions (hypertension, high cholesterol) than younger preconceptional women. Results suggest how interventions could be tailored to women’s reproductive stages. [Copyright &y& Elsevier]

With the increasing number of treatment options for heart disease, decision-making requires profiles of risk for conventional cardiac surgery. Refinements in techniques and clinical practices seem to have reduced surgical risk. This study was performed to determine current risk factors. From July 1, 1990, to June 30, 1996, 1,036 consecutive patients underwent 1,042 heart operations using standard incisions and cardiopulmonary bypass with cardioplegia. Univariate and multivariate analyses using a logistic regression model were performed to determine factors significant for combined 30-day and hospital mortality. To determine if there were trends in the results and the risk factors, the last 500 consecutive cases in the series were analyzed separately. Overall, 30-day mortality was 17 of 1,042 (1.6%) and combined 30-day and hospital mortality was 27 of 1,042 (2.6%). Significant risk factors for combined 30-day and hospital mortality by multivariate analyses were: emergent/resuscitative status, preoperative dialysis, left ventricular ejection fraction < or = 30%, valve operation, and creatinine > or = 1.5 mg/dl. Comparison with baseline characteristics of the patients undergoing the last 500 consecutive operations to the earlier 542 operations in the study group showed that risk factors had a very similar profile for the 2 groups. The overall 30-day mortality for the last 500 consecutive operations was 5 of 500 (1.0%) and combined 30-day and hospital mortality was 8 of 500 (1.6%). The significant risk factors by multivariate analyses were reduced to left ventricular ejection fraction < or = 30% and creatinine > or = 1.5 mg/dl. These results indicate that modern techniques and clinical practices have mitigated well-recognized risk factors in conventional cardiac surgery and this trend is ongoing. [ABSTRACT FROM AUTHOR]

Both anxiety and depression are associated with lower self-perceived health status (HS) in persons with Parkinson's disease (PD). Given the high co-morbidity with depression and other non-motor symptoms, it is unclear whether anxiety disorders, in general, versus specific anxiety subtypes have an independent effect on HS in PD. To examine this question, comprehensive assessments of motor and non-motor symptoms from 249 subjects with idiopathic PD followed in three community-based movement disorders neurology practices were analyzed. HS was measured using the 8-item PD Questionnaire (PDQ-8). Psychiatric diagnoses were established by consensus using a panel of six psychiatrists with expertise in geriatric psychiatry and movement disorders. Stepwise multiple regression analyses were used, with the PDQ-8 score as the dependent variable, to identify independent predictors of HS among motor, psychiatric, and other non-motor variables. Among the anxiety disorders, only anxiety associated with motor fluctuations was an independent predictor of HS after accounting for co-morbid depression and other clinical features. In addition, depressive disorders were also an independent predictor of lower HS. Prevention or treatment of state-dependent anxiety may improve HS in persons with PD. [ABSTRACT FROM AUTHOR]

Objective: This study tests the hypothesis that vaginal douching among women of reproductive age is associated with exposure to intimate partner violence (IPV). Methods: The data source is a cross-sectional population-based sample of 2,002 women ages 18–45 in the Central Pennsylvania Women’s Health Study. The survey included measures of IPV, douching behavior, and relevant sociodemographic and health-related covariates. Findings: Six percent of the sample reported experiencing any type of IPV in the past year, and 23% reported douching in the past year. IPV is significantly associated with douching after controlling for sociodemographic and health-related covariates. This finding holds for women with and without current reproductive capacity. Conclusions: This is the first study to identify an association between vaginal douching and IPV. Because vaginal douching is a risk factor for sexually transmitted infections, bacterial vaginosis, and adverse pregnancy outcomes, the findings could have important implications for prevention. Further research is needed to identify the reasons why women who have been exposed to IPV are more likely to douche. [Copyright &y& Elsevier]

We performed one of the first systematic, population-based surveys of women in Amish culture. We used these data to examine health status and health risks in a representative sample of 288 Amish women ages 18–45 living in Lancaster County, Pennsylvania, in particular for risks associated with preterm and low birthweight infants, compared with a general population sample of 2,002 women in Central Pennsylvania. Compared with women in the general population, Amish women rated their physical health approximately at the same level, but reported less stress, fewer symptoms of depression, and had higher aggregate scores for mental health. Amish women reported low levels of intimate partner violence, high levels of social support, and they perceived low levels of unfair treatment owing to gender compared with the general population. Amish women also reported higher fertility, fewer low birthweight babies, but the same number of preterm births as the general population. The findings suggest that these outcomes may be due to higher levels of social support and better preconceptional behavior among Amish women. [Copyright &y& Elsevier]