Women’s Health

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21642

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Assessing Women’s Perceptions of Their HPV and Cervical Cancer Knowledge
(2019-03-05) Matthes, Sarah; Thompson, Erika; O'Neal, Morgan
Purpose: This project aimed to assess women’s HPV and cervical cancer knowledge and women’s perceptions of their knowledge. With recent changes to cervical cancer screening guidelines in the US, it is an opportune time to assess women’s knowledge of cervical cancer and its primary cause, human papillomavirus (HPV). Women’s knowledge of HPV and cervical cancer may be beneficial for reducing anxiety and uncertainty with cervical cancer screening. Moreover, there is a need to examine if women’s perceptions of their knowledge align with knowledge levels, which may present opportunity for health education. Methods: An online survey (n=812) of women 30-65 years old without hysterectomy was conducted in June 2018. Survey items assessed knowledge of HPV (16-items), cervical cancer (12-items) and perceived ease of understanding cervical cancer screening information (Likert scale). Knowledge scores were created from correct responses to true/false questions. Descriptive frequencies for items and Kruskal-Wallis tests were used in SAS 9.4. Results: Most women (70%) perceived understanding cervical cancer screening information as easy or very easy. The mean HPV knowledge score was 8.10 (out of 16). The mean cervical cancer knowledge score was 6.88 (out of 12). Women’s perceptions of their understanding were significantly associated with HPV and cervical cancer screening knowledge (p Conclusion: Results indicate that women have an accurate perception of their cervical cancer screening knowledge. Additionally, the association between HPV and cervical cancer was noted by participants. Increasing knowledge of the high likelihood of HPV infection may increase screening willingness. Education that the clinical course of cervical cancer is slow and preventable may reduce testing anxiety. More public information on no and low cost screening resources may also help increase screening. These gaps represent patient and provider education opportunities that may assist in increasing adherence to cervical cancer screening recommendations.
The Cost of DIY: Correlates of Women’s Willingness to Pay for At-Home HPV Self-Sampling
(2019-03-05) O'Neal, Morgan; Thompson, Erika; Matthes, Sarah
Objective: Cervical cancer is largely preventable through screening, including Pap testing and human papillomavirus (HPV) testing. Yet, most women who get cervical cancer are under-screened. At-home self-sampling for HPV, the causal virus for virtually all cervical cancers, offers a potential opportunity to reach more women. Users may need to pay when this service becomes available. Therefore, research is needed to inform strategies to promote uptake of HPV self-sampling among under-screened women. This study identified correlates of women’s willingness to pay for HPV self-sampling, particularly among women not compliant with cervical cancer screening guidelines. Methods: Women 30-65 years old who have never had a hysterectomy completed an online survey in June 2018 (n=812). The survey assessed correlates of willingness to pay for HPV self-sampling (Yes/No), including sociodemographic characteristics, perceived benefits (6-items), perceived risks (4-items), and trusting a healthcare provider. Descriptive statistics were assessed, and logistic regression modeled correlates of willingness to pay for self-sampling using SAS 9.4. The same method was followed for a subpopulation of women not compliant with cervical cancer screening guidelines (n=232). Results: Nearly one-third (36.0%) of participants were willing to pay for self-sampling. Women reported being willing to pay an average of $35.12 for testing. Significant correlates of willingness to pay for HPV self-sampling were age, salary, four of six perceived benefits (e.g. ease of use, comfort, autonomy, and not embarrassing), two of four perceived risks (e.g. pain and uncertainty test performed correctly), and trusting information from a healthcare provider. The perceived benefit, ease of use, was the strongest predictor for willingness to pay for HPV self-sampling (OR=3.91, 95%CI 1.80-8.59). Among women noncompliant with cervical cancer screening guidelines, trusting a healthcare provider was the only statistically significant correlate, with those who did not trust their provider at all being less likely to be willing to pay for self-sampling than those who trusted their provider a lot (OR=0.09, 95%CI 0.02-0.42). Conclusion: Perceived risks and benefits were correlates of willingness to pay for HPV self-sampling among women. Understanding the perspectives of potential end-users can inform future efforts to utilize innovative approaches for cervical cancer screening, especially among under-screened women.
Mitochondrial oxidative stress and extrusion of mitochondrial DNA from endothelial cells: implications for maternal endothelial dysfunction in preeclampsia
(2019-03-05) Cushen, Spencer; Phillips, Nicole; Goulopoulou, Styliani; Nguyen, Ryan
Purpose: Preeclampsia is one of the leading causes of maternal mortality during pregnancy and a risk factor of cardiovascular disease for the mother later in life. Hypertension and endothelial dysfunction are common characteristics of the maternal syndrome in preeclampsia, and oxidative stress is considered a pathogenic mediator of these maternal features. Mitochondria are the primary cellular producers of reactive oxygen species (ROS) and overproduction of mitochondrial ROS (mtROS) is detrimental to cellular processes, often leading to cell death. Mitochondrial DNA (mtDNA) has pro-inflammatory properties when released from dying cells into the extracellular space and its concentrations are increased in women with preeclampsia. The objective of this study was to determine the effects of mtROS in mtDNA release into the extracellular space. We hypothesize that inhibition of mitochondrial transport chain results in extrusion of mtDNA from vascular endothelial cells. Also, inhibition of Complex III causes a greater release of mtDNA compared to inhibition of Complex I. Methods: Human umbilical vein endothelial cells (HUVEC) were grown to 80-90% confluency before being treated with a mitochondrial complex I inhibitor (Rotenone: 5, 10, 25 mM – 4h) and mitochondrial complex III inhibitor (Antimycin A: 10, 50, 100 mM – 4h). After treatment, the cell media supernatant was collected and stored in -80 °C until further mtDNA quantification. mtDNA was isolated using the Mag-Bind Blood & Tissue DNA HDQ 96 Kit and quantified using the TaqMan chemistry-based method of absolute qPCR. Results: HUVEC cells treated with rotenone, regardless of dose, had no effect on concentrations of extracellular mtDNA (Figure A; One-way ANOVA followed by Sidak’s post-hoc test). Concentrations of mtDNA increased in HUVECs treated with 100 mM of Antimycin A (Figure B; One-way ANOVA followed by Sidak’s post-hoc test). Lower concentrations of Antimycin A had no effect on concentrations of extracellular mtDNA (Figure B). Conclusions: Inhibition of mitochondrial respiratory chain complex III, but not inhibition of complex I, results in extrusion of mtDNA. The increase in mtDNA released from dysfunctional cells may contribute to the increased circulating mtDNA concentrations seen in pregnancies with maternal endothelial dysfunction, such as pregnancies with preeclampsia.
An unlikely culprit of abdominal pain in a 23-year-old female: a case study
(2019-03-05) Garda, Jacqueline; Bunyard, Julie
Background: Ovarian cancer is the most common cause of gynecologic cancer death in the United States. Ovarian cancer is most commonly seen in women over the age of 60, and the incidence of women aged 20 to 29 at diagnosis is 1.8 to 2.2 per 100,000 cases. Ovarian cancer can present either acutely or subacutely, and patients can remain asymptomatic for extended periods of time. Acute presentations involve shortness of breath due to malignant pleural effusion or severe nausea and vomiting due to a bowel obstruction, whereas subacute presentations involve bloating, urinary symptoms, early satiety, and pelvic or abdominal pain. Case Information: A 23-year-old female with no past medical history presented to the Emergency Department with sharp abdominal pain for 3 days duration, associated with subjective fever, chills, and nausea. On examination, she was hypertensive and tachycardic with abdominal distension and tenderness in the left lower quadrant. Her white blood cell count was elevated, and an abdominal and pelvic CT scan showed an extremely large complex solid and cystic mass measuring 31 by 27 by 20 cm concerning for ovarian malignancy. The patient was transferred to Obstetrics and Gynecology, where she reported further history of 15 pound weight gain, early satiety and new-onset irregular heavy bleeding for the last 3 months. A heavy, immobile mass was palpated during bimanual exam. An exploratory laparotomy was conducted, at which time the right ovary was found to fill the entire abdominal cavity up to the diaphragm. Right salpingoophorectomy and pelvic washings were performed and sent for preliminary frozen pathological examination, which resulted as possible mucinous adenocarcinoma. The mass excised was more than 10 kilograms. Gynecologic Oncology was consulted, and completed omentectomy, appendectomy and staging procedure. The patient recovered well post-operatively, and was discharged home 3 days later. The final pathology report was resulted as invasive adenocarcinoma of the right ovary arising in borderline mucinous cystic neoplasm, with no evidence of tumor in omentum, appendix, or lymph nodes. Conclusions: This case calls attention to the insidious progression of ovarian cancer, which is all the more dangerous when occurring in a patient demographic with such low incidence of disease. As the most common cause of gynecologic cancer death, ovarian cancer is an important differential to consider when patients present with even one vague subacute symptom.
Virilization and Pelvic Pain in a Premenopausal Ovarian Steroid Cell Neoplasm
(2019-03-05) Moorhead, Ava
Background: Ovarian neoplasms generally considered as derived from surface epithelium, stromal tissue, or germ cells within the ovary. Steroid cell tumors are classified as stromal tumors, and these neoplasms comprise less than 0.1% of all ovarian neoplasms. Steroid cell tumors could be classified as Leydig cell, stromal-luteal or not otherwise specified. NOS neoplasms are the most common type of steroid cell neoplasm. This report describes an ovarian steroid cell tumor attaching to a eutopic left ovary and its clinical course in a 33-year old woman with an extensive medical history. Case Information: We present a woman who initially complains of pelvic pain and virilization, with a history of PCOS. Secondary to uncontrolled blood glucose and concern for surgical risk, her symptoms progressed over a 2-year course. After being lost to follow-up for a time, this patient underwent a right sided salpingectomy and left salpingo-oophorectomy. Pathology reported this to be a steroid cell tumor, not otherwise specified of which there are fewer than 25 cases out in current literature. To date, this patient recovered well and has not has a resurgence of this neoplasm. Conclusions: Her uncontrolled diabetes and HIV status remained barriers to devise and adhere to treatment plans. Presumptive PCOS overlying or potentiating neoplastic symptoms may have led to delayed diagnosis. In addition, the persistence of some hirsutism may support PCOS as a culprit for her facial hair, as her postoperative serum Testosterone levels were normal. This is the first patient presentation of this specific tumor who was HIV positive and especially given the lack of diagnostic or treatment algorithm it will be valuable to follow this patient after the mass removal, even though her symptoms did completely resolve.
Is Weight Status Related to Sleep Duration in Middle Aged Women?
(2019-03-05) Hartos, Jessica; Alston, Annalee; Jones, Jessica; Sparks, Cori; Cavazos, Emily
Purpose: Both obesity and short sleep duration are epidemics in the United States but the relationship between these has yet to be studied exclusively in females age 45-64. The purpose of this study was to examine the relationship between weight status and sleep duration in middle aged women. Methods: This study was a cross-sectional analysis that used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) for middle-aged females (45-64 years old) from Alabama (N=1,235), Arkansas (N=947), Louisiana (N=1,045), and Mississippi (N=942). Ordered logistic regression was conducted separately by state to assess the relationship between weight status and sleep duration while controlling for health conditions, tobacco use, alcohol use, education level, employment status, income level, ethnicity, and age. Results: A quarter of the participants reported having short or long sleep duration (24-27%), and almost half reported having an obese weight status (44-48%) and two or more health conditions (40-45%). There was no significant relationship between weight status and sleep duration in middle aged females’, however, sleep duration was related to health conditions in three of four states. Conclusion: There was no relation between weight status and sleep duration among middle aged females across states. However, short sleep was related to two or more health conditions in three of four states. Results of the study may be generalized to middle aged women in a primary care setting. Because of the relationship we found, this target population should be screened for short sleep duration and number of health conditions, if they present with symptoms of either. Education about healthy BMI and sleep duration should be provided to all middle aged women due to their significant comorbidities. Referral to sleep therapy for those who report short sleep duration could prove beneficial.
Is Mental Health Status Related To Alcohol Use In Pregnant Women Ages 21-35?
(2019-03-05) Hartos, Jessica PhD; Ramsey, Jessie B.S.; Sdao, Alee B.S.; Warner, Mackenzie B.S.; Friesenhahn, Lindsay B.S.
1. Purpose: Alcohol consumption during pregnancy is a major health concern that is entirely preventable. The purpose of this study is to determine whether mental health status during pregnancy is related to alcohol use in pregnant women ages 21-35 years in the general population. 2. Methods: This cross-sectional analysis used 2016 data from the Behavioral Risk Factor Surveillance System (BRFSS) for 418 pregnant females ages 21 to 35 in Florida, Michigan, Minnesota, and New York. Logistic regression with combined state data was used to assess the relationship between mental health and alcohol use during pregnancy while controlling for tobacco use, educational level, income level, employment status, marital status, ethnicity/race, and age. 3. Results: Across states, few participants reported any alcohol use (10-12%), about one-third reported having mental health issues in the last thirty days (27-40%), and few reported they were current smokers (0-15%). Adjusted results indicated that alcohol use during pregnancy was highly related to mental health status and tobacco use. 4. Conclusions: This study found that mental health status was significantly related to alcohol use during pregnancy for women ages 21-35 years. Clinicians in obstetrics and gynecology should expect to find approximately 1 out of 10 women to report any alcohol use during pregnancy and about one-third to have mental health issues in the last 30 days. Since these two factors are problematic and highly related, providers should screen and counsel all pregnant women about alcohol use and mental health at each appointment. Smoking was also found to be highly related to antenatal drinking. At each visit, clinicians should continue to screen and counsel any pregnant patients on smoking cessation. If additional treatment for mental health or substance use is required clinicians should provide additional resources and referrals to psychiatry or substance abuse programs.
Tarrant County Breast, Cervical, and Ovarian Cancer Resources
(2019-03-05) Philip, Sarah; DeVille, Heather; Mickle, Rebecca; Sankar, Aparna; Dolan, Kathryn J.; Hutton, Sarah
Purpose Breast, cervical and ovarian cancer are significant sources of morbidity and mortality in women in the United States, Texas and Tarrant County. One of the best ways to combat these cancers is taking appropriate preventative measures as needed as well as understanding one’s individual risk . Often survivors of breast, cervical, and/or ovarian cancer require significant community resources to help them navigate and recover from their cancers. This poster describes risk factors and demographics and identifies local support in Tarrant County for these groups. Methods The primary method of gathering the information and data shown here was research on governmental and non-governmental sources regarding statistics and demographics. Tarrant County community resources for these groups were identified using tarrant211.org and the Tarrant Cares website. Results Our research showed that that breast, ovarian, and cervical cancers are most commonly diagnosed in women aged 62 and older, 50-60 years old, and 35-44 years old respectively. Risk factors for each of these three cancers are identified, as well as resources for preventative screening and support for those who have had one of these diseases. Resources identified include the local chapter of the Susan B. Komen foundation, local chapters of the National Cervical and Ovarian Cancer Coalitions, the Tarrant County Indigent Health Care Program, and JPS Connection at John Peter Smith Hospital. Conclusions In Tarrant County, there are many different resources available for those who have breast, ovarian and cervical cancer, including local and national organizations that provide financial, medical and transportation services. Lack of both awareness and access to appropriate screening tools and information about these diseases are some of the biggest obstacles women in Tarrant county face.
Knowledge, Attitudes, and Perceptions of Sex Workers in Substance Abuse Recovery on Women’s Health
(2019-03-05) Felini, Martha; Nguyen, Tammy
Purpose: Street sex worker populations are underrepresented in women’s health research. Of the few studies, women moving in and out of the criminal justice system demonstrate higher prevalence of co-occurring substance use disorders, poor reproductive outcomes, and cervical cancers compared to other women. Barriers to healthy screening behaviors include access, experience of discrimination and/or stigmatization, and competing priorities. This study sought to examine whether knowledge, perceptions and attitudes would affect the uptake of well woman exams in this underserved population. Methods: A cross-sectional study was conducted among women diverted through the Prostitute Diversion Initiative and into substance abuse recovery in lieu of jail. Trauma-sensitive cancer prevention education was conducted prior to a well woman exam (2012-2017). Self-administered baseline assessments of 36 items measured on the Likert-scale was used to assess baseline knowledge (n=14), attitudes (n=4), and perceptions (n=18) about well woman exams. Statistical analysis was performed using SAS statistical software to assess difference overall, and by age, education and history of trauma. Results: Only 32% of 219 women believed they were at increased risk of cervical cancer. The majority (92%) knew well woman exams were important even if asymptomatic, but fewer (58%) knew when their daughters should initiate exams. Knowing someone with cervical cancer was significantly associated with uptake (p Conclusions: Although knowledge about cervical cancer screenings was relatively high, and attitudes mostly encouraging, there remains misconceptions about risk and perceived barriers like provider’s gender and anxiety waiting for results that needs to be addressed to scale up cervical screening uptake rates in this underserved population.
Placental Exposure to Hypoxia and Oxidative Stress Causes Mitochondrial DNA Release into the Extracellular Space
(2019-03-05) Osikoya, Oluwatobiloba; Blessing, Alexandra; Phillips, Nicole; Goulopoulou, Styliani; Cushen, Spencer
Purpose In preeclampsia, a severe hypertensive disorder of pregnancy, placentae experience reduced perfusion, increased cell death, and oxidative stress. Also, there is an increase in circulating cell-free mitochondrial DNA (mtDNA) in the maternal blood. The main objective of this study was to determine the role of hypoxia and oxidative stress in mtDNA release from placental cells, and to examine the effects of soluble factors from hypoxia-exposed placentae on vascular reactivity. To address this objective, the following hypotheses will be tested: a) Exposure to hypoxia and oxidative stress will result in mtDNA release via cell-death dependent mechanisms in human trophoblast cells. b) Soluble factors from hypoxia-exposed placentae will result in reduced vasodilation in rat maternal arteries. Methods To examine the effects of preeclampsia-related placental stressors on mtDNA release, we treated human trophoblast cells (BeWo cell line) with: 1) hypoxia (1% O2) vs. normoxia (21% O2) for 15 h, or 2) a mitochondrial complex I inhibitor (Rotenone, 10 μM) vs. vehicle for 4 h. mtDNA in cell culture supernatant was measured using absolute qPCR and cell death was quantified using flow cytometry. To test the effects of hypoxic placenta-derived factors on maternal vascular function, we used mesenteric arteries and placenta-conditioned media (PLmedia) from pregnant rats. Placentae were incubated in physiological salt solution (37oC) for 3 h in either 1% or 21% O2, while arteries were mounted on a wire myograph and underwent a baseline [(-) PLmedia] concentration-response curve (CRC) to acetylcholine (ACh, 10-9 – 3x10-5 M) followed by 30-min incubation with PLmedia, after which the CRC was repeated. Results Exposure of trophoblast cells to rotenone resulted in cell death (Vehicle: 28.17 ± 2.67% vs. Rotenone: 48.43 ± 1.22%, n = 3, P = 0.002) and mtDNA release (Vehicle: 1.69 ± 0.12 ng/uL vs. Rotenone: 2.39 ± 0.10 ng/uL, n = 5, P = 0.002). Hypoxia did not induce trophoblast cell death (Normoxia: 24.7 ± 0.50% vs. Hypoxia: 24.25 ± 0.45%, n = 2, P = 0.6), but increased release of mtDNA (Normoxia: 14.22 ± 1.20 pg/uL vs. Hypoxia: 20.64 ± 0.39 pg/uL, n = 3, P = 0.007). PLmedia from normoxic and hypoxic placentae reduced sensitivity to ACh (–logEC50, Normoxia: (–)PLmedia: 7.48 ± 0.03 vs. (+)PLmedia: 6.96 ± 0.10, n = 4, P = 0.02; Hypoxia: (–)PLmedia: 7.35 ± 0.35 vs. (+)PLmedia: 6.70 ± 0.29, n = 3, P = 0.08). Conclusion A placental cell model of mitochondrial stress results in cell death and release of mtDNA, while a hypoxic model of stress results in release of mtDNA without cell death. Placental factors decrease resistance artery sensitivity to vasodilators in both normoxic and hypoxic conditions, indicating that the placenta contributes to maternal vascular tone in healthy pregnancies and in pregnancies complicated with reduced perfusion. Ongoing studies investigate the vasoactive potential of placenta-derived cell-free mtDNA.
Uterine perivascular adipose tissue: A novel regulator of uterine artery hemodynamics during normal pregnancy
(2019-03-05) Ahmed, Hijab; Panahi, Sareh; Bourque, Stephane; Goulopoulou, Styliani; Osikoya, Oluwatobiloba
Introduction During pregnancy, uterine artery (UtA) blood flow increases compared to non-pregnant state, in part due to reductions in uterine artery tone. The main objective of this study was to determine the role of adipose tissue surrounding UtA (perivascular adipose tissue, PVAT) in pregnancy-induced changes in UtA blood flow and vasodilatory capacity. We hypothesized that uterine PVAT augments UtA blood flow and potentiates UtA dilatory responses in pregnant rats. Also, we hypothesized that pregnancy induces distinct changes in uterine PVAT morphology and gene expression as compared to other adipose depots. Methods Blood flow and vascular reactivity were measured in UtA in pregnant and non-pregnant rats using transonic perivascular probes and wire myography techniques, respectively. Reactivity to acetylcholine (ACh: induces endothelium-dependent relaxation, 10-9 - 3x10-5 M) and sodium nitroprusside (SNP: induces endothelium-independent relaxation, 10-11 - 3x10-5 M) was measured in isolated UtA in the presence and absence of PVAT-conditioned media (PVATmedia, 30-min incubation). Adipocyte size was determined in hematoxylin and eosin-stained sections of uterine PVAT and ovarian adipose tissue. Gene expression was determined in uterine and periaortic PVAT using qRT-PCR. Results Maximum and minimum uterine artery blood flow (UBF) were increased in UtA with intact PVAT compared to PVAT-denuded UtA from pregnant rats (UBFmax (mL/min); denuded: 1.47 ± 0.3 vs. intact: 2.23 ± 0.2, p = 0.01; UBFmin (mL/min); denuded: 0.71 ± 0.1 vs. intact: 1.16 ± 0.1, p = 0.0002). Uterine PVAT had no effect on UBF in non-pregnant rats (p [greater than] 0.9). UtA from pregnant and non-pregnant rats incubated with PVATmedia had reduced sensitivity to ACh compared to UtA controls (Pregnant, pEC50; -PVATmedia: 7.14 ± 0.1 vs. +PVATmedia: 6.38 ± 0.2, p = 0.0006; Non-pregnant, pEC50; -PVATmedia: 7.01 ± 0.1 vs. +PVATmedia: 6.50 ± 0.1, p = 0.005). PVATmedia had no effect on UtA sensitivity to SNP in either pregnant (p = 0.48) or non-pregnant rats (p = 0.2). Adipocyte area was greater in ovarian adipose tissue from pregnant compared to non-pregnant rats [Area (μm2/unit cell); Non-pregnant: 563.6 ± 76.6 vs. Pregnant: 857.6 ± 31.0, p = 0.02] but there were no group differences in uterine PVAT morphology (p = 0.6). Expression of uncoupling protein-1 (UCP-1) was downregulated (p = 0.02) in aortic PVAT but was unchanged in uterine PVAT (p = 0.4). Expression of peroxisome proliferator-activated receptor gamma (PPAR-γ), adiponectin receptor (AdipoR1), and leptin were downregulated in uterine PVAT (p p [greater than] 0.6). Conclusions Uterine PVAT plays a regulatory role in uterine artery hemodynamics and reactivity during normal pregnancy and has a distinct and differential gene profile as compared to other perivascular depots. Ongoing studies investigate the effects of pregnancy on cross-talk between PVAT and maternal uterine arteries. Support or Funding Information University of North Texas Health Science Center Pilot Grant, CIHR (MOP142396) and the Women and Children's Health Research Institute at the University of Alberta
Does Mental Health Differ by Ethnicity and Income in Middle-Aged Females?
(2019-03-05) Swickard, Shannon; Cahill, Abby; Powell, Sharonica; Samuels, Kenya; Hartos, Jessica; Jamieson, Sean
Abstract Purpose: There is conflicting research surrounding how mental health in middle-aged women differs by ethnicity and income. Therefore, the purpose of this study was to examine whether mental health differs by ethnicity and income in middle-aged women in the general population. Methods: This cross-sectional analysis used 2016 BRFSS data for middle-aged women from Alabama (N=1455), Mississippi (N=1082), North Carolina (N=1215), South Carolina (N=2277), and Tennessee (N=1263). Ordered logistic regression analysis by state was used to assess the relationship between mental health and ethnicity and income, while controlling for age, marital status, educational level, employment status, physical health status, tobacco use, and alcohol use. Results: About half of the middle-aged women reported low to moderate mental health (39-48%), half to most reported being white (52-81%), and about half reported an income of less than 50,000 per year (52-67%). The results of this study indicated that mental health did not differ significantly by income, but did differ significantly by ethnicity after controlling for health-related and demographic factors. In addition, mental health was consistently and significantly related to age, tobacco use, and physical health. Conclusion: Overall, ethnicity was found to be related to mental health in general population samples of middle-aged women ages 40-64; however, income was not found to be related to mental health. Limitations of this study include underrepresentation of particular ethnicities and a lack of more in-depth measures that may affect mental health. Providers can expect a moderate (38-45%) proportion of patients with low to moderate mental health. It is recommended that practitioners in a primary care setting screen all middle-aged women for mental health; taking special care to screen white patients, smokers, those with low to moderate physical health, and those under the age of 55. It is recommended that providers treat, educate, and refer these patients as necessary.
Cervical cancer screening: Does educational attainment moderate Protection Motivation Theory correlates?
(2019-03-05) Garg, Ashvita; Matthes, Sarah; Thompson, Erika; Galvin, Annalynn
Purpose: Cervical cancer screening is recommended for women 21-65 years old. Disparities in cervical cancer screening exist by education attainment, yet no study to date has differentiated cervical cancer screening psychosocial predictors between women of varying education levels. This study assessed Protection Motivation Theory psychosocial factors (e.g., threat and coping appraisal) for cervical cancer screening adherence by educational attainment among U.S. women. Methods: Women, aged 30-65 years, without a hysterectomy, were surveyed online (n=812). The outcome was adherence (yes/no) to 2012 cervical cancer screening guidelines: 3-year pap testing or 5-year HPV co-testing. Threat and coping appraisal predictor variables were derived from the Protection Motivation Theory. Educational attainment was operationalized as high school or less (33%), some college (37%), and college graduate (30%). Using SAS 9.4, adjusted odds ratios estimated cervical cancer screening nonadherence, stratified by education. Results: Most women (71%) were adherent to screening recommendations: 68% of high school or less, 71% of some college, and 76% of college graduates. Salient predictors of screening nonadherence varied by educational attainment: lacking knowledge of community screening resources (aOR=3.05; 95%CI 1.44-6.45) for women with high school or less; perceiving screenings as painful (aOR=2.16; 95%CI 1.08-4.32) for women with some college; and uncertainty about cervical cancer curability (aOR=2.97; 95%CI 1.24-7.12) for women with college degrees. Conclusions: Designing interventions without factoring educational attainment may result in limited improvements to cervical cancer screening adherence. Accounting for education level can improve health-literate and population-specific initiatives seeking to address cervical cancer screening disparities.
Dysmenorrhea and Sleep Disturbances as Predictors of Depressed Mood in Adolescents
(2019-03-05) Roane, Brandy; Issac, Nisha
Purpose: Pubertal changes mark a distinction in the trajectory of the sexes such that post-pubescent females are twice as likely to experience disturbed sleep and depression compared to males. Painful menses (dysmenorrhea) may be a contributing factor to this divergence as females who experience dysmenorrhea report both elevated depression and sleep disturbances. We predicted that teens with dysmenorrhea would exhibit increased depressed mood compared to their peers when accounting for disturbed sleep. Methods: Participants were 33 healthy post-pubescent teens from the Fort Worth area. Mean age was 15.2 years (SD=1) with 73% female (mean gynecological age=3.4) and 24% Latino. Data were collected during an experimental study examining sleep and health. Parents and teens gave informed consent/assent before reporting on disturbed sleep (SDIS), depressed mood (PHQ9), phase preference, and daytime sleepiness (PDSS). For 1 week, females reported daily on menstrual status and all teens wore actigraphy to capture sleep from which sleep duration (TST), timing (bed-/wake-time), and efficiency (SE) were calculated. At week’s end, teens completed a second PHQ9 and PDSS. Groups were determined by biological sex, menses status (active or not), and pain medication use resulting in 4 groups: females with menses and pain (dysmenorrhea), females with menses and no pain, females without menses or pain, and males without pain. Univariate ANOVAs determined significant contributors to mood for the final repeated measures ANOVA model that examined group differences in depressed mood. All analyses were evaluated at p Results: A repeated measures ANOVA examined differences in mood with covariates SDIS, PDSS, and wake-time. Results showed trend overall group differences in mood, F(3,25)=2.68, p= 0.069. Planned pairwise comparisons showed females with dysmenorrhea had significantly higher depressed mood than females without menses (12.3 vs 5.5, p=0.037) and males (12.3 vs 3.2, p=0.016). Disturbed sleep also contributed significantly to depressed mood, F(1,25)=9.13, p=0.003). Conclusions: Dysmenorrhea contributed to sustained depressed mood in teens. Importantly, depressed mood remained elevated as menses ended for these females, but not for those without dysmenorrhea. Long-term studies should examine the role dysmenorrhea has in chronic depressed mood in teens, and if sleep interventions can improve dysmenorrhea and prevent chronic depressed mood in adolescent females.
Giant ICA Aneurysm in Pregnancy: A Case Report
(2019-03-05) Hoang, Christine; Naik, Divya
Background: Giant internal carotid artery (ICA) aneurysm in pregnancy is rare, especially without a history of trauma. There are many risk factors for the development of intracranial aneurysms, including hypertension, smoking, carotid artery stenosis, and hypercholesterolemia. 85% of saccular aneurysms arise from the arteries of the circle of Willis, with the ICA accounting for 30%. Aneurysms are hard to diagnose while asymptomatic and become challenging to manage during pregnancy, especially when a patient is late in the third trimester. Case Information: A 22-year-old G2P0010 female in the third trimester presented to the ED complaining of headache secondary to left orbital socket infection onset. The patient was initially diagnosed at 31 weeks with an eye infection but saw no improvement with antibiotics. Upon return to the ED at 36 weeks, physical exam revealed left eye exophthalmos, dysconjugate gaze, and blurred vision. She had no history of trauma, past cardiac events, or complications with the current pregnancy. Her risk factors included developing HTN during the third trimester as well as obesity with a BMI of 40.34. In addition, the patient reported occasional smoking. Imaging was ordered, and patient was admitted to the hospital after MRI without contrast revealed a giant left paraophthalmic ICA aneurysm measuring 2.6 cm. Neurosurgery recommended delivery before pursuing treatment, and after MFM consult, antenatal steroids were administered. At 36 weeks, 3 days intrauterine pregnancy, a primary low transverse Cesarean section was performed with no complications. 9 days after delivery, neurosurgery performed a successful pipeline embolization of the aneurysm. 8 months following the surgery patient had an MRA w/wo contrast completed that showed no evidence for residual aneurysm. Conclusions: It is rare for giant ICA aneurysm to occur during pregnancy without a history of trauma. Upon review of the literature, this case was found to be unique in that there were less than a handful of cases with ICA aneurysm presenting during the third trimester, with most cases presenting post-partum. Although the patient was pre-term, maternal risks with delaying delivery did not outweigh potential benefit to the infant, with management notable in pursuing antenatal steroids before delivery. A main takeaway from this case was the importance of maintaining a multidisciplinary approach in developing the best treatment plan.
Outcomes and economic burden of hormonal contraceptive failure in developing countries: A case for improving effectiveness?
(2019-03-05) White, Annesha; Srinivasan, Meenakshi
PURPOSE- Unintended pregnancies (UP) result from contraception non-use or inconsistent and incorrect use leading to negative maternal and child health outcomes. The burden of healthcare spending on the consequences of UP and associated opportunity costs are substantial in resource-scarce developing regions. Among users of hormonal contraceptives (HC) which include IUDs, implants, injectables and pills, contraception failure can occur from non-compliance or drug-drug interactions (DDI) with co-medications. The objective of this study is to evaluate the prevalence of use, outcomes and cost burdens of HC failure in developing regions. METHODS- Country, region-wise contraceptive prevalence, distribution of contraceptive use by marital status and pregnancy intention, outcomes of UP and costs were taken from the “Adding It Up, 2017” dataset published from Guttmacher Institute. The developing countries were divided into sub-regions by UNDP classifications and included Africa, Asia, Latin America and the Caribbean. Number of UP were calculated by multiplying contraceptive method specific failure rates and number of users of each of the ten methods. Outcomes of UP were estimated by multiplying proportions of each outcome with total number of UP. Only costs of UP resulting in abortion are reported. Descriptive analysis and visualization was done using R (v. 3.5.1). RESULTS- The lowest hormonal contraceptive coverage was seen in Middle Africa (3.8%) while the highest is seen in Eastern Asia (35%). In developing countries, 44% of all pregnancies were unintended. Of the 885 million women who wish to avoid a pregnancy, 24% of women have an unmet need of contraception relying on traditional methods or no method. These women contribute to around 70 million (84%) of unintended pregnancies. However, users of HCs contribute to around 6.6 million (8%) of the unintended pregnancies. Of these, 2 million result in unplanned births, 1.8 million result in safe abortions and 1.9 million result in unsafe abortions. UP results in 98% of total abortions costs ($1.7 billion) with HC failure estimated to account for 8% ($144 million). CONCLUSIONS- Hormonal contraceptives are known to be highly cost-effective, consequently increasing their access in developing countries is imperative. Apart from an emphasis on using long acting contraceptives whose efficacy does not rely on patient adherence, healthcare providers must be sensitized about potential pregnancy risk due to DDI’s in the subset of women taking HCs and interacting co-medications.

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