Cardiovascular Disease Risk Factor Interventions in Women With Prior Gestational Hypertensive Disorders or Diabetes in North America: A Rapid Review.

Women with previous hypertensive disorders of pregnancy (HDP) or gestational diabetes mellitus (GDM) have a 2- to 3-fold increased risk of cardiovascular disease (CVD). The goal of this rapid review was to summarize evidence of the effectiveness of CVD risk factor interventions for postpartum women with a history of HDP or GDM. A comprehensive search strategy was used to search articles published in 5 databases-Ovid MEDLINE, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase). Observational and intervention studies that identified CVD prevention, screening, and/or risk factor management interventions among postpartum women with prior HDP or GDM in Canada and the US were included. The quality of observational and interventional studies, and their risk of bias, were assessed using appropriate critical appraisal checklists. Eight studies, including 4 observational cohorts, 3 randomized controlled trials, and 1 quasi-experimental study, merited inclusion for analysis. A total of 2449 participants were involved in the included studies. The most effective CVD risk factor intervention was comprised of postpartum transition and follow-up, CVD risk factor education, and advice on lifestyle changes. Most of the observational studies led to improvements in CVD risk factors, including improvements in CVD lifetime risk scores. However, none of the RCTs led to improvements in cardiometabolic risk factors. Few studies have investigated CVD risk factor interventions in the postpartum in women with previous HDP or GDM in North America. Further studies of higher quality are needed.

Les femmes ayant déjà souffert de troubles hypertensifs de la grossesse (THG) ou d'un diabète gestationnel (DG) présentent un risque de maladie cardiovasculaire (MCV) accru de 2 à 3 fois. Cette brève revue de littérature visait à colliger les évidences concernant l'efficacité des interventions se concentrant sur les facteurs de risque de MCV chez les femmes en post-partum ayant des antécédents de THG ou de DG. Une stratégie de recherche exhaustive a été employée pour rechercher des articles publiés dans 5 bases de données (Ovid MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO et Embase). Les études d'observation et d'intervention qui ont identifié des interventions de prévention, de dépistage et/ou de gestion des facteurs de risque des MCV chez les femmes en post-partum ayant déjà souffert de THG ou de DG au Canada et aux États-Unis ont été incluses. La qualité des études observationnelles et interventionnelles, ainsi que leur risque de biais, ont été évalués à l'aide de listes de contrôle d'évaluation critique appropriées. Huit études, dont quatre cohortes observationnelles, trois essais contrôlés randomisés (ECR) et une étude quasi expérimentale, ont été incluses pour l'analyse, impliquant au total 2 449 participantes. L'intervention la plus efficace sur les facteurs de risque de MCV incluait une transition et un suivi post-partum, une sensibilisation aux facteurs de risque de MCV et des conseils sur les changements de mode de vie. La plupart des études observationnelles ont conduit à des améliorations concernant les facteurs de risque de MCV. Cependant, aucun des ECR n'a conduit à des améliorations des facteurs de risque cardiométabolique. Peu d'études ont examiné les interventions sur les facteurs de risque de MCV pendant le post-partum chez les femmes ayant déjà souffert de THG ou de DG en Amérique du Nord. D'autres études de meilleure qualité sont nécessaires.

A 40-Year-Old Man with a 7-Year History of Polyarthritis and a Late Diagnosis of Whipple Disease: A Journey to Resolve the Mystery.

BACKGROUND Whipple disease (WD) is rare, with an incidence of only a few patients per million. It is caused by infection with the gram-positive bacterium Tropheryma whipplei, and presents with symptoms that include joint pain, fever, diarrhea, and weight loss. This report is of a 40-year-old man with a 7-year history of polyarthritis and a late diagnosis of Whipple disease. The atypical nature of his symptoms led to misdirection and misdiagnosis for years. CASE REPORT A middle-aged white man with seronegative migratory polyarticular arthritis underwent 7 years of treatment with steroids, disease-modifying anti-rheumatic drugs (DMARDs), and a TNF (tumor necrosis factor)-alpha inhibitor, all without any clinical improvement. Throughout this period, he had persistent loose stools and iron-deficiency anemia. Extensive diagnostic investigations for various possibilities yielded negative results. However, after 7 years, he began displaying clinical signs of malabsorption. This prompted further evaluation, including an upper-gastrointestinal endoscopy and biopsy, which revealed the presence of PAS (periodic acid-Schiff)-positive Treponema whipplei, which led to the diagnosis of WD. Following initiation of appropriate treatment, the patient experienced complete resolution of symptoms. Retrospectively, all the pieces of this puzzle fell into place, providing a comprehensive understanding of the prolonged medical challenge the patient faced. CONCLUSIONS This case illuminates the diagnostic challenge faced when dealing with migratory polyarticular inflammatory arthritis and fever. This report has highlighted that Whipple disease can be associated with multiple symptoms and signs, which can result in a delay in diagnosis. However, once the diagnosis is confirmed, antibiotic treatment is effective.

Behavioral Welfare Research for the Management of Sanctuary Chimpanzees (Pan troglodytes).

Chimp Haven is a sanctuary for chimpanzees retired from biomedical research, rescued from the pet trade, or re-homed after other organizations could no longer care for them. To provide optimal care for over 300 chimpanzees, Chimp Haven's animal care team includes experts in behavioral science, veterinary treatment, and husbandry practices. To aid these teams in making routine welfare management decisions, a system of behavioral metrics provides objective data to guide decisions and track outcomes. Chimp Haven has built and piloted seven behavioral metric protocols over the past 5 years to provide staff with an objective and comprehensive picture of the chimpanzees' behavioral welfare. The data from behavioral observations, staff surveys, and routine staff documentation are analyzed and processed through Google Forms, ZooMonitor, Microsoft Power Bi, Microsoft Excel, and R. Each metric assists staff in making data-based decisions regarding the management of captive chimpanzees related to abnormal behavior, hair loss, wounding, social relationships, positive reinforcement training and overall wellness. In this article, we explore examples of each metric and how they have been utilized to monitor and make decisions for both social groups of chimpanzees as well as individuals. These metrics can be collected and shared easily in an understandable format, which may provide an important framework for others to follow to enable the tracking of welfare for other sanctuaries, non-human primates, as well as other species.

Victim-Survivors' Prioritization of Reasons for Non-Reporting Adult Sexual Assaults to Law Enforcement.

Despite the potential benefits of reporting a sexual assault to the police, few sexual assault victim-survivors choose to do so. Prior research on reasons for non-reporting has lacked American Indian/Alaska Native representation as well as a quantitative prioritization of non-reporting reasons. This study sought to fill those gaps by using quantitative data from 95 participants in an online, self-administered survey of victim-survivors of adult sexual assaults in Alaska. Descriptive, univariate results revealed great variation in the reasons for non-reporting. Further, which reasons were more commonly endorsed changed when measuring victim-survivor prioritization of reasons (primary, secondary, and tertiary) rather than simple endorsement. Lastly, there were few subgroup differences when conducting bivariate analyses using racial/ethnic identity and the act of reporting other adult sexual assaults in Alaska. The results of this study add to existing literature on non-reporting with an emphasis on changing how we measure the reasons behind non-reporting. The results also signal to criminal justice policy makers and practitioners that proactive, comprehensive efforts must be made to regain the faith and trust of current and potential victim-survivors so that they see the criminal justice system as a viable avenue for securing justice in ways that are meaningful to them.

Early molar pregnancy: experience in a large abortion service.

BACKGROUND: With 1.1 million US women having first-trimester abortions annually, clinicians have an opportunity to diagnose molar pregnancy early. Early moles, however, may lack "classic" diagnostic hallmarks. STUDY DESIGN: This study aimed to assess the accuracy of the diagnosis of hydatidiform mole in women seeking abortion services at a large Planned Parenthood affiliate. We retrospectively identified women with a histopathologic diagnosis of mole from the affiliate's risk management database. The tissue specimens were reviewed by an expert independent pathologist and analyzed by flow cytometry and p57(KIP2) immunohistochemical staining to clarify the diagnosis. RESULTS: Of 21 patients who received an initial histopathologic diagnosis of mole, only six proved to have the condition. The interobserver correlation coefficient (kappa) for pathology examination was (-) 0.353. Overdiagnosis of partial moles was the most common error. CONCLUSIONS: Improved, cost-effective strategies for detection of early moles would benefit patients and providers.

Impact of formal family planning residency training on clinical competence in uterine evacuation techniques.

BACKGROUND: The goal of this study was to assess the impact of formal opt-out family planning training on clinical competence in uterine evacuation. STUDY DESIGN: Residents who participated in newly established, routine opt-out family planning training completed surveys before and after their rotations. The surveys asked residents to report clinical experience and competence in family planning. RESULTS: One hundred ninety-six pre- and postrotation questionnaires were collected for a total response rate of 63%. After completing the rotation, residents reported higher competence in medical abortion, manual uterine aspiration, electric uterine aspiration and dilation and evacuation (p<.001). Residents also reported increased clinical experience with methods of termination, postabortion contraception, including intrauterine contraception, ultrasound and perioperative pain management. CONCLUSIONS: Participation in a formal opt-out family planning rotation results in increased clinical exposure to family planning and in reported competence in pregnancy termination.

Obstetrics and gynecology resident satisfaction with an integrated, comprehensive abortion rotation.

OBJECTIVE: To evaluate obstetrics and gynecology resident satisfaction with a comprehensive, integrated abortion rotation. METHODS: The University of California, San Francisco obstetrics and gynecology residency program includes a 6-week PGY-3 family planning rotation at an in-hospital clinic where abortions are provided up to 23 weeks of gestation. Residents annually evaluate the educational value of all clinical rotations on a 5-point Likert scale, with 5 indicating "maximum value," and 1 "no value." Using data from 1998-2003, we compared ratings of the family planning rotation with all other PGY-3 rotations. We also surveyed residents 1 to 3 years after graduation to assess the rotation qualitatively and quantitatively. RESULTS: Forty residents completed the abortion training, none opted out of training, and all completed the evaluations. Of all rotations in the third year, the family planning rotation was the highest rated (4.70), was similar in value to a high-volume surgical rotation (4.51, P > .10) and the elective rotation (4.45, P >.05), and surpassed the average score for all inpatient rotations (4.00, P < .001), continuity clinic (4.10, P < .001), and outpatient clinical experiences (4.06, P <.01). According to residency graduates, the family planning rotation was rated 4.8 (where 5 indicates "far greater value" than other rotations), and 85% of respondents rated it of "maximum learning value". CONCLUSION: Obstetrics and gynecology residents place high value in the University of California, San Francisco PGY-3 family planning rotation during their training and in their first years of practice.

Enhancing resident training in abortion and contraception through hospital-community partnership.

OBJECTIVES: The study was undertaken to assess the efficacy of a hospital-community rotation in abortion and contraception. STUDY DESIGN: The program was developed and implemented by the Planned Parenthood League of Massachusetts (PPLM) and the Department of Obstetrics and Gynecology at Baystate Medical Center in November 2000. Abortion and contraceptive training is integrated into postgraduate year 3 and includes didactic presentations and 10 mandatory clinical sessions in first trimester abortion care. RESULTS: Five residents complete the program annually. Before rotation, residents report their competence in first-trimester abortion procedure as 2 on a scale of 1 to 5 (1=not at all comfortable, 5=very comfortable). After rotation, the reported competency rating is 4.5 on the same scale. Residents, trainers, and staff report high satisfaction with the program. CONCLUSION: A collaborative hospital-community rotation in abortion and contraception increases residents' clinical competence in these areas and is highly acceptable to residents, faculty, and staff.