Predictors of Human Papillomavirus Vaccination in the Postpartum Period for Individuals Aged 18-26.

Background: Human papillomavirus (HPV) vaccination during the postpartum period is an opportunity for vaccine eligible individuals to be vaccinated. Objective: Identify predictors of vaccine acceptance in the postpartum period among patients aged 18-26. Study Design: A retrospective chart review was conducted to evaluate the rate of HPV vaccination to eligible postpartum patients aged 18-26 who delivered between January 2021 and May 2023 at our institution. Clinical and demographic data were extracted. Comparisons were made between fully vaccinated individuals and those who were unvaccinated or incompletely vaccinated. Variables significantly associated with vaccination status or acceptance were included in a multivariable logistic regression model. Results: Of the 1,130 patients who met the study inclusion criteria, 42.1% were eligible for postpartum HPV vaccination. The average age was 23 years, the majority White (74.5%), and English speaking (93.1%). Nineteen percent of eligible patients accepted HPV vaccination, with differences between those who accepted or declined the vaccine identified in: preferred language, tobacco use, delivering provider's specialty, and receiving any vaccination during pregnancy. Spanish-speaking patients had >5× the odds of accepting the vaccine compared with English-speaking patients. Smokers, patients delivered by a family medicine provider, and those who accepted any vaccine during pregnancy had more than twice the odds of receiving the vaccine postpartum. Conclusion(s): The postpartum period remains an opportunity to provide HPV vaccination. Our study identified patients less likely to be vaccinated prior to delivery, as well as patients who are more likely to accept vaccinations postpartum.

Do gender differences exist in letters of recommendation for reproductive endocrinology and infertility fellowship?

OBJECTIVE(S): To determine if gender differences exist in letters of recommendation (LORs) for reproductive endocrinology and infertility fellowship. DESIGN: Cohort study. SETTING: Academic medical center. PATIENTS: A cohort of applicants to a reproductive endocrinology and infertility fellowship program at a single Midwestern academic institution in a single year. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Quantitative measures included linguistics inquiry and word count analysis, with 4 summary variables and 25 word categories, to quantify tone and themes present by gender. Performing qualitative analysis in parallel to linguistic analysis allowed for the exploration of themes not conveyed in quantitative methods alone. Qualitative measures included the frequency of code themes in LOR by applicant gender. RESULTS: There were 272 letters from 72 applicants, 54 (76%) of which were women and 17 (24%) were men. One applicant was excluded because gender information was not specified; 269 letters were included in the quantitative linguistics and qualitative coding analysis. One hundred 10 letters (41%) were written by women and 159 (59%) by men. LOR written for men had a higher mean word count than those written for women (537 vs. 474, P=.04). Linguistics Inquiry and Word Count analysis exhibited more risk words used to describe men applicants (P=.01). When comparing word categories by letter writer gender, women letter writers more frequently used communal, affect, and home word categories whereas men writers more frequently used affiliation-related words. Qualitative analysis revealed that letters for men applicants described leadership, altruism, rapport with patients, and strong endorsements more frequently, whereas women applicants' letters more often mentioned doubt raisers and disclosures of personal life. In addition, letters for women applicants more often described candidates as drama free, not easy to "fluster," and not complainers. Furthermore, letters for women more frequently disclosed parenthood status. CONCLUSIONS: Gender differences exist among both letter writers and applicants. Qualitative analysis revealed that women applicants were more likely to be described with doubt raisers and personal life disclosures, whereas men were more likely to be described by their altruism and with a strong endorsement. Increasing bias awareness and implementing mitigation strategies would improve gender equity in LOR.

Validation of prognosis-based in vitro fertilization grant selection criteria.

Objective: To validate a prognosis-based scoring system for in vitro fertilization (IVF) grant allocation. Design: Retrospective cohort study. Setting: A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Patients: Grant recipients from 2015 to 2019. Interventions: None. Main outcome measures: Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. Results: A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. Conclusions: A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting.

DMOG Negatively Impacts Tissue Engineered Cartilage Development.

OBJECTIVE: Articular cartilage exists in a hypoxic environment, which motivates the use of hypoxia-simulating chemical agents to improve matrix production in cartilage tissue engineering. The aim of this study was to investigate whether dimethyloxalylglycine (DMOG), a HIF-1α stabilizer, would improve matrix production in 3-dimensional (3D) porcine synovial-derived mesenchymal stem cell (SYN-MSC) co-culture with chondrocytes. DESIGN: Pellet cultures and scaffold-based engineered cartilage were grown in vitro to determine the impact of chemically simulated hypoxia on 2 types of 3D cell culture. DMOG-treated groups were exposed to DMOG from day 14 to day 21 and grown up to 6 weeks with n = 3 per condition and time point. RESULTS: The addition of DMOG resulted in HIF-1α stabilization in the exterior of the engineered constructs, which resulted in increased regional type II collagen deposition, but the stabilization did not translate to overall increased extracellular matrix deposition. There was no increase in HIF-1α stabilization in the pellet cultures. DMOG treatment also negatively affected the mechanical competency of the engineered cartilage. CONCLUSIONS: Despite previous studies that demonstrated the efficacy of DMOG, here, short-term treatment with DMOG did not have a uniformly positive impact on the chondrogenic capacity of SYN-MSCs in either pellet culture or in scaffold-based engineered cartilage, as evidenced by reduced matrix production. Such 3D constructs generally have a naturally occurring hypoxic center, which allows for the stabilization of HIF-1α in the interior tissue. Thus, short-term addition of DMOG may not further improve this in cartilage tissue engineered constructs.