Divya A. Patel

Graphic integration of causal factors of pelvic floor disorders : an integrated life span model

There is growing interest in causal factors for pelvic floor disorders. These conditions include pelvic organ prolapse and urinary and fecal incontinence and are affected by a myriad of factors that increase occurrence of symptomatic disease. Unraveling the complex causal network of genetic factors, birth-induced injury, connective tissue aging, lifestyle and comorbid factors is challenging. We describe a graphical tool to integrate the factors affecting pelvic floor disorders. It plots pelvic floor function in 3 major life phases: (1) development of functional reserve during an individuals growth, (2) variations in the amount of injury and potential recovery that occur during and after vaginal birth, and (3) deterioration that occurs with advancing age. This graphical tool accounts for changes in different phases to be integrated to form a disease model to help assess the overlap of different causal factors.

Human papillomavirus vaccine intent and uptake among female college students

Abstract Objective: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students. Participants: Females aged 18 to 26 attending a university health service gynecology clinic (n = 256). Methods: Participants were randomized to receive either HPV-specific education with a mailed reminder or standard care. Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified. Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake. Conclusions: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.

Sexual Behavior of Older Women: Results of a Random-Digit-Dialing Survey of 2000 Women in the United States

Background There are few reports describing sexual activity among women older than 50 years of age. Goal The goal of the study was to describe sexual practices and health behaviors of women aged 18–94 years, highlighting characteristics of older women (aged 60–94 years). Study Design The study involved a random-digit-dialing survey (N = 2000) of women aged 18–94 years living in the continental United States. Results Frequency and occurrence of sexual activity decreased with age. Married women in every age group were more likely to have engaged in recent sexual activity. Condom use decreased with age and lubricant use increased with age. Over one-third of all women reported douching in a typical month, and there was no trend with age. Conclusion Women in older age groups vary greatly in terms of sexual practices and health behaviors.

Temporal Trends in Sexual Behaviors and Sexually Transmitted Disease History Among 18- to 39-Year-Old Seattle, Washington, Residents: Results of Random Digit-Dial Surveys

Objectives: The objectives of this study were to describe sexual behaviors of Seattle residents in 2003–2004 and report changes since 1995. Methods: We conducted a random digit-dial (RDD) survey among 18- to 39-year-old men and women in 2003–2004. We compared the results with the results of a 1995 RDD survey conducted in the same population. Questionnaire batteries and sampling methods were similar in the 2 surveys. Results: Between 1995 and 2004, the median number of lifetime sex partners increased from 7 to 8. Vaginal douching declined from 70.6% to 25.9% (P = 0.004) among black women; from 8.3% to 5.9% (P <0.05) among Asian American women; and from 15.5% to 2.4% (P <0.05) overall. After adjustment, proportions of women who reported practicing vaginal douching (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.7–0.22), the proportion of respondents who reported a history of any sexually transmitted disease (OR, 0.70; 95% CI, 0.53–0.93) and a history of gonorrhea (OR, 0.48; 95% CI, 0.25–0.89) declined between 1995 and 2004. Conversely, the proportion of respondents who reported only same-sex partners (OR, 3.27; 95% CI, 1.33–9.88), condom use at first sex with their most recent sex partner (OR, 1.38; 95% CI, 1.06–1.78), and reported practice of anal sex (OR, 2.01; 95% CI, 1.21–3.48) increased between 1995 and 2004. Among blacks, proportions reporting an age difference of only 2 years with their partners declined from 64.3% to 25.9% (P <0.05), indicating increased age mixing. Conclusions: Some risk behaviors declined whereas others increased between 1995 and 2004; several trends were divergent between the general population and minority populations. Our data hint at an increasing divergence in risk behaviors and morbidity between minority populations and the general population. Also, anal sex and number of sex partners have increased. These patterns have serious implications for the design, targeting, and implementation of prevention programs.

The impact of out-of-pocket expense on IUD utilization among women with private insurance.

BACKGROUND The study was conducted to evaluate the impact of out-of-pocket expense on intrauterine device (IUD) utilization among women with private insurance. STUDY DESIGN We reviewed the records of all women with private insurance who requested an IUD for contraception from an urban academic gynecology practice from May 2007 through April 2008. For each patient, we determined the out-of-pocket expense that would be incurred and whether she ultimately had an IUD placed. The total charge for placement of a copper or levonorgestrel IUD (including the device) was

Racial differences in colorectal cancer survival in the Detroit Metropolitan area

815. RESULTS Ninety-five women requested an IUD during the study period. The distribution of out-of-pocket expense was bimodal: less than

Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan

50 for 35 (37%) women and greater than

Racial Similarities in Response to Standardized Offer of Influenza Vaccination

500 for 52 (55%) women. Intrauterine device insertion occurred in 24 (25%) women, 19 of whom had an out-of-pocket expense less than

Fecal Incontinence in Older Women: Are Levator Ani Defects a Factor?

50. In univariate and multivariable analysis, women with insurance coverage that resulted in less than

Fecal incontinence in pregnancy and post partum

50 out-of-pocket expense for the IUD were more likely to have an IUD placed than women required to pay