Abstracts from Women's Health 2013: The 21 st Annual Congress March 22–24,2013 Washington,DC

1 Dean of Science & Medical Studies, Female Campus, King Saud University, Riyadh, Saudi Arabia 2 King Fahad Medical City, Riyadh, Saudi Arabia P1. Association Between Core Muscle Strength, Stress Urinary Incontinence, and Low Back Pain: A Case-Control Study

Background: Recent studies suggest an association between low back pain (LBP) and stress urinary incontinence (SUI), and clinicians commonly note that treating one component often impacts the other. It is hypothesized that core muscles must be functioning optimally for an individual to be free of LBP, and to be continent during activities which increase the intra-abdominal pressure.

Objective(s): This study investigates the relationship between LBP, SUI and core muscle strength.

Materials/Methods: A total of 303 women aged 18–45 years were included in this case control study. Cases with LBP were recruited through outpatient physical therapy departments, targeting patients referred with LBP of 6 months duration or longer. Outcome measures included the Oswestry Disability Index (ODI) to assess LBP, and the International Consultation on Incontinence Questionnaire (ICIQ) to assess SUI. Core muscle strength was assessed using the prone plank test. Correlational analysis and Chi-square test were used to test for associations and differences respectively.

Results: There were no statistically significant differences in the demographics between the control group (n=160), and cases with LBP (n=143). Over 60% of cases with LBP had SUI compared to 20% incidence of SUI in the control group. SUI was significantly greater in the LBP cases compared to the control group (p<0.05). Core muscle strength moderately correlated with the ODI (r=−0.54). Core muscle strength and SUI were moderately correlated in the control group (r=−0.6), and highly correlated in the cases with LBP (r=−0.75).

Conclusions: Women with LBP have a higher risk of developing SUI especially if the core muscles are not functioning optimally. This study highlights the importance of utilizing the core muscles in their entirety in the assessment and treatment of both conditions. The findings have implications for clinicians designing prevention and treatment programs for this subgroup of women.

1 Virginia Commonwealth University Health Systems, Department of Obstetrics and Gynecology, Richmond, VA 2 Virginia Commonwealth University, Department of Epidemiology and Community Health, Richmond, VA P2. Effectiveness of Centering Pregnancy in Reducing Poor Birth Outcomes

Background: Preterm birth (PTB) and low birthweight (LBW) are significant public health concerns. In the US, 500,000 premature and 350,000 LBW infants are born annually. The Centering Pregnancy prenatal care model has shown promise in reducing these poor birth outcomes. Prior studies, although not conclusive, suggest that this model of care may improve birth outcomes.

Objective(s): To examine the impact of Centering Pregnancy prenatal care on poor birth outcomes and breastfeeding initiation.

Materials/Methods: This is a retrospective cohort study comparing women with singleton gestations who received group prenatal care in Centering Pregnancy to those who received traditional individual prenatal care at Nelson Clinic and delivered at MCV between 2009–2010. Medical record reviews were conducted on 168 women. Information was collected on maternal medical conditions, prior pregnancy history, maternal demographics and maternal substance use, infant birth weight, gestational age at delivery, and breastfeeding initiation. Data was analyzed using a multiple logistic regression model.

Results: There was no statistically significant difference between the Centering and the usual care groups with regard to race/ethnicity, marital status or employment. Compared to women who received the usual care, women who received Centering Pregnancy had lower rates of preterm birth (8.8% vs. 11.2%) and low birth weight (10.3% vs. 16.9%). However, the difference was not statistically significant [PTB (AOR=0.91, 95% CI=0.27–3.10), and LBW (AOR=0.29, 95% CI=0.07–1.23)]. Women who received Centering Pregnancy had higher rate of breastfeeding initiation (AOR=6.06, 95% CI=1.09–33.77).

Conclusions: Although not statistically significant, Centering Pregnancy may reduce the rate of PTB and LBW. Further analysis using a larger sample size should be conducted to confirm this result. The current analysis does demonstrate that Centering Pregnancy significantly improves the rate of breastfeeding initiation.

1 Kaiser Permanente, Division of Research Oakland, CA 2 Departments of Epidemiology and Obstetrics & Gynecology, University of Washington Seattle, WA 3 Kaiser Permanente, Department of Obstetrics and Gynecology Oakland, CA P3. Clinic-Based Counseling at the Time of Self-Referred Pregnancy Testing in Teens: Effects on Contraceptive Use and Pregnancy Rates

Background: Teens who self-refer for pregnancy testing have most likely had unprotected intercourse and are therefore at high risk for unintended pregnancy. Contraceptive counseling at the time of self-referred pregnancy testing may increase contraceptive use and decrease pregnancy rates among teens not already using effective contraception.

Objective(s): The objective of this study was to evaluate the effect of a clinic-based brief counseling intervention at self-referred pregnancy test on continuous use of effective contraception and teen pregnancy rates during the 12 months after the index pregnancy test.

Materials/Methods: A retrospective cohort study was conducted on 702 teens aged 13–17 with a negative pregnancy test result who self-referred for a pregnancy test from facilities with and without the intervention between 9/1/2007–12/31/2009. The intervention used motivational interviewing to counsel teens about contraception and offered same-day initiation of hormonal contraception. Demographic and clinical characteristics, contraceptive use (prescribed) and pregnancy during the 12 months following the pregnancy test were obtained through electronic database extraction and medical records. Statistical analyses were conducting using Chi-square tests, logistic regression and Cox proportional hazards models.

Results: Teens without effective contraception who received the intervention at the time of self-referred pregnancy testing were significantly more likely to use effective contraception at 3 (OR=1.9), 9 (OR=1.7) and 12 months (OR=1.9), (all p<0.04); age and median household income were not significant. Based on the Cox proportional hazards model results, teens in the control group had 1.73 times the hazard of experiencing pregnancy in 12 months as teens in the intervention group, controlling for race, parity, age, and income.

Conclusions: A brief, immediate counseling intervention given to teens not using contraception at the time of a self-referred pregnancy test improved continuous use of effective contraception over 1 year follow-up. Teens not on effective contraception who received the intervention were less likely to become pregnant in the follow-up year.

1 Wake Forest University School of Medicine Winston-Salem, NC 2 University of Massachusetts Medical School Worcester, MA 3 Graduate School of Public Health, University of Pittsburgh Pittsburgh, PA 4 Department of Medicine, University of Minnesota Minneapolis, MN 5 School of Medicine, University of California Los Angeles, CA 6 UC Davis School of Medicine, Davis, CA P4. Duration of Vasomotor Symptoms During the Menopausal Transition

Background: Vasomotor symptoms (VMS), hallmark symptoms associated with the menopausal transition (MT), are experienced by up to 87% of women undergoing natural menopause, and can substantially affect quality of life. VMS are one of the chief menopausal complaints for which US women seek medical treatment and are the primary reason that women begin hormone therapy. Until recently, we have lacked sufficient longitudinal data before and after the final menstrual period to adequately inform women of the possible duration of VMS.

Objective(s): To determine the average duration (in years) and correlates of frequent VMS.

Materials/Methods: Data for these analyses come from the Study of Women's Health Across the Nation (SWAN), a 16-year multi-ethnic longitudinal study of the MT. Women were aged 42–52 and pre or early perimenopausal at baseline. The primary outcome, duration of frequent VMS defined as experiencing hot flashes or night sweats at least 6 days in the past 2 weeks, was based on the number of annual visits at which frequent VMS were reported. VMS duration was modeled using survival analysis, including Kaplan-Meier estimation and Cox proportional hazards to account for censoring (e.g., due to dropout). Covariates were MT stage, race/ethnicity, hormone therapy use, age, body mass index, partner status, economic hardship, education, cigarette smoking, alcohol, physical activity, attitudes towards menopause, symptom sensitivity, anxiety, perceived stress, and depressive symptoms.

Results: Median VMS duration in the entire sample was 8.7 years. Duration varied greatly by race/ethnicity: African-American women had a longer duration (>9.8 yrs.) and Chinese (5.4 yrs.), Japanese (5.5 yrs.), and Hispanic (>3.7 yrs.) women had a shorter duration compared to Caucasian women (8.5 yrs.). In multivariate analyses, VMS duration was significantly longer for women who were younger, premenopausal at the first symptomatic visit, African-American, reported higher perceived stress and lower social support at the first symptomatic visit, and used hormone therapy concurrent with frequent VMS.

Conclusions: Frequent VMS last longer than previously thought and vary by race/ethnicity, independent of a wide range of covariates.

1 Department of Physical Therapy, Faculty of Anhanguera Campinas, Campinas/SP, Brazil 2 Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas/SP, Brazil P5. Effect of Pilates in Strengthening Pelvic Floor Muscles of Patients with Stress Urinary Incontinence

Background: Stress urinary incontinence represents an important public health problem because it adversely effects the quality of life of women. Strengthening the pelvic floor muscles is considered the first line of treatments in these cases, and Pilates can bring positive results because the exercises are performed in conjunction with contraction of the pelvic floor muscles.

Objective(s): To verify the effect of Pilates on the strength of pelvic floor muscles and the symptoms of women diagnosed with stress urinary incontinence.

Materials/Methods: A clinical trial was conducted in the Faculty of Anhanguera in Campinas, Brazil. 5 women with clinical diagnoses of stress urinary incontinence were included. An evaluation was conducted pre- and post-treatment and consisted of a functional assessment of the pelvic floor, which consisted of examination and strength evaluation by bidigital palpation, as well as a questionnaire established for this research regarding personal data, clinical history, and symptoms of urinary incontinence. The treatment included a program of Pilates exercises in different positions - supine, prone, on all fours, sitting, and standing - in ten 45 minute sessions 2 times per week.

Results: After completion of the 10 sessions, the patients showed improvement in strength and endurance of the pelvic floor muscles, as well as decreases in nocturia, Intraabdominal pressure, volume of urine loss, and the number of absorbents used.

Conclusions: The patients achieved satisfactory results with the exercise program, suggesting that Pilates is an effective method for the treatment of Stress Urinary Incontinence. However, the literature is sparse in this area and more research is needed of appropriate methodological quality to increase external validity of these results and to generalize them to other incontinent women.

1 Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 2 Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 3 Neuroscience Institute, Georgia State University, Atlanta, GA; Department of Psychology, University of Massachusetts, Amherst, MA 4 Department of Psychology, University of Massachusetts, Amherst, MA 5 Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 6 Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA; Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA P7. Plasma 25-Hydroxyvitamin D Levels and Risk of Premenstrual Syndrome in A Population-Based Study

Background: Moderate to severe premenstrual syndrome (PMS) affects as many as 20 percent of premenopausal women. Because pharmacologic treatments for PMS have substantial limitations, novel strategies to prevent and treat PMS are needed. Previous studies suggest that high dietary vitamin D intake may reduce risk, but the association of vitamin D status with PMS overall and with specific menstrual symptoms remains unclear.

Objective(s): We have assessed the relation of plasma 25-hydroxyvitamin D (25OHD), total calcium and parathyroid hormone levels with PMS and specific menstrual symptoms in a case-control study nested within the prospective Nurses' Health Study II.

Materials/Methods: Participants included 402 women who developed PMS over 14 years (1991–2005) and 402 matched controls without PMS. Biomarkers were assayed in luteal phase blood samples provided in 1996–1999. Blood samples were collected prior to diagnosis for 123 “incident” cases, allowing for both prospective and cross-sectional analyses.

Results: Overall, we did not find plasma 25OHD, total calcium or parathyroid hormone levels to be associated with PMS. In prospective analyses of incident cases, 25OHD levels were inversely related to risk of specific symptoms including breast tenderness, fatigue, diarrhea and/or constipation, and depression. For example, each 1 nmol/L increase in 25OHD was associated with a significant 2.5% lower risk of experiencing PMS with breast tenderness (P=0.01).

Conclusions: While plasma 25OHD levels were unrelated to PMS status overall, results from prospective analyses suggest that vitamin D may be associated with lower risk of edema symptoms and depression, and consequently that associations may be obscured if PMS is evaluated only as a single aggregate disorder. Clinical trials are necessary to determine if vitamin D holds promise for preventing and/or treating specific symptoms or subtypes of PMS.

1 VA San Diego Healthcare System, San Diego CA P9. Service Utilization and Treatment Outcomes for Women Veterans with MST

Background: With the number of female Veterans rising, increased attention and efforts have been placed on expanding and improving VA services for this growing population. One area of care that is of particular relevance to women veterans is treatment for distress related to military sexual trauma (MST). MST is reported by 20% of women presenting for VA healthcare services, and has been associated with high rates of PTSD and other psychological symptoms (see Allard et al. 2011).

Objective(s): We studied 183 Veterans with MST histories seeking services in the MST Clinic at the VA San Diego Healthcare System over a two-year period.

Materials/Methods: Veterans completed the Patient Health Questionnaire (PHQ-9) and PTSD Checklist (PCL-S) at several points throughout their contact with the clinic; during intake, at pre-treatment, between sessions, and post-treatment.

Results: Eighty-one percent of the Veterans were women (Mage=39.87, SE=12.64), most of whom were Caucasian (51.7%) or African-American (23.1%), identified as heterosexual (86.9%), an also reported other trauma experiences (45.9% childhood sexual, 21.6% childhood physical, 25.7% intimate partner, 10.1% adult sexual, 2.7% adult physical). Forty-eight percent initiated PTSD treatment (CPT, PE or ACT) completing an average of 9.63 (SD=12.70) treatment sessions. Veterans experienced statistically and clinically significant pre- (M-52.56, SD=15.63) to post-treatment (M=46.37, S=15.94) reductions in PTSD Checklist (PCL-S) scores, and pre- (M=12.44, SD=6.37) to post-treatment (M=10.60, SD=5.82) reductions in Patient Healthcare Questionnaire (PHQ-() depression scores, but scores on average remained above the cutoffs suggestive of PTSD and depression diagnoses, respectively.

Conclusions: In summary, a substantial proportion of women Veterans present to VA with MST related distress; however, a large portion does not engage in treatment. Those who do engage in treatment appear to experience some benefit but continue to be symptomatic and may need ongoing care. These results suggest the need for developing and testing strategies to improve treatment engagement and treatment outcomes in this population.

1 Department of Psychological Science, Carthage College, Kenosha, WI P10. Pregnancy Changes Subjective But Not Objective Measures of Olfaction

Background: Olfaction is important for detecting danger, enjoying food, and overall quality of life. Hyposmia and anosmia (loss of sense of smell) are more common than hyperosmia (heightened olfactory sensitivity). Smell loss has received more scientific attention than hyperosmia given its potential consequences (e.g., failure to detect dangerous odors such as smoke or gas). However, hyperosmia is also associated with negative consequences, such as nausea, vomiting and disgust. Hyperosmia is suspected in pregnancy; however, no empirical study using well-validated measures of olfactory function has ever documented the anecdotal reports of this problem.

Objective(s): The goal of the current study was to compare the olfactory sensitivity of pregnant women to that of non-pregnant women and men using state-of-the-art quantitative test measures. Each person's self-report of their sensitivity was also assessed.

Materials/Methods: One hundred and four women and 32 men participated. All rated their sense of smell and pregnant women (N=47) listed the odors to which they were most sensitive. Detection thresholds for phenyl ethyl alcohol (rose odor) were measured using a well-validated protocol. A subset of 30 pregnant women and 25 non-pregnant women were studied longitudinally using a signal detection procedure designed to detect small differences in sensitivity.

Results: Pregnant women rated their sense of smell, particularly in the first trimester, to be higher than non-pregnant women and men. They also indicated many odors (primarily unpleasant) to which they were more sensitive. Women rated their sense of smell higher than men. However, there was no sex difference in thresholds and neither thresholds nor measures of signal detection were affected by either sex or pregnancy status.

Conclusions: The implications of the lack of relationship between subjective and objective measures of olfaction, particularly in pregnancy, will be discussed. The role of perceived hypersensitivity in nausea, vomiting and heightened levels of disgust will be explored.

1 Mayo Clinic, Jacksonville, FL P11. The Benefit of Cooled Radiofrequency in Women with Chronic Sacroiliac Joint Pain: A Clinical Note

Background: The prevalence of chronic low back pain (CLBP) in women [1] has noticeably increased. Sacroiliac Joint pain often leads to functional limitations, psychological symptoms, and higher healthcare costs. Moreover, the treatment for women with CLBP caused by sacroiliac joint dysfunction is limited. One option to address this pain is cool radiofrequency (CRF) [2,3].

Objective(s): The purpose of this retrospective study was to assess the impact of a cool radiofrequency denervation on patients with sacroiliac joint pain.

Materials/Methods: We reviewed the electronic medical records of patients who had chronic sacroiliac joint pain and were treated at the Pain Medicine Clinic at the Mayo Clinic in Jacksonville, Florida between 2008–2012. Patients in our study if they were over the age of 21, non-pregnant, and elected to have CRF. Within each medical record were questionaires regarding severity of pain and the onset and duration of pain relief. Patients participated in the questionnaires prior to each procedure and additionally at one, three, six, 12 and 15 months post-procedure. Additionally, the frequency with which the procedure was repeated was also documented.

Results: The preliminary results reflect that women represented 76% of the total cases with a mean age of the women was 67 years. Moreover, 42% of these women elected to have the CRF procedure repeated or applied to the contralateral side, resulting in prolonged intervals of pain relief. The average duration of pain relief for women was six months; unexpectedly, the maximum duration of pain relief observed was at 26 months.

Conclusions: This is the first report describing the benefits of Cooled Radiofrequency denervation in women. Using a non-surgical approach CRF extends relief from chronic sacroiliac joint pain. This technique appears to be a viable and safe option for sacroiliac joint dysfunction in women.

1 Division of General Internal Medicine; Penn State College of Medicine; 500 University Drive, HO34; Hershey, PA 2 Department of Public Health Sciences; Penn State College of Medicine; 600 University Drive, A210; Hershey, PA P14. Pregnancy Intention and Ambivalence in Obese and Non-Obese Women

Background: Studies report that obese women are less likely to use contraception, although the reasons for this are unclear. Ambivalence toward future pregnancy (i.e., not sure if you want a future pregnancy or not) has been associated with contraceptive non-use and increased risk for unintended pregnancy.

Objective(s): To compare future pregnancy intentions and ambivalence toward future pregnancy in obese and non-obese women.

Materials/Methods: Participants of the First Baby Study, a cohort of 3,006 women recruited during the pregnancy of their first child, were interviewed during the 3rd trimester. Dependent variables were intending future pregnancy (Y/N) and certainty/ambivalence about those intentions (very sure vs. somewhat sure/not at all sure/don't know). Logistic regression analysis modeled the outcomes of pregnancy intention and ambivalence, adjusting for age, race/ethnicity, education, marital status, pregnancy complications, and intendedness of current pregnancy.

Results: There were 607 (20%) obese and 2365 (80%) non-obese women in the study sample. Most women (86%) reported intending a future pregnancy, with 44% ambivalent (i.e., unsure) about those intentions. Pregnancy intention did not differ by weight category, however obese women were more likely to be ambivalent about future pregnancy than non-obese women (49% vs. 43%, p=0.006), which persisted in multivariable analysis (adjusted OR 1.23, 95% CI 1.01–1.50).

Conclusions: Obese women were more likely than non-obese women to report ambivalence toward future pregnancy. Since ambivalence has been linked to inconsistent contraceptive behavior, greater ambivalence may partly explain why obese women have been found to be less likely to use contraception and have higher rates of contraceptive failure.

1 Division of General Internal Medicine; Penn State College of Medicine; Hershey, PA 2 Penn State College of Medicine; Hershey, PA 3 Cornell University; Ithaca, NY 4 Department of Public Health Sciences; Penn State College of Medicine; Hershey, PA P15. Behaviors of Pregnant Women who Achieve and Exceed Recommended Gestational Weight Gain

Background: Excessive gestational weight gain (GWG) results in increased risk for pregnancy-related complications, postpartum weight retention, and long-term obesity. The majority of U.S. pregnant women gain more than the Institute of Medicine recommended GWG guidelines (25–35 pounds, 15–20 pounds, and 11–20 pounds for pre-pregnancy normal weight, overweight, and obese women, respectively). Little is known about the specific behavioral habits of pregnant women who achieve vs. exceed GWG recommendations.

Objective(s): To identify habits of overweight and obese women who achieve and exceed current GWG recommendations.

Materials/Methods: In 2011, we conducted semi-structured interviews with 29 women following the birth of their first child. Participants were overweight or obese prior to pregnancy. Using principles of positive deviance—an inductive approach of identifying the effective practices of people who have succeeded at a task that many people fail—we describe the diet, physical activity, and self-monitoring habits of women who achieve and exceed GWG recommendations.

Results: Of the 29 women interviewed, 14 women were overweight and 15 were obese before pregnancy. Eighteen (62%) exceeded the GWG recommendations. Women achieving appropriate GWG reported deliberate planning to avoid gaining too much weight with only modest increases in caloric intake (if at all) and careful meal and snack planning (“I put more time and effort in my eating choices, it was definitely a conscious decision.”) Women with excessive GWG described liberalized eating (“I had the mindset that I was eating for two, so I could eat double. I allowed myself to eat way more than I ever would had I not been pregnant, thinking I will show quicker, I can eat whatever I want.”) Nearly all women with excessive GWG reported exercising less during pregnancy (or remaining sedentary), while women with appropriate GWG largely increased or maintained pre-pregnancy physical activity levels. About half of the sample reported self-monitoring weight gain during pregn

Conclusions: Women who were overweight or obese prior to pregnancy and achieved appropriate GWG reported deliberately planned diet and physical activity habits, in addition to appropriate GWG goals during pregnancy. Women exceeding recommended GWG described “eating-for-two,” were sedentary, and either had no goals for GWG or intended to gain more than recommended.

1 Johns Creek Primary Care, Suwanee, GA 2 Mark Mouton MD, Baker, LA 3 Wake Forest Family Physicians, Wake Forest, NC 4 Arizona Sun, Gilbert, AZ 5 Vanderbilt University, Nashville, TN P16. The Use of a Personalized Gene Expression Test to Improve Decision Making in the Evaluation of Women with Suspected Coronary Artery Disease

Background: More accurate coronary artery disease (CAD) assessment methods are needed to reduce overuse of non-invasive diagnostic testing and associated risks of radiation and dye exposure, particularly in women.

Objective(s): We hypothesized that gene expression score (GES) results would improve the diagnostic evaluation of women by reduction of referrals to the cardiologist.

Materials/Methods: The GES is a validated quantitative diagnostic test for non-diabetic patients, measuring expression levels of 23 genes from peripheral blood cells to determine the likelihood of a patient having at least one vessel with ≥50% coronary artery stenosis. As previously reported in a large study of patients referred for non-invasive testing, the GES has a negative predictive value of 96%. Four primary care practices underwent education and training in the use and interpretation of the GES. A total of 141 female patients presented to these practices with chest pain and underwent GES testing from January to September 2011. In this gender-based post-hoc analysis, we extracted medical chart information on patient demographics, chest pain symptoms, diagnostic testing, GES, and cardiology referrals.

Results: Patients had a median age of 58 years and presented with typical and atypical symptoms (n=78, 55%), with ≥3 risk factors for CAD (n=49, 35%), or with <3 risk factors for CAD (n=14, 10%). There were 103 (73%) patients with low GES (≤15, 1–40 scale). The primary analysis was the proportion of referrals to a cardiologist among low and elevated GES patients. Overall, 30 (21%) patients were referred to a cardiologist: 12% (n=12) of low and 48% (n=18) of elevated GES patients. The odds ratio by logistic regression for referral for low GES patients was 0.23 (p=0.029), controlling for age, type of symptoms, and practice site. There were no major adverse cardiac events among the 67% (n=95) of patients available for follow-up with an average duration of 163 days.

Conclusions: Patients with low GES were 77% less likely to be referred to a cardiologist. This clinical practice innovation involving personalized gene expression scores may be used by primary care physicians to rule out women patients at low-risk for obstructive CAD.

1 Yale University School of Medicine, New Haven CT 2 CardioDx, Palo Alto, CA 3 Columbia University Medical Center, New York, NY 4 Vanderbilt Heart and Vascular Institute, Nashville, TN 5 Duke University School of Medicine, Durham, NC P17. A Gender-Specific Blood-Based Gene Expression Score for Assessing Obstructive Coronary Artery Disease in Nondiabetic Patients: Results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) Trial

Background: Currently available noninvasive tests to risk stratify patients for obstructive coronary disease result in many unnecessary cardiac catheterizations, especially in women.

Objective(s): We sought to compare the diagnostic accuracy of presenting symptoms, noninvasive test results, and a gene expression score (GES) in identifying obstructive coronary artery disease (CAD) according to gender, using quantitative coronary angiography as the criterion standard.

Materials/Methods: The PREDICT trial is a prospective multicenter observational study designed to develop and validate gene expression algorithms to assess obstructive CAD, defined as at least one ≥50% diameter stenosis measured by quantitative coronary angiography. Patients referred for diagnostic cardiac catheterization with suspected but previously unknown CAD were enrolled. Noninvasive myocardial perfusion imaging (MPI) was available in 60% of patients. The GES, comprising gender-specific age functions and 6 gene expression terms containing 23 genes, was performed for all patients.

Results: A total of 1,160 consecutive patients (57.6% men and 42.4% women) were enrolled in PREDICT. The prevalence of obstructive CAD was 46.7% in men and 22.0% in women. Chest pain symptoms were a discriminator of obstructive CAD in men (P b .001) but not in women. The positive predictive value of MPI was significantly higher in men (45%) than in women (22%). An abnormal site-read MPI was not significantly associated with obstructive or severity of CAD. The GES was significantly associated with a 2-fold increase in the odds of obstructive CAD for every 10-point increment in the GES and had a significant association with all measures of severity and burden of CAD. By multivariable analysis, GES was an independent predictor of obstructive CAD in the overall population (odds ratio [OR] 2.53, P=.001) and in the male (OR 1.99, P=.001) and female (OR 3.45, P=.001) subgroups separately, whereas MPI was not.

Conclusions: Commonly used diagnostic approaches including symptom evaluation and MPI performed less well in women than in men for identifying significant CAD. In contrast, gender-specific GES performed similarly in women and men. Gene expression score offers a reliable diagnostic approach for the assessment of nondiabetic patients and, in particular, women with suspected obstructive CAD. (Am Heart J 2012;164:320-6.)

1 Temple University Health Sciences Center, Rm 943 Parkinson Pavilion Philadelphia, PA 2 Temple University Health Sciences Center, Philadelphia, PA 3 University of Illinois, College of Applied Health Sciences, Chicago, IL P20. Missed Opportunity to Favorably Alter Cardiovascular Disease Risk Factors in African Americans, Especially African American Women

Background: African-American Women (AAW) are a particularly high risk group, for which novel Cardiovascular Disease (CVD) risk reduction strategies are needed. Traditional CVD risk factors contribute to the development of diastolic dysfunction (DD). Early detection of DD may be a useful tool to assist in setting more aggressive cholesterol management goals.

Objective(s): The purpose of this study was to determine whether echocardiographic assessment of DD has incremental benefit in AAW at risk for CVD.

Materials/Methods: Forty-nine healthy, middle-age AA men (AAM, n=11) and AAW (n=38) were included in this study. CVD risk was assessed using the Framingham risk score (FRS). Fasting blood samples were collected for lipid analysis. Echocardiography including tissue Doppler imaging was performed. An abnormal myocardial relaxation velocity (E') was defined as <8 cm/s. All subjects had normal LV function. Continuous variables were summarized as mean±SEM. Data was analyzed using ANOVA and regression analysis.

Results: Both AAW and AAM had modest LDL levels (112.5±3.9 vs. 113.5±4.1, p=0.89). There was no difference in blood pressure (BP) or levels of FRS predictors between AAW and AAM, yet AAW received a lower 10-year risk score (6.3%±1.5 vs. 1.5%±0.2, p<0.005). 91% of subjects had an E′ velocity<8 cm/s. AAW had a higher E/E′ratio compared to AAM. Associated with these abnormalities, AAW had a greater degree of concentric remodeling (0.628±0.02 vs. 0.48±0.029, p=0.001). Regression analysis showed that these modifiable CVD risk factors: triglycerides, BP, body weight, Low Density Lipoprotein, and High Density Lipoprotein levels predicted E′ velocity. Diastolic BP, age, fasting blood glucose and height were independent predictors of E′ and E/E′.

Conclusions: Among AA's, modifiable CVD risk factors are associated with DD. Furthermore, AA's have evidence of early changes in myocardial structure associated with CVD progression. In a population at risk for development of CVD, opportunities to reduce CVD risk are being missed. The assessment of diastolic function may be a useful adjunctive measure to determine whether more aggressive cholesterol management is warranted. This strategy may be especially helpful among AAW whose FRS underestimates their risk.

1 Appalachian State University, Boone, NC 2 Metropolitan State University, Denver, CO P21. The Role of Reasons for Exercise, Exercise Behaviors, and Relative Size in Determining Body Esteem; Differences Across Gender

Background: Research links exercising for appearance-related reasons with disordered eating, poor body-esteem, self-esteem, and negative psychological well-being.

Objective(s): Compare the relationships between body esteem, exercise behaviors, reasons for exercise, and relative size. Determine if differences in these patterns arise for men and women.

Materials/Methods: Expanding this research, college undergraduates, 144 males, and 272 females, completed the body esteem scale (BES), reasons for exercise inventory (REI) and measures of relative size (current-ideal BMI), and exercise behaviors. Over half of women and nearly three quarters of men reported exercising regularly. Between genders there was no difference in time spent exercising.

Results: Active females, who exercised for mood/stress management, reported lower body esteem for both sexual and physical attractiveness. Women who exercised to improve health had lower body esteem in both physical condition and sexual attractiveness. Similarly, active men who exercised for health management were low in physical attractiveness body esteem. By contrast, for men, mood and stress management reasons were not related to BES measures. As expected, women hoped to lose or maintain weight but, for men, relative size was variable. More men hoped to gain rather than lose weight. Sedentary and active women dissatisfied with their BMI scored lower on BES weight control and physical condition. Sedentary men at their ideal BMI scored higher in BES physical condition and upper body strength, than unsatisfied men.

Conclusions: Contrary to previous research, these data suggest that women who exercise for appearance/weight based reasons report higher weight control body-esteem. The relationship between women's body esteem and relative size was not dependent on exercise. For men, exercise influenced the relationship between upper body strength/physical condition body esteem. Only sedentary men, meeting ideal BMI, experienced a body esteem boon. Though women have higher body esteem when they engage in exercise for weight management, the negative impact of an untainted ideal on body esteem is not altered. Men's experiences are different. Understanding of this relationship is important in constructing interventions targeting risky behaviors.

1 Office of Women's Health, Food and Drug Administration, Silver Spring, MD 2 Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD P22. Inclusion of Women and Sex Analyses in Pivotal Clinical Trials of New Molecular Entity (NME) Drugs and Biologics Approved by FDA from 2010 to 2011

Background: Historically, women have been underrepresented in clinical trials. Sex difference in disease prevalence, progression and prognosis requires appropriate inclusion of males and females in clinical trials. To accurately assess the safety and efficacy of therapeutics prior to approval, the US Food and Drug Administration (FDA) has made a conscious effort towards adequate representation of women and minorities in clinical trials through guidance documents and regulations.

Objective(s): This study tracked the participation of women in pivotal trials, as well as the analyses of the effects of sex on efficacy and safety, for FDA-approved New Drug Applications (NDAs) and Biologics License Applications (BLAs) from 2010 to 2011.

Materials/Methods: The statistical and medical reviews of the NMEs approved between January 2010 and December 2011 were obtained from Drugs@FDA. All pivotal clinical trials referenced in the reviews were evaluated for the extent of female participation and data analysis by sex. Pivotal trials were defined as those phase 3 or 2/3 studies that were described in the label or medical review in support of the drug approval.

Results: Fifty-one NMEs (39 NDAs and 12 BLAs) were approved by the FDA from 2010–2011. Drugs with sex-specific indications were excluded (n=6). Overall, the participation of women was 41% for NDAs and 64% for BLAs. The therapeutic area with the lowest female inclusion was Pulmonary, Allergy and Rheumatology (30%), while Dermatology and Dental had the highest women representation (93%). Of the 45 NMEs sex analysis was reported in 42 (93%) for efficacy, 36 (80%) for safety and 35 (77%) for both, as reflected by information in the statistical and medical reviews.

Conclusions: Women's participation in the pivotal trials for NMEs approved between 2010–2011 averaged 43%. The 2001 GAO reported an average of 52% for drugs approved between 1998 and 2000. The frequency of analyses of the effects of gender on both safety and efficacy conducted by Sponsors has increased to 77% since the 2001 GAO report of 72%.

1 National Centre for Epidemiology, Public Health Institute Carlos III, Madrid, Spain 2 Hospital Universitario La Fe, Valencia, Spain 3 Hospital Universitario Ramon y Cajal, Madrid, Spain 4 Hospital Universitario San Pedro, La Rioja, Spain 5 Hospital Universitario de Elche, Alicante, Spain 6 National Centre for Epidemiology, Public Health Institute Carlos III, Madrid, Spain P23. Reproductive Desire in Women with HIV Infection in Spain

Background: Since the availability of highly active antiretroviral treatment (HAART), the quality of life and prognosis in HIV-infected persons has improved significantly. Moreover, HAART in women with HIV infection together with programmed caesarean sections have reduced mother to child transmission to rates of under 2%. All this has led a growing number of HIV-infected persons to consider the possibility of having children. Studies in women diagnosed with HIV infection show that many of these women decide to have children, even after knowing that they are seropositive. For that, it is important to understand the fertility desires and intentions of HIV+ women in order to develop programs to support them in planning safe pregnancies.

Objective(s): To estimate reproductive desire and sociodemographics and clinical related-factors in HIV-infected women included in the cohort of Spanish Network on HIV/AIDS Research.

Materials/Methods: HIV-infected women, in reproductive age (18–45 years) attended in 10 hospital of 6 Autonomous Community of Spain. Data were collected by phone-interview through “ad hoc” questionnaire between November 2010 and June 2012. Reproductive desire (RD) was defined as woman has a desired pregnant at the time of the interview, as having unprotected sex in order to procreation or showing children desire in next future.

Results: Overall, 134 women were interviewed, 49% had RD. A 55% were Spanish, 20% Latin-Americans, 15% Europeans and 11% Africans. A 77% had secondary education and a 35% were unemployed. An 84% had been infected through unprotected sex with a median time from diagnosis of 4.5 years and an 85% were receiving antiretroviral treatment. A 53% had received information on reproductive health. An 86% had been pregnant with a total of 280 pregnancies. A 35% of the all pregnancies had occurred when woman was HIV positive, and 33 women were diagnosed of HIV infection during pregnancy or delivery. In the multivariate logistic regression, reproductive desire was associated with age, compared with women between 30 and 39 years, women younger than 30 years had a higher reproductive desire (OR=4.5 CI95% 1.4–14.3) and; had any child (OR=0.3 0.1–0.7) compared with none child; be immigrant (OR=2.2; 1.0–5.0) and receive antiretroviral treatment (OR=3.6; 1.1–12.1).

Conclusions: Desire for children in women with HIV infection is primarily related to not have children and age. By other hand, there is a lack information about reproductive issues in these women, for that, it is very important integrate these issues in the health care.

1 Mayo Clinic, Phoenix, Arizona 2 Mayo Clinic, Rochester, Minnesota P24. Effect of Menopausal Hormone Therapy (MHT) on Endothelial Function in Recently Menopausal Women: A Kronos Early Estrogen Prevention (KEEPS) Sub-Study

Background: Endothelial dysfunction occurs early in the atherosclerotic disease process, often preceding symptoms. Estrogenic treatments sustain endothelial function in experimental animals and increase endothelium-dependent vasodilation in human studies. However, effects of MHT on endothelial function in recently menopausal women are unknown.

Objective(s): To determine effects of four years of MHT on endothelial function in healthy, recently menopausal women.

Materials/Methods: Digital pulse volume during reactive hyperemia was measured by digital tonometry (EndoPat2000, Itamar Medical, Israel) in 118 women (age: 52±2) enrolled in KEEPS and randomized to oral conjugated equine estrogen (0.45 mg), transdermal 17β estradiol (50 μg), each with intermittent progesterone (200 mg daily for 12 days of the month), or placebo. Reactive hyperemia index (RHI) was determined prior to randomization (baseline) and annually for four years. Normal, abnormal and indeterminate RHI values were defined as: >2.0, <1.7, and 1.7–2.0. Analysis of covariance was used to test for a significant treatment effect on change in RHI at 4 years.

Results: Among the 72 women with data at both visits, the mean (±SD) baseline and 4 year RHI values were, respectively, 2.2 (±0.6) and 2.1 (±0.6) for subjects on transdermal estrogen, 2.3 (±0.7) and 2.3 (±0.6) for subjects on oral estrogen, and 2.4 (±0.7) and 2.5 (±0.7) for subjects on placebo. Change in RHI after 4 years of treatment did not significantly differ among groups (p=0.55).

Conclusions: In recently menopausal women, MHT for 4 years had no significant beneficial or deleterious effect on endothelial function, as measured by RHI. This observation concurs with the overall findings of the KEEPS trial demonstrating no significant adverse effects on surrogate end-points of cardiovascular health.

1 Groupe d'analyse, Ltée, Montréal, QC, Canada 2 Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ 3 Analysis Group, Inc., Boston, MA 4 Bixby Center for Global Reproductive Health, University of California, San Francisco, CA P25. Medicaid Spending for Users of Contraceptives and Pregnancy-Related Care

Background: Contraception coverage and healthcare costs associated with unintended pregnancy are current highly debated and important topics for public and women's health.

Objective(s): The current study aims to evaluate Medicaid spending on contraception and pregnancy care.

Materials/Methods: We analyzed Medicaid health claims data from five states (FL, IA, KS, MS, and NJ) from 2004–2010. Women 14–49 years of age initiating short-acting reversible contraception (SARC: oral contraceptive [OC], transdermal, vaginal, or injectable) or long-acting reversible contraception (LARC: intrauterine device/system [IUD/IUS] or implant) methods and pregnant women were included as separate cohorts. Each woman was followed from the first contraceptive claim (contraceptive cohort) or from the first pregnancy or pregnancy-related diagnosis (pregnancy cohort), until the earliest of 12 months of follow-up, health plan disenrollment, or end of data availability. Medicaid spending for each cohort was summarized using mean all-cause and contraceptive/pregnancy healthcare payments per patient per month (PPPM).

Results: Contraceptive cohorts of SARC (OC: 115,873; transdermal: 11,577; vaginal ring: 7,970; injectable: 29,817) and LARC (IUD/IUS: 37,767; implant; 6,526) users were identified. Mean (median) age was 22.7 (21) years for SARC users and 24.5 (23) for LARC users. All-cause and contraceptive healthcare payments PPPM were respectively $365 and $18.3 for OC users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, $410 and $8.8 for injectable users, $194 and $36.8 for IUD/IUS, and $237 and $29.9 for implant users. For the pregnancy cohort, 97,972 pregnant women were identified; mean (median) age was 23.3 (21) years. All-cause mean healthcare payments PPPM for the pregnancy cohort was $610, including $391 (64% of all-cause payments) for claims directly related to pregnancy care.

Conclusions: This large study of Medicaid beneficiaries demonstrated that Medicaid payments for pregnancy care are higher than for contraception coverage, the most effective methods being associated with the lowest costs. Unrestricted access to effective contraception could potentially reduce the costs associated with unintended pregnancies.

1 Groupe d'analyse, Ltée, Montréal, QC, Canada 2 Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ 3 Analysis Group, Inc., Boston, MA 4 Bixby Center for Global Reproductive Health, University of California, San Francisco, CA P26. Actuarial Analysis of Medicaid Spending for Contraception and Pregnancy Care

Background: Up to 50% of pregnancies are unintended in the United States and the consequent healthcare costs for hospitalization associated with pregnancy and newborn infants are among the most expensive. Adequate coverage of and access to contraception are thus important topics for payers and a public health perspective.

Objective(s): To evaluate Medicaid payments for contraception and pregnancy care through an actuarial analysis.

Materials/Methods: Medicaid health claims data from five states (Florida, Iowa, Kansas, Missouri, and New Jersey) were analyzed. Medicaid beneficiaries enrolled at any time during the year 2008 were included. To adjust for the various lengths of enrollment of each Medicaid beneficiary, the per-member-per-month (PMPM) approach (aggregated costs [US $2011] divided by aggregated months of enrollment, with both values summed across all members) was used. Medicaid payments per female of childbearing age (14–49 years) per month (PFCPM) and PMPM were calculated for short-acting reversible contraception (SARC: oral contraceptive, transdermal, vaginal, or injectable), long-acting reversible contraception (LARC: intrauterine device/system or implant) and pregnancy care. Proportion of unintended pregnancy payments were also estimated using the rate of unintended pregnancy reported in the literature for each state.

Results: A total of 7,031,223 Medicaid members and 2,712,765 women of childbearing age were identified. Medicaid payments PFCPM for SARC, LARC and pregnancy care were $0.91, $0.53, and $39.91, respectively. Corresponding payments PMPM for SARC, LARC and pregnancy care were $0.35, $0.20, and $14.81, respectively. Payments for unintended pregnancy PFCPM and PMPM were estimated at $21.95 and $8.15, respectively. Payments PFCPM and PMPM for contraception and pregnancy care stratified by states showed similar trends.

Conclusions: This actuarial analysis of over 2.5 million Medicaid women of childbearing age showed that contraception payments represented only a small fraction of the estimated payments for unintended pregnancy in 2008. Unrestricted access to contraception could potentially reduce the costs associated with unintended pregnancies with more effective contraceptive methods resulting in lower costs.

1 Boston Health Economics, Inc., Waltham, MA 2 Yale University, New Haven, CT 3 George Washington University, Washington, DC 4 Social Science Research Solutions, Media, PA 5 Pfizer Inc., Groton, CT 6 Pfizer Inc., New York, NY; contractor of Atrium Staffing, Inc., New York, NY 7 Pfizer Inc., New York, NY P27. Burden of Illness Associated with Selected Health Conditions Among Women Aged 40–64 Years: Findings from a U.S. Nationally-Representative Survey

Background: Many studies evaluate the prevalence and burden of common women's health conditions individually, however, little is known of the prevalence and cumulative burden of co-existing health conditions including chronic joint and muscular pain (“Pain”), urinary incontinence (UI), major depressive disorder (MDD), osteoporosis risk, moderate/severe vasomotor symptoms (VMS), and vulvar/vaginal atrophy (VVA).

Objective: To ascertain the prevalence of and health status associated with one, two, and three or more coexisting conditions by surveying a U.S. nationally-representative sample of midlife (age 40-64 years) women.

Methods: This cross-sectional, telephone survey collected data from a sample of English- and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, as well as condition specific symptom/disease risk screening instruments. The EQ-5D was used to measure health status.

Results: 3058 women (mean age 53.4 years; 13.4% 40–44 years, 15.6% 45–49, 21.7% 50–54, 21.9% 55–59, 24.3% 60–64, 3.1% missing) completed the survey. Women were from all geographic areas of the U.S. (Northeast, 19.6%; North Central, 23%; South, 37.3%; West, 20.1%). The majority were white (75.6%), married (60.5%), employed full or part-time (59%) and post-menopausal (69.8%). The prevalence (95% CI) of 0, 1, 2, and 3+conditions was 36.9% (35.1–38.6), 35.5% (33.8–37.2), 17.2% (15.9–18.6), and 10.4% (9.3–11.5), respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%), UI (26.6%), Pain (17%), MDD (12.6%), and VMS (4.4%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%), UI and Pain (7.6%), and Pain and VVA (7%). Increasingly lower EQ-5D scores were associated with 0, 1, 2, and 3+conditions (means: 0.92, 0.86, 0.76, 0.59, respectively; P<0.01); incremental differences were mostly within the range of minimal clinically important differences reported for the EQ-5D (0.011–0.140).

Conclusion: Over 25% of women aged 40–64 years in this survey had multiple coexisting women's health conditions. Having multiple conditions was associated with worsening general health status, which declined with each added condition.

1 School of Nursing, The Hong Kong Polytechnic University 2 Department of Applied Social Sciences, The Hong Kong Polytechnic University P28. Couple-Oriented Program for Patients with Cancer and Their Spousal Caregivers

Background: A diagnosis of cancer not only impacts the patients, but also affects their spouse. This leads to the shift of focus of cancer care from the individual level of care to the patient-spousal caregiver dyads level.

Objective(s): This literature review aims to delineate the effect of couple-oriented programs for couples coping with cancer, and to describe the current pattern of the patient-spousal caregiver dyads' adaptation to cancer.

Materials/Methods: The literature on couple-oriented programs for couples coping with cancer, and patient-spousal caregiver dyads' adaptation to cancer was identified through a systematic search, using an electronic search, a manual search for the bibliography of related studies, and an author search. The search for relevant literature included studies published in English from January 2000 to October 2012. The PICO (Population/problem, Intervention/exposure, Comparison, and Outcome) format was applied to guide the identification of the key terms for literature search. The databases searched included MEDLINE, CINAHL, SCI Expanded, Scopus, and PsychINFO. Articles were extracted according to predefined inclusion and exclusion criteria. The PRISMA flow diagram was used to outline the literature search and selection process.

Results: Findings are described according to a Relationship Intimacy Model of couples' adaptation to cancer. It is revealed that relationship-enhancing behaviours (reciprocal self-disclosure, partner responsiveness, and relationship engagement) between couple's coping with cancer facilitated the couple's adaptation to cancer and lead to improved mood, marital relationship, and quality of life. While relationship-compromising behaviours (avoidance, criticism, and pressure-withdraw) between couples related to both partners' psycho-sociological distress, created tension in their marital relationship and impaired their quality of life. Interventions those focus both on improving relationship-enhancing behaviours and reducing relationship-compromising behaviours facilitate couples' adaptation to cancer.

Conclusions: These findings highlight the importance of relationship-enhancing behaviours in couples' adaptation to cancer. It is recognized that relationship-enhancing behaviours between couples may have positive effects on couple's intimacy, and to improve both the patients and caregiving outcomes. Further research is needed to explore interventions that benefit couples' relationship-enhancing behaviours, including reciprocal self-disclosure, partner responsiveness, and relationship engagement.

1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel 2 Hadassah-Hebrew University Medical Center, Israel 3 Hadassah-Hebrew University Medical Center, Israel P30. Pelvic Floor Muscle Training (PFMT) Following Birth in the Delivery Room: Project Evaluation Study

Background: Vaginal delivery is the main contributor to pelvic floor and perineal trauma, resulting in organ prolapse, urinary and fecal incontinence. Pelvic floor muscle training (PFMT) has been proven to be a non-invasive treatment for strengthening pelvic floor muscles and preventing or reducing urinary and fecal incontinence in the pre- and postnatal period.

Objective(s): We implemented a PFMT program whose aims were: 1. To educate and train midwives and maternity ward nurses so that they can utilize PFMT in their personal daily lives. 2. To initiate PFMT awareness by midwives in the delivery room and later by maternity ward nurses.

Materials/Methods: Self-administered questionnaires (PFMT-SAQ), developed by a team of midwives and physiotherapists, which were completed prior to program initiation. Midwives began PFMT awareness 2 hours after delivery, including close inspection of anal contractions to ensure proper movement, nurses continued activities in the maternity ward. All activities were based on a structured protocol. Midwives and nurses completed the PFMT-SAQ again after one year.

Results: Forty-five (51.1%) midwives and 43 (48.9%) nurses completed the PFMT-SAQ questionnaires prior to the start of the program. Twenty-five participants (33%) responded that they provide PFMT two hours following delivery. Most of the midwives and nurses demonstrated knowledge of PFMT, but only 27 (30.7%) practice PFMT with only 19 (26.7%) doing so every day. In comparing the results before and after the program, we found that 24 (53.3%) participants provided PFMT at the end of the first year as compared with 13 (28.8%) prior to the start of the study (p=0.008). By the end of the first year, midwife documentation in the women's charts had tripled.

Conclusions: The innovative portion of this program is the initiation of PFMT awareness in the delivery room; becoming an integral midwife task. It is important to expand the maternity ward program.

1 University of Illinois at Chicago Chicago, IL 2 Nanjing University of Chinese Traditional Medicine, Nanjing, People's Republic of China P32. Safety of Menoprogen, a TCM Formula for the Treatment of Menopausal Symptoms

Background: Menoprogen is an ancient TCM formula that has been used for the management of menopausal symptoms in China for many years.

Objective(s): To determine in vitro and in vivo safety of Menoprogen (MPG) by assessing its effects on the proliferation of breast cancer cell lines, as well as its effect on the endometrium of rats and general toxicity.

Materials/Methods: Breast cancer cell lines MCF-7, T-47-D, BT-474 and MDA-MB-231 were maintained as previously described and treated with increasing concentrations of MPG (10–100 μg/ml). Forty female rats (14 months) were randomized into 4 groups (two doses of Menoprogen administration, and positive control), 10 each. The 10 female rats (4 months) were used as the normal control. The two doses were given with Menoprogen of 0.648 g/kg body weight (large dose group) and 0.324 g/kg body weight (small dose group), respectively, for 8 weeks. The positive control animals were supplemented with Estradiol at 0.18 mg/kg for 8 weeks, then the rats were euthanized.

Results: In vitro, MPG did not significantly increase breast cancer cell proliferation, or bind to ERα or ERβ receptors. In a ERE reporter gene assay, MPG in concentrations of 10- 100 μg/ml did not significantly up regulate the expression of ERE. In vivo, MPG does not stimulate protein expression of ERα, progesterone receptor, c-jun and c-fos in the uterus of treated rats. Serum levels of ALT, as well as those of BUN and CRE, were not altered in treated animals as compared with controls, thus demonstrating that MPG does not cause liver or kidney damage. In addition, ER, PR, c-jun and c-fos proteins were not detected in the uterus of OVX rats treated with MPG, suggesting a low potential for endometrial cancinogenesis.

Conclusions: MPG does not appear to impact breast cancer cell proliferation, have direct estrogenic effects or cause any toxicity in rats.

1 University of Illinois at Chicago Chicago, IL 2 Nanjing University of Chinese Traditional Medicine, Nanjing, People's Republic of China P33. Novel Mechanism of Action for Menoprogen, a Traditional Chinese Formula for the Treatment of Menopause

Background: Menoprogen is an ancient TCM formula that has been used for the management of menopausal symptoms in China for many years.

Objective(s): To investigate the effect of Menoprogen, a TCM formula for menopause, on granulosa-cell (GC) apoptosis in aged female rats.

Materials/Methods: Naturally aged (NAR) female SD rats (14 months) were randomly divided into 5 groups: Negative control, MPG1 (162 mg/kg body weight), MPG2 (324 mg/kg), MPG3 (648 mg/kg) and positive control (Estradiol) group (0.18 mg/kg, p.o.). Rats in the treatment groups were treated orally with an aqueous extract of Menoprogen. After sacrifice, bilateral ovaries and uterus were removed, and wet weight recorded. One bilateral ovary was used electron microscopy and flow cytometry (FCM) analysis, and another was fixed in 10% neutral formalin for 24 h, gradually dehydrated by alcohol, transparentized with xylene, and then embedded in paraffin for TUNEL test and immunohistochemical assay. Granulosa cells (GCs) were isolated and fixed with 2% (v/v) glutaraldehyde in PBS for 2h and then with 2% (v/v) O3O4 for additional 2h and sections were prepared, stained and analyzed by TEM.

Results: Intragastric administration of Menoprogen to 14-month female rats for 8 weeks increased the plasma estrogen level and the weight of both ovarian and uterine tissues of the animals. Moreover, flow cytometric (FCM) analysis of the GCs showed reductions in the G0/G1 ratio and apoptotic peaks. Electron microscopy of the cells showed an increase in cell size, the numbers of cytoplastic organelles and intracellular gap junctions, reappearance of secretory granules and no apoptotic bodies. Results from a TdT-mediated dUTP nick end-labeling (TUNEL) test revealed a reduction of GC apoptosis; and an immunohistochemical assay exhibited down-regulation of Bax proteins but up-regulation of Bcl-2 proteins. In vitro, the addition of Menoprogen to the media of GCs reduced cadmium chloride-induced apoptosis.

Conclusions: Menoprogen inhibits GC apoptosis in female rats, indicating a novel mechanism of action.

1 Department of Medicine, Universidade do Vale do Sapucai, Pouso Alegre, Minas Gerais, Brasil 2 Department of Physiotherapy, Universidade do Vale do Sapucai, Pouso Alegre, Minas Gerais, Brasil P34. Gender Differences in Relationship Between Biopsychosocial Factors and Functional Capacity in Diabetic Patients

Background: Diabetes mellitus (DM) is associated with an increased incidence of functional disability, which is likely to further erode health status and quality of life.

Objective(s): To evaluate gender differences in relationship between biopsychosocial factors and functional capacity in diabetic patients.

Materials/Methods: It was a cross-sectional study with a sample of 165 diabetic patients (90 women and 75 men), aged 50–69 years, from a single public health service in Brazil. The study was approved by the Research Ethics Committee of the Sapucaí Valley University (UNIVÁS), Brazil. The patients were interviewed with a questionnaire which contained information on sociodemographic profile, physical health conditions, cognitive functioning and depressive symptoms, in addition to Katz's and Lawton's indices to measure basic activities of daily living (BADL's) and instrumental activities of daily living (IADL's). The statistical analysis was made through test t, chi-square test and Spearman correlation, considering a p<0.05 significance level.

Results: In the Katz Index, 2.2% of the women were dependents and none (0%) man was dependent (p=0.2). In Lawton Index 42.2% of the women and 20% of the men were dependents (p=0.2). In women, Lawton Index correlated with income less than $4,000 per year (rs=0.23; p=0.01), illiteracy, unemployment or retirement (rs=0.22; p=0.01), sedentary habits (rs=0.18; p=0.03), cognitive decline (rs=0.10; p=0.05), symptoms of depression (rs=0.19; p=0.02) and low glomerular filtration rate (rs=0.21; p=0.01).

Conclusions: In the Katz Index, 2.2% of the women were dependents and none (0%) man was dependent (p=0.2). In Lawton Index 42.2% of the women and 20% of the men were dependents (p=0.2). In women, Lawton Index correlated with income less than $ 4,000 per year (rs=0.23; p=0.01), illiteracy, unemployment or retirement (rs=0.22; p=0.01), sedentary habits (rs=0.18; p=0.03), cognitive decline (rs=0.10; p=0.05), symptoms of depression (rs=0.19; p=0.02) and low glomerular filtration rate (rs=0.21; p=0.01).

1 Virginia Commonwealth University, Richmond, Virginia 2 Department of Epidemiology and Community Health and Obstetrics and Gynecology; VCU Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia P39. Predictors of Adequate Prenatal Care

Background: Prenatal care is widely acknowledged as an effective means to identify pregnancy complications and provide services to reduce poor pregnancy and birth outcomes. Despite its benefits in reducing poor pregnancy outcomes, the rate of prenatal care among under-served, ethnic minorities is relatively low.

Objective(s): To determine predictors of inadequate prenatal care and examine racial differences in factors affecting adequate prenatal care.

Materials/Methods: Data from the Virginia Pregnancy Risk Assessment Monitoring System was analyzed (N=1639). Adequacy of prenatal utilization was determined using the Kotelchuck index. The index was categorized as inadequate, intermediate, adequate and adequate plus. Predictors examined included sociodemographic, reproductive and lifestyle factors. Multiple regression analysis was conducted and OR and 95% confidence intervals were reported.

Results: The majority of the study population was non Hispanic White, had high school or more education, and married. The study showed that marital status, education, income, race, pregnancy intention, previous preterm birth, smoking and stress level were significant predictors of adequate receipt of pregnancy. In addition to the demographic factors, smoking, stress, and receipt of public assistance were significant predictors among African Americans.

Conclusions: In addition to the well known factors, this study was able to identify factors stress and pregnancy intentions to be significant predictors of prenatal care utilization. To effectively improve prenatal care utilization, health care providers and public health professionals should be aware of these factors.

1 Appalachian State University, Boone, NC 2 Metropolotian State University Denver, Denver, CO P42. Exercise, Risky Eating, and Body Esteem: College Women's Struggles and Successes

Background: Women are continuously exposed to societal standards of beauty which results in a preoccupation with attaining the “thin-is-ideal” appearance. To achieve this ideal, females commonly resort to exercise and dieting. Furnham, Badmin, and Sneade (2002) explored relationships between reasons for exercise, self-esteem and disordered eating, and found negative reasons for exercise (attractiveness, weight control, and tone) are positively associated with disordered eating, whereas positive reasons for exercise (enjoyment, health, mood, fitness) have no relation to disordered eating. Furthermore, results indicated a positive relationship between self-esteem and exercising for weight control.

Objective(s): This study further explores the relationships between reasons for exercise, disordered eating, and body esteem among college-aged females who participate in sports activities.

Materials/Methods: Female participants who indicated current participation in a sport activity completed the Reasons for Exercise Inventory (REI), Body Esteem Scale (BES), Eating Attitudes Test-26 (EAT) and measures of height and weight to compute body mass index (BMI). Correlations were conducted within low and high BMI women.

Results: Results demonstrated a negative relationship between disordered eating and negative reasons for exercise among those with low BMI, whereas no relationship between negative reasons for exercise and disordered eating was present for those with high BMI. Additionally, results indicated a positive relationship between the Binging and Purging Behaviors subscale of the EAT and positive reasons for exercise. This relationship was found for participants who reported a low BMI, but not for participants who reported a high BMI. Finally, exercise for weight control was found to be positively related to the Weight Control subscale of the BES for all participants.

Conclusions: Results of the current study are not consistent with Furnham et al. (2002); warranting further investigation into the relationship between disordered eating and reasons for exercise.

1 Division of Research, Kaiser Permanente, Northern California; Oakland, CA 2 Obstetrics and Gynecology Department Kaiser Permanente, Colorado; Westminster, CO 3 Office of Population Research, Princeton University, Princeton, New Jersey and The Hull York Medical School, Hull UK P43. Evaluation of Cost Savings of the LNG-IUD for Treatment of Dysfunctional Uterine Bleeding, and Pelvic Pain in an Integrated Health Care Setting

Background: Levonorgestrel Intrauterine Device (LNG-IUD) is commonly used for contraceptive and non-contraceptive purposes. In a large integrated health care system, costs were compared in women with dysfunctional or abnormal uterine bleeding (DUB/AUB), pelvic pain or dysmenorrhea. Costs were included for women with and without a pregnancy in the 12 months before and after insertion in those who did and did not keep the LNG-IUD for 12 months.

Objective(s): We sought to evaluate potential cost savings in women using the LNG-IUD for dysfunctional or abnormal uterine bleeding (DUB/AUB), pelvic pain or dysmenorrhea in a large integrated health care system.

Materials/Methods: A retrospective cohort study was conducted of 4304 women, ages 18–55, with DUB/AUB, pelvic pain or dysmenorrhea within 12 months before LNG-IUD insertion in 2008–2009. Costs for inpatient and outpatient obstetric and gynecologic services were compared between women who did and did not retain their LNG-IUD for 12 months. Stratified (age, race/ethnicity and BMI) analyses were performed using Chi-square and T-tests. Mean costs savings, adjusted for age, race/ethnicity, and BMI were estimated using Ordinary Least Squares (OLS) regressions.

Results: There were no statistically significant differences in race/ethnicity or BMI between women who retained the LNG-IUD (77%, N=3303) for 12 months and those who did not (23%, N=1001). Total adjusted cost savings for the cohort for hospitalizations, outpatient and emergency department visits for anemia or gynecologic reasons, procedures, lab and pharmacy were $1,226,640. Cost savings of $3,626,694 occurred in continuous 12-month LNG-IUD users. Additional costs of $2,223,368 resulted from hysterectomies and $178,961 from alternative treatments or no treatments for women who discontinued IUD use within 12 months.

Conclusions: Use of the LNG-IUD for treatment of women with diagnoses of DUB/AUB, pelvic pain or dysmenorrhea, resulted in decreased costs in a large integrated health care system within 12 months.

1 Mayo Clinic, Rochester MN 2 University of Wisconsin, Madison, WI P44. Effects of Menopausal Hormone Therapy on Serum Serotonin and Self-Report Depression in Healthy, Recently Menopausal Women

Background: Low levels of brain serotonin (5-hydroxytryptamine, 5-HT) associate with the incidence of depression and mood disorders. During menopause, depressive symptoms in women increase. Menopausal hormone therapy (MHT) modulates serotonergic function, but an association between systemic 5-HT and mood in healthy, recently menopausal women is unknown.

Objective(s): This study examined effects of MHT on peripheral blood 5-HT levels and their correlation with mood in healthy, recently menopausal women of the Kronos Early Estrogen Prevention Study (KEEPS).

Materials/Methods: Women within 6 months-3 years of their last menses (n=118) were randomized to placebo, oral (conjugated equine estrogen, 0.45 mg/day) or transdermal (17β-estradiol, 50 μg/day) treatment with intermittent micronized progesterone (200 mg) for 48 months. Serum 5-HT was measured in a subset of women (n=59) by ELISA at baseline and 48 months and correlated to self-reported depression evaluated by the Profile of Mood States assessment tool.

Results: At baseline, none of the women met criteria for clinical depression; baseline serum 5-HT level was 77 ng/mL±1.92 and depression score was 4±0.94 (mean±SE). In 14 (42%) of women treated (n=33) with MHT, serum 5-HT increased and depression scores improved compared to 4 out of 26 (15%) in the placebo group. Moreover, in 3 (9%) of women taking MHT, serum 5-HT levels decreased and depression scores were higher as compared to 7 (27%) in the placebo group. In some women, 5-HT and depression scores did not change (MHT: 6 (18%); placebo: 7 (27%)). Serum 5-HT did not correlate with platelet number at either time point.

Conclusions: MHT may exert beneficial effects on mood in part through modulation of serotonergic systems. Supported by the Aurora Foundation, NIH HL90639, NS066147, HD65987, R01 AG029624, BIRCWH, CTSA and the Mayo Foundation.

1 Plastic surgeon; Student of Master Course of Translational Surgery of UNIFESP (Federal University of Sao Paulo); Sao Paulo, Brazil 2 Plastic Surgeon, Full professor of the Plastic Surgery Course; Coordinator in the Postgraduate Program in Translational Surgery at UNIFESP (Federal University of Sao Paulo); Sao Paulo, Brazil 3 Plastic Surgeon, Doctor in Plastic Surgery of UNIFESP (Federal University of Sao Paulo); Sao Paulo, Brazil Professor in the Postgraduate Program in Translational Surgery at UNIFESP, Sao Paulo Brazil 4 Psycologyst; Doctor in Plastic Surgery of UNIFESP (Federal University of Sao Paulo); Sao Paulo, Brazil Professor in the Postgraduate Program in Translational Surgery at UNIFESP, Sao Paulo Brazil 5 Plastic Surgeon, Full professor of the Plastic Surgery Course; Coordinator in the Postgraduate Program in Translational Surgery at UNIFESP (Federal University of Sao Paulo); Sao Paulo, Brazil P45. Sexuality in Patients Submitted to Reduction Mammography

Background: Breasts are the symbol of femininity, sexuality, and motherhood, and with a major significance for the physical and psychological completeness of women. Any size and shape distortion may affect the several aspects of life quality. There is no conflict of interests in the present study. Registration Clinical Trials.gov: NTC01297621.

Objectives: The objective of this study was the evaluation of the reduction mammoplasty impact on the sexual function of patients with breast hypertrophy.

Materials/Methods: Sixty women, aged between 18 and 45, with breast hypertrophy were selected, randomly divided into two groups with 30 patients each. The control group patients have taken part of the study baseline assessment, and after 6 months of eligibility. The surgical group has been assessed for study eligibility, and after 6 months of the reduction mammoplasty. To evaluate the sexual function, a Brazilian evaluation questionnaire of the female sexual function – Sexual Quotient – Female Version (Quociente Sexual Versao Feminina) – was applied. The groups and the evaluation moments were statistically compared through the Wilcoxon Signed Rank Test and the Mann-Whitney U Test.

Results: Compared with the main demographic data (Age: p=0.50; BMI: p=0.98; Sacchini Score: p=0.67) and in connection with the sexual function in the baseline evaluation the groups were homogeneous (p-0.98). Considering the intragroup evaluation, a significant improvement of the sexual function was found on the surgical group (p-0.00), and there were no differences between the two moments of application for the control group (p=0.21). Considering the intergroup evaluation, a statistically significant difference was found on the surgical group when compared with the control group (p=0.00).

Conclusion: Reduction mammoplasty has a positive impact on the sexual function of the patients with breast hypertrophy.

1 Senior Resident Physician, Changi General Hospital Singapore 2 Associate Consultant, Changi General Hospital Singapore 3 Medical Officer, Changi General Hospital Singapore 4 Chief of Surgery, Senior Consultant Changi General Hospital, Singapore P47. Knowledge, Perceptions and Attitudes of Breast Screening in Young Asian Women

Background: Singapore has the highest incidence of breast cancer in Asia, with breast cancer being the most common cancer among women. A nationwide breast cancer screening program was started in 2002, in conjunction with aggressive public education through the media. Most of the campaign, however, has been targeted at women in the recommended screening age group of 40 years old and above.

Objective(s): We aim to study the knowledge, perceptions, and attitudes of younger women (age<40 years) towards breast screening. These can be taken into consideration in future health promotion efforts to increase the uptake of mammographic breast screening when this group of women subsequently reach the screening age of 40.

Materials/Methods: A face-to-face questionnaire was administered to 271 female visitors and patients below 40 years of age at four primary healthcare institutions based on random convenience sampling.

Results: The median age of the respondents was 30 years old (17–39 years). Of these, 60.9% are Chinese, 27.7% Malay, 7.7% Indians, and the rest were of other ethnicity. Only 53.5% were aware of the existence of the national breast screening program. The mean knowledge score was 4.24 out of 8. Respondents with a good knowledge of breast cancer screening expressed a greater intention to go for mammographic screening compared to those with a poor knowledge score (p<0.05). Despite the high percentage of respondents who recognise the importance of screening, only 35.4% were aware that breast screening should be carried out even if they are asymptomatic. 21.4% of the respondents had the perception that a screening mammogram was costly, while 15.1% perceived it to be painful, and 11.9% thought it was an embarrassing procedure.

Conclusions: Although the young women in our population have a fair knowledge about breast screening, there are still prevalent misconceptions and erroneous perceptions which may deter them from attending breast screening. Health promotion initiatives should aim to clarify these misconceptions and remove barriers, as this may improve the attendance rate when these women become eligible for breast screening.

1 Nursing Program, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor, Malaysia 2 Medical Imaging Program, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor, Malaysia 3 Medical Laboratory Technology, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, 42300 Puncak Alam, Selangor, Malaysia P48. Expression of P53 Protein of Women in Menopausal Phases

Background: Mutation is known to occur before development of many types of cancer. Mutation in p53 gene can be found in human breast cancers. It is reported that overexpression of p53 protein will accumulates within the nucleus of breast cancer tissues and this enables the detection of p53 proteins by immunohistochemistry (IHD).

Objective(s): The purpose of this study is to determine the correlation between the p53 protein expressions with women in menopausal phases.

Materials/Methods: A total of 122 breast cancer tissues and 50 benign breast disease tissue (control) samples were examined for p53 protein expression by IHD.

Results: Ap53 positive (p53+) over-expression was observed in 38 (31%) breast cancer tissues and significantly (p<0.05) associated with majority of women ≥41 years old. Significant p53+ over-expression (p<0.05) were most frequently detected in women in age group of 41–50 and 51–60 years old. Odds ratio (ORs) of p53+ and p53- breast cancer tissue compared with control in women age group; 41–50 and 51–60 years old were 5.67 times higher in tendency for developing breast cancer with or without over-expression of p53 protein.

Conclusions: In conclusion, with or without overexpression of p53 protein women above 41 years old are at greater risk diagnosed with breast cancer. However, this preliminary outcomes in analysis of the overexpression of the p53 protein is likely to have value in diagnosis, primary assessment and ultimately in therapeutic algorithm of breast cancer.

1 Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY Department of Obstetrics and Gynecology, Metropolitan Hospital, New York, NY 2 Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA 3 Department of Anesthesiology, Metropolitan Hospital, New York, NY 4 Departments of Pharmacology and Anesthesiology, New York Medical College, Valhalla, NY 5 Department of Anesthesiology, New York Medical College, Valhalla, NY Department of Anesthesiology, Metropolitan Hospital, New York, NY P50. The Use of Combined Spinal-Epidural Analgesia Utilizing Intrathecal Morphine for Labor Pain in the Community Hospital

Background: In the US 50–60% of eligible pregnant women receive the regional (neuraxial) analgesia as a part of labor pain management. Combined spinal (SA) and epidural (EA) analgesia (CSE) has relief and provides faster and reliable onset of pain with fewer operative vaginal births and less urinary retention compared to traditional EA epidural analgesia alone. However, the optimal drug combinations and dosages for CSE are not established.

Objective(s): To assess the effectiveness and incidence of adverse outcomes in healthy laboring patients who received low dose intrathecal morphine as part of the regional analgesia.

Materials/Methods: Retrospective observational study of 205 laboring patients who delivered at 35 or more gestational weeks at a large community hospital between January 2006 and December 2009. All patients received Duramorph 250 mcg and Fentanyl 25 mcg intercalary. Adverse outcomes included high pain scores, delayed maternal respiratory depression, low Apgar scores, and postpartum hemorrhage.

Results: About a half of participants delivered with a single-shot intrathecal opioids with pain control similar to pain control observed for epidural analgesia group, demonstrating the feasibility of using spinal analgesia alone in settings with limited access to anesthesiology services. Among all study participants, only about 4% of them (N=9) had pain scores greater than 4. No cases of respiratory depression requiring naloxone administration were reported during the study. No infants had Apgar scores less than 7 at five minutes for reasons related to anesthesia, 25% of patients (N=53) underwent cesarean section, and less than 1% of deliveries (N=2) were complicated by postpartum hemorrhage.

Conclusions: The results of our study showed that low dose intrathecal morphine can be a valuable tool for clinicians delivering pain management to laboring patients.

1 George Washington University, Washington, DC 2 Sprout Pharmaceuticals, Raleigh, NC 3 The Columbus Center For Women's Health Research, Columbus, OH 4 Sprout Pharmaceuticals, Raleigh, NC P51. Hypoactive Sexual Desire Disorder (HSDD) Treatment with Flibanserin: Consistent Efficacy and Safety in Pre and Postmenopausal Women

Background: Low sexual desire with personal distress (similar to HSDD) is the most common female sexual dysfunction affecting 9% of pre and 12% of postmenopausal women. Flibanserin is a novel 5-HT1A agonist/5-HT2A antagonist in development for HSDD.

Objective(s): To generate long-term efficacy and safety data for flibanserin in pre- and naturally postmenopausal women with HSDD.

Materials/Methods: 28-week, multicenter open-label extension study of women who completed one of three large, randomized, double-blind, placebo controlled “parent trials”. (n=2777, one in pre- and two in naturally postmenopausal women with HSDD). Subjects in the “extension” (premenopausal: n=346; postmenopausal: n=249) took Flibanserin 100 mg qhs.

Results: EFFICACY was assessed using the FSDS-R total score, and FSFI, validated scales for assessing sexual distress, and sexual function in HSDD, respectively. The study demonstrated a consistent reduction in distress (FSDS-R total and Q13), and increase in sexual function on the FSFI (total and desire) for pre- and post-menopausal women. SAFETY was determined using adverse events (AEs) and serious adverse events (SAEs). The majority of AEs were mild or moderate. None of the SAEs were considered related to treatment. The most common AEs (>5% of subjects) were (Pre/Postmenopausal): dizziness (8.7/10.8%), somnolence (9.0/6.4%), insomnia (5.2/5.2%) and nausea (5.5/5.2%).

Conclusions: Flibanserin 100 mg qhs was effective in increasing desire and decreasing distress associated with HSDD in both pre and postmenopausal women. Flibanserin's most common AEs are: dizziness, somnolence, insomnia, and nausea. No new AEs or SAEs were reported in this open-label extension. Flibanserin appears to be safe and effective for the treatment of HSDD in both pre and postmenopausal women. Additional studies are underway to confirm and extend these observations.

1 Virginia Commonwealth University, Department of Microbiology and Immunology, VCU School of Medicine, Institute of Women's Health, Richmond, Virginia 2 Virginia Commonwealth University, VCU School of Medicine, Institute of Women's Health, Massey Cancer Center, Richmond, Virginia 3 Virginia Commonwealth University, VCU School of Nursing, Center for Biobehavioral Clinical Research, Institute of Women's Health, Richmond, Virginia P53. Unique Cytokine Signature in the Serum of Patients with Fibromyalgia

Background: Fibromyalgia (FMS) is a chronic pain syndrome with a complex but poorly understood pathogenesis affecting approximately 10 million adults in the United States. It is estimated that 90% of diagnoses are reported in women. The lack of a clear etiology of FMS has limited the effective diagnosis and treatment of this debilitating condition.

Objective(s): The objective of this study was to examine serum cytokine levels of women who participated in a cross-sectional, observational study conducted to characterize the relationships among perceived stress, pain, fatigue, depression, sleep quality, biomarkers, and functional status in women with FMS.

Materials/Methods: The protocol was approved by the Institutional Review Board (IRB) of Virginia Commonwealth University. Study participants were administered a set of questionnaires, followed by venipuncture and collection of a 3 cc blood sample for biomarker analysis. Blood samples were collected into heparinized Vacutainer^® tubes. All samples were analyzed for cytokine levels using the 17-plex Human Bio-Rad^® cytokine, chemokine, and growth factor assay kit (Bio-Rad; Hercules, CA).

Results: Post hoc analysis of serum cytokine levels was performed to determine if patterns appeared that were not specified a priori. Upon examination of the 17 cytokines/chemokines detected, patients with FMS exhibited increases in key patterns of cytokines that are consistent with a T helper cell type one signature. This TH1 skewed cytokine pattern was characterized by an elevated average serum IFN-γ of 31.1 pg/mL (normal range 2–5 pg/mL) and decreased average serum IL-4. Furthermore there was a clear elevation in hematopoietic cytokines such as IL-7 (FMS 9.27 pg/mL, normal<1 pg/mL) and GM-CSF (FMS 25.90 pg/mL, normal 2.5 pg/mL).

Conclusions: The finding of a well-known inflammatory pattern of cytokine elevations not only supports the role of inflammation in FMS but may lead to more definitive diagnostic tools for clinicians treating FMS. The elevation of the hematopoietic cytokines provide strong evidence of immune dysregulation in patients with FMS.

1 Department of Veterans Affairs, New York, NY 2 Department of Veterans Affairs, Menlo Park, CA 3 Department of Veterans Affairs, Menlo Park, CA; Stanford University, Palo Alto, CA 4 Department of Veterans Affairs, Ann Arbor, MI; University of Michigan, Ann Arbor, MI 5 Department of Veterans Affairs, West Haven, CT; Yale University, New Haven, CT P57. Chest Pain and Resource Utilization in Women and Men Veterans

Background: The number of women Veterans (WV) using Veterans Health Administration (VHA) medical care has doubled in the past decade. VHA is increasing services to assure WV receive equitable, high quality healthcare (e.g. care for cardiovascular disease (CVD)).

Objective(s): To evaluate rates of chest pain and clinic utilization received in VHA.

Materials/Methods: We created cohorts of all women Veteran (WV) and men Veteran (MV) VHA patients aged 18–44, 45–64 and 65+, based on the Fiscal Year 2010 (FY10) VHA outpatient utilization file. We used Agency for Health Research and Quality's Clinical Classifications Software to group ICD9 codes into cardiovascular conditions, and clinic stop codes to determine visit type, and then examined rates of diagnoses and visits by gender.

Results: The proportion of WV with chest pain was modestly higher compared to MV in all age groups ((18–44: 3.7% vs. 3.5%); (45–64: 7.3% vs. 6.8%); (65+: 5.4% vs. 4.1%)) whereas diagnosis of coronary artery disease (CAD) was markedly lower for women in all age groups ((18–44: 0.3% vs. 0.9%); (45–64: 3.4% vs. 13.2%); (65+: 14.0%, vs. 28.5%)). A greater proportion of all women with chest pain than men also had Emergency Department (ED) visits in FY10 (total WV 55.8% vs. MV 50.9%) while women with chest pain in 45–64 and 65+ age groups had fewer visits to Cardiology Clinics. Chest pain diagnosis was more commonly assigned in Primary Care than ED for both men and women across all ages.

Conclusions: WV have more common diagnoses of chest pain but less frequent diagnoses of CAD and fewer visits to Cardiology Clinics than MV. These results may represent higher rates of non-cardiac chest pain in women than men, or under recognition of women with CAD, and highlight the need for further research and ongoing efforts to raise awareness of CVD in WV.

1 Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China 2 Department of Obstetrics & Gynecology, Shihezi University School of Medicine, Shihezi, Xinjiang, China 3 Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China 4 Key Laboratories for Xinjiang Ethnic and Endemic Diseases, Shihezi University School of Medicine, Shihezi, Xinjiang, China P58. Effective Screening for Cervical Cancer in Low-Income Settings: Combining Modified Papanicolaou Smear and Visual Examination as a Sensitive Single-Visit Strategy

Background: Cervical cancer is a typical public health disparity reflected by >85% of cases and deaths in developing countries. Yet, due to poor transportation, affordability and low willingness, loss of follow-up is severe in low-income settings making cervical-cancer screening less effective.

Objective(s): Developing a single-visit strategy using multiple economic methods is desirable to maximize sensitivity and minimize loss of follow-up in cervical-cancer screening in low-income settings.

Materials/Methods: Visual inspection with acetic acid (VIA) and Papanicolaou (Pap) smear are economic and effective screening methods for cervical cancer but they cannot be performed on the same day due to technical interference. We first modified Pap smearing by taking cervical mucus cells using a cotton-stick (other than scraping the cervix with a spatula) without interfering VIA/VILI examination allowing VIA and Pap smear to be performed in single-visit. We then tested the effectiveness of VIA+Pap bi-method single-visit strategy by screening 1,967 women (30–59 year-olds), of whom 92.3% lived on or below US$1.00/day, in a resource-poor rural community in far western China. (IERB approval No. SHZ2008LL01).

Results: This simple modification allowed consecutive performance and completion of VIA and Pap within 2 hours, making following biopsies possible on the same-day visit. The modified Pap screening reached a sensitivity of 75.0% (95% CI, 60.9–89.1) and a specificity of 76.6% (95% CI, 70.3–82.9) in detecting cervical intraepithelial neoplasia grades 2/3 (CIN2/3) and cervical cancer. Furthermore, VIA+ Pap bi-method screening increased the sensitivity to 97.2% (95% CI, 90–100) with a reduced specificity of 55.0% (95% CI, 47.5–62.5). Due to increased sensitivity and minimized loss of follow-ups, this single-visit screening revealed extremely high prevalence of CIN1 (2,950/100,000), CIN2+ 3 (1,480/100,000), and cervical cancer (407/100,000) in this low-income population.

Conclusions: The modified Pap smear can be performed with VIA in same-day single-visit, serving as a sensitive and cost-effective (locally $4.50/visit) screening strategy for cervical cancer in low-income settings. (MOST funding: 2009BAI82B02, 2009BAI82B03, 2010DFB34100)

1 Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 2 Tulane University School of Medicine, New Orleans, LA 3 Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 4 Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA P59. Gender Differences in Preventive Care Services Utilization among Older Americans for Flu Shots, Cholesterol Screenings, and Dental Visits

Background: Utilization of preventive services can help control existing disease and delay the onset of new disease. This is particularly important among older adults with comorbid conditions. Aging presents different health challenges by gender yet little research is available describing preventive services utilization by gender among older adults.

Objective(s): To analyze gender differences in preventive care utilization and consistency in the use of preventive care services by examining influenza vaccination, cholesterol screening, and dental visits among older adults.

Materials/Methods: Data from US adults over the age of 51 years who participated in the Health and Retirement Study, a nationally representative longitudinal survey, between 1992 and 2010 were analyzed. Longitudinal data were first treated as a pooled cross-section, and logistic regression was estimated. Respondents were later classified as “consistent user” (always yes), “occasional user” (sometimes yes), and “non-user” (always no) based on their consistency of preventive care utilization observed during 1992–2010. Multinomial logistic regression was used to estimate gender differences in the consistency of preventive care utilization controlling for individual characteristics. Analyses were stratified by 51–64 and 65+ age groups.

Results: Gender differences were observed in overall utilization of all three types of services for those <65 years old (p<0.05 for each model). Gender differences were only seen in dental care for those older than 65 years (p<0.05). For the constructed measures of consistency of preventive care utilization, women were more likely to be “consistent user” in their use of flu shot and dental care than “occasional user” (p<0.05). Gender differences varied by age group for being “non-user” of flu shot and dental care. Gender differences in the consistent use of cholesterol screening were not observed; however, women were more likely to have occasional cholesterol screenings than not.

Conclusions: Gender differences in utilization of preventive care services depend on age for selected preventive care measures.

1 Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria 2 Department of Psychiatry, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria 3 Department of Community Medicine, University College Hospital, Ibadan, Nigeria P60. Knowledge of Cervical Cancer, Human Papilloma Virus (HPV) and HPV Vaccination: A Survey of Market Women in South-Western Nigeria

Background: Cervical cancer is a preventable cancer afflicting female population yet the leading cause of death among them. Human Papilloma Virus (HPV) have been implicated in its aetiology and vaccines to prevent HPV infections are now available. The busy nature of job and low level of education of majority of market women may limit their assess to information about their health.

Objective(s): The objectives of this study were to assess the knowledge of cervical cancer and HPV infections, the screening practices for cervical cancer and acceptability of HPV vaccine among women who are traders at Aleshinloye Market in South-Western Nigeria.

Materials/Methods: A cross-sectional descriptive study was conducted using a pretested, structured, interviewer administered questionnaire. Chi square statistics was used at level of significance of 5%.

Results: A total of 107 female traders were interviewed. The mean age of the respondents was 42.64±13.6 years. About 65.4% were married with 35.7% of them in polygamous marriage. All respondents were sexually active with 76.6% of them having multiple sexual partners. Mean number of lifetime sexual partner was 2.67±1.42 years. About 51.4% of the respondents had heard of cervical cancer but only 9.1% of them had good knowledge of it. About 21.7% had heard of Papaniculaou smear for cervical cancer screening and only 4.7% of the respondents had been screened. However, majority (70%) were willing to be screened if the services are available and affordable. Only 3.7% of the respondents had heard of HPV infections and 0.9% of them had heard of HPV vaccination. Significantly higher proportion of those who had more than six years education were aware of cervical cancer and a higher proportion of those who were willing to be vaccinated would allow HPV vaccination for their daug

Conclusions: The knowledge of cervical cancer, Human Papilloma Virus (HPV) and HPV vaccination among the female traders in this study was poor. This study highlighted the importance of reaching out to this group of women by organising public health education using culturally sensitizing information and communication strategies. Affordable screening services and vaccination should also be provided close to them.

1 OptumHealth, Orange, CA 2 OptumHealth, Golden Valley, MN P64. Effects of a Telephonic Maternity Care Management Program among Women with Gestational Hypertension

Background: Gestational hypertension affects approximately 6% of pregnant women nationally. Risks include delayed newborn growth, increased risk of low birth weight, and premature delivery. The Maternity Support Program (MSP) offered by Optum is a telephonic care management program which provides care guidance and ongoing monitoring to expectant mothers. Gestational hypertension is just one condition which the program seeks to impact, with the overall objective of reducing NICU utilization and costs.

Objective(s): The purpose of this study is to examine whether participation in a maternity support program can reduce newborn NICU costs in pregnant women with hypertension.

Materials/Methods: Using medical claims and program operational data, we analyzed mothers in a commercial insurance program with gestational hypertension who had live births between 2010 and 2011 (n=2,431). We compared NICU costs between mothers who were actively engaged in the program at least 90 days before delivery (n=905) and mothers who were referred to the program but did not participate (n=1,526). A propensity score model was developed to account for differences in demographics and risk factors between the engaged and non-engaged mothers. Using inverse propensity score weights, a generalized linear model was built to measure the impact of program engagement on resulting NICU costs.

Results: There were statistically significant (p-value=0.0468) differences in NICU costs between the engaged and non-engaged groups. NICU newborns from non-engaged mothers cost $71,496 versus $54,946 for NICU newborns from engaged mothers, resulting in a cost savings of $16,551 per case.

Conclusions: After adjusting for differences in demographics and risk factors, this study has shown that engagement in the Optum Maternity Support Program significantly lowers newborn NICU costs for pregnant women with hypertension.

1 Faculty of Health Sciences, University of Sydney, Sdney, NSW, Australia 2 Faculty of Health Sciences, University of Sydney, NSW, Australia 3 Sydney Nursing School, University of Sydney, NSW, Australia 4 Faculty of Health Sciences, University of Sydney, NSW, Australia 5 School of Medical Sciences, University of Sydney, NSW, Australia P66. Cultural Influences on Sun Exposure and Vitamin D in Immigrant East Asian Women Living in Australia

Background: A number of epidemiological Australian studies have found that Asian immigrants have low vitamin D status (as measured by 25(OH)D levels) compared to their Australian counterparts, a finding that has been hypothesized to be due to insufficient sun exposure. An attitudinal survey in Hong Kong suggested that East Asian women often deliberately avoided sunlight as they traditionally prefer “fair skin”. The idealization of fair skin, especially for women, has a long history in many East Asian countries, where Buddhism and Confucianism have strong influences; A fair complexion being an indication of beauty, privilege, social status and femininity.

Objective(s): Thus we aimed to investigate qualitatively the cultural beliefs and attitudes that were related to sun avoidance behavior in East Asian immigrant women living in Australia.

Materials/Methods: Chinese and Korean immigrant women who participated in a larger cross sectional quantitative study of vitamin D blood levels (n=114) were asked to to participate in in-depth interviews investigating attitudes and practces towards sun exposure and vitamin d knowledge in their native language (n=36).

Results: These Australian immigrant women reported a number of cultural factors that influenced their attitudes and behaviors re sun exposure. They expressed preference for fair skin, a tradition of covering skin when outdoors and a lack of sunbathing culture. They believed that fair skin was more beautiful than tanned skin. They reported that beauty was the reason for active avoidance of sunlight exposure. Although they reported knowledge of sun avoidance due to skin cancer risk there was little knowledge about the benefits of sun exposure for vitamin D adequacy.

Conclusions: These findings are interesting as they may be the reason for vitamin D deficiency previously reported in these populations. Thus we recommend that these attitudes of excessive sun protection and limiting sun exposure in this immigrant group need to be further investigated as there maybe implications for planning and delivery of health promotion programs to this growing population of immigrants in Australia and the USA.

1 Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond VA 2 Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, VA 3 Virginia Department of Health, Richmond VA 4 Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh PA P68. An Evaluation of Project Connect Training and Outcomes in a Sample of Family Planning and Public Health Care Providers

Background: Over $4 billion in physical and mental health service costs result annually from intimate partner violence (IPV) in the United States. Many victims of IPV—predominantly women—thus visit health care providers, yet only about 10% of providers routinely screen for IPV exposure. Reasons cited include lacking appropriate tools, fear of disclosure, fear of offending patients, lacking appropriate referrals, and endangering patients. Project Connect is a national initiative to change how adolescent health, reproductive health, and home visiting programs identify and respond to sexual and domestic violence. Research suggests that women in these programs are at high abuse risk, and that evidence-based interventions improve out.

Objective(s): This qualitative evaluation research project explores outcomes of Project Connect training among Virginia clinic-based and home care providers screening for violence and abuse, intervention, and policy development. Goals are to evaluate implementation of the training initiative from the perspective of trained providers and staff; and examine perceived quality, satisfaction, and success with Project Connect screening and intervention strategies among staff and providers.

Materials/Methods: Semi-structured focus groups and individual interviews are conducted with trained providers. Questions cover satisfaction with training, knowledge gained, implementation, cultural competency, and barriers to implementation or policy development. Thematic analysis of data identifies common provider themes.

Results: Providers express satisfaction with training, and screenings are increased. Providers cite ongoing rapport with patients as helpful to implementation of screening and intervention protocols, but note issues of cultural relevance in universalized interventions. Links between providers and community resources are not always adequate.

Conclusions: Project Connect provides beneficial training in screening and resource development among providers of services to at-risk women and families. Follow-up training and evaluation is needed to individualize and enhance application of tools provided. Providing caregivers with tools and strategies increases identification of and intervention with victims and survivors of domestic and sexual violence.

1 Health professional -Kigali Rwanda 2 Researcher-Kigali Rwanda 3 Therapist-Kigali Rwanda P69. Sexual Abuse Among Young Girls

Background: The genocide of 1994 was marked by horrific forms of violence particularly against girls and women; rape was part of the genocidal plan and part of the systematic degradation of women and of girls. The Government of Rwanda considers gender as one of the most important initiatives in the construction of durable peace and sustainable socioeconomic development. A study of behavioral surveillance in 2006 conducted by MIGESPOC showed that 12.1% of Rwandan girls reported having had first sexual relationships with a man at least ten years older. In a 2005 survey on demography and health, HIV prevalence was estimated at 1.4% among women aged 15–24, a rate three times higher than among young men the same age.

Objective(s): Create awareness for health professionals on psychosocial care of the young girls sexually abused.

Materials/Methods: Since 2010, Capacitar Rwanda took the initiative to educating teenage girls (14–18 years) who were sexually abused and infected and/or by HIV/AIDS. Capacitar as the holistic approach has greatly being helpful to them. Working with those girls, we emphasize on psychological aspect by individual and family therapy, group support and relaxation.

Results: Capacitar Rwanda created a space for the support group for the young girls once a week. This group includes female sexual abused in age of 14–18 years. These girls find that opportunity to share their experience, which help them to express their emotions such as fear, anger and shame, thereafter feel released and reintegrated. With the time, 90% of the members of this group became more cohesive and productive

Conclusions: Support groups for young women, is a successful strategy to address and prevent gender based violence.

1 University of Southern California School of Social Work, Los Angeles, CA 2 RAND Corporation, Santa Monica, CA P71. Adopting an Evidence-Based Intervention for Homeless Women: Engaging the Community in Shared Decision-Making

Background: Evidence-based interventions (EBIs) have proven to reduce HIV risk exposure for many high-risk populations. One group hot commonly targeted is homeless women. Adapting HIV risk reduction EBIs is a cost effective manner of translating and diffusing these interventions. However, ensuring their cultural appropriateness is essential.

Objective(s): This project engaged homeless service providers, key informants, and homeless women in the collaborative process of selecting an HIV risk reduction EBI that could be adapted for use with homeless women. Main findings from the focus groups and key informant interviews, the selection of the 4 EBIs, the process of conducting the consensus groups, and final selection of the EBI for adaptation are described.

Materials/Methods: In this process we convened 4 focus groups (N=31) with shelter providers, completed individual interviews with HIV experts (N=3), selected 4 EBIs for discussion, and then completed 3 consensus groups with homeless women (N=22) and 3 consensus groups with homeless service providers (N=21) to select an HIV risk reduction EBI for adaptation.

Results: Focus groups and key informant interview participants agreed that HIV risk reduction was a high priority due to the risks associated with homelessness. A focus on HIV consequences and related risky behaviors and an intervention that was brief were suggested to address both organizational resource barriers and fit within the reality of homelessness services. EBIs were selected based on these results; consensus groups used a ranking and discussion process for final selection of an EBI for adaptation.

Conclusions: Engaging providers and the intervention target group in the process of selecting an HIV risk reduction EBI increases community buy-in through empowering individuals as the experts of their domains. This contributes to the selection of appropriate and feasible interventions, increases the likelihood of a successful, culturally specific adaptation, and reduces barriers to provider/agency diffusion and individual-level uptake.

1 Faculty of Nursing, Research Project Manager, University of Calgary, Doha, Qatar 2 Faculty of Nursing, Associate Dean of Research, University of Calgary, Doha, Qatar 3 Chairman of Medical Research Centre, Al Amal Hospital, Hamad Medical Corporation, Doha, Qatar 4 Chair Person of ICC, Al Amal Hospital, Hamad Medical Corporation, Doha, Qatar 5 Executive Director of Nursing, Hamad Medical Corporation, Doha, Qatar 6 Managing Director, Primary Health Care, Hamad Medical Corporation, Doha, Qatar P72. Breast Cancer and Screening Practices Among Arab Women Living in Qatar: Beliefs and Attitudes

Background: Despite rising breast cancer incidence and mortality rates in Qatar, breast cancer screening (BCS) rates among women remain low. Arab women are at risk for late diagnosis and have been found to present at younger ages than Western women. While there is little data collected on the beliefs of women towards BCS in Qatar, previous studies indicate the need to better understand the many complex beliefs, values, and attitudes that influence Arab women's health-seeking behavior.

Objectives: This study investigates BCS activities, beliefs and attitudes of Arabic-speaking women living in Qatar for the development of culturally appropriate and effective awareness and intervention strategies to address breast cancer in the Middle East.

Materials/Methods: A cross-sectional quantitative survey was conducted among 1.063 female Qatari Arabic-speaking residents, 35 year of age or older. Due to potential difficulty in reaching our study population, convenience sampling was used. To reduce bias, all potentially eligible participates were approached at random times of the day and evening in participating health center, which resulted in an 87% response rate.

Results: In addition to low levels of awareness and participation rates in BCS, one-quarter of the participants stated their doctors talked to them about breast cancer. Less than half of the women interviewed believed breast cancer can be prevented, and the majority believed cancer is due to fate, unhealthy lifestyles, and can be hereditary. Women who engaged in BCS practice were more likely to have a doctor who talked to them about breast cancer, believe they were in good-to-excellent health, that cancer can be prevented or that it may be hereditary. Although the majority stated they would make a mammogram appointment if their doctor recommended it, the main reasons for not planning BCS were lack of a doctor recommendation, fear, and embarrassment. Other factors related to noncompliance included the beliefs that cancer is due to God's punishment or preference for female physicians.

Conclusions: Current findings give insight on why, despite the availability of health care services and gender-appropriate health care providers in Qatar, less than one-third of the women interviewed practiced BCS according to national guidelines. This study found several complex beliefs and attitudes towards BCS among Arabic-speaking women in Qatar influence their BCS uptake, indicating a variety of channels (health care providers, media, breast cancer survivors, community leaders) should be utilized to create culturally appropriate intervention and awareness programs about breast cancer and the benefits of early detection to help reduce mortality rates amongst Arab women living in the State of Qatar.

1 Professor, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan 2 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan 3 Charles and Gerda Spence Professor of Nursing & Adjunct Professor, Psychology, University of Washington, Seattle, USA P73. Depression in Taiwanese Women During the Peri- and Post-Menopause Years: Associations with Demographic, Health, and Psychosocial Characteristics

Background: Depression is reported to be the leading cause of health-related disability and disease burden for women during the peri- and post-menopause years. Understanding the demographic, health, and psychosocial correlates of depression during these years is important for targeting those at risk for developing depressive symptoms and providing health guidance.

Objectives: The purpose of this study was to evaluate the prevalence of depression in peri- and post-menopausal Taiwanese women, and to investigate the relation between depression and demographic variables, chronic disease status, health habits, stress management, menopausal symptoms, and attitudes towards menopause and aging.

Materials/Methods: A cross-sectional design was used. Participants were purposively sampled from a medical center and residential community in Southern Taiwan. A total of 566 women between 45 and 60 years of age participated in the study, and completed a demographic and health habits questionnaire, the Women's Health Initiative Symptom Scale, the Attitudes toward Menopause Scale, and the Center for Epidemiological Studies–Depression Scale (CES-D).

Results: The prevalence of depression (CES-D score ≥ 16) was 38.7%. Bivariate correlations and analyses of variance indicated that higher CES-D scores were related to lower family income, younger age, smoking for a greater number of years, consuming more alcohol, having multiple chronic diseases, not exercising regularly, consulting with a specialist for stress management, having more severe menopausal symptoms, and more negative attitudes towards menopause and aging. A stepwise multiple regression analysis indicated that the key predictors, accounting for 33.7% of the variance, were menopausal symptoms, attitudes towards menopause and aging, family income, and chronic disease status.

Conclusion: Results highlight the importance of considering psychosocial factors, life style, and chronic disease management in providing health guidance for peri- and post-menopausal women to enhance their quality of life and reduce the risk of depression.

1 Western Pennsylvania Hospital – OB/GYN Resident Pittsburgh, Pennsylvania 2 Western Pennsylvania Hospital – Gynecology Oncologist, and OB/GYN Residency Program Director Pittsburgh, Pennsylvania 3 Significant Applications, LLC – Statistical analyst Fortson, Georgia P74. Breastfeeding Education and Encouragement on the OB Timeline

Background: Breastfeeding is endorsed worldwide as the optimal method of infant feeding. The World Health Organization, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology all recommend exclusive breastfeeding for the first 6 months of life. Despite these recommendations, breastfeeding is a practice many mothers choose not to participate in at all or quit prematurely. Obstetricians follow a specific timeline in a woman's prenatal course to ensure certain milestones are met and important screening tests are not missed. For instance, glucola testing is done at 28 weeks and GBS screening is done at 36 weeks. However, scheduled time for breastfeeding education is not required at any specific point.

Objective(s): Therefore, this exploratory study examines the intervention of standardized breastfeeding education and support by placing it on this ldquo;OB Timeline.” Our hypothesis is that inadequate education about the advantages of breast milk and/or inadequate encouragement by obstetricians at prenatal visits affects breastfeeding initiation and duration.

Materials/Methods: To test this hypothesis, a two-part Quasi experimental design study was conducted. All mothers who were patients of the Western Pennsylvania OB/GYN Ambulatory Clinic and delivered their baby at Western Pennsylvania Hospital in Pittsburgh, PA in 2010 (Part 1) and from September 2011 to February 2012 (Part 2) were recruited. A survey was given to each patient in Part 1 to determine breastfeeding initiation and duration rates, motivating factors for choosing breast milk vs. formula, and whether or not physician influence played a role. Then in 2011, scheduled breastfeeding education time was initiated at the patient's 26–28 week return OB visit (the same day their glucola test was given). This intervention included distribution and review of a fact sheet on 10 advantages of breast milk. These facts were also reviewed periodically at subsequent third trimester visits. Then, the same survey was given to patients postpartum in Part 2 to determine if a difference was made.

Results: Of the 274 total patients recruited, 78 responded to the survey for study completion and data analysis. This provided a 28% response rate. 53 patients (68%) served as the control in Part 1, and 25 patients (32%) were exposed to the educational intervention in Part 2. 8% of patients indicated that a lack of physician encouragement served as a barrier to breastfeeding practices. In addition to the intervention, three possible inhibitors of breastfeeding were evaluated for potential relationships to breastfeeding initiation and duration. These included maternal issues/concerns as the cause for not breastfeeding or quitting (i.e. decreased milk supply, lack of interest), baby issues/concerns as the cause (i.e. baby still seemed hungry/not satisfied), and reported lack of physician encouragement when reported as an obstructive barrier. A series of analyses were conducted including multinomial and ordinal logistic regression. However, the independent predictors combined were not predictive.

Conclusions: Statistical significance was not found in our investigation. However, this may be due to small effect size. It may also indicate that physician influence is outweighed by other factors contributing to a woman's decision to breastfeed in our patient population. Regardless, putting breastfeeding education and encouragement on the OB Timeline allows all patients to be exposed to this intervention, and ensures that patients who will change behaviors as a result of this exposure are not missed. This exploratory study highlights areas in need of future research.

1 Tufts University Medical Center, Department of Obstetrics and Gynecology, Boston, MA 2 Empowered Women International, Alexandria VA 3 Tufts University Medical Center, Department of Obstetrics and Gynecology, Boston, MA P76. Sexual Violence at a Large, Urban University; Examining Student Knowledge of Available Resources

Background: Sexual assault occurs at an alarming rate on college campuses.

Objective(s): To review student perceptions of available resources for sexual violence on campus and in the community.

To review student perceptions regarding the prevalence of sexual violence on campus.

To determine if differences lie between gender and year in school when analyzing these questions.

Materials/Methods: A survey was sent out via email to 5,097 undergraduate and graduate students. The survey consisted of seven true and false questions covering prevalence, awareness, programs, and the availability of resources regarding sexual assault on the university campus.

Results: Of the surveys emailed, 1,032 (20%) were completed. Sixty-one percent felt that sexual assault is a problem at the school and 15% of students knew someone who had been sexually assaulted. Underclass students were significantly more likely to believe sexual violence was not a problem on campus as compared to upper class students. Additionally, upperclass students were more likely to know someone who had been sexually assaulted on campus. Eighty-nine percent believed that trained personnel were available to perform rape kits at the University hospital when that is false. Although rape kits were not available at student health services, 62% of students believed they were. Seventy-four percent felt that the university does not educate the community regarding resources available to victims of sexual assault but 71% felt that the school had the resources to help from crisis to recovery. Female students were significantly more likely to answer the questions correctly.

Conclusions: More can be done to decrease the number of sexual assaults that occur on campus, increase the number of reports, and ensure that victims receive proper care from crisis to recovery. Information on campuses should be provided throughout students' college course to ensure the student body has adequate knowledge of resources available on campus and in the community.

1 2115 Executive Drive Suite 9A, Hampton, VA 23666 2 Health Sciences Building, Rm 3122, 4608 Hampton Blvd. Norfolk, VA 23529 P78. Facebook: An Educational Tool for Young Women in an OB/GYN Practice

Background: Sexually transmitted diseases (STDs) are a critical health challenge facing the nation's health. Currently, there are an estimated 19 million new STD infections diagnosed yearly. Forty-eight percent of STD's are acquired by persons ages 15–24. Undiagnosed or untreated STD's can lead to serious health sequelae for young women. Creative educational methods are needed to effectively reach this at risk group. Social media, such as Facebook, has recently been shown to be a successful method for education and patient support.

Objectives: The purpose of this study is to evaluate the effectiveness of a Facebook educational platform to educate women ages 18–24 on STD's. Three evidence-based questions will be evaluated: 1) Will young women show improved knowledge of STDs following an educational intervention delivered via Facebook? 2) Will young women prefer using traditional written and verbal STD education compared to the Facebook educational platform, 3) Will young women report ease and satisfaction regarding the use of a Facebook educational platform for STDs?

Materials/Method: A one group pretest/posttest design has been used. The setting is a private OB/GYN office. A Convenience sampling of 37 women was used. Participants participated in an 8 week educational platform delivered via Facebook. Knowledge will be assessed pre-intervention and post-intervention. Satisfaction with the education platform will be assessed post-intervention.

Results: Participant outcomes will be measured for improved knowledge and satisfaction. It is expected that participants will have improved knowledge and report satisfaction and ease with the Facebook intervention.

Conclusion: Improved knowledge of STDs and satisfaction with the use of education via Facebook may enhance young women's ability to obtain health information and to care for themselves' more effectively.

1 Office of Diversity and Inclusion; Department of Medicine, Division of Cardiovascular Diseases; Mayo Clinic, Rochester, MN 2 Department of Medicine, Division of Geriatric Medicine and Gerontology; Emory University, Atlanta, GA and The Links, Incorporated 3 The Links, Incorporated, Washington, DC 4 Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ and The Links, Incorporated P79. Achieving Mutual and Distinct Organizational Health and Research Outcomes via a National Strategic Partnership Incorporating Education and Community-Based Participatory Research: The Links, Incorporated/ Mayo Clinic Experience

Background: The Links, Incorporated (Links) is an international not-for-profit African American (AA) women's service organization committed to improving health and reducing health disparities in AAs and other communities of color. Mayo Clinic (Mayo) is a not-for-profit healthcare, research, and educational organization with goals to provide high quality, culturally appropriate care to all, identify and address health disparities, promote research among minority populations, and enrich the pipeline of minorities in health care professions. These concordant and overlapping priorities led Links and Mayo to work together to achieve mutual goals.

Objective(s): Develop a durable, multi-faceted national Links-Mayo partnership incorporating research participation, education, advocacy, and healthcare, leveraging the strengths of each organization to reduce health disparities among AA women (AAW).

Materials/Methods: Links and Mayo utilized an exploratory and shared decision-making model to identify strategies to achieve outcomes together. Each organization collaboratively adapted or developed novel internal processes, resource allocation, funding mechanisms, and policy exceptions to insure success of the partnership and its initiatives.

Results: Mutual priorities include engaging communities of color in medical research to increase participation and reduce health disparities, improving health care delivery, particularly for conditions that disproportionately affect AAs, and enhancing research capacity for minority investigators. Key Links-Mayo initiatives include community-based participatory research (CBPR) on AAW's knowledge, attitudes, and behaviors regarding participation in medical research; creation and distribution of an educational video for AAW to encourage research participation; development of culturally appropriate educational materials focused on breast cancer, heart disease, and other Links health priorities; co-sponsorship of regional community-based health education and screening programs; an AA breast cancer survivor support group; and developing a CBPR project to reduce obesity in AA communities.

Conclusions: A novel national multi-pronged partnership between a minority-focused voluntary organization and a large academic health system built capacity in both organizations to mutually address health disparities and improve health interventions among AAW through research, education and community outreach. Replication by other organizations could improve the health of minority women.

1 Division of Epidemiology, School of Public Health and Primary Care, Chinese University of Hong Kong P80. Association of Life Course Sunlight Exposure and Breast Cancer Risk: A Population-Based Study in Chinese Premenopausal Women

Background: Sun exposure is the major source of vitamin D. Limited studies have suggested the protective effect of sun exposure on breast cancer risk.

Objective(s): This population-based study aimed to assess the association of sunlight exposure with breast cancer risk, measured by Tabár mammographic pattern, in Chinese premenopausal women.

Materials/Methods: A total of 676 premenopausal women from an ongoing population-based cohort study on breast cancer risk were recruited to participate in this study. Women were invited to the Prince of Wales Hospital in Shatin District in Hong Kong for mammography using a dedicated mammographic equipment (Senographe DMR; General Electric Medical Systems, Milwaukee, WI). The mammograms were classified according to Tabar's classification for parenchyma. Pattern IV & V and I, II & III indicated high and low breast cancer risk respectively. Life course exposure to sunlight at different age stages (6–12 y, 13–19 y, 20–34 y, ≥35 y) was assessed using the validated sunlight exposure questionnaire through telephone interview.

Results:Women with high breast cancer risk pattern (Tabár pattern IV &V) had fewer mean hours spent in the sun at any age stage than those with low risk (I, II & III). Women aged 40–44 yrs belonging to the highest tertile of lifetime sunlight exposure (hours) had an adjusted OR of 0.41 (95%CI, 0.18–0.92; P trend=0.03) compared with those in the lowest tertile of exposure. For the sunlight exposure during 6–12 yrs, the comparable OR was 0.37 (95% CI, 0.15–0.91; P trend=0.03).

Conclusions: Our results suggest that higher life course sunlight exposure, particularly during earlier years, is related to lower breast cancer risk pattern (Tabár pattern IV &V vs. I, II & III) at age 40–44 y among Chinese premenopausal women.

1 Department of Epidemiology and Community Health, Obstetrics and Gynecology and VCU Institute of Women's Health at Virginia Commonwealth University, Richmond, Virginia 2 School of Social Work Virginia Commonwealth University, Richmond VA 3 Family and Community Health, School of Nursing Virginia Commonwealth University, Richmond VA P86. Racial Differences in the Association between Stress and Preterm Birth

Background: Racial disparity in preterm birth is a major problem in the United States. Previous research has shown that women who experience high levels of stress during pregnancy deliver babies earlier than women with less stress. However, few studies have examined racial differences in the association between preconception stress and poor birth outcomes.

Objective(s): This study seeks to (1) determine the association between preconception stress and preterm birth and (2) examine racial and ethnic differences in preconception stress.

Materials/Methods: Pregnant women who were in their first trimester, attending three inner city clinics between February 2010-February 2011 were included in this study (N=220). History of stress was assessed using the Perceived Stress Scale and Stressful Life Event Inventory. Additionally, salivary cortisol was collected to determine salivary the stress level. Birth outcome data was captured from participants' electronic medical records upon delivery. Multiple logistic regression was conducted to examine the associations.

Results: Adjusting for social support, race, smoking status, and previous preterm birth, there was a linear increase in preterm birth per unit increase in stress score. While a positive association was found between high cortisol and stress score and preterm birth in African Americans, no association was found in Caucasian Americans.

Conclusions: Although not statistically significant, there is a positive relationship between stress and preterm birth, particularly in African American women. Stress may play a role in the racial disparities in poor birth outcomes. The interaction between race and stress need to be investigated in future studies, which should include larger sample sizes and other stress related biomarkers.

1 San Francisco General Hospital - Women's Options Center San Francisco, CA 2 San Francisco General Hospital - Birth Center San Francisco, CA 3 University of California, San Francisco MEPN program and the Bay Area Doula Project San Francisco, CA 4 Birth Justice Project San Francisco, CA P87. Birth Outcomes Associated With Doula Support During Labor

Background: Doulas have been successfully utilized in an urban birth center since 2004 with a volunteer-based, nurse run service. An anonymous, digital database of birth outcomes was created to collect data on the acceptability and efficacy of the volunteer doula support service. The purpose of this study was to determine if there were differences in birth outcomes and satisfaction scores of women attended by doulas, stratified by provider (i.e., Certified Nurse Midwife, Physician, or Both).

Objective(s):

1. To describe the impact of doula support on birth outcomes stratified by provider (i.e., CNM, MD or both)

Materials/Methods: All women with complete data were eligible for analysis in this study. Maternal variables extracted included: age, ethnicity, gravity, parity, history of previous cesarean section, number of centimeters dilated at time of doula arrival, maternal position and type of birth. Doula specific variables included: pain medications administered prior to and after doula arrival and if massage, breathing support, and familial support was provided. Finally, patient experience and satisfaction data were collected from women choosing volunteer doula support.

Results: No statistically significant differences in birth outcomes were found between women attended by Certified Nurse Midwives and Physicians when birth doulas were present. Women were extremely satisfied with doulas present during the birth experiences and report high satisfaction with doula support.

Discussion - Volunteer birth doula support for low income women with public insurance is highly effective in providing quality evidence based care. Doulas in this setting are equally utilized by Certified Nurse Midwives, Registered Nurses and Physicians and are able to provide support to women regardless of their familial or other types of support. Women report high satisfaction with doula support and have birth outcomes consistent with doula, nursing and midwifery practice.

Conclusions: Volunteer birth doula support for low-income women with public insurance is highly effective in providing quality evidence based care. Partnership models of doulas and nurses that support women across the reproductive spectrum in varying settings have the capacity to improve clinical outcomes. Our model of care emphasizes support of women, clear communication and role expectations, and volunteer service. Doulas in the Birth Center setting are equally utilized by CNMs, Registered Nurses and Physicians and are able to provide support to women regardless of their familial or other types of support. Women report high satisfaction with doula support and have birth outcomes consistent with doula, nursing and midwi.

1 Urban Indian Center Salt Lake City, UT 2 Best of Africa Salt Lake City, UT 3 Calvary Baptist Church Salt Lake City, UT 4 Hispanic Healthcare Task Force Salt Lake City, UT 5 National Tongan American Society Salt Lake City, UT 6 Utah Department of Health Salt Lake City, UT P88. Woman-to-Woman Coaching: An Innovative Program for Community Outreach in Underserved Populations

Background: Community Health Workers (CHWs) can help individuals obtain health and medical services. However, CHWs are often engaged only after individuals have developed a chronic condition. Many women in underserved populations have excess rates of some chronic diseases, but lack opportunity to reduce their risk. The Community Faces of Utah (CFU), a coalition representing African, African American, American Indian, Hispanic/Latino, and Pacific Islander communities, the University of Utah, and the Utah Department of Health, proposed a program to train women to be CHWs, but quickly realized the even greater need for community “wellness coaches” who could promote primary disease prevention.

Objective(s): In 2010, CFU joined with the Utah Women's Health Coalition to form the Coalition for a Healthier Community for Utah Women and Girls (UWAG). UWAG's primary objective was to adapt and test an evidence-based lifestyle intervention program for women, conducted by other community women serving as wellness coaches.

Materials/Methods: With funding from the Office of Women's Health, UWAG developed and implemented the Community Wellness Coach Program (CWCP). The CWCP is based on A New Leaf, an evidence-based intervention that uses tailored goal-setting and motivational interviewing to meet the unique needs of each woman who is coached. A 13-week curriculum promoting healthy choices was developed with input from community, academic and government coalition members. Long-term effectiveness and cost-effectiveness of the intervention is being evaluated.

Results: Seven women, all from CFU communities, have completed the training and are now certified wellness coaches. All report high levels of satisfaction with the training. More community women have asked for the training, and a hybrid in-person/online course is under development to meet the demand.

Conclusions: Too many at-risk women lack information and opportunity for preventive care. Community-based programs with woman-to-woman coaching may be an effective way to empower women to adopt healthier lifestyles and reduce their risk for disease.

1 University of Michigan, Center for Managing Chronic Disease, Ann Arbor, Michigan 2 University of Michigan Medical School and Departments of Internal Medicine and Pediatrics, Ann Arbor Michigan 3 Director, Center for Managing Chronic Disease, University of Michigan, Ann Arbor Michigan P89. Depression Among African American Women with Asthma

Background: African American women are disproportionately affected by asthma in terms of prevalence and poor outcomes. Depression has been linked with greater severity of asthma. Given the burden of asthma among African American women, it is important to understand how depression relates to managing this chronic disease.

Objective(s): To assess the 1) prevalence of depression reported by African American women with asthma; and 2) the relationships between depression and asthma control, asthma morbidity, and asthma management.

Materials/Methods: A total of 343 women were recruited from the University of Michigan Health System for participation in a randomized controlled trial of the ‘Women of Color and Asthma Control’ telephone-based asthma-management intervention. Baseline data were collected via telephone survey and included measures of: current levels of depression, asthma symptoms, asthma management practices and challenges, overall asthma control, asthma-related quality of life, asthma self-regulation skills and self-efficacy, and gender-specific management problems. Age-adjusted logistic regression models were used to assess the relationship between depression and asthma outcomes.

Results: The mean age of women in the study was 43 years. Self-reported prevalence of depression was 34%. There were no significant associations between depression and overall asthma control. However, the odds of reporting depression increased significantly with asthma symptom severity (OR=5.46); and level of asthma management challenges (OR=2.08). The odds of having depression decreased significantly with greater confidence in ability to manage asthma (OR=0.84), greater social support (OR=0.73) and higher asthma-related quality of life (OR=0.68).

Conclusions: In our sample of African American women, depression was associated with both more asthma symptoms and asthma management challenges. It is important that health care providers assess and understand women's level of depression and how this may contribute to their ability to manage asthma. Interventions designed to enhance asthma self-management should consider means to assist women experiencing depression.

1 Department of Community Medicine, University College Hospital, Ibadan, NIGERIA 2 Department of Obstetrics and Gynaecology, University of Helsinki, Finland P92. Improving the Knowledge and Use of Contraceptives to Reduce Unwanted Pregnancies among Hairdressers in Ibadan, Southwest Nigeria

Background: Hairdressers are predominantly females mostly in their reproductive years. Social networking in salons creates opportunity for peer influence which may predispose to unhealthy lifestyles and ensuing reproductive health problems.

Objective(s): To improve knowledge of contraceptives and reduce the occurrence of unwanted pregnancies among hairdressers by health education intervention.

Materials/Methods: A community based interventional study was conducted among hairdressers. At baseline, 1700 hairdressers were interviewed after obtaining informed consent. Socio-demographic characteristics, knowledge and use of contraceptive methods and experience of unwanted pregnancy and abortions were recorded. Hairdressers were then divided into study and control groups. A workplace educational intervention was carried out for the study group and these items were tested again six months later in both groups.

Results: Hairdressers' mean age was 27.0±8.1years. 860 (50.6%) were single and 840 (49.4%) were ever married, 40% were apprentices. Mean age at first sexual intercourse was 19.6±3.0 years. Of the singles, 19% reported unwanted pregnancy, 17% had had abortion. 32% and 39% of married hairdressers had unwanted pregnancies and abortions respectively, p=0.00. Current contraceptive use rates were 42.6% for single and 54.9% for married hairdressers. Predictors for current contraceptive use were being single OR 1.36 (1.05–1.76), lower education OR 1.64 (1.30–2.07) and being an apprentice, OR 1.39 (1.08–1.78). 33% of the study group had good knowledge of contraceptive methods at baseline compared to 52% post intervention, p<0.05. The proportion of hairdressers with knowledge of female condom rose from 53% to 72%, spermicides from 10% to 43% and cervical diaphragm from 16% to 45% in 6 months. Current contraceptive use did not change at 49%.

Conclusions: Health education on reproductive health issues improved the knowledge of hairdressers about contraceptives. These messages need to be reinforced before knowledge can translate to practice.

1 Department of Obstetrics and Gynecology, Campinas University - UNICAMP, Campinas, University - UNICAMP, Campinas, Sao Paulo, Brazil 2 Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil 3 Federal University of Espirito Santo, Vitoria, Espirito Santo, Brazil P94. Feminine Genital Hygiene Practices: Population-Based Study For Brazilian Women

Background: The daily care with the female genitalia is important and necessary to all women.

Objective(s): To describe genital hygiene daily practices of young Brazilian women and to correlate them with socioeconomic characteristics.

Materials/Methods: Cross-sectional study enrolled 146 women registered in the Family Health Program, Vitória, Brazil, from May to October 2012. Women were randomly selected and interviewed at home. Data about genital hygiene habits were obtained by means of specific questionnaire with 57 questions.

Results: The mean age was 29 years. Interviewed women reported to have vaginal discharge in 53% of cases and 44.6% performed vaginal douche. Soap and water is the most common way of cleaning (91.7%) and 45.8% used specific liquid soap. Comparing schooling levels (Cut-off: 13 years) and incomes (Cut-off: BR $1,500.00) the results showed that women with high education level spend more time working outside home (p=0.009) and they believe that this period impoverishes their genital hygiene (p=0.03). On the other hand, women with low level of education were associated with a greater number of full body baths per day (p=0.02) and women with low levels of education and income were associated with longer time to wash their genital area (more than 3 minutes) (p=0.0479 and p=0.002 respectively).

Conclusions: Although women with low level of education and income are more concerned about body and genital hygiene, probably, they do because they have more vaginal discharge. In conclusion, the general female population requires further information and awareness programs of hygiene management.

1 Rutgers University, Camden, NJ 2 Arizona State University, Phoenix, AZ 3 Johns Hopkins University, Baltimore, MD P95. A Longitudinal Study of Injury Among Female Nurses and Nursing Personnel

Background: Workplace Injury is a serious problem among nurses and nursing personnel. However, there is a paucity of longitudinal studies examining predictors of injury over time among this high risk population.

Objective(s): This longitudinal study examined the impact of injury, depression, and exposure to workplace violence (WPV) at baseline on injury on the job six months later among 1028 female nurses and nursing personnel.

Materials/Methods: Participants were involved in the Safe at Work Study, a prospective study of workplace violence (R010H007953); they completed online surveys at baseline and at six month follow-up. The baseline survey consisted of questions about injury on the job, exposure to WPV in the past 12 months, and the Center for Epidemiologic Studies Depression Scale (CES-D) assessing depression in the past week. The follow-up survey consisted of the CES-D, questions about injury on the job and exposure to WPV since the baseline interview. A logistic regression was used to predict injury on the job at follow-up; independent variables included baseline and current depression, baseline injury, WPV at baseline and follow-up, age, administrative unit, job shift (day/non-day), job type (part/full-time), job position (nurse/nursing personnel), working mandatory overtime (none/any), and a variable controlling for the case-control study design.

Results: The prevalence of injury on the job at baseline and follow-up was 16.6% and 10.6% respectively. When controlling for other variables (e.g., age, functional unit, etc.), female nurses and nursing personnel who experienced recent injury on the job at baseline or who experienced WPV between baseline and follow-up had 4 times (AOR=4.44; 95% CI: 2.81–6.99) and 2 times (AOR=2.12; 95% CI: 1.30–3.46) greater odds respectively of experiencing injury on the job at follow-up compared to their counterparts who had not experienced workplace injury at baseline or WPV between baseline and follow-up.

Conclusions: Workplace injuries can impact the health and thus the quality of patient care provided by healthcare workers. Addressing WPV along with assessment and treatment of workplace injury among this important population of health care workers may reduce future incidents of injury on the job.

1 School of Social Work, Virginia Commonwealth University Richmond, VA 2 Department of Epidemiology and Community Health, Virginia Commonwealth University Richmond, VA P96. Bridging the Mental Health Services Gap for Low-Income Women with Perinatal Depression: Results from a Community-Based Translational Research Pilot

Background: Low-income and ethnic minority women experience barriers to accessible, affordable, and timely treatment of depression occurring during and around the time of pregnancy. Maternal and child health (MCH) home visiting programs may play an integral role in identifying and addressing depression, particularly when traditional mental health services are not readily available.

Objective(s): Our study compared the efficacy of the Enhanced Engagement (EE) model, a brief psychosocial and service enhancement intervention infused within usual care MCH home visiting. The consumer-informed EE model is grounded in motivational interviewing, interpersonal psychotherapy, and cognitive-behavioral therapy.

Materials/Methods: The quasi-experimental mixed methods design compared team delivered EE with usual care home visiting which also included mental health support (N=25). Quantitative group x time analysis examined hypothesized decreases in depressive symptoms (PHQ-9) and increases in social support (SSQ-R). Qualitative content analysis examined post-intervention spontaneous recall of intervention content between groups. Program data and record reviews compared cost-benefit and service utilization outcomes.

Results: A repeated analysis of variance model revealed significant decreases in depressive symptoms (PHQ-9; t=−3.24, p=0.0036) and increases in perceived social support associated with the intervention (SSQ-R; t=3.35, p=0.0027). There were no significant pre-post differences in the usual care group. Content analysis demonstrated more frequent and specific working content recall in the intervention group over usual care. The intervention group had fewer failed visits, greater service engagement, and fewer staff hours spent in crisis intervention between visits.

Conclusions: Enhanced Engagement may be a viable brief intervention to reduce symptoms of depression and enhance social support in women receiving maternal and child health home visiting. The quantitative, qualitative and cost-benefit outcomes from this pilot study offer a promising foundation for future research and replication of the model, particularly in communities where service utilization barriers preclude or delay traditional mental health treatment.

1 Department of Health Sciences Research, Division of Health Care Policy and Research; Mayo Clinic, Rochester, MN 2 Department of Medicine, Division of Geriatric Medicine and Gerontology; Emory University, Atlanta, GA and The Links, Incorporated 3 Office for Community Engaged Research, Center for Translational Sciences Activities; Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic, Rochester, MN 4 Department of Radiation Oncology; Mayo Clinic, Phoenix, AZ and The Links, Incorporated 5 The Links, Incorporated 6 Office of Diversity and Inclusion; Department of Medicine, Division of Cardiovascular Diseases; Mayo Clinic, Rochester, MN P97. African-American Women's Perceptions and Attitudes Regarding Participation in Health Research

Background: Many African Americans (AAs) have negative attitudes toward research and mistrust of scientists, reflecting historical events. This undermines research participation and contributes to health disparities. AA women can be a powerful force for changing these attitudes in their communities. Members of The Links, Incorporated (Links), an international not-for-profit AA women's service organization include educated, professional women whose attitudes toward research are unknown and who can serve as opinion leaders regarding research participation thereby improving health and reducing health disparities.

Objective(s): This study examined attitudes toward research participation among Links membership.

Materials/Methods: Self-administered questionnaires were distributed at the Links National Assembly in July 2012. Questionnaires included a definition of health-related research, a targeted message regarding research participation, and belief and behavioral items. Fourteen attitude statements from Mouton et al. (1997) were presented with a 5-point “strongly disagree” to “strongly agree” rating scale; “strongly agree” and “agree” were combined to reflect agreement.

Results: A total of 381 surveys were analyzed. Median age was 59 years. A majority were married (66%), employed (69%), and college-educated (96%). Approximately 35% had previously participated in research. Overall, 78% agreed with the statement: “Participation in research will mean better care,” 24% agreed “Participation in research is risky,” and 3% agreed “Scientists cannot be trusted.” These data depart from those of educated black women (n=29) in the 1997 study, where agreement with these statements was 30%, 61%, and 32%, respectively. Fifty-two percent of Links respondents (vs. 28% in Mouton et al.) agreed with the statement “Research conducted in the United States is ethical.”

Conclusions: Attitudes toward science and research participation were favorable among Links respondents. Leveraging the influence of the Links may improve trust and increase research participation in AA communities, thereby improving health and reducing disparities.

1 School of Health Sciences, Department of Advanced Nursing Science, University of Venda, Thohoyandou 0950, South Africa 2 School of health Sciences, Department of Public Health, University of Venda, Thohoyandou 0950, South Africa P99. Understanding the Concept of Menopause Among Rural Women in Limpopo Province, South Africa

Background: The word ‘menopause’ is derived from men and pausis and is a direct description of the psychological and physical events in women where menstruation ceases to occur. It is the time in a woman's life when she has experienced the last menstrual bleed. Menopause is not a disease per se but a condition associated with hormonal changes where estrogen diminishes to a low level causing health related symptoms.

Objective(s): The purpose of this study was to explore and describe the understanding of the concept menopause among rural women in Limpopo Province, South Africa.

Materials/Methods: A qualitative, explorative, descriptive and contextual design was used. Purposive sampling was used to select the four villages and the focus groups. Sample size was determined by data saturation.

Results: The findings of the study indicated that the rural women in rural villages had the common traditional understanding of the concept menopause, that blood is gone, old age, it was God’ nature of doing things and that cessation of menstruation was a normal and natural transition. They could not attach cessation of menstruation to menopausal conditions that give rise to physical as well as psychological health related problems but to old age.

Conclusions: There is need for health care providers to conduct workshops in order to enlighten rural women in this community regarding phenomenal issues of menopause.

1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 2 Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, GA P100. Risk-Based Cholesterol Screening for Women

Background: High cholesterol often precedes cardiovascular disease (CVD) and cholesterol screening is recommended for at-risk women. Definitions of CVD risk vary and prevalence of high cholesterol among women may depend upon age and definitions of risk.

Objective(s): We sought to examine the prevalence of undiagnosed dyslipidemia (abnormal total cholesterol, high density lipoprotein cholesterol (HDL-C), or non-HDL-C) among women according to different definitions of CVD risk and stratified by age.

Materials/Methods: This study used 2007–08 National Health and Nutrition Examination Survey data (n=1,781), a representative sample of the U.S. civilian, non institutionalized population, to estimate the proportion of women without previous dyslipidemia diagnosis who are U.S. Preventive Services Task Force (USPSTF)-at risk and American Heart Association (AHA)-at-risk. We also report dyslipidemia prevalence stratified by age, reproductive age women (20–44 years) and older women (≥45 years).

Results: Over hall of reproductive age women (55.0%) and 74.2% of older women were USPSTF-at risk, while nearly all reproductive age and older women had at least one AHA risk factor (99.5% and 99.6%, respectively). Dyslipidemia prevalence was high regardless of at-risk definition. Among reproductive age women it was 47.3% (95% confidence interval [C] 42.2–52.5) for USPSTF-at risk and 39.5% (95% CI: 35.7–43.4) for AHA-at risk. Among older women, it was 65.5% (95% CI: 60 8–69.9) for USPSTF-at risk and 63.3% (95% CI: 59.0–67.4) for AHA-at risk.

Conclusions: Both definitions of at-risk identified similar prevalence of dyslipidemia among women. However, the AHA definition of CVD risk identified 45% more younger women at risk than the USPSTF definition. Given a high prevalence of dyslipidemia among younger women, future research is needed to assess whether identification and treatment of young women with dyslipidemia will decrease CVD mortality among them later in life.

1 community based mental health nursing research center, Faculty of Nursing, Shiraz University of Medical Sciencesi P102. Enhancing Women's Health by Screening Common Cancers Among Single Mothers in Shiraz Southern Iran

Background: Cancer growth in recent decades has shown its harmful effects on the physical, psychological, social, economical and spiritual aspects of patients' lives and their families. So the establishment of preventive screening programs is necessary. Breast and cervical cancer are the most common cancer in women.

Objective(s): The objective of this project was to improve the health of single mothers by screening them for breast and cervical cancer.

Materials/Methods: This cross-sectional study was performed on 6000 women between the age of 35 to 70 years during 2009=2011 in Mottahari Clinic in Shiraz, southern of Iran.

Initially, the Women were examined clinically by surgeons and trained physicians and then mammography and sonography were done as complementary procedures. Also, biopsy samples were taken if needed. Moreover pelvic exam and Pap smears were performed by gynecologist. Data regarding the patients' age, number of children, age at marriage, number of pregnancies, age at menarche and history of cancer were collected by questionnaires.

Results: After reviewing the results of 41 patients who underwent biopsy for suspected breast cancer. Malignancy was diagnosed in 8 patients and mastectomy was performed.

With respect to cervical cancer, 60 women were suspected of having cancer. Of these, 7 were finally diagnosed by repeated pap smears and underwent hysterectomy and 14 underwent cryosurgery.

Conclusions: Mammography and pap smear can be used as a routine procedure for the detection of malignancies and reducing mortality in women with breast and cervical cancer.

1 Planned Parenthood Federation of America, Inc., New York, NY 2 Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger Jr., Hospital of Cook County, Chicago, IL 3 Planned Parenthood Federation of America, Inc., New York, NY 4 Planned Parenthood Fed. of America, Inc., Div of Family Planning, Dept of Ob/Gyn, John H. Stroger Jr., Hospital of Cook County, Chicago, IL; and Dept of Ob/Gyn School of Med, Northwestern Univ., Chicago, IL P105. HPV Vaccine Series Completion: Does Knowledge Make a Difference?

Background: Despite widespread support for human papillomavirus (HPV) vaccination within the public health community, uptake and completion rates of the HPV vaccine series remain low. Educating patients and parents about HPV has been suggested as a way to increase HPV vaccine completion.

Objective: To assess the impact of HPV knowledge on HPV vaccine series completion

Materials/Methods: This study is part of a larger randomized control trial testing the effect of a novel reminder system on HPV vaccination completion. 365 women age 19–26 were enrolled at 10 outpatient reproductive health clinics. At time of first dose, a 23-item survey assessed knowledge of HPV and the HPV vaccine. Question responses included “true”, “false” and “I don't know.” Women were then tracked for 32 weeks, i.e., 8 weeks beyond the recommended time frame for receipt of the three-dose series, to determine which factors were correlated with completion of the vaccine series. Chi Square tests and logistic regression were used to calculate the relationship between HPV knowledge and vaccine completion.

Results: Knowledge score was not correlated to likelihood of completing vaccine series (p=0.5; OR=0.98). This held true after controlling for study arm (i.e., control vs. intervention). Overall HPV knowledge was poor and highly variable; mean knowledge score was 52.5% (range 0–100%, SD 18.4). Only one item of the twenty-three – can HPV cause HIV/AIDS? – was predictive of vaccine series completion. Women who erroneously believed that HPV could cause HIV/AIDS (n=32; 34%) were 2.5 times more likely to complete the vaccine series than women who correctly answered that it could not (n=235; 17%) (p=0.0191).

Conclusions: HPV knowledge score did not predict vaccine series completion in a group of women initiating HPV vaccine. This has concerning implications for public health efforts aimed at educating the public about the health effects of HPV in an effort to encouraging vaccination.

1 Universidade Federal de São Paulo and Universidade do Vale do Sapucaí, Pouso Alegre - Minas Gerais, Brazil 2 Universidade do Vale do Sapucaí, Pouso Alegre - Minas Gerais, Brazil P107. Influence of Body Mass Index on Sexual Function and Body Image of Brazilian Women

Background: Dissatisfaction with body shape or appearance is considered to be frequent among women. Obesity has been associated with greater impairment in sexual quality of life. Both overweight and obesity have been identified as risk factors for sexual dysfunction in men, but the relationship between sexual function and body mass index (BMI) in females is still obscure.

Objective(s): To evaluate the influence BMI on sexual function and body image of Brazilian women.

Materials/Methods: Premenopausal and reportedly sexually active women were enrolled (n=129). Participants were allocated, according to body mass index (BMI), into three groups: Lean (n=63), with BMI less than 25Kg/m²; Overweight (n=26), BMI ranging from 25 to 29.9Kg/m²; or Obese group (n=40), BMI equal or over 30Kg/m². The Female Sexual Function Inventory (FSFI) and the Body Shape Questionnaire (BSQ) were used to assess sexual function and body image, respectively. FSFI provides scores on six functional domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). It also provides a total score, ranging from 2 to 36, that can be used to differentiate women with and without sexual dysfunction (score≤26 determines sexual dysfunction). BSQ produces one score, ranging from 34 to 204. The following scores were taken into account to quantify concerns with body image: no concern (total score≤110), mild (total score>110 and ≤138), moderate (total score>138 and ≤167), or severe concern (total score≥167). A statistical analysis of results was performed.

Results: Median age was 24.0, 27.0 and 40.5 years old in lean, overweight and obese groups, respectively (p=0.000). Groups did not differ regarding to sexual dysfunction occurrence (p=0.143). There was statistical difference among the three groups in regard to the FSFI domain “orgasm” (p=0.003); overweight women had better results. Lean women presented better body image than overweight and obese women (p=0.000).

Conclusions: BMI did not influence occurrence of sexual dysfunction in Brazilian premenopausal women. Overweight women presented better results for “orgasm” and lean women demonstrated better body image.

1 Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine; Cancer Prevention and Control Program, Yale Cancer Center; New Haven, CT 2 Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT P108. Do Women Really have a Harder Time Quitting Smoking?

Background: Considerable research has shown that men are more likely to quit smoking than women. However, a recent paper utilizing cross-sectional epidemiological data from three countries (U.S., Canada, Britain; Jarvis MJ, Cohen JE, Delnevo CD, et al. Tobacco Control, 2012, doi:10.1136/tobaccocontrol-2011-050279) aimed to ‘dispel the myth’ of gender differences in cessation outcomes and concluded that men and women evidence similar smoking cessation rates.

Objective(s): We extend the findings of this recent report and investigate the association of gender to multiple smoking transitions (i.e., smoking cessation, smoking relapse, smoking initiation) using longitudinal data from a national sample of U.S. adults.

Materials/Methods: Analyses were based on 30,798 U.S. adults who provided smoking status information at two waves of data collection for the National Epidemiological Survey on Alcohol and Related Conditions (Wave 1, 2001–2002; Wave 2, 2004–2005) and who were classified as Current Daily Smokers, Former Daily Smokers, or Never Smokers at the Wave 1 assessment. Participants within each Wave 1 smoking classification were determined to be current smokers or non-smokers at the Wave 2 assessment.

Results: Gender was not associated with the smoking quit rate over the three year period (OR=1.00, 95% CI=0.83, 1.20) but was significantly associated with smoking relapse and smoking initiation. Women who were former daily smokers at Wave 1 were more likely than men to have relapsed to smoking at Wave 2 (OR=1.49, 95% CI=2.00, 1.11). Men who were never smokers at Wave 1 were more likely to have initiated smoking at Wave 2 than women (OR=1.77, 95% CI=1.44, 2.18).

Conclusions: While men and women appear equally likely to quit smoking, gender differences exist in smoking relapse and smoking initiation. Importantly, women have more difficulty quitting smoking in the long-term due to higher smoking relapse rates, and clearly need treatments that are gender-specific and of longer duration in order to abstain from smoking successfully.

1 iWomansHealth, Washington, DC 20002 2 Southern California Center for Sexual Health and Survivorship, Newport Beach, CA 92663 3 University Hospitals Case Medical Center, Cleveland OH 44106 P109. REVIVE (REal Women's VIew of Treatment Options for Menopausal Vulvar/Vaginal ChangEs) Survey Results

Background: Vulvar/vaginal atrophy (VVA) and associated symptoms affect an estimated 25–50% of postmenopausal women; roughly 32 million women currently suffer from VVA. Although VVA symptoms do not improve without treatment, only 2.3 million (7%) women currently receive prescription therapy.

Objective(s): This survey was conducted to characterize women's knowledge of VVA, describe its impact on women's lives, and evaluate women's likes and dislikes of currently available treatments.

Materials/Methods: Women age 45–75 were invited to participate in an IRB-approved online survey developed and analyzed by healthcare experts in the field of menopause. A total of 3,046 menopausal (natural/surgical) women who had experienced, at some point, one or more symptoms of VVA were enrolled and stratified by treatment status (current [Rx or OTC], lapsed or naïve users).

Results: On an unaided basis, only 25% of women cited menopause as the cause of their symptoms. Only about half (56%), indicated that they discussed their symptoms with their HCP. Of the participants, 29% were using OTC only, 7% Rx only, and 4% Rx and OTC, for a total of 40% currently treated. Among current users, women using an OTC product vs. Rx product reported more symptoms within the past month (Dryness: 50% vs. 16%; Dyspareunia: 55% vs. 18%; Tenderness: 58% vs.15%; Irritation: 44% vs. 14% for OTC and Rx respectively). Despite better symptom relief with Rx, overall only about 30- 40% of women were satisfied with either their OTC or Rx treatment.

Conclusions: Knowledge is low of VVA as a condition of menopause and also that symptoms (eg, dyspareunia, dryness) can significantly impact women's lives. Women remain dissatisfied with currently available OTC products and prescription topical VVA treatments. Additional therapeutic options would be helpful for women suffering from this chronic, distressing condition.

1 Department of Psychiatry, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria 2 Department of Community Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria P111. The Impact of a 3-Day Workshop on the Knowledge, Attitude and Prctice of Community Health Workers on Intimate Partner Violence in South-Western Nigeria

Background: The World Health Organization (WHO) had posited that Intimate Partner Violence (IPV) is an urgent public health priority and it reiterated the need to follow international guidelines to screen for IPV at all healthcare levels. IPV contributes significantly to women mental health burden, their mortality, adverse outcome on the child/children and the entire family, economic loss and adverse effect on the productivity of the nation. Growing evidence on this issue highlighted the need for community efforts at prevention. Training of the primary health care workers will help to create a high level of suspicion for IPV and help to reduce the severity of its outcome or in its prevention in the community.

Objective(s): To assess the impact of 3 days training workshop on the knowledge, attitude and practice of non-specialist primary health care workers in Nigeria.

Materials/Methods: An intensive 3 days training workshop was organized for sixty community health officers from five local government areas in Osun State (South-West Nigeria). Participants completed a 30-point questionnaire (adapted from Abuse Assessment Scale) designed to assess knowledge of, attitude to and practice of IPV before and after the training.

Results: There were sixty participants with mean age 40.90±10.19. Fifty (83.3%) were female and 46.7% are in the 30–44 years age group. About 30% thought they have seen a case of IPV in their practice prior to the workshop and this increased to 80% post workshop. The overall assessment of knowledge of IPV increased from a mean score of 12.98±3.50 to 23.35±4.45 (t-test=18.19; P<0.001).

Conclusions: There was a significant improvement in the knowledge and attitude of non-specialist community health workers following the 3 days training workshop. Over 90% of community health officers in most sub-Saharan Africa countries are non-specialists, making it imperative for concerned authorities to adopt a policy in the training of this cadre of health care providers on this important aspect of womens health.

1 University of Illinois at Chicago, Chicago, IL 2 Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL P112. Keeping It All Together: Female Physicians Balancing Medicine and Motherhood

Background: Female physicians have a unique combination of personal and professional roles that requires constant balancing and prioritization throughout their lives. Based on personal accounts by female physicians and mentorship programs coordinated by organizations dedicated to the advancement of female physicians in academic medicine, there appears to be a general consensus that more should be done to help female physicians achieve the desired balance of personal and professional roles.

Objectives: To critically examine published literature and synthesize it to define factors that facilitate or hinder female physicians in achieving their personal and professional goals and maximize their potential.

Materials/Methods: Online search of Medline using PubMed, Web of Science and Embase for published literature about female physicians per defined search terms. Article review and selection per study eligibility criteria and synthesis to answer study research questions and provide recommendations.

Results: Of 25 initially identified articles, 11 (44%) articles met eligibility criteria. 2 (8%) articles provided a combination of personal perspective and statistic. 1 reference qualified as a historical piece. 2 (8%) articles discussed overall changes in medical workplace hours. 2 (8%) articles were studies on how medicine is expected to change with feminization of the profession. 2 (8%) articles were specifically focused on the incorporation of mentorship programs to ease the challenges of the career and family combination.

Conclusion: The perspectives and professional opinions demonstrated by female physicians and faculty members in the medical field highlight the importance of working together to further accommodate female physicians. The purpose of such unified efforts is to create skilled physicians who still benefit their families, resulting in career satisfaction and overall better patient care. This can be made possible with more unity from women doctors starting at the medical school level with the incorporation of mentorship programs.

1 Co-chair of Gender Equity Task Force, American Medical Women's Association, Professor of Otolaryngology and Pediatrics (retired); University of Buffalo, NY 2 2nd year student, Trinity Medical College of Dublin; Dublin Ireland 3 Co-Chair of Gender Equity Task Force, American Medical Women's Association, Reston, VA 4 Associate Professor-Sociology & Anthropology, University of Texas, Arlington, TX P114. Defining the Work Habits, Attitudes and Experiences of Women in Medicine - Initial Insights from a Funded Grant Writing Project

Background: Understanding the work habits, attitudes and experiences of women physicians is critical to their providing optimal patient care. Comparison to male physicians has been the standard by which we characterize women, thereby generally ignoring valuable qualities women specifically bring to medicine. “Adapt or exit” choices to challenges have not worked.

Objective(s): With resources provided by The Giambalvo Scholarship we planned: 1. To analyze the recent literature key to understanding what is “known” about women in medicine, 2. To identify areas most pertinent to women physicians, and 3. To prepare a grant proposal uses more effective methodologies to obtain actionable data leading to effective change. Small focus groups are underway.

Materials/Methods: Seventy papers (1990 to present) were reviewed to identify themes pertinent to the study of women physicians. Study methods were also evaluated as to their provision of data that would result in effective change.

Results: Three themes - productivity, attitudes, and work habits - emerged. Productivity models primarily focus on quantitative measures, e.g. work hours, procedures, publications. Studies seldom captured the context of differing work habits, the effects of workplace attitudes and often seriously challenging experiences of women doctors. Women never measured up to the current male mold as “optimal,” assuming that women would do well fitting into the existing workplace environments. Few studies used qualitative methodologies; those provided more nuanced and actionable data. Expanded descriptions of the results of small focus groups support these observations and will be provided.

Conclusions: Study of women physicians are needed to re-define the benchmark as to how women physicians work. New approaches of study will likely dismantle gendered schemas more effectively, resulting in better utilization of women physicians. These

1 National Healthy Mothers, Healthy Babies Coalition, Alexandria, VA 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA P116. Text4baby as a Valuable Tool for Providers and Patients

Background: Cell phones represent an opportunity to address health inequalities given that they are nearly ubiquitous in the US and can be used to reach populations at highest risk for poor health outcomes with vital health information and resources. Text4baby is a free mobile service that provides timely health information to pregnant women and moms with babies under one year old. By texting “BABY” (or “BEBE” for Spanish) to 511411, women receive texts about a range of topics, including prenatal and infant care, immunization, nutrition, breastfeeding, and sleep safety.Text4baby content also includes alert messages and interactive enhancements

Objective(s): To describe:

• The text4baby content development and review process, including the new content council which includes professional organizations, such as ACOG and AAP

Materials/Methods: Text4baby recently implemented data collection and analysis efforts to examine: enrollment and cancellation rates, type of user, referral sources, and response to interactive features.

Results: Since program launch in 2010, more than 450,000 individuals have enrolled and 850 outreach partners are promoting the service nationwide. Results from a poverty-level zip code analysis of text4baby enrollees and those who have cancelled suggest that participation and retention are higher in low-income areas. The majority of users are pregnant women (71%) and new mothers (25%); the remaining 4% are observers. Descriptive data on user-reported referral source and from the new interactive enhancements will be presented. Results from the 2011 influenza module suggest users are engaged and willing to respond to text surveys: 31% (29,316 of 96,070) responded to a text asking about their intention to get a flu shot.

Conclusions: Text4baby is an important tool for healthcare providers, researchers, policymakers and public health professionals, especially because it is free to the end user and to partners. Text4baby has a rigorous content development process and providers can be assured that the messages are clinically accurate. Program enhancements are based on lessons learned on user engagement and adoption.

1 University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 2 Pittsburgh Affiliate of Susan G. Komen for the Cure Pittsburgh, PA P117. A Community Based Participatory Research (CBPR) Initiative to Address Breast Cancer Health Disparities

Background: Significant racial disparities exist in the diagnosis and treatment of breast cancer. While white women have the highest incidence rate for breast cancer, African American women are more likely to die from the disease. In Allegheny County, PA the death rate of African American females is 1.5 times the national Healthy People 2010 goal for breast cancer. Allegheny County's largest minority group is African Americans.

Objective(s): To develop a community based participatory research (CBPR) collaborative between multiple academic and community stakeholders working to address the Continuum of Care for breast cancer (i.e. screening, diagnosis, treatment and follow-up screening) among African American women in Allegheny County.

Materials/Methods: Using CBPR funding provided from the University of Pittsburgh Clinical and Translational Sciences Institute, monthly meetings are held to nurture relationship development among the interdisciplinary project team including representation from public health, nursing, medicine and community advocacy.

Results: Building from Komen Pittsburgh's connections to community partners who are committed to lowering breast cancer rates among African American women, the team has identified a list of 50 relevant stakeholders. An on-line resource assessment survey tool is under development and will be use to assess local breast health resources and capacity. Results from this survey will be used to identify, address and prioritize gaps in current knowledge and practice for addressing the Continuum of Care for breast health in African American women in Allegheny County.

Conclusions: Komen Pittsburgh and the Pitt Graduate School of Public Health are committed to the work of eliminating breast cancer disparities among African American women. This approach is an example of how partnerships can be nurtured and developed to inform research with a strong potential for influencing advocacy efforts, creating a healthier environment in western PA, and informing testable hypotheses for future qualitative and quantitative, multi-level, research on this topic.

1 Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ 2 Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, Australia 3 Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN P118. Intrauterine Contraception for Nulliparous Women: A Global Survey of Providers' Knowledge and Attitudes

Background: Intrauterine contraception (IUC) is highly effective and safe in nulliparous women (NW); nevertheless, barriers limit its use in this group.

Objective(s): This analysis aimed to determine whether those who teach/supervise the provision of IUC have a better understanding of its use in NW, and whether the barriers reported by clinicians vary depending on the number of years post training.

Materials/Methods: An online survey of clinicians providing contraceptive services was conducted across Europe, Canada, the USA, Latin America and Australia (15 countries). Respondents completed a 13-item questionnaire examining their attitudes/beliefs about IUC and the accuracy of their knowledge regarding the use IUC in NW.

1787 respondents, equally distributed between three categories: >20, 11–20 and 1–10 years in practice, completed the survey, categorizing themselves as an ‘inserter’ (70%), ‘trainer/inserter’ (8%), ‘trainer/supervisor’ only (1%), or ‘referrer’ (21%). For analysis all trainers were combined.

Results: Awareness that IUC in NW is WHO MEC category 2 (benefits outweigh risks) was used as a marker for knowledge. Overall, only 50% of respondents correctly identified nulliparity as category 2: 58% of trainers, 52% of inserters, and 38% of referrers. No differences were observed according to respondents' duration of practice.

Main barriers to provision of IUC in general for trainers were pelvic inflammatory disease (47%), nulliparity (40%), menstrual disruption (31%) and painful insertion (30%). Inserter's principal concern was nulliparity (49%), although pelvic inflammatory disease (44%), pain (28%) and difficult insertion (24%) were among their top issues. Nulliparity was reported by 54% and 43% of those practicing >20 years and 1–10 years, respectively.

Conclusions: Continued education is needed worldwide to remove barriers to IUC use in nulliparous women. In particular, efforts need to be made to improve evidence based knowledge among trainers to allow for expanded use of this safe and effective method in the future.

1 DC Department of Health, Washington, DC 2 University of the District of Columbia Washington, DC 3 The Graduate School Washington, DC 4 DC Cancer Consortium Washington, DC P120. Preparing the Future Workforce for Comprehensive Cancer Control

Background: Cancer is the second leading cause of death in the United States claiming more than half a million people each year. However, due to progress in both early detection and cancer treatment mortality rates have decline and 5-year cancer survival rates have increased. Critical to sustaining this trajectory is insuring a well trained and motivated cancer control workforce. Unfortunately, recent studies suggest the public health workforce (PHW) is in a dangerous decline. A shortage of one-third of the PHW is anticipated by 2020. And few programs exist to prepare the PHW for the role in comprehensive cancer control. Developing programs to expand the workforce in this area is paramount to addressing cancer survivor needs.

Objective(s): The District of Columbia Cancer and Health Internship Program (DC-CHIP) tested the viability of implementing a disease specific city-wide internship program to prepare students to participate in the comprehensive cancer control workforce thereby and building capacity among organizations to address the cancer burden in the District. To that end, the program team developed and implemented a process for recruiting and assessing minority public and allied health students; provided training in comprehensive cancer control competencies; described potential career paths in comprehensive cancer control; and prepared students to work in professional public health settings. The CHIP objectives were to 1) recruit and train 30 students in comprehensive cancer control and 2) recruit 15 organizations engaged in cancer control activities to host DC-CHIP interns.

Materials/Methods: CHIP was a public/private partnership between the University of the District of Columbia (UDC), the Graduate School USA, the DC Cancer Consortium (DCCC) and the DC Department of Health. CHIP candidates completed an application outlining previous experience, interest area, etc. Host sites, recruited from DCCC membership, completed applications outlining skills and qualifications needed. Selected interns participated in a 4-hour comprehensive cancer control training addressing core competencies in the cancer continuum. Host sites presented on organizational mission, activities and possible intern activities. Preliminary matches were made at the conclusion of the training. A 3-tiered matching algorithm was employed to match students to sites based on interest, past experience, and organizational need. Students were then deployed to CHIP Host Sites. Interns and host sites will participate in a culminating evaluation at the end of the semester. Lessons learned with be implemented in the second cohort of students interns in 2013.

Results: Twenty eight students were matched to 14 host sites including community based organizations, hospitals, national voluntaries, and advocacy groups. The mean age of CHIP interns was 35 years with a maximum of 61 years. Seventy five percent of interns were women and 93% were minority. The majority of students were studying at the undergraduate level (70%) and participating in the internship for course credit (75%); 66% were majoring in public health, and the remaining were majoring in allied health fields. Thirty nine percent of interns were interested in working on African American issues, 35% were interested with youth and with low SES. Thirty two percent were interested in women's issues. None of the students had any previous training in comprehensive cancer control and none were paid during the course of their internship.

Conclusions: Several lessons were learned during implementation. Although, professionalism and positive work ethic were addressed during training, at least one student was terminated due to dependability issues. Also, unreasonable site expectations resulted in one site's withdrawal from the program. CHIP interns were older than the traditional intern and many were from diverse cultural backgrounds. This diversity was well matched to the needs of the host sites. Feedback from host sites has been positive, with at least one site already signed up for the next semester. The creation of a topic specific internship program is a viable means of increasing organizational capacity to meet needs and expanding the public health workforce.

1 David Geffen School of Medicine at UCLA, Los Angeles, CA 2 Department of Graduate Medical Education, David Geffen School of Medicine at UCLA, Los Angeles, CA P121. Women's Health Elective for Medical Students at the David Geffen School of Medicine at UCLA: An innovative approach to the expansion of women's health education initiatives

Background: Integrating women's health and gender specific content into medical school curricula has been a challenge. Incorporating women's health topics into medical school curricula has shown to positively affect medical students in many areas including understanding health and disease from a gender-specific perspective, enhancing a strong social and public health awareness of issues that adversely affect the health of women, and increasing knowledge of gender differences in overall health outcomes.

Objective(s): To describe the integration of a women's health elective into medical school curricula and its impact on developing women's health education initiatives.

Materials/Methods: Medical students at the David Geffen School of Medicine at UCLA created the first elective for women's health education in the school's history 10 years ago. The elective was entirely student conceived and organized and was comprised of two components: (1) a lecture series and (2) a shadowing experience. Faculty members participated on a voluntary basis giving lectures and/or inviting students to shadow them in daily activities. In addition to the traditional focus of reproductive health, this course integrated unique aspects of women's health in diverse areas such as psychiatric disease, cardiovascular disease, pharmacology, and immunology.

Results: To date, 120 students have completed the women's health elective and 24 faculty members have participated either as lecturers or mentors. The program is now entering its 10th year and continues to be student-run and faculty supported.

Conclusions: The women's health elective has proven to be a sustainable, low-cost method for incorporating women's health in the medical school curricula and has fueled the rapid expansion of women's health programming, including the development of a fourth year integrated women's health elective at the David Geffen School of Medicine UCLA.