Women's Health Commons^™

Hungarian Validation Of The Pelvic Floor Distress Inventory - 20 (Pfdi-20) Questionnaire And The Pelvic Floor Impact Questionnaire - 7 (Pfiq - 7), Barbara Kozma, Bence Kozma, Peter Takacs, Dávid Rátonyi, Nelli Farkas, Attila G. Sipos, Balint Farkas

Department of Obstetrics & Gynecology Faculty Publications

Introduction and Hypotheses

Pelvic floor disorders (PFDs) affect women's quality of life through physical, psychological, and social domains. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) are validated tools for assessing symptom severity and quality of life impact. The current study aim to investigate the reliability and validity of the Hungarian versions of these questionnaires in women with PFD symptoms.

Methods

This validation study was carried out at the University of Debrecen among women with clinically confirmed pelvic floor disorders. The PFDI-20 and PFIQ-7 questionnaires were translated into Hungarian using independent native English speaker in …

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

The Association Between Social Vulnerability And Racial Disparities In Preterm Birth, Anita Pershad, Gabby Adams, Lindsay Robbins, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the association between county-level social vulnerability and preterm birth and assess whether racial disparities vary across levels of vulnerability.

Methods

This cross-sectional study utilized restricted Centers for Disease Control and Prevention natality data from 2023. We included Black or White births with singleton pregnancies across 3123 US counties from 50 US states and the District of Columbia. Participants were grouped into quartiles based on the county-level Social Vulnerability Index (SVI), with quartile 4 representing the most socially vulnerable populations. The primary outcome was preterm birth, defined as delivery before 37 weeks. Secondary outcomes included small for gestational …

Prepregnancy Diet Quality Index And Adverse Pregnancy Outcomes, Ummayhany Bharmal, George Saade, Philip Greenland, Brenda J. Smith, Andrea C. Kozai, Stephanie A. Fisher, Lauren Theilen, William Grobman, Noel Bairey Merz, Uma Reddy, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Adverse pregnancy outcomes (APOs) are a major cause of maternal and neonatal morbidity.¹ Preconception diet quality is associated with APO risk,² but prior pregnancy-related indices had notable limitations.³ We developed the Prepregnancy Dietary Quality Index (PreP-DQI) to assess its association with APOs and cardiometabolic health.

Methods

This cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (NuMoM2b) and the NuMoM2b-Heart Health Study (NuMoM2b-HHS),⁴,⁵ excluding individuals who delivered before 23 weeks of gestation, had fetal anomalies, missing dietary data, or had implausible caloric intake (below 1st percentile or above 99th percentile). All participants in the original studies …

Development Of A Semi-Mechanistic Population Pharmacokinetic Model For Predicting Tenofovir Disoproxil Fumarate And Tenofovir Alafenamide Exposure In Plasma And Cellular Matrices During Pregnancy And Postpartum, Yifan Yu, Kristina M. Brooks, Gustavo F. Doncel, Brookie M. Best, Mark A. Marzinke, Mark Mirochnick, Peter Anderson, Landon Myer, Connie Celum, Renee Heffron, Jenell Coleman, Dvora Joseph Davey, Craig W. Hendrix, Jeremiah D. Momper, Robert Bies, Rachel K. Scott

CONRAD Publications

Background and Objective

Tenofovir (TFV)-based regimens are backbones of both HIV treatment and pre-exposure prophylaxis during pregnancy. Multiple studies have shown up to one-third decreases in dried blood spot tenofovir-diphosphate concentrations during pregnancy among participants taking tenofovir disoproxil fumarate (TDF). Currently, there are no mechanism-based models describing the pharmacokinetics of tenofovir diphosphate (the active anabolite) in peripheral blood mononuclear cells (PBMCs) of pregnant individuals receiving TDF or tenofovir alafenamide (TAF), and the mechanisms behind observed differences between dried blood spots and PBMCs remain unclear.

Methods

To address this gap, we developed a semi-mechanistic model to simultaneously describe the pharmacokinetics of …

Micrornas Regulated By Pregnancy Target Antiviral And Cancer Immunity Overlapping With The Hiv Interactome, Paula F. T. Cezar-De-Mello, Jonathan M. Dreyfuss, Pai-Lien Chen, Hidemi Yamamoto, Xiaoming Gao, Hui Pan, Charles Morrison, Gustavo F. Doncel, Robert L. Barbieri, Raina N. Fichorova

CONRAD Publications

Innate immunity predictors of HIV-1 risk and pathogenesis vary with reproductive hormones, pregnancy, and lactation, yet the underlying mechanisms remain unclear. We hypothesized that pregnancy-associated physiological adaptations alter systemic microRNA (miRNA) expression, thereby regulating immunity, pathogenesis and susceptibility to infection. We analyzed 174 serum samples from 88 participants in a longitudinal cohort from Uganda and Zimbabwe across pre-pregnancy (PP), pregnancy (P), and postpartum breastfeeding (BF). Cell-free peripheral blood miRNAs (n = 2083) were profiled using HTG EdgeSeq. Pregnancy-specific miRNAs were identified by intersecting differentially expressed (DE) miRNAs from P vs. PP and P vs. BF comparisons. miRNA targets and pathways …

Vitamin D Status During Pregnancy Modulates The Effect Of Pre-Pregnancy Obesity On Gestational Diabetes Mellitus Risk: A Birth Cohort Study, Ali H. Ziyab, Abdullah Al-Taiar, Reem Al-Sabah, Majeda S. Hammoud, Saeed Akhtar

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objective:

To determine whether gestational vitamin D status modulates the effect of pre-pregnancy obesity on gestational diabetes mellitus (GDM) risk while stratifying by maternal age.

Design:

Birth cohort.

Setting:

A major maternity hospital in Kuwait.

Participants:

Pregnant women in their second/third trimester of gestation were enrolled. Pre-pregnancy body mass index (BMI, kg/m²) was categorized as under/normal weight (< 25.0), overweight (25.0 to < 30.0), and obesity (≥30.0). Gestational 25-hydroxyvitamin D concentrations were categorized as deficiency (< 50 nmol/L) or insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression.

Results:

Data from 957 pregnant women were analyzed, with GDM affecting 166 (17.4%) pregnancies. Pre-pregnancy obesity and gestational vitamin D deficiency was ascertained in 275 (28.7%) and 533 (55.7%) pregnant women, respectively. The association between pre-pregnancy obesity and GDM risk differed according …

Neurotensin Drives Theca Cell Migration During Ovulation In Primates, Jessica S. Miller, Megan A. G. Sage, Thomas E. Curry Jr., Diane M. Duffy

Department of Biomedical and Translational Sciences Faculty Publications

Theca cells are a critical steroidogenic cell type of the ovarian follicle and corpus luteum. The ovulatory luteinizing hormone (LH) surge (or human chorionic gonadotropin (hCG)) stimulates theca cell relocation from the stroma surrounding the dominant follicle to full integration into the developing corpus luteum. Luteinizing hormone/human chorionic gonadotropin also stimulates granulosa cells to produce local mediators of ovulation, including the peptide neurotensin (NTS). To determine if hCG-stimulated NTS regulates theca cell relocation within the ovulatory follicle, vehicle or an NTS receptor antagonist was injected into a macaque dominant follicle, and ovaries were removed 48 h after hCG administration. Additional …

Skeletal Muscle Myofiber Development In Non-Human Primate Offspring Deprived Of Estrogen In Utero, Phillip J. Gauronskas, Terrie J. Lynch, Eugene D. Albrecht, Gerald J. Pepe

Department of Biomedical and Translational Sciences Faculty Publications

Introduction: We previously showed that baboon offspring born to mothers deprived of estrogen during the second half of gestation exhibited insulin resistance prior to and after the onset of puberty. Moreover, the size of skeletal muscle myofibers and the number of microvessels important for delivery of insulin/glucose to myofibers were lower in near-term fetuses deprived of estrogen during pregnancy, and myofiber capillarization remained reduced in post-pubertal offspring deprived of estrogen in utero. However, it remains to be determined whether skeletal muscle size is restored to normal in animals deprived of estrogen in utero after the onset of puberty/gonadal estrogen production. …

Timelines Of Care: Analyzing Treatment Access For Women With Ongoing Reproductive Health Needs, Nyla M. Keith

Honors Undergraduate Theses

Mandates in the United States created pressure on an already strained healthcare system post-COVID-19 pandemic. With new regulations placed upon abortion care forcing the closing of low-cost health clinics such as Planned Parenthood, legislation that has made health insurance more expensive, and rising pharmaceutical prices, women’s OB/GYN care in America has struggled to meet patient needs. A cross-sectional survey was developed and distributed to four clinics in the Orlando area to assess patients' perceived access to care and identify barriers to receiving OB/GYN care. The survey took approximately 10 – 15 minutes to complete, was available in print and online …

Medical Image Feature Extraction And Selection Based On Inception V3 And Gini Index For Cervical Cancer Cells Identification, Rachida Assawab, Mounir Ouzir, Badreddine Benyacoub, Abderrahim Electrochemical Sensor For Tenofovir Allati, Ismail El Moudden

Research and Infrastructure Service Enterprise (RISE) Faculty Publications

Background: Cervical cancer remains the fourth most common cancer in women globally, with 604,000 new cases annually. Early detection through cytological screening is critical, but manual interpretation suffers from high false negative rates and requires expert pathologists often unavailable in resource-limited settings.

Methods: We developed a novel hybrid framework combining InceptionV3-based deep feature extraction with Gini Index feature selection for automated cervical cancer cell classification. Using the Herlev dataset (917 Pap smear images: 242 normal, 675 abnormal), we extracted 2048 deep features and applied systematic feature selection to identify optimal discriminative subsets. Comprehensive clustering analysis (K-means, K-medoid, Fuzzy clustering) validated …

Osmotic Dilators Vs. Foley Balloons: Bayesian Secondary Analyses Of The Dilafol Trial, Antonio F. Saad, Elenir B. C. Avritscher, Claudia Pedroza, Xiao Han, George R. Saade

Department of Obstetrics & Gynecology Faculty Publications

Background: Dilapan-S, a synthetic osmotic dilator used for pre-induction cervical ripening, has proven to be as effective as the Foley balloon in terms of vaginal versus cesarean delivery and has been associated with increased patient satisfaction. Nevertheless, its ability to lower cesarean rates and its cost-effectiveness remain poorly studied.

Objectives: To estimate the likelihood that synthetic osmotic dilators reduce cesarean deliveries and to evaluate their health system costs (2026 US$) and incremental cost-effectiveness compared to the Foley balloon during cervical ripening.

Study Design: Secondary Bayesian analyses were conducted using data from the single-center DILAFOL randomized controlled trial, which enrolled 419 …

Low-Lying Placenta Is Associated With Increased Risk Of Hemorrhage And Severe Maternal Morbidity: A Nationwide Analysis, May Abiad, Giulia Bonanni, Nikan Zargarzadeh, Ali Javinani, Scott A. Shainker, Anna M. Modest, George R. Saade, Kjersti Aagaard, Alireza A. Shamshirsaz

Department of Obstetrics & Gynecology Faculty Publications

Background

Placenta previa (PP) is a well-recognized obstetric complication with established maternal risks, particularly hemorrhage, that contribute significantly to maternal morbidity. In contrast, low-lying placenta (LLP) has historically been grouped with previa in both coding and clinical practice, limiting our ability to study its imparted associated outcomes as a distinct entity. However, in 2017, coding revisions allowed for a parsed diagnosis of LLP and PP and enabled the current study of differentiated associated outcomes.

Objectives

To describe and compare the independent rates of hemorrhage and severe maternal morbidity (SMM) associated with LLP and PP relative to normal placentation.

Methods

We …

Prepregnancy Overweight And Obesity In Kuwait Birth Cohort Study, Abdullah Al-Taiar, Ali H. Ziyab, Eelaf A. Husain, Maryam M.Y. Mohammad, Maryem A. Shamsah, Noor Salah Alali, Reem Sharaf-Alddin, Majeda S. Hammoud

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: This study aimed to estimate the prevalence of prepregnancy obesity and overweight, and to identify a set of sociodemographic factors that could guide weight management interventions for women prior to conception.

Design, Sample, and Measurements: Pregnant women (N = 989) were recruited in the Kuwait Birth Cohort Study during the period June 2017 to February 2020. Prepregnancy weight and height were self-reported, while current weight and height were measured in a standardized procedure. Data on sociodemographic factors were collected through face-to-face interviews conducted by a trained data collector. Multinomial logistic regression was used to investigate the association between sociodemographic …

Analysis And Numerical Investigation Of A Breast Cancer Treatment Model Incorporating Ketogenic Diet And Immune Boosters Via Optimal Control Theory, Kunnisai Muniroh, Ummu Habibah, Wuryansari Muharini Kusumawinahyu, Nur’Izzati Hamdan

Mathematical Modelling and Numerical Simulation with Applications

This paper develops a mathematical model to investigate breast cancer dynamics by incorporating tumor–immune interactions, ketogenic diet effects, and medical treatment. The model is formulated as a system of nonlinear ordinary differential equations and analyzed within an optimal control framework. Time-dependent control variables are introduced to represent treatment strategies aimed at minimizing tumor progression while reducing therapeutic costs. The model’s well-posedness is established through positivity and boundedness analysis. The necessary conditions for optimality are derived using Pontryagin’s Minimum Principle, resulting in a coupled system of state and adjoint equations. Numerical solutions are obtained using the fourth-order Runge–Kutta method combined with …

Intimate Partner Violence And Brain Injury In Women: Understanding Prevalence, Symptomatology, And Consequences, Jacob T. Perez

Undergraduate Research Symposium

Intimate partner violence (IPV) refers to physical, sexual, or psychological harm caused by a current or former partner. While IPV can affect anyone, women are particularly vulnerable and disproportionately affected. Physical IPV often includes experiences of repeated trauma to the head, face, and neck, including strangulation. These injuries can result in a range of consequences, including comorbid conditions such as depression, PTSD, anxiety, and cognitive impairments, along with neurological effects like reduced brain connectivity and white matter integrity. Common brain injuries associated with IPV include traumatic brain injury (TBI), which results from blunt force trauma; subconcussive/repetitive blows, caused by head …

Cardiovascular Disease And Pregnancy: Clinical Outcomes From A Tertiary Center Experience In Saudi Arabia, Nouf Alanazi, Sara Abou Al-Saud, Wareef Almousa, Ghada Alshalan, Jumana Alqahtani, Munira Alsharif, Abrar Alshahrani, Hessah Alothman

Journal of the Saudi Heart Association

Cardiovascular disease complicates pregnancy and elevates maternal and fetal risks. Local data in Saudi Arabia is scarce. This study examines pregnancy outcomes in women with cardiovascular disease at a tertiary center. A retrospective cohort study of 103 cardio-obstetric patients (2015-2023) at King Khalid University Hospital. Multivariable logistic regression identified risk factors for adverse maternal and neonatal outcomes, with significance at p

A Feasibility Study Of Sexual Organ-Dose Sparing Volumetric Modulated Arc Therapy In Female Low Rectal Cancer Patients Treated With Three-Dimensional Conformal Radiation Therapy, Margaret Downes, Victoria Olsen, Andre Williams, Rendi Sheu, Maria Thor, Lucy Greenwald, Vishruta Dumane, Kristin Hsieh, Ayesha Ali, Orly Morgan, Michael Buckstein, Deborah Marshall

Department of Radiation Oncology Faculty Papers

BACKGROUND: Sexual dysfunction is a significant toxicity of pelvic radiation therapy (RT) for female rectal cancer patients and may be more common with intensity-modulated techniques compared to three-dimensional conformal radiation therapy (3D-CRT). However, limited research has evaluated dose sparing of female sexual organs at risk (OARs), particularly erectile tissues that are critical for sexual function.

PURPOSE: This feasibility study aimed to demonstrate the practicality of contouring and sparing female sexual OARs in rectal cancer RT by generating sexual organ-sparing volumetric modulated arc therapy (SO-VMAT) plans from a small 3D-CRT cohort and comparing dose distributions to guide future planning.

METHODS: Nine …

Assessing The Impact Of Maternal Oral Health On The Risk Of Adverse Birth Outcomes, May Amr Salama

Health Services Research Dissertations

Preterm birth (PTB) and low birth weight (LBW) are leading causes of neonatal morbidity and mortality. Maternal periodontal disease (PD) has been increasingly linked to these adverse birth outcomes (ABOs), yet questions about causality and treatment effectiveness persist due to study design heterogeneity and potential unmeasured confounding. These gaps hinder the development of clear clinical and public health guidelines. This dissertation addresses these gaps through three interconnected studies assessing the relationship between maternal oral health and ABOs.

The first study employed a meta-epidemiological analysis of 62 original studies from nine systematic reviews to evaluate the impact of unmeasured confounding on …

Interplay Of Menopause, Coronary Artery Calcium Score And Cardiovascular Disease Risk, Tanisha Mishra, Diksha Sanjana Pasnoor, Murtaza Gandhi, Nida Mohamed, Shaylika Chauhan, Kokou Adompreh-Fia, Kesha Mayank Doshi, Prerana Sevella, Rupak Desai

Abington Jefferson Health Papers

BACKGROUND: Postmenopausal women face an increased risk of cardiovascular disease (CVD) due to estrogen withdrawal, which exacerbates traditional cardiovascular risk factors such as dyslipidemia, glucose intolerance, and hypertension. Coronary Artery Calcium Score (CACS), a well-established marker of subclinical atherosclerosis, has emerged as a key predictor of adverse cardiovascular events. Despite the recognized association between menopause and heightened CVD risk, there remains a paucity of literature exploring the specific role of menopause in influencing CACS and its implications for cardiovascular morbidity and mortality.

AIM: To examine the interplay between menopause, CACS, and cardiovascular health by synthesizing existing literature.

METHODS: A comprehensive …

Age-Specific Distribution Of Cervical Precancer And Cancer Among Women Living With Hiv Across Seven Countries: A Systematic Review And An Individual Patient Data Meta-Analysis, Shona Dalal, Karin Sundström, Ronaldo Silva, Katayoun Taghavi, Helen Cejtin, Michael Chung, Sharon Greene, Smita Joshi, Helen Kelly, Elkanah Orang'o

Obstetrics and Gynaecology, East Africa

Background Women living with HIV have an elevated risk for cervical cancer, present earlier, and have more recurrent human papillomavirus (HPV) infections compared with women without HIV. To update WHO recommendations on screening and treatment to prevent cervical cancer, we aimed to identify whether women living with HIV should be screened for cervical cancer at a specific age, the optimal screening interval following a negative cervical screen, and the screening interval following treatment.

Methods We conducted a systematic literature review on cervical cancer and HIV by searching MEDLINE, Embase, CENTRAL, the Cochrane Library, and clinical trial registries covering Jan 1, …

Implementation Of The Multicountry Who Covid-19 Pregnancy Cohort Study: Challenges And Lessons Learned During The Pandemic, Maria Costa, Renato Souza, Jose Cecatti, Sami Gottlieb, Marie Delnord, Soe Soe Thwin, Ndema Habib, Marleen Temmerman, Ingrid Gichere, Beth Maina

Obstetrics and Gynaecology, East Africa

Introduction A generic research protocol was developed for a prospective cohort study to allow systematic, harmonized data collection of the impact of SARS-CoV-2 infection and vaccination during pregnancy on maternal, obstetric, and neonatal outcomes across different settings. This article describes the study conception, development, implementation, challenges, and key lessons learned within study sites across the world.

Methods The protocol was implemented in 43 facilities in 10 countries during the pandemic, involving consecutive recruitment of over 16,000 pregnant or postpartum women. We evaluated selection of study sites, ethical approvals, staff recruitment and training, recruitment and follow-up, and incorporation of new elements …

Identifying Sex- And Gender-Specific Endocrinological, Lifestyle, Psychosocial, And Socio-Cultural Targets For Alzheimer's Disease Prevention In Africans: The Female Brain Health And Endocrine Research In Africa (Fember-Africa) Project, Chinedu Momoh, Benard Aliwa, Lukoye Atwoli, Karen Blackmon, Edna Bosire, Samuel Gitau, Harrison Kaleli, Ciru Kamanda, Linda Khakali, Rachel Maina, Peter Mativo, Sylvia Mbugua, Zul Merali, Kendi Muchungi, Anne Njogu, Douglas Nyankira, Alice Ondieki, Catherine Onyancha, Stanely Onyango, Jasmit Shah, Sheena Shah, Cynthia Smith, Dilraj Sokhi, Sheila Waa, Thomas Thesen

Brain and Mind Institute

Dementia rates are rising globally, with the burden increasing most rapidly in low- tomiddle-income countries. Despite this, research into Alzheimer’s disease and relateddementias (ADRD) among African populations remains limited, with existing modelsbased on Western cohorts that overlook sex-, gender-, and ancestry-specific factors.The Female Brain Health and Endocrine Research in Africa (FemBER-Africa) project,hosted at the Brain and Mind Institute, Aga Khan University, Kenya, will establish adeeply phenotyped cohort of 250 African individuals across the ADRD spectrum. Itwill assess sex-specific risk factors linked to ethnicity, lifestyle, and endocrinologicalvariables using fluid-based biomarkers (blood and saliva), neuroimaging (magneticresonance imaging and positron emission tomography), and …

Cervical Hpv 18 Detection Is Associated With High-Grade Cervical Dysplasia In Kenyan And Ugandan Women Living With Hiv, Miriam Nakalembe, Collins Mpamani, Jane Namugga, Carolyn Nakisige, Grace Banturaki, Phillip Tonui, Peter Itsura, Elkanah Orang'o, Kapten Muthoka, Anthony Ngeresa

Obstetrics and Gynaecology, East Africa

Objectives Cervical cancer, caused by “high-risk” (HR) HPV, is the most common malignancy and the leading cause of cancer deaths among women living in Kenya and Uganda. Women living with HIV (WLWH) are at a high risk for HR-HPV infection. This longitudinal, observational cohort analysis was conducted to identify factors that are important among WLWH in prediction of cervical intraepithelial neoplasia grades 2 or 3 (CIN2/3).

Methods Data of this analysis was based on a study of HPV natural history and cervical cancer among Kenyan and Ugandan WLWH. Demographic, behavioral and biological data were collected; HR-HPV DNA testing of cervical …

Minimizing Travel Burden Of Gynecologic Cancer Surveillance Through A Unique Multidisciplinary Telehealth Program, Avni Shridhar, Suzanne Viator, Tara Castellano, Holly Provost, Navya Nair, Elizabeth Neupert, Amma Agyemang, Amelia Jernigan

School of Medicine Faculty Publications

OBJECTIVE: STEEL MAGNOLIAS (shared telehealth for multidisciplinary gynecologic cancer survivorship) is a novel gynecologic cancer surveillance care-delivery program in which rural patients see a close-by gynecologist in person with simultaneous virtual gynecologic oncology consultation. This study assesses feasibility of STEEL MAGNOLIAS by examining travel burden reduction, cancer outcomes, visit activities, guideline adherence, and patient satisfaction. METHODS: We retrospectively reviewed charts of patients with gynecologic cancer in remission under the STEEL MAGNOLIAS program in rural south Louisiana (March 2020-September 2023). Travel metrics, patient satisfaction, cancer outcomes, survival status, reasons for visit, and adherence to follow-up as per National Comprehensive Cancer Network …

Low Unintended Dural Puncture Rate Using A Flush-Measure-Check-Advance Technique To Perform Combined Spinal-Epidural Anesthesia In Parturients: A Quality Improvement Clinical Series, James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton

School of Medicine Faculty Publications

Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s. Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm. Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) …

Interplay Between Admission And Early Postpartum Blood Pressure And Risk Of Postpartum Readmission For Hypertension, Juan C. Naranjo, J. Hunter Collins, Elizabeth F. Sutton

School of Medicine Faculty Publications

No abstract provided.

Medical Students’ Perspectives On Dobbs V Jackson Women’S Health Organization, Victoria Lazarov, Cecilia Mastrogiacomo, Mikaela Koch, Kirsten Wohlars, Tova Ablove, Student Perspectives On Reproductive Rights Research Group

Cooper Rowan Medical Journal

Background: In June 2022, the Dobbs v Jackson Women’s Health Organization ruling overturned the previously upheld constitutional right to abortion. The resulting impact on medical training and student decision-making remains uncertain. This study aims to assess the nationwide impact of the Dobbs decision on medical students’ geographic residency preferences, specialty selection, and level of concern regarding civil and criminal charges for physicians providing abortion and fertility care.

Methods: An anonymous IRB-approved REDCap survey was distributed to American accredited medical schools across the United States and Israel between December 2022 and May 2023. Participants indicated specialty interests and geographic preferences for …

Bridging Gaps In Breast Cancer Care: A Breast Cancer Care Quality Index To Improve Outcomes Worldwide, Eduardo Cazap, Benjamin Anderson, Giuseppe Curigliano, Sandeep Sehdev, Fatima Cardoso, Ana Gonzalez, Emad Shash, Cheng-Har Yip, André Mattar, Miriam Mutebi

General Surgery, East Africa

Background: Breast cancer (BC) care faces challenges in early detection, timely diagnosis and comprehensive management. Disparities persist, with underserved populations facing the greatest barriers. Addressing these requires policies that support consistent, evidence-based practices and enhance healthcare capacity and technology advancements. This document presents the development of the Breast Cancer Care Quality Index (BCCQI), supported by evidence to promote equitable care and improve BC outcomes globally, and discusses its adoption as a strategic tool within National Cancer Control Plans.

Methods: A two-part methodology identified challenges in BC care and defined dimensions, targets and indicators for the BCCQI, aligned with …

Routine Antenatal Ultrasound By Nurse-Midwives In Rural Kenya: A Pragmatic Trial Assessing Feasibility And Effects Of The Mimba Yangu (My Pregnancy) Project, Claudia Hanson, Lucy Nyaga, Nidhi Leekha, Michaela Mantel, Sarah Kedenge, Caroline Gitonga, Violet Naanyu, Jasmit Shah, Marleen Temmerman

Centre of Excellence in Women and Child Health

Introduction: Task-sharing of obstetric ultrasound between nurse-midwives and doctors has the potential to operationalize the World Health Organization’s recommendation of at least one ultrasound before 24 weeks of gestational age for every pregnant woman. Here, we report on the feasibility, acceptability, and effects of the Mimba Yangu (My Pregnancy) task-sharing approach in rural Kenya.

Methods: We conducted a pragmatic trial including 28 primary care facilities between April 2021 and March 2022, selected based on feasibility criteria. Fourteen facilities received the ultrasound intervention composed of (i) task-sharing with nurse-midwives, (ii) the use of portable ultrasound devices (Lumify™) connected to a tablet, …