Sexual Behavior and Contraceptive Use at Brown University: 1975-2011.

OBJECTIVE: To assess sexual behaviors and contraceptive use in a sample of Brown University students. STUDY DESIGN: A total of 255 undergraduate students responded to an anonymous online survey in May 2011. The survey addressed level of sexual activity, behaviors, and contraceptive use. Female responders were compared to results from surveys conducted in 1975, 1986, 1989, and 1995. RESULTS: Of the surveyed undergraduates 62% were sexually active. Sexual activity among women was similar to that of previous survey years. Contraceptive pills were the most common primary contraceptive method, reported by 59% of students, and 32% used dual method contraceptive use for sexually transmitted disease (STD) and pregnancy prevention. We observed a plateau in condom use among women in 2011 after an increase from 1975-1995. Use of long-acting reversible contraception (LARC) was uncommon (3%). CONCLUSION: Educational efforts should emphasize the effectiveness of LARC and dual method contraceptive use to reduce the risk of STDs and unintended pregnancies.

Impact of obesity on outcomes of hysterectomy.

STUDY OBJECTIVES: To evaluate the impact of obesity on complications of hysterectomy. STUDY DESIGN: Retrospective cohort study (Canadian Task Force II-2). SETTING: The Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI. PATIENTS: Patients who had a hysterectomy at WIH between July 2006 and January 2009. INTERVENTIONS: Hysterectomy by any mode. MEASUREMENTS AND MAIN RESULTS: We collected data from medical records of all laparoscopic hysterectomies during the time period and collected data from a random subset of abdominal and vaginal hysterectomies. The independent variable, body mass index, was grouped according to World Health Organization guidelines. A composite of surgical complications was generated. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We collected data from 907 hysterectomies, and 29.9% (n = 267) of the population was obese. Eighteen percent of patients (n = 154) had at least 1 complication. Compared to non-obese women, obese women were at increased odds of having any complication (OR 1.62, 95% CI 1.12-2-34). Performing subgroup analyses by mode of hysterectomy and controlling for confounding factors, we were unable to detect differences odds of complications between obese and non-obese women who underwent either an abdominal, vaginal, or laparoscopic hysterectomy. CONCLUSION: In our study, we found that among women who had a hysterectomy, obese women had a higher rate of complications than nonobese women.

Women presenting to an emergency facility with abnormal uterine bleeding: patient characteristics and prevalence of anemia.

OBJECTIVE: To describe the population of women seeking urgent medical attention for abnormal uterine bleeding (AUB), in terms of symptoms, medical history and clinical examination findings, and to determine characteristics associated with anemia in this population. STUDY DESIGN: We performed a retrospective cohort study of patients seen in the Women and Infants Hospital Emergency Room for AUB from August 2005 to February 2006 (n = 378). Data collected included demographic factors, clinical history, physical examination findings, and laboratory and radiologic findings. We calculated prevalence ratios for moderate to severe anemia (defined as hemoglobin <10 g/dL) and sensitivity and specificity of clinical characteristics for identifying women with anemia. RESULTS: The median age of patients was 32 years (range, 12-72 years). Approximately half (49.2%) had a concurrent medical condition which could affect their treatment options, and 14% had moderate to severe anemia. The only factors associated with moderate to severe anemia were (1) having both tachycardia and hypotension, (2) duration of bleeding >7 days and (3) hemoglobin of <10 g/dL in the previous year. CONCLUSION: A substantial proportion of patients seeking urgent medical attention for AUB had potential contraindications for the mainstays of treatment. Clinical symptoms and bleeding history were poorly predictive for moderate to severe anemia in this population of women.

Inflammatory diseases of the breast.

Inflammatory disorders of the breast are common benign breast conditions. Lactational mastitis occurs in breastfeeding women and may be associated with breast abscess in severe cases. Non-lactational inflammatory disorders are less common and include idiopathic granulomatous mastitis, periductal mastitis, and tuberculous mastitis. While these disorders have some similarities in their presentation, each disorder requires a specific treatment regimen for resolution, and correct diagnosis is crucial for appropriate treatment. In this chapter, we will review the presentation, diagnosis, and management of each of these distinct clinical entities.

Executive Summary of the Early-Onset Breast Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at an in-person meeting of stakeholder professional and patient advocacy organizations in April 2019. This article summarizes the relevant literature, existing guidance, and validated tools to guide health care providers in the prevention, early detection, and special considerations of early-onset breast cancer. Substantive knowledge gaps were noted and summarized to provide guidance for future research.