A pilot study evaluating genetic and environmental factors for postpartum depression.

OBJECTIVE: To assess the influence of genetic and environmental risk factors upon postpartum depression. DESIGN: Case-control, prospective study. SETTING: The University of California at San Francisco Obstetric and Gynecology Clinic. PARTICIPANTS: Mothers screened for postpartum depression six weeks after delivery with the Edinburgh Postnatal Depression Scale and recruited as cases and controls. MEASUREMENTS: Eligible subjects completed a series of assessments and a structured clinical interview to confirm diagnosis of depression. Deoxyribonucleic acid was obtained for genotyping of 81 single nucleotide polymorphisms in 12 genes hypothesized to be postpartum depression-related. RESULTS: Twenty-four cases and 24 controls were eligible for analysis. Three single necleotide polymorphisms in the serotonin 2A receptor (HTR2A) gene were associated with postpartum depression. The strongest association at a functional promoter polymorphism (rs6311), a functional promoter single nucleotide polymorphisms (p=0.002, odds ratio 0.25, 95% confidence interval:0.10-0.63), was a finding robust to population stratification. Gene-wide association was significant for HTR2A (permuted p=0.008), but not when corrected for all 12 genes. Analysis of demographic and psychosocial risk factors identified distressed relationship, unplanned pregnancy, and a previous history of depression as significant predictive variables (p≤0.05). CONCLUSIONS: This pilot data suggests deoxyribonucleic acid variations in HTR2A may be associated with postpartum depression. Psychosocial variables were also identified as risk factors. The relative influence of these variables on the manifestation of postpartum depression is yet to be determined.

Use of barrier protection for sexual activity among women who have sex with women.

OBJECTIVE: To assess the frequency and associations of barrier protection use during sexual activity in a population of women who have sex with women (WSW). METHODS: WSW were invited to participate in an international internet-based survey. Information regarding ethnodemographics, sexual health, and barrier use during sexual activities was collected. RESULTS: The study cohort comprised 1557 participants. Barrier use was least prevalent during digital genital stimulation (11.3% ever used barriers) and most prevalent during stimulation with a sex toy (34.4% ever used barriers). Univariate analysis revealed that women in non-monogamous relationships were more likely than monogamous women to always use barrier protection for sexual activity (14.3% vs 3.5%). On multivariate analysis, there was no association between barrier use and frequency of casual sexual activity or history of sexually transmitted infection. Small associations were noted between barrier use and certain sexual activities, age, race, and number of partners. CONCLUSION: Many WSW do not use barrier protection during sexual activity, even in the context of potentially risky sexual behaviors. Safer-sex practices among WSW merit increased attention from healthcare providers and public health researchers.

An Internet survey of demographic and health factors associated with risk of sexual dysfunction in women who have sex with women.

INTRODUCTION: There has been scant attention to predictors of sexual dysfunction in women who have sex with women (WSW). AIM: To investigate the associations of high risk for sexual dysfunction in an Internet cohort of WSW. MAIN OUTCOME MEASURE: A modified version of the Female Sexual Function Index (FSFI) was used to quantify each subject's sexual function. METHODS: Women who have sex with women were invited to participate in an Internet-based survey by invitations posted on e-mail listservs and on social media sites catering to WSW. Ethnodemographic, health status, and sexual/relationship data were collected. RESULTS: The study was completed by 2,433 adult women. Of these, 1,566 participants had complete data on the FSFI and comprised the study cohort; 388 (24.8%) met the FSFI criteria for high risk of female sexual dysfunction (HRFSD). On multivariable analysis, the following variables were found to be independently associated with the HRFSD; moderate or severe subjective bother regarding sexual function (OR 4.8, 95% CI 3.0-7.9 and 13.7, 95% CI 7.5-25.1, respectively), overactive bladder (OAB) (OR 2.1, 95% CI 1.0-4.5), having a nonfemale or no partner (OR 2.3, 95% CI 1.1-4.7 and 3.2, 95% CI 2.0-5.2, respectively). A history of pregnancy was associated with lower odds of HRFSD (OR 0.567, 95% CI 0.37-0.87). Mean FSFI domain scores for all domains except desire were negatively impacted by partner factors and OAB. CONCLUSIONS: A single-item question on sexual bother is strongly predictive of potentially distressing sexual problems in the WSW. A number of health and social factors are associated with risk of sexual problems in the WSW. Assessment of sexual well-being in the WSW is a priority for practicing healthcare providers.

Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace.

Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.

Development and pilot testing of a reflective learning guide for medical education.

BACKGROUND: Reflection is increasingly incorporated into all levels of medical education but little is known about best practices for teaching and learning reflection. AIMS: To develop a literature-based reflective learning guide for medical education and conduct a pilot study to determine whether (1) guide use enhances medical students' reflective writing skills and (2) reflective scores correlate with participant demographics and satisfaction. METHODS: Guide development consisted of literature review, needs assessment, single institution survey, and educational leader consensus. The pilot cohort study compared professionalism reflections written with and without the guide by third-year medical students on their core obstetrics and gynecology rotation. Reflections were scored using a previously validated rubric. A demographics and satisfaction survey examined effects of gender and satisfaction, as well as qualitative analysis of optional written comments. Analyses used independent t-tests and Pearson's correlations. RESULTS: We developed a two-page, literature-based guide in clinical Subjective-Objective-Assessment-Plan (SOAP) note format. There was a statistically significant difference, p < 0.001, in the reflection scores between groups, but no effects of gender or satisfaction. Student satisfaction with the guide varied widely. CONCLUSIONS: A single exposure to a literature-based guide to reflective learning improved written reflections by third-year medical students.

Burden, responsibility, and reward: preceptor experiences with the continuity of teaching in a longitudinal integrated clerkship.

BACKGROUND: To address challenges to clinical education, clerkships should be designed to promote continuity of educational experiences including continuity in teaching. Yet, little is known about how continuity in teaching impacts clinical teachers. Experiences of clinical teachers who precept students during a longitudinal integrated clerkship (LIC) must be examined. METHOD: The authors interviewed 27 preceptors who could compare their LIC with traditional clerkship teaching experiences. RESULTS: Teaching during an LIC had a significant impact on preceptors' time, effort, and clinic responsibilities. Preceptors felt they bore sole responsibility for teaching a discipline and ensuring students' learning, and they experienced a deep sense of reward observing students' growth. CONCLUSIONS: To support and sustain the reward of LIC teaching for faculty, LIC developers should focus on targeted faculty development and resource allocation to clinical teaching.

A critical intervention in lesbian, gay, bisexual, and transgender health: knowledge and attitude outcomes among second-year medical students.

BACKGROUND: Lesbian, gay, bisexual, and transgender (LGBT) persons represent an underserved population susceptible to health care disparities. DESCRIPTION: In February 2004, we implemented an LGBT health curriculum for students at the University of California at San Francisco. Confidential matched questionnaires elicited students' knowledge, attitudes, and beliefs about LGBT health issues before and after the intervention. EVALUATION: The surveyed population (52% response rate) was demographically similar to the entire class. There was statistically significant change in the responses to 4 of 16 questionnaire items (p

Neonatal outcomes in immediate versus delayed conceptions after spontaneous abortion: a retrospective case series.

OBJECTIVE: This study was undertaken to determine differences in neonatal outcomes between successful pregnancies conceived immediately after a spontaneous abortion (SAB) and successful pregnancies conceived after two menstrual cycles or at least 100 days from the spontaneous abortion. STUDY DESIGN: This study was a retrospective case series. Deliveries were identified from the University of California-San Francisco Perinatal Database among patients with a history of one SAB. Medical records of 268 patients were reviewed. Sixty-four patients fulfilled study criteria, with 19 in the immediate conception group and 45 in the delayed conception group. Categorical variables were analyzed using chi(2) tests and Fisher exact tests for variables with expected values of <5, whereas continuous variables were analyzed using Student t tests. RESULTS: Neonatal outcomes for the 2 groups were similar, although neonates in the delayed conception group were more likely to have at least one of the following: low birth weight, an Apgar score <7 at 5 minutes, or admission to the neonatal intensive care unit. CONCLUSION: In this small retrospective case series, there was no evidence of adverse neonatal outcomes associated with conception immediately after a SAB.

Risk factors for ovarian cancer: lesbian and heterosexual women.

PURPOSE/OBJECTIVES: To compare the distribution of risk factors for developing ovarian cancer in lesbian and heterosexual women. DESIGN: Secondary analysis of a retrospective medical record review. SETTING: Urban health clinic with special outreach to lesbians. SAMPLE: Typical participant (N = 1,019) was 42.9 years old and white (70%). Most were without health insurance, and 99% were poor (< $15,780 annual income). The majority (58%, n = 586) described themselves as heterosexual; 42% (n = 433) said they were lesbian. METHODS: Data were collected from medical records and analyzed using analysis of covariance and logistic regression techniques. MAIN RESEARCH VARIABLES: Ovarian cancer risk factors (parity, exogenous hormone use, smoking, body mass index [BMI], and tubal ligation/hysterectomy). FINDINGS: Lesbians had a higher BMI; heterosexual women had higher rates of current smoking and a higher incidence of the protective factors of pregnancy, children, miscarriages, abortions, and use of birth control pills. CONCLUSIONS: The results of this study indicate that lesbians may have an increased risk for developing ovarian cancer. A study designed specifically to explore the risk factors of lesbian and heterosexual women for developing ovarian cancer must be undertaken to confirm these findings. IMPLICATIONS FOR NURSING PRACTICE: Differences in risk levels may exist for lesbians; therefore, healthcare providers must become comfortable asking questions about sexual orientation and behavior.