Bernard Harlow - Academia.edu (original) (raw)
Papers by Bernard Harlow
Annals of epidemiology, Jan 20, 2015
Epidemiologists often seek a representative sample of particular persons from geographically boun... more Epidemiologists often seek a representative sample of particular persons from geographically bounded areas. However, it has become increasingly difficult to identify a sample frame that truly represents the underlying target population. We assessed the degree to which a clinic-based sample represents a target community. Our sample frame is from a large health care provider from the Minneapolis-Saint Paul, Minnesota, metropolitan area. We used U.S. Census data to examine the sociodemographic and geospatial distribution of the sampling frame and among those who did and did not respond. Our study's overall response rate was 57%. The most impoverished areas of the target population were under-represented in our sample frame, but this under-representation was similar for both respondents and nonrespondents. In addition, our sampled population was slightly older compared to the target population. Using ecological-level census-derived markers of sociodemographic characteristics, member...
Current Diabetes Reports, 2010
Both depression and diabetes are common in the perinatal period and result in serious consequence... more Both depression and diabetes are common in the perinatal period and result in serious consequences for mother and fetus. Although the association between depression and diabetes is well established, few studies have examined the association between these disorders during the perinatal period, when the etiology of depression and diabetes may differ from other periods over the life course. This article reviews the four most relevant epidemiologic papers that examined the association between depression and diabetes in the perinatal period and makes recommendations for future studies about how best to examine the association between these disorders during the perinatal period.
Psychology, Health & Medicine, 2012
Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these... more Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these pain conditions are associated with feeling invalidated by others and feeling socially isolated. It is unclear, however, how the presence of additional pain co-morbidities are associated with the psychosocial wellbeing of women with vulvodynia. We used data from a survey administered by the National Vulvodynia Association. Women reported clinician-diagnosed vulvodynia, presence of co-morbid pain, and how often they felt that they felt no one believed their pain existed (invalidated) and isolated. Analyses determined prevalence of feeling invalidated or isolated, and the difference in prevalence when co-morbidities existed. Forty-five percent of these 1847 women with vulvodynia reported having at least one of the following five chronic pain conditions, chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Adjusted baseline prevalence among all women of feeling invalidated was 9% and of feeling isolated was 14%. Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing. However, the temporality of the association could not be elucidated and therefore we cannot conclude that these pain conditions cause poor psychosocial wellbeing. Despite this, future studies should explore the utility of promoting validation of women's pain conditions and reducing social isolation for women with chronic pain.
Maturitas, 2013
Perimenopause significantly impacts women&amp... more Perimenopause significantly impacts women's health, but is under-researched due to challenges in assessing perimenopause status. Using CARDIA data, we compared the validity of six approaches for classifying perimenopause status in order to better understand the performance of classification techniques which can be applied to general cohort data. Specifically, we examined the validity of a self-reported question concerning changes in menstrual cycle length and two full prediction models using all available data concerning menstrual cycles as potential indicators of perimenopause. The validity of these three novel methods of perimenopause classification were compared to three previously established classification methods. For each method, women were classified as pre- or peri-menopausal at Year 15 of follow-up (ages 32-46). Year 15 perimenopause status was then used to predict Year 20 post-menopausal status (yes/no) to estimate measures of validity and area under the curve. The validity of the methods varied greatly, with four having an area under the curve greater than 0.8. When designing studies, researchers should collect the data required to construct a prediction model for classifying perimenopause status that includes age, smoking status, vasomotor symptoms, and cycle irregularities as predictors. The inclusion of additional data regarding menstrual cycles can be used to construct a full prediction model which may offer improved validity. Valid classification methods that use readily available data are needed to improve the scientific accuracy of research regarding perimenopause, promote research on this topic, and inform clinical practices.
Journal of Affective Disorders, 2002
Background: Consistent data on the prevalence and predictors of premenstrual dysphoric disorder (... more Background: Consistent data on the prevalence and predictors of premenstrual dysphoric disorder (PMDD) in the general population are lacking. Methods: Premenstrual symptoms of 4164 women (aged 36-44 years) were retrospectively assessed by the Moos Premenstrual Inventory. From this original sample, 976 subjects were further interviewed at which time demographic and lifestyle characteristics, gynecologic history, and medical conditions were examined. The Structured Clinical Interview for DSM-IV Axis I disorders (SCID) was used to assess past and current psychiatric morbidity. Additionally, 513 of these women completed a prospective evaluation of premenstrual symptoms by using the Daily Rating of Severity of Problems Form (DRSP). Results: The diagnosis of PMDD was confirmed in 33 of 513 women (6.4%) who completed the prospective evaluation with daily records. Fourteen subjects (2.7%) met criteria for PMDD without a previous history of depression. PMDD was associated with lower education (odds ratio [OR] 5 2.3, confidence interval [CI] 5 1.1-4.9), a history of major depression (OR 5 3.6, CI 5 1.7-7.4), and current cigarette smoking (OR 5 4.1, CI 5 1.5-11.1). In addition, women not working outside the home were significantly less likely to meet criteria for PMDD (OR 5 0.2, CI 5 0.1-0.9). Limitations: Only 513 of 976 women agreed to have their symptoms documented prospectively. Symptoms were assessed over the course of one menstrual cycle. Conclusions: This study indicates a significant prevalence of PMDD in a large community-based sample. Given the associated impairment in social and occupational functioning seen in PMDD, these prevalence data provide a strong rationale for enhanced recognition and treatment of the disorder.
American Journal of Obstetrics and Gynecology, 2014
Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine the... more Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine their association with a localized vulvodynia (vestibulodynia) diagnosis in women from the general population. Methods: A sample of 12,435 women completed a self-administered screening questionnaire for the presence of specific types and characteristics of vulvar pain lasting 3 months or longer. Sensitivity, specificity, and predictive values were calculated for each cross-classification of vulvar pain type and characteristic, using as the gold standard 121 subjects with a clinically confirmed vestibulodynia diagnosis. Results: Relative to women with clinically confirmed vestibulodynia, 83% reported >10 episodes of pain on contact at the time of tampon insertion, intercourse, or pelvic examination, and 83% also reported pain on contact that limited or prevented sexual intercourse. These strong associations with a vestibulodynia diagnosis were not observed with respect to women who reported vulvar pain symptoms of burning or knifelike pain, or vulvar pain characteristics of continuous versus intermittent pain, or provoked versus spontaneous pain. Conclusions: Our findings suggest that a small number of symptoms may be suitable for identifying a large proportion of women suffering from vestibulodynia which may be ideal for the development of an effective screening test in the future. However, we also recognize that a large proportion of women experiencing vulvar pain symptoms will not meet the diagnostic criteria for vestibulodynia. Thus, implementing such a screening procedure as part of a routine examination or testing would require a subsequent pelvic examination to confirm a vestibulodynia diagnosis and to rule out other known explanations for vulvar pain.
Pain research and treatment, 2014
Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy;... more Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0-10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was highe...
Annals of epidemiology, Jan 20, 2015
Epidemiologists often seek a representative sample of particular persons from geographically boun... more Epidemiologists often seek a representative sample of particular persons from geographically bounded areas. However, it has become increasingly difficult to identify a sample frame that truly represents the underlying target population. We assessed the degree to which a clinic-based sample represents a target community. Our sample frame is from a large health care provider from the Minneapolis-Saint Paul, Minnesota, metropolitan area. We used U.S. Census data to examine the sociodemographic and geospatial distribution of the sampling frame and among those who did and did not respond. Our study's overall response rate was 57%. The most impoverished areas of the target population were under-represented in our sample frame, but this under-representation was similar for both respondents and nonrespondents. In addition, our sampled population was slightly older compared to the target population. Using ecological-level census-derived markers of sociodemographic characteristics, member...
Current Diabetes Reports, 2010
Both depression and diabetes are common in the perinatal period and result in serious consequence... more Both depression and diabetes are common in the perinatal period and result in serious consequences for mother and fetus. Although the association between depression and diabetes is well established, few studies have examined the association between these disorders during the perinatal period, when the etiology of depression and diabetes may differ from other periods over the life course. This article reviews the four most relevant epidemiologic papers that examined the association between depression and diabetes in the perinatal period and makes recommendations for future studies about how best to examine the association between these disorders during the perinatal period.
Psychology, Health & Medicine, 2012
Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these... more Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these pain conditions are associated with feeling invalidated by others and feeling socially isolated. It is unclear, however, how the presence of additional pain co-morbidities are associated with the psychosocial wellbeing of women with vulvodynia. We used data from a survey administered by the National Vulvodynia Association. Women reported clinician-diagnosed vulvodynia, presence of co-morbid pain, and how often they felt that they felt no one believed their pain existed (invalidated) and isolated. Analyses determined prevalence of feeling invalidated or isolated, and the difference in prevalence when co-morbidities existed. Forty-five percent of these 1847 women with vulvodynia reported having at least one of the following five chronic pain conditions, chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Adjusted baseline prevalence among all women of feeling invalidated was 9% and of feeling isolated was 14%. Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing. However, the temporality of the association could not be elucidated and therefore we cannot conclude that these pain conditions cause poor psychosocial wellbeing. Despite this, future studies should explore the utility of promoting validation of women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s pain conditions and reducing social isolation for women with chronic pain.
Maturitas, 2013
Perimenopause significantly impacts women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more Perimenopause significantly impacts women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s health, but is under-researched due to challenges in assessing perimenopause status. Using CARDIA data, we compared the validity of six approaches for classifying perimenopause status in order to better understand the performance of classification techniques which can be applied to general cohort data. Specifically, we examined the validity of a self-reported question concerning changes in menstrual cycle length and two full prediction models using all available data concerning menstrual cycles as potential indicators of perimenopause. The validity of these three novel methods of perimenopause classification were compared to three previously established classification methods. For each method, women were classified as pre- or peri-menopausal at Year 15 of follow-up (ages 32-46). Year 15 perimenopause status was then used to predict Year 20 post-menopausal status (yes/no) to estimate measures of validity and area under the curve. The validity of the methods varied greatly, with four having an area under the curve greater than 0.8. When designing studies, researchers should collect the data required to construct a prediction model for classifying perimenopause status that includes age, smoking status, vasomotor symptoms, and cycle irregularities as predictors. The inclusion of additional data regarding menstrual cycles can be used to construct a full prediction model which may offer improved validity. Valid classification methods that use readily available data are needed to improve the scientific accuracy of research regarding perimenopause, promote research on this topic, and inform clinical practices.
Journal of Affective Disorders, 2002
Background: Consistent data on the prevalence and predictors of premenstrual dysphoric disorder (... more Background: Consistent data on the prevalence and predictors of premenstrual dysphoric disorder (PMDD) in the general population are lacking. Methods: Premenstrual symptoms of 4164 women (aged 36-44 years) were retrospectively assessed by the Moos Premenstrual Inventory. From this original sample, 976 subjects were further interviewed at which time demographic and lifestyle characteristics, gynecologic history, and medical conditions were examined. The Structured Clinical Interview for DSM-IV Axis I disorders (SCID) was used to assess past and current psychiatric morbidity. Additionally, 513 of these women completed a prospective evaluation of premenstrual symptoms by using the Daily Rating of Severity of Problems Form (DRSP). Results: The diagnosis of PMDD was confirmed in 33 of 513 women (6.4%) who completed the prospective evaluation with daily records. Fourteen subjects (2.7%) met criteria for PMDD without a previous history of depression. PMDD was associated with lower education (odds ratio [OR] 5 2.3, confidence interval [CI] 5 1.1-4.9), a history of major depression (OR 5 3.6, CI 5 1.7-7.4), and current cigarette smoking (OR 5 4.1, CI 5 1.5-11.1). In addition, women not working outside the home were significantly less likely to meet criteria for PMDD (OR 5 0.2, CI 5 0.1-0.9). Limitations: Only 513 of 976 women agreed to have their symptoms documented prospectively. Symptoms were assessed over the course of one menstrual cycle. Conclusions: This study indicates a significant prevalence of PMDD in a large community-based sample. Given the associated impairment in social and occupational functioning seen in PMDD, these prevalence data provide a strong rationale for enhanced recognition and treatment of the disorder.
American Journal of Obstetrics and Gynecology, 2014
Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine the... more Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine their association with a localized vulvodynia (vestibulodynia) diagnosis in women from the general population. Methods: A sample of 12,435 women completed a self-administered screening questionnaire for the presence of specific types and characteristics of vulvar pain lasting 3 months or longer. Sensitivity, specificity, and predictive values were calculated for each cross-classification of vulvar pain type and characteristic, using as the gold standard 121 subjects with a clinically confirmed vestibulodynia diagnosis. Results: Relative to women with clinically confirmed vestibulodynia, 83% reported >10 episodes of pain on contact at the time of tampon insertion, intercourse, or pelvic examination, and 83% also reported pain on contact that limited or prevented sexual intercourse. These strong associations with a vestibulodynia diagnosis were not observed with respect to women who reported vulvar pain symptoms of burning or knifelike pain, or vulvar pain characteristics of continuous versus intermittent pain, or provoked versus spontaneous pain. Conclusions: Our findings suggest that a small number of symptoms may be suitable for identifying a large proportion of women suffering from vestibulodynia which may be ideal for the development of an effective screening test in the future. However, we also recognize that a large proportion of women experiencing vulvar pain symptoms will not meet the diagnostic criteria for vestibulodynia. Thus, implementing such a screening procedure as part of a routine examination or testing would require a subsequent pelvic examination to confirm a vestibulodynia diagnosis and to rule out other known explanations for vulvar pain.
Pain research and treatment, 2014
Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy;... more Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0-10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was highe...