Nicole W. Karjane

New Cervical Cancer Screening Guidelines, Again

Guidelines for cervical cancer screening have continued to evolve as we have accumulated new information about the pathogenesis of cervical cancer and the role of the human papilloma virus. Most recently, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology issued revised joint recommendations for the prevention and early detection of cervical cancer. In addition, the US Preventative Services Task Force revised its guidelines, and the American College of Obstetricians and Gynecologists updated its practice bulletin.

Long Curriculum in Resident Education.

1 Pediatric and Adolescent Gynecology, Kosair Childrens Hospital, Louisville, Kentucky 2 Pediatric and Adolescent Gynecology, Seattle Childrens Hospital, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington Division of Adolescent Medicine, Childrens Hospital at Memorial University Medical Center, Mercer School of Medicine, Savanah, Georgia Division of Adolescent Medicine, Seattle Childrens Hospital, University of Washington School of Medicine, Seattle, Washington 5 Pediatric and Adolescent Gynecology, Childrens Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 7 Section of Adolescent Medicine, Childrens Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado Division of Adolescent Medicine, Childrens Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island 10 Pediatric and Adolescent Gynecology, Childrens Hospital of Eastern Ontario, Department of Obstetrics and Gynecology, University of Ottawa, Canada

Alcohol abuse risk factors and psychiatric disorders in pregnant women with a history of infertility.

OBJECTIVE To determine if a history of infertility is associated with alcohol abuse risk factors, depression, and other psychiatric disorders. METHODS Pregnant women awaiting their first prenatal visit completed a questionnaire and subsequently participated in an interview consisting of the Structured Clinical Interview for DSM-IIIR and the Family Alcohol and Drug Survey. The data obtained from women with a history of infertility were compared with the data from women without prior infertility. RESULTS Eighty-nine pregnant women participated in the study, 27 with prior infertility and 62 without. Subjects were demographically similar, except that women with a history of infertility were slightly older than controls (34.7 vs. 31.1 years, p < 0.001). Pregnant women with a history of infertility reported needing significantly more drinks to get high, (3.3 vs. 2.7, p = 0.04) and were more likely to have clinically elevated tolerance, annoyance, cut-down, and eye-opener (T-ACE) alcohol tolerance scores (83.3% vs. 52.3%, p < 0.01) than women without such history. Major depression (lifetime) was diagnosed in 69.2% of infertility subjects compared with 30% of controls (p < 0.05). Lifetime simple phobia (23.1% vs. 10%, p < 0.01), generalized anxiety disorder (23.1% vs. 3%, p < 0.01), panic disorder (15.4% vs. 0%, p < 0.05), and bulimia (7.7% vs. 0%, p < 0.05) were also more common in women with a history of infertility compared with controls. CONCLUSIONS Pregnant women with a history of infertility are at increased risk for alcohol abuse and are more likely to suffer from other psychiatric disorders than women without such history. Special attention to these issues is warranted when caring for pregnant women who were previously infertile.

Discussion: ‘Uterine artery embolization vs surgery’ by van der Kooij et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: van der Kooij SM, Bipat S, Hehenkemp WJK, et al. Uterine artery embolization vs surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol 2011;205:317.e1-18.

Persistence with oral contraceptive pills versus metformin in women with polycystic ovary syndrome.

OBJECTIVE We studied patient persistence with oral contraceptive pills (OCPs) compared to metformin for treatment of polycystic ovary syndrome (PCOS) in an urban university clinic population. METHODS We conducted a retrospective cohort study of women with PCOS who were treated in our specialty clinic between 2004 and 2006. All women with the diagnosis of PCOS, defined as oligomenorrhea or amenorrhea in conjunction with clinical or biochemical evidence of hyperandrogenism, with exclusion of other causes, were included in the study. We abstracted data on demographic characteristics, medical history, anthropometrical measures, desire for pregnancy, prescribed treatment, and patient report of persistence with treatment at 3, 6, and 12 months. The primary outcome measure was persistence with prescribed treatment. RESULTS One hundred nineteen subjects were included in the study. Demographic and anthropometrical characteristics were similar between the groups. At 3 months, 57.1% were persistent with OCPs, and 57.8% were persistent with metformin (p=0.93). At 6 months, the percentages dropped to 38.1% with OCPs and 43.9% with metformin (p=0.46). At 12 months, only 21.7% continued with OCPs compared to 31.2% with metformin (p=0.19). Subjects were significantly more likely to be persistent with either OCPs or metformin at 3 months compared to either 6 or 12 months (p<0.01). CONCLUSIONS Women with PCOS showed similar persistence rates with OCPs compared to metformin. Persistence with either treatment precipitously decreases over time and is modest at 12 months.

Complementary and Alternative Medicine Use in a Heterogeneous Sample of Women

This study examined prevalence of biologically-based Complementary and Alternative Medicine (CAM) use in adult women receiving care at three different sites in a health care system and to explore associated use of caffeine, alcohol, and tobacco. The Complementary and Alternative Medicine Prevalence Survey (CAMPS) assessed frequency, quantity and reason for use of 36 biologically-based CAMs and communication with a physician/ pharmacist about use. CAMPS also assessed depressive symptoms and prior week use of alcohol, tobacco and caffeine. Of 289 participants, 83% reported CAM use in their lifetime, with 64% of respondents reporting regular use of at least one CAM. Only 51% of those using CAM reported informing their physician/pharmacist about it. African American women were less likely to report use than Caucasian women. Use was more prevalent among women reporting regular alcohol and/or caffeine use. Use of CAM is prevalent in this diverse sample of women. Underreporting to medical providers suggests a need for screening in healthcare settings. Failure to do so could increase risk for interactions between CAM and prescribed medications. Further, the association between CAM use and regular or problematic use of alcohol or caffeine consumption warrants further study focusing on potential consequences.

Creation and Dissemination of a Multispecialty Graduate Medical Education Curriculum in Pediatric and Adolescent Gynecology: The North American Society for Pediatric and Adolescent Gynecology Resident Education Committee Experiences

STUDY OBJECTIVE The goal was to develop a multispecialty committee to address deficiencies in pediatric and adolescent gynecology (PAG) resident education through curricular development under the auspices of the North American Society for Pediatric and Adolescent Gynecology. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A multispecialty North American committee was organized to develop short as well as long curricula in PAG through a combination of conference calls and face-to-face meetings. Content was guided by objectives of national accrediting organizations. The curricula used print as well as interactive electronic resources. RESULTS After publication of the short and long curricula, a dissemination strategy was developed to present the information at national meetings. A curricular study was performed after introduction of the curriculum to evaluate its efficacy. Long-term plans for further curricular components and expansion of educational tools are ongoing. CONCLUSION We gathered a diverse multispecialty group of doctors to collaborate on a unified educational goal. This committee developed and disseminated resident PAG curricula using a variety of learning tools. This curricular development and implementation can occur with a minimal financial burden.