bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surrogates of Progression-Free Survival in Endometrial Cancer Patients: An Evaluation of Tissue Composition [19J]
Authors: Penick Emily , Tian Chunqiao , Wang Guisong , Maxwell George , Hamilton Chad , Darcy Kathleen 
Published: May 2017

INTRODUCTION:
Endometrial cancer (EC) is a heterogeneous disease that varies in tumor composition. The goal of this study was to determine if the composition of endometrial tumors have potential prognostic value.

METHODS:
Tissue composition of frozen tumors and clinical outcome data were downloaded from the Cancer Genome Atlas (TCGA) Uterine Corpus Endometrial Carcinoma project. Tumors were scored by TCGA pathologists for percent tumor cellularity, necrosis, stromal cells, lymphocytes, monocytes, and neutrophils. The relationship between these measures of tissue composition and clinical outcome were evaluated using log-rank test and Cox modeling. Relationships with clinical characteristics were evaluated using Fisher exact testing.

RESULTS:
There were 547 evaluable EC patients, including 28% with advanced stage, 75% with endometrioid histology and 21% with serous cancers. Presence versus absence of necrosis, stromal cells, or neutrophils in the tumor samples was associated with worse progression-free survival (PFS) and an increased risk of disease progression (P < .05). The presence of necrosis in the research sample was also an independent surrogate of poor PFS in EC patients after adjustments for stage, cell type, grade and myometrial invasion (hazard ratio=1.56, P=.044). Necrosis was more common in patients with advanced stage (P=.012), higher grade (P < .0001), and deeper myometrial invasion (P < .0001).

CONCLUSION:
The presence versus absence of necrosis in EC tumors is a promising surrogate of poor versus good prognosis for EC patients with independent prognostic value after adjustment for stage, cell type and tumor grade.
Cervical Cancer Risk Perceptions and Justifications Among Women in Rural El Salvador [22J]
Authors: Rosenbaum Alan , Figueroa Ruben , Maza Mauricio , Alfaro Karla , Chang Judy , Cremer Miriam 
Published: May 2017

INTRODUCTION:
To describe cervical cancer risk perceptions and justifications among women in rural El Salvador.

METHODS:
Salvadoran women participating in a cervical cancer educational session were asked in an open-ended manner to describe their self-perceived cancer risk and explain their justification for that belief. Responses were recorded as close to verbatim as possible. Women were later given a cervical cancer screening appointment, for which attendance was recorded. Two investigators performed content analyses coding and categorized participant’s risk perceptions and justifications; agreement was assessed with Cohen’s Kappa correlations. Associations between self-perceived risk, risk perception justifications, and screening attendance were assessed with Pearson’s Chi-square statistics.

RESULTS:
Of 409 participants, 187 (45.7%) women viewed themselves at risk of cervical cancer, 65 (15.9%) not at risk, and 157 (38.4%) unsure. Justification for those beliefs included the perception of having an ability or inability to change their cancer risk and that cancer risk was associated with certain risk factors or indiscriminate. Women viewing themselves at risk of cervical cancer were less likely to attend screening. Women believing they lacked ability to affect their cancer risk and those believing cancer to be indiscriminate more frequently reported being at risk. Additionally, the perception that cancer risk is indiscriminate was associated with decreased attendance.

CONCLUSION:
This study revealed themes that women’s decisions to participate in cervical cancer screening is influenced by beliefs regarding personal risk and sense of control over those risks. Understanding these motivations may allow public health programs to tailor cervical cancer education to improve screening participation in Latin America.
Tobacco-Related Healthcare Among Women of Reproductive Age [29J]
Authors: Pineles Beth L. , Samet Jonathan M. 
Published: May 2017

INTRODUCTION:
After a decades-long decline, smoking prevalence has plateaued. It remains one of the most important modifiable risk factors for dozens of health and birth outcomes. Despite evidence that advice to quit and brief counseling improve quit rates, tobacco-related healthcare is suboptimal. We examined correlates of the receipt of tobacco-related healthcare in ambulatory care visits by women of reproductive age.

METHODS:
The National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) collect data annually from nationally-representative samples of ambulatory care visits. We analyzed restricted data on 130,363 visits by women aged 15-44 in the NAMCS and NHAMCS surveys for the years 2001-9.

RESULTS:
Tobacco use was identified in 67% of women and 73% of pregnant women, and this frequency decreased from 2001 to 2009 among pregnant women. Tobacco use/exposure counseling was provided in 19% of visits by tobacco users and 21% of visits by pregnant tobacco users. Obstetrician-gynecologists were more likely to identify tobacco use than were most other specialists. Pregnant women were more likely to have tobacco use identified than were nonpregnant women. Non-white patient race was associated with a lower rate of tobacco use identification. Medical school-affiliated outpatient departments were less likely to identify tobacco use but more likely to provide tobacco use/exposure counseling.

CONCLUSION:
Low and declining rates of identification of tobacco use reinforce the need for improvement. Several associations with suboptimal tobacco-related healthcare were identified which can help tailor programs for improvement.
Knowledge of STIs Among Heterosexual and Sexual Minority Hispanic Women Living in Puerto Rico [30J]
Authors: Garcia-Crescioni Keyla , Cardenas-Suarez Natalia , Muns-Aponte Sofia , Roura Jaime , Romaguera Josefina 
Published: May 2017

INTRODUCTION:
Sexually transmitted infections (STIs) are among the most common contagious diseases leading to severe health complications in women. When compared to heterosexual (HET) women, sexual minority women (SMW) have been perceived as a low risk group for STIs. Studies have reported that SMW engage in riskier sexual activities, yet there is insufficient data related to STIs. Here, we examine STIs knowledge in a sample of HET and SMW in PR.

METHODS:
A descriptive cross-sectional, online survey study was employed to collect data from Puerto Rican women (HET=333 and SMW=143). Sociodemographic data, STIs knowledge (using a cultural adaptation of the STD-KQ) and perceived risk of STIs were obtained. Using Mann Whitney Wilcoxon and Chi-square we compare knowledge and perceived risk of STIs.

RESULTS:
Mean age was 34 years (±10), education level of a bachelor’s degree or higher was (HET=75%; SMW=68.6%), and most were in a relationship at the time of the study (HET= 75.7%; SMW= 73.4%). An 80 or better score in the STD-KQ was obtained in 43.8% of HET and 39.6% of SMW (p=0.46). In terms of STIs risk perception, there were no statistically significant differences among groups; both reported to be at no or low risk of acquiring STIs.

CONCLUSION:
Heterosexual and sexual minority women were unaware of general STIs knowledge and perceived themselves as a low risk group. It is imperative to develop culturally appropriate intervention programs to educate and increase both awareness and STIs knowledge in women in PR.
Knowledge and Use of Folic Acid Among Hispanic Women Visiting University of Puerto Rico Prenatal Clinics [31J]
Authors: Rivera-Segarra Stephanie , Ramos-Tollinchi Lizzie , Cardenas-Suarez Natalia 
Published: May 2017

INTRODUCTION:
Neural tube defects (NTDs) are mostly caused by a deficiency of folic acid (FA). Although supplementation is recommended for all reproductive-aged women, the incidence of NTD in Puerto Rico has not significantly decreased. In this study, we aim to identify the level of awareness regarding the time to begin FA supplementation and the recommended preconceptional dosage. We also aim to correlate the source of education with the knowledge patients have about the benefits of FA.

METHODS:
This is a descriptive study from August 2015 to November 2015 at the Adults University Hospital High Risk Prenatal Care Clinics. A self-administered questionnaire was assessed and analyzed with Epi Info 7.

RESULTS:
A total of 200 patients were recruited. An 87% of participants were Puerto Rican, most had a high school education and low income status. A 66.5% of participants were taking FA at the time of the study. Of these, 77% understood that the best time to start FA supplementation was before pregnancy. However, 23% of these patients took FA preconceptionally. Most of the patients referred to have received information about FA from a health care professional. Nevertheless, many patients could not identify all of FA benefits.

CONCLUSION:
Although most of our patients are aware of the adequate time for FA supplementation, the majority begin intake once pregnancy is discovered. However, even though the awareness is present, the knowledge received from health care professional is not enough. Most women remain unclear about the benefits of FA supplementation.
Effect of Introduction of a Lactation Counselor on Breastfeeding Uptake and Satisfaction in an Urban Prenatal Clinic [39A]
Authors: Martinez Noelle , Nguyen Antoinette , Hu Fengling , Strohbach Angelina , Hajjar Nadia , Yee Lynn 
Published: May 2017

INTRODUCTION:
To assess the association between introduction of a full-time lactation counselor (LC) and breastfeeding outcomes.

METHODS:
This is a prospective observational study of low-income, minority women receiving care in a publicly funded prenatal clinic 6 months before and after introduction of a LC. The LC provided inpatient and outpatient one-on-one antenatal and postpartum lactation education and support. Chart review and survey data were collected to compare women receiving care before versus after LC introduction. The primary outcome was breastfeeding continuation (exclusive or partial) at 6 weeks postpartum; secondary outcomes included breastfeeding comfort, confidence,and training satisfaction. Bivariable and multivariable analyses were utilized as appropriate.

RESULTS:
Of 218 women, 54.6% were post-LC introduction; there were no demographic differences between cohorts. Factors associated with breastfeeding continuation included greater maternal education (aOR 4.10, 95% CI 1.73-9.69) and breastfeeding comfort and confidence (aOR 3.04, 95% CI 1.34-6.91; aOR 4.56, 95% CI 1.81-11.46). Women with LC were more likely to be satisfied with BF training (98.2% vs 84.5%, p=.01), and were more likely to have performed any breastfeeding (89.7% vs 73.6%, p=.007), which remained significant on regression analysis (aOR 3.41, 95% CI 1.35-8.63). However, LC was not associated with continued BF at 6 weeks (aOR 1.28, 95% CI 0.69-2.38).

CONCLUSION:
Continued breastfeeding at 6 weeks postpartum among low-income, minority women was associated with greater maternal education and with breastfeeding comfort and confidence. Lactation counselor introduction was associated with improved breastfeeding training satisfaction and increased rates of any breastfeeding, but was not associated with continued breastfeeding at 6 weeks.
Does 17a-Hydroxyprogesterone Caproate for Preterm Birth Prevention Affect Midtrimester Cervical Length? [37F]
Authors: Wood S. Lindsay , Williams Bria , Tang Ying , Owen John 
Published: May 2017

INTRODUCTION:
Weekly intramuscular 17a-hydroxyprogesterone caproate (17P) is endorsed by the American College of Obstetricians and Gynecologists for recurrent preterm birth (PTB) prevention. Cerclage is indicated in patients with prior PTB and a midtrimester cervical length (CL) less than 25 mm. While 17P and CL screening are used concurrently in this population, 17P’s effect on CL is unclear. As such, we aimed to investigate the effect of 17P on midtrimester CL in patients with prior PTB.

METHODS:
Retrospective cohort of all singletons delivered at a single center that underwent CL screening from 2011 to 2016 for prior PTB. Exposure was defined as at least one dose of 17P administered prior to the last measured CL. Primary outcome was shortest observed CL. Secondary outcomes included rate of CL shortening to less than 25 mm and cerclage. ANCOVA was used to assess the relationship between 17P and shortest observed CL, controlling for significant covariates.

RESULTS:
Of 409 women who had CL screening, 211 received and 198 did not receive 17P prior to the last CL. Exposed and unexposed groups differed by initial CL (38.3 vs 36.0 mm, respectively; P < .005) and gestational age of earliest prior PTB (27.1 vs 29.2 weeks, respectively; P < .001). Rates of CL shortening to less than 25 mm (P = .93) and cerclage (P = .471) were similar. After controlling for confounders, shortest observed CL was significantly shorter in those who received 17P prior to the last CL (30.2 vs 32.7 mm; P < .001).

CONCLUSION:
17P does not prevent midtrimester CL shortening in patients with prior PTB.
Application of “Capacity Cascade” as Novel Approach to Emergency Obstetric Care Readiness Assessment in Guatemala [38G]
Authors: Tesfalul Martha , Madriz Solange , Cranmer John , Kestler Edgar , Walker Dilys 
Published: May 2017

INTRODUCTION:
Preventing maternal and neonatal morbidity and mortality in health care facilities depends heavily on the provision of emergency obstetric care (EmOC). A dominant framework for assessing EmOC capacity focuses on the presence of tracer items (e.g. antibiotics, MgSO4) for signal functions (e.g. sepsis treatment, management of preeclampsia). Our study aims to assess the feasibility of a novel capacity cascades framework to measure facility EmOC readiness and to compare it with the known signal function framework.

METHODS:
The capacity cascades framework is characterized by three stages of EmOC readiness: 1) identification of emergency, 2) treatment, 3) monitoring and modification of treatment. Retrospective facility inventory data were obtained from 36 Guatemalan basic EmOC facilities. Mapping of the capacity cascades and signal function framework variables was done using STATA12 for: hemorrhage, hypertensive emergency, retained placenta, sepsis. Proportion of facilities meeting criteria for readiness based on each cascade stage and signal function was calculated.

RESULTS:
For hemorrhage EmOC readiness, 75.0% of facilities met signal function criteria versus 97.2% capacity cascade stage 1; 75.0% stage 2; 33.3% stage 3. For hypertensive emergency, 86.1% versus 97.2%; 77.8%; 38.9%. For retained placenta, 75.0% versus 97.2%; 52.8%; 13.9%. For sepsis, 100% versus 100%; 75%; 33.3%.

CONCLUSION:
This study shows that capacity cascade framework is easy to apply and demonstrates a discrepancy from the signal function framework that suggests an overestimate of EmOC readiness by the latter. An early study in Kenya showed similar trends, demonstrating reproducibility. Further work needs to be done investigating association with clinical outcomes to determine clinical relevance.
Postoperative Care After Gender Reassignment Surgery for Trans Women [39Q]
Authors: Luikenaar Rixt 
Published: May 2017

INTRODUCTION:
Gender reassignment surgery (GRS) has been performed for many years. There are few surgeons that offer these surgeries and patients often travel far to have this done as part of their transitioning. We have few data regarding postoperative and follow up care. Each surgeon has their own preferred protocol regarding dilatation, use of lubrication and other topical ointments. There is currently no peer committee overseeing these surgeons and their postoperative recommendations.

METHODS:
We performed a literature study and looked at different Gender Reassignment Clinics and their postoperative protocols. These are also provided to my patients after surgery when I do their postoperative care.

RESULTS:
Most clinics have their own recommendations for postoperative care after Gender Reassignment surgery. Often patients come to a gynecologist for postoperative care. There are different recommendations out there and there is limited follow up from the primary surgeons nor communication with the physicians that performed postoperative care.

CONCLUSION:
There needs to be more transparency in postoperative care of patients that undergo GRS. There is little communication with primary surgeons and their patient’s physician that is responsible for postoperative care. Gynecologists will see an increase in patients that need postoperative care after GRS and we need more data on how to do this appropriately and a peer committee that oversees these GRS surgeons, including looking at complications, techniques and outcomes.
Gestational Weight Gain and Perinatal Outcomes by Pre-Pregnancy Obesity Class [1OP]
Authors: Wilkins Emilia , Alabaster Amy , Gunderson Erica 
Published: May 2017

INTRODUCTION:
Gestational weight gain (GWG) is a modifiable risk factor that could mitigate poor perinatal outcomes for obese women. This study evaluated the risk of adverse perinatal outcomes among obese women that fall below the Institute of Medicine (IOM) guidelines for GWG.

METHODS:
This retrospective cohort study included 19,810 obese women delivering singleton, live births, greater than 35 weeks in 2009-2012 at Kaiser Permanente Northern California hospitals. Logistic regression was used to estimate the odds ratios (OR, 95% CI) of newborn [size for gestational age, NICU admission, length of hospital stay (LOS)] and maternal (mode of delivery, preeclampsia, gestational hypertension) outcomes associated with GWG below IOM guidelines (less than −2kg, -2kg – 2kg, or 2kg – 5kg) compared to within IOM guidelines (5kg-9kg) for pre-pregnancy obesity classes 1 to 3. Models were adjusted for socio-demographics, parity, gestational age, prenatal care, diabetes, hypertension and smoking.

RESULTS:
Among class 3 obese women, GWG below -2 kg compared to GWG within IOM guidelines was associated with lower odds of: large for gestational age infants OR=0.44 (0.27 – 0.71), preeclampsia/eclampsia OR=0.51 (0.26 – 0.93), cesarean section OR=0.50 (0.35 – 0.71), NICU admission OR 0.70 (0.45 – 1.08) and LOS greater than 3 days OR=0.53 (0.28 – 0.76), but higher odds of small for gestational age OR=2.61 (1.11 – 6.20). Findings were similar for other obesity classes.

CONCLUSION:
Weight loss among severely obese women is associated with improved perinatal outcomes, and higher risk of small for gestational age infants, but without the increased risk of other poor neonatal outcomes.
Does Obesity Affect the Assessment of Third Trimester Amniotic Fluid? [1P]
Authors: Andrikopoulou Maria , Kinzler Wendy , Calixte Rose , Chavez Martin , Fetsak Galyna , Vintzileos Anthony 
Published: May 2017

INTRODUCTION:
To determine the inter-observer and intra-observer variability of amniotic fluid index (AFI) and maximum vertical pocket (MVP) measurements in obese pregnant women compared to non-obese pregnant.

METHODS:
This is a prospective study of women presenting for scheduled 3rd trimester clinically indicated ultrasound. AFI and MVP were measured by two sonographers. The first sonographer collected each measurement twice to assess intra-observer variability. The second sonographer was blinded to the measurement of the first sonographer to provide the measurement of inter-observer variability. Both measures of variability were estimated using the intra-class correlation (ICC) with 95% confidence intervals, ICC of 0.4 was considered the minimally accepted level of variability. All analyses were done using SAS 9.4®.

RESULTS:
Of the 126 patients enrolled, there was a mean maternal age of 33.8±5.5 years, mean BMI of 29.1±7.1 kg/m2 and mean gestational age 32.9±0.9 weeks. At that time, 57.8% of the patients were obese, 20.6% of the patients were affected by gestational diabetes, and 19% of the patients had prior cesarean section. The mean BMI for obese patients was 36.9±5.6 kg/m2 and for non-obese 26.5±2.8 kg/m2. ICC and 95% CI are presented for the overall cohort, as well as obese and non-obese women.

CONCLUSION:
Intra-observer variability for both MVP and AFI were acceptable in obese and non-obese women. Inter-observer correlation was poor, particularly when MVP was assessed in both obese and non-obese women. Obesity does not appear to have a significant impact on the variability of amniotic fluid assessment in the third trimester.
Baseline T Classification Predicts Early Tumor Regrowth After Nonoperative Management in Distal Rectal Cancer After Extended Neoadjuvant Chemoradiation and Initial Complete Clinical Response
Authors: Habr-Gama Angelita , São Julião Guilherme Pagin , Gama-Rodrigues Joaquim , Vailati Bruna Borba , Ortega Cinthia , Fernandez Laura Melina , Araújo Sérgio Eduardo Alonso , Perez Rodrigo Oliva 
Published: May 2017

BACKGROUND:
Selected patients with rectal cancer and complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively with acceptable outcomes. However, ≈20% of these patients will develop early tumor regrowth. Identification of these patients could select candidates for more intensive follow-up.

OBJECTIVE:
The purpose of this study was to investigate the influence of baseline radiological T classification on recurrences after a complete clinical response managed nonoperatively after chemoradiation.

DESIGN:
This was a retrospective review of a prospective collected database.

SETTINGS:
The study was conducted at a single center.

PATIENTS:
Patients with distal rectal cancer (cT2-4N0-2M0) undergoing extended chemoradiation (54 Gy + 5-fluorouracil–based chemotherapy) were eligible. Patients were reassessed for tumor response at 10 weeks after radiation completion. Patients with complete clinical response (clinical, radiological, and endoscopic) were managed nonoperatively and strictly followed.

MAIN OUTCOMES MEASURES:
Complete clinical response rates, early tumor regrowth rates (<12 mo), local recurrence-free survival, and distant metastases-free survival were measured.

RESULTS:
A total of 91 consecutive patients with rectal cancer underwent extended chemoradiation. Sixty-one patients developed initial complete clinical response (67%). cT2 patients developed similar initial complete clinical response rates compared with cT3/T4 (72% vs 63%; p = 0.403). Early tumor regrowths were more frequent among baseline cT3/4 when compared with cT2 patients (30% vs 3%; p = 0.007). There were no differences in late local recurrences (p = 0.593) or systemic recurrences (p = 0.387). Local recurrence-free survival was significantly better for cT2 patients at 1 year (96% vs 69%; p = 0.009). After Cox regression analysis, baseline T stage was an independent predictor of improved local recurrence-free survival at 1 year (p = 0.03; OR = 0.09 (95% CI, 0.01–0.81)).

LIMITATIONS:
This study was limited by its small sample size, retrospective nature, and short follow-up.

CONCLUSIONS:
cT2 patients who develop complete clinical response after extended chemoradiation managed nonoperatively are less likely to develop early tumor regrowths when compared with cT3/4 patients. cT3/4 patients should undergo more intensive follow-up after a complete clinical response to allow for early detection of early regrowths.