Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

Introduction: In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women.

Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995.

Background: In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time.

Barriers to Postpartum Care: A Mixed Methods Study of Midwestern Postpartum Women.

Purpose: Postpartum care is an opportunity to provide essential follow-up care to people who have given birth, but inequalities in access by race and socioeconomic status (SES) are well-documented. The purpose of this study is to provide an in-depth description of the barriers to postpartum care using a mixed-methods design.

Methods: Mixed method analyses using convergent design with three stages including (1) bivariate logistic regression of survey data representative of postpartum women in Kalamazoo County, Michigan, (2) thematic qualitative analyses of focus group interviews of survey participants, and (3) bivariate logistic regression and logistic regression meditation analyses using themes operationalized with survey data measures.

Parental sociodemographics of medically assisted reproduction births in the United States: a dyadic population-level study.

Objective: To study how men's and couples' sociodemographic characteristics predict the probability of having a birth conceived using medically assisted reproduction (MAR) in the United States.

Design: Population-based study.

Setting: Not applicable.

'I just think it's weird': the nature of ethical and substantive non-ethical concerns about infertility treatments among Black and White women in U.S. graduate programmes.

In the United States, Black women's use of infertility treatments is relatively low, despite elevated or similar rates of infertility compared with White women. Ethical concerns about infertility treatments have been identified as a potential sociocultural factor contributing to these treatment-seeking disparities. Despite documented differences, the substance of these ethical concerns is unclear.

Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis.

Purpose: To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics.

Methods: Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information.

Results: At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.

The Future of Assisted Reproductive Technology Live Births in the United States.

As postponement of first births continues in the United States, women and couples will likely continue to turn to assisted reproductive technologies (ART) to overcome biological barriers to childbearing. This paper uses stochastic projections to estimate the potential impacts of ART on the US total fertility rate (TFR) overall and across sociodemographic groups using publicly available data. Assuming the trends in ART continue and the TFR remains at the mean estimate, the projection shows the ART TFR will rise from 0.

Accounting for past patient composition in evaluations of quality reporting.

Objective: To investigate whether accounting for past patient composition in evaluations of the association between public quality reports and patient selectivity changes findings and conclusions.

Data Sources: Secondary data analysis of public reports of Assisted Reproductive Technology Clinic success rates between 2011 and 2018.

Study Design: Two sets of fixed effects models, (1) a standard fixed-effects model (FE) and (2) a dynamic panel model using structural equation modeling estimated with maximum-likelihood (ML-SEM) with one- and two-year lagged patient characteristics, are compared.

Is there evidence of weathering among women seeking fertility treatments?: Evidence and insights.

Racial disparities in outcomes of assisted reproductive technologies (ART) are well-documented, and evidence of racial disparities in other forms of fertility treatments has also been observed. To date, much of the research on these disparities has focused on individual-level causes. This paper contextualizes these disparities using the weathering hypothesis.

Assisted reproductive technology use in the United States: a population assessment.

Objective: To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States.

Design: Population-based study.

Setting: Not applicable.

Care Transformation Strategies and Approaches of Accountable Care Organizations.

Although accountable care organizations (ACOs) proliferate, little is known about the activities and strategies ACOs are pursuing to meet goals of reducing costs and improving quality. We use semistructured interviews with executives at 16 ACOs to understand ACO approaches. We identified two overarching ACO approaches to changing clinical care: a practice-based transformation approach, working to overhaul care processes and teams from the inside out; and an overlay approach, where ACO activities were centralized and delivered external to physician practices.

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations.

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form.

Significance of Monocyte Counts at Recurrence on Survival Outcome of Women With Endometrial Cancer.

Objective: Tumor-associated macrophages (TAMs) are known to have adverse effects on the survival of women with endometrial cancer. Because monocytes function as progenitors of macrophages, this study examined the association between monocyte count at the first recurrence/progression of endometrial cancer and survival time after recurrence/progression (SAR).

Methods: This is a retrospective study evaluating 141 consecutive cases of recurrent endometrial cancer after surgical staging (n = 114) and progression after nonsurgical management (n = 27).

Endoplasmic reticulum stress in complex atypical hyperplasia as a possible predictor of occult carcinoma and progestin response.

Unlabelled: Glucose-regulated protein (GRP)-78, the key regulator of endoplasmic reticulum (ER) stress, is associated with endometrial cancer (EC) development and progression. However, its role in the continuum from complex atypical hyperplasia (CAH) to EC is unknown and the focus of this study.

Methods: 252 formalin-fixed, paraffin-embedded endometrial biopsies from patients with CAH diagnosed between 2003 and 2011 were evaluated for GRP78 expression by immunohistochemistry.

Characteristics of ovarian tumors of low malignant potential in BRCA mutation carriers: A case series.

•Tumor characteristics of 5 cases of ovarian tumor of low malignant potential (LMP) with BRCA mutation were examined.•Young age, BRCA1 mutation, and presence of invasive implants may be characteristics of BRCA carriers with ovarian LMP.

Intraocular metastasis from primary cervical cancer: A case report and review of the literature.

•Metastatic disease should be considered in cervical cancer patients presenting with eye pain and vision complaints.•Distant metastasis involving less common organ sites, such as the eye, suggest a poor prognosis with short life expectancy.•In cases of cervical cancer metastatic to the eye, radiotherapy may decrease the incidence of retinal detachment and vision loss.

Few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care.

Accountable care organizations (ACOs) may be well positioned to increase the focus on managing behavioral health conditions (mental health and substance abuse) through the integration of behavioral health treatment and primary care. We used a mixed-methods research design to examine the extent to which ACOs are clinically, organizationally, and financially integrating behavioral health care and primary care. We used data from 257 respondents to the National Survey of Accountable Care Organizations, a nationally representative survey of ACOs.

Abdominal aortic resection and Y-graft placement to achieve complete cytoreduction in stage IIIc ovarian carcinoma.

Background: Major vascular resection with reconstruction in patients with gynecologic malignancy is rarely performed and infrequently reported.

Case: A 40-year-old woman undergoing surgery for stage IIIc ovarian papillary serous adenocarcinoma was left with a 7-cm aortic metastasis not separable from the infrarenal abdominal aorta. An aortic resection with prosthetic graft placement was performed to achieve complete tumor resection.

Recurrent leiomyosarcoma presenting as malignant arterial tumor thrombus.

► The report reviews unique arterial embolic phenomena in the context of newly diagnosed recurrent leiomyosarcoma. ► Metastatic work-up should be initiated in those diagnosed with malignant arterial tumor emboli.

Cervical conization of adenocarcinoma in situ: a predicting model of residual disease.

Objective: To determine factors associated with the presence of residual disease in women who have undergone cervical conization for adenocarcinoma in situ (ACIS) of the cervix.

Study Design: We identified women who underwent a cervical conization for a diagnosis of ACIS followed by repeat conization or hysterectomy between Jan. 1, 1995, and April 30, 2010.

Novel application of a fecal management system for vaginal use in radiotherapy-associated rectovaginal fistula.

While highly effective for treating certain gynecologic malignancies, radiotherapy carries known risks, including fistula formation. We report a 75-year-old female with advanced cervical carcinoma who was provided a vaginally placed fecal management system after developing a rectovaginal fistula following primary treatment with chemoradiation. This report presents and discusses a novel method to palliate symptomatic RVFs in advanced-stage cancer.

Significance of perioperative infection in survival of patients with ovarian cancer.

Objectives: Perioperative infectious diseases comprise some of the most common causes of surgical mortality in women with ovarian cancer. This study was aimed to evaluate the significance of perioperative infections in survival of patients with ovarian cancer.

Methods: Patients who underwent primary cytoreductive surgery were included in the analysis (n = 276).

Fetoscopic laser photocoagulation of feeding vessels to a large placental chorioangioma following fetal deterioration after amnioreduction.

Large placental chorioangiomas (>4 cm) can precipitate severe polyhydramnios, fetal anemia, growth restriction, high-output cardiac failure, hydrops, and fetal demise. We report a case of a large chorioangioma that was treated in a stepwise fashion with amnioreduction to ameliorate maternal discomfort, followed by fetoscopic laser ablation of the feeding vessels after rapid evolution of heart failure. Although amnioreduction was helpful in improving maternal symptoms, we suspect that the drop in intrauterine pressure from the amniotic fluid decompression may have resulted in increased tumor perfusion, thereby promoting fetal deterioration due to a 'steal' phenomenon.