Heather B. Clayton

Discussion of fertility preservation with newly diagnosed patients: oncologists’ views

IntroductionAlthough physician discussion with patients regarding fertility preservation (FP) options prior to cancer treatment can provide important information for survivors concerning their future fertility, little is known about the extent to which physicians discuss FP with patients. This qualitative study sought to identify current physician FP communication practices and determine factors that may impact communication efforts regarding FP.Materials and methodsQualitative data were collected using semi structured interviews with 16 physicians practicing at a major cancer center in the South.ResultsAll providers were board certified in medical oncology, radiation oncology or surgical oncology. The main factors that emerged from qualitative analysis included distinct variations in quality of discussion about FP, knowledge of FP resources, attitudes, practice behaviors and perceptions of patient characteristics.DiscussionWhile most physicians discussed potential fertility loss as a side effect of cancer treatment, few provided information to patients about preserving fertility. Patient characteristics such as gender and cancer site may impact the discussion, as well as system factors such as costs of procedures and access to FP resources. Education and training for physicians about FP options for cancer patients, particularly females, may promote discussion of FP. In addition, system barriers related to availability and affordability of FP resources must also be addressed.Implications for cancer survivorsPhysicians should consider providing patients with timely, understandable information related to their FP options, prior to the administration of treatment. Such discussions may lead to improved quality of life for individuals as they transition from patients to survivors.

Stalking Victimization Among College Women and Subsequent Help-Seeking Behaviors

Objective: The authors examined the incidence of stalking victimization and subsequent help-seeking behaviors among college women. Participants and Methods: A stratified random sample of college women (N = 391) completed an anonymous Internet-based questionnaire in spring 2006. Results: One-fifth of women reported stalking victimization while enrolled at their current institution. Individuals known by victims, such as the following, were most commonly reported as stalkers: acquaintances (48.7%), classmates (37.2%), and boyfriends or ex-boyfriends (34.6%). Approximately half of the women reporting stalking victimization acknowledged not seeking help from anyone in relation to these incidents. Of those seeking some sort of help, most sought assistance from friends (90.2%), parents (29.3%), residence hall advisors (12.2%), or police (7.3%). Conclusion: Comparing their findings to a national study of college women, the authors report that being watched, followed or spied on, and sent unsolicited emails are stalking behaviors on the rise. They present implications for college health and future directions for research.

The psychosocial impact of vesico-vaginal fistula in Niger

PurposeTo explore the psycho-social impact of vesico-vaginal fistula (VVF) on women in Niger.Study designWe conducted a qualitative study on 21 women in convalescence at the DIMOL Reproductive Health Center in Niamey, Niger, in 2008 and 2009. The women had undergone 1–3 fistula repair operations and all had stillborn infants.ResultsWomen reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives. Social consequences of fistula reported by these women included rejection from society, isolation, rejection from husband and/or divorce. Almost half of the women reported of having lost their social network and support as a result of the fistula. Women with VVF were deemed unworthy, and their illness was often attributed to some fault of their own.ConclusionsOur findings support the notion that socio-economic factors, though they certainly contribute to obstetric fistula, are not the primary reason for fistula, particularly in Niger. Fistula is a direct result of lack of access to skilled birth attendants and emergency obstetric care.

Low pre-pregnancy body mass index and risk of medically indicated versus spontaneous preterm singleton birth §

OBJECTIVE(S) There were three primary objectives of this study: (1) to estimate the risk of preterm and very preterm birth by severity of low pre-pregnancy body mass index (BMI), (2) to determine if the risk in preterm and very preterm birth by severity of low pre-pregnancy BMI differs for spontaneous versus medically indicated preterm delivery, and finally (3) to determine if there is a difference in the risk for preterm and very preterm birth by severity of low pre-pregnancy BMI across gradations of gestational weight gain. STUDY DESIGN This study utilized the Missouri maternally linked cohort files from 1989 to 1997. After restricting analyses to singleton live births (gestational age 20-44 weeks) and women with either a low or normal BMI, the final study population consisted of 437,403 births. Pre-pregnancy BMI was categorized as normal (19.5-24.9), mild thinness (17.0-18.5), moderate thinness (16.0-16.9) and severe thinness (< or =15.9). Statistical analyses included chi-square tests and logistic regression with generalized estimating equations (GEE). RESULTS Underweight mothers were more likely to experience a preterm delivery. For all preterm births, the risk among underweight mothers increased with ascending underweight severity (p<0.01). Higher risk estimates were observed for spontaneous than for medically indicated preterm birth. For each BMI category, extreme risk values for spontaneous preterm births were observed among women with very low gestational weight gain (<0.12 kg/week). Severely thin mothers with very low and very high pregnancy weight gain were at the greatest risk for spontaneous preterm birth. By contrast, underweight women with moderate gestational weight gain (0.23-0.68 kg/week) had the lowest risk for spontaneous preterm birth with the sole exception of moderately underweight gravidas. CONCLUSIONS These findings suggest that women with low or normal pre-pregnancy BMI should be counseled to maintain a moderate level of gestational weight gain (0.23-0.68 kg/week) in order to reduce their risk for preterm birth. Further, our observation that severity of low pre-pregnancy BMI was associated directly (in a dose-response pattern) with preterm birth highlights the importance of preconceptional counseling for women-specifically the importance of women achieving or maintaining a normal weight status prior to pregnancy.

An ecological approach to understanding black-white disparities in perinatal mortality.

Despite appreciable improvement in the overall reduction of infant mortality in the United States, black infants are twice as likely to die within the first year of life as white infants, even after controlling for socioeconomic factors. There is consensus in the literature that a complex web of factors contributes to racial health disparities. This paper presents these factors utilizing the socioecological framework to underscore the importance of their interaction and its impact on birth outcomes of Black women. Based on a review of evidence-based research on Black–White disparities in infant mortality, we describe in this paper a missing potent ingredient in the application of the ecological model to understanding Black–White disparities in infant mortality: the historical context of the Black woman in the United States. The ecological model suggests that birth outcomes are impacted by maternal and family characteristics, which are in turn strongly influenced by the larger community and society. In addition to infant, maternal, family, community and societal characteristics, we present research linking racism to negative birth outcomes and describe how it permeates and is embedded in every aspect of the lives of African American women. Understanding the contribution of history to the various factors of life of Black women in the United States will aid in developing more effective policies and programs to reduce Black infant mortality.

Association between intimate partner violence and induced abortion in Cameroon

To examine the association between intimate partner violence (IPV; physical, sexual, and emotional violence) and induced abortion in Cameroon.

Spousal Concordance in Attitudes Toward Violence and Reported Physical Abuse in African Couples

Purpose: We examined the potential association between African couples’ concordance on attitudes toward violence (ATV) and risk for intimate partner violence (IPV). Method: Analyses included 13,837 couples from Demographic and Health Surveys conducted between 2003 and 2007, from six African countries. Concordance on ATV was defined as both spouses justifying physical abuse, and IPV was defined as incidence of a physically violent act against the wife. We constructed a concordance measure from the surveys to assess overall and country-level differences in couple’s ATV concordance rates and assessed the association between concordance in ATV and IPV using hierarchical regression modeling that adjusted for multilevel influences on risk estimates. Negative concordance (perfect agreement in negative ATV) was used as referent category in all analyses. Findings: Overall, spousal ATV concordance was associated with higher likelihood for IPV (adjusted odds ratio [AOR] = 2.27, 95% confidence interval [CI] = [2.01, 2.56]). The level of wealth, educational attainment, rural/urban residence, presence of a cowife, religion, maternal age, and parity were characteristics that predicted the occurrence of IPV within couples. Spousal ATV concordance was significantly associated with violence in every African nation included in the analysis except Rwanda. Conclusions: African couples with high rates of ATV concor- dance experience higher risks for IPV, with some variation in magnitude of risk across countries. In African settings, ATV positive concordance could serve as a supplemental screening tool to detect spousal violence. Understanding ATV could potentially enhance our ability to formulate public health intervention to detect and prevent spousal abuse.

Extreme obesity and risk of placental abruption

BACKGROUND Data on extreme obesity and placental abruption are scarce. This study aimed to determine the association between pre-pregnancy weight and placental abruption and whether pregnancy weight gain impacts this risk. METHODS We used the Missouri maternally linked cohort files (years 1989-1997). Analyses were restricted to singleton live births (n = 461 729). Maternal body mass index (BMI) was classified as normal (18.5-24.9) (referent group), obese [Class 1 (30.0-34.9), Class 2 (35.0-39.9) and extreme or Class 3 (> or =40)]. Pregnancy weight gain categories included: < or =0.22 kg/week (low), 0.23-0.68 kg/week (moderate) and > or =0.69 kg/week (high). Adjusted odds ratios generated from generalized estimating equations for logistic regression models were used to approximate relative risks. RESULTS; Obese women were less likely to have placental abruption than normal weight women (adjusted odds ratio = 0.8, 95% confidence interval 0.7-0.9). The risk was similar regardless of severity of obesity. However, analyses stratified by weight gain during pregnancy indicated that reduced risk was limited to obese women with low or moderate weight gain during pregnancy, although the analyses by subclass of obesity were only statistically significant for women with moderate weight gain. Among women with moderate weight gain, the risk of placental abruption decreased with increasing BMI in a dose-dependent pattern (P < 0.01). CONCLUSIONS Obesity is associated with reduced risk for placental abruption when the weight gain during pregnancy is moderate. These findings underscore the need for further research on the role of nutritional status during pregnancy as a protective factor against placental abruption so that preventive strategies may be appropriately developed.

Patterns and success of fetal programming among women with low and extremely low pre-pregnancy BMI.

PurposeTo estimate the frequency of fetal programming phenotypes among women with low BMI and the success of these programming patterns-to determine if small for gestational age (SGA) is a biologically adaptive mechanism to improve chances for infant survival.MethodsWe examined the frequency of fetal programming phenotypes: SGA, large for gestational age (LGA), and adequate for gestational age (AGA) among 1,063,888 singleton live births from 1978 to 1997. We also estimated the success of fetal programming phenotypes using neonatal death as the primary study outcome.ResultsUnderweight gravidas with AGA and LGA babies had elevated risk of neonatal mortality when compared to normal weight mothers, while the risk for neonatal mortality among mothers with SGA babies was reduced.ConclusionsThe variation in relative degrees of fetal programming patterns and success observed suggests that underweight mothers are more likely to succeed in programming SGA fetuses rather than any other phenotype.