Culturally responsive care for menopausal women.

The experience of menopause is not "one size fits all." Instead, biologic, physiologic, and sociocultural factors strongly affect women's experiences of menopause symptoms and the ways in which they would like to manage their care. By providing culturally sensitive and patient-centered care, clinicians may be able to improve menopause experiences for all of their patients. However, a literature review revealed a lack of information about culturally responsive care for menopause. The first objective of this review is to discuss the ways in which sociocultural identity influences menopause care-seeking and management. The second objective is to introduce a framework of culturally responsive care for menopause.

COVID-19 Vaccine Perspective From Adolescents' Lens in the US.

Introduction The COVID-19 pandemic has presented an unprecedented global health issue. The World Health Organization estimates 773 million confirmed cases and 7 million deaths. Vaccination continues to be the most effective way to prevent COVID-19 and has demonstrated safety and efficacy in all age groups. Though a lot of studies have looked at COVID-19 vaccination acceptance and hesitancy in adults, there is scarce research addressing adolescent vaccination readiness. COVID-19 infection in this age group may result in lost school days, school and community transmission, and loss of productivity for parents. Aim This study aims to determine COVID-19 vaccination rates and factors influencing its acceptance and hesitancy in adolescents in a community setting. Methods A voluntary survey was conducted at a local high school in May 2023. Information was collected about the demographics of adolescents and the educational background of parents/guardians. The survey assessed the COVID vaccine rate, reasons for COVID-19 vaccine acceptance or refusal, number of doses of COVID-19 vaccine and boosters received, prior history of COVID-19 infection, source of information on COVID-19 vaccine, flu vaccine acceptance by the students, and whether they would be willing to take a COVID-19 vaccine booster. Results Four hundred participants, ranging in age from 13 to 19, were surveyed. The vaccination rate in boys was comparable to that in girls. 72% received at least one COVID-19 vaccine, and 66% were considered completely vaccinated. Of those completely vaccinated, 80% had undergone further updated COVID-19 booster vaccinations. Adolescents whose parents/guardians were college graduates had a higher vaccination rate than those whose parents/guardians were not. Caucasians and Asians had a higher vaccination rate compared to African Americans and mixed races. The vaccination rate was not statistically different in adolescents with prior COVID-19 infection versus no prior infection. Flu vaccination was associated with higher COVID-19 vaccination rates. Lack of trust was an important reason for vaccine hesitancy, along with questions about efficacy, concerns about side effects, parent/guardian decisions, and religious reasons. Protecting oneself, family/friends, and community were the major reasons to take the vaccine. Parents/guardians, physicians, peers, television, social media, flyers, and schools were the primary sources that adolescents relied on for information about the COVID-19 vaccination. Conclusion Lower education attainment among parents/guardians, African Americans, and mixed races was associated with lower vaccination rates. Lack of trust in the vaccine, questions about efficacy, and fear of side effects were the most frequently cited reasons for vaccine hesitancy. Parent/guardian influence and religious reasons were other significant reasons for vaccine hesitancy. Flu vaccination was associated with higher COVID-19 vaccination rates. Understanding factors influencing COVID-19 vaccination will allow us to address barriers to COVID-19 vaccination and other vaccinations appropriate for this age group. Educating adolescents in schools, involving local and state health departments to increase awareness about the vaccine, and educating parents and guardians along with the teenagers can help increase the acceptance of the vaccine. These interventions will also positively affect the acceptance of the booster and prepare us for any future pandemics.

Postpartum Opportunistic Salpingectomy Compared With Bilateral Tubal Ligation After Vaginal Delivery for Ovarian Cancer Risk Reduction: A Cost-Effectiveness Analysis.

OBJECTIVE: To compare the cost effectiveness of opportunistic salpingectomy and bilateral tubal ligation for sterilization immediately after vaginal delivery. METHODS: A cost-effectiveness analytic decision model was used to compare opportunistic salpingectomy with bilateral tubal ligation during vaginal delivery admission. Probability and cost inputs were derived from local data and available literature. Salpingectomy was assumed to be performed with a handheld bipolar energy device. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2019 U.S. dollars per quality-adjusted life-year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to determine the proportion of simulations in which salpingectomy would be cost effective. RESULTS: Opportunistic salpingectomy was more cost effective than bilateral tubal ligation with an ICER of $26,150/QALY. In 10,000 patients desiring sterilization after vaginal delivery, opportunistic salpingectomy would result in 25 fewer ovarian cancer cases, 19 fewer ovarian cancer deaths, and 116 fewer unintended pregnancies than bilateral tubal ligation. In sensitivity analysis, salpingectomy was cost effective in 89.8% of simulations and cost saving in 13% of simulations. CONCLUSION: In patients undergoing sterilization immediately after vaginal deliveries, opportunistic salpingectomy is more cost effective and may be more cost saving than bilateral tubal ligation for reducing ovarian cancer risk.

High fidelity one-pot DNA assembly using orthogonal serine integrases.

BACKGROUND: Large serine integrases (LSIs, derived from temperate phages) have been adapted for use in a multipart DNA assembly process in vitro, called serine integrase recombinational assembly (SIRA). The versatility, efficiency, and fidelity of SIRA is limited by lack of a sufficient number of LSIs whose activities have been characterized in vitro. METHODS AND MAJOR RESULTS: In this report, we compared the activities in vitro of 10 orthogonal LSIs to explore their suitability for multiplex SIRA reactions. We found that Bxb1, ϕR4, and TG1 integrases were the most active among the set we studied, but several others were also usable. As proof of principle, we demonstrated high-efficiency one-pot assembly of six DNA fragments (made by PCR) into a 7.5 kb plasmid that expresses the enzymes of the ß-carotenoid pathway in Escherichia coli, using six different LSIs. We further showed that a combined approach using a few highly active LSIs, each acting on multiple pairs of att sites with distinct central dinucleotides, can be used to scale up "poly-part" gene assembly and editing. CONCLUSIONS AND IMPLICATIONS: We conclude that use of multiple orthogonal integrases may be the most predictable, efficient, and programmable approach for SIRA and other in vitro applications.

A review of African American women's experiences in menopause.

IMPORTANCE AND OBJECTIVE: Little is known and reported about the experiences of African American women as they transition to and experience menopause. Accepted norms are based on the experience of a predominantly White population. The aim of this study is to review available data about the distinct experiences of African American women during the menopause transition and menopause. METHODS: A literature search was developed and executed by the review team in collaboration with a health sciences librarian. The search combined controlled vocabulary and title/abstract terms related to the health status disparities of African Americans in the menopause transition and menopause. The following databases were searched from inception through April 28, 2022: PubMed, Scopus (Elsevier), and Web of Science Core Collection (Clarivate). DISCUSSION AND CONCLUSION: African American women experience distinct differences in physical, psychological, social, and quality of life measures during menopause. Increasing awareness about the unique menopause experiences of African American women is critically important to improve the health of this underserved population.

Barriers to surgical menopause counseling in gynecologic cancers: a quantitative and qualitative study of patients and providers.

OBJECTIVE: The objective of this study is to identify factors associated with receiving surgical menopause counseling in gynecologic cancer patients, as well as patient and provider perspectives, regarding surgical menopause counseling and management. METHODS: We conducted a single-institution mixed-method study combining retrospective chart review and patient and provider surveys. Patients younger than 51 years who experienced surgical menopause after gynecologic cancer treatment from January 2017 to December 2019 were surveyed in April 2021 about experiences with menopause counseling, barriers to care, and quality of life. We then reviewed charts of only patients who fully completed surveys. All gynecologic oncology providers were surveyed about surgical menopause practices. Logistic regression identified factors associated with receiving counseling. RESULTS: Sixty-six of 75 identified met inclusion criteria and received survey invitations. Thirty-five (53%) completed surveys. Sixty percent had documented surgical menopause counseling. Patients who were counseled were younger (43 vs 48.5 years, P = 0.005), more likely to have referrals for menopause care (12 vs 9, P = 0.036), more likely to have menopause providers other than oncology providers (14 vs 8, P = 0.001), and had fewer comorbidities. Decreasing age at surgery increased odds of counseling. Most reported continued menopause symptoms and quality of life disturbances. Half were satisfied with menopause care. Majority preferred counseling from oncology providers. Most providers always counseled on surgical menopause but cited lack of time as the primary obstacle for complete counseling. CONCLUSIONS: Younger age at surgery increased odds of receiving surgical menopause counseling. Gynecologic cancer patients experienced significant menopause-related disturbances. Improved understanding of patient and provider preferences and greater emphases on surgical menopause and survivorship will improve care for gynecologic oncology patients.

Postpartum Salpingectomy Compared With Standard Tubal Ligation After Vaginal Delivery.

OBJECTIVE: To compare operative outcomes of postpartum salpingectomy and tubal ligation after vaginal delivery. METHODS: This retrospective cohort study identified patients who underwent tubal sterilization between January 1, 2009, and December 31, 2019, at a large academic hospital, using the electronic medical record. All patients who delivered vaginally and underwent tubal sterilization during their delivery admissions were included. The primary outcome was total operative time. Secondary outcomes included estimated blood loss, perioperative complications, and readmission within 6 weeks postpartum. Patients who underwent bilateral tubal ligation were compared with those who underwent bilateral salpingectomy using Pearson's χ2 test, Fisher exact, and Student's t test. RESULTS: A total of 317 eligible patients were identified. One hundred and six (94%) salpingectomies were completed using a bipolar electrocautery device. Operative time was 3 minutes shorter in the salpingectomy group, 30 minutes (interquartile range 24-38) compared with 33.5 (26-42) minutes, P=.032. Patients who underwent salpingectomy were more likely to have estimated blood loss of 5 mL or less (our institutional shorthand for minimal blood loss) than women who underwent bilateral tubal ligation (78 [69%] vs 112 [55%], P=.015). There were no significant differences in perioperative complications between the groups. CONCLUSION: When using electrocautery, bilateral salpingectomy can be completed in the immediate postpartum period after vaginal delivery with equivalent operative times to bilateral tubal ligation.

Factors associated with counseling and postoperative hormone therapy use in surgically menopausal women.

OBJECTIVE: To determine the rates of and factors associated with preoperative counseling about menopausal symptoms and use of hormone therapy postoperatively in surgically menopausal women. METHODS: This retrospective chart review included patients who underwent bilateral oophorectomies before age 52 at an academic institution during a 3-year period. We used descriptive analyses to characterize the sample and logistic regression to identify factors associated with preoperative counseling about and postoperative systemic hormone therapy for menopausal symptoms. RESULTS: This review included 152 patients with a mean age of 44 ±â€Š5 years (range 28-51). The indications for surgery were risk reduction (66%), BRCA positive (35%), and history of breast cancer (38%). One-third of women were not counseled preoperatively about menopausal symptoms. Women with cardiovascular disease and older age were less likely to receive preoperative counseling. Preoperative counseling was positively associated with risk reducing surgery.Out of 124 women with postoperative data regarding symptoms and treatment, 90 (73%) experienced vasomotor symptoms, 33 (27%) received hormone therapy (systemic or vaginal), 61 (49%) received other therapies, and 41 (33%) did not receive therapy. Younger age and negative history of breast cancer were significantly associated with systemic estrogen therapy use. CONCLUSIONS: Within our cohort, 66% had no documentation of counseling about menopausal symptoms before surgical menopause. Most women experienced symptoms postoperatively, but less than one-third of symptomatic women received hormone therapy. We have an opportunity to improve anticipatory guidance and informed consent for women undergoing surgical menopause.

Control of ϕC31 integrase-mediated site-specific recombination by protein trans-splicing.

Serine integrases are emerging as core tools in synthetic biology and have applications in biotechnology and genome engineering. We have designed a split-intein serine integrase-based system with potential for regulation of site-specific recombination events at the protein level in vivo. The ϕC31 integrase was split into two extein domains, and intein sequences (Npu DnaEN and Ssp DnaEC) were attached to the two termini to be fused. Expression of these two components followed by post-translational protein trans-splicing in Escherichia coli generated a fully functional ϕC31 integrase. We showed that protein splicing is necessary for recombination activity; deletion of intein domains or mutation of key intein residues inactivated recombination. We used an invertible promoter reporter system to demonstrate a potential application of the split intein-regulated site-specific recombination system in building reversible genetic switches. We used the same split inteins to control the reconstitution of a split Integrase-Recombination Directionality Factor fusion (Integrase-RDF) that efficiently catalysed the reverse attR x attL recombination. This demonstrates the potential for split-intein regulation of the forward and reverse reactions using the integrase and the integrase-RDF fusion, respectively. The split-intein integrase is a potentially versatile, regulatable component for building synthetic genetic circuits and devices.

Telehealth with remote blood pressure monitoring for postpartum hypertension: A prospective single-cohort feasibility study.

OBJECTIVE: Investigate feasibility of telehealth with remote blood pressure monitoring for management of hypertension in postpartum women at risk of severe hypertension after hospital discharge. METHODS: In a single-center, prospective single-cohort feasibility study, women with hypertension in pregnancy participated in a postpartum telehealth intervention for blood pressure management after discharge. The primary feasibility outcome measures were recruitment and retention through 6 weeks postpartum. Secondary outcomes included the incidence of severe postpartum hypertension and/or need for blood pressure treatment after discharge, participant satisfaction, and 6-week hospital readmission. Participants received a tablet and equipment to transmit vital signs to a central monitoring site daily. Participants participated in telehealth or telephone visits with a nurse at 48 h and as needed. RESULTS: Among 1413 deliveries 263 (19%) women had hypertension in pregnancy and 55/124 (47%) of women approached were consented. The retention rate was 95%. Among study participants, the incidence of severe hypertension after discharge was 9 (16%). 29 (53%) of participants required treatment due to exacerbations in blood pressure after discharge, in which 9(16%) were severe. There were no hospital readmissions. Overall 39 (86%) participants were satisfied with the remote monitoring. CONCLUSIONS: Feasibility and participant satisfaction were demonstrated. The incidence of severe hypertension and need for blood pressure treatment after discharge and during 6 weeks postpartum was 16% and 53%. Our results indicate telehealth is a promising strategy for postpartum hypertension management to decrease maternal morbidity and hospital readmission.