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1.
Arch Gynecol Obstet ; 308(3): 863-870, 2023 Sep.
Article in English | MEDLINE | ID: mdl-36068361

ABSTRACT

PURPOSE: To evaluate the rates of vaginal birth after cesarean (VBAC) among parturients attempting preterm trial of labor following a cesarean delivery (TOLAC) vs. term TOLAC. METHODS: A multicenter historic cohort study was conducted at two university-affiliated centers between August 2005 and March 2021. Parturients in their second delivery, attempting TOLAC after a single low segment transverse cesarean delivery were included. We retrospectively examined computerized medical records of all preterm (< 37 weeks) and term (37-42 weeks) births. Multifetal gestations and postterm deliveries (≥ 42 weeks) were excluded. A univariate analysis was conducted, followed by a multivariate analysis. RESULTS: 4865 second deliveries following previous cesarean were identified: 212 (4.4%) preterm and 4653 (95.6%) term. Hypertensive disorders, diabetes and fertility treatments were significantly more prevalent in the preterm group. VBAC rate was significantly lower in preterm group (57.5 vs 79.7%., p < 0.01), including both spontaneous and vaginal-assisted deliveries. In multivariate analysis, preterm TOLAC was independently associated with TOLAC failure [adjusted odds ratio 2.24, [95% confidence interval 1.62-3.09]. Overall, maternal outcomes were favorable. Rates of uterine rupture, re-laparotomy and postpartum hemorrhage were comparable between groups. Neonatal outcomes were less favorable among the preterm group; however, preterm vs. term TOLAC was not associated with low 5 min Apgar score (aOR 1.76, 95% CI 0.92-3.40). CONCLUSION: In our study, VBAC rates were lower in preterm compared to term deliveries. Maternal outcomes were comparable. Neonatal outcomes were less favorable in the preterm group, more likely due to prematurity than delivery mode.


Subject(s)
Labor, Obstetric , Vaginal Birth after Cesarean , Pregnancy , Female , Infant, Newborn , Humans , Retrospective Studies , Trial of Labor , Cohort Studies , Cesarean Section, Repeat , Vaginal Birth after Cesarean/adverse effects
2.
Isr Med Assoc J ; 25(1): 18-22, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36718731

ABSTRACT

BACKGROUND: Population screening for the BRCA mutations in Ashkenazi Jewish women was recently implemented in Israel and is expected to lead to a 10-fold increase in the diagnosis of asymptomatic carriers. Performing the screening follow-up within multidisciplinary dedicated clinics for carriers is recommended for early detection and risk reduction. OBJECTIVES: : To determine the availability, capacity, and practices of dedicated screening clinic for BRCA carriers in Israel. METHODS: A telephone-based survey of all public hospitals in Israel was conducted October 2020 to August 2021 to determine whether they had a dedicated clinic. Dedicated clinics were defined as multidisciplinary screening clinics offering at least breast and gynecological screening and risk reducing services on site. The clinic director or nurse navigator answered a questionnaire about screening practices followed by a semi-structured interview. RESULTS: Of the ten dedicated BRCA clinics found in Israel, nine participated. Approximately 4500 BRCA carriers are currently being followed. No specialized clinics are available in the southern district or in the northernmost half of the northern district of Israel, leading to a disparity between periphery and center. Screening recommendations, although asserted as adhering to international guidelines, vary among clinics including age at initiating of clinical exam, use of adjunct imaging modalities, and follow-up during lactation and after risk reducing surgery. CONCLUSIONS: There is a suboptimal distribution of dedicated clinics for BRCA carriers in Israel. Nationally centralized attempt to create guidelines that will unify screening practices is warranted, especially considering the expected increase in demand.


Subject(s)
Breast Neoplasms , Gynecology , Ovarian Neoplasms , Humans , Female , Mutation , Israel/epidemiology , Heterozygote , Breast , Breast Neoplasms/diagnosis , Breast Neoplasms/genetics , BRCA1 Protein/genetics , BRCA2 Protein/genetics
3.
Article in English | MEDLINE | ID: mdl-38050984

ABSTRACT

INTRODUCTION: Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS: In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum (N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS: In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION: Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.

4.
BMC Pregnancy Childbirth ; 20(1): 228, 2020 Apr 17.
Article in English | MEDLINE | ID: mdl-32303192

ABSTRACT

BACKGROUND: Women's fertility intentions, their desired number of children and desired inter-pregnancy interval (IPI) are related to micro (personal) and macro (socio-cultural) level factors. We investigated factors that contribute to changes in women's fertility intentions in Israel, a developed country with high birth rates. METHODS: Pregnant women (N = 1163), recruited from prenatal clinics and hospitals in two major metropolitan areas, completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (2 months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum. RESULTS: The findings indicated that background characteristics were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was women's degree of religiosity- the more religious they were, the more children they desired and the shorter their intended IPI. Women's postpartum fertility intentions were mostly consistent with their prenatal reports. In regression models, women who were very-religious, more educated and had previously given birth were less likely to report a lower number of desired of children at postpartum, compared to their prenatal report. Women who reported greater birth satisfaction and gave birth for the first time were less likely to change desired IPI. CONCLUSION: Having a negative birth experience could adversely affect women's fertility intentions. Yet, in a pronatalist and medicalized birth culture, social pressures may decrease the effects of birth experiences on fertility intentions.


Subject(s)
Birth Intervals/psychology , Fertility , Intention , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , Israel , Longitudinal Studies , Parturition , Pregnancy , Prospective Studies , Religion , Surveys and Questionnaires
5.
Birth ; 47(2): 237-245, 2020 06.
Article in English | MEDLINE | ID: mdl-32052497

ABSTRACT

INTRODUCTION: Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS: This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS: Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS: Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.


Subject(s)
Cesarean Section/psychology , Choice Behavior , Parturition , Patient Preference , Adult , Cesarean Section/statistics & numerical data , Cesarean Section, Repeat/psychology , Female , Humans , Israel , Pregnancy , Prospective Studies , Regression Analysis , Religion , Surveys and Questionnaires , Vaginal Birth after Cesarean/psychology
6.
Cancer ; 125(5): 698-703, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30489631

ABSTRACT

BACKGROUND: BRCA1/2 mutation carriers have an increased risk of developing ovarian cancer, leading to the recommendation of risk-reducing salpingo-oophorectomy (RRSO) at 35-40 years of age. The role, if any, that BRCA mutations play in conferring uterine cancer risk, is unresolved. METHOD: Jewish Israeli women, carriers of one of the predominant Jewish mutations in BRCA1/2 from 1998 to 2016, were recruited. Cancer diagnoses were determined through the Israeli National Cancer Registry. Uterine cancer risk was assessed by computing the standardized incidence ratio of observed-to-expected number of cases, using the exact 2-sided P value of Poisson count. RESULTS: Overall, 2627 eligible mutation carriers were recruited from 1998 to 2016, 2312 (88%) of whom were Ashkenazi Jews (1463 BRCA1, 1154 BRCA2 mutation carriers, 10 double mutation carriers). Among these participants, 1310 underwent RRSO without hysterectomy at a mean (± standard deviation) age of 43.6 years (± 4.4 years). During 32,774 women-years of follow up, 14 women developed uterine cancer, and the observed-to-expected rate of all histological subtypes was 3.98 (95% confidence interval [CI], 2.17-6.67; P < .001). For serous papillary (n = 5), the observed-to-expected ratio was 14.29 (95% CI, 4.64-33.34; P < .001), and for sarcoma (n = 4) it was 37.74 (95% CI, 10.28-96.62). These rates were also higher than those detected in a group of 1844 age- and ethnicity-matched women (53% with breast cancer). CONCLUSION: Israeli BRCA1 or BRCA2 mutation carriers are at an increased risk for developing uterine cancer, especially serous papillary and sarcoma. These elevated risks of uterine cancer should be discussed with BRCA carriers.


Subject(s)
BRCA1 Protein/genetics , BRCA2 Protein/genetics , Jews/genetics , Mutation , Ovarian Neoplasms/surgery , Uterine Neoplasms/genetics , Adenocarcinoma, Papillary/epidemiology , Adenocarcinoma, Papillary/genetics , Adult , Cystadenocarcinoma, Serous/epidemiology , Cystadenocarcinoma, Serous/genetics , Female , Genetic Carrier Screening/methods , Genetic Predisposition to Disease , Humans , Israel/ethnology , Middle Aged , Ovarian Neoplasms/genetics , Registries , Retrospective Studies , Salpingo-oophorectomy , Sarcoma/epidemiology , Sarcoma/genetics , Uterine Neoplasms/epidemiology
7.
J Genet Couns ; 27(6): 1386-1394, 2018 12.
Article in English | MEDLINE | ID: mdl-29858758

ABSTRACT

Women with a germline pathogenic variant in the BReast CAncer susceptibility genes (BRCA1 or BRCA2) have an increased risk of early-onset breast and ovarian cancer. In addition to weighing cancer screening and risk-reduction options, healthy BRCA mutation carriers of childbearing age may choose to preclude passing the mutation to the next generation. In the current study, we report on preimplantation genetic diagnosis (PGD) practices in BRCA-positive Israeli women who were offered PGD at no cost. Methods: we measured PGD uptake, decision satisfaction or regret, and predictors of uptake. Of the 70 participant female carriers, only 25.7% chose to use PGD to prevent transmission of the mutation, and were not predicted by age or religious affiliation. For those who chose IVF/PGD, satisfaction with the decision regarding IVF and PGD was significantly higher than those who did not have IVF and PGD (p < 0.04). Experiencing previous infertility was the only significant predictor of uptake of IVF/PGD (p < 0.001), which may suggest that BRCA status is secondary to infertility in the decision-making process for PGD in women with a BRCA mutation.


Subject(s)
BRCA1 Protein/genetics , BRCA2 Protein/genetics , Genetic Carrier Screening , Patient Acceptance of Health Care , Patient Satisfaction , Preimplantation Diagnosis , Adult , Female , Humans , Mutation , Pregnancy
8.
J Genet Couns ; 25(2): 314-24, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26371363

ABSTRACT

Many factors predict the intention to disclose genetic information to relatives. The article examines the impact of patients' socio-demographic factors on their intention to disclose genetic testing results to their relatives. Data were collected in eight genetic clinics in Israel. Patients were requested to fill in a questionnaire after counseling. A convenience sample of 564 participants who visited these clinics was collected for a response rate of 85 %. Of them, 282 participants came for susceptibility testing for hereditary cancers (cancer group), and 282 for genetic screening tests (prenatal group). In the cancer group, being secular and having more years of education correlated positively with the intention to disclose test results to relatives. In the prenatal group, being married and female correlated positively with the intention to disclose. In the cancer group, being religious and with less years of education correlated positively with the view that the clinician should deliver the results to the family. In the prenatal group, being male and unmarried correlated positively with this belief. In both groups, being of young age correlated with the perception that genetic information is private. Varied sociodemographic factors affect the intention to inform family members. Thus, knowing the social background of patients will shed light on people's attitudes to genetic information and will help clinicians provide effective counseling in discussions with patients about the implications of test results for relatives.


Subject(s)
Family/psychology , Genetic Counseling/psychology , Genetic Privacy/psychology , Genetic Testing , Health Knowledge, Attitudes, Practice , Self Disclosure , Adult , Aged , BRCA1 Protein/genetics , BRCA2 Protein/genetics , Breast Neoplasms/genetics , Breast Neoplasms/psychology , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Colorectal Neoplasms, Hereditary Nonpolyposis/psychology , Female , Genetic Predisposition to Disease/genetics , Genetic Predisposition to Disease/psychology , Humans , Israel , Male , Middle Aged , Neoplastic Syndromes, Hereditary/genetics , Neoplastic Syndromes, Hereditary/psychology , Socioeconomic Factors , Surveys and Questionnaires
9.
Isr Med Assoc J ; 18(6): 313-7, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27468521

ABSTRACT

BACKGROUND: Fertility treatments are responsible for the rise in high order pregnancies in recent decades and their associated complications. Reducing the number of embryos returned to the uterus will reduce the rate of high order pregnancies. OBJECTIVES: To explore whether obstetric history and parity have a role in the clinician's decision making regarding the number of embryos transferred to the uterus during in vitro fertilization (IVF). METHODS: In a retrospective study for the period August 2005 to March 2012, data of twin deliveries > 24 weeks were collected, including parity, mode of conception (IVF vs. spontaneous), gestational age at delivery, preeclampsia, birth weight, admission to the neonatal intensive care unit (NICU), and Apgar scores. RESULTS: A total of 1651 twin deliveries > 24 weeks were record- ed, of which 959 (58%) were at term (> 37 weeks). The early preterm delivery (PTD) rate (< 32 weeks) was significantly lower with increased parity (12.6%, 8.5%, and 5.6%, in women with 0, 1, and ≥ 2 previous term deliveries, respectively). Risks for PTD (< 37 weeks), preeclampsia and NICU admission were significantly higher in primiparous women compared to those who had one or more previous term deliveries. Primiparity and preeclampsia, but not IVF, were significant risk factors for PTD. CONCLUSIONS: The risk for PTD in twin pregnancies is significantly lower in women who had a previous term delivery and decreases further after two or more previous term deliveries. This finding should be considered when deciding on the number of embryos to be transferred in IV.


Subject(s)
Embryo Transfer , Fertilization in Vitro , Premature Birth , Adult , Apgar Score , Delivery, Obstetric/statistics & numerical data , Embryo Transfer/adverse effects , Embryo Transfer/methods , Embryo Transfer/statistics & numerical data , Female , Fertilization in Vitro/adverse effects , Fertilization in Vitro/methods , Fertilization in Vitro/statistics & numerical data , Gestational Age , Humans , Infant, Low Birth Weight , Infant, Newborn , Israel/epidemiology , Parity , Pregnancy , Pregnancy Outcome/epidemiology , Pregnancy, Twin/statistics & numerical data , Premature Birth/epidemiology , Premature Birth/etiology , Reproductive History , Retrospective Studies
10.
Int J Gynecol Cancer ; 24(2): 233-7, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24378620

ABSTRACT

UNLABELLED: Controversy exists about the impact of BRCA1/2 mutations on female fertility. Previous studies are small or based on indirect parameters (eg, self-reported infertility), which depend on additional factors unrelated to true fertility potential. Most of the previous studies did not use strict fertility markers. OBJECTIVE: The aim of this study is to evaluate the relation between carrying a BRCA1/2 mutation and fertility using the level of anti-müllerian hormone (AMH), which has been previously shown to be an accurate marker of ovarian reserve and fertility potential. PATIENTS AND METHODS: Forty-one healthy BRCA1/2 mutation carriers, aged 26 to 40 years, attending a multidisciplinary breast and ovarian cancer surveillance clinic, were tested for AMH levels using a 2-site ELISA. Levels were compared with those of our general population and with well-established normograms of the general population. RESULTS: The mean age of carriers was 33.2 years (26-39 years; SD, 3.99 years). The mean parity of carriers was 1.97 (0-7; SD, 1.49). All women carried at least 1 Ashkenazi Jewish founder mutation. The AMH levels for most carriers were in the reference range, 2.71 ± 0.59 ng/mL (approximately 50th percentile of normograms). These levels were similar to those in the control group, in which the AMH levels were 2.02 ± 0.12 ng/mL (P = 0.27). CONCLUSIONS: The AMH levels of healthy BRCA1/2 mutation carriers are similar to those of noncarrier women matched for age; therefore, their ovarian reserve is comparable. This is the only study, to the best of our knowledge, that directly examines ovarian reserve in a relatively large group of carriers with an accurate marker. The results of this study may possibly give reassurance to female carriers concerning fertility potential.


Subject(s)
Fertility/genetics , Genes, BRCA1 , Genes, BRCA2 , Genetic Markers , Ovary , Adult , Anti-Mullerian Hormone/genetics , Carrier State/blood , Female , Genetic Carrier Screening , Humans , Pilot Projects
11.
Rambam Maimonides Med J ; 15(2)2024 Apr 28.
Article in English | MEDLINE | ID: mdl-38717180

ABSTRACT

BACKGROUND: Halacha is the corpus of Jewish law which serves as a life blueprint for observant Jewish individuals. Health professionals counseling halachically observant populations at risk for breast cancer gene (BRCA) mutations should be well informed of the halachic approach to screening for BRCA mutations and subsequent interventions. AIM: To address the intersection of halacha with ethical norms and current medical evidence-based data as they relate to potential and identified BRCA mutation carriers at their various stages of decision-making. RESULTS: Halacha, ethics, and medicine have much in common, but there are specific principles which guide halacha; decision-making in light of halacha is complex and varies with respect to the multi-faceted aspects of screening and intervention. Halacha encourages the exercise of autonomy regarding situations in which beneficence is not clear-cut and dependent on subjective perceptions. CONCLUSIONS: Health professionals knowledgeable of halacha are better equipped to counsel the observant Jewish population at risk of BRCA mutations or identified as mutation carriers, enabling them to present targeted questions to halachic authorities and thus achieve optimal decision-making.

12.
Int J Gynaecol Obstet ; 153(3): 457-461, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33599285

ABSTRACT

OBJECTIVE: We aimed to assess the rates of overall diagnosis of ectopic pregnancy (EP), treatment modality and associated complications during the COVID-19 pandemic compared to the exact time period in the previous year (pre-COVID-19). METHODS: A retrospective cohort study was conducted at a single referral regional center (Shaare Zedek Medical Center, Jerusalem, Israel). Prevalence of the diagnosis of EP, treatment modality and associated complications during the COVID-19 lockdown period in the state of Israel (March 10-May 12, 2020) was compared to patients receiving the same diagnosis during the parallel timeframe in the previous year (2019). RESULTS: Overall there were 29 and 43 cases of EP during the COVID-19 and pre COVID-19 epoch, respectively. COVID-19 period patients presented to the emergency room with significantly higher ß-human chorionic gonadotrophin level; median of 1364 versus 633 IU, P = 0.001. The rate of ruptured EP was; 20.7% versus 4.3% P = 0.031, and surgical approach; 55.2% versus 27.9%, P = 0.001. Significantly higher median volume of blood loss; median volume 852 versus 300 ml, P = 0.042 were observed in patients during the COVID-19 epoch. CONCLUSION: The COVID-19 pandemic led to delayed presentation of patients with EP, and the requirement of subsequent emergency surgical management and excessive blood loss. Special attention should be given to the decline in routine medical care during the pandemic.


Subject(s)
Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/epidemiology , Pregnancy, Ectopic/therapy , Adult , COVID-19/epidemiology , Chorionic Gonadotropin, beta Subunit, Human/blood , Cohort Studies , Delayed Diagnosis , Emergencies , Female , Humans , Israel/epidemiology , Pregnancy , Pregnancy, Ectopic/surgery , Retrospective Studies , Rupture, Spontaneous/epidemiology , Rupture, Spontaneous/surgery , SARS-CoV-2
13.
Eur J Obstet Gynecol Reprod Biol ; 262: 147-154, 2021 Jul.
Article in English | MEDLINE | ID: mdl-34022592

ABSTRACT

OBJECTIVE: In recent years there has been growing interest in the relationship between the workload of an individual practitioner and its short- and long-term consequences on birth outcomes. In this respect, data is limited with regard to midwives' workload. We aimed to evaluate the association between midwives' annual birth workload and the short-term, adverse maternal and neonatal outcomes occurring at birth. STUDY DESIGN: This retrospective cohort study was performed in a single tertiary academic center between 2006 and 2018. All single, live vertex term vaginal births were included and categorized into two groups based on the midwife's median annual volume of births during the study duration. The "high-volume" and "low-volume" groups included births above and below the median annual volume, respectively as a dichotomous variable. Further analyses were performed for the annual volume by deciles. Short term maternal and neonatal outcomes were compared between groups and between deciles. RESULTS: During the study period 140,856 births met the study criteria. The median annual volume of births of a single midwife was 152 [114-195]. Maternal and labor characteristics were comparable between the groups. Maternal outcomes were not significantly associated with the midwifes' annual workload. However, neonates delivered by midwives with "low" annual volume had higher rate of neonatal jaundice (aOR 1.07, 95 % CI [1.00-1.14]) and mechanical ventilation (aOR 1.32, 95 % CI [1.05-1.66). CONCLUSION: Adverse perinatal outcomes are only mildly affected by midwives' annual volume after controlling for the midwife, parturient and neonate's characteristics.


Subject(s)
Midwifery , Delivery, Obstetric , Female , Humans , Infant, Newborn , Parturition , Pregnancy , Retrospective Studies , Workload
14.
Eur J Cancer ; 148: 95-102, 2021 05.
Article in English | MEDLINE | ID: mdl-33743487

ABSTRACT

INTRODUCTION: BRCA1/BRCA2 mutation carriers often undergo risk-reducing salpingo-oophorectomy (RRSO) before natural menopause, raising the issue of hormonal replacement treatment (HRT) use. There is conflicting evidence on the effect of HRT on breast cancer (BC) risk, and there are limited data on risk based on age at exposure. In the general population, HRT users have an increased BC risk (hazard ratio = 1.34). We assessed the impact of short-term HRT use on BC risk among healthy BRCA1/2 mutation carriers, with emphasis on age at exposure to HRT. METHODS: A retrospective cohort of 306 consecutive healthy BRCA1/2 mutation carriers who had undergone RRSO was followed up for a mean of 7.26 years. We compared BC incidence over time in carriers who received HRT with that in those who did not receive. RESULTS: Thirty-six of the carriers were diagnosed with BC, 20 of 148 patients (13.5%) in the HRT group compared with 16 of 155 (10.3%) in the non-HRT group (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 0.7-2.7). In women who were aged 45 years or younger at RRSO, HRT did not affect BC rates. However, in those older than 45 years at RRSO, BC rates were significantly higher in HRT users than in non-users (OR = 3.43, p < 0.05, 95% CI = 1.2-9.8). CONCLUSIONS: In BRCA1/BRCA2 carriers in this study, short-term post-RRSO HRT use was associated with a threefold risk of BC in carriers older than 45 years. These results suggest that risk may be related to time of exposure to HRT around the natural age of menopause, even among BRCA1/2 carriers. Further studies are needed for validation and to guide future recommendations.


Subject(s)
BRCA1 Protein/genetics , BRCA2 Protein/genetics , Breast Neoplasms/drug therapy , Heterozygote , Hormone Replacement Therapy/methods , Mutation , Salpingo-oophorectomy/methods , Adult , Aged , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Follow-Up Studies , Genetic Predisposition to Disease , Humans , Middle Aged , Prognosis , Retrospective Studies , Risk Reduction Behavior , Survival Rate
15.
Qual Health Res ; 17(4): 548-61, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17416708

ABSTRACT

The purpose of this article is to make visible the multiple ways in which doctoral students from various qualitative research traditions learned to think, read, and write interpretively as they completed an assignment requiring the interpretive analysis of a common interview transcript. Students were asked to offer a convincing account of the text and to demonstrate an understanding of what it means to interpret within their selected research tradition. Shared and disputed meanings arising from the interpretive process are presented and discussed. This description of their collective experience might be useful to novice researchers and their mentors.


Subject(s)
Anthropology, Cultural , Comprehension , Narration , Qualitative Research , Research Personnel/education , Humans , Interviews as Topic , Models, Psychological , Reading , Research Personnel/psychology , Writing
16.
Rambam Maimonides Med J ; 7(3)2016 Jul 28.
Article in English | MEDLINE | ID: mdl-27487314

ABSTRACT

BACKGROUND: There is a consensus among the halachic authorities that life-saving actions override Sabbath prohibitions. They are painstaking in securing that the sanctity of the Sabbath is maintained but that not a single life be lost. OBJECTIVE: This manuscript examines if and when a relative's presence at the bedside of a seriously ill individual is potentially life-saving against the backdrop of the scientific literature. It specifically addresses the permissibility of traveling in a motorized vehicle, generally prohibited on the Sabbath, to be with one's relative in hospital for the provision of emotional support. METHODS: Discourse of the halachic issues in the context of the scientific literature. RESULTS: Stress, mental or physical, has been determined as a potentially life-threatening condition in many disease entities. The literature attests to both the patient's and the professionals' perception of the curative potential of the presence of loved ones by advocating for the patient and relieving stress in the hospital experience. Emotional support from a loved one is perceived by some patients as vital to survival. There is halachic consensus that a patient's perception of the emotional need for a relative's presence is sufficient to permit overriding rabbinic prohibitions. Torah prohibitions, which may be overridden for medical needs, may be overridden for emotional support, providing a health professional or family member attests to the fulfilment of this specific need as diminishing the danger to the patient's life. In certain cases, the latter contingency is unnecessary. CONCLUSIONS: Emotional support has an impact on the patient's health status; the degree to which its impact is strong enough to save life is still being studied. As more data from scientific studies emerge, they may be relevant to sharpening the halachic rulings with respect to the issue at hand.

18.
Nurs Ethics ; 15(4): 512-22, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18515440

ABSTRACT

Persons exhibiting mutations in two tumor suppressor genes, BRCA1 and BRCA2, have a greatly increased risk of developing breast and/or ovarian cancer. The incidence of BRCA gene mutation is very high in Ashkenazi Jewish women of European descent, and many issues can arise, particularly for observant Orthodox women, because of their genetic status. Their obligations under the Jewish code of ethics, referred to as Jewish law, with respect to the acceptability of various risk-reducing strategies, may be poorly understood. In this article the moral direction that Jewish law gives to women regarding testing, confidentiality, and other issues is explored. The intent is to broaden nurses' knowledge of how a particular religious tradition could impact on decision making around genetics testing, with the aim of enhancing their understanding of culturally sensitive ethical care.


Subject(s)
Genes, BRCA1/ethics , Genes, BRCA2/ethics , Genetic Testing/ethics , Jews/genetics , Judaism , Women's Health/ethics , Adult , Attitude to Health/ethnology , Breast Neoplasms/genetics , Codes of Ethics , Confidentiality/ethics , Decision Making/ethics , Female , Genetic Carrier Screening , Genetic Predisposition to Disease/ethnology , Genetic Predisposition to Disease/genetics , Humans , Informed Consent/ethics , Informed Consent/psychology , Israel , Jews/ethnology , Judaism/psychology , Mutation/genetics , Nurse's Role , Ovarian Neoplasms/genetics , Religion and Medicine , Women's Health/ethnology
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