Jessica Fields

Vitamin D in the Persian Gulf: Integrative Physiology and Socioeconomic Factors

Countries of the Persian Gulf region—Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates—have become increasingly modernized, resulting in a transformation of lifestyle based on technology, sedentary activity, lack of sunlight, and unhealthy dietary patterns. These factors have led to a higher prevalence not only of vitamin D undernutrition, but also chronic obesity, insulin resistance, prediabetes, and type 2 diabetes. This review explores the integrative physiologic effects of vitamin D with socioeconomic factors and propose a hypothesis-driven model for their contributions to obesity and diabetes in the Persian Gulf. Further research into these interactions may ultimately lead to novel preventive strategies and therapies for metabolic disorders in this geographic region.

Lack of correlation between antiobesity policy and obesity growth rates: review and analysis.

OBJECTIVE To review federal, state, and local antiobesity policies and to assess their relationships with obesity growth rates. METHODS We performed a literature review, acquired data from governmental Internet sources, and assessed the statistical correlation between state antiobesity policies and the concavity in obesity growth rates. RESULTS State-by-state antiobesity policies in 3 categories-taxation of sugared beverages and snacks, physical education and physical activity in schools, and funding for bicycle trails-were found to have no significant immediate correlation with the change in obesity growth rates. CONCLUSIONS Ineffective antiobesity legislation may be attributable to shortcomings in policy implementation. Behavioral economics and addressing large-scale cultural issues may have critical roles in promoting more healthful lifestyles. We propose that a systems-based paradigm evaluating complex interactions among pathophysiological, cultural, political, economic, and behavioral components can improve antiobesity policy implementation and should therefore be a research focus.

Outcomes of Twin Pregnancies in Women 45 Years of Age or Older

OBJECTIVE To investigate outcomes of twin gestations in women 45 years or older at the time of delivery. METHODS This was a retrospective cohort study of 139 women with twin gestations who were at least 45 years old when they delivered. They were cared for at two referral centers between 2005 and 2016. Analysis included baseline characteristics and pregnancy outcomes including mode of delivery, gestational age at delivery, hypertensive disease in pregnancy, gestational diabetes, and fetal growth restriction. Univariate analysis of the association between patient characteristics and outcomes was performed. RESULTS The mean maternal age at delivery was 47.3±1.9 years with 99.3% undergoing in vitro fertilization and 95% using donor eggs. Patients had low baseline rates of hypertension (7.2%), obesity (9.5%), and pregestational diabetes (1.4%). The average gestational age of delivery was 35.4 weeks; 22.3% delivered before 34 weeks of gestation. There were high rates of cesarean delivery (93.5%, 95% confidence interval [CI] 87.7-96.8%), preeclampsia (44.6%, 95% CI 36.3-53.3%), and gestational diabetes (19%, 95% CI 13.0-26.8%). Preeclampsia developed in 50.5% of nulliparous women compared with 30.5% of women with a prior birth (P=.028). Preterm birth at less than 34 weeks of gestation occurred in 18.1% of women of white race compared with 30.3% of women of nonwhite race (P=.036). CONCLUSION Twin pregnancy in a predominantly healthy cohort of women who were at least 45 years old when they delivered was associated with high rates of cesarean delivery, preeclampsia, and gestational diabetes, but overall favorable outcomes.

Clinical Outcomes of Type II Endometrial Cancer in Open Versus Minimally Invasive Staging Surgery.

Demographic data, surgical parameters and histopathology details were analyzed. Intervention: We performed da Vinci robot-assisted radical hysterectomy. The learning curve was evaluated using the cumulative summation (CUSUM) technique. Measurements and Main Results: The mean operating time (273.9 88.5 min) of phase I was significantly longer than phase II (222.0 51.4min) (p = 0.032) and phase III (218.2 50.6 min) (p = 0.015). Significant differences were found among the 3 groups which the number of pelvic autonomic nerve preservation and para-aortic lymph node resection, (p \ 0.005). There were no significant differences between the three groups with respect to lymph node yield and identifying positive lymph nodes, and pathologic outcome. Time to resume voiding function did differ between the three groups, (p \ 0.005). The learning period of da Vinci robotic surgical system for radical hysterectomy to reach a turning point was calculated to be 30 cases. Conclusion: An extended learning period can be required for da Vinci robotic surgical system for radical hysterectomy, during which pathologic outcome of radical hysterectomy may not be adversely affected. As for the surgeons with abundant experiences of laparoscopic surgery for cervical cancer surgery, after about 30 resections, they can overcome the learning curve and master da Vinci robotic surgical system for radical hysterectomy in cervical cancer.