R. Soon

Seafood consumption and umbilical cord blood mercury concentrations in a multiethnic maternal and child health cohort

BackgroundFish consumption is common among the cultures of Hawaii, and given public health attention to mercury exposure in pregnancy, it is important to better understand patterns of fish consumption and mercury in pregnancy. This study examined the influence of maternal fish consumption during pregnancy on umbilical cord mercury (Hg) concentrations in a multiethnic cohort of women in Hawaii.MethodsThis secondary analysis of a prospective cohort pilot study examined antenatal seafood consumption and neonatal outcomes in Hawaii. The first 100 eligible women who consented were enrolled. After delivery, umbilical cord blood and a dietary survey were obtained.ResultsMost women (86%) consumed seafood during the month prior to delivery. Overall, 9% of women consumed more than the recommended limit of 12 ounces/week. Seafood consumption varied significantly by ethnicity and income, with 30% of poor women consuming more than the recommended limit. Seafood consumption did not vary by age or education.Umbilical cord blood Hg levels were 5xa0μg/L or more in 44% of women. Filipina were significantly less likely to have elevated Hg levels compared with non- Filipina (pu2009<u2009.05). Mercury levels did not vary by other demographic characteristics.Women reporting consumption exceeding 12 ounces fish per week were significantly more likely to have cord blood Hg levels of 5xa0μg/L or more, but mean Hg concentrations were not significantly higher (6.1u2009±u20093.3 v 5.0u2009±u20093.7). The odds ratio for elevated Hg, however, was significant among seafood-consumers compared with non-consumers (5.7; 95% confidence interval: 1.2, 27.1).ConclusionsDespite Environmental Protection Agency (EPA) guidelines, a significant portion of pregnant women consumed more than the recommended amount of seafood, which was associated with race and income. Further, almost half of study participants had cord blood Hg concentrations at or exceeding 5xa0μg/L.

Factors Affecting Sex Education in the School System

STUDY OBJECTIVEnTo describe the current status of school based sex education and to determine predictors of providing a comprehensive sex education curriculum.nnnDESIGNnCross-sectional mailed surveynnnSETTINGnHawaiinnnPARTICIPANTSnSeventh and eighth grade health teachersnnnINTERVENTIONSnParticipants were surveyed regarding the content, quality, and influences on sex education for the 2007 to 2008 academic year.nnnMAIN OUTCOME MEASURESnMeasures of association (chi-square, ANOVA) and multiple logistic regression were used to determine predictors for teaching comprehensive sex education topics including sexually transmitted infections and pregnancy prevention.nnnRESULTSnApproximately 80% of teachers incorporated some form of sex education into their curriculum and 54.4% of teachers incorporated a comprehensive education. Teachers indicated that personal values and the availability of curriculum had the greatest influence on the content of the curriculum. Specific factors which were associated with an increased likelihood of providing a comprehensive curriculum included teaching in a public school (public 66.7% versus private 34.6%, P = 0.01), receiving formal training in sex education (received training 77.8% versus did not receive training 50.0%, P = 0.03) and having contact with a student who became pregnant (contact 72.7% versus no contact 46.7%, P = 0.04).nnnCONCLUSIONnAlthough most teachers incorporate some form of sex education, only half incorporate a comprehensive curriculum. Personal values as well as teacher resources play an important role in the content of the curriculum.

Norms, Attitudes, and Preferences: Responses to a Survey of Teens about Sexually Transmitted Infection and Pregnancy Prevention

STUDY OBJECTIVEnTo assess the values and beliefs regarding sexual behavior, sexual decision-making, and reproductive health learning preferences among teens in Hawaii.nnnDESIGNnSurvey regarding teens knowledge, attitudes, and beliefs about sexual behaviors and preferences for learning about reproductive health.nnnSETTINGnUniversity of Hawaii Department of Obstetrics and Gynecology clinics in Honolulu, Hawaii.nnnPARTICIPANTSnFemale patients and their male or female companions ages 14-19xa0years.nnnINTERVENTIONSnA 30-question anonymous survey.nnnMAIN OUTCOME MEASURESnThe main outcome was to describe the norms, attitudes, beliefs, and preferences of teens in this setting with regard to sexual health and sexual health education. For this, we provide a description of response frequencies and a comparison of mean scores across demographic characteristics.nnnRESULTSnWe analyzed a total of 100 surveys. Teens endorsed more values and norms protective against sexually transmitted infection than those protective against pregnancy. Younger teens expressed more protective values as a result of the influence of perceived parental values, whereas older teens expressed less protective values on the basis of the influence of peers. Respondents expressed comfort talking with their clinician about sexual health, and also expressed a slight preference that their clinicians initiate these conversations.nnnCONCLUSIONnThe influence of parental values and peer norms on sexual behavior must be taken into consideration when designing interventions to address adolescent sexual health. Additionally, teens greater concern about the consequences of sexually transmitted infection could be leveraged by clinicians to initiate broader conversations about sexual health, and a variety of modalities, including online resources and in-person conversations, should be used to meet the diversity of preferences expressed by teens across demographic groups.

Unintended Pregnancy in the Native Hawaiian Community: Key Informants’ Perspectives

CONTEXTnNative Hawaiians experience the highest reported rate of unintended pregnancy of any ethnic group in Hawaii. Understanding the context in which they make decisions that influence pregnancy and pregnancy planning is essential to reducing this rate.nnnMETHODSnA qualitative study was carried out in partnership with a community health center serving a large Native Hawaiian population to explore how Native Hawaiians conceptualize pregnancy and pregnancy planning. Between August and October 2013, semistructured interviews were conducted with 10 diverse key informants from the Hawaiian community. Content analysis was used to identify themes and patterns that emerged from the interviews.nnnRESULTSnCore Hawaiian values of children and family strongly affect how Native Hawaiians view pregnancy, pregnancy planning and unintended pregnancies. Ohana (families) are large and characterized by tremendous support, which is perceived to lessen the burden of an unintended pregnancy. Pregnancies, whether planned or not, are seen as blessings because children are highly valued. Because of these concepts, there is an expectation for women to continue unplanned pregnancies. Although Hawaiians ascribe value to planning pregnancies and hope that children are born under what they identify as ideal circumstances, they acknowledge that these circumstances are not necessary and often do not occur.nnnCONCLUSIONnThe concepts of family and children serve as core values to Native Hawaiians and are linked to the ways in which they view pregnancy and pregnancy planning.

Patient choice of adjunctive nonpharmacologic pain management during first-trimester abortion: a randomized controlled trial

OBJECTIVEnTo determine if offering patients a choice of adjunctive nonpharmacologic pain management during first-trimester aspiration abortion results in lower pain scores when compared with standard care.nnnSTUDY DESIGNnWe enrolled women receiving first-trimester aspiration abortion at the University of Hawaii. We randomized patients to standard care (control) or standard care plus a choice of nonpharmacologic pain management options (intervention). Standard care was ibuprofen 800 mg orally at least 30u202fmin preprocedure, lidocaine paracervical block and anticipatory guidance from the provider. We measured pain on a 100-mm visual analog scale immediately postprocedure with adequate sample size to detect a 20-mm difference in pain scores.nnnRESULTSnSeventy-four women participated in the trial and reported an overall mean pain score of 61.9±27.0. Participants in the control and intervention groups reported similar overall mean pain scores (control 60.6±28.8, intervention 63.3±28.5). We found procedure time, complications, provider-perceived case difficulty and patient satisfaction with pain management to be similar between groups. Providers underestimated participant pain compared to participants own scores (mean physician estimate of participant pain: 46.3±18.5, mean participant pain score: 61.9±27.0, p<.01). Intervention group participants most frequently selected ambient music (59%) as the nonpharmacologic intervention. Forty-one percent (15/37) of participants in the intervention group chose more than one nonpharmacologic intervention.nnnCONCLUSIONSnParticipants in the control group reported similar pain scores to participants in the intervention group. Procedure time and difficulty were similar between the two groups.nnnIMPLICATIONSnIncorporating patient choice into a nonpharmacologic pain management model did not result in lower pain scores. This approach did increase the patients visit time. Abortion providers frequently use nonpharmacologic pain management in the United States, and these techniques did not negatively impact patient pain scores in our study.

Use of medications to decrease bleeding during surgical abortion: a survey of abortion providers' practices in the United States

OBJECTIVEnOur objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.nnnSTUDY DESIGNnWe emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.nnnRESULTSnOne hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.nnnCONCLUSIONnWe found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.nnnIMPLICATIONSnWe found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.

Association between prophylactic oxytocin use during dilation and evacuation and estimated blood loss

OBJECTIVESnSome providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage, although evidence to support this is scarce. We sought to describe the association between prophylactic oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E.nnnSTUDY DESIGNnWe performed a chart review of 730 women at 14 to 26 weeks gestation who had a D&E at our institution between May 2010 and May 2014 to assess the association between prophylactic oxytocin use and EBL. We determined whether sociodemographic and health-related factors were associated with excessive blood loss (EBL≥250 mL) and whether oxytocin use was associated with complications, including hemorrhage (i.e., EBL≥500 mL or interventions for bleeding). We performed univariate analyses and multivariable regression models to evaluate the relationship between health-related factors and EBL≥250 mL.nnnRESULTSnProviders used prophylactic oxytocin in 59.9% of procedures. Asian (p=.005 and Native Hawaiian/Pacific Islander (p=.005) race, nulliparity (p=.007) and higher gestational age (p<.001) were associated with prophylactic oxytocin use. We found no difference in mean EBL (116.2±105.5 mL versus 130.7±125.5 mL, p=.09), EBL≥250 mL (31.4% vs. 68.6%, p=.15) or complications (6.1% vs. 7.1%, p=.73) including hemorrhage (1.4% vs. 5.3%, p=.14) between those who did not receive prophylactic oxytocin and those who did. No transfusions occurred in either group. In multivariable regression modeling, the adjusted OR for excessive blood loss was 0.42 (95% confidence interval 0.16-1.07) with prophylactic oxytocin use.nnnCONCLUSIONSnProphylactic oxytocin use during D&E was not associated with hemorrhage or transfusion in our population.nnnIMPLICATIONSnRoutine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.