Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study.

Cesarean scar defect, also known as niche, isthmocele, uteroperitoneal fistula and uterine diverticulum, is a known complication after cesarean delivery. Due to the rising cesarean delivery rates, niche has become more common and can present as irregular bleeding, pelvic pain, infertility, cesarean scar pregnancy and uterine rupture. Treatments for symptomatic cesarean scar defect vary and include hormonal therapy, hysteroscopic resection, vaginal or laparoscopic repair, and hysterectomy. We report on the safety and efficacy of our method of repairing cesarean scar defects in 27 patients without adverse outcomes: two-layer repair where the suture does not enter the uterine cavity. Our method of laparoscopic niche repair improves symptoms in nearly 77% of patients, restores fertility in 73% of patients, and decreases the time to conception.

Prevalence and Social-Ecological Correlates of Intimate Partner Violence in a Conflict Zone-Evidence From the 2015 Afghanistan Demographic and Health Survey.

This study examined the prevalence and social-ecological correlates of male-to-female intimate partner violence (IPV) in Afghanistan. Using data from the 2015 Afghanistan Demographic and Health Survey, which included 20,793 currently married women, we found that the past-year prevalence of physical IPV was highest (46%), followed by emotional (34%) and sexual forms (6%). Results also showed that the risk of IPV in general was associated with an array of community and societal-, family and relationship-, and person-level factors. Our findings point to potential intervention targets for women in this conflict zone where IPV is a highly pervasive and complex societal challenge.

Exploring the Usability of a Community Resiliency Model Approach in a High Need/Low Resourced Traumatized Community.

This study tested the usability of a non-stigmatizing community-based trauma intervention delivered by trained community members. The Community Resiliency Model (CRM) was taught to a high-crime, low-income community designated as a Mental Health Provider Shortage Area (19 MPSA score). Five groups of Latino, African-American, LGBTQ, Asian Pacific Islander, and Veteran participants (N-57) with a history of complex/cumulative traumas and untreated posttraumatic stress undertook a five-day 40-h CRM training with master trainers. Measures included Treatment Relevance, Use and Satisfaction (TRUSS), Brief CRM Questionnaire (Brief CRM), and Symptom Questionnaire (SQ). Participant preparedness to teach CRM to others was high (98%) and sustained at the 3-6 months follow-up with 93% reporting a daily use. Pre-to post comparison analyses showed a significant decrease in distress indicators and increase in wellbeing indicators. CRM's high usability holds promise for a broader, low cost and sustainable implementation in traumatized and under-resourced communities.

Factors Influencing Formal and Informal Resource Utilization for Mental Distress Among Korean Americans in Southern California.

Despite the high prevalence of mental distress in the Korean American (KA) community, KAs continue to have significantly lower rates of professional mental health utilization than the general U.S. population, making it increasingly critical to study factors related to such utilization. A total of 243 surveys were collected at Korean churches of various denominations in the greater Los Angeles area. This cross sectional study examined KAs' resource utilization using Andersen's Behavioral Model of Health Services Use as a multi-level theoretical framework. Level of education and employment status significantly predicted professional health service utilization. Informal resource utilization was significantly influenced by gender, attitudes toward professional mental health services, acculturation, and views of God and religion. Future studies should further explore which types of interventions or resources would be most effective for KAs to decrease their high levels of mental distress based on their unique intersections and cultural realities.

Impact of Heart Disease Risk Factors, Respiratory Illness, Mastery, and Quality of Life on the Health Status of Individuals Living Near a Major Railyard in Southern California.

The potential health risks for communities that surround railyards have largely been understudied. Mastery and quality of life (QoL) have been associated with self-reported health status in the general population, but few studies have explored this variable among highly vulnerable low-income groups exposed to harmful air pollutants. This study investigates the relationship between self-reported health status and correlates of Heart Disease Risk Factors (HDRF) and Respiratory Illness (RI) with mastery and QoL acting as potential protective buffers. This cross-sectional study of 684 residents residing near a Southern California railyard attempts to address this limitation. Results from three separate hierarchal linear regressions showed that those who reported being diagnosed with at least one type of HDRF and/or RI reported lower perceived health status. For those that lived further from the railyard, mastery and QoL predicted modest increases in perceived health status. Results suggest that mastery and QoL may be helpful as tools in developing interventions but should not solely be used to assess risk and health outcomes as perceived health status may not measure actual health status.

Effect of Perceived Discrimination on Depressive Symptoms in 1st- and 2nd-Generation Afghan-Americans.

While it is well established that Afghan refugees are disproportionately affected by mental health problems, limited evidence exists concerning the psychosocial needs of their children who are transitioning to adulthood in the United States; that is, of 1st- and 2nd-generation Afghan-Americans. The purpose of this study was to examine the effect of perceived discrimination on depressive symptoms in this population, and to determine whether discrimination is buffered by ethnic identity and social support. A convenience sample of 133 1st- and 2nd-generation Afghan-Americans participated in this study by completing a brief survey. We used OLS regression methods to control for covariates, and to sequentially test study hypotheses. The results show that perceived discrimination was significantly associated with high levels of depression. Furthermore, the effect of discrimination on depression was not buffered by ethnic identity or social support. We found that perceived discrimination was a significant source of stress and a risk-factor for negative mental health outcomes among 1st- and 2nd-generation Afghan-Americans. Future research should examine additional pre-dispositional and protective factors for discriminatory experiences and associated health outcomes.

Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul.

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Casting for determinants of blastocyst yield and of rates of implantation and of pregnancy after blastocyst transfers.

OBJECTIVE: To identify determinants of blastocyst yield, implantation rate, and pregnancy outcome. DESIGN: Retrospective analysis of outcomes of 1,653 cycles of IVF. SETTING: Private infertility clinic. PATIENT(S): Couples presenting to an infertility clinic for IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Blastocyst yield, implantation rate, and pregnancy. RESULT(S): Of a broad array of potential determinants, only the total numbers of oocytes retrieved and properties of day 3 embryos were consistently predictive of blastocyst formation. Relative to numbers of oocytes fertilized by intracytoplasmic sperm injection (ICSI), yields of quality blastocysts were highest in cycles in which <10 oocytes were retrieved. Blastocyst yield was closely linearly correlated with average numbers of blastomeres in embryos on day 3. As oocyte yields rose, average grades and the implantation potential of the blastocysts selected for transfer increased by approximately 0.015 and 0.15%, respectively, for each additional oocyte. Independently, the implantation potential of blastocysts decreased 1.1% for each advancing year in age of the oocyte provider, and, for autologous transfers, uterine receptivity declined an additional 0.6% per year. Higher yields of blastocysts from cycles with high oocyte numbers afforded better selection of blastocysts for transfer, supporting higher overall implantation and pregnancy rates. CONCLUSION(S): While the proportion of fertilized oocytes that progressed to quality blastocysts diminished as numbers of recovered oocytes rose, rates of implantation and pregnancy after transfer of the selected best blastocysts increased. The age of the oocyte provider and oocyte yields independently impacted blastocyst implantation potential and uterine receptivity after controlled ovarian hyperstimulation, ICSI, and blastocyst transfer.