Prehospital Training on Obstetric and Neonatal Issues for Prehospital Education in Rwanda—A Collaboration Between SAMU, Ministry of Health of Rwanda and Virginia Commonwealth University
Ashley Rosenberg, MD,4 Jeanne D'arc Nyinawankusi, MBA,2 Kenneth Williams,3 Luke Wolfe 4 Jean Marie Uwitonze, MIPH, MHM,1 Ignace Kabagema,1 Theophile Dushime, MD, MSC,1 and Sudha Jayaraman, MD, MSC4
1Ministry of Health Rwanda, Kigali, Rwanda, 2Service d'Aide Medicale Urgente Ministry of Health Rwanda, Kigali, Rwanda, 3Virginia Commonwealth University Center for Trauma and Critical Care Education, Richmond, Virginia, 4Virginia Commonwealth University Department of Surgery, Richmond, VA
Background: More than 135 million women give birth per year and nearly 830 women die daily due to complications, most of which can be prevented. Our collaboration developed and implemented a context‐specific, prehospital Emergency Obstetrics and Neonatal Course (EONC) and train‐the‐trainers program for SAMU, based on established international best practices.
Methods: Two cohorts of staff participated in the program– the first group (Instructor core) 20 SAMU staff and the second 38‐staff chosen by from 23 district, provincial and referral hospitals. A two‐day EONC was developed, consisting of skills stations, simulations and didactics. The Instructor core had EONC 1, then they taught the second cohort EONC2. A 50‐question assessment was administered to both cohorts before and after the courses.
Results: EONC 1 median scores were 60% vs 92% (pre vs post), using matched pair analysis of 20 participants. EONC 2 median scores were 52% vs 96% (pre vs post), using matched pair analysis of 29 participants. EONC 1 had a statistically significant mean change in pre to assessment test scores of 32% compared to 41% for EONC 2, p < 0.0001, with 95% confidence using a two‐tailed paired t‐test. A one‐way ANOVA mean square analysis showed that all trainees reached similar post‐ assessment scores, F (1) = 8.35, p = 0.0059.
Conclusions: This study demonstrates effective implementation of a context‐appropriate prehospital obstetric and neonatal training program for prehospital staff in Kigali, Rwanda. This program may be effective to support capacity development for prehospital trauma care in the country using a qualified local source of instructors.
Emergency Obstetric Care in the Prehospital Setting: The SAMU Experience in Kigali, Rwanda
Ashley Rosenberg, MD,5 Jeanne D'arc Nyinawankusi, MBA,3 Rose Habihirwe,3 Myles Dworkin1 Vizir Nsengimana, MD,4 Jean Marie Uwitonze, MIPH, MHM,2 Ignace Kabagema,2 Theophile Dushime, MD, MSC,2 and Sudha Jayaraman, MD, MSC5
1Jefferson University School of Medicine, Philadelphia, Pennsylvania, 2Ministry of Health Rwanda, Kigali, Rwanda, 3Service d'Aide Medicale Urgente Ministry of Health Rwanda, Kigali, Rwanda, 4University Teaching Hospital of Kigali, Kigali, Rwanda, 5Virginia Commonwealth University Department of Surgery, Richmond, VA
Background: In Rwanda, 69% of the population is <31 years of age, 25% of the population is of child bearing age. We sought to understand the care provided for obstetric emergencies in the prehospital setting by SAMU, the public ambulance service in Rwanda.
Methods: Descriptive analysis was performed of demographic, indication and intervention data for obstetric emergencies between December 2012 to May 2016 collected in a prospective database.
Results: Nearly 16% of 11,161 patients seen by SAMU were for obstetric emergencies which represented 38.7% of all women seen by SAMU. The average age was 26 + 9 and 57% were delivery‐related—labor (75%) and retained placenta (19%). Pregnancy‐related complications such as bleeding (22%) and threatened abortion (22%) were a quarter of all obstetric calls and 11% were postpartum problems including eclampsia, hemorrhage, other. Four percent had gyn complaints including cervical cancer, and metrorrhagia. Of 826 in labor, on average, women were dilated to 5.5 + 3 cm.
Conclusions: Obstetric emergencies need early recognition and intervention to support optimal outcomes for both mother and child. In Kigali, Rwanda, SAMU prehospital service provides much needed emergency obstetric care. Supporting their training in management of obstetric emergencies, ensuring supply chain of critical medications such as misoprostol and TXA and optimizing rapid communication with receiving hospitals is likely to have substantial impact on maternal and fetal outcomes in the country.
Attitude Toward the Pap Test Among the Sexually Active Unmarried Women
Hae Won Kim, PhD, RN
Seoul National University, College of Nursing, the Research Institute of Nursing Science, Seoul, South Korea
Background: This study aimed to examine the attitude toward Pap testing of unmarried university female students, sexually active in Korea, and to investigate the factors associated with the intention to receive the Pap testing.
Methods: This study was a web based survey design, a total 124 students completed the survey items. Measurement were that perceived importance of the Pap test, confidence in Pap testing, intention to receive the test and attitude toward the Pap test using theory of planned behavior (including benefit, barrier, subjective norms). Associations between variables and intention to receive the Pap testing were analyzed using correlation analysis. Variables yielding significant associations (p < 0.05) were included in a stepwise multiple regression model of intention to receive the Pap testing.
Results: The need for regular Pap testing was less important (score, 75.78) than other methods of cervical cancer prevention. They were not confident that is was an effective method of cervical cancer prevention for themselves (score, 53.09). The subjective norm was the most important predictor of intention to receive the Pap testing (R2 = 23.8%).
Conclusions: There was low awareness of the Pap test among unmarried university women, sexually active. Thus, strategies to increase the intention to receive the Pap screening should be introduced. Health professionals in Korea should be responsible for the provision of education about Pap testing, especially for young or unmarried women.
Acknowledgement: This study was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (Grant No. 2018R1A2B2001231).
Awareness About the Seriousness of Unwanted Pregnancy Among Sexually Active University Students
Hae Won Kim, PhD, RN
Seoul National University, College of Nursing, the Research Institute of Nursing Science, Seoul, South Korea
Background: Severity perception about unwanted pregnancy is the key element for preventing unwanted pregnancy, especially among the unmarried sexually active young adults. In order to guide the contraceptive education related to preventing unwanted pregnancy for the sexually active university students, the identification of the levels of severity perception about unwanted pregnancy and its associated factors could be helpful to perform tailored education for them. Thus, this study aimed to explore how much the students perceive unwanted pregnancy seriously and the relationship between the perception and demographic/sexual characteristics among Korean students.
Methods: Original study was performed via online survey using questionnaire in one university setting. This study is the second analysis of the previous study sample. In this analysis, the elegible participants were 865 (of the 1445) who met the criteria as sexually active. In the measurements, the levels of severity perception about unwanted pregnancy consisted of 4 items with 5 Likerts scale (Cronbach's alpha = 0.74). In the demographic factors, gender, age, religion, smoking, alcohol drinking were included. In the sexual characteristics, status of HPV vaccination, previous experience of STI, abortion, and contraceptive methods were included. The relationships between perception and related factors were examined using Spearman correlation and adjusted Odds Ratio to estimate the impact of possible factors on students' severity perception. The statistical analysis was done using IBM SPSS (version 23.0).
Results: Women [7.44 (SD1.02)] was higher scores in severity perception about unwanted pregnancy than men [7.13 (SD 1.24)] did(p < .001). In the correlation, the significant factors on severity percpetion were that gender (Rho = 0.14, p < .001), age (Rho = −0.07, p = 0.05), smoking (Rho = −0.07, p = 0.05)HPV vaccination (Rho = 0.08, p = 0.02), and previous use of withdrawal method (Rhp = 0.11, p < 0.01). Finally in the calculation of Adjusted Odds Ratio, the significant influencing factors were found that age (reference/ under 23 years; OR 1.45 [1.05‐2.00]), smoking (reference/non smoker; OR 1.42[1.02‐1.99]), previous use of withdrawal method (reference/no; OR 0.48 [95 CI 0.33‐0.71].
Conclusions: Based on the results, the recognition about the severity of the unwanted pregnancy would be the more focused on the younger students and the users of the withdrawal methods as a contraception among the university students. The role of the health behavior (in terms of smoking) could be reexamined in related to contraceptive behavior and cognitive evaluation of the contraception. In further study, sex differences in their associated factors in perceptions would be necessary.
Acknowledgement: This study was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (Grant No. 2018R1A2B2001231).
Epidemiological Profile of Neonatal Mortality in Piauí
Amanda Costa Pinheiro, Samuel Chaves Cardoso de Matos, and Dr. Lis Cardoso Marinho Medeiros
Universidade Federal do Piaui, Teresina‐Brasil
Background: Own
Methods: We chose a retrospective, descriptive, quantitative approach, and the data are being collected in the DATASUS system, using TABWIN AND TABNET. The data consolidation is done by simple statistics. The period used to collect the data was from 2007 to 2016. To reach the proposed objective, the absolute frequencies of infant deaths by residence and occurrence are being analyzed; the proportion of neonatal deaths in relation to the total number of infant deaths in the year and in the period considered; the proportion of early neonatal deaths and late neonatal deaths; infant mortality in relation to birth weight; gestational age; the municipalities with the highest absolute numbers of infant and neonatal death; the main groups of causes of infant and neonatal deaths. The research was submitted to the Ethics and Research Committee of the Federal University of Piauí and follows the ethical principles contained in Resolution No. 466 of 2012 of the National Health Council.
Results: It is a retrospective, descriptive, quantitative study, and the data were collected in the DATASUS system, using TABWIN and TABNET from 2007 to 2016. The research was approved by the Ethics and Research Committee of the Federal University of Piauí. It was observed that two‐thirds of deaths in children under one year are concentrated in neonatal mortality. The macroregions Parnaíba (80.46%) and Picos (77.25%), (70.32%) and Floriano (70.64) and São Raimundo Nonato macroregion presented a percentage greater than 94% for deaths between birth and sixth day of life among neonatal deaths. These values are relevant because they reflect the health care of each macro‐region, prenatal and postnatal follow‐up. A high percentage of neonatal deaths, coupled with the high percentage of early neonatal deaths in the macro regions of Piauí state, demonstrate the lack of adequacy of the health services offered to pregnant women and women in relation to their needs. In the analysis, it was identified that more than 53% of the deaths are of low birth weight, that is, they were born with less than 2500g. Another important observation when analyzing the data is the lack of adherence of the health professionals by filling in data in the ODs, as the records with information related to birth weight and gestational age with ignored field, which are 12.86% and 19.42%, respectively.
Conclusions: The greater adherence to the correct compliance of death certificates and declaration of live births, the better the quality of the information generated from the data available in DATASUS and thus better interventions may arise based on the state data.
A Fitoterapia Como Alternativa Terapêutica: O Alho Bravo (Mansoa Sp) E Seus Constituintes Químicos
Cláudia Cardinalle Lima Teixeira, Dr. Antônia Maria das Graças Lopes Citó, Danilo de Oliveira Ribeiro, Francisca Maria Macêdo Pereira, Fernanda Sousa Reinaldo, Iolanda Souza do Carmo, Lorenna Fonseca, Alek André Costa de Sousa, Arkellau Kenned Silva Moura, Chistiane Mendes Feitosa, Dr. Juliana de Sousa Figuerêdo, Dr. Lydia Masako Ferreira, and Dr. Lis Cardoso Marinho Medeiros
University Piaui Brazil
Background: Own
Methods: The aim of this study was to evaluate the therapeutic potential of ‘Garlic Bravo‘ (Mansoa sp). bioactive product analysis study of a plant popularly known as ‘Garlic Bravo’, held in Teresina‐Pi, in the period from June to August 2018. It consisted of several stages, began the acquisition of the plant ‘Garlic Bravo’ (Mansoa sp), the voucher specimen preparation, there was obtained the crude ethanolic extract (BSE) and its fractions (hexane, ethyl acetate, dichloromethane and hydroalcoholic), phytochemical screening, extracted essential oil, held inhibition assays the enzyme acetylcholinesterase (AChE) and biological tests. With the voucher specimen was identified family and the plant genus under study.
Results: With the voucher specimen was identified family and the plant genus under study. In the inhibition assay of the enzyme acetylcholinesterase (AChE) and the BSE samples essential oil showed the same inhibitory activity, it was observed the presence of white spot on the chromatography plate‐CCD Ponta layer. The phytochemical approach ‘Garlic Bravo’ (Mansoa sp) revealed the presence of alkaloids, tannins, flavonoids, saponins and coumarins. The crude ethanolic extract (BSE) from 'Garlic Bravo' (Mansoa sp) was fractionated by fractional dissolution technique of increasing polarity solvents (hexane, dichloromethane, ethyl acetate). The essential oil Mansoa sp showed pale yellow in color and characteristic odor of garlic, organosulfur compounds were identified.
Conclusions: Considering the proposed objectives and based on the results, it was concluded that the phytochemical knowledge of the species will bring great scientific contribution and provide the creation of new natural products with a viewthe limited number of researches on the study plan.
Counseling for Menstrual Protection: Limited Clinician Counseling
Helen Yang,2 and Nancy Philllips, MD1
1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 2Rutgers Robert Wood Johnson Medical School, Piscataway NJ
Background: Products for menstrual protection expand much further than choosing between disposable sanitary pads or tampons and include reusable options such as menstrual cups, period panties, or menstrual sea sponges. Even pads and tampons have differences in size, shape and applicators. Circumstances such as cost, comfort, ability to maintain hygiene (with consideration to access to water or disposal facilities), and the demands of individual social, professional, or athletic needs via internal or external methods of menstrual protection should be discussed. Cultural issues also need consideration. Yet there is little evidence that providers make recommendations to women to fit their protection needs. A 2012 survey had 70% of adolescents respond that no doctor has spoken to them about menstrual products, specifically tampon use.
Methods: PubMed, Scopus, and Google Scholar were searched for articles using the key terms: ‘menstrual hygiene product,’ ‘menstrual protection’ and ‘physician's role,’ ‘patient education’ or ‘health care provider.’
Results: Many websites provide limited information concerning menstrual protection, many of which are the manufacturers and advertisers. Planned Parenthood offers some information and ACOG has a FAQ page which describes pads, tampons and cups without detail. Literature surrounding counseling was limited.
Conclusions: More effort to assess provider counseling and women's needs should be undertaken to determine if women, especially adolescents, are being well counseled regarding menstrual protection.
The Impact of the Aging Biological Father on Maternal and Child Health: Need for Comprehensive Paternal Counseling
Leahannah Taylor, BS,2 Gloria Bachmann, MD,3 and Nancy Phillips, MD1
1Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 2Robert Wood Johnson Medical School, School of Graduate Studies, New Brunswick, NJ, 3Rutgers Robert Wood Johnson Medical School, Women's Health Institute, New Brunswick, NJ
Background: Over the past 40 years in the U.S, infants born to fathers who are advanced in reproductive age, have increased from 4% to 10%.[1,2] There has been extensive research regarding infertility and comorbidities in the aging mother, however studies exploring similar reproductive factors in the aging father are sparse in comparison. A literature review was undertaken to 1. examine what is currently known about advanced reproductive age of the biological father in association with fertility, maternal comorbidities and pregnancy outcomes; 2. to explore how current research findings can translate into initiatives to bring more awareness to the risks of advanced paternal age, and 3. to examine if further public health research should be conducted exploring the implications of increased paternal age.
Methods: Data that reported any association analysis of perinatal, childhood or maternal outcomes, advanced paternal age or gender roles in the reproductive process were included.
Results: Results suggest an association between decreased fertility, increased neonatal complication rate, increase in maternal morbidities and an increased incidence of abnormal child psychological development with the aging biological father.
Conclusions: The literature recognizes that advanced paternal age is not the only determining factor in these outcomes, and the health and age of the biological mother contribute to a greater degree. Paternal age should be included in fertility and preconception counseling, and included in updated guidelines, educational tools and protocols.
The Moderating Role of Insurance Status in the Association Between Intimate Partner Violence Before Pregnancy and Short Interbirth Interval in the U.S.
Sylvia S. Rozarrio, PhD (c), MBBS, MPH, and Saba W. Masho, MD, MPH, DrPH
Virginia Commonwealth University, Richmond, VA
Background: Both short interbirth interval (SIBI) and intimate partner violence (IPV) around time of pregnancy have serious adverse consequences on maternal and perinatal health. IPV is associated with unintended pregnancy and thus may contribute to SIBI. Further, this association might be moderated by access to health care. The objectives of this study are to examine association between IPV and SIBI among U.S. women and to explore whether participants' insurance status modifies such association.
Methods: 2012‐2015 National Pregnancy Risk Assessment Monitoring System data was analyzed (N = 13,675). IPV before pregnancy (yes; no), insurance status (Private insurance; Medicaid; no insurance), and SIBI (yes: IBI <3 yrs.; no: IBI ≥3 yrs.) were examined. Multiple logistic regression analysis stratified by insurance status was conducted and adjusted odds ratios with corresponding 95% confidence intervals were calculated.
Results: After adjusting for confounders, women who reported IPV were 148% more likely to have SIBI compared to women who did not report IPV (AOR = 2.48, 95% CI = 1.41, 4.38). Further, the odds of SIBI was significantly higher among women with no insurance and women on Medicaid who reported IPV, compared to women who did not report IPV (AOR = 3.35, 95% CI: 1.07, 6.02 & AOR = 2.90, 95% CI = 1.06, 5.85; respectively).
Conclusions: Women who experience IPV are significantly more likely to have SIBI than women who do not experience IPV. Further, the risk of SIBI is highest among abused women who are uninsured or on Medicaid. This knowledge may facilitate screening and intervention for IPV in preconception care and early detection of women at risk for SIBI.
A Population Based Study of the Combined Effect Of Interpregnancy Interval aand Maternal Body Mass Index on Pregnancy Induced Hypertension in the U.S.
Sylvia S. Rozario, PhD (c), MBBS, MPH,2 Jordyn T. Wallenborn, PhD, MPH,1 Timothy Ihongbe, PhD, MBBS, MPH,2 and Saba W. Masho, MD, MPH, DrPH2
1University of California, Berkeley, CA, 2Virginia Commonwealth University, Richmond, VA
Background: The incidence of pregnancy induced hypertension, one of the most frequent causes of maternal and neonatal morbidity, has increased significantly in the U.S. in last two decades. However, the reasons for this rise are not well explored. The interrelationship between interpregnancy interval (IPI), prepregnancy body mass index (BMI), and pregnancy induced hypertension might play a role in this rise. This study aims to investigate the combined effect of IPI and prepregnancy BMI on pregnancy induced hypertension.
Methods: The 2017 Vital Statistics Natality Data was analyzed (N = 1,046,350). A combined variable was created using IPI and prepregnancy BMI. Adjusted odds ratios and 95% confidence intervals were generated for IPI and pre‐pregnancy BMI, independently and combined, and pregnancy induced hypertension using multiple logistic regression models.
Results: IPI and prepregnancy BMI were statistically significantly associated with pregnancy induced hypertension, both independently and in combination, after adjusting for potential confounders. The largest effect size was observed among women with long IPI and obesity (Adjusted OR = 4.01, 95% CI = 3.84, 4.25). Further, short IPI in combination with underweight BMI was found to be inversely associated with pregnancy induced hypertension (AOR = 0.64, 95% CI = 0.53, 0.78).
Conclusions: When combined, IPI and BMI are crucial risk factors for pregnancy induced hypertension. The highest risk of pregnancy‐induced hypertension is in women with long IPI in combination with high BMI categories. Healthcare professionals should be cognizant of the additional increased risk of pregnancy induced hypertension for the overweight and obese women with long interpregnancy interval.
Effect of Osteopathic Visceral Manipulation on Female Pelvic Congestion Syndrome
Abeer Eldeeb, PhD,2 Yara Marwan, MSc,2 Mohammed Alshafie, PhD,1 and Hanan El‐Mekawy, PhD2
1Faculty of Medicine, Ain Shams University, Ain Shams, Egypt, 2Faculty of Physical Therapy, Cairo University, Giza, Egypt
Background: Pelvic congestion synrome (PCS) is a chronic positional pelvic pain that lasts for more than six months. It is associated with pelvic and vulvar varicosities and symptoms of dyspareunia and postcoital pain. This study aimed to determine the effect of of visceral manipulation techniques on pain and ovarian vein diameter in premenopausal women with PCS.
Methods: Thirty premenopausal women aged 35‐45 years and body mass index was >25 kg/m2 and <30 kg/m2 participated in the study. They were diagnosed with dilated, tortuous ovarian veins with a width greater than 4 mm.They are randomly distributed into two groups. Control group received non‐steroidal anti‐inflammatory drug (NSAID), 400‐800 mg PO /6hr for 10 days, and medroxyprogesterone acetate (MPA), 30 mg/day for 12 weeks. Study group received the same medical treatment, and visceral manipulation techniques on pelvis, 45 minutes, one session every 2 weeks for a total of 6 sessions for 12 weeks period. Pain was evaluated using Modified McGill Pain Questionnaire and ovarian vein diameter was evaluated using Doppler ultrasound at starting and after 12 weeks of treatment course.
Results: The control and study groups showed decreases in dullness (P = 0.02; P = 0.001), and pain rating index (P = 0.02; P = 0.001) respectively. Only study group showed a decrease (P = 0.001) in ovarian vein diameter. Compared with the control group, the study group showed greater decrease (P = 0.001) in dullness, pain rating index, and ovarian vein diameter.
Conclusions: The osteopathic visceral manipulative techniques by virtue of its philosophy decreases pain and ovarian vein diameter in premenpausal women with PCS.
Development of Algorithms and App for Prevention, Evaluation and Therapeutic Orientation in Nipple Trauma from Breastfeeding
Adriana Rodrigues dos Anjos Mendonça, PhD,1 Iaura Mônica Cunha da Silva Esteves, MSc,1 Geraldo Magela Salomé, PhD,1 Lydia Masako Ferreira, MD, PhD,2 and Daniela Francescato Veiga, MD, PhD1,2
1Universidade do Vale do Sapucaí, Pouso Alegre ‐ MG, Brazil, 2Universidade Federal de São Paulo, São Paulo ‐ SP, Brazil
Background: Breast milk is the best food for newborns. However, the nipple trauma from breastfeeding can lead to early weaning. We aimed to construct and evaluate the internal consistency of algorithms for prevention, evaluation and therapeutic orientation related to nipple trauma, and to develop an algorithm‐based app.
Methods: The construction of the algorithms ‘Prevention of Nipple Trauma from breastfeeding’ and ‘Evaluation and Therapeutic Conduct in Nipple Trauma from breastfeeding’ was based on a literature review on the subject. A total of 168 professionals of mother and childhood health were invited to participate as evaluators. Of these, 100 accepted and answered to an electronic questionnaire. The partial report was obtained, based on evaluators' responses to the questionnaire, and it was statistically analyzed.
Results: Professionals indicated predominantly the ‘Excellent’ and ‘Good’ responses to the questionnaire, considered as positive responses. More than 90% of the evaluators agreed that the algorithms might support the clinician's decisions. The Cronbach's Alpha for the algorithms ‘Prevention of Nipple Trauma from breastfeeding’ and ‘Evaluation and Therapeutic Conduct in Nipple Trauma from breastfeeding’ were 0.904 and 0.952, respectively. Through the information contained in the algorithms, an app for smartphones was developed.
Conclusions: The algorithms showed internal reliability for prevention, evaluation and therapeutic conduct in nipple trauma from breastfeeding, and they enabled the development of an application for smartphones, easy to access for mothers who are breastfeeding.
Menopausal Symptom Differences in Arizona: A Cross‐Sectional Survey of Women From Different Socioeconomic Backgrounds
Alanna N. De Mello,3 Matthew R. Buras, MS,1 and Juliana M. Kling, MD, MPH2
1Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, 2Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, 3Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
Background: Menopausal symptoms can differ by geography and ethnicity, but the impact of socioeconomic factors is less clear. Our objective was to compare menopausal symptoms between women of different socioeconomic backgrounds in Arizona.
Methods: Women aged 40 ‐ 65 from Phoenix and Scottsdale were surveyed. Phoenix participants completed surveys at a clinic for uninsured or a homeless clinic. Scottsdale participants received surveys via mail. Deidentified surveys in Spanish and English included the Greene Climacteric Scale (GCS) and demographic questions. GCS total and domain were evaluated with higher scores indicating more symptoms.
Results: Responses from 139 women from Phoenix and 163 from Scottsdale were analyzed. Scottsdale participants were on average 53.8 years old (SD 7.51), White (94.3%) and were insured (100%). Phoenix participants were on average 50.2 years old (SD 9.48), Hispanic (56.3%), White (25.8%) or African American (10.2%) and uninsured (53.2%). Total GCS scores were higher in the Phoenix cohort vs the Scottsdale cohort (40.9 vs 30.5, p < 0.01), which was also seen by domain; psychological (21.7 vs 17.6, p = 0.01), somatic (13.6 vs 9.5, p < 0.001), depression (11.7 vs 8.0, p < 0.001). No statistically significant differences were seen for the vasomotor (3.7 vs. 3.6, p = 0.597) and anxiety domains (10.1 vs. 9.6, p = 0.671). 2.3% of Phoenix women were on menopausal hormone therapy (HT) vs. 23.8% in the Scottsdale group (p < 0.001).
Conclusions: Significant differences were found across these women despite geographic proximity. More women were on HT in the Scottsdale group which may partially explain these differences. However, the vasomotor results suggest that other variables such as socioeconomics and ethnicity may contribute.
Association Between Pre‐Pregnancy Diabetes and Post‐Partum Weight Retention in Urban Kampala: A Prospective Cohort Study
Alex Urunzy,1,2 and Passy Tumusiime1
1Edu Child Foundation, Kampala, Uganda, 2Kampala International University, Kampala, Uganda
Background: Increasing body mass index (BMI) after childbirth is an emerging public health concern among women in Uganda. We aimed at determining the predictors of weight retention among post‐partum women in central Uganda.
Methods: A prospective cohort study used to follow‐up 380 pregnant women attending prenatal care included women in the first trimester and followed up to six months postpartum in Kampala, Uganda. The outcome variable was post‐partum obesity measured as a categorical BMI [≥25.0(yes)/<25.0(no)]. A multivariable logistic regression model using STATAS/Ev15 was fitted controlling for maternal demographic, medical history and fertility characteristics as well as conducting effect modification reporting adjusted odds ratios (AOR) with p ≤ 0.05 considered statistically significant.
Results: Among 380 respondents, the mean age ± standard deviation was 23.6 ± 2.4 years, mean BMI ± SD was 22.6 ± 1.7 kg/m2 and 39.5%(n = 150) had pre‐pregnancy diabetes. Factors independently associated with postpartum obesity were pre‐pregnancy diabetes (AOR 6.2; 95%CI 3.2‐7.9), having depressive symptoms (AOR 2.1; 95%CI 1.8‐3.6) and pre‐exclampsia (AOR 2.6; 95%CI 1.9‐3.7).
Conclusions: Pre‐pregnancy diabetes is strongly associated with postpartum weight retention among women in urban Kampala. Prevention efforts targeting pre‐conception and prenatal care period may reduce adverse sequalae of pre‐pregnancy diabetes.
Patients' Satisfaction in Subpectoral Breast Augmentation
Alice Teixeira Leite, MD, Miguel Sabino Neto, MD, PhD, Mayara Mytzi de Aquino Silva, MD, PhD, Daniela Francescato Veiga, MD, PhD, and Lydia Masako Ferreira, MD, PhD
Universidade Federal de São Paulo, São Paulo ‐ SP, Brazil
Background: Breast augmentation is the most performed aesthetic plastic surgery, not only in Brazil, but worldwide, and its main goal is patients satisfaction. Previous studies demonstrated its positive impact in women's quality of life, notably in self‐esteem and sexuality. The present prospective study aims to evaluate satisfaction of women undergoing breast augmentation with implants.
Methods: Forty female patients with hypomastia, older than 18 years‐old and candidates to surgical treatment were included and submitted to subpectoral breast augmentation with implants. They were evaluated pre and post‐operatively (2 and 4 months) with Breast Q‐Augmentation module, a PRO instrument validated in Brazil to assess several aspects of quality of life and satisfaction with surgical result. Different moments of evaluation were compared with analysis of variance (ANOVA).
Results: Patients were aged 19‐42 years (median 29 years) and implant size varied from 175ml to 325ml (median 275ml). Significant improvement compared to pre‐operative evaluation was observed in satisfaction with breasts (p < 0.001), psychosocial well‐being (p < 0.001) and sexual well‐being (p < 0.001) at 2 and 4 months after surgery. Post‐operative physical well‐being presented lower scores at 2 and 4 months (p < 0.001) compared to pre‐operative, probably due to post‐operative pain.
Conclusions: Subpectoral breast augmentation with implants led to an increase in satisfaction with breasts and quality of life, but to a lower physical well‐being after 2 and 4 months. Possibly a later evaluation would present a different result regarding physical well‐being.
Quality of Life After Reflexology in Diabetic Women
Beatriz Bertolaccini Martínez, Aline Coelho Schwart, and Adriana Tereza da Silva
Universidade do Vale do Sapucaí (Univás) Pouso Alegre, MG. Brazil
Background: Reflexology is the science of studying the human health through certain specific reflex areas quantized on feet, hands, and ears. This therapy has emerged as a form of noninvasive and nonpharmacological complementary therapy for several medical conditions. It is reported in the literature that the application of reflexology therapy can improve the quality of life in some diseases. The objective of this study was to evaluate the quality of life after reflexology in diabetic women.
Methods: A longitudinal and prospective study was conducted with 26 Brazilian diabetic women for 30 consecutive days. On the first day the women answered the short form 36 health survey questionnaire (SF36), and on the second day the reflexology therapy began on the feet until the thirtieth day. On the thirtieth day, women respond to the SF36 again. The results were submitted to statistical analysis using SPSS 22.0. The chi‐square and Mann‐Whitney tests were used to compare variables; p < 0.05.
Results: The mean age was 65.8 ± 6.5 years old; 90% white ethnicity. In the SF36 domains, there were differences in Functional Capacity (Before = 80.1 ± 7.3 and After = 92.0 ± 9.6; p = 0.01); Physical Aspects (Before = 80.7 ± 4.8 and After = 94.3 ± 8.3 = 0.01), Pain (Before = 57.4 ± 10.1 and After = 86.2 ± 4.2, p = 0.01), and Emotional Aspects (Before = 79.5 ± 12.3 and After = 96.4 ± 6.6, p = 0.01).
Conclusions: Foot reflexology therapy improved the quality of life of diabetic women.
Efficacy of Focused Ultrasound on Abdominal Fat Thickness During Post‐Natal Rehabilitation Program
Amel M. Yousef, PhD,1 Gehan A. Abdel Samea, PhD,1 Salwa M. El‐Badry, PhD,1 and Mohamed N. Mawsouf, MD2
1Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Egypt, 2National Cancer Institute, Cairo University
Background: Rehabilitation of abdominal muscles post natlly is a target of women especially if they have abdominal obesity.This study was conducted to examine the efficacy of focused ultrasound on abdominal fat thickness during post‐natal rehabilitation program.
Methods: Forty volunteer primiparae obese women at 12 weeks' postnatally, their age ranged between 20 to 30 years old were participated in this study from the outpatient clinic of the family planning of Embaba Hospital. They were assigned randomly into two groups (A & B) equal in numbers: Group (A) control group: participated in an aerobic exercise program (weight bearing exercise and abdominal exercises), and Group (B) study group: received focused ultrasound treatment sessions on their abdominal region in addition to the same program of exercise prescribed for group (A), twice per week for 6 weeks. Evaluations of both groups (A&B) were done before starting and after the end of study through measuring their weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist‐hip ratio (WHR), abdominal subcutaneous fat thickness (SF) at three levels (at umbilicus as well as above and below it by 5 cm), abdominal preperitoneal fat thickness (PF) and visceral fat thickness (VF).
Results: The results of this study showed a statistically highly significant (P < 0.001) decrease in weight, BMI, WC, HC, WHR, SF at their three levels, PF and VF in group (A) as well as in group (B). Comparison between both groups (A&B) before starting the study reveals that there was a statistically non significant difference between them. And at the end of the study, there was a statistically non significant difference between them in the weight, BMI and HC. While there was a statistically highly significant (P < 0.001) decrease in WC, WHR, SF at their three levels, PF and VF in favor to group (B).
Conclusions: It could be concluded that focused ultrasound treatment is an effective modality for decreasing the abdominal fat thickness, as well as, it is a non‐invasive and simple modality for post‐natal women.
Effect of Pelvic Floor Stretching Exercises on Primary Vaginismus
Amel M. Yousef, PhD,2 Abeer M. ELDeeb, PhD,2 Heba G. Kotb, MD,1 and Sara M. Fathi, MSc2
1Department of Forensic Medicine, Faculty of Medicine, Cairo University, Egypt, 2Department of Physical Therapy for Women's Health, Faculty of Physical Therapy,Cairo University, Egypt
Background: Vaginismus is one of the common sexual dysfunction in women. It is characterized by an involuntary spasm of the muscles around the lower one third of the vagina, resulting from the association of sexual activity with pain and fear. This study aimed to investigate the effect of stretching exercises on women with vaginismus.
Methods: Forty participants aged 25‐35 years randomly distributed to one of 2 groups. Control group received training with electromyography (EMG) biofeedback with vaginal electrode, 2 sessions/week for 3 weeks; while the study group received EMG biofeedback training, in addition to pelvic floor stretching exercises for the same duration. Evaluation of each female was performed through assessment of pelvic floor muscle tone using portable biofeedback device (peritron9300), and through assessment of pain intensity using numerical rating scale (NRS).
Results: Results revealed that the control and study groups showed a highly significant decrease (P < 0.001) in the pelvic floor muscle tone and pain intensity. Compared to the control group, the study group showed a highly significant decrease (P < 0.001) in the pelvic floor muscle tone and pain intensity.
Conclusions: It can be concluded that adding pelvic floor stretching exercises to EMG biofeedback training was more effective and successful treatment for treating pelvic floor muscle spasm and pain than EMG biofeedback alone in women with vaginismus.
Acmella Oleracea Analgesia During Laser Epilation
Ana Beatriz Alkmim Teixeira Loyola, PhD,1 Maísa da Silva, MSc,1 Bárbara Maria Tavares Pereira,1 Lydia Masako Ferreira, MD, PhD,2 and Daniela Francescato Veiga, MD, PhD1,2
1Universidade do Vale do Sapucaí, Pouso Alegre ‐ MG, Brazil, 2Universidade Federal de São Paulo, São Paulo ‐ SP, Brazil
Background: Removal of unwanted hair is common in dermatological practices with the use of Lasers. The ideal patient for laser hair removal is one who has thick, dark terminal hair, fair skin and normal hormonal status. Laser hair removal is associated with discomfort and pain. Acmella oleracea is an aliphatic amide that produces anesthetic effect and tongue tingling, as well as being able to penetrate the skin. The objective of the study was to evaluate the intensity of the pain, with the use of the extract of the Acmella oleracea plant in the groin, during the Laser epilation.
Methods: Healthy and non‐pregnant volunteers, aged between 18 and 55 years, female, without restriction to schooling who accepted to participate in the research, and skin with phototypes from I to III (light skin), who never performed Laser epilation. The number of individuals was 60 volunteers who underwent left and right intervention of the groin with application of the two products: Control Group and Group A. oleracea. The volunteers assessed the pain through a multidimensional EMADOR scale.
Results: The intensity of pain evaluated by the EMADOR scale in the A. oleracea group was statistically lower than in the control group (p = 0.0001). The words that recurred most acutely to the Control Group by 19 volunteers were terrible, unbearable, profound, intense and monstrous and for Group A. oleracea by 5 volunteers were profound, tremendous and intense.
Conclusions: The extract of the Acmella oleracea plant decreases the intensity of groin pain during laser epilation.
Bremelanotide for Hypoactive Sexual Desire Disorder: Contraceptive Subgroups Efficacy Analysis
Anita Clayton, MD,6 Sheryl Kingsberg, PhD,5 James Simon, MD, CCD, NCMP, IF, FACOG,2,3 Robert Jordan,4 Laura Williams, MD, MPH,1 and Julie Krop, MD1
1AMAG Pharmaceuticals, Inc., Waltham, MA, 2George Washington University, Washington, DC, 3IntimMedicine Specialists, 4Palatin Technologies, Inc., Cranbury, NJ, 5University Hospitals Cleveland Medical Center, Cleveland, OH, 6University of Virginia, Charlottesville, VA
Background: Bremelanotide, an investigational new drug, demonstrated efficacy in premenopausal women with hypoactive sexual desire disorder (HSDD) in the RECONNECT studies. In this analysis, bremelanotide efficacy was investigated across hormonal contraceptive subgroups.
Methods: RECONNECT comprised two identically designed phase 3, double‐blind, randomized, placebo‐controlled, IRB‐approved studies. Subjects self‐administered bremelanotide 1.75 mg or placebo subcutaneously for 24 weeks, using an autoinjector pen on demand prior to sexual activity. Subjects were evaluated ('yes' and 'no' subgroups) based on concurrent use of hormonal contraceptives (including oral contraceptives and other estrogen‐containing products). Efficacy was assessed using RECONNECT co‐primary endpoints: change from baseline to end‐of‐study (EOS) for Female Sexual Function Index‐desire domain (FSFI‐D) and Female Sexual Distress Scale‐Desire/Arousal/Orgasm (FSDS‐DAO) Item 13 scores.
Results: In the integrated population (N = 1202), difference in mean change in FSFI‐D and FSDS‐DAO Item 13 from baseline to EOS (bremelanotide‐placebo) was 0.35 and −0.33, respectively (P < .0001 for both endpoints). In the study, 18.4% (N = 221) concurrently used hormonal contraceptives (‘yes’ subgroup) and showed a numerical difference in favor of bremelanotide (N = 112) versus placebo (N = 109; 0.19, P = .1557). Subjects in ‘no’ subgroup who were treated with bremelanotide (N = 484) showed a statistically significant increase in FSFI‐D relative to placebo (N = 497; 0.39, P < .0001). Change from baseline to EOS in FSDS‐DAO Item 13 was statistically significant in favor of bremelanotide relative to placebo in both subgroups (−0.30 and −0.34; P = .0471 and P < .0001, respectively).
Conclusions: Independent of the type of contraceptive used, bremelanotide demonstrated improvements in sexual desire and related distress in premenopausal women with HSDD.
Migraine Self‐Management: Pathways to Learning
Anna R. Matthews, BSN, RN, PhD, and Shawn M. Kneipp, PhD., RN, ANP, APHN‐BC, FAANP
University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Self‐management is the cornerstone of migraine management. Women in lower social locations (i.e., those with lower income and education) are disproportionately affected by migraine severity and disability, which is related to self‐management. How women might learn migraine self‐management, however, is largely unexplored. The objective of the current study is to explore pathways to learning self‐management of migraine in women from higher and lower social locations.
Methods: Part of a parent study on migraine self‐management, this exploratory portion of the study used semi‐structured interviews to gain insight into perceptions of how women with migraine learn to self‐manage their condition. Grounded theory and content analysis were used to analyze qualitative interview data in QSR International's NVivo 11 Pro Software (2017).
Results: Women model self‐management strategies as well as agency in relationship to migraine that they saw trusted family members (i.e., trusted migraineurs) use early in life. Women in lower social locations displayed more passive self‐management strategies and expressed a lack of agency in relation to their migraine symptoms and burden.
Conclusions: Clinicians may use these preliminary findings to facilitate management of migraine in women. Learned behaviors and attitudes may contribute to the disparity in burden of migraine among women of lower social location. In caring for women with migraine, particularly those in lower social positions, it is pertinent for clinicians to consider the generational and familial context in which women learn to self‐manage migraine.
The Use of Safe Acid Technology in the Prevention of Post‐Caesarean Endometritis
Arielle Worth, MS, OMS‐II, and Benjamin Lam, DO
Philadelphia College of Osteopathic Medicine, Philadelphia, PA
Background: Postpartum endometritis is a major complication that occurs in up to 27% of cesarean births. Aerobic and anaerobic vaginal bacteria enter the womb, creating a polymicrobial infection and causing inflammation of the endometrial lining of the uterus. Safe Acid Technology (SAT) is a unique agent that is non‐toxic to human mucosa but efficacious in the elimination of microbes and biofilms. SAT has a potential use as a preoperative vaginal preparation to prevent post‐cesarean endometritis.
Methods: SAT is a formulation of hydrochloric acid, phosphoric acid, and citric acid. SAT anti‐biofilm testing was administered by the Montana State University Center for BioFilm Engineering using a single species (Pseudomonas aeruginosa) biofilm grown in the CDC reactor according to ASTM E2871‐12 on polycarbonate coupons. After establishing biofilms, the polycarbonate coupons were exposed to SAT formulations for multiple exposure times and in varied concentrations.
Results: All SAT treatments were efficacious in the destruction of biofilm. Log reductions of biofilm ranged from 3.61 for treatment C50 at the low end and 4.82 for treatment C25 at the high end, compared to biofilm accumulated on control coupons of Log 8.6. Reaching a pH of ‐0.5, SAT eliminates microbes on contact and achieves a 7 Log reduction of organisms in less than 90 seconds of contact time. Despite SAT's disinfectant power, it has passed the EPA's stringent toxic six‐pack criteria that assess toxicity and irritation to human tissues.
Conclusions: Safe Acid Technology has dual properties of high acidity and non‐toxicity that make it a suitable intervention in the cleansing of the vagina prior to cesarean delivery. A vaginal scrub with a sponge stick saturated with SAT should be considered as a method to prevent postpartum intrauterine infection and associated complications such as pelvic abscesses, peritonitis, and sepsis.
Navigating Sexual History Taking: Perspectives from Family Medicine Providers at Urban Federally‐Qualified Health Centers
Ashley Chastain, MPH, DrPH(c), and Emmeline Rodriguez, MPH
CUNY Graduate School of Public Health and Health Policy, New York, NY
Background: Preventive screening practices are increasingly important for women as rates of sexually transmitted infections (STIs) and intimate partner violence (IPV) continue to rise. With greater emphasis on integrating family planning and sexual and reproductive health care in primary care settings, better understanding of patient‐provider communication about sexual health is needed. Therefore, this qualitative study explored family medicine provider perspectives on sexual history taking at federally‐qualified health centers (FQHCs).
Methods: In a large, diverse, urban area of the US, we recruited nine family medicine providers from two FQHCs to participate in in‐depth interviews. Eligible physicians and nurse practitioners must have provided regular gynecological care (3+ pelvic exams/week). Interviewees were asked questions about a recent gynecological care encounter, how they navigate sexual history taking, and any barriers and facilitators to sexual health discussions with female patients. Interviews were recorded, transcribed, and thematically analyzed via NVivo 12.
Results: Emerging themes included: 1) Risk‐ or consequences‐based definition; 3) 'Constantly learning vs. Knowing it all'; 3) Difficult topics; and, 4) Harmonized definitions. Providers described sexual health concepts in a risk or consequences‐based framework, emphasizing HIV/STIs and pregnancy. Interviewees mentioned feeling tension between continuously educating themselves and an expectation to know every treatment, test, and condition. IPV and sexual dysfunction were named as difficult to discuss with patients, in addition to other facilitators and barriers to sexual health discussions, including harmonized (or disharmonized) definitions of sex.
Conclusions: This study provides insights into how family medicine providers navigate sexual history taking at FQHCs, and common barriers and facilitators. Study findings can inform future patient‐provider communication curricula at medical and nursing schools.
Barriers to Accessing Sexual and Reproductive Health Care Among Middle‐Eastern Immigrant and Refugee Women
Background: The purpose of this study is to examine the present perspectives Western healthcare providers possess on the barriers refugee and immigrant females commonly encounter when attempting to access reproductive, sexual, and maternal health services. Refugee and immigrant women fleeing from war torn and impoverished areas of the Middle East encounter numerous barriers in accessing adequate sexual and reproductive health care services. Navigating a new and foreign health care system while facing numerous challenging factors can be a hindrance for these women and having control over their health. Health care providers can better benefit by exploring the obstacles this particular population faces in order to optimally provide quality sexual and reproductive health care.
Methods: An integrative literature review was conducted exploring the challenges healthcare providers face in their efforts to provide optimal care to this target population such as language and cultural differences.
Results: Our literature review show that various factors ranging from education variability, linguistic barriers, cultural beliefs, high costs, and access to care (e.g. transportation) play a role in these women's health status. In addition, the lack of resources available for health care providers prevent them from addressing SRH care and mostly focus on urgent care needs.
Conclusions: Discussed are examples of various interventions and practical recommendations for health care providers and health care organizations that can be utilized to deliver improved access to sexual and reproductive health services for refugee and immigrant women. Implications of the reported findings and developed recommendations for healthcare providers are summarized.
Low‐Dose Naproxen Sodium Provides Significantly Greater and Longer‐Lasting Relief of Menstrual Cramp Pain Over 12‐Hours Compared with Acetaminophen
Azita Tajaddini, Robert Centofanti, Donna Morella, Robert An, and Alberto Paredes‐Diaz
Bayer Healthcare, Whippany, NJ
Background: Menstrual cramp pain affects many women and impairs quality of life. Guidelines recommend non‐steroidal anti‐inflammatory drugs and acetaminophen as first‐line therapies. We evaluated the analgesic efficacy of a single, non‐prescription dose of naproxen sodium compared with acetaminophen in the treatment of menstrual pain associated with primary dysmenorrhea.
Methods: This double‐blind, randomized, crossover study included healthy females with self‐reported primary dysmenorrhea (moderate severity, ≥5 on 1‐10 numerical rating scale). Participants received either a single dose of naproxen (440 mg) when their menstrual cramp pain was moderate, crossing over to acetaminophen (1000 mg) in the next cycle, or vice versa. The primary outcome was the total pain relief (TOTPAR) score over 12 h. Secondary outcomes included summed pain intensity differences (SPID), and patients' evaluation of treatment.
Results: Overall, 201 participants (mean age 24.8 years) were enrolled who used either naproxen (n = 170) or acetaminophen (n = 160). Over 12 h, total pain relief was significantly greater with naproxen than acetaminophen (TOTPAR0‐12 least‐squares (LS) mean difference 4.31; p < 0.001), and pain intensity was significantly lower (SPID0‐12 LS mean difference 9.80; p < 0.001). The difference in total pain relief and pain intensity became significant with naproxen versus acetaminophen from around 6 h (TOTPAR6‐12 LSmean difference 3.75; SPID6‐12 LSmean difference 8.27; both p < 0.001). Significantly more patients rated naproxen sodium as good‐to‐excellent (70.6%) versus acetaminophen (63.1%) (p = 0.002).
Conclusions: A single, non‐prescription dose of naproxen sodium provides a significantly greater and longer lasting relief of menstrual cramp pain over a 12h period compared to acetaminophen.
Body Image and Self‐Esteem in Diabetic Patientes: Sex Differences
Beatriz Bertolaccini Martínez, Maraysa Freitas Rezende, and Leticia Morandim de Andrade
Universidade do Vale do Sapucaí (Univás) Pouso Alegre, MG. Brazil
Background: Body image and self‐esteem are human phenomena involving cognitive, affective, social and cultural aspects that influence the treatment of diabetic patients. The objective of this study was to evaluate the relationship between body image and self‐esteem, with adherence to treatment in diabetic patients, according to sex.
Methods: A cross‐sectional study was conducted with 96 Brazilian diabetic women and 79 diabetic men. To assess self‐esteem and body image, the diabetic patients answered two questionnaires, Rosenberg Self‐Esteem Scale and the Body Shape Questionnaire, respectively. The results were submitted to statistical analysis using SPSS 22.0. For the statistical analysis of the data the chi‐square and Wilcoxin tests were used; p < 0.05.
Results: The mean age was 64.1 ± 8.3 years, in women, and 64.8 ± 8.9 years, in men; 76% of women vs 57% of men were sedentary (p = 0.001); 31.2% of women vs 13.9% of men used psychotropic drugs (p = 0.01); Self‐esteem was unsatisfactory in 100% of the women and 100% of the men (p > 0.05). There was dissatisfaction with body image in 27.1% of the women and 16.4% of the men (p = 0.09); Nonadherence to treatment was 92.7% in women and 92.4% in men (P > 0.05).
Conclusions: It was observed that unsatisfactory self‐esteem in all patients, regardless of gender. As the percentage of non‐adherence to treatment was high, in both sexes, it was not possible to correlate it with self‐esteem and satisfaction with body image.
Postpartum Depression Screening Tools: A Review
Nneamaka Ukatu, BA, Maria Brulja, DO, and Camille A. Clare, MD, MPH
New York Medical College, Valhalla, New York
Background: Postpartum depression (PPD) is undiagnosed in up to 50% of all cases. This illustrates the need for effective methods to identify women with this condition. There has not been a consensus among the medical community regarding which tool is most effective for screening for PPD. As such, there is no universal policy in place for when and how to screen women for postpartum depression. The objective of this study was to analyze the accuracy of screening tools in detecting postpartum depression (PPD).
Methods: A review of the literature was conducted using PubMed, Clinical Key and Google Scholar from the years 2001 to 2016. The keywords, “postnatal depression screening,” “antenatal depression screening,” and “maternal depression” were used in the search. Sixty‐eight articles were reviewed, and thirty‐six articles were further analyzed.
Results: The accuracy of screening tools was dependent upon a number of factors. The studies reviewed differed in the types of screening tools tested; the combination of screening tools administered; the timing in which screening tools were administered; the geographic location of patients screened; and the reference standard(s) used. As a result, the measured sensitivity and specificity of each tool varied within the studies that were reviewed.
Conclusions: No tool was best at accurately detecting PPD on the basis of sensitivity and specificity. Additionally, there was no recommended time period in which screening should be done. However, the different factors which may impact screening tool accuracy, was identified. This information can guide clinicians towards picking an appropriate screening tool for their patient population. Furthermore, this information can help guide additional research efforts. Overall, further research is needed to elucidate the accuracy of PPD screening.
Inflammation and Metabolism in Perimenopause‐Onset Depression
Karla Thompson, RN,1 Pedro Martinez, MD,1 David R. Rubinow, MD,1 Peter J. Schmidt, MD,2 Camille Basurto, MS,2 and Gioia Guerrieri, DO, FAPA2
1Behavioral Endocrinology Branch outpatient clinic, NIH/NIMH, Bethesda, MD, 2Division of Anesthesia, Analgesia, and Addiction Products, FDA, Silver Spring, MD
Background: The perimenopause is associated with increased risks of depression, cardiovascular and metabolic disease. Depression alone also increases the risk of cardiovascular mortality in mid‐life women. We evaluated cardiovascular, metabolic, and inflammatory measures in depressed perimenopausal women (PMD) compared to asymptomatic perimenopausal women (ACs).
Methods: Women with PMD (n = 80) met the following criteria: 1) onset of depression during the perimenopause; 2) the presence of major or minor depression of moderate severity confirmed by the Structured Clinical Interview; and 3) menstrual cycle irregularity >6 months and <1 year amenorrhea, and elevated plasma FSH levels. ACs (n = 42) had no history of depression and met criteria for the perimenopause. All women (ages 42–59 years) were medication‐free and medically‐healthy. Outcome measures (plasma) were batched and analyzed using ELISA or RIAs for TNF‐alpha, TGF‐beta, IGF‐1, IL‐2, IL‐6, IL‐17, hsCRP, BDNF, ghrelin, leptin, VEGF, and HSP‐70. Analysis: ANOVA (log transformed) with diagnosis (PMD vs ACs) and presence/absence of self‐reported hot‐flushes as between‐subjects' factors.
Results: No diagnostic differences were observed in demographics except baseline mood severity (p < .001). ANOVA showed no significant main or interactive effects of PMD or hot‐flushes (p = ns, all comparisons).
Conclusions: These preliminary results suggest that abnormalities of peripheral measures of inflammatory and metabolic function do not distinguish women with PMD from reproductively‐matched ACs: consistent with some, but not all, published studies in PMD. Limitations of both our sample size and assay batteries notwithstanding, the explanation for the observed associations between PMD and immune/metabolic dysregulation might not be found in single cross‐sectional plasma measures.
Is it Healthy to be Strong? Results of an Internet‐Based Pilot Study of African‐American Women with High Metabolic Syndrome Risk
Candace C. Johnson, PhD, MPH, RN
Virginia Commonwealth University School of Nursing, Richmond, VA
Background: African‐American women experience the highest prevalence of metabolic syndrome (MetS) and they are at highest risk for death from cardiovascular diseases. Identification with Strong Black Woman (SBW) cultural construct, an archetype associated with exuding strength and bearing overwhelming responsibility, is thought to be a socio‐cultural determinant of health that influences health and behavior management strategies. The primary aim of this study was to determine the preliminary effects of an Internet‐based multiple risk factor intervention (Yogic Dance) on the health/health behaviors of community‐based women (ages 35‐50) and at‐risk for MetS.
Methods: Twenty‐eight women were enrolled using a widely‐used social networking site; 22 women (mean age 43.3 ± 4.69 years) completed the study. The 4‐week study involved an assessment of MetS risk factors and sedentary levels before and after the intervention. Participants engaged daily with internet‐based health education, stress management and activity instructional videos viewed on a free, publicly available video platform. The women monitored their daily physical activity with commercial activity trackers and blood pressures with electronic monitors.
Results: Identifying with SBW archetype was strongly associated with high MetS risk at study baseline (Spearman's rho = .583, p = .002). Additionally, identifying with SBW archetype was associated with engaging in pilot study activities (Spearman's rho = .647, p = .002). Of the women who engaged with the study, women who identified with SBW archetype experienced the greatest reductions in blood pressures (Spearman's rho = −.539, p = .01).
Conclusions: Being strong may be perceived as both a benefit and barrier to African‐American women's health.
Body Image Dissatisfaction Influences Cardiovascular Health in Overweight and Obese African American Women
Chandrika Manjunath, BSc,1 Sarah Jenkins, MS,2 Sean Phelan, PhD,3 Carmen Radecki Breitkopf, PhD,4 Sharonne Hayes, MD,1 Lisa Cooper, MD, MPH,5 Christi Patten, PhD,6 and LaPrincess C. Brewer, MD, MPH1
1Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, 2Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, 3Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 5Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 6Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN
Background: African American (AA) women are 5 times less likely than white women to meet ≥5 or more ideal cardiovascular (CV) health metrics of the American Heart Association Life's Simple 7 (LS7) components. Few studies have probed the influence of sociocultural factors such as body image dissatisfaction (BID), on these disparities. Our objective was to determine whether BID would have a negative association with CV health in overweight/obese AA women.
Methods: We enrolled 32 women (mean age 49 years), from 5 AA churches participating in a larger community‐based participatory study (FAITH! App Pilot Study). We conducted a cross‐sectional analysis of baseline data to evaluate the association of BID with CV health and select psychosocial factors. Outcome measures included a LS7 composite score and a BID score based on the Pulvers scale.
Results: Forty‐four percent of women had no/low BID and 56% had high BID. Those with high BID were more likely to be obese compared to no/low BID (94% versus 57%, p = 0.03). Although not statistically significant, the mean LS7 composite score was 1 point higher among those with no/low BID, versus high BID (8.8 versus 7.8, p = 0.25). Compared to those with high BID, women with no/low BID were more likely to have greater intrinsic motivation (p = 0.01), integrated regulation for healthy eating (p = 0.007), and self‐regulation to reduce fat/caloric intake (p = 0.01).
Conclusions: High BID was associated with lower motivation and self‐regulation, which predict CV health. BID and other psychosocial factors for behavior change are potential targets for culturally‐tailored lifestyle interventions in AA women.
Role Stress and Sense of Control Predict Stress Eating in Midlife Women
Dana R. Schreiber, and Natalie D. Dautovich
Virginia Commonwealth University, Richmond, VA
Background: Women in midlife are at risk for poor weight‐related health outcomes with two risk factors including stress and engagement in negative eating behaviors (e.g., stress eating). However, there is a lack of understanding regarding the connection between specific stressors and stress eating in this population. As midlife women experience a host of psychosocial stressors that impact daily functioning, the current study examined the association between role stress (i.e., stress due to specific roles) and stress eating and additionally examined sense of control as a potential mediator.
Methods: An archival analysis was performed using data from the Midlife in the United States‐II study (MIDUS‐II). The sample consisted of 638 midlife women (range:40‐64). Measures included role stress (i.e., family, work, spouse, friend), sense of control, and coping questionnaires.
Results: Hierarchical linear regression demonstrated that work stress (β = .171, P < .001) and family stress (β = .131, P < .05) significantly predicted stress eating. Additionally, PROCESS mediation demonstrated that sense of control was a significant mediator in the work stress‐stress eating (b = 0.03, 95% CI [.0056, .0528]), and family stress‐stress eating associations (b = 0.02, 95% CI [.0058, .0369]).
Conclusions: Results provide evidence on what types of stress influence stress eating and how stress may lead to this behavior. Specifically, family and work stress increased stress eating and sense of control mediated the role stress‐stress eating relation. Specifically, greater work and family stress predicted decreased sense of control which predicted more stress eating. Current findings can inform research investigating stress and health and inform clinical recommendations regarding management of weight‐related outcomes in midlife women.
Cosmetic Results of Breast Cancer Conserving Surgery: Objective Evaluation by BCCT.CORE®
Daniela Francescato Veiga, MD, PhD,2,3 Rafaela Lemos Martins Maia, MD,2 Lucas Bezerra Moura, MD,2 Ivanildo Archangelo Junior, MD, MSc,2 Joel Veiga Filho, MD, PhD,2 Neil Ferreira Novo, PhD,1,2 and Lydia Masako Ferreira, MD, PhD3
1Universidade de Santo Amaro, Santo Amaro, SP, Brazil, 2Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil, 3Universidade Federal de São Paulo, São Paulo, SP, Brazil
Background: Surgical treatment of breast cancer has a major negative impact on multiple psychosocial aspects of women. Even when breast conservative surgery (BCS) is performed, cosmetic sequelae are not uncommon and represent not only the loss of body integrity, but also the stigma of a malignant disease. This study aimed to assess the cosmetic results of BCCS, with or without immediate breast reconstruction.
Methods: Ninety breast cancer patients where enrolled in this cross‐sectional study. Standardized photographs were obtained from 45 patients who had undergone BCS at least six months before (BCS group, BCSG), and also from 45 patients in the 6th postoperative month of immediate breast reconstrucion following BCS (Breast reconstruction group, BRG). The reconstruction, in all cases, was performed by the use of locoregional flaps. Digital standardized photographs were analysed by the software BCCT.CORE®, which classifies the cosmetic results into four categories: excellent, good, fair or poor, considering breast symetry, scars appeareance and eventual differences in color between breasts.
Results: The groups were homogeneous regarding age (p = 0.130), body mass index (p = 0.320), axillar dissection (p = 0.170) and chemotherapy (p = 0.160). All the patients underwent radiotherapy. The cosmetic result, for both groups, were predominantly classified as ‘good’ (51% and 58% for BCSG and BRG, respectively), followed by ‘fair’ (35% and 22% for BCCSG and BRG, respectively). There was no statistical difference between groups (p = 0.701).
Conclusions: Different from other studies, the analysis by BCCT.CORE® demonstrated no differences in cosmetic results when immediate breast reconstruction was performed or not, after BCS.
Individual and Neighborhood‐Level Factors and Pre‐Eclampsia: A Cross‐Sectional Study in Virginia, 2008‐2015
DaShaunda D. H. Taylor, MPH,2 Hadiza I. Galadima, PhD,1 and Derek A. Chapman, PhD2
1Old Dominion University, Norfolk, VA, 2Virginia Commonwealth University, Richmond, VA
Background: Pre‐eclampsia is a condition characterized by hypertension and proteinuria that affects approximately 3‐8% of pregnancies. Women with pre‐eclampsia may experience maternal and fetal morbidity and mortality. Although individual factors have been investigated as potential risk factors, neighborhood‐level indicators may play a role in preeclampsia outcomes as well. Objectives: This cross‐sectional study aimed to approximate pre‐eclampsia prevalence and to investigate the relationship between individual and neighborhood factors and pre‐eclampsia in Virginia.
Methods: Data from Virginia Health Information, the United States Census Bureau American Community Survey, and the 2010 United States Census Bureau decennial census were utilized. The study population consisted of pregnant women in Virginia hospitals between January 1, 2008 and September 30, 2015. Women who had a hysterectomy, eclampsia, pre‐existing hypertension, unspecified hypertension, or multiple gestation were excluded from analysis. Multilevel modeling was attempted but could not be completed due to data sparsity. Hence, logistic regression was conducted to assess the associations between potential predictors and preeclampsia.
Results: There were 696,078 pregnancy‐related discharges from 94 hospitals with a pre‐eclampsia prevalence of 3.3% (n = 23,167). Several individual and neighborhood‐level variables demonstrated mild associations with pre‐eclampsia. However, these small associations could be spurious and due only to the large sample size.
Conclusions: In agreement with previous research, this study reiterated the importance of individual‐level factors regarding pre‐eclampsia prevalence. Neighborhood‐level indicators should be further explored using multilevel modeling to confirm the presence and strength of their relationships with pre‐eclampsia, keeping in mind the ultimate goal of reducing disparities.
Non‐Vitamin/Non‐Mineral Use Among Non‐Pregnant Women of Reproductive Age
Mary K. Maneno, PhD, Rachel K. Mayaka, BPharm, MBA, Debbynie J. Barsh, BS, Monika Daftary, PharmD, Earl Ettienne, LPD, MBA, BSc, Pharm, and La'Marcus T. Wingate, PharmD, PhD
Howard University, Washington, DC
Background: Assessing the prevalence of chronic conditions and medication use among women of reproductive age is important given the high rate of unintended pregnancy. The objective of this study was to evaluate racial trends in patient characteristics and non‐mineral/non‐vitamin medication prescribing among non‐pregnant women of reproductive age.
Methods: A cross‐sectional analysis of office‐based ambulatory care visits of non‐pregnant women of reproductive age was conducted using the National Ambulatory Care Survey (NAMCS) from 2012 to 2015. Weighted descriptive statistics were estimated. Weighted bivariable analyses were used to examine statistical differences in patient characteristics and prescribing of non‐vitamin/non‐mineral medications by race. All analyses were performed using SAS 9.4 (α = 0.05).
Results: A total of 28,624 visits (528 million weighted visits) of non‐pregnant women of reproductive age were included. Of them, 81.7%, 11.7%, and 6.6% were of White, Black, and Other race respectively. Study results showed racial differences in age, tobacco use, primary expected payment source, and metropolitan statistical area (p < 0.05) among visits occurring in non‐pregnant women of reproductive age. Racial differences in the presence of at least one chronic condition were also observed among the included office visits (Black: 46.5%; White: 40.9%; Other race: 34.4%; p = 0.0049). Medication use findings showed that at least half of all included visits from women of reproductive age had a non‐vitamin/non‐mineral medication prescribed. No racial differences in the prescribing of non‐vitamin/non‐mineral medications were observed.
Conclusions: Racial differences in the prevalence of at least one chronic condition in non‐pregnant women of reproductive age was shown in this study.
Evolution of the Results of Reduction Mammaplasty Over the Postoperative Period
Edgard da Silva Garcia, MD, PhD,1 Joel Veiga Filho, MD, PhD,2 Ana Mikaele de Paula,2 Yara Juliano, PhD,1,2 Lydia Masako Ferreira, MD, PhD,1 and Daniela Francescato Veiga, MD, PhD1,2
1Universidade Federal de São Paulo, São Paulo‐SP, Brazil, 2Universidade de Vale do Sapucaí, Pouso Alegre‐MG, Brazil
Background: Breast hypertrophy is a frequent condition, and reduction mammaplasty has a positive impact on different aspects of women's quality of life. However, the action of time and the action of gravity may lead to breast ptosis in the postoperative period. This prospective study aimed to evaluate the evolution of results of reduction mammaplasty during the postoperative period.
Methods: Fifty patients with breast hypertrophy who were candidates for reduction mammaplasty were prospectively enrolled. Standard measurements of the breasts were taken in the pre and postoperative periods of 30 and 180 days. The measurements were used to calculate the Sacchini index. The higher the value of the index, the greater the degree of breast ptosis. Friedman's analysis of variance was applied to compare pre and post‐operative values of 30 and 180 days.
Results: Median age, body mass index and resected breast weight were 31 years‐old, 25 kg/m2 and 635g, respectively. Sacchini index values were lower in the postoperative period of one month, when compared to the six‐month period, indicating a loss of outcome over time, but remaining lower than the preoperative period (p < 0.0001; 30 days <180 days < pre‐operative). There was no significant difference between the right and left breasts at any time of evaluation.
Conclusions: Reduction mammaplasty was effective in the correction of breast ptosis. There was ptosis of the nipple‐areola complex after six months, in relation to the one‐month postoperative period. However, after six months a significant positive difference remained in relation to the preoperative period.
Shame, Stigma, and Healthcare‐Seeking Experiences of Female Patients Receiving Gynecological Care at Federally Qualified Health Centers (FQHCS) in New York City (NYC)
Emmeline Rodriguez, MPH, and Ashley Chastain, MPH
CUNY Graduate School of Public Health and Health Policy, New York, NY
Background: In NYC, risks of acquiring HIV and other sexually transmitted infections (STIs) are greater for some neighborhood residents than others; similar disparities exist with intimate partner violence (IPV) prevalence. Within these neighborhoods, healthcare providers see female patients with varying health needs and access to medical care. For these patients, preventive screenings and risk assessments are important despite the stigmatizing and sensitive nature of these topics. With ever‐increasing integration of reproductive healthcare into primary care settings, better understanding of patient experiences when seeking gynecological care in this setting is needed.
Methods: Eighteen female patients (18‐44) who had a pelvic exam at two NYC‐based FQHCs participated in in‐depth interviews. Interviewees were asked about how it felt to discuss any sexual health topics with their provider. Interviews were recorded, professionally transcribed, and analyzed using conventional content analysis.
Results: Emerging themes included: 1) Fear of judgement; 2) Overcoming fear; and, 3) Provider responsibility. Interviewees expressed fear of judgment from their provider, which impacted their health history disclosure; patients described modifying details to avoid shame. Patients explained that it was important to overcome fear of judgement to receive appropriate diagnoses and treatment. Interviewees also expressed a belief that providers are responsible for creating a comfortable environment when discussing sensitive and stigmatizing sexual health topics.
Conclusions: This study provides insights into healthcare‐seeking experiences of female patients accessing gynecological care in primary care settings. Clinical best practice guidelines for preventive health screenings must be informed by patient experiences. Guidelines should address feelings of shame and stigma on behalf of patients, raise awareness of implicit biases among providers, and outline effective strategies for reducing the impact of biases on patient care.
Triple Negative Breast Cancer: Increased Apoptotic Response to Platinum is Dependent on Mutant P53 Level
Eziafa I. Oduah, MD, MS, MPH, Barbara B. Szomju, BA, Oluwatoyin E. Akande, PhD, and Steven R. Grossman, MD, PhD
Virginia Commonwealth University, Richmond, VA
Background: Mutant p53 is found in over 80 percent of triple negative breast cancer (TNBC), and is emerging as a potential therapeutic target. Mutant p53, in contrast to wild type p53, is an oncogene characterized by high stability and a long half‐life. Tumors harboring mutant p53 are dependent on its high level for increased oncogenic activity including proliferation, invasion and metastasis. This has been proposed as a potential mechanism for the aggressiveness of TNBC, which remains with a substantially poorer prognosis than other subtypes of breast cancer.
Methods: DBC1 was shown in a recent report to stabilize wild type p53. Hence we postulated that DBC1 would also stabilize mutant p53 and aid its oncogenic abilities. We proposed that by depleting DBC1 there would be decreased stability and oncogenic activity, and conversely increased response to treatment in mutant p53 expressing cancers such as TNBC. Stable DBC1 depleted TNBC cell lines were created using shRNA and the stability of mutant p53 and apoptotic response to platinum chemotherapy was then investigated using western blot, cyclohexamide chase assays, immunoprecipitation and flow cytometry techniques.
Results: We detected increased apoptosis in DBC1 depleted cells, more pronounced at 48 hours than at 24 hours following treatment with cisplatin. This was found to correspond to the long half‐life of mutant p53, found to be over 48 hours in these cells.
Conclusions: Together, these results suggest that mutant p53 warrants closer attention as an actionable target in TNBC.
Using Animals to Teach Techniques of the Physical Exam and Communication Practices to Health Professional Students
Florence Dasrath, Erica Concors, Fred Bosoy, and Gloria Bachmann, MD
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Background: Teaching technical skills and communication techniques in the field of obstetrics and gynecology can be challenging because of high‐pressure environments that exist within certain clinical settings. Not all types of communication techniques are standard across cultures and may be interpreted differently based on a person's background. Therefore, training those in the medical field to employ certain techniques can be challenging, especially when they may not be consistent for certain populations. We propose an alternative teaching model using ewes to understand how certain body languages may be interpreted in addition to gaining knowledge about the obstetrical physical exam.
Methods: Medical students from Rutgers Robert Wood Johnson Medical School, mentored by an Ob/Gyn faculty member visited Perry Sheep Farm in New Jersey where they were able to interact with sheep and pregnant ewes performing elements of a physical exam on the ewes. Students were provided questionnaires to evaluate their expectations and perceptions of the experience.
Results: Students reported being hyper‐aware of nonverbal body cues used during their interactions with the ewes and changing their behavior during the physical exam in attempts to decrease the stress of the animals. Students employed a more submissive body language to decrease the tension of the animals.
Conclusions: Allowing students to perform physical exams on farm animals can contribute to the development of both verbal and nonverbal communication skills as well as the physical exam techniques while still maintaining a low‐stress learning environment.
A Narrative‐Based Peer‐to‐Peer Educational Modality for Peripartum Mood and Anxiety Disorders
Frederick M. Bosoy, Rebecca Temkin, Katherine Schertz, and Gloria Bachmann, MD
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Background: Peripartum mood and anxiety disorders (PMADs) affect 10 to 21% of women in industrialized countries. The aim of this project was to develop a novel modality for peer‐to‐peer education among women living with PMADs such that future parents may feel less isolated and understand that PMADs are medical illnesses rather than personal failings.
Methods: Three Rutgers Robert Wood Johnson Medical School students collected personal accounts and artistic renderings from women with PMADs partaking in 8 support group sessions. Participants, many of whom are native Spanish speakers, provided accounts in their language of choice, with translation provided as needed. Women signed forms acknowledging release of their work and were informed that all identifiers would be removed from the book.
Results: Within the 8 groups, 38 women contributed their expressions of PMADs. The medical students curated this material and select pieces were included in the anthology, INSPIRE: Stories of Motherhood. Distribution of the book to a variety of clinical settings is planned.
Conclusions: Providing women the opportunity to recount their experiences with PMADs empowers them and others to generate their own dialogue on the topic. A narrative approach leverages the power of personal experience and mobilizes women to become their own advocates. The book represents one type of educational modality that can be used in the clinical setting. It will perhaps serve as affirmation for affected women that they are not alone in their experience of PMADs and encourage them to reach out for resources.
Medical Aspects of Nutrition in the Female Athlete: A Review
Mary Downes Gastrich, PhD, EdD,2 Gloria Bachmann, MD,2 and Alexa McDonald Moriarty, MS, RDN, CSSD1
1Princeton University, Princeton, NJ, 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Background: Data suggest that the nutrition of female athletes needs to be monitored, as eating disorders and nutrition‐related health concerns are common throughout the sports world, especially in women. Therefore, the nutritional behaviors of female athletes need to be more objectively monitored and then, where inadequacies are noted, implement ways for improvement. The objective of this review is to assess the adverse nutritional behaviors of female athletes and, to identify opportunities for positive change.
Methods: Randomized control trials, observational studies (prospective cohort studies and case‐control studies) with a sufficient number (N ≥ 30) are reviewed, using PRISMA guidelines. Also included are meta‐analyses, scientific reviews, recommendations from governmental agencies, athletic organizations geared to female athletes, and nutritional recommendations from colleges.
Results: Data suggest that the diets of many female athletes are often insufficient in meeting nutritional needs. Further, these studies noted that knowledge of nutrition among athletes, sports teams, and coaches may not be comprehensive and should be addressed and enhanced.
Conclusions: Mandatory educational programs for athletes, coaches, and health care professionals should be considered and the monitoring of dietary supplements, including banned ones, should be encouraged. Interdisciplinary working groups, comprised of athletes, coaches, physicians, dietitians and other professionals are needed to monitor the nutrition of female athletes and to recommend measures to improve their diet.
Malnutrition in Female Athletes and Associated Health Problems
Stephanie Giessner, Nancy Phillips, MD, and Gloria Bachmann, MD
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Background: In 2017, ESPN created a list of 100 of the world's most famous athletes, and the most popularly known athletes are men. Only eight women are listed in the top 100, and the first woman mentioned does not appear until rank #16. Thus, it can be inferred that in the sports realm not much attention is given to female athletes. As such, their struggles are not necessarily attended to by the media or public—which leads to a continuation and exacerbation of their problems. Specifically, these issues are nutrition and diet. Therefore, we investigated the causes of malnutrition in female athletes and the associated health problems, in order to educate others about this topic.
Methods: We performed a literary review using databases such as Cochrane and PubMed.
Results: Malnutrition in female athletes is due to gender differences in exercise metabolism. For example, women utilize proportionally more lipid and less carbohydrate than men, although a high carbohydrate diet is recommended in athletes. Also, there is a higher prevalence of eating disorders in female athletes due to societal pressures of body image. Consequently, female athletes suffer from irregular menses, infertility, and osteoporosis.
Conclusions: There is a gender gap for health issues in athletes, one that is overlooked and ignored by the public—and that is an issue with nutrition and diet in female athletes. Also, these lead to long‐term consequences that can affect their athletic performance. Female athletes should have their own nutritional recommendations and encouraged to eat healthily rather than worry about body image.
The Neurokinin 3 Receptor Antagonist, Fezolinetant, is Effective in Treatment of Menopausal Vasomotor Symptoms: A Randomized, Placebo‐Controlled, Double‐Blind, Dose‐Ranging Study
Graeme Fraser, PhD,5 Samuel Lederman, MD,1 Arthur Waldbaum, MD,4 Misun Lee, PhD,3 Laurence Skillern, MD,2 and Steven Ramael, MD5
1Altus Research, Lake Worth, FL, 2Astellas Pharma Europe Ltd, Chertsey, UK, 3Astellas Pharma, Inc., Northbrook, IL, 4Downtown Women's Healthcare, Denver, CO, 5OGEDA SA, a wholly owned subsidiary of Astellas Pharma, Inc., Gosselies, Belgium
Background: The brain's thermoregulatory center is stimulated by neurokinin 3 receptor (NK3R) activation and inhibited by estrogen negative‐feedback. In menopause, declining estrogen disturbs this balance and produces vasomotor symptoms (VMS). This trial evaluated the NK3R antagonist fezolinetant in VMS.
Methods: This phase 2b, double‐blind trial (NCT03192176) randomized menopausal women (>40 − 65y) with moderate/severe VMS (≥50/wk) to fezolinetant 15, 30, 60, or 90 mg BID or 30, 60, or 120 mg QD or placebo. Coprimary efficacy outcomes were frequency and severity of VMS at weeks 4 and 12; secondary outcomes included changes by study week.
Results: Of 356 women randomized, 352 received ≥1 dose study drug (safety population; mean [SD] age: 54.6 [4.7] y; 73% white) and 287 (81%) completed the study (placebo: 84%; fezolinetant: 80%). Discontinuations occurred most commonly for withdrawal of consent (6.7%) and AEs (5.9%). VMS frequency and severity at weeks 4 and 12 were reduced in all fezolinetant groups. Differences from placebo in least squares mean changes from baseline in VMS daily frequency at week 4 were −1.9, −3.0, −2.8, and −3.5 for 15, 30, 60, and 90 mg BID and −2.3, −3.0, and −2.4 for 30, 60, and 120 mg QD, respectively (common SE: 0.8; all P < .05). Differences at week 12 were −1.8, −2.1, −2.3, −2.6 and −2.1, −2.6, −2.1, respectively (common SE: ∼0.7; all P < .05). A significant dose response was apparent by week 1. Most TEAEs were mild/moderate. No deaths or serious treatment‐related TEAEs occurred.
Conclusions: Fezolinetant was well tolerated and rapidly reduced moderate/severe menopausal VMS.
An Examination of Contraceptive Use and Reasons for Non‐Use in Appalachian, Drug‐Using Women Recruited from Rural Jails
Gretchen E. Ely, PhD,1 and Michele Staton, PhD2
1University at Buffalo, Buffalo, NY, 2University of Kentucky, Lexington, KY
Background: General rates of contraceptive use in the US are known, but the contraceptive use rates of women who use drugs and are involved with the criminal justice system have not been explored in depth.
Methods: A cross‐sectional, secondary data analysis of existing baseline data was employed to examine contraceptive use, reasons for non‐use of condoms, and correlates of condom use.
Results: Respondents' average age was 32.81 (SD: 8.24; range: 18‐61), and they were majority white (99%) and heterosexual (79.3%). The majority (96.5%) reported a lifetime history of contraceptive use, and most (70.5%) had a history of using multiple methods. Less than one‐third of respondents reported contraceptive use within the last year, and of those, the majority, 76% (n = 95), used male condoms, oral contraceptive pills or IUDs (both 14.4%), or contraceptive injections (13.6%). Reasons for condom non‐use included: (a) having one sex partner (59.6%), (b) not thinking about it (39.1%), (c) getting high and forgetting (26.1%), and (d) partner not wanting to (11.8%). Respondents with better relationship decision making autonomy, and those perceiving that partners would not get violent, angry, suspicious, or exert control in their relationship were more likely to use condoms.
Conclusions: Further investigation into the disparity between lifetime rates of contraceptive use and use within the last year is warranted, and the design of culturally appropriate programs to improve contraceptive use is suggested.
Social Acceptability of Marijuana Use Among Adult Women: Correlates and Trends in Use
Jaclyn Sara Sadicario, MS, Anna Beth Parlier‐Ahmad, BS, Kathryn Polak, MS, Sydney Kelpin, MS, Lisa Phipps PharmD, Nicole Karjane, MD, and Dace Svikis, PhD
Virginia Commonwealth University, Richmond, VA
Background: In the US, use of marijuana (MJ) is on the rise. However, little is known about the perception of MJ use by adult women. This is particularly important due to the potential harm of perinatal MJ use. Additionally, women who use MJ may be more likely to develop mental health issues than men who use. This study aims to examine (1) prevalence rates of MJ use, (2) perceived social acceptability of MJ use, and (3) correlates of MJ social acceptability in a sample of adult women.
Methods: Participants were N = 210 non‐pregnant women recruited from two women's health clinics in Virginia. The sample completed a computerized survey about their complementary and integrative medicine use, substance use, mental health, and health conditions. Analyses included chi‐square for categorical and t‐tests/ANOVA for continuous measures.
Results: Approximately 37% of the sample endorsed lifetime MJ use and 13% endorsed recent MJ use. Additionally, 35% found MJ use socially unacceptable, 35% found it acceptable, and 30% were neutral. Perceptions of MJ use differed from cigarette use, with 65% of the sample reporting cigarettes as unacceptable (p < .01). Individuals who find MJ use unacceptable were more likely to endorse no prior use of cigarettes or MJ (p < .01). Further analysis will be completed to determine correlates of MJ use social acceptability.
Conclusions: Women found MJ use more socially acceptable than cigarette use. This may present an opportunity for education based on differential risks of using MJ for women. Changing policies on MJ use affirm the need for further research to better understand perceptions of use of MJ in this population.
Unmet Needs in the Management of Hypoactive Sexual Desire Disorder in Premenopausal Women
1AMAG Pharmaceuticals, Inc., Waltham, MA, 2George Washington University, Washington, DC, 3IntimMedicine Specialists, 4Trinity Partners, Waltham, MA
Background: Hypoactive sexual desire disorder (HSDD) is characterized by a decrease or lack of sexual desire accompanied by distress. The aim of this study was to gain insight into the diagnosis and management of HSDD among premenopausal women reporting a diagnosis or symptoms of HSDD.
Methods: A 45‐minute, IRB‐approved survey was designed to explore the patient experience and physical and psychosocial burden related to HSDD. Inclusion criteria were ≥18 years of age, a diagnosis of HSDD in accordance with the Decreased Sexual Desire Screener, and currently in a stable, monogamous relationship with a partner for ≥6 months.
Results: 530 women were included in the analysis. HSDD was most commonly managed by obstetricians/gynecologists (43%) or primary care physicians (35%). Among respondents who discussed their HSDD symptoms with their physician/therapist (n = 397), 82% initiated the conversation themselves. Of those who initiated the conversation, 18% believed their health care professionals (HCPs) were not aware of HSDD as a medical condition. The most commonly prescribed treatments were nonpharmacologic including lubricants (52%) and meditation/yoga (43%). Respondents who received nonpharmacologic treatments (n = 409) generally found treatments safe, but 33% cited poor efficacy; common reasons for poor efficacy included no change in interest in sexual activity (68%) and inability to 'stay in the moment' during sexual activity (53%).
Conclusions: There is a need for improved HCP education, as many lack knowledge of how to diagnose and treat HSDD. Frequent nonpharmacologic prescription patterns among HCPs suggest a limited understanding of the disease etiology and a lack of efficacious treatment options.
LGBTQ Medicine Training for Medical Students, Residents, and Faculty
Joanne Thambuswamy, MD, Hunter Holloway, MD, Sarai Morrison, MD, Christian Markham, Morgan Botkin, Noaa Spiekerman, Agatha Parks‐Savage, EdD, RN, LPC, Stephen Brawley, MD, PhD, and Steven Lewis, MD, MPH
Eastern Virginia Medical School, Portsmouth, Virginia
Background: Residents do not have consistent training in LGBTQ healthcare, hormone therapy, or history taking of LGBTQ patients. Limited studies have evaluated the attitudes of providers with regard to treatment of LGBTQ patients and even fewer studies have evaluated the implementation of an integrative training approach and how that affects the attitudes of those providers.
Methods: This project explores the knowledge, attitudes, and beliefs of medical students, physician‐faculty, physician‐residents, and fellows regarding LGBTQ patients. Furthermore, it attempts to design and implement an integrative training approach and evaluate how the program affects the attitudes of providers. Data was collected by administering surveys to Eastern Virginia Medical School Family Medicine residents prior to their first training session and then having them repeat the survey after the training session.
Results: This project explores the knowledge, attitudes, and beliefs of medical students, physician‐faculty, physician‐residents, and fellows regarding LGBTQ patients. Furthermore, it attempts to design and implement an integrative training approach and evaluate how the program affects the attitudes of providers. Data was collected by administering surveys to Eastern Virginia Medical School Family Medicine residents prior to their first training session and then having them repeat the survey after the training session.
Conclusions: We hypothesize that this difference in knowledge base and in attitudes toward treating transgender and LGB patients will prove statistically significant after data analysis is performed and will contribute to the evidence base for implementing training programs focused on transgender healthcare to medical professionals.
Public Health at The Bedside: Using the Theory of Planned Behavior yo Promote the Identification of an Obstetric Hemorrhage by the Obstetric Healthcare Team
Kara Heird, RN, MPH,2 and Kellie Carlyle, PhD, MPH1
1Virginia Commonwealth University, Richmond, VA, 2VCU Health, Richmond, VA
Background: The maternal mortality rate in the United States is higher than 49 other countries, and it is rising. One leading cause is obstetric hemorrhage. An accurate measurement of blood loss is important to identify the presence and severity of a hemorrhage. The traditional method of measurement is visual estimation, however this is proven to be inaccurate. The adoption of a quantifiable method of measuring blood loss (QBL) is recommended by all major obstetric professional organizations as it is more accurate than visual estimation alone. Objectives: This project aims to promote the adoption of QBL by Labor and Delivery nurses at VCU Health, an urban tertiary care center, through the development of promotional materials informed by the Theory of Planned Behavior (TPB).
Methods: A quasi‐experimental single group, pre‐ and post‐test design was used. Results of the pretest informed the focus of the promotional materials. A flier, interactive bulletin board, and newsletter were developed based on TPB constructs identified as suboptimal in the pretest. Pretest and Post‐test means were compared using an two sample T‐tests for constructs as a whole as well as individual questions. Pearson's correlations were performed on TBP constructs and behavioral as well as exposure to materials and TBP constructs.
Results: Mean TPB construct scores increased significantly. Intention to perform QBL and self‐reported compliance with QBL increased significantly. The TPB construct of attitude significantly positively correlated with behavioral intention and past compliance, and exposure to the bulletin board significantly positively correlated with the construct of perceived behavioral control.
Conclusions: The use of a TPB informed intervention was successful in promoting the adoption of QBL among Labor and Delivery nurses. Other institutions may use this method when promoting behavior change. VCU Health is ready to move forward with interventions to most effectively manage a hemorrhage once it has been identified.
Nationwide Cohort‐Study of Patients with Endometriosis Associated with Higher Risk of Sjögren's Syndrome
Kevin Ma
National Taiwan University, Taipei, Taiwan
Background: We sought to determine whether endometriosis patients have higher risk of Sjögren's syndrome (SS).
Methods: We performed a retrospective cohort study of females with newly diagnosed endometriosis from 1999 to 2013 from the Longitudinal Health Insurance Dataset of National Taiwan Insurance Research Database. Data on age, diagnosis code, history of comorbidities, the use of corticosteroids and non‐steroidal anti‐inflammatory drugs (NSAIDs) were retrieved. We recruited cases (n = 15,949) of endometriosis and age‐matched controls (n = 31,880) without endometriosis. Propensity score matching between endometriosis and non‐endometriosis group was then conducted to exclude confounding factors including comorbidities and medications. A Cox proportional hazard model was developed to estimate the risk of SS in endometriosis patients. A cumulative probability model was adopted to assess the time‐dependent effect of endometriosis on SS development, implying the casual link of the association. Sensitivity tests and subgroup analysis was conducted to confirm the risk of SS in endometriosis patients.
Results: The mean ± SD age (38.8 ± 8.8 y/o) was the same for patients with or without endometriosis (p = 0.406). Patients with endometriosis were more likely to have SS than non‐endometriosis controls (adjusted hazard ratio 1.5, 95% confidence interval 1.27‐1.77, P < 0.05), which persisted in sensitivity tests (adjusted HR = 1.34, 95% CI = 1.04‐1.74, P < 0.05).
Conclusions: Our findings suggest the association between endometriosis and higher risks of developing SS. Endometriosis may be a risk factor for, or share a common cause, with SS. Steroids and NSAIDs might reduce such association.
Early Intervention: Early Childhood Program to Promote Good Family Mental Health and Well‐Being Across the Life Course
Mr. Linos Muvhu
Society for Pre and Post Natal Services (SPANS)
Background: By 2020, maternal depression will be the leading cause of disability among women globally (WHO, 2018). Advances in research on how mental health across the life course is influenced by parental mental health and the parent/carer—infant relationship has led to perinatal and infant mental health being a global health priority (WHO, 2018; UNICEF, 2017).To promote good mental health and well‐being for families across the life‐course in a rural setting in Zimbabwe.
Methods: The Mashonaland east province under Goromonzi district is a pre‐urban and a rural setting in Zimbabwe. Families here face significant levels of social and economic disadvantage. SPANS will undertake to: educate parents and caregivers about the importance of good parental and infant mental health, educate parents and communities about how infant mental health is developed and promoted in the perinatal period and beyond and Identify parental and infant mental health problems early via screening families in the first 3 months of booking their pregnancy.
Results: The Early Childhood Program aims to improve the mental health of families in a rural setting in Zimbabwe through empowering families and communities through; raising awareness, partnership working, offering acceptable and accessible support; and providing cost effective interventions at the earliest opportunity.
Conclusions: There is a lack of funded services to support good family mental health in Zimbabwe and our work with families in a resource poor country may have important lessons for other communities facing these challenges.
Aesthetic Removal of Ribs: Is There Evidence in the Literature?
Lydia Masako Ferreira,1 Gabriel de Almeida Arruda Felix,2 Pedro Eduardo Nader Ferreira,3 Afrânio Benedito Silva Bernardes,3 Gabriel Felsky dos Anjos,3 Ognev Meireles Cosac,3 Ricardo Oliva Willhelm,3 Wanda Elizabeth Massierey Correa,3 and Edina Mariko Koga da Silva4
1Head and Full Professor Plastic Surgery Division at Unifesp‐EPM and Member of Plastic Surgery Technical Camera at Brazilian Federal Council of Medicine, 2Resident of Plastic Surgery Division at Unifesp‐EPM, 3Member of Plastic Surgery Technical Camera at Brazilian Federal Council of Medicine, 4Associate Professor at Unifesp‐EPM
Background: There is the debate between the benefits of surgically reducing the waist and its potential complications, such as risk of pneumothorax, influence on the respiratory mechanism, reduction of the protection of intra‐abdominal organs and long‐term chest deformities. Objective: to evaluate scientific evidence on the effectiveness and safety of ribs removal for aesthetic purposes.
Methods: Method: a systematic literature review was carried out with the following characteristics, following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA)6 guidelines. The inclusion criteria were randomized clinical trials, prospective and retrospective cohort studies, case‐control studies, case series and case reports published in all period. There were included studies with adults who underwent surgical intervention for aesthetic purposes by removing any of the floating ribs (11th and 12th) to reduce waist circumference. The primary outcome was the decrease in waist circumference. The secondary outcomes were adverse events and patient satisfaction. The search was performed for all years in the following databases: EMBASE/Elsevier, Scopus, Medline, PubMed, BVS, SciELO, and Lilacs.
Results: Results: In total, only 03 articles on the surgical ribs removal published in the period were found in all databases. Of these, 2 articles were selected for their relevance to the topic of the systematic review according to the title and abstract.
Conclusions: Conclusion: There is no scientific evidence to support the effectiveness and safety of the removal of ribs for aesthetic purposes.
Trimester Differences in Post‐Abortion Intra‐Uterine Device Insertion and Expulsion Rates in Young University Students in Central Uganda
Manuela Letaru,2 and Claire Driwaru1
1Entebbe Municipal Council, Wakiso, Uganda, 2Nkumba University, Wakiso, Uganda
Background: In Uganda, preventing unsafe induced abortions is critical especially in the local context of legally restricted abortions except when saving the mothers' life. We aimed at determining whether factors associated with post‐abortion intra‐uterine device (IUD) use differed by gestation age at pregnancy termination.
Methods: 388 female students aged 18‐30 years seeking first and second trimester post‐abortion care in a large, urban‐based, private health unit in central Kampala were followed‐up from Oct‐Dec 2018. Outcome variables were IUD insertion in 1st and 2nd post‐abortion period. The key independent variable was post‐IUD insertion expulsion. Descriptive statistics for frequencies and chi‐square tests for bivariate analysis were used. Covariates controlled for were socio‐demographic and fertility characteristics using multi‐variable logistic regression analysis.
Results: Among 388 female university students, the mean age was 20.3 (SD = 1.3) years, 31.2% and 68.8% were first and second trimester post‐abortion care seekers. IUDs were inserted in 10.7% and 19.1% of first and second trimester post‐abortion care seekers (13/121 vs. 51/267; p = 0.014). No differences were observed in first (2.1%) and second (0.4%) trimester post‐abortion IUD expulsion rates (1/13 = 7.7% vs. 4/51 = 7.8%; p = 0.63). History of unintended pregnancy and previous IUD use was associated with first (AOR = 3.31, 95%CI 2.19‐4.87) and second (AOR = 5.67, 95%CI 2.19‐4.87) trimester post‐abortion IUD insertion respectively.
Conclusions: A high proportion of young university students seeking post‐abortion services were in the second trimester. Promoting effective contraceptive use in the post‐abortion period like IUD is essential for reduction of unintended pregnancy among young university students.
Acmella Oleracea in Dyspareunia in Postmenopausal Women
Ana Beatriz Alkmim Teixeira Loyola, PhD,1 Marcelle Ferraz Resk, MSc,1 Caio Rosa de Almeida Lima,1 Pedro Henrique Alves Pereira,1 Luiz Francisley de Paiva, MSc,1 Lydia Masako Ferreira, MD, PhD,2 and Daniela Francescato Veiga, MD, PhD1,2
1Universidade do Vale do Sapucaí, Pouso Alegre ‐ MG, Brazil, 2Universidade Federal de São Paulo, São Paulo ‐ SP, Brazil
Background: Menopause, with loss of vaginal elasticity and genital atrophy, and may cause dyspareunia. A new therapeutic option is Spilanthes oleracea is a plant popularly used as an anesthetic, analgesic. The objective was to elaborate an herbal gel based on A. oleracea and to evaluate the intensity of pain in the vaginal introitus, during sexual intercourse in postmenopausal women and alterations in the vaginal microbiota.
Methods: A randomized, controlled, double‐blind clinical trial was conducted with healthy volunteers from August 2017 to September 2018. The randomized product, being a Natrozol® gel control group (n = 20) and the other gel group A oleracea (n = 20). In the consultation the volunteer was applied to the numerical visual scale of standardized pain to determine the degree of pain felt during intercourse. Collection of vaginal secretion was performed before and after the use of the product drawn. The vaginal smear stained by the Gram method was performed through swabs.
Results: The pain intensity assessed by the EVN scale in the A oleracea group was statistically lower compared to the Natrozol® group (p = 0.029). The results of the microbiological evaluation according to the variables Bacillus Doderlein, Gram Negative Bacillus, Coco Gram Positive and yeasts did not show statistical difference after the use of the A oleracea gel.
Conclusions: The herbal gel based on A oleracea was elaborated and significantly reduced the intensity of pain in sexual intercourse (dyspareunia) in postmenopausal women without modifying the vaginal microbiota.
'Mainstreaming Gender Into Research' Means Gender Medicine in the Medical Education
Bader Angelika,1,2 and Hochleitner Margarethe1,2
1Medical University of Innsbruck, Gender Medicine Unit. Austria, 2Women's Health Centre, Innsbruck Austria
Background: Gender Mainstreaming is mandatory within the European Union for state Universities and the health systeme. To get Gender Medicine into medical research it is essential to include it in all curricula offered at medical universities. It must also be included in the core curriculum of all study phases and in all cumulative examinations. So it will become the status quo for all medical students.
Methods: Gender Medicine is instructed in the core curriculum twice: in the third semester the fundamentals of Gender Medicine, and in the tenth semester its clinical and research relevance. This material is also covered in the two cumulative exams. Gender Medicine was recently established as a compulsory subject in the PhD‐programme. One Gender aspect must be elaborated from the PhD‐thesis with subsequent congress presentation or publication of a scientific paper.
Results: We started in 2013. Until now more than 150 diploma‐theses and 30 PhD‐theses were registered on the subject, and 5 poster prizes were awarded at national and international congresses for PhD‐Gender‐posters.
Conclusions: To get Gender and Gender Medicine into medical research they must already be included in the core curriculum if they are to be considered a 'normal' subject. Another important factor is to emphasize the usefulness of Gender‐Medicine‐findings with regard to research possibilities, project applications, grants and resources. We hope that being forced to include Gender aspect in their PhD‐theses will help them to get used to it and they will do it also in future projects.
CKACS: Contraception Knowledge Assessment in College Students
Marian Evans, MD, MPH, CRA
Southern CT State University, New Haven, CT
Background: Unintended pregnancy continues to be a public health concern for more than 40 years. In 2011, the overall percentage of unintended pregnancy among all females of reproductive age (15‐44 years old) was 45%. There is a need to provide resources and intervention to prevent unintended pregnancy in 18‐24 years old; one point of possible intervention is to target students who attend college. The incidence and prevalence of unintended pregnancy can potentially be reduced by increasing knowledge and awareness about contraception options.
Methods: A convenience sampling was used with a custom survey conducted in regularly scheduled elective Women's Health classes from 2015‐2018. Surveys contained questions about demographic characteristics and knowledge of contraception options. Paired sample t‐test was performed as well as means and percentages using SPSS for analysis.
Results: The sample was N = 170, 81% female; 16%. 36% were juniors, and 45% were seniors. 39%‐White; 25% AA, 12%‐Latinx, 15% other. The mean pretest score was 5.76 out of 10, and the mean posttest score was 6.96, t = 24.3, p = .000, Cohen's d = .77.
Conclusions: Knowledge increased significantly from pretest to posttest. Future studies are needed to better understand the depth of knowledge around newer methods of contraception (LARCs) and testing throughout the university. Longitudinal studies of students' attitude, behaviors, and gaps in contraception knowledge are needed.
Development of a Program of Physiotherapeutic Exercises for the Upper Limb After Mastectomies
1Universidade do Vale do Sapucaí, Pouso Alegre‐MG, Brazil, 2Universidade Federal de São Paulo, São Paulo‐SP, Brazil
Background: Breast cancer is the second most frequent in women. Mastectomy, many times associated with axillary lymphadenectomy, may cause limitation of the homolateral upper limb movement range. Breast reconstruction procedures can also have a negative impact on function. Therefore, physiotherapy plays an important role at all treatment stages. This study aimed to verify the limitations of upper limb movement in the postoperative period of mastectomy and to support the elaboration of a program of physiotherapy exercises for the patients.
Methods: The sample calculation for this cross‐sectional study resulted in 48 individuals. Thus, 48 breast cancer patients who underwent mastectomy at least one month before, with or without breast reconstruction procedures, were enrolled. The Brazilian validated version of the Disabilities of the Arm, Shoulder and Hand (DASH) was applied to identify the restrictions.
Results: Patients' ages ranged from 31 to 90 years (median 51 years), and 42% of them had implant‐based breast reconstruction. The major restrictions were related to the upper limb abduction and shoulder flexion. 65% of the patients had difficulty in performing shoulder flexion (29% could not perform flexion at all); 56% had no upper limb weakness, but 2% had extreme weakness, limiting daily tasks. Breast reconstruction did not increase the restrictions.
Conclusions: The main limitations observed were upper limb abduction and shoulder flexion. Based on these results, a specific physiotherapy exercises program was developed and transformed into an algorithm, which will allow the development of an easily accessible app to be used by patients in the postoperative period.
A Multidimensional Gender‐Based Study on UCSF Electronic Medical Record to Improve Women Health
University of California San Francisco, San Francisco, CA
Background: The main objective of this study is multidimensional data analytics on UCSF Electronic Medical Records (EMR) to find the gender‐based differences of treatment plans to improve women health.
Methods: We analyzed EMR including patient's demographics, allergies, billing information, coverage, departments, diagnoses, encounters, flowsheet, immunization, lab, medication orders, procedure orders, providers, and vitals. We provided the statistical analysis (e.g. p‐value). Then we did deep learning with Tensor Flow to find the most effective predictors for outcomes (e.g. status of the patients). We designed and implemented a model to find the sequence of events from the time of admission to release for each individual patient.
Results: As of July 2018, all patients at UCSF includes 573,033 Female and 474,367 Male are analyzed. Our statistical analysis showed that there are significant gender‐based differences (e.g. surgical procedures on the pericardium with the p‐value of 0.23 on 989 female versus 2 male), patients under extracorporeal membrane oxygenation with the p‐value of 0.18 on 423 female versus 10 male. In term of medication, there are significant differences in some medicine such as Hydroxychloroquine on 875 male versus 3890 female. Hydroxychloroquine is used to treat malaria. This medication is also used with other medications, to treat certain auto‐immune diseases (lupus, rheumatoid arthritis). This observation raises a question of the reason for gender‐based differences. Due to the word limitation, more results can discuss later.
Conclusions: We found the evidence to determine the gender‐based differences in real‐world practice. The results of this study could improve women health by suggesting a different guideline for treatment considering their genders.
Healthymama Application: Feasibility, Acceptability and Utility of an Innovative Mhealth Intervention to Improve Maternal Child Health Services in Rural Uganda
Mary Babirye, and Tumusiime Passy
Watoto Ministries, Kampala, Uganda
Background: Evidence‐based technologies are essential, and World Health Organization recommended to improve maternal and child health service utilization in Uganda. We developed and assessed the HealthyMama App aimed at improving the quality of maternal and newborn care services in rural Uganda.
Methods: As part of a larger study, the HealthyMama App is mobile health, digital health intervention that integrates real‐time data collection by healthcare workers during provision of prenatal, skilled birth delivery and postnatal care services. Our mixed‐methods study conducted in a rural district hospital in Eastern Uganda employed a quasi‐experimental design to assess the usability of HealthyMama App to improve MCH services. Summary statistics using frequency with percentages and paired t‐test to compare differences in pre‐post app utility. In an iterative process, the qualitative component explored and informed the applications feasibility, and acceptability in this rural health setting.
Results: The mean App utility was high at 71.2(SD = 1.8). Pre‐post App utility was high and significantly different at 82.3 vs. 94.8; p < 0.001 respectively. Clinicians had favorable perceptions about feasibility and acceptability of the HealthyMama App. Most healthcare workers reported high‐perceived improvement in quality of maternal health service provision and utility. Self‐reported improvement in patient‐physician shared decision making and quality of care provided.
Conclusions: Development of collaborative, integrative and innovative user‐focused m‐health interventions are critical towards improving maternal, newborn and child health services in rural Uganda.
High Risk Pregnancy Ambulatory's Health Service Quality Scale
Pablo do Vale e Silva Vieira, MS, and Antônio Marcos Coldibelli Francisco, MD
Universidade do Vale do Sapucaí, MG, Brazil
Background: The knowledge of the service's quality is an essential point for an improvement project, this work focuses primarily on the awareness of the service provided by the attention sector to high risk pregnant women, to propose improvements for excellence in health care. The Health Service Quality Scale questionnaire was used, translated and validated for the Portuguese language and Brazilian culture (EQSS / EPM)—a specific tool for the health sector.
Methods: The EQSS / EPM (ROCHA et al, 2013) was applied to 50 high‐risk pregnant women attending the OB/GYN of Universidade do Sapucaí ‐ UNIVáS ‐ Pouso Alegre MG ‐ Brazil. The instrument has 73 questions, divided into 3 blocks, subdivided into 16 groups, evaluating service qualities. The minimal score to define the service as satisfactory is chosen by the Stakeholders of the studied sector, according to their singularities. For the High Risk Pregnancy ambulatory the defined score was 8 points on a scale of 1 to 10.
Results: The service's global grade was 8.3. In the intra‐block analysis all three of them scored above minimal score. In the intra‐group analysis, 4 of them were below it, the worst one analized service's pontuality.
Conclusions: This study expects to have a regional impact becoming an instrument to the stakeholders to promote an efficient high‐risk pregnancy ambulatory according to the pacient's opinion.
Utilization of Long Acting Reversible Contraceptives and Provider Perceptions in Urban Kampala, Uganda: A Mixed Methods Study
Patience Asiimwe, BA, and Maureen Namara, BA
Edu Child Foundation Uganda (ECFU), Kampala, Uganda
Background: With increasing effective contraceptive use in urban settings, we explored LARC use and provider experiences in Kampala, Uganda.
Methods: We conducted a cross‐sectional, mixed methods health facility‐based study among 480 women of reproductive age (15‐49 years) and eight clinicians in urban Kampala from Aug‐Dec 2018. Structured questionnaires were administered to measure the outcome variable; long‐acting reversible contraceptives (LARC) use i.e. IUD and implant and attitudes towards LARC use. A forward fitting, multivariable logistic regression model was run in STATA/SEv15. Adjusted odds ratios(AOR) estimated for determinants of LARC use. Eight audio‐recorded key informant interviews were transcribed verbatim and thematically analyzed using pre‐determined themes; provider practices, services provided, perceptions and challenges of contraceptive provision.
Results: Women's mean age was 23.4 years (SD = 2.7) and LARC use 18.2%; implants (24.6%) and IUD (7.8%). Women agreeing to using: preferred contraceptive (AOR 4.1; 95%CI:2.1‐5.9), current method to limit birth (AOR 3.4; 95%CI:2.7–4.3) and belief that contraceptives are intended for married couples only (AOR 0.4; 95%CI:0.2‐0.8) were independently associated with LARC use. Practices were; 'altered' clinic scheduling, LARC's provided, clinician skills and increasing LARC provision. Contraceptive services provided were; counselling, integrated outreach campaigns and referrals for improved access. Provider perceptions were user preferences and contraceptive affordability while challenges were stock outs, high client turnover and provider absenteeism.
Conclusions: Addressing information, referrals, outreaches and cultural needs for contraceptive services including task sharing by health workers may improve LARC uptake.
Gender Differences in Depression Prior to Open‐Heart Surgery: The Role of General Health Conditions and Optimism
Amy L. Ai, PhD,3 Henry Carretta, PhD, MPH,2 and Rachel M. Harris, MSW1
1College of Social Work, Florida State University, Tallahassee, FL, 2Departments of Sciences and Social Medicine, College of Medicine; Colleges of Social Work, Florida State University, Tallahassee, FL, 3Institute of Longevity, Departments of Psychology and Social Medicine, Colleges of Social Work and Nursing, Florida State University, Tallahassee, FL
Background: Open‐heart surgery (OHS) is a life‐saving/expanding, yet stressful, intervention in late life for patients with advanced heart disease (HD). Patients with advanced HD (e.g., congestive heart failure (CHF), myocardial infarction (MI)) often suffer from depression. Further, more women report depression and had higher scores of HD‐related depression, compared to their male counterparts. No research has targeted sex differences in post‐OHS depression in conjuncture with pre‐OHS character strengths with adequate control for HD‐specific and surgical confounders. Using cross‐disciplinary data collected from patients undergoing OHS, this prospective study explored the prediction of sex, event‐based HD‐specific indices, and character strengths for post‐OHS depression.
Methods: The three‐wave interview data of 481 patients (age +62+, female 42%) and their key medical record in the Society of Thoracic Surgeon (STS) national database were used to test our hypotheses. Hierarchical multiple linear regression analyses were performed to identify predictors for post‐OHS depression.
Results: Female gender, older age, living alone, pre‐OHS depression, greater number of diseased arteries, and operation time indicating surgical complexity predicted higher levels of post‐OHS depression. Patients who scored higher on dispositional optimism or had a diagnosis of left main disease were less likely to have post‐OHs depression. Although pre‐OHS sense of secular reverence was related to more depression, women who experienced greater pre‐OHS secular reverence, compared with women who did not, were less likely to report post‐OHS depression.
Conclusions: Women in the cohort had higher levels of depressive symptoms even after controlling for pre‐OHS symptoms and multiple medical, cardiac, and surgical indices. Both subgroup could be more vulnerable due to disadvantages in HD conditions. This study provides more reliable information on protection of sex, CSs, and HD‐specific confounders on depression in the critical recovery month following OHS, which could have important clinical implications for patient‐centered, pre‐OHS care of women with advanced HD.
Sex Differences, Event Impacts, and Character Strengths in Depression Following Open‐Heart Surgery
Amy L. Ai, PhD,3 Susan S. Smyth, MD,2 and Rachel M. Harris, MSW1
1College of Social Work, Florida State University, Tallahassee, FL, 2Division of Cardiovascular Medicine, The Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, 3Institute of Longevity, Departments of Psychology and Social Medicine, Colleges of Social Work and Nursing, Florida State University, Tallahassee, FL
Background: Open‐heart surgery (OHS) is a life‐saving/expanding, yet stressful, intervention in late life for patients with advanced heart disease (HD). Patients with advanced HD (e.g., congestive heart failure (CHF), myocardial infarction (MI) often suffer from depression. Further, more women report depression and had higher scores of HD‐related depression, compared to their male counterparts. No research has targeted sex differences in post‐OHS depression in conjuncture with pre‐OHS character strengths with adequate control for HD‐specific and surgical confounders. Using cross‐disciplinary data collected from patients undergoing OHS, this prospective study explored the prediction of sex, event‐based HD‐specific indices, and character strengths for post‐OHS depression.
Methods: The three‐wave interview data of 481 patients (age +62+, female 42%) and their key medical record in the Society of Thoracic Surgeon (STS) national database were used to test our hypotheses. Hierarchical multiple linear regression analyses were performed to identify predictors for post‐OHS depression.
Results: Female gender, older age, living alone, pre‐OHS depression, greater number of diseased arteries, and operation time indicating surgical complexity predicted higher levels of post‐OHS depression. Patients who scored higher on dispositional optimism or had a diagnosis of left main disease were less likely to have post‐OHs depression. Although pre‐OHS sense of secular reverence was related to more depression, women who experienced greater pre‐OHS secular reverence, compared with women who did not, were less likely to report post‐OHS depression.
Conclusions: Women in the cohort had higher levels of depressive symptoms even after controlling for pre‐OHS symptoms and multiple medical, cardiac, and surgical indices. Both subgroup could be more vulnerable due to disadvantages in HD conditions. This study provides more reliable information on protection of sex, CSs, and HD‐specific confounders on depression in the critical recovery month following OHS, which could have important clinical implications for patient‐centered, pre‐OHS care of women with advanced HD.
Effectiveness of the Brazilian Public Health Policy for Mammographic Screening After the Age of 50 Years
1Universidade de Santo Amaro, Santo Amaro ‐ SP, 2Universidade do Vale do Sapucaí, Pouso Alegre ‐ MG, Brazil, 3Universidade Federal de São Paulo, São Paulo ‐ SP, Brazil
Background: In Brazil, mammography breast cancer screening is performed in women between 50 and 69 years of age, with a biannual interval. Currently, there is no consensus on the performance of mammographic screening for women aged 40 to 49 years. Discrepancies in benefits and harms of screening have generated differences between the main guidelines on which age to start, at what age to discontinue and how often to recommend screening mammograms in women at low or medium risk. This study aimed to determine the age of patients to the diagnosis of breast cancer in the Mastology outpatient unities of an university hospital and to correlate with the size of the tumor, to verify if the mammographic screening before 50 years of age is benefitial.
Methods: This is a cross‐sectional study, with convenience sampling. All patients diagnosed with breast cancer attended from March 2016 to March 2018 were enrolled. Data on age at diagnosis of cancer, mammographic screening, family history and on the disease and its treatment were recorded.
Results: A total of 3,264 patients were attended and 220 met the eligibility criteria. Patients' age ranged from 27 to 89 years (median: 54,5 years‐old). From these, 79 (36%) were up to 49 years‐old, and 141 (64%) were 50 years or older. There was no statistical difference between groups regarding tumor size (p = 0.3320), type of surgery, whether radical or conservative (p = 0.41236), or staging (p = 0.08018).
Conclusions: The data obtained corroborate the effectiveness of the public health policy for mammographic screening practiced in Brazil.
Association of Mindfulness with Female Sexual Dysfunction and Related Distress
Richa Sood, MD, MS,3 Jackie M. Thielen, MD,3 Carol L. Kuhle, MD,3 Ekta Kapoor, MD,2,3 Kristin C. Mara, MS,1 and Stephanie F. Faubion, MD3
1Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 2Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 3Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
Background: Female sexual dysfunction (FSD) is a prevalent and distressing set of conditions that affects women of all ages. The practice of mindfulness may help FSD as it allows for non‐judgmental present moment awareness and decreased emotional reactivity. We sought to assess the association of mindfulness to FSD among women seen at a tertiary care women's health clinic.
Methods: In this cross‐sectional study, women completed questionnaires including the Mindfulness Attention Awareness Scale (MAAS), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale—Revised (FSDS‐R). Linear regression was used to test the associations of mindfulness, sexual function, and sexual distress with the use of univariate and multivariable analysis, adjusting for potential confounders.
Results: In this cohort of 1718 cisgender women (average age 51.9 years), 57% women had FSD (FSFI scores ≤26.55 and FSDS‐R ≥11). Women <30 years had higher FSDS‐R scores compared to older women. The FSFI satisfaction domain demonstrated the strongest negative correlation with distress. Univariately, high MAAS scores were associated with higher FSFI and lower FSDS‐R scores and lower odds of FSD independently. On multivariable analysis, higher MAAS scores were associated with lower distress, controlling for FSFI scores and other covariates.
Conclusions: Among women seen at a tertiary care women's health clinic, higher mindfulness correlated with higher sexual function scores, lower distress and a lower likelihood of FSD independently. Controlling for the FSFI score, higher mindfulness was independently associated with lower distress. Mindfulness appears to be a promising tool to mitigate sexual dysfunction and distress related to female sexual dysfunction.
Bremelanotide for Hypoactive Sexual Desire Disorder in the RECONNECT Studies: Analysis of Baseline Arousal Subgroups
Sheryl Kingsberg, PhD,5 Anita Clayton, MD,6 James Simon, MD, CCD, NCMP, IF, FACOG,2,3 Robert Jordan,4 Johna Lucas, MD,4 Laura Williams, MD, MPH,1 and Julie Krop, MD1
1AMAG Pharmaceuticals, Inc., Waltham, MA, 2George Washington University, Washington, DC, 3IntimMedicine Specialists, 4Palatin Technologies, Inc., Cranbury, NJ, 5University Hospitals Cleveland Medical Center, Cleveland, OH, 6University of Virginia, Charlottesville, VA
Background: Bremelanotide, an investigational new drug, demonstrated efficacy in premenopausal women with hypoactive sexual desire disorder (HSDD) in RECONNECT. In this analysis, bremelanotide efficacy was investigated across arousal subgroups.
Methods: RECONNECT comprised two identically designed, phase 3, double‐blind, randomized, placebo‐controlled studies. Subjects self‐administered bremelanotide 1.75 mg or placebo subcutaneously, on demand, for 24 weeks. Eligibility was determined using the Diagnostic and Statistical Manual of Mental Disorders‐IV (DSM‐IV) criteria for HSDD. However, DSM‐5 diagnostic criteria data were also collected for informational purposes. Subjects were evaluated based on arousal function at screening. Efficacy was assessed using change from baseline to end‐of‐study (EOS) for Female Sexual Function Index‐desire domain (FSFI‐D) and Female Sexual Distress Scale‐Desire/Arousal/Orgasm (FSDS‐DAO) Item 13 scores.
Results: Of the total RECONNECT population (N = 1202), 854 subjects reported HSDD with decreased arousal, and 348 subjects reported HSDD without decreased arousal. For the total population, the differences in mean change in FSFI‐D from baseline to EOS (bremelanotide‐placebo) was 0.35 (P < .0001). The differences in mean change in FSFI‐D from baseline to EOS for subjects with decreased arousal (N = 420–434) and without decreased arousal (N = 172–176) were 0.30 and 0.49 (P < .0001 for both subgroups), respectively. For FSDS‐DAO Item 13, the difference in mean change from baseline to EOS was −0.33 (P < .0001) in the total population. The differences in mean change in FSDS‐DAO Item 13 from baseline to EOS for those with decreased arousal and without decreased arousal were −0.32 and −0.38 (P < .0001 and P = .0014), respectively.
Conclusions: Bremelanotide significantly restored sexual desire and reduced distress across arousal subgroups.
A Study to Assess Parenting Stress and Psychological Health of Women Having Single Parenting Experience in Delhi‐NCR
Sudha Lama, MSc,1 Dr. Sandhya Gupta,2 and Dr. Sujata Satapathy3
1All India Institute of Medical Sciences, New‐Delhi, Delhi, India, 2College Of Nursing, All India Institute of Medical Sciences, New‐Delhi, Delhi, India, 3Dept. Of Psychiatry, All India Institute of Medical Sciences, New‐Delhi, Delhi, India
Background: Studies comparing parental stress in single‐parent families to those raised in families with two biological parents consistently find that those raised in two‐parent families with biological parents do better on educational achievement and adjustment in school. In Indian population the single parenting is considered a taboo and no one comes forth, hence there is a dearth of studies conducted in this area. Also there is dearth of studies exploring the stress factor in this specific population.
Methods: The study was conducted using a descriptive, cross sectional design on a hundred women having single parenting experience (widow, divorced/separated, or doing single parenting because of employment or other reasons) chosen by snowball sampling and convenience sampling techniques in community dwellings in Delhi‐NCR. Three standardised tools were used, Parental Stress Scale and MSPSS and GHQ‐30 to assess Parenting stress and psychological health including social support.
Results: The women having single parenting stress had moderate parenting stress. Out of 100, half of the women having single parenting experience had good psychological health and other half had poor psychological health. Most of the women having single parenting experience had moderate levels of anxiety, depression, social dysfunction and inadequate coping. The social support was available mostly from the family followed by friends and others.. There was a statistically significant association between parenting stress of women having single parenting experience with their low education, low monthly income, no occupation, hindu, muslims/other religions and lack of financial help from the spouse. And also there was a statistical significant association between psychological health of women with their lower age and lower monthly income.
Conclusions: Women having single parenting experience had moderate parenting stress, which had an impact on psychological health, which was poor.
Sex Differences in the Prevalence of Stroke Risk Factors at an Urban Medical Center
Tamala Gondwe, PhD, MPH, Susan G. Kornstein, MD, Saba W. Masho, MD, MPH, DrPH, Christine Huynh, MD, Jeneane Henry, RN, BSN, and Warren L. Felton III, MD
Virginia Commonwealth University School of Medicine, Richmond, VA
Background: Previous studies have focused on sex differences in stroke incidence, however, less is known about whether existing risk factors for stroke differ between men and women. Awareness of differences in modifiable risk factors in particular could inform patient management in primary care practice.
Methods: Using patient baseline data from the Virginia Women's Health Stroke Prevention Initiative, we assessed sex differences in the prevalence of hypertension, smoking, cardiovascular disease, atrial fibrillation, diabetes, and total cholesterol. Log‐binomial regression models obtained prevalence ratios (PR) and 95% confidence intervals (CI).
Results: Out of 7,190 patients, 65.2% were women, and 62.6% were African American. The median age for women was 60 years, and 61 years for men (p = 0.8220). As patient race (white, African American, or other) was found to modify the association between the risk factors and patient sex, models were stratified by race. Overall, women had significantly lower prevalence of hypertension, smoking, cardiovascular disease, atrial fibrillation, and diabetes compared to men. However, within race groups, there was no significant difference between white women and men in smoking and atrial fibrillation, while only the prevalence of smoking was significantly different between women and men of other races (PR 0.40, 95% CI 0.22–0.72). African American and white women had a higher prevalence of total cholesterol ≥200 mg/dL compared to men.
Conclusions: In this patient sample, sex differences in stroke risk factors were found overall and within racial groups. These findings could provide guidance for tailoring primary and secondary stroke prevention plans.
