Elizabeth W. Patton

Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants

This study uses data from a survey of NIH Mentored Career Development grant awardees to determine if sponsorship critical for career advancement of young professionals differs among men and women.

How does religious affiliation affect women's attitudes toward reproductive health policy? Implications for the Affordable Care Act

BACKGROUND Supreme Court cases challenging the Affordable Care Act (ACA) mandate for employer-provided reproductive health care have focused on religiously based opposition to coverage. Little is known about womens perspectives on such reproductive health policies. STUDY DESIGN Data were drawn from the Womens Health Care Experiences and Preferences survey, a randomly selected, nationally representative sample of 1078 US women aged 18-55 years. We examined associations between religious affiliation and attitudes toward employer-provided insurance coverage of contraception and abortion services as well as the exclusion of religious institutions from this coverage. We used chi-square and multivariable logistic regression for analysis. RESULTS Respondents self-identified as Baptist (18%), Protestant (Other Mainline, 17%), Catholic (17%), Other Christian (20%), Religious, Non-Christian (7%) or No Affiliation (21%). Religious affiliation was associated with proportions of agreement for contraception (p=.03), abortion (p<.01) and religious exclusion (p<.01) policies. In multivariable models, differences in the odds of agreement varied across religious affiliations and frequency of service attendance. For example, compared to non-affiliated women, Baptists and Other Nondenominational Christians (but not Catholics) had lower odds of agreement with employer coverage of contraception (OR 0.63, 95% CI 0.4-0.1 and OR 0.57, CI 0.4-0.9, respectively); women who attended services weekly or more than weekly had lower odds of agreement (OR 0.53, 95% CI 0.3-0.8 and OR 0.33, CI 0.2-0.6, respectively), compared to less frequent attenders. CONCLUSIONS Recent religiously motivated legal challenges to employer-provided reproductive health care coverage may not represent the attitudes of many religious women. IMPLICATIONS Recent challenges to the ACA contraceptive mandate appear to equate religious belief with opposition to employer-sponsored reproductive health coverage, but womens views are more complex.

U.S. Women's Intended Sources for Reproductive Health Care.

INTRODUCTION The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. METHODS Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18-45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. RESULTS The response rate was 61% (n = 2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<

Fertility-Preserving Management of a Uterine Arteriovenous Malformation: A Case Report of Uterine Artery Embolization (UAE) Followed by Laparoscopic Resection

25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. CONCLUSIONS While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.

Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies: A Qualitative Analysis

Herein is presented a fertility-preserving approach in the management of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The patient had a documented AVM and underwent 2 uterine artery embolization procedures, with subsequent recurrence of symptoms. Doppler ultrasound demonstrated recanalization of the AVM. Ultimately, laparoscopic resection of the AVM was performed after laparoscopic ligation of the uterine arteries. Postoperatively, the patient has remained asymptomatic. Laparoscopic resection of a uterine AVM may offer a fertility-preserving alternative to hysterectomy in patients in whom endovascular management has failed.

Techniques in Reproductive Surgery

Background: Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies. Objectives: We assessed VA women’s health providers’ and administrators’ perceptions of coordination challenges for Veterans’ gynecologic cancer care, and potential approaches for addressing these challenges. Research Design and Participants: We carried out semistructured qualitative interviews with field-based key informants (VA gynecologists, women’s health medical directors, and other staff directly involved in women’s health care coordination) at 15 VA facilities. Transcripts were summarized in a template to capture key points. Themes were identified and iteratively revised (inductively/deductively) via a collaborative decision-making process utilizing matrices to compare content across interviews. Results: Key informants (n=23) noted that services for patients with gynecologic cancers are provided through a combination of VA and community care with wide variation in care arrangements by facility. Care coordination challenges included care fragmentation, lack of role clarity and care tracking, and difficulties associated with VA and community provider communication, patient communication, patient records exchange, and authorizations. Care coordination roles suggested for addressing challenges included: care tracker, provider point-of-contact, patient liaison, and records administrator. Conclusions: Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.

Health services research in obstetrics and gynecology: The legacy of the Robert Wood Johnson Foundation Clinical Scholars

Advances in gynecologic minimally invasive surgical techniques coupled with basic and translational research have led to the development of multiple laparoscopic surgical applications for fertility preservation. Procedures discussed in this chapter include salpingolysis and fimbrioplasty for tubal occlusion, reversal of tubal ligation and tubal reanastomosis, treatment of hydrosalpinx or salpingectomy to improve in vitro fertility rates, and removal of hysteroscopic sterilization devices. In addition, laparoscopic approaches for oophoropexy and ovarian transposition to prevent recurrent torsion or to avoid damage secondary to radiation treatment are reviewed.

A population-based study of US women’s preferred versus usual sources of reproductive health care

According to the Agency for Healthcare Research and Quality, health services research (HSR) ‘examines how people get access to care, how much care costs, and what happens to patients as a result of this care’ [1]. Research examining areas as varied as health disparities, health behavior change, implementation science, organizational processes, and cost effectiveness are united under the broad term HSR. Because HSR is inherently interdisciplinary, it is open to emerging ideas from fields such as engineering or informatics, and core ideas from these areas can be linked with core principles from economics or sociology and applied in new medical contexts. Too often, health policy decisions in women’s health are made without adequate input from the clinicians who truly understand the clinical implications of these decisions. Arguably, this is partly because of the fact that relatively few opportunities exist for obstetricians and gynecologists to be trained in HSR. For almost 50 years, the Robert Wood Johnson Foundation (RWJF) Clinical Scholars has tried to fill this gap and has provided a vital, unique opportunity for obstetricians and gynecologists to learn rigorous health services methodology and hone leadership skills.