Gillian E. Hanley

Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention

OBJECTIVE The purpose of this study was to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in low-risk women after a regional initiative that was aimed at general gynecologists in the province of British Columbia, Canada. STUDY DESIGN This population-based retrospective cohort study evaluated 43,931 women in British Columbia from 2008-2011 who underwent hysterectomy that was performed with and without BS or bilateral salpingo-oophorectomy or who underwent surgical sterilization by means of BS or tubal ligation. Parameters that were examined include patient age, operating time, surgical approach, indication, length of hospital stay, and perioperative complications. RESULTS There was an increase in the uptake of hysterectomy with BS (5-35%; P < .001) and BS for sterilization (0.5-33%; P < .001) over the study period, particularly in women <50 years old. Minimal additional surgical time is required for hysterectomy with BS (16 minutes; P < .001) and BS for sterilization (10 minutes; P < .001) compared with hysterectomy alone or tubal ligation, respectively. No significant differences were observed in the risks of hospital readmission or blood transfusions in women who underwent hysterectomy with BS (adjusted odds ratio [aOR], 0.91; 95% confidence interval [CI], 0.75-1.10; and aOR, 0.86; 95% CI, 0.67-1.10, respectively) or BS for sterilization (aOR, 0.8; 95% CI, 0.56-1.21; and aOR, 0.75; 95% CI, 0.32-1.73, respectively). From 2008-2011 the proportion of hysterectomies with BS performed by open laparotomy decreased from 77-44% with uptake in laparoscopic, vaginal, and combined procedures (P < .001). CONCLUSION After our 2010 educational initiative, there has been a shift in surgical paradigm in our province. This cancer prevention approach does not increase the risk of operative/perioperative complications and appears both feasible and safe.

Prescription drug use during pregnancy in developed countries: a systematic review

To review the literature describing patterns of outpatient prescription drug use during pregnancy by therapeutic category, potential for fetal harm, and overall.

Infant developmental outcomes following prenatal exposure to antidepressants, and maternal depressed mood and positive affect

BACKGROUND Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical. AIMS To examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10months of age. STUDY DESIGN Prospective study of mothers and their 10-month-old infants. SUBJECTS We examined 31 mother-child pairs exposed prenatally to SRIs and 52 mother-child pairs who were nonexposed. OUTCOME MEASURE The Bayley Scales of Infant Development (third edition) scores. RESULTS Infants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P=0.03), social-emotional (P=0.04) and adaptive behavior (P=0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P>0.05). Increased levels of maternal positive affect at 10 months predicted increased social-emotional scores (P=0.03). CONCLUSIONS Infants prenatally exposed to SRIs score significantly lower on the gross motor, social-emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.

On the validity of area-based income measures to proxy household income

BackgroundThis paper assesses the agreement between household-level income data and an area-based income measure, and whether or not discrepancies create meaningful differences when applied in regression equations estimating total household prescription drug expenditures.MethodsUsing administrative data files for the population of BC, Canada, we calculate income deciles from both area-based census data and Canada Revenue Agency validated household-level data. These deciles are then compared for misclassification. Spearmans correlation, kappa coefficients and weighted kappa coefficients are all calculated. We then assess the validity of using the area-based income measure as a proxy for household income in regression equations explaining socio-economic inequalities in total prescription drug expenditures.ResultsThe variability between household-level income and area-based income is large. Only 37% of households are classified by area-based measures to be within one decile of the classification based on household-level incomes. Statistical evidence of the disagreement between income measures also indicates substantial misclassification, with Spearmans correlations, kappa coefficients and weighted kappa coefficients all indicating little agreement. The regression results show that the size of the coefficients changes considerably when area-based measures are used instead of household-level measures, and that use of area-based measures smooths out important variation across the income distribution.ConclusionThese results suggest that, in some contexts, the choice of area-based versus household-level income can drive conclusions in an important way. Access to reliable household-level income/socio-economic data such as the tax-validated data used in this study would unambiguously improve health research and therefore the evidence on which health and social policy would ideally rest.

Costs and benefits of opportunistic salpingectomy as an ovarian cancer prevention strategy.

OBJECTIVE: To conduct a cost-effectiveness analysis of opportunistic salpingectomy (elective salpingectomy at hysterectomy or instead of tubal ligation). METHODS: A Markov Monte Carlo simulation model estimated the costs and benefits of opportunistic salpingectomy in a hypothetical cohort of women undergoing hysterectomy for benign gynecologic conditions or surgical sterilization. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured in terms of life expectancy gain. Sensitivity analyses accounted for uncertainty around various parameters. Monte Carlo simulation estimated the number of ovarian cancer cases associated with each strategy in the Canadian population. RESULTS: Salpingectomy with hysterectomy was less costly (

Prescription Drug Use in Pregnancy: A Retrospective, Population-Based Study in British Columbia, Canada (2001–2006)

11,044.32±

Patterns in the use of benzodiazepines in British Columbia: Examining the impact of increasing research and guideline cautions against long-term use

1.56) than hysterectomy alone (

Clinician-scientists in Canada: barriers to career entry and progress.

11,206.52±

Patterns of psychotropic medicine use in pregnancy in the United States from 2006 to 2011 among women with private insurance

29.81) or with bilateral salpingo-oophorectomy (

Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

12,626.84±