bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Chlamydia Screening Provision During Outpatient Visits for Young Women in the United States [26E]
Authors: Flagler Emily , Kobernik Emily , Kamdar Neil , Dalton Vanessa 
Published: May 2017

INTRODUCTION:
The purpose of this study was to 1) examine rates of chlamydia screening between 2005 and 2012, and 2) to identify visit characteristics associated with chlamydia screening during encounters with young women.

METHODS:
We used data from the 2005-2012 National Ambulatory Medical Care Survey, a nationally representative sample of physician-reported, office-based medical visits. Bivariate analysis was performed to compare office visit characteristics among women 14-20 yo and 21-25 yo, respectively, and by time period of screening (period 1: 2005-2008, period 2: 2009-2012). Multivariable logistic regression with appropriate survey weights was performed for all office visits to identify predictors of chlamydia screening and subsequent age-stratified models were developed to identify independent predictors of chlamydia screening.

RESULTS:
Among 16,707 office visits, the overall chlamydia screening rate was 2.7% and 4.2% among 14-20 yo and 21-25 yo, respectively. Age, race, provider type, and visit type were associated with screening during an office visit. After risk adjustment, the odds of receiving chlamydia screening were significantly higher during period 2 (aOR=1.28, 95%CI: 1.01-1.63), among women aged 21-25 (aOR=1.56, 95%CI: 1.22-1.99), among non-Hispanic blacks (aOR=2.12, 95%CI: 1.60-2.81), and during preventive care visits (preventive care: aOR=12.95, 95%CI: 7.93-21.2). In age stratified models, preventive care visits, and being seen by an obstetrician-gynecologist were significant predictors of screening in both age groups, however non-Hispanic black race was a predictor only for visits among 21-25 yo.

CONCLUSION:
Chlamydia screening rates during outpatient visits remain low despite clinical guidelines. Visit characteristics are associated with screening and suggest intervention strategies to improve screening rates.
Compliance With ASCCP Guidelines for Evaluation and Management of Abnormal Pap Smears [28E]
Authors: Hedman Elizabeth , Thompson Paul , Hansen Keith 
Published: May 2017

INTRODUCTION:
American Society for Colposcopy and Cervical Pathology (ASCCP) 2012 revised guidelines were developed to improve the detection and management of cervical dysplasia. A recent study revealed that not all health care providers are knowledgeable or aware of the 2012 national cervical cancer screening guidelines (Teoh et al., 2015). The goal of this study was to determine if primary care providers and Gynecologists manage abnormal PAP smears according to ASCCP current guidelines.

METHODS:
This was a retrospective study conducted at a Midwestern, regional medical center. An electronic search was conducted for abnormal PAP smears during a 12-month period performed by Gynecologists, Internal Medicine, and Family Medicine providers. The patients’ charts were reviewed and entered into an electronic database. The results of the PAP smear and its optimal management according to the 2012 ASCCP guidelines were compared to the providers’ next step in the treatment and management of the abnormal PAP smear. Proportions and 95% confidence intervals were determined for age of patient, type of provider and field of medicine.

RESULTS:
284 charts were reviewed. The proportion of PAP smears that were managed appropriately was 0.658 (95% CI 0.603-0.714). The proportion of ASCCP guideline managed PAP smears were similar for age of patient, type of provider (physician or Advanced Practice Provider) and field of medicine.

CONCLUSION:
In this study, providers were not always managing abnormal PAP smears according to the current ASCCP guidelines. These results may reflect that providers are unaware of the recent guidelines or the guidelines are too complicated.
Prevalence and Genotyping of HPV in Women With Cervical and Anal Neoplasia [32E]
Authors: Amorim Melania , Heraclio Sandra , Rolland de Souza Alex Sandro , Katz Leila 
Published: May 2017

INTRODUCTION:
Persistent human papillomavirus (HPV) infection has been strongly associated with the development of anogenital cancer precursor lesions. Therefore, the objective of this study was to determine the prevalence of oncogenic HPV genotypes and associated factors in women with anal neoplasia.

METHODS:
A cross-sectional study was conducted in 152 women with anal intraepithelial or invasive neoplasia, to identify HPV genotypes.

RESULTS:
Fourteen different HPV types were identified. HPV 16 and 18 were found in 53% (n=30) of anal high-grade squamous intraepithelial lesions (HSIL). HPV 31 and 33 were identified in 37% (n=21) of anal HSIL. In the logistic regression analysis, the factors that remained associated with high-risk HPV types were: an anal histopathology report of HSIL or worse (OR=8·96; 95%CI: 3·40-23·57; p < 0·0001) and alcohol consumption (OR: 2·20; 95%CI: 1·01-4·80; p=0·04) as risk factors, and condom use as a protective factor (OR=0·33; 95%CI: 0·12-0·87; p=0·02).

CONCLUSION:
The prevalence of HR-HPV in women with high grade AIN and cervical neoplasia is high. Fourteen different HPV types were found, and HPV16, 31,33 and 18 were the four major genotypes identified.
Evaluation of African American Women at High Risk for Ovarian Cancer in the Southeast [34E]
Authors: Barrington David A. , Champion Macie , Farmer Meagan , Haygood Christy , Boitano Teresa , Leath Charles A. 
Published: May 2017

INTRODUCTION:
This study aimed to describe patient characteristics in African American (AA) women seen at a large southeastern comprehensive cancer center.

METHODS:
We reviewed an IRB approved, prospectively gathered cohort of patients seen in an Ovarian Cancer Risk Assessment Clinic. Data evaluated included family history, frequency of genetic testing, frequency and types of genetic mutations, and frequency of surgical intervention and development of ovarian cancer.

RESULTS:
1227 patients were evaluated from 2003-2015, of which 97 (7.9%) were AA. Eighteen patients had a personal history of ovarian cancer. Sixty-eight (70%) underwent genetic testing and 29 (30%) elected for genetic counseling only. Of women tested 38 (56%) had abnormal results. Nine and 14 patients had deleterious mutations for BRCA 1 and 2 respectively. Twelve had BRCA variants of undetermined significance. Two were found to have PALB2 mutations and one MLH 1 mutation was identified. Of the patients with abnormal testing, five of 23 women with BRCA deletions underwent risk reducing salpingo-oophorectomy (RRSO).

CONCLUSION:
Our study demonstrates that in a region where AAs represent 27% of the population, the proportion of AA patients referred to an Ovarian Cancer Risk Assessment Clinic remains low. Rates of genetic testing were comparable to Caucasians, potentially signifying that barriers to genetic counseling may be overcome when evaluated in a dedicated clinic. Mutation and variant rates were high in patients tested, possibly representing a selection bias of high risk patients. Endeavors should continue to identify minorities at risk for ovarian cancer and institute measures to provide thorough genetic counseling and testing.
Association of Planned Natural Childbirth With Spontaneous Vaginal Delivery, Interventions, and Complications [36E]
Authors: Cohen Lauren , Waldron Carolyn , Brustman Lois 
Published: May 2017

INTRODUCTION:
There is a paucity of literature suggesting that women who deliver in a birthing center are more likely to achieve a normal spontaneous vaginal delivery (NSVD). This led us to compare outcomes between laboring women admitted to our hospital-based birthing center (BC) and those admitted to our labor and delivery unit (L&D).

METHODS:
A retrospective chart review included all nulliparous patients admitted to the BC in 2013. BC patients were defined as low risk based on maternal age (18-43), gestational age (37-41 weeks), and estimated fetal weight (10th-90th percentile). All BC patients were matched to low-risk patients admitted in active labor to L&D. Univariate analysis was conducted with Chi-square and Fisher’s exact tests. Multivariate logistic regression identified factors associated with mode of delivery.

RESULTS:
The 161 women admitted to BC were significantly more likely to have an NSVD than patients initially admitted to L&D (144 (89%) vs. 107 (66%), respectively; p < 0.0001). Significant predictors of operative and cesarean deliveries were epidural anesthesia (OR 2.943, CI 1.462-5.926; p=0.0025), initial admission to L&D (OR 2.105, CI 1.012-4.376; p=0.0464), non-white race (OR 1.972, CI 1.075-3.618; p=0.02830), and increasing maternal age (OR 1.7, CI 1.119-2.621; p=0.0131). If labor care was initiated in the BC versus L&D, significantly-lower rates of Pitocin augmentation (16 (10%) vs. 36 (22%); p=0.0025), episiotomy (5 (3%) vs.18 (11%); p=0.046) and epidural anesthesia (21 (13%) vs. 115 (71%); p=0.001), resulted. There were no significant differences in maternal or fetal morbidity.

CONCLUSION:
Planning for and starting care in a hospital-based BC appears to enhance outcomes and should be encouraged for appropriate patients.
Association Between Time of Hysterotomy to Delivery and 5-Minute Neonatal Apgar Score: A Retrospective Cohort Study [37E]
Authors: Dogal Natalie , Cotton-Caballero Amaya , Dudley Donald 
Published: May 2017

INTRODUCTION:
We investigated the association between time of hysterotomy to delivery greater than or equal to 3 minutes and 5-minute neonatal Apgar score less than 7.

METHODS:
Women undergoing cesarean delivery of a live birth at UVA Health System were included. Data was extracted from electronic medical records. Means and SDs were calculated for all continuous variables. Potential confounders were categorized and univariate chi-squared tests were performed. Logistic regression was used for multivariable analysis.

RESULTS:
The mean time from hysterotomy to delivery was 2.39 minutes, mean Apgar score was 8.28, mean birth weight was 3082.97 grams with mean gestational age at delivery of 37.63 weeks. Neither time greater than or equal to 3 minutes (p=.85) or time greater than or equal to 5 minutes (p=.90) appeared associated with Apgar score. Preterm delivery (p< .001) and size for gestational age at delivery (p< .001) both appeared associated with Apgar score less than 7. Time from incision greater than or equal to 3 minutes was not associated with Apgar score (P=.54) when adjusting for size-for-gestational age at delivery and preterm delivery. Small for gestational age had an OR=3.21 (95%CI 1.39-7.44), large-for gestational age had an OR=.75 (95%CI .31-1.83). Preterm delivery also increased the odds (P=.01) of Apgar score less than 7 by OR=2.78 (95%CI 1.36-5.70). Time from incision greater than or equal to 5 minutes was not associated with Apgar score less than 7 (p=0.90) when confounders were considered.

CONCLUSION:
Our data are reassuring that time from hysterotomy to delivery is not associated with adverse neonatal outcomes.
What Women Want From Their Doctors About Pregnancy Options Counseling [3F]
Authors: French Valerie , Steinauer Jody , Kimport Katrina 
Published: May 2017

INTRODUCTION:
The recommendations on pregnancy options counseling by many professional organizations conflict with some doctors’ desire to exercise their personal beliefs. To understand a patient-centered framework for pregnancy options counseling, we explored pregnant women’s preferences for pregnancy options counseling from doctors.

METHODS:
We conducted semi-structured interviews with 28 pregnant women recruited from a prenatal clinic and an abortion clinic. We asked women about recent discussions—or lack thereof—about pregnancy options (parenting, adoption and abortion) with a doctor, and what they would want their doctor to discuss about pregnancy options. We analyzed transcripts using modified grounded theory.

RESULTS:
Most participants, in both prenatal and abortion care, said doctors should discuss pregnancy options, including abortion, with pregnant women. In counseling, participants wanted physicians to: 1) respect patient autonomy, 2) avoid assumptions about a woman’s desired pregnancy outcome, and 3) consider the patient as a whole person. In general, participants wanted their doctors to assess a pregnancy’s particular circumstances to determine the appropriateness of options counseling. A few participants reported not wanting options counseling. Explaining this preference, they cited preservation of privacy, having already made a decision for the pregnancy, or not wanting to discuss abortion. Regarding best practices for providing options counseling, participants said it should be done in a routine manner, with discretion, and early in pregnancy.

CONCLUSION:
Pregnant women seeking both prenatal and abortion care broadly support options counseling. These findings suggest options counseling that includes discussion of abortion is consistent with providing patient-centered care and supports women’s preferences.
Pregnancy Risk, Contraception and Sexually Transmitted Infections in the Transgender Patient [4F]
Authors: Jasani Sona , Balica Adrian , Marshall Ian , Ayers Charletta , Bachmann Gloria , Francis Amanda 
Published: May 2017

INTRODUCTION:
Reproductive risk assessment, STI prevention and contraception counseling represent an emerging challenge in the transgender population. Despite increased awareness of transgender healthcare needs, provider templates of care based on evidence based data that address the reproductive healthcare needs of transgender individuals are limited.

METHODS:
We performed a literature search using Pub Med, Scopus and Google Scholar between 2010-2016. Search terms used included transgender, pregnancy, contraception, and STI. Of the six relevant articles, three were cross sectional surveys and three were retrospective cohort studies.

RESULTS:
Among transgender youth, contraception use did not differ between those at risk for pregnancy vs those not at risk. As expected, sexual activity was associated with higher STI risk. Positive HIV status did not differ in transmen compared to transwomen: overall HIV prevalence was higher in the trans vs non-trans population. Unprotected sex may be a factor with STI. In one study, 88% of transmen reported using no protection. Further, pregnancy appears to be desired in select transmen, as one study noted that 68% in their cohort had a planned gestation while 32% had an unplanned one.

CONCLUSION:
There are limited data to formulate guidelines regarding pregnancy, STI counseling and contraceptive management of transgender individuals. Both pregnancy risk/desire exists in this population and should be a counseling topic. In addition, contraceptive and STI counseling is essential during all clinical encounters. For those at risk for HPV coinfection continued gynecological surveillance should be part of their preventive health management.
Perspectives on a Quality Abortion Care Experience: A Patient Centered Approach [9F]
Authors: Mnuk Rachel , Mariam Savabi , Bayat Lily , Pereda Brenda 
Published: May 2017

INTRODUCTION:
A third of US women have an abortion—often a painful and emotional experience—during their reproductive years. Few studies have examined patients’ experience in abortion care, resulting in limited evidence to guide clinicians on aspects of abortion care most important to women. Similarly, providers’ perceptions of the patient experience have not been studied. Our study objective was to better understand women’s and providers’ perspectives on a high quality abortion experience to inform patient-centered abortion care.

METHODS:
We conducted semi-structured interviews with 10 abortion providers at the University of New Mexico Center for Reproductive Health, and 25 women seeking first-trimester surgical abortion. Participants underwent a pre-procedure in-person interview as well as a post-procedure phone interview. New participant interviews were performed until thematic saturation was achieved. Interviews were transcribed and coded using Dedoose.™

RESULTS:
Women and providers value similar aspects of abortion care. When evaluating perspectives, an inverse hierarchy of priorities was observed. Providers consistently cited health metrics such as safety, procedure length, and pain control as primary determinants of providing quality abortion care. In contrast, patients desired empathy, a genuine connection with their abortion provider and clinic staff, as well as feeling heard and understood in a non-judgmental environment.

CONCLUSION:
Women and providers valued somewhat different but complementary aspects of abortion care. The global clinical care, including all clinic personnel’s attention to women’s psychosocial needs, is integral to high quality abortion care.
Awareness of Sexually Transmitted Infection and Cervical Cancer in Nigerian Female Adolescents [12F]
Authors: Eli Sukarime , Inimgba Nestor , Okpani Anthony 
Published: May 2017

INTRODUCTION:
Cervical cancer is a sequel of Human Papillomavirus infection. Female adolescents in Nigeria are at high risk for future occurrence of this malignancy because of multiple concurrent sexual partners, and unprotected sex. High incomes and sophisticated lifestyles induced by the Niger Delta crude oil operations, youth unrest, peer group pressure, and substance abuse promote these sexually transmitted infections. Data should be collected from these adolescents to facilitate sexual behavioral change.

METHODS:
To determine the level of awareness of the relationship between sexually transmitted infection and cervical cancer. Information was collected from Two hundred and forty female adolescent secondary school students and undergraduates attending a holiday camp in Port Harcourt, South Nigeria.

RESULTS:
The mean age of the subjects was 15 years. Forty- eight (20%) subjects were under 13 years. 51% were aged 14 years to 16 years, and 29% were aged 17 years to 19 years. Forty-five per cent of the subjects were aware of cervical cancer but only 4% knew there was a relationship between unprotected sex and cervical cancer. The commonest sources of information were the media (50%), and hospitals (30%). None of the subjects was aware of the Human Papillomavirus vaccine.

CONCLUSION:
Adolescents are at increased risk for sexually transmitted infections, but have low levels of knowledge about their sequel. Promotion of sexual behavior attitudinal change facilitated by collection of data on sexuality will assist in reducing the incidence of cervical cancer in Nigeria.
A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Immediate Postpartum Sterilization [14F]
Authors: Hahn Taylor , Tucker-Edmonds Brownsyne , Layman Shelley , Daggy Joanne 
Published: May 2017

INTRODUCTION:
To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive interval sterilization by 3 months postpartum.

METHODS:
Prospective observational cohort study of women delivering over an 8 month period and requesting immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid Consent form and secondarily all other reasons for unfulfilled requests and alternative contraceptive methods chosen. Bivariate analyses were performed to evaluate the relationship between unfulfilled sterilization and sociodemographic characteristics.

RESULTS:
334 women delivered and requested immediate postpartum sterilization. 173 women (52%) received requested sterilization while 161 women (48%) did not. Medicaid Consent was the primary reason for unfulfilled request for 61 women (37.9%). Within this group, six women (9.8%) received interval sterilization by 3 months postpartum, while the remaining 90.2% were still awaiting interval sterilization (14.8%), had chosen an alternative contraceptive method (52.5%), or did not receive postpartum care (23.0%). Of the sociodemographic factors assessed, only advanced age was associated with increased sterilization (p=0.02).

CONCLUSION:
A sizable proportion of women requesting postpartum sterilization continue to have unfulfilled requests due to an issue with the Medicaid Consent and they have a low likelihood of receiving interval sterilization. This has important implications for ongoing reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired sterilization.
Complications Associated With Second Trimester Inductions Requiring Over Five Doses of Misoprostol [15F]
Authors: Diaz Nicole M. , Kuchta Kristine , Ouyang David W. 
Published: May 2017

INTRODUCTION:
The objective of this study was to evaluate outcomes associated with second trimester inductions requiring greater than five (>5) doses of misoprostol as compared to those that delivered with five or less (≤5). The American College of Obstetricians and Gynecologists recommends a maximum of five misoprostol doses for second trimester induction terminations.

METHODS:
A retrospective cohort study was conducted that included women between 14 and 23 weeks who underwent induction for termination or demise from 2005 to 2015. During this timeframe, inductions undelivered after five doses of vaginal misoprostol continued further doses without delay. Characteristics and outcomes between inductions requiring >5 doses versus ≤5 were assessed.

RESULTS:
Of 478 women included in our analysis, 396 delivered with ≤5 doses of misoprostol, while 82 required >5 doses. Those requiring >5 doses were more likely to be nulliparous, have an unfavorable cervix and have greater gestational age. The groups were similar in terms of age and prior cesarean. No significant differences in chorioamnionitis, retained placenta, postpartum hemorrhage, transfusion, or uterine rupture were noted in spite of the >5 cohort taking significantly longer to deliver (29.7 hours vs 10.1 hours, P < .0001). Regional anesthesia was more common in the >5 group (OR 1.69, P=0.035). The only uterine rupture occurred in the ≤5 group after one dose of misoprostol.

CONCLUSION:
The frequency of complications associated with second trimester inductions requiring >5 doses of misoprostol is comparable to those requiring ≤5. These data suggest women should be able to continue induction following the fifth dose without delay.