Association between serum estradiol level on day of progesterone start and outcomes from frozen blastocyst transfer cycles utilizing oral estradiol.

PURPOSE: Supraphysiologic serum estradiol levels may negatively impact the likelihood of conception and live birth following IVF. The purpose of this study is to determine if there is an association between serum estradiol level on the day of progesterone start and clinical outcomes following programmed frozen blastocyst transfer cycles utilizing oral estradiol. METHODS: This is a retrospective cohort study at an academic fertility center analyzing 363 patients who underwent their first autologous single (SET) or double frozen embryo transfer (DET) utilizing oral estradiol and resulting in blastocyst transfer from June 1, 2012, to June 30, 2018. Main outcome measures included implantation, clinical pregnancy, live birth, and miscarriage rates. Cycles were stratified by quartile of serum estradiol on the day of progesterone start and separately analyzed for SET cycles only. Poisson and Log binomial regression were used to calculate relative risks (RR) with 95% confidence intervals (CI) for implantation, clinical pregnancy, live birth, and miscarriage with adjustments made for age and BMI. RESULTS: Cycles with the highest quartile of estradiol (mean 528 pg/mL) were associated with lower risks of implantation (RR 0.66, CI 0.50-0.86), ongoing pregnancy (RR 0.66, CI 0.49-0.88), and live birth (RR 0.70, CI 0.52-0.94) compared with those with the lowest estradiol quartile (mean 212 pg/mL). Similar findings were seen for analyses limited to SETs. There was no significant difference in miscarriage rate or endometrial thickness between groups. CONCLUSION: High levels of serum estradiol on the day of progesterone start may be detrimental to implantation, pregnancy, and live birth following frozen blastocyst transfer.

An examination of electronic nicotine delivery system use among college students using social cognitive theory.

Objective: Using social cognitive theory as a framework, this study examined electronic nicotine delivery systems (ENDS) use, related cognitions, and context among college students. Participants: Respondents were 1229 students attending a mid-sized, northeastern university. Methods: A cross-sectional survey was administered and SPSS was used for analysis. Results: Almost 41% of respondents reported ENDS use in the prior month (past-month user), 26.8% reported trying ENDS but no use in the prior month (occasional user), and 32.3% reported never trying ENDS. The results highlight significant associations in past-month versus occasional use and reasons for initation, location for ENDS use, perceived norms for ENDS use, and outcome expectations for ENDS use. Conclusions: This study highlights a need for theory-based, multi-level strategies to reduce ENDS use. Interventions should increase awareness about the risks of ENDS, include peer-based interventions to foster health-promoting campus social environments, and explore the use of policies restricting campus ENDS use.

The use of intraoral devices in reducing oral and dental side effects in head and neck cancer patients undergoing radiotherapy - a systematic review.

PURPOSE: To evaluate whether intraoral devices reduce the adverse oral and dental effects of radiotherapy in head and neck cancer patients. MATERIALS AND METHODS: A systematic search of the Medline and Embase databases for articles published before March 2019 was performed by two independent reviewers. Studies published in English that evaluated whether intraoral devices reduced the risk of radiotherapy-related complications in patients receiving radiotherapy to the head and neck region were included. The kappa statistic was used to calculate the level of inter-reviewer agreement. RESULTS: Five studies met the inclusion criteria, although only one was considered to be a low risk of bias. One study reported that intraoral devices did not reduce the severity of mucositis after 7 weeks. The remaining four studies reported that intraoral devices reduced the risk of xerostomia, mucositis, trismus, dysphagia, and dental caries over 2 to 6 months. CONCLUSION: There are limited data to support the use of intraoral devices in head and neck cancer patients undergoing radiotherapy. Well-designed clinical studies that consider long-term outcomes are necessary to draw definitive conclusions.

Impact of residual disease at interval debulking surgery on platinum resistance and patterns of recurrence for advanced-stage ovarian cancer.

OBJECTIVE: To evaluate the impact of size and distribution of residual disease after interval debulking surgery on the timing and patterns of recurrence for patients with advanced-stage epithelial ovarian cancer. METHODS: Patient demographics and data on disease treatment/recurrence were collected from medical records of patients with stage IIIC/IV epithelial ovarian cancer who were managed with neoadjuvant chemotherapy/interval debulking surgery between January 2010 and December 2014. Among patients without complete surgical resection but with ≤1 cm of residual disease, the number of anatomic sites (<1 cm single anatomic location vs <1 cm multiple anatomic locations) was used to describe the size and distribution of residual disease. RESULTS: A total of 224 patients were included. Of these, 70.5% (n=158) had a complete surgical resection, 12.5% (n=28) had <1 cm single anatomic location, and 17.0% (n=38) had <1 cm multiple anatomic locations. Two-year progression-free survival for complete surgical resection, <1 cm single anatomic location, and <1 cm multiple anatomic locations was 22.2%, 17.9% and 7%, respectively (p=0.007). Size and distribution of residual disease after interval debulking surgery did not affect location of recurrence and most patients had recurrence at multiple sites (complete surgical resection: 64.7%, <1 cm single anatomic location: 55.6%, and <1 cm multiple anatomic locations: 71.4%). Controlling for additional factors that may influence platinum resistance and surgical complexity, the rate of platinum-resistant recurrence was similar for patients with complete surgical resection and <1 cm single anatomic location (OR=1.07, 95% CI 0.40 to 2.86; p=0.888), but women with <1 cm multiple anatomic locations had an increased risk of platinum resistance (OR=3.09, 95% CI 1.41 to 6.78 p=0.005). CONCLUSIONS: Despite current classification as 'optimal,' <1 cm multiple anatomic location at the time of interval debulking surgery is associated with a shorter progression-free survival and increased risk of platinum resistance.

The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival.

BACKGROUND: Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes. METHODS: The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]). RESULTS: The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3- and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS: FP+, 85.4%; FP-, 79.4%; P = .411; 5-year IDFS: FP+, 73.7%; FP-, 67.1%; P = .288). Similarly, no difference in overall survival (OS) was observed between the 2 groups (3-year OS: FP+, 95.5%; FP-, 93.5%; P = .854; 5-year OS: FP+, 84.2%; FP-, 81.4%; P = .700). CONCLUSIONS: FP after a breast cancer diagnosis delays the time to treatment by a small amount, but this delay does not lead to inferior IDFS or OS.

Objectively measured chronic disease risk among food pantry patrons.

OBJECTIVES AND DESIGN: This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons. SAMPLE AND MEASUREMENT: Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries. RESULTS: Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services. CONCLUSION: Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population.

Simultaneous Use of Alcohol and Electronic Nicotine Delivery Systems among College Students: Vaping History, Motivations for Use, and Outcome Expectancies.

Introduction: Simultaneous polydrug use of electronic nicotine delivery systems (ENDS) and alcohol among college students is not well understood despite high rates of vaping and alcohol use among this population. The current study examined rates of simultaneous use and compared demographic characteristics, vaping history, motivations for initiating use, and outcome expectancies based on polydrug use status. Methods: An online and paper-and pencil questionnaire was administered to undergraduate students at a university in the northeast of the U.S. Purposive sampling strategies were used and a raffle was offered to incentivize participation. Results: Simultaneous polydrug use was prevalent in the sample of 670 college students, with 55.6% reporting simultaneous and non-simultaneous use, 34.0% reporting simultaneous use only, and 10.4% reporting non-simultaneous use only. An examination of differences based on polydrug use status indicated that students who reported simultaneous and non-simultaneous use were more likely to be males, report vaping daily, and endorse a wide range of motivations for use. Students who engaged in simultaneous use only were more likely to be females, indicate a social contextual-related motivation for initiating use, and had higher scores on appetite control, emotion regulation, and taste sensation outcome expectancies. Students who engaged in non-simultaneous use only were more likely to be nonwhite students and report the lowest expectation of health risks. Conclusions: The findings reveal differences based on simultaneous polydrug use status that can be informative in the development of contextually relevant prevention programming. Future research is needed to further explore simultaneous use of ENDS and alcohol.

Walking Toward a Brighter Future: A Participatory Research Process to Advocate for Improved Walk-to-School Corridors.

Inclusive place-making is an important strategy to ensure that built-environment improvements contribute rather than detract from community health. We conducted participatory research to support 15 youth leaders as they advocated for improvements to their walk-to-school environment. The project included four phases. During Phase 1 (Route and Experience Identification), we visited 21 classrooms in three Bridgeport high schools and used an interactive mapping process with students to identify the most often used walk-to-school routes. Youth leaders also collected questionnaires from 187 peers about their school travel experiences. During Phase 2 (Route Assessment), the youth leaders examined the quality of these routes using the Microscale Audit of Pedestrian Streetscapes assessment tool. During Phase 3 (Data Analysis), the University partners analyzed the data collected in the prior phases. Percentage scores were calculated for each segment and crossing along the routes assessed. We used chi-square tests to examine associations between students' travel model and negative travel-related experiences. Almost all segments (82%) and crossings (91%) examined received a failing grade (<64%). In addition, a greater proportion of students who walk/cycle/skate to school rather than ride in a motor vehicle reported feeling unsafe (p = .001), missing first period (p = .006), and lower grades (p = .001) due to travel-related challenges. The findings from these assessments were used during Phase 4 (Youth Campaign) to advocate for safer routes to schools. We describe both the lessons learned and successes from the project. Other municipalities might benefit from replicating the youth-led, participatory approach used in this study.

Food insecurity: Comparing odds between working-age veterans and nonveterans with children.

BACKGROUND: Low-income, working-age Veterans with children have risk for food insecurity. Less known is extent to which their risk compares to nonveterans. PURPOSE: To evaluate odds of food insecurity for working-age Veterans with children compared to socioeconomically-matched nonveterans with children. METHOD: We constructed a propensity score-matched cohort using 2011-2014 National Health and Nutrition Examination Survey data. Covariate-adjusted logistic regressions estimated Veterans' odds for overall food insecurity and for each level of severity compared to nonveterans. FINDINGS: We matched 155 Veterans to 310 nonveterans on gender, race/ethnicity, education, income. Models were adjusted for age, marital-status, depression, and listed matched variables. Although Veteran-status had no effect on overall food insecurity (odds ratio = 1.09, 95% confidence interval [0.62,1.93]), Veteran-status increased odds for very low food security (odds ratio = 2.71, 95% confidence interval [1.21, 6.07]). DISCUSSION: Veterans do not have higher odds of food insecurity than non-veterans, but they are more likely to have the more severe very low food security (often associated with hunger) than non-veterans. Investigation of food insecurity's impact on Veteran health/well-being is needed.

Conflicting demands that dentists and dental care professionals experience when using social media: a scoping review.

Introduction There are many conflicting demands for dentists and dental care professionals (DCPs) when using social media, for example between using social media for marketing and as professional provider of information. To gain a fuller understanding of how dentists/DCPs should optimally use social media, these conflicting demands need to be explored. The aim of this scoping review was to map out the current state of the literature describing the conflicting demands encountered by dentists and DCPs when using social media and the approaches used to manage these conflicting demands.Methods A scoping review was carried out. PubMed and Web of Science Core Collection were searched using inclusion and exclusion criteria. Data was extracted from the identified articles and analysed.Results The review identified 39 articles for inclusion. Conflicting demands were related to marketing and education with little information about how these conflicting demands can be managed.Conclusions The published literature on dentists'/DCPs' use of social media highlights that there are conflicting demands and little advice on management strategies. To gain an understanding of these conflicting demands, further research is required, including looking at the patient perspective, to inform future practice.

Perceptions Prediagnosis and Social Experiences Postdiagnosis Among a Sample of High-Risk Peruvian Men Who Have Sex With Men.

This pilot study examines associations of perceived stigma pre-diagnosis with experienced stigma and social support post-diagnosis with qualitative data; and quantifies the interplay between pre- and post-diagnosis social factors on depressive symptoms among a sample of newly diagnosed Peruvian men who have sex with men (n = 67 total). Qualitative findings highlight the differences between perceptions of stigma pre-disclosure and actual social experiences post-disclosure for most participants. Perceived stigma pre-diagnosis was significantly related to post-diagnosis social support, B = -0.35, p = 0.03, and marginally associated with experienced stigma, B = 0.29, p = 0.07. Pre-diagnosis perceived stigma was associated with greater depressive symptoms, but only among individuals who reported higher amounts of social support, B = 0.55, p = 0.01. Findings suggest the importance of addressing social perceptions in order to optimize the beneficial effects of social support resources among newly diagnosed individuals.

Impact of pre-diagnosis awareness of HIV-related stigma and dispositional coping on linkage to HIV care among newly diagnosed HIV+ Peruvian patients.

A substantial body of literature has characterized how psychosocial factors, including HIV-related stigma and coping, are associated with HIV testing and HIV care utilization post-diagnosis. Less is known about if certain psychosocial characteristics pre-diagnosis may also predict linkage to care among individuals who receive an HIV-positive diagnosis. We examined if pre-diagnosis awareness/perception about HIV-related stigma and dispositional coping styles predicted linkage to HIV care within three months post-diagnosis with a secondary analysis of 604 patients from a randomized controlled trial (Sabes Study). Awareness/perception about HIV-related stigma, dispositional maladaptive and adaptive coping were measured before patients underwent an HIV test. Linkage to care was measured as receipt of care within three months of receiving the diagnosis. After adjusting for covariates, individuals who reported greater dispositional maladaptive coping pre-diagnosis had lower odds of linking to care, OR = 0.82, 95%CI [0.67, 1.00], p = .05. There was also a non-significant inverse association between dispositional adaptive coping pre-diagnosis and linkage to care. These preliminary data suggest the need for further longitudinal research and highlight the potential utility of pre-diagnosis psychosocial assessment and tailored counseling when providing positive HIV diagnosis results.

Implementation and Evaluation of a Physical Activity and Dietary Program in Federal Incarcerated Females.

The purpose of this 3-month quasi-experimental pilot study was to examine the effect of a physical activity and dietary education program on body mass index (BMI) and resilience. Participants were given data-storing pedometers to record their physical activity, attended classes on healthy eating, and used portion control tools from http://ChooseMyPlate.gov . MyPlate usage and commissary purchases were collected weekly. BMI and resilience scores were measured at baseline, 6 weeks, and 12 weeks. Twenty-nine female prisoners completed the study. There was a statistically significant reduction in BMI after 12 weeks (χ2 = 7.56, p = .023) and resilience levels increased but did not reach statistical significance (χ2 = 1.66, p = .437). A physical activity and dietary intervention delivered by a correctional health nurse practitioner was an efficacious approach to reducing BMI and improving resilience among female prisoners.

Isolated para-aortic lymph node metastasis in FIGO stage IA2-IB2 carcinoma of the cervix: Revisiting the role of surgical assessment.

OBJECTIVES: To investigate the utility of para-aortic lymph node dissection among women undergoing radical hysterectomy and pelvic lymph adenectomy for FIGO Stage IA2-IB2 cervical cancer using the National Cancer Database (NCDB). METHODS: We identified patients with stage IA2-IB2 squamous cell, adenosquamous, or adenocarcinoma of the cervix diagnosed 2011-2014 in the NCDB. The primary outcome was the negative predictive value of histologically assessed pelvic lymph node status for para-aortic lymph node status among women undergoing pelvic and para-aortic lymph node dissection. We calculated probability of para-aortic lymph node metastasis conditional on pelvic lymph node status. Finally, we compared overall survival between patients undergoing para-aortic lymph node dissection and those in whom this procedure was omitted. RESULTS: A total of 3212 patients met study inclusion criteria, of whom 994 (30.9%) underwent para-aortic lymph node dissection. In this group, the risk of isolated para-aortic metastasis was 0.11%. The negative predictive value of surgically assessed pelvic lymph nodes to predict para-aortic lymph node status was 99.9% (95% CI 99.9-99.9). Among 93 patients with pelvic lymph node metastasis, 18 (19.4%) had concurrent para-aortic lymph node metastasis. There was no difference in overall survival between women undergoing pelvic and para-aortic lymph node dissection compared with those undergoing pelvic lymphadenectomy only (p = 0.69). CONCLUSIONS: In patients undergoing radical hysterectomy and pelvic lymphadenectomy for stage IA2-IB2 cervical cancer, para-aortic lymph node dissection is not warranted based on the low risk of isolated metastatic disease, and lack of survival benefit associated with the procedure.

Formative Research to Create a Farm-to-School Program for High School Students in a Lower Income, Diverse, Urban Community.

BACKGROUND: Using Social Cognitive Theory as a framework, we examined opportunities for promoting local produce consumption among high school students in a lower-income, ethnically diverse, urban community. METHODS: Six focus groups (N = 53) were conducted with students. Using Atlas.ti qualitative software, data were coded and reviewed to identify code categories which could be taken to represent themes. RESULTS: Students (56.8% girls, 86.5% nonwhite) described local produce as being grown "nearby" or "in Connecticut." Overwhelmingly, students perceived local produce to be of higher quality (eg, "tastes better," "fresher") than nonlocal produce. Students reported that the foods served at school are "unnatural" and "made in a factory." Salient perceived outcomes associated with consuming local produce included "benefits the environment," "builds community and trust," and "keeps taxes down." Students recommended hanging large colorful posters highlighting the positive outcomes associated with consuming local produce in school locations with captive audiences such as lunch lines and classrooms. Labels identifying the food origins of cafeteria foods provided as well as taste tests of local produce might support students' self-efficacy for consuming local fruits and vegetables. CONCLUSIONS: These findings provide theory-based strategies for how to promote local produce consumption among a diverse group of urban high schools students.

Identifying Windows of Opportunity for Active Living and Healthy Eating Policies in Connecticut, 2016.

We examined the relative importance of 23 community issues among elected officials and health directors in Connecticut in 2016. For this cross-sectional study, 74 elected officials (40.7% response rate) and 47 health directors (62.7% response rate), who were purposively sampled, completed a questionnaire to rate their perceived importance of 23 community issues. Eight of these issues were related to active living, healthy eating, or obesity. We used χ2 tests to evaluate differences in responses. Compared with elected officials, health directors significantly more often perceived obesity, access to healthy groceries, poor nutrition, lack of pedestrian walkways, and pedestrian safety as important. Elected officials significantly more often than health directors perceived lack of good jobs, quality of public education, and cost of living as important. Health advocates should work with both groups to develop and frame policies to address both upstream (eg, jobs, education) and downstream (eg, healthy eating policies) determinants of obesity.

Use of a Unique Farmers' Market Program Targeting Lower-Income Community Members.

We examined use of a farmers' market that leverages community partnerships to provide free produce to lower-income persons. Participants (n = 422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees' reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P < 0.001) and in 2015 was low-income (P < 0.001). Most attendees heard about the market through flyers (P < 0.001) and word of mouth (P ≤ 0.001) in 2014 and through local, non-profit services (P < 0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P < 0.001). Impoverished households (P = 0.020) and households receiving more financial support services (P < 0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption.

OBJECTIVE: To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption. DESIGN: Cross-sectional survey research. SETTING: Public high schools in a lower-income, diverse, urban, northeastern community. PARTICIPANTS: A total of 327 students from 3 public high schools. MAIN OUTCOME MEASURE(S): Exposures were prior experience helping on a farm or community garden (yes/no) and having a home garden (yes/no). Outcomes were perceptions about local produce consumption (α = .73), willingness to try new fruits (α = .86) and vegetables (α = .86), and adequate fruit and vegetable consumption (yes/no) as measured by a valid 2-item cup screener. ANALYSIS: Independent t tests, 1-way ANOVA, and chi-square tests were used. RESULTS: Half of students (52.9%) reported prior farm experience; 29.7% reported having a garden at home. Few students reported consuming at least 3 cups/d of vegetables (9.8%) or 2 cups/d of fruit (37.0%). Students with prior farm experience had more favorable scores for local produce perceptions (P = .002) and willingness to try new fruits (P = .001) and vegetables (P < .001) than were students without prior experience. Students with a home garden had more favorable scores for local produce perceptions (P = .02) and willingness to try new fruits (P = .001) and vegetables (P = .001) and more often consumed adequate vegetables (P = .007) than did students without a garden. CONCLUSIONS AND IMPLICATIONS: Those working with high school students might consider offering agriculture experiences that could promote positive fruit and vegetable attitudes and behaviors.