Non-black Women Research Articles

Self-esteem assessment of young female university students according to race/skin color criteria.

Objective:to evaluate and compare the self-esteem of young female university students aged between 18 and 24 years old according to race/skin color criteria.Method:a cross-sectional and quantitative study, developed with 240 undergraduate female students from a public Brazilian university. Data collection took place online through a structured questionnaire that included the participants’ sociodemographic and lifestyle habits, and the Rosenberg Self-Esteem Scale. For data analysis, descriptive statistics, association test, and comparison of means were used.Results:most of the young women had a mean level of self-esteem. No statistically significant association was found among the “self-esteem level” and “self-reported skin color or race” variables.Conclusion:although no significant association was identified between self-reported skin color or race and level of self-esteem, young black women have lower mean self-esteem scores than young non-black women. Strategies that strengthen the self-esteem of young female university students are necessary to prevent harms to their physical and mental health, and, consequently, to their academic performance.

394: The fourth trimester in high deprivation areas: Are we missing the highest risk patients?

The postpartum period is increasingly recognized as a critical time when women need access to medical care but may be lost to follow-up. SMFM and ACOG recently reinforced the “fourth trimester” as a critical component of both pregnancy care and life-long health for women. We aimed to examine the association between area deprivation index (ADI) and receipt of postpartum care (PPC) to test how race and other risk factors may inform targeting populations at highest risk of falling out of PPC. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” developed by the University of Wisconsin, which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Receipt of PPC was examined across ADI quartiles from least (1st quartile) to most (4th quartile) disadvantaged. Patient-level variables including race, stress levels, depression scores, and medical comorbidities were tested for effect modification in the relationship between deprivation and PPC. 848 pregnant women were included. Women are significantly less likely to receive PPC as deprivation levels increased, from 90% in areas of lowest deprivation to only 64% in areas of highest deprivation. Black race did not significantly modify this relationship although notable disparities exist with black women were less likely to receive PPC than non-black women in both areas of low (67.4% versus 91.5%) and high deprivation (64% versus 71%). 40% of women in areas of highest deprivation fall out of care during the postpartum period. There is also racial disparity in PPC with black women significantly less likely to receive PPC than non-black women in both areas of low and high deprivation. ADI can identify specific geographic regions where targeted interventions to improve PPC would be highest yield.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1126: Early pregnancy stress and depression: differences among race and parity

Socioeconomic deprivation, stress, and depression are associated with poor pregnancy outcomes. How race and parity interact with social deprivation to influence stress and depression is unknown. In this analysis, we examined the association between high deprivation and maternal stress and depression in early pregnancy, as influenced by race and parity. This analysis was part of a prospective cohort study designed to identify novel markers for preterm delivery. Area of deprivation index (ADI) was derived from participants’ address using the “Neighborhood Atlas” (University of Wisconsin) and state census data. ADI score is based on various factors contributing to socioeconomic advantage/disadvantage (education, housing etc.) The Perceived Stress Scale (PSS) quantified stress and the Edinburgh Perinatal Depression Scale (EDPS) identified women with depression. Risk for moderate to high stress and depression were compared by level of ADI and were stratified by race and parity. We included 848 women. Those with ADI above the median were significantly more likely to report moderate/high stress levels (RR 1.4, 95%CI 1.2-1.6) and nearly 3 times more likely to be diagnosed with depression in the 1st trimester (2.9, 95%CI 2.0-4.0). The relationships between perceived stress and depression with ADI both above and below the median were not significantly different between black and nonblack women. However, parity demonstrated a significant interaction in the relationship between stress with ADI. The relationship between deprivation and stress was stronger in nulliparas than multiparas, who had higher but more stable stress levels across deprivation scores. The relationship between deprivation and depression did not differ by race or parity. High ADI is associated with significantly increased rates of stress and depression in early pregnancy, with over half of women at high deprivation reporting moderate/high stress and 20% screening positive for depression. ADI is a clinically obtainable characteristic that can target women at risk for high stress and depression in early pregnancy.

800: Area deprivation index and adverse obstetric outcomes

Preterm birth and low birth weight continue to be vexing obstetric and pediatric problems, complicating many pregnancies, with few effective interventions, and troubling racial disparities. Our objective was to examine the associations between area deprivation index (ADI), race, and adverse obstetric outcomes to target populations at highest risk. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” (University of Wisconsin), which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Preterm birth < 37 weeks and low birth weight (birthweight < 2500 grams) were compared across ADI quartiles from the least (1st quartile) to the most (4th quartile) disadvantaged. The analysis was stratified by race to explore the effect of race on the relationship between deprivation and adverse obstetric outcomes. 848 pregnant women were included. Low birth weight significantly increased as ADI increased, from 7% in areas of lowest deprivation to 20% in areas of highest deprivation (Table). Preterm birth less than 37 weeks and less than 34 weeks increased as deprivation increased with a 2 times higher risk for PTB < 37 and and nearly 3 times the risk for PTB < 34 weeks at the highest quartile of neighborhood deprivation. Notable disparities exist with nonblack women even at the most highly disadvantaged ADI still having a lower risk for LBW (8.3%) than black women at low ADI (17.4%). Increasing ADI is associated with a significant increase in risk for LBW and to a smaller extent risk for preterm birth, with notable racial disparities. Future studies testing actionable screening and prevention interventions targeted specifically for populations living in high neighborhood disadvantage should be performed to minimize risk for LWB and PTB outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

276: Inpatient management protocol reduces racial disparity in treatment of severe maternal hypertension

Prompt treatment of severe maternal hypertension (systolic ≥160 mmHg or diastolic ≥110 mmHg for 15 minutes) is recommended within 60 min. Protocol based treatment reduces severe maternal morbidity (SMM). Non-Hispanic black women are at increased risk of SMM from preeclampsia. The effect of protocol based hypertension treatment on racial disparity is understudied. We examined the impact of protocol based treatment in black women. This is a retrospective cohort study of women with severe maternal hypertension from 2015 to 2018. The primary outcome was acute treatment < 60 min, pre- vs post- 2016 protocol implementation. We compared demographics and SMM, between women treated < vs ≥ 60 min. Race was self-identified. Regression analysis incorporated factors including protocol implementation into a model to predict treatment < 60 min and SMM. Before entry, continuous variables were dichotomized for interpretability based on the value that was most discriminative on its receiver operating characteristic curve. Bootstrapping with 1000 repetitions was used for internal validation of area under the curve prediction model. Of 552 women with sustained severe hypertension, 399 were black. Pre- protocol, 30.3% of black and 40.7% of non-black women were treated < 60 min (p = 0.30). Post-protocol, 57.6% of black and 61.1% of non-black women were treated < 60 min (p = 0.54). Treatment disparity between groups was reduced by 6.9% for black women (p=< 0.01). Women with higher pre-treatment systolic and diastolic blood pressure and those treated post-protocol were more likely be treated < 60 min (Table 1). In the regression, treatment post-protocol was the strongest predictor of treatment < 60 min (aOR 3.38 95% CI 2.16-5.29, Table 2). In a separate analysis, treatment < 60 min predicted reduction of SMM (aOR 0.47, 95% CI 0.24-0.91). Inpatient management protocol reduced racial disparity in treatment times. Time to treatment < 60 min is associated with reduced SMM, protocol driven treatment may potentially reduce morbidity related to severe hypertension in black women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Racial disparities in brachytherapy administration and survival in women with locally advanced cervical cancer

ObjectiveBlack women have the highest incidence and mortality from cervical cancer in the United States. This study evaluated whether racial disparities in the receipt of brachytherapy (BT) for locally advanced cervical cancer mediate survival differences by race using the National Cancer Database. MethodsA retrospective cohort study was performed using 16,116 women with stage IB2-IVA cervical cancer treated from 2004 to 2014. Women who did not receive external beam radiation therapy, those with unknown survival data or stage, and those status post hysterectomy or pelvic exenteration were excluded. Multivariate logistic regression was performed to evaluate factors associated with BT use. Using a propensity score adjusted model with inverse probability treatment weighting, adjusted hazard ratios for overall survival were calculated, including an interaction term between BT and race. ResultsOf 16,116 patients, 19.2% were black and 55.8% received BT. Black women were significantly less likely to receive BT (AOR 0.87, 95% confidence interval [CI] 0.79–0.96, p = 0.007) and had worse all-cause mortality (median survival 3.9 years [95% CI 3.6–4.6] versus 5.2 years [95% CI 4.9–5.5] for non-black women, p < 0.001). In the adjusted model, black patients had an increased risk of death compared to non-black patients (AHR 1.14, 95% CI 1.05–1.24; p = 0.002) among women who did not receive BT. However, there was no difference in survival by race when both groups received BT (AHR 1.04, 95% CI 0.95–1.13, p = 0.42; p-interaction = 0.005). ConclusionsBlack women with locally advanced cervical cancer are less likely to receive brachytherapy, which mediates survival differences by race. Improving access to brachytherapy may improve overall survival.

Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections?

To examine the effect of a care bundle on racial disparities in surgical site infections (SSIs). This was a retrospective cohort study of women undergoing cesarean delivery at ≥23 weeks' gestation. The care bundle included routine antibiotics (both cefazolin and azithromycin), chlorhexidine skin preparation, clippers, vaginal cleansing, placental removal by cord traction, subcutaneous tissue closure, suture skin closure, dressing removal in 24 to 48 hours, and postoperative chlorhexidine soap. Our primary outcome was SSI (superficial incisional, deep incisional, and organ/space) occurring up to 6 weeks. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated, adjusting for predefined covariates. Of 2,696 women, 1,947 were black (1,014 in the preimplementation period and 933 in the postimplementation period) and 749 were nonblack (370 in the preimplementation period and 379 in the postimplementation period). Regardless of race, women in the postimplementation period had lower rates of SSI compared with those in the preimplementation period (black: 2.9 vs. 5.2%, aOR: 0.53 [95% CI: 0.33-0.85]; nonblack: 1.1 vs. 3.5%, aOR: 0.28 [95% CI: 0.09-0.89]). There was no interaction by race (p for interaction = 0.94). The care bundle decreased SSI in both black and nonblack women but did not reduce racial disparities.

Preeclampsia outcomes at delivery and race

Objective: The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of preeclampsia.Study design: This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Health care Research and Quality for the years 2012–2014. Women aged 15–54 with a diagnosis of preeclampsia were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. The overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with the risk for specific outcomes such as stroke, acute heart failure or pulmonary edema, eclampsia, and acute renal failure. The risk for severe morbidity was stratified by comorbid risk and compared by race. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect.Results: A total of 101,741 women with preeclampsia from 2012 to 2014 were included in this analysis. The risk for severe morbidity was significantly higher among non-Hispanic black women (9.8%) than non-Hispanic white, Hispanic, and all other women, respectively (6.1, 7.7, and 7.5%, respectively, p < .01). For non-Hispanic black compared to non-Hispanic white, Hispanic, and all other women, risk was higher for stroke (17.1 versus 6.5, 12.7, and 9.3 per 10,000 deliveries, respectively, p < .01) and pulmonary edema or heart failure (56.2 versus 32.7, 30.2, and 38.4 per 10,000 deliveries, respectively, p < .01). Non-Hispanic black women were also more likely than non-Hispanic white women to experience renal failure (136.4 versus 60.4 per 10,000 deliveries, p < .01). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (p < .01). The risk for death was higher for black compared to non-black women (121.8 per 100,000 deliveries, 95% CI 69.7–212.9 versus 24.1 per 100,000 deliveries, 95% CI 14.6–39.8, respectively, p < .01)Conclusion: Black women were at higher risk for severe morbidity and mortality associated with preeclampsia.

1031: There are racial disparities in birth satisfaction for women undergoing induction of labor

Induction of labor (IOL) is one of the most common obstetrical procedures. Racial disparities are present in most obstetric outcomes with Black women at greater risk of perinatal morbidity than non-Black women. Prior studies have demonstrated decreased birth satisfaction associated with IOL. We aimed to determine if there are racial disparities in birth satisfaction for women undergoing IOL. We performed a prospective cohort study of women with term (≥37 weeks) singleton gestations undergoing IOL with an unfavorable cervix at our institution from Jan 2018 to June 2018. Women completed a modified version of the validated 10 question Birth Satisfaction Scale-Revised (BSS-R) postpartum, which utilizes a 5-point Likert scale (1-least satisfied, 5-most satisfied). The total BSS-R ranges from 10-50 with higher scores indicating increased satisfaction. The BSS-R is subdivided into 3 domains of satisfaction (see Table). We compared results among Black and non-Black women. 330 of 414 (79.7%) of eligible patients completed the BSS-R and were included in the analysis (Black: 213 (64.5%) non-Black: 117 (35.5%)). Black women had lower median total BSS-R score than non-Black women (38 [36- 43] vs. 40 [34-42], p=0.02). While there was no difference in domain 1 (stress experienced during labor), there were significant differences between Black and non-Black women for the individual questions in that domain (Table). Specifically, Black women were more likely to state that their “labor was excessively long”; even when achieving a vaginal delivery. In contrast, Black women were more likely to report agreement with the statement “I came through labor unharmed”. There were no differences between Black and non-Black women for domain 2 (quality of care provision). Scores for domain 3 (women’s personal attributes), which reflects underlying anxiety and preparedness for labor, were lower for Black women than non-Black women. We identified racial disparities in birth satisfaction for women undergoing IOL. Specifically, Black women had lower satisfaction with the overall birth process, as well as the domain that reflects preparedness for labor. Disparities in birth satisfaction may contribute to disparities in perinatal outcomes. Further studies should explore interventions to eliminate these disparities.

Chronodisruption is associated with delayed time to conception

Circadian rhythms are important to normal physiologic function. Chronic misalignment between sleep timing and daily biologic rhythms is associated with a number of different diseases. We sought to determine associations between various measures of chronodisruption and time to conception (TTC) in a cohort of pregnancy planners. Prospective cohort. Women planning pregnancy were recruited from the local community. They were asked to wear actigraphy watches continuously for two weeks and followed for TTC. Women included in analysis had at least 7 days of usable actigraphy data and their conception date was confirmed. IVF patients were excluded. Participants who did not conceive were censored at one year. Actigraphy data was analyzed for sleep onset, sleep offset and sleep duration. Most women had set wake-up times due to alarm clock use, therefore day to day variability in timing of sleep was defined as the standard deviation of sleep onset change from one day to the next. This variability was stratified into quartiles as follows: Q1: <67 minutes, Q2: 67-100 minutes, Q3: 100-138 minutes, and Q4: >138 minutes where Q1 was the most regular pattern, and Q4 was the most erratic pattern. Covariates included age, race, BMI, education, income, and smoking status. Our primary outcome was TTC. Log-rank tests and Cox regression models were conducted to generate unadjusted and adjusted hazard ratios for TTC. 176 participants met criteria. 75 were pregnant, and 101 were not by the end of one year followup. In bivariate analysis the following covariates were associated with faster TTC: white, lower BMI, higher income and education. Smoking was associated with longer TTC. Participants with set, regular bedtimes had significantly faster TTC than women with more erratic onset of sleep. The association occurred in a dose-dependent with unadjusted hazard ratios of 4.33 (95%CI: 2.05-9.15), 2.64 (95%CI: 1.20, 5.79), and 2.00 (95%CI: 0.89, 4.49) for Q1, Q2, and Q3 respectively when compared with Q4 group. After adjusting for BMI and income, this association remained significant for women with the most regular sleeping patterns (HR: 2.39, 95% CI 1.08-5.29). Obesity was negatively associated with TTC (HR 0.41, 95% CI: 0.2-0.84) whereas higher income was associated with faster TTC (HR 2.31, 95%CI: 1.01-5.3). These results remained significant for non-black women when the data was stratified by race, and trended similarly for black women. Sleep offset and duration were not associated with TTC. Chronodisruption may be associated with a longer TTC. Further work is needed to determine if establishing set sleeping times would benefit women with subfertility.

Breast cancer awareness in the sub-Saharan African ABC-DO cohort: African Breast Cancer-Disparities in Outcomes study.

A greater understanding of the nature and drivers of poor breast cancer (BC) awareness in sub-Saharan Africa (SSA) will inform much needed awareness programmes. We aimed to assess the level and nature of BC awareness in the multi-country African Breast Cancer-Disparities in Outcome (ABC-DO) cohort of women newly diagnosed with BC during 2014-2017. Awareness indicators were assessed during a baseline interview at/near diagnosis. Logistic/ordinal regression was used to estimate odds ratios (OR) for indicators of BC awareness in relation to woman-level characteristics for individual settings and then meta-analyzed. In the 1,451 women included, almost all Namibian non-black women (n = 104) knew of BC and its curability, while in Namibian black and Zambian women, one in 7 (~ 15%) had not previously heard of BC and 25-40% did not know it was curable. In Uganda and Nigeria awareness was lowest: one in four women had no BC awareness, and 2 in 3 had no knowledge of its cure potential. Low educational level, unskilled employment, low socioeconomic position, rural residence, older age, being unmarried, and in some settings HIV-positivity, were associated with lower BC awareness-e.g., having unskilled employment was associated with not having heard of BC (summary OR 3.37; 95% confidence interval (CI) 2.17-5.23), believing that it is incurable (2.43; 1.81-3.26), and not recognizing a breast lump symptom (1.85; 1.41-2.43) but with between-setting variation (I2 > 68% for all). The findings provide evidence of the level and difference in BC awareness and beliefs across different settings, highlighting the urgent need for context-specific education programmes in the SSA region.

No one to turn to: low social support and the incidence of undesired pregnancy in the United States

ObjectiveYoung women may experience social barriers to achieving their reproductive goals. This analysis explored whether low social support may contribute to the high incidence of undesired pregnancy in young women in the United States. Study designUsing 6 months of data from a prospective cohort of 970 women ages 18–22 years in the United States, we described contraceptive use and applied multivariable logistic regression and standardization to estimate adjusted odds and absolute risk of undesired pregnancy among women reporting low social support versus higher social support. We investigated several measures of contraceptive use as possible explanations for this pathway. ResultsSixty-five pregnancies were reported in the 6 months of the study, of which 30 (46%) were classified as undesired prior to conception. Among young women who reported low social support, 8% reported an undesired pregnancy during the study period as compared to 3% of the young women who reported higher levels of social support. Among non-black women, those who reported low social support had nearly seven times the odds of an undesired pregnancy as compared to women who reported higher social support (aOR: 6.8, 95%CI: 1.7, 27.1). We found no association between social support and undesired pregnancy among young black women. Contraceptive method use differed by social support at baseline, and throughout follow-up. ConclusionsLow social support — defined as the feeling of not having anyone to turn to – may be a risk factor for persistently high levels of undesired pregnancy among young women in the U.S. This association may be driven by differences in contraceptive use by level of social support. ImplicationsInterventions to increase young women's perceptions of social support may reduce the risk of undesired pregnancy for some individuals.

Screening Women Aged 50-59 for CRC Using Fecal Occult Blood Test Produces Outcomes Similar to Men Undergoing Screening Colonoscopy.

Average-risk women aged 50-59years have a lower incidence and mortality of colorectal cancer relative to age-matched men, calling into question the benefit of screening colonoscopy in this age group. We aimed to determine whether FOBT is an effective initial screening test in 50-59-year-old women. We conducted a cross-sectional study using a computerized endoscopic report generator. We identified 320,906 individuals who had average-risk screening colonoscopy and 32,369 who had colonoscopy for positive FOBT. The primary outcome was the positive predictive value (PPV) of FOBT for large polyp(s) greater than 9mm, as a surrogate for advanced neoplasia. Among patients aged 50-59years undergoing screening colonoscopy, men were more likely than women to have large polyps (6.3 vs 4.2%, p < 0.0001). Black women undergoing screening colonoscopy had higher rates of large polyps compared to non-Black women. The PPV in FOBT-positive men aged 50-54 (11.5%) and 55-59 (14.4%) was higher than in women aged 50-54 (6.1%) and 55-59 (5.4%). Despite this lower PPV, women aged 50-54 with a positive FOBT had a similar rate of large polyps as 50-54-year-old men undergoing screening colonoscopy (6.1 vs 6.3%, p = 0.626). CRC screening with FOBT identifies 50-59-year-old men and women with a higher risk of large polyps. Since younger women have a lower risk of large polyps than men, screening with FOBT in 50-59-year-old non-Black women could be an effective screening strategy, with outcomes similar to the use of screening colonoscopy in 50-59-year-old men.

Postpartum hemorrhage outcomes and race

How race is associated with adverse outcomesinthe setting of postpartum hemorrhage is not well characterized. The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of postpartum hemorrhage. This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality for the years 2012-2014. Women aged 15-54 years with a diagnosis of postpartum hemorrhage were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. Overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with risk for specific outcomes such as disseminated intravascular coagulation, hysterectomy, transfusion, and maternal death. Risk for severe morbidity was stratified by comorbid risk and compared byrace. Weights were applied to create population estimates. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect. A total of 360,370 women with postpartum hemorrhage from 2012 to 2014 were included in this analysis. Risk for severe morbidity was significantly higher among non-Hispanic black women (26.6%) than non-Hispanic white, Hispanic, or Asian or Pacific Islander women (20.7%, 22.5%, and 21.4%, respectively, P < .01). For non-Hispanic black compared with non-Hispanic white, Hispanic, and Asian or Pacific Islander women risk was higher for disseminated intravascular coagulation (8.4% vs 7.1%, 6.8%, and 6.8%, respectively, P < .01) and transfusion (19.4% vs 13.9%, 16.1%, and 15.8%, respectively, P < .01). Black women were also more likely than non-Hispanic white women to undergo hysterectomy (2.4% vs 1.9%, P<.01), although Asian or Pacific Islander women were at highest risk (2.9%). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (P < .01). Risk for death for non-Hispanic black women was significantly higher than for nonblack women (121.8 per 100,000 deliveries, 95% confidence interval, 94.7-156.8 vs 24.1 per 100,000 deliveries, 95% confidence interval, 19.2-30.2, respectively, P < .01). Black women were at higher risk for severe morbidity and mortality associated with postpartum hemorrhage.

Remnants of Venus: Signifying Black Beauty and Sexuality

Remnants of Venus examines popular representations of the big booty, often associated with and serving as a stand-in for black women's sexualities. This essay calls into question whether such representations, embodied through racial appropriations by non-black women or satirized by black women like Kara Walker and Nicki Minaj, can exist beyond signs of sexual excess or whether they can be mobilized toward black sexual freedom and an aesthetic of black beauty, as other artists have attempted, from Janelle Monae to Beyonce to young women twerk dancing.

Lack of Impact of Race Alone on Cervical Cancer Survival in Brazil

Objective:To analyze differences in survival between black and non-black women diagnosed with cervical cancer and treated at the National Cancer Institute in Brazil.Methods:This retrospective cohort study was conducted using medical records of patients who were treated for cervical cancer between 2006 and 2009 at the Brazilian National Cancer Institute - Rio de Janeiro - Brazil. The clinical and epidemiological characteristics of black and non-black patients were compared using the chi-square test. Survival functions over five years were calculated using the Kaplan-Meier estimator and compared using the log-rank test. Associations between race and mortality risk were analyzed using the Cox proportional hazards model. P-values <0.05 were considered statistically significant.Results:The study included 1,482 women, of whom 188 (12.7%) were black, 1,209 (81.6%) were non-black and 85 (5.7%) were of unspecified race. The age at diagnosis of the patients ranged from 19 to 84 years (mean 50.1 years; SD±13.2). Hemoglobin <12 g/dL at the time of diagnosis (p=0.008) and absence of surgery as primary treatment (p = 0.005) were more frequent among black women. Cox analysis adjusted for these two factors showed no statistically significant difference in the mortality risk associated with cervical cancer among black and non-black women (HR=1.1 95% CI 0.9-1.5; p=0.27).Conclusion:After adjusting for hemoglobin levels and surgery, race alone was not shown to be a prognostic factor for patients with cervical cancer.

Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy: A Randomized Controlled Trial.

URL: https://www.isrctn.com. Unique identifier: ISRCTN40973936.

OP 31 The effect of ethnicity on the performance of protein-creatinine ratio in the prediction of significant proteinuria in pregnancies at risk of or with established hypertension – An implementation audit and cost implications

Background The replacement of 24-h urine collection by protein-creatinine ratio (PCR) as one of the diagnostic criteria for pre-eclampsia has been recently recommended. However, the literature is conflicting and there are concerns on the impact of demographic factors on the performance of PCR as a screening tool. Methods This was an implementation audit of the introduction of PCR in a London Tertiary obstetric unit. Women with suspected pre-eclampsia (N = 476) were asked to complete a 24-h urine collection and an untimed urine sample for PCR calculation. Multivariate logistic regression was used to assess the independent predictors of significant proteinuria. Results In a pregnant population ethnicity and PCR are the main predictors of 300 mg or more of proteinuria in a 24-h urine collection. With a PCR cut-off of 30 mg/mmol, 41.4% and 22.9% of black and non-black women, respectively, would have been incorrectly classified as non-proteinuric. Sensitivity of 100% is achieved at cut-offs of 8.67 and 20.56 mg/mmol for black and non-black women, respectively. Applying these levels as a primary screening tool to inform for the need to perform a 24-h urine collection in 1000 women, it would lead to a financial saving of £2587 in non-black and to a loss of £2905 black women, respectively. Conclusions PCR has 100% sensitivity and is cost efficient in non-black pregnant women, at a cut-off of 20.5 mg/mmol, in the detection of more than 300 mg in a 24-h urine collection. However, in black pregnant populations the performance of PCR is both clinically and financially suboptimal. Download : Download high-res image (77KB) Download : Download full-size image Download : Download high-res image (133KB) Download : Download full-size image

Population-attributable fraction of tubal factor infertility associated with chlamydia

Chlamydia trachomatis infection is highly prevalent among young women in the United States. Prevention of long-term sequelae of infection, including tubal factor infertility, is a primary goal of chlamydia screening and treatment activities. However, the population-attributable fraction of tubal factor infertility associated with chlamydia is unclear, and optimal measures for assessing tubal factor infertility and prior chlamydia in epidemiological studies have not been established. Black women have increased rates of chlamydia and tubal factor infertility compared with White women but have been underrepresented in prior studies of the association of chlamydia and tubal factor infertility. The objectives of the study were to estimate the population-attributable fraction of tubal factor infertility associated with Chlamydia trachomatis infection by race (Black, non-Black) and assess how different definitions of Chlamydia trachomatis seropositivity and tubal factor infertility affect population-attributable fraction estimates. We conducted a case-control study, enrolling infertile women attending infertility practices in Birmingham, AL, and Pittsburgh, PA, during October 2012 through June 2015. Tubal factor infertility case status was primarily defined by unilateral or bilateral fallopian tube occlusion (cases) or bilateral fallopian tube patency (controls) on hysterosalpingogram. Alternate tubal factor infertility definitions incorporated history suggestive of tubal damage or were based on laparoscopic evidence of tubal damage. We aimed to enroll all eligible women, with an expected ratio of 1 and 3 controls per case for Black and non-Black women, respectively. We assessed Chlamydia trachomatis seropositivity with a commercial assay and a more sensitive research assay; our primary measure of seropositivity was defined as positivity on either assay. We estimated Chlamydia trachomatis seropositivity and calculated Chlamydia trachomatis-tubal factor infertility odds ratios and population-attributable fraction, stratified by race. We enrolled 107 Black women (47 cases, 60 controls) and 620 non-Black women (140 cases, 480 controls). Chlamydia trachomatis seropositivity by either assay was 81% (95% confidence interval, 73-89%) among Black and 31% (95% confidence interval, 28-35%) among non-Black participants (P < .001). Using the primary Chlamydia trachomatis seropositivity and tubal factor infertility definitions, no significant association was detected between chlamydia and tubal factor infertility among Blacks (odds ratio, 1.22, 95% confidence interval, 0.45-3.28) or non-Blacks (odds ratio, 1.41, 95% confidence interval, 0.95-2.09), and the estimated population-attributable fraction was 15% (95% confidence interval, -97% to 68%) among Blacks and 11% (95% confidence interval, -3% to 23%) among non-Blacks. Use of alternate serological measures and tubal factor infertility definitions had an impact on the magnitude of the chlamydia-tubal factor infertility association and resulted in a significant association among non-Blacks. Low population-attributable fraction estimates suggest factors in addition to chlamydia contribute to tubal factor infertility in the study population. However, high background Chlamydia trachomatis seropositivity among controls, most striking among Black participants, could have obscured an association with tubal factor infertility and resulted in a population-attributable fraction that underestimates the true etiological role of chlamydia. Choice of chlamydia and tubal factor infertility definitions also has an impact on the odds ratio and population-attributable fraction estimates.

Medicaid Patients With Immediate Postpartum Contraceptive Implants: Continuation &amp; Rapid Repeat Pregnancy Rates [38A

INTRODUCTION: To determine the 6 and 12-month rates of contraceptive continuation and rapid repeat pregnancy (RRP) for publicly insured patients receiving an immediate postpartum etonogestrel contraceptive implant. METHODS: This prospective cohort study recruited Medicaid insured women, who delivered between April 2014 and 2015, and received a postpartum etonogestrel contraceptive implant prior to discharge from a safety-net institution. Patients were surveyed at placement regarding contraceptive decision-making and counseling. Medical records were reviewed at 6 and 12 months to assess implant continuation and if RRP had occurred. If this information was unable to be ascertained by medical record review, the participant was contacted by telephone. RESULTS: Of the 413 eligible participants, 223 (54%) enrolled. Data were available for 198 patients (89%) at 6 months where 14 (7%) discontinuations and 1 RRP (0.5%) occurred. Data were available for 168 participants (75%) at 12 months, where 40 (24%) discontinuations and 7 RRPs (4.2%) occurred. There were not any pregnancies among participants who retained their implant. Overall, black participants were more likely to discontinue the implant and have a RRP than non-black women (16% versus 2%, p &lt; 0.009). Participants who continued their implant at 12 months were more likely to report at enrollment prior use of a hormonal implant (OR 2.91, CI 1.04-8.17) and plans to keep the implant for all 3 years (OR 2.42, CI 1.04-5.66). CONCLUSION: Among Medicaid patients receiving an immediate postpartum etonogestrel implant at a safety-net hospital, continuation rates were high and rapid repeat pregnancy rates were low.