bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Homelessness on Management of Menstruation and Dysmenorrhea in Pomona, California [ID 2683481]
Authors: Ahuja Grace , Holtzman Stone A. , Gilmore Elisabeth , Nelson Anita L. , Fuchs Sebastien 
Published: May 2024

INTRODUCTION:
Given the challenges to menstrual hygiene many women face and the high rate of homelessness in Pomona, California, we suspected women without housing would have increased difficulty managing their menstrual hygiene and dysmenorrhea primarily due to resource inaccessibility.

METHODS:
After IRB approval and beta testing, we partnered with local homeless shelters and a student-run clinic to screen for eligible participants, obtain verbal consent, and conduct anonymous interviews. Each interview lasted 15 minutes with 26 questions spanning demographics, menstrual hygiene and dysmenorrhea management, and history of homelessness.

RESULTS:
Analysis of 50 surveys (96% response rate) revealed that 37% of participants reportedly relied on shelter pantries for access to menstrual hygiene products, 27% of participants admitted to stealing their preferred products, and almost 10% of participants reported resorting to using alternate methods such as free bleeding and old clothes to catch their menstrual flow. For management of dysmenorrhea-associated painful cramping, 96% of participants reported preferring medication management but not having access to it when homeless so instead their only option was to “just deal with it” (60%).

CONCLUSION:
The results of this study illuminate the gap in existing literature regarding the specific struggles that homeless people face when managing their menstrual hygiene and dysmenorrhea. The discrepancies in management of hygiene and pain when housed versus unhoused come down to lack of access to essential resources. Shelter pantries do not have enough funding to effectively support the size and demand of the growing menstruating homeless population.
Exploring Disparities in Cancer Screening Among Women With Disabilities [ID 2683490]
Authors: Aslam Anam , Waxman Andrea , Maran Patricia 
Published: May 2024

INTRODUCTION:
Unequal access to health care for individuals with disabilities is an increasingly relevant disparity. Further, accessibility to cancer screening remains inadequate. Steele et al. (2017) reported a lower prevalence of women with disabilities undergoing screening for cancer versus women overall in the 2013 National Health Interview Study. The purpose of this study is to compare screening rates for breast, cervical, and colon cancer among female patients with and without disabilities within our health network.

METHODS:
The study is a retrospective review of patient charts between January 1, 2015 and January 1, 2020. Sample size calculations yielded need for 450 charts to achieve adequate power to detect a 10% reduction in each of the three screening rate analyses. Sample was drawn from electonic medical records and identified female patients ages 21–75 receiving gynecologic care at an eastern Pennsylvania health network. ICD-10-CM codes for disabilities identified patients with cognitive, mobility, speech, or hearing impairments. Statistical analyses included chi-squared goodness-of-fit tests.

RESULTS:
Cancer screening rates were significantly lower in the sample population. For cervical cancer, patients with disabilities had a 43.3% screening rate versus 66.0% in the general population. For breast cancer, the sample screened at 67.6% versus the general population at 75.0%. For colorectal cancer screening, the sample was at 54.8%, whereas the general population had a 66.0% screening rate (P<.001).

CONCLUSION:
Understanding the mechanisms behind lower preventive care rates can help to improve health outcomes for this patient population. The future goal is to offer solutions to address disparities in cancer screening.
Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522]
Authors: Srinivas Tara , Lulseged Bethlehelm , Mirza-Aghazadeh-Attari Mohammad , Weiss Clifford R. , Borahay Mostafa A. A. 
Published: May 2024

INTRODUCTION:
Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women.

METHODS:
Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias.

RESULTS:
Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance.

CONCLUSION:
Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.
Exploring the Association of Intimate Partner Violence and Statewide Abortion Restrictiveness [ID 2683529]
Authors: Neff Katherine E. , Hall Stephanie V. , Pangori Andrea , Zivin Kara R. , Dalton Vanessa 
Published: May 2024

INTRODUCTION:
Intimate partner violence (IPV) in pregnancy may result in poor maternal and infant health outcomes. Intimate partner violence may lead to unintended pregnancy, and denial of wanted abortions can increase the risk of future IPV. Prior to the 2022 reversal of Roe v. Wade, many states had already enacted policies hindering access to abortion. Whether state-level abortion restrictions are associated with IPV remains unknown. This study aims to investigate the relationship between IPV during pregnancy and abortion restrictions.

METHODS:
We analyzed data from 38 states participating in the CDC Pregnancy Risk Assessment Monitoring System in 2020 representing 1,368,237 deliveries. We divided states into restrictive (N=16) and nonrestrictive (N=22) categories based on the Guttmacher Abortion Policy Hostility Index. We used weighted logistic regression to assess the relationship between state abortion restrictiveness and self-reported IPV.

RESULTS:
Those who lived in restrictive states reported 1.52 times (95% CI, 1.24, 1.87) higher likelihood of experiencing IPV during pregnancy compared to those in nonrestrictive states, adjusting for confounding factors. Among Black individuals, those who lived in restrictive states reported 1.64 times (95% CI, 1.15, 2.34) higher likelihood of experiencing IPV compared to those in nonrestrictive states. White individuals in restrictive states reported 1.48 times (95% CI, 1.15, 1.91) higher likelihood of experiencing IPV than those in nonrestrictive states.

CONCLUSION:
Even when abortion was federally protected, individuals in restrictive states had an increased likelihood of experiencing IPV. These findings highlight potential detrimental effects of recent abortion bans on health and health inequities.
Using the Life Course Model to Develop, Validate, and Apply a State Reproductive Health Scorecard to Investigate Trends in Abortion Restrictions [ID 2683672]
Authors: Ramachandran Lakshmi , Vinekar Kavita , Koch Mikaela 
Published: May 2024

INTRODUCTION:
Current health care scorecards either omit reproductive health metrics altogether or include a limited list of indicators to characterize a diverse population. In this study, we aimed to use the life course model to develop and validate a comprehensive state-level reproductive scorecard and apply the scorecard to explore the relationship between a state’s reproductive health score and its abortion restrictions.

METHODS:
We expanded the reproductive component of a previously validated health scorecard to include a total of 30 indicators. We collected publicly available data across five domains: health outcomes, prevention, access/infrastructure, insurance, and equity. We created standardized z-scores for each indicator, which were subsequently averaged—and therefore equally weighted—to yield composite state scores. The scorecard was validated by comparing composite scores to scores using the original indicators. We then conducted independent t-tests using Excel and Stata to compare states with and without abortion bans post-Roe reversal.

RESULTS:
States without abortion bans ranked an average of 20.7 out of 50, or 60th percentile, whereas states that banned abortion ranked 37 on average, or 24th percentile (P<.001). States that banned abortion exhibited notably lower reproductive health scores in key domains including health care outcomes, access, and insurance (P<.01). There were not statistically significant differences in prevention or equity scores.

CONCLUSION:
A reproductive health scorecard can serve as a powerful framework to investigate the interplay between health outcomes and policy. In this application, we found that state-level reproductive scores correlated with abortion legality across metrics including health outcomes, access, and insurance.
Standardization of Evaluation and Management of Early Pregnancy Concerns in the Emergency Department: A Quality Improvement Initiative [ID 2683509]
Authors: Taper Gabrielle , Thaxton Lauren D. , Tristan Sigrid , Alvarez Miriam J. 
Published: May 2024

INTRODUCTION:
This study explored the effect of a standardized protocol for gynecologic consultation on readmissions for early pregnancy concerns in the emergency department (ED).

METHODS:
We conducted a retrospective cohort study of pregnant patients presenting to the ED for first trimester pregnancy concerns from January 2020 to March 2023. In October 2022, ED protocols were standardized such that gynecology was consulted for all pregnant patients without intrauterine pregnancy and cardiac motion. Patients seen before implementation (January 2020 to June 2021) were compared to patients seen after (October 2022 to March 2023). Chi-squared test and Fisher's exact test were used to investigate the association between readmission and reason for readmission to intervention period. The primary outcome, preventable readmission rate, was defined as a readmission that could have been prevented if the patient received correct counseling, diagnosis, or management at the index admission. This protocol was approved for IRB exemption by the University of Texas at Austin Dell Medical School.

RESULTS:
We identified 383 patients in the pre-implementation cohort compared to 130 patients seen after. There was an increase in the rate of gynecologic consultation for all concerns (30% before versus 40% after; P=.06). Fewer readmissions occurred after implementation (31% before versus 26% after) and preventable readmission decreased significantly (28% before versus 0% after; P<.001). Documented counseling about diagnosis also increased (74% versus 96%; P<.001) post-implementation.

CONCLUSION:
Readmission to the ED is common in early pregnancy; standardization of gynecologic consultation for early pregnancy care in the ED can improve quality of care and reduce readmissions.
Vaginal Cuff Self-Suspension Technique: A Novel Apical Suspension Technique for Patients With Uterovaginal Prolapse and Poor Tissue Integrity [ID 2683606]
Authors: Martingano Daniel J. S. , Theodros Mahelate , Nguyen Ashley , Martingano Francis X. 
Published: May 2024

INTRODUCTION:
Of all surgical approaches to correct apical prolapse, transvaginal native tissue repair (TNTR) accounts for 80–90% of cases. Conditions such as uncontrolled diabetes lead to poor tissue integrity, often rendering the anatomical structures necessary insufficient, resulting in recurrent prolapse or immediate procedure failure. We present a novel TNTR technique, called “vaginal cuff self-suspension technique” (VCST) that can be used in such cases to provide a potentially more reliable and efficient means of apical suspension.

METHODS:
We conducted a prospective observational study from July 2022 to July 2023 and followed all patients who underwent a total hysterectomy and subsequent TNTR for advanced uterovaginal prolapse and concurrent stage IV endometriosis or uncontrolled diabetes. Advanced uterovaginal prolapse was defined as either a POP-Q score of 3 or 4 or Baden-Walker Grade 3 or 4. Patients receiving VCST were compared with matched controls receiving other TNTR methods. The primary outcomes were recurrent apical prolapse at 6 months or failure at initial surgery, as discrete events. All appropriate IRB approvals were obtained.

RESULTS:
The study included 88 patients with 33 receiving VCST and 55 controls. Of the 55 controls, 42 utilized uterosacral ligament suspensions (USLS) and 13 utilized sacrospinous ligament fixations. Demographic factors were not significantly different. Patients receiving VCST had lower rates of initial failed suspension (6% versus 23%; P=.002) as well as a 37% decreased risk in confounder-adjusted models (risk ratio [RR] 0.63; 95% CI, 0.36–0.81; P=.003). Among patients with poorly controlled diabetes, the VCST had lower rates of recurrent prolapse (9% versus 47%) and a 81% decreased risk in confounder-adjusted models (RR 0.19; 95% CI, 0.08–0.31; P<.001).

CONCLUSION:
Vaginal cuff self-suspension technique offers a simple and effective way to potentially prevent recurrent apical prolapse and/or immediate procedure failure for patients with advanced uterovaginal prolapse and concurrent stage IV endometriosis or poorly controlled diabetes.
Laparoscopy Compared With Laparotomy as a Risk Factor for Intra-abdominal Adhesion Formation [ID 2683454]
Authors: Maghsoudlou Parmida , Cohen Rassier Sarah L. , Ajao Mobolaji , King Louise Perkins , Clark Nisse , Greenberg James A. 
Published: May 2024

INTRODUCTION:
The objective of this study is to compare the incidence and severity of abdominal and pelvic adhesions after laparoscopy versus laparotomy.

METHODS:
All patients undergoing laparoscopic surgery with study staff were included in this IRB-approved study. Postoperatively, surgeons filled out data collection forms to capture pertinent details. Patients with a history of only laparoscopy or only laparotomy were included, whereas those with known past inflammatory events, no prior surgeries, or a combination of laparoscopic and open procedures were excluded.

RESULTS:
Seventy-six laparoscopy-only and 83 laparotomy-only patients were included in this cohort. Adhesions were noted in 31 laparoscopy patients (40.8%) versus 74 laparotomy patients (89.2%; P<.001). Filmy adhesions were noted in 22 laparoscopy patients (28.9%) versus 37 laparotomy patients (44.6%), without statistical significance (P=.06098). Higher-grade adhesions were significantly more prominent in the laparotomy group. Laparotomy group had significantly more dense adhesions (55.4% versus 11.8%; P<.001) and cohesive adhesions with attached surfaces (32.5% versus 10.5%; P=.001614). By location, the laparotomy group had significantly more periumbilical adhesions (34.9% versus 3.9%; P<.001). Adhesiolysis time was shorter in laparoscopy (3 versus 10 minutes; P=.008439).

CONCLUSION:
Our data demonstrate that not only does laparotomy present a greater risk for adhesion formation than laparoscopy, but they are more likely to be present in the periumbilical area and the quality of those adhesions are significantly more likely to be dense and/or cohesive in nature, subjecting patients to more risk and requiring more surgical time to address.
Patient Preferences Regarding the Cervix, Ovaries, and Fallopian Tubes at the Time of Hysterectomy: A Qualitative Study [ID 2683453]
Authors: Louie Michelle , Adams Jenna C. , Conner Madelyn , Wong Jacqueline , Knittel Andrea Kathleen K. 
Published: May 2024

INTRODUCTION:
Although hysterectomy is one of the most common surgical procedures performed in the United States, preoperative patient counseling regarding removal or preservation of the cervix, fallopian tubes, and ovaries during benign hysterectomy is far from standardized. We aimed to understand patients' preexisting values, beliefs, and preferences regarding removal or preservation of the cervix, ovaries, and fallopian tubes at the time of benign hysterectomy.

METHODS:
We performed a qualitative study using semistructured interview of patients referred for benign hysterectomy with a minimally invasive gynecologic surgery division. Participants were recruited according to prespecified diversity axes. The interview guide was informed by literature review, expert stakeholders, and pilot testing. Telephone interviews occurred prior to their scheduled consultation with a surgeon. Responses were analyzed for themes using Rapid and Rigorous Data Qualitative Analysis. IRB approval was obtained.

RESULTS:
Age of participants (n=13) ranged from 24 to 60. Participants reported their race as non-Hispanic White (n=6), non-Hispanic Black (n=3), Hispanic (n=2), and multiracial or another race (n=2). Participants reported use of commercial insurance (n=8), Medicaid/Medicare (n=2), or self-pay/financial assistance (n=3). Identified themes included knowledge, decision making, treatment goals, short- and long-term consequences, fertility, identity, and lack of concern. Many participants expressed lacking necessary knowledge of the risks and benefits of removing the cervix and adnexa. Treatment goals included symptom relief and definitive treatment. Long-term consequences included concerns about menopause and future cancer.

CONCLUSION:
Prior to counseling, many patients express some degree of lack of knowledge, desire to remove most or all pelvic structures, and no attachment to their reproductive organs. Many patients expressed making decisions based on how organ removal will relieve current symptoms and long-term consequences, rather than immediate surgical risk, which can inform patient-centered counseling by their surgeon.
Time Is Ovary: Assessment of Current Latencies and Areas for Improvement in the Initial Assessment of Ovarian Torsion [ID 2683553]
Authors: Ekhteraei Setareh , Wilcox Mark 
Published: May 2024

INTRODUCTION:
Ovarian torsion is a gynecologic emergency with potential complications including reduced ovarian function, ovarian necrosis, and peritonitis. There are few studies that examine the effect of time from initial presentation to surgery on ovarian preservation.

METHODS:
We conducted an IRB-waived retrospective review of patients cared for at a single academic center from August 2018 to August 2023. The SlicerDicer tool in Epic was used to identify diagnostic laparoscopy performed by gynecologists for suspicion of ovarian torsion (n=60). We extracted times of key events and calculated corresponding latencies, including from initial presentation to examination, imaging, gynecologic consultation, and start of anesthesia. Patient characteristics, imaging findings, and surgical outcomes were noted.

RESULTS:
Patients undergoing diagnostic laparoscopy for suspected ovarian torsion were age 33 years on average. A pelvic examination was performed on initial evaluation in 20% of patients. Torsion was confirmed in 58% of patients (n=35), and 40% of these patients underwent oophorectomy. The average ovarian volume for patients with confirmed torsion was 241 and 57 cm3 in patients without torsion (P=.01, two-sample t-test). Although not statistically significant, patients who underwent oophorectomy experienced a longer time from presentation to anesthesia (n=14; 516 minutes) compared to those who underwent ovarian preservation procedures (n=21; 474 minutes).

CONCLUSION:
Patients with confirmed torsion had higher ovarian volumes on ultrasound. Interventions to reduce latencies may include strategies to expedite imaging results and fast-tracking consultation for patients with higher ovarian volumes.
Mixed-Methods Evaluation of the Implementation of a Hereditary Cancer Risk Screening Questionnaire in a Safety Net Hospital [ID 2683409]
Authors: Zielenbach Molly , De Leon Wendy Cervantes , Hamilton Alison , Marsh Leah , Mendoza Marlene , Holschneider Christine 
Published: May 2024

INTRODUCTION:
Patients belonging to medically underserved groups who meet testing criteria for hereditary cancer syndromes are less likely to be referred for genetic services and to complete testing. In our safety net hospital women’s health clinics, we introduced a novel National Comprehensive Cancer Network (NCCN)-based screening questionnaire as part of a community health worker (CHW)-supported hereditary cancer risk assessment and testing program.

METHODS:
We quantified program effect and conducted semistructured interviews with nurses and providers (n=12). We used rapid qualitative analysis to assess familiarity with screening questionnaire and barriers to its utilization. Institutional review board approval was obtained.

RESULTS:
Since January 2020, 2,282 patients were screened: 169 via provider referral and 2,113 via questionnaire. 312 met NCCN criteria for testing, with 30 ultimately testing positive. Nurses were familiar with the screening questionnaire and assumed an active role in facilitating completion. They reported minimal familiarity with the process after questionnaire completion. Providers reported minimal familiarity with the screening questionnaire but did assess family history and refer for genetic services. Barriers to successful utilization of the questionnaire included time constraints, patient literacy, language barriers, and gaps in patients' knowledge of their family history.

CONCLUSION:
Implementation of a targeted questionnaire may increase access to testing for hereditary cancer syndromes. We identified the following opportunities for implementation improvement: staff education, increased clinic efficiency, and CHW support with collection of accurate histories from patients with limited literacy/knowledge of their family's health history. Replication of a CHW-supported questionnaire-based screening program could reduce disparities in access to genetic services for patients in safety net settings.