Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas.

BACKGROUND: Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city. METHODS: We conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance. RESULTS: Overall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval. CONCLUSIONS: Compared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (≤ 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.

Analysis of count data in the setting of cervical cancer detection.

Women with an abnormal Pap smear are often referred to colposcopy, a procedure during which endocervical curettage (ECC) may be performed. ECC is a scraping of the endocervical canal lining. Our goal was to compare the performance of a naïve Poisson (NP) regression model with that of a zero-inflated Poisson (ZIP) model when identifying predictors of the number of distress/pain vocalizations made by women undergoing ECC. Data on women seen in the colposcopy clinic at a medical school in El Paso, Texas, were analyzed. The outcome was the number of pain vocalizations made by the patient during ECC. Six dichotomous predictors were evaluated. Initially, NP regression was used to model the data. A high proportion of patients did not make any vocalizations, and hence a ZIP model was also fit and relative rates (RRs) and 95% CIs were calculated. AIC was used to identify the best model (NP or ZIP). Of the 210 women, 154 (73.3%) had a value of 0 for the number of ECC vocalizations. NP identified three statistically significant predictors (language preference of the subject, sexual abuse history and length of the colposcopy), while ZIP identified one: history of sexual abuse (yes vs no; adjusted RR=2.70, 95% CI 1.47 to 4.97). ZIP was preferred over NP. ZIP performed better than NP regression. Clinicians and epidemiologists should consider using the ZIP model (or the zero-inflated negative binomial model) for zero-inflated count data.

Barriers to seeking care for urinary incontinence in Mexican American women.

INTRODUCTION AND HYPOTHESIS: The majority of epidemiologic studies of urinary incontinence (UI) have been conducted in non-Hispanic populations. We conducted a case-control study to identify factors associated with delayed care-seeking behavior in adult Mexican American women with UI. METHODS: Cases were women with UI who sought care >2 years after the onset of symptoms (delayed care group). Controls were women with UI who sought care ≤2 years after the onset of symptoms. Participants were women who self-identified as Mexican American, Hispanic, Chicana or Latina, and were 18 years of age or older. RESULTS: A total of 209 records (107 cases and 102 controls) were available for analysis. Of the women in the delayed care and control groups, 32% and 23%, respectively, were ≥66 years of age (P = 0.12). Women in the delayed care group were less likely than those in the control group to report that the following item was a barrier (adjusted OR = 0.54, P = 0.06): "The wait is too long to the appointment". Women in the delayed care group were twice as likely as those in the control group (adjusted OR = 2.17, P = 0.03) to agree that lack of interest on the part of the health-care practitioner and staff was a barrier. In addition to standardized responses, open-ended responses were solicited and the most frequent barrier was lack of knowledge. CONCLUSIONS: Among Mexican American women with UI, those who delayed seeking care for their UI were more likely than those who sought care promptly to cite lack of interest on the part of a health-care provider as a barrier to seeking care in a timely fashion.

Is maternal colonization with group B streptococci a risk factor for preeclampsia?

OBJECTIVE: To explore the association between maternal rectovaginal colonization with group B Streptococcus (GBS) and the outcome of preeclampsia, and to identify other factors such as maternal chocolate consumption that may be associated with preeclampsia on the Texas-Mexico border. STUDY DESIGN: A case-control study was conducted among 330 women who delivered at a teaching hospital in El Paso, Texas, during the time period April 2010 to April 2012. Preeclamptic cases (n = 165) and controls free of preeclampsia (n = 165) were matched by gestational age and date of delivery. Conditional logistic regression (with multiple imputation for missing data) was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) that were adjusted for maternal age and other factors. RESULTS: Cases (94.6%) and controls (97.0%) were predominantly Hispanic. GBS colonization was not associated with preeclampsia: adjusted OR = 1.73 (95% CI 0.63-4.74, p = 0.29). Maternal consumption of chocolate desserts once daily or more frequently as compared to < 7 times weekly was associated with a 76% reduction in the odds of preeclampsia: adjusted OR = 0.24 (95% CI 0.09-0.63, p = 0.004). CONCLUSION: Our study did not confirm the protective association between GBS and preeclampsia that was found in 2 existing state hospital datasets. Chocolate consumption during pregnancy was inversely associated with preeclampsia.