bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Examination of Posttraumatic Stress Disorder (PTSD) Among Women Living With HIV (WLHIV) [15OP]
Authors: Ereme Keemi , Cardin Noa , McCaul Mary E. , Hutton Heidi E. 
Published: May 2017

INTRODUCTION:
The purpose of this study is to quantify the prevalence of PTSD in WLHIV in a high risk population. WLHIV have a prevalence of PTSD that is five time higher than in the general population. A diagnosis of PTSD in WLHIV is associated with poor antiretroviral treatment (ART) adherence, alcohol dependence, and negative health outcomes.

METHODS:
369 WLHIV were recruited from April 2006 to July 2010 from the Johns Hopkins HIV Clinic in Baltimore, MD. The Structured Clinical Interview for the DSM IV (SCID) was used to determine psychiatric diagnoses. All participants were categorized as having: no trauma, trauma, or PTSD. SCIDS were processed using double blind coding. We controlled for age, race, and illicit drug use.

RESULTS:
The majority of women experienced at least one trauma (82.3%). About half of the study sample met criteria for lifetime PTSD (43.1%) and 20% met criteria for current PTSD (19.9%). The most common traumas were rape (39.3%), physical assault (28.7%), and seeing violence (17.1%). One third of all rapes occurred before the age of 17 (34.7%). Molestation was also prominent in this sample with 10.8% reporting inappropriate sexual conduct under the age of 15. Major depressive disorder (MDD) was the most frequent co-morbid psychiatric diagnosis (lifetime MDD= 48.6%; current MDD=12.3%).

CONCLUSION:
Findings from this study demonstrate the need for PTSD and trauma screening in the integrative treatment of WLHIV for better health outcomes and the avoidance of behaviors that negatively impact health and longevity.
Adherence to Recommended Cervical Cancer Screening Based on Human Papillomavirus Vaccination Status [17OP]
Authors: Terk Daniel , Bonham Adrienne , Caveglia Sarah , Li Dongmei , Prast Brendan , Day Serena 
Published: May 2017

INTRODUCTION:
Human Papillomavirus (HPV) vaccination and routine cervical cytology both aim to prevent cervical cancer, however limited data exists for how vaccination affects patient behavior. The objective of this study is to examine if adherence to cervical cancer screening is affected by HPV vaccination.

METHODS:
Retrospective chart review was completed using billing data for cervical cytology and HPV vaccination from 2006 to 2010. These years were chosen because the HPV vaccine was released in 2006, and annual cervical cytology was recommended until 2010. Participants were included based on birth year, ensuring participants were old enough to obtain cervical cancer screening and young enough to receive the HPV vaccine. For inclusion two or more cervical cytology samples were needed, and vaccination status confirmed via billing data or chart review. Adherence to cervical cancer screening was assessed using a ratio of appropriately timed pap smears to all pap smears in the study period.

RESULTS:
2,397 charts were reviewed, 943 were included, of these 350 were vaccinated and 593 were unvaccinated. Adherence to screening was not affected by overall vaccination status. For the sub-group of women vaccinated mid-study, adherence was compared before and after vaccination and it was found that these women were significantly less likely to be adherent after vaccination (N=140, adjusted OR 0.19, CI 0.08 - 0.49).

CONCLUSION:
Comparing patterns of adherence to cervical cancer screening before and after vaccination shows that women were less likely to adhere to screening guidelines after HPV vaccination. This may represent an unintended consequence of the HPV vaccination program.
Increased Incidence of Endometrial Cancer Following the WHI: An Assessment of Risk Factors [18OP]
Authors: Constantine Ginger , Kessler Grant , Goldstein Steven R. 
Published: May 2017

INTRODUCTION:
The US incidence of Type I Endometrial cancer (EC) dramatically increased following the Women’s Health Initiative (WHI). While most cancer rates are decreasing, EC incidence increased from 2003 to 2013. EC rates were stable 1992 to 2002, prior to the announcement of WHI results. Potential etiologies for this increase are examined, including compounded hormone therapy use, which may not provide adequate endometrial protection.

METHODS:
EC incidence was obtained from Surveillance, Epidemiology, and End Result Program database from 1975 through 2013. The incidence of risk factors thought to be associated with EC, including age, obesity, race, number of menstrual cycles, gravidity and parity, metabolic syndromes (diabetes mellitus, PCOS), diet and exercise, and medications (hormone therapy including FDA-approved and unapproved [compounded] estrogens and progesterone, tamoxifen, and hormonal contraceptives) were evaluated and temporal trends were compared to EC trends.

RESULTS:
Endometrial cancer rates were constant from 1992 to 2002 in women 50-74 years of age, but have increased 2.5% annually with a 10% increase from 2006 to 2012 (test for trend 0.82). The greatest percentage of new cases was in women 55-64 years of age. Use of estrogen and progestin combinations have decreased while risk factors remained constant or decreased during the same time; however, obesity and compounded hormone use have increased coincident with the EC increase.

CONCLUSION:
EC increased post-2002 following the WHI, which may be multifactorial. The combination of an increase in obesity concurrent with decreasing exogenous progesterone and an increase in compounded hormone therapy is a public health issue requiring further evaluation.
Detection of Fetal Fraction During Noninvasive Prenatal Screening in HIV Infected Pregnant Women [21OP]
Authors: Aziz Aleha , Van Arsdale Anne , Klugman Susan , Wright Rodney L. 
Published: May 2017

INTRODUCTION:
To describe the reliability of Noninvasive Prenatal Screening (NIPS) in HIV infected (HIV+) pregnant women. NIPS analyzes cell free fetal DNA which circulates in maternal plasma but originates from the placenta and is quantitated as “fetal fraction” (FF). Sensitivity of NIPS increases with FF. NIPS reliability decreases in certain situations, such as obesity, due to decreased FF. Our study aims to determine if immune system alterations such as HIV or antiretroviral medications impact FF.

METHODS:
A 2:1 matched case-control study was carried out comparing 20 HIV+ pregnant women to 40 without HIV undergoing NIPS. Univariable and multivariable conditional logistic regression was fit to assess the association between demographic and clinical variables, and FF. Immune status and antiretroviral medications were evaluated in correlation with FF in HIV+ patients.

RESULTS:
HIV+ patients receiving integrase inhibitors (INI) had lower mean FF than those without INI - 6.18 (SD 3.68) versus 12.87 (SD 6.03) (p= 0.006). HIV + patients with an undetectable viral load (VL) at NIPS had a lower median FF than those with a detectable VL – 6.5 versus 11.8 (p=0.28). INI users had a significantly lower median VL at NIPS compared to non-INI users (p=0.02).

CONCLUSION:
Integrase inhibitors may play a role in reliability of NIPS in HIV+ women, as reflected by lower FF for patients taking INI. INI use is increasing due to their tolerability and potency, thereby potentially making our findings more significant. Further study is needed to fully elucidate the mechanism for INI and decreased FF.
Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study [23OP]
Authors: Liu Brian , Ordon Michael , Bodley Janet , Liu Grace , Kroft Jamie 
Published: May 2017

INTRODUCTION:
The Obstetrics program at the University of Toronto recently adopted a “night float” system, whereby residents work for a restricted number of hours overnight, but for four consecutive nights. The objective of this study was to determine if there has been a change in obstetrical patient outcomes following the introduction of restricted resident work hours.

METHODS:
We performed a population-based, retrospective cohort study using linked healthcare administrative databases in the province of Ontario, Canada. We included all obstetrical patients who underwent a delivery between July 2011 and June 2015 (two years prior to and after the implementation of resident duty hour restrictions), at three academic hospitals in Toronto, Canada. The primary outcome was a composite index of numerous maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage, maternal infection, fetal mortality, NICU admissions and surgical/obstetrical complications. Secondary outcomes included assessment of each of the components of the primary outcome examined separately. A generalized estimating equation model, clustered by institution, was utilized to assess for a difference post-intervention.

RESULTS:
The pre-intervention cohort consisted of 6,763 deliveries, and the post-intervention cohort 5,548 deliveries. There were no differences in baseline patient demographics between groups. After the implementation of the restrictions, no significant difference was seen in the primary outcome. However, an increased incidence of composite maternal surgical/obstetrical outcomes (OR 1.2298, P=.0016) and transfusion/postpartum hemorrhage (OR 1.2629, P=.0006) was found.

CONCLUSION:
Since the implementation of resident duty hour restrictions with the addition of consecutive night shifts, there was an increased incidence of surgical/obstetrical complications and transfusion/postpartum hemorrhage.
Effect of Increased Abdominal Circumference on Outcomes in Ultrasounds With Estimated Fetal Weight Greater Than 90% [2P]
Authors: Nicasio Erica , Leung Katherine , Moore Simas Tiffany A. , Belady Petra , Leftwich Heidi 
Published: May 2017

INTRODUCTION:
Macrosomia is associated with increased perinatal complications. Avoiding poor outcomes is an important goal of obstetric care, yet prenatal diagnosis of macrosomia remains a challenge. Third trimester ultrasound can predict large for gestational age (LGA), but the accuracy is unreliable. We sought to evaluate whether increased abdominal circumference (AC), predicts poor perinatal outcomes in pregnancies with estimate fetal weight (EFW) greater than 90%.

METHODS:
Retrospective cohort study of singleton pregnancies with EFW greater than 90% between 2006 and 2015. Exclusion criteria were lack of third trimester ultrasound, multiples and delivery outside of study institution. Primary outcome was cesarean delivery (CD). Secondary outcomes included 5 minute Apgar less than 7, NICU admission, LGA, shoulder dystocia, and composite of these 4. Demographics and outcomes were compared and adjusted for confounding factors.

RESULTS:
360 pregnancies met eligibility criteria. Pregnancies with fetal AC greater than 90% were more than twice as likely to be LGA and have a poor composite outcome in adjusted and unadjusted analysis. They were twice as likely to have a CD in unadjusted analysis only. However, those with AC greater than 95% had an almost 3 times increased risk of CD, which remained significant on adjusted analysis. They were also 3 to 4 fold more likely to have each of the poor obstetric outcomes and had a higher mean birth weight, all still significant in adjusted analysis.

CONCLUSION:
Our study shows that large AC, specifically AC greater than 95%, conveys the greatest risk for LGA, poor perinatal outcomes and CD in this cohort.
Effects of Ambient Light on the Biophysical Profile [6P]
Authors: Said Heather M. , Gupta Shweta , Wand Katy , Nguyen Thinh , Gross Gilad , Vricella Laura 
Published: May 2017

INTRODUCTION:
The objective is to assess if ambient light serves as a fetal stimulus to decrease the time needed to complete a biophysical profile (BPP).

METHODS:
This is a randomized controlled trial in which 190 women with singletons were randomized to ambient overhead light or no ambient light during BPP. The hypothesis is that the ambient light group would require less total time to complete the BPP. Secondary outcomes include BPP total and subcomponent scores, delivery and neonatal outcomes. Sonographers not involved with the study performed the BPPs and documented end times. The investigators were blinded to allocation group when analyzing the data.

RESULTS:
89 women were randomized to no ambient light and 101 to ambient light. Demographics were similar among the two groups with the exception of race (81% African American with ambient light; 66% African American without ambient light; p = 0.006). No difference was noted among indication for testing, gestational age, fetal position, placenta location, BPP start time or performance of Doppler during the assessment. There was no difference in the time needed to complete the BPP (10.3 + 8.4 minutes with ambient light; 11.1 + 9.2 minutes without ambient light; p=0.518) or in total BPP ultrasound score (7.78 + 0.74 with light; 7.84 + 0.54 without light; p=0.527). Gestational age at delivery, mode of delivery, neonatal weight, Apgars, cord pH and NICU admissions were not different between groups.

CONCLUSION:
There is no evidence ambient light serves as a fetal stimulus to decrease the time needed to complete a BPP.
Litigation in Obstetrical Sonography: Lessons Learned From 100 Consecutive Cases in the Public Library of Law [7P]
Authors: Malik Yusria , Jackson David 
Published: May 2017

INTRODUCTION:
Ultrasound is an essential technology in the practice of obstetrics and gynecology. Instruction in point-of-care obstetrical imaging is necessary for both resident and medical student curriculum. Few articles have examined case law in obstetrical sonography, with the last published case series reported in 2003.

METHODS:
A search was conducted in the US Public Library of Law for cases regarding obstetrical imaging. Of approximately 270 consecutive cases reviewed, one hundred were determined to be directly related to obstetrical imaging. These were extracted for location, year, causation, legal content, and resolution. Group comparisons for continuous variables were made using the Student's t test. Categorical variables were compared with Fisher's exact tests.

RESULTS:
Cases occurred from 1988 to 2016, with no measurable increase in frequency in the last decade. The most common states were New York, New Jersey and California. The most commonly represented ACOG districts were districts II, VI, IV, and VI. Four major categories of causation were elicited. Of missed diagnosis, 20% were due to inaccurate fetal biometry, 10% missed ectopic pregnancy, and the remainder were missed diagnoses of fetal abnormalities. Three out of six sonographer-related cases involved sexual assault. A subset of cases specifically related to wrongful life, wrongful birth, and wrongful death were brought in 20% of cases.

CONCLUSION:
Modern curriculum must stress meticulous fetal biometry, specific communication techniques, anatomic integrity, and diagnostic criteria to be met for ectopic gestations. The concepts of “wrongful life”, “wrongful birth” and “wrongful death” should be included in ongoing resident and student education.
Role of Genetic Sonogram After EIF Detection: A Cost-effectiveness Analysis [8P]
Authors: Hacker Francis , Griffin Emily , Shaffer Brian , Caughey Aaron B. 
Published: May 2017

INTRODUCTION:
Echogenic Intracardiac Foci (EIF) have been associated with trisomy 21 (t21) but in isolation, the positive likelihood ratio is low or nonsignificant. The 2014 Fetal Imaging Workshop recommends a completed targeted ultrasound (US) to identify other findings associated with t21. In light of US's low sensitivity, difficulty achieving adequate visualization due to maternal factors, and barrier to specialized care for rural populations, our goal was to evaluate outcomes and costs of this recommendation.

METHODS:
A decision-analytic model was constructed using TreeAge software and probabilities derived from the literature. The model compared targeted US with no further studies in women with both a negative quad screen and fetal EIF identified on screening US. This was stratified by maternal age. T21 Sensitivities for US and quad screen for women below and above 35 were assumed at 69%, 68%, and 91% and were examined in sensitivity analysis. Strategies were compared to generate an incremental cost-effectiveness ratio, with a threshold set to $100,000 per QALY.

RESULTS:
Compared to no follow up, a targeted US in women less than 35 with an EIF and negative quad resulted in cost savings of $26,725,134 per 10,000 pregnancies, a dominant strategy in cost-effectiveness. In women 35 or older, the targeted US strategy resulted in 55 additional QALYs with cost savings of $19,692,030 per 10,000 pregnancies, also a dominant strategy. This remained cost effective to a risk for t21 of 0.0006 in fetuses with EIF.

CONCLUSION:
Our results indicate it is cost-effective to offer a targeted US when an EIF is visualized.
Does the Fetus With Klinefelter Syndrome Have a Disproportionately Long Femur Length at the Anatomy Ultrasound? [9P]
Authors: Navathe Reshama , Orzechowski Kelly , Brent Elyssa , Patel Shivani , Ross Judith , Weiner Stuart 
Published: May 2017

INTRODUCTION:
To determine if children with a known diagnosis of Klinefelter Syndrome (KS) had a fetal anatomy ultrasound demonstrating long femur length (FL).

METHODS:
Case series of males with Klinefelter Syndrome (KS) receiving medical care in the pediatric endocrinology division at Thomas Jefferson University Hospital (TJUH) in 2014. We invited the mothers of these male children to participate in our study. Women who agreed to participate signed a medical records release form, which was sent to the delivering obstetrician requesting prenatal and delivery records. Records were reviewed for demographics, biometric measurements from the 18-22 week anatomy ultrasound, and delivery outcomes. Primary outcome was FL (calculated percentile based on Hadlock) from the anatomy ultrasound.

RESULTS:
In 2014, there were 100 males with KS being cared for at TJUH. 52 women agreed to participate in the study. We received medical records on 40 of these women (77%); of these, 30 records had the anatomy ultrasound report and delivery information. Mean gestational age at the time of the anatomy ultrasound 19.71 weeks (SD ± 1.29 weeks). 41% of women had an amniocentesis and a known prenatal diagnosis of KS. Femur length percentile was computed based on gestational age at the time of the ultrasound; mean FL percentile was 51.6% (SD ± 14.7%, range 8.7%-77.6%).

CONCLUSION:
The phenotype of males with Klinefelter Syndrome commonly results in tall stature, with a disproportionately long femur from early childhood. However, fetal femur length does not appear to predict an increased risk for Klinefelter Syndrome at the time of anatomy ultrasound.
Does Polyhydramnios Predict Adverse Perinatal Outcome in Congenital Diaphragmatic Hernia? [10P]
Authors: Berger Victoria , Sparks Teresa , Gosnell Kristin , Farrell Jody , Velez Juan Gonzalez , Norton Mary E. 
Published: May 2017

INTRODUCTION:
To examine polyhydramnios as a predictor of adverse perinatal outcomes in prenatally diagnosed congenital diaphragmatic hernia (CDH).

METHODS:
A retrospective cohort study of CDH cases evaluated between 11/2008 and 6/2016. Perinatal outcomes including preterm birth and mode of delivery were compared between CDH cases with polyhydramnios (amniotic fluid index greater than 25 cm) and those with normal amniotic fluid index. Additional data compared between groups were fetal anatomic characteristics, intrauterine fetal demise (IUFD), gestational age at delivery, preterm birth, length of hospital stay, and neonatal death. Cases that resulted in termination were excluded. Chi square and Fischer's exact tests were used to compare proportions.

RESULTS:
192 cases were identified, and 56 of these (29.2%) had polyhydramnios. No significant associations were observed in fetal anatomic characteristics between the polyhydramnios and normal amniotic fluid groups. Similarly, there were no differences in gestational age at delivery, preterm birth, vaginal delivery, or neonatal or infant death between these groups. However, cases with polyhydramnios demonstrated a trend toward a higher risk of IUFD (33.3% vs. 66.7%, p = 0.06), and were more likely to have a prolonged neonatal length of hospital stay (37 days versus 22 days, p= 0.03) compared to cases with normal amniotic fluid.

CONCLUSION:
Comparing CDH cases with polyhydramnios to those with normal amniotic fluid, similar rates of fetal anatomic characteristics, preterm birth, vaginal delivery, and neonatal or infant death were observed. There was a trend toward a higher risk of IUFD in the polyhydramnios group, suggesting that these cases may merit closer antepartum surveillance.
Teleultrasound: A Validation Study [15P]
Authors: Rabie Nader , Sandlin Adam , Ounpraseuth Songthip , Nembhard Wendy , Lowery Curtis , Magann Everett 
Published: May 2017

INTRODUCTION:
Ultrasound serves an important role in the prenatal diagnosis of fetal anomalies. There has been an increase in the use of teleultrasound protocols for fetal anatomical surveys. Despite the rising popularity of this modality, there are no large studies comparing the sensitivity and specificity of teleultrasound to on-site ultrasound.

METHODS:
This is a retrospective noninferiority study comparing teleultrasound to on-site ultrasound. We included all ultrasound studies performed for anatomical survey. We excluded those performed at < 17 weeks' gestation and on patients with multiple gestations. Every study was interpreted by a Maternal-Fetal Medicine specialist. Prenatal diagnoses were compared to postnatal diagnoses obtained from a mandatory statewide birth defects surveillance registry.

RESULTS:
During the study period, 5,430 ultrasounds met the inclusion criteria; there were 2,341 studies in the teleultrasound group and 3,089 studies in the on-site ultrasound group. The sensitivity, specificity and accuracy of teleultrasound were 53.96%, 98.14% and 95.51% respectively. The sensitivity, specificity and accuracy of on-site ultrasound were 68.29%, 92.95% and 90.16% respectively. We compared the two groups using the Farrington-Manning score test for noninferiority with a 0.15 noninferiority margin and 90% confidence interval. The proportion differences for sensitivity, specificity and accuracy were -0.1433 (CI -0.2240 – 0.0626), 0.0518 (CI 0.0369 – 0.0668) and 0.0535 (CI 0.0381 – 0.0689).

CONCLUSION:
The sensitivity of teleultrasound is inferior to that of on-site ultrasound. Teleultrasound is less likely to detect fetal anomalies, but is comparable to on-site ultrasound in identifying the specific anomaly. In addition, teleultrasound is comparable to on-site ultrasound in identifying non-anomalous fetuses.