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Witt LB, Wolff S, Shih G, French V. Abortion and Contraception in Medical School Curricula: A Survey of North American Family Medicine Clinical Curriculum Directors. Teach Learn Med 2024; 36:174-182. [PMID: 36636862 DOI: 10.1080/10401334.2022.2163399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Phenomenon: Contraception and abortion care are commonly accessed health services, and physicians in training will encounter patients seeking this care. Curricula that teach contraception and abortion provision during medical school equip medical students with valuable skills and may influence their intention to provide these services during their careers. Family planning is nevertheless understood to be underrepresented in most medical curricula, including in North American medical schools where the laws on providing contraception and abortion have been consequentially changing. This study investigated the prevalence and predictors of contraception and abortion education in North American medical curricula in 2021. Approach: We asked family medicine clerkship directors from Canada and the United States (US) to report about contraception and abortion teaching in their clinical curricula and their school's whole curriculum and to report on associated factors. Survey questions were included in the 2021 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors at accredited North American medical schools. Surveys were distributed between April 29 and May 28, 2021, to the 160 clerkship directors listed in the CERA organization database. Findings: Seventy-eight directors responded to the survey (78/160, 48%). 47% of responding directors reported no contraception teaching in the family medicine clerkship. 81.7% of responding directors reported no abortion teaching in the clerkship, and 66% indicated abortion was not being taught in their school's whole curriculum. Medical school region correlated with the presence of abortion curricula, and schools with high graduation rates into the family medicine specialty reported abortion teaching more frequently. Fewer than 40% of responding directors had received training on both contraception and abortion care themselves. Insights: Contraception and abortion are both underrepresented in North American medical curricula. Formal abortion education may be absent from most family medicine clerkships and whole program curricula. To enhance family planning teaching in North American medical schools, we recommend that national curriculum resources be revised to include specific contraception and abortion learning objectives and for increased development and support for clinical curricula directors to universally include family planning teaching in whole program and family medicine clerkship curricula.
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Affiliation(s)
- Laurel B Witt
- Department of Family Medicine and Community Health, University of Kansas, Kansas City, Kansas, USA
| | - Sharon Wolff
- Department of Population Health, University of Kansas, Kansas City, Kansas, USA
| | - Grace Shih
- Department of Family Medicine, University of Washington, Seattle, Washington DC, USA
| | - Valerie French
- Department of Obstetrics and Gynecology, University of Kansas, Medical Center, Kansas City, Kansas, USA
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Thomson CJ, Zhang Y, Weidner A, Summit AK, Miles C, Cole AM, Shih G. Patient concerns about accessing sexual and reproductive health services outside of primary care: A survey in rural and urban settings in the Pacific Northwest. Contraception 2023; 119:109901. [PMID: 36257376 PMCID: PMC10719870 DOI: 10.1016/j.contraception.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES While primary care providers are a major source of sexual and reproductive health (SRH) services in the United States, particularly in rural areas, not all primary care settings offer a full range of SRH services. We aimed to understand primary care patient concerns regarding accessing SRH services, including abortion care, outside of their primary care clinic and if those concerns differed by urban or rural setting. STUDY DESIGN An anonymous survey was distributed over a 2-week period between December 2019 to March 2020 to all adult patients in four primary care clinics in Idaho, Washington, and Wyoming. The survey assessed patient concerns regarding accessing SRH services outside of their primary care clinic and their willingness to travel to access SRH services. RESULTS The overall response rate was 69% (745/1086). Over 85% of respondents identified at least one concern to seeking SRH services outside of a primary care setting, with cost, insurance coverage, length of wait time, and lack of an established relationship being the most frequently reported concerns. A majority of respondents were willing to travel a maximum of 1 hour for most SRH services. Respondents from rural-serving clinics were significantly more likely to be willing to travel longer amounts of time for medication abortion, aspiration abortion, and intrauterine device placement. CONCLUSION Our findings highlight that a majority of both urban and rural primary care patients have concerns regarding accessing SRH services outside of their primary care clinic and are unwilling to travel more than 1 hour to access most SRH services. IMPLICATIONS A majority of primary care patients have concerns regarding accessing SRH services outside of primary care settings. Health care policy changes should aim to strengthen the SRH services available in primary care settings to alleviate the burdens primary care patients face in accessing SRH services outside of their primary care clinic, particularly for rural populations.
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Affiliation(s)
- Claire J Thomson
- Swedish First Hill Family Medicine Residency, Seattle, WA, United States.
| | - Ying Zhang
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Amanda Weidner
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Aleza K Summit
- RHEDI, Montefiore Medical Center (Department of Family and Social Medicine), Bronx, NY, United States
| | - Christina Miles
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Allison M Cole
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Grace Shih
- University of Washington, Department of Family Medicine, Seattle, WA, United States
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Boobalan E, Thompson AH, Alur RP, McGaughey DM, Dong L, Shih G, Vieta-Ferrer ER, Onojafe IF, Kalaskar VK, Arno G, Lotery AJ, Guan B, Bender C, Memon O, Brinster L, Soleilhavoup C, Panman L, Badea TC, Minella A, Lopez AJ, Thomasy SM, Moshiri A, Blain D, Hufnagel RB, Cogliati T, Bharti K, Brooks BP. Zfp503/Nlz2 Is Required for RPE Differentiation and Optic Fissure Closure. Invest Ophthalmol Vis Sci 2022; 63:5. [PMID: 36326727 PMCID: PMC9645360 DOI: 10.1167/iovs.63.12.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose Uveal coloboma is a congenital eye malformation caused by failure of the optic fissure to close in early human development. Despite significant progress in identifying genes whose regulation is important for executing this closure, mutations are detected in a minority of cases using known gene panels, implying additional genetic complexity. We have previously shown knockdown of znf503 (the ortholog of mouse Zfp503) in zebrafish causes coloboma. Here we characterize Zfp503 knockout (KO) mice and evaluate transcriptomic profiling of mutant versus wild-type (WT) retinal pigment epithelium (RPE)/choroid. Methods Zfp503 KO mice were generated by gene targeting using homologous recombination. Embryos were characterized grossly and histologically. Patterns and level of developmentally relevant proteins/genes were examined with immunostaining/in situ hybridization. The transcriptomic profile of E11.5 KO RPE/choroid was compared to that of WT. Results Zfp503 is dynamically expressed in developing mouse eyes, and loss of its expression results in uveal coloboma. KO embryos exhibit altered mRNA levels and expression patterns of several key transcription factors involved in eye development, including Otx2, Mitf, Pax6, Pax2, Vax1, and Vax2, resulting in a failure to maintain the presumptive RPE, as evidenced by reduced melanin pigmentation and its differentiation into a neural retina-like lineage. Comparison of RNA sequencing data from WT and KO E11.5 embryos demonstrated reduced expression of melanin-related genes and significant overlap with genes known to be dynamically regulated at the optic fissure. Conclusions These results demonstrate a critical role of Zfp503 in maintaining RPE fate and optic fissure closure.
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Affiliation(s)
- Elangovan Boobalan
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Amy H. Thompson
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Ramakrishna P. Alur
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - David M. McGaughey
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Lijin Dong
- Mouse Genetic Engineering Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Grace Shih
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Emile R. Vieta-Ferrer
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Ighovie F. Onojafe
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Vijay K. Kalaskar
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Gavin Arno
- University College London Institute of Ophthalmology, London, United Kingdom,Moorfields Eye Hospital, London, United Kingdom
| | - Andrew J. Lotery
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Bin Guan
- Ophthalmic Genetics Laboratory, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Chelsea Bender
- Ophthalmic Genetics Laboratory, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Omar Memon
- Ocular and Stem Cell Translational Research Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Lauren Brinster
- Division of Veterinary Resources, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | | | - Lia Panman
- MRC Toxicology Unit, University of Cambridge, Leicester, United Kingdom
| | - Tudor C. Badea
- Retinal Circuit Development and Genetics Unit, Neurobiology, Neurodegeneration and Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States,Research and Development Institute, Transilvania University of Brașov, Brașov, Romania,National Center for Brain Research, ICIA, Romanian Academy, Bucharest, România
| | - Andrea Minella
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California–Davis, Davis, California, United States
| | - Antonio Jacobo Lopez
- Department of Ophthalmology and Vision Science, School of Medicine, University of California–Davis, Davis, California, United States
| | - Sara M. Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California–Davis, Davis, California, United States,Department of Ophthalmology and Vision Science, School of Medicine, University of California–Davis, Davis, California, United States
| | - Ala Moshiri
- Department of Ophthalmology and Vision Science, School of Medicine, University of California–Davis, Davis, California, United States
| | - Delphine Blain
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert B. Hufnagel
- Ophthalmic Genetics Laboratory, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Tiziana Cogliati
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Kapil Bharti
- Ocular and Stem Cell Translational Research Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Brian P. Brooks
- Pediatric, Developmental & Genetic Ophthalmology Section, Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
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Weidner A, Ormsby M, Shih G. What’s Worth Doing in Virtual Recruitment? A Regional Survey of Program Directors and Incoming Interns. Fam Med 2022; 54:784-790. [DOI: 10.22454/fammed.2022.359153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Objectives: In 2020-2021, the Family Medicine Residency Network (FMRN) programs participated in virtual recruitment. We conducted a study to describe the recruitment activities utilized by programs and to identify which of these activities were most and least helpful to both students and the programs.
Methods: In May 2021, we sent an electronic survey to the incoming interns (n=242) asking which recruitment activities they participated in, which were most and least helpful in deciding their rank list, and which most positively impacted their perception of the program. Simultaneously, we surveyed the 43 FMRN program directors (PDs), asking them which virtual recruitment activities they offered, which were most and least helpful in creating their rank list, and which they thought most positively impacted students’ perception.
Results: The 167 intern survey responses (69% response) indicated that virtual interviews and virtual get-togethers with residents were most helpful to deciding rank list order while receiving gifts and meals were least helpful. Websites, bios, and social media positively impacted perception of a program. PDs (79% response) overestimated the importance of the recruitment video and a prerecorded hospital/clinic tour and underestimated the importance of resident-only social interactions to the applicants.
Conclusions: Programs may improve the effectiveness of their virtual recruitment process by maximizing interactions with current residents and creating opportunities for interviews with individuals in different positions across the program. Reducing spending on gifts and meals frees up funds better spent on activities with greater impact such as website improvement and more events for student interaction with current residents.
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Affiliation(s)
- Amanda Weidner
- University of Washington Department of Family Medicine, Family Medicine Residency Network, Seattle, WA
| | - Molly Ormsby
- University of Washington Department of Family Medicine, Family Medicine Residency Network, Seattle, WA
| | - Grace Shih
- University of Washington Department of Family Medicine, Family Medicine Residency Network, Seattle, WA
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Miles C, Weidner A, Summit AK, Thomson CJ, Zhang Y, Cole AM, Shih G. Patient opinions on sexual and reproductive health services in primary care in rural and urban clinics. Contraception 2022; 114:26-31. [PMID: 35489391 DOI: 10.1016/j.contraception.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Primary care providers are a major source of sexual and reproductive health care in the United States, particularly in rural areas, and not all providers offer the same services. This study aimed to understand patient preferences and expectations around reproductive health services including abortion care in a primary care setting and if those expectations differed by urban or rural setting. STUDY DESIGN An anonymous survey was distributed to all patients 18 years or older in 4 primary care clinics in Idaho, Washington, and Wyoming over a 2-week period. The survey asked patients about which reproductive health services should be available in primary care. RESULTS The overall response rate was 69% (745/1086). For all queried reproductive health services except for aspiration abortion, the majority of respondents reported that primary care clinics should have that service available. Forty-two percent of respondents reported that aspiration abortion should be available in primary care. Overall, most respondents reported that medication abortion (58%) and miscarriage management (65%) should be available in primary care. More respondents in urban clinics thought IUD services (84% vs 71%), medication abortion (74% vs 37%), and aspiration abortion (52% vs 28%) should be accessible in primary care compared to those in rural-serving clinics. CONCLUSIONS This study of 4 primary care clinics in Idaho, Washington, and Wyoming, spanning urban and rural settings, highlights that most patients desire contraception services and miscarriage management to be available in primary care. IMPLICATIONS Increasing training may help meet patient desires for access to reproductive services in primary care, however, further exploration of barriers to this care is warranted. High rates of respondents desiring miscarriage management access highlights the need to train more primary care clinicians to provide full spectrum miscarriage management options.
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Affiliation(s)
- Christina Miles
- University of Washington, Department of Family Medicine, Seattle, WA, United States.
| | - Amanda Weidner
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Aleza K Summit
- RHEDI, Montefiore Medical Center (Department of Family and Social Medicine), Bronx, NY, United States
| | - Claire J Thomson
- Swedish First Hill Family Medicine Residency, Seattle, WA, United States
| | - Ying Zhang
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Allison M Cole
- University of Washington, Department of Family Medicine, Seattle, WA, United States
| | - Grace Shih
- University of Washington, Department of Family Medicine, Seattle, WA, United States
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Patel J, Nguyen BT, Shih G, Or M, Harper DM. Vasectomy Training in Family Medicine Residency Programs: A National Survey of Residency Program Directors. Fam Med 2022; 54:438-443. [DOI: 10.22454/fammed.2022.649054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background and Objectives: Vasectomy is considered a permanent contraceptive method with fewer associated harms than bilateral tubal ligation. However, the number of vasectomy-trained providers may not be meeting the demand for vasectomy in the United States. We describe the vasectomy training landscape in family medicine residencies and factors related to increased procedural training.
Methods: Program-specific data were collected from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2019. Program characteristics, vasectomy training (eg, time spent, procedural numbers), as well as direct and specific faculty support are described, with bivariate analyses for factors related to procedural competency, defined as more than five vasectomy procedures per resident.
Results: We received responses from 250 program directors (response rate=39.8%), with representation across all US regions, and program types. Nearly half (47.5%) offered less than 1 day of vasectomy didactics and/or procedural training; 38.9% of programs reported having a family medicine faculty champion for vasectomy. Only 16 programs (6.8%) reported that their average graduating residents performed more than five vasectomies. Programs with a faculty champion (OR 28.1, CI 3.6-216.4) or family medicine faculty as primary trainer (OR 17.6, CI 2.2-138.2) were more likely to graduate residents who had performed more than five vasectomies.
Conclusions: Fewer than 10% of surveyed family medicine residency programs offer adequate vasectomy procedural training. Family medicine faculty who serve as primary trainers and act as faculty champions can increase vasectomy training opportunities for residents, and thereby increase the supply of vasectomy providers in the United States.
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Affiliation(s)
- Jasmine Patel
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California Irvine
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brian T. Nguyen
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Maya Or
- Department of Obstetrics and Gynecology, George Washington University Hospital, Washington, DC
| | - Diane M. Harper
- Department of Family Medicine and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI
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Shih G, Stulberg D, Barreto TW, Andrilla CHA, Guzman S, Nothnagle M. Faculty and Resident Contraceptive Opt Outs and Training Site Restrictions: A CERA Study. Fam Med 2022; 54:123-128. [DOI: 10.22454/fammed.2022.410546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: Contraception is a core component of family medicine residency curriculum. Institutional environments can influence residents’ access to contraceptive training and thus their ability to meet the reproductive health needs of their patients.
Methods: Contraceptive training questions were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked how many faculty and residents opt out of providing contraceptive methods for moral or religious reasons, and whether training sites have institutional restrictions on contraception. We performed descriptive statistics and regression to identify program characteristics associated with having a resident or faculty opt out of providing contraceptive care.
Results: Of 626 program directors, 249 responded to the survey, and 237 answered the contraceptive questions. Percentages of program directors reporting any residents or faculty who opted out of contraceptive services are as follows: pill/patch/ring (residents 27%; faculty 17%), emergency contraception (residents 40%, faculty 33%), or intrauterine devices/implants (resident 29%; faculty 23%). Programs in the South (OR 2.78; 1.19-6.49) and those with Catholic affiliation (OR 2.35; 1.23-4.91) had higher adjusted odds of at least one opt-out faculty but were not associated with having opt-out residents. Eleven percent of programs had at least one training site with institutional restrictions on contraception.
Conclusions: To ensure that residents have access to adequate contraceptive training, residencies should proactively seek faculty and training environments that meet residents’ needs, and should make limitations on services clear to potential residents and patients.
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Affiliation(s)
- Grace Shih
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Debra Stulberg
- Department of Family Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | | | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Melissa Nothnagle
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, Salinas, CA
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Wallace R, Shih G. Complex family planning - Demarginalizing abortion care requires uplifting primary care and non-CFP providers. Contraception 2021; 105:86. [PMID: 34600932 DOI: 10.1016/j.contraception.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Robin Wallace
- Planned Parenthood South Atlantic, Chapel Hill, NC, United States; Campus Health Services, University of North Carolina, Chapel Hill, NC, United States.
| | - Grace Shih
- Department of Family Medicine, University of Washington, Seattle, WA, United States
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Zhang Y, Sheth S, Weidner AKH, Egwuatu P, Webb L, Shih G. Immediate Postpartum IUD Training Within a Regional Network of Family Medicine Residencies. PRiMER 2021; 5:24. [PMID: 34286227 PMCID: PMC8284491 DOI: 10.22454/primer.2021.421778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Immediate postpartum placement of intrauterine devices (PPIUD) offers important benefits to patients. Little is known about PPIUD training or knowledge within family medicine residency programs. We evaluated PPIUD experience and prior training among family medicine residents and faculty. METHODS We conducted a cross-sectional survey of residents and faculty in 24 regional family medicine residency programs in 2018. Survey questions focused on reception of PPIUD training and experience with PPIUD counseling and placement. RESULTS The final survey sample included 203 residents and 100 faculty with an overall response rate of 39%. About 26% (n=79) of all participants reported receiving prior training for counseling and placement of PPIUDs, while 16% (n=48) of participants had ever placed a PPIUD. Twenty-six percent (n=78) of participants reported that their residency programs offered PPIUD training. Residents and faculty who reported past PPIUD training and/or placement experience were more likely to have ever counseled patients about PPIUD (P<.001) and report that their primary training hospital offered PPIUD to patients (P<.001) and their residency programs offered PPIUD training (P<.001). CONCLUSIONS Few programs offer routine PPIUD training opportunities for family medicine residents and faculty, which may contribute to limited availability of PPIUD to patients. There is a need to improve PPIUD training and placement opportunities for both family medicine residents and faculty.
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Affiliation(s)
- Ying Zhang
- University of Washington, Family Medicine Department, Seattle, WA
| | - Sonali Sheth
- University of Washington, Family Medicine Department, Seattle, WA
| | - Amanda K H Weidner
- University of Washington Family Medicine Residency Network, Department of Family Medicine
| | - Patricia Egwuatu
- University of Washington, Family Medicine Department, Seattle, WA
| | - Lauren Webb
- University of Washington, Family Medicine Department, Seattle, WA
| | - Grace Shih
- University of Washington, Family Medicine Department, Seattle, WA | and University of Washington, Family Medicine Department, Seattle, WA
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Shanbhag SS, Shih G, Bispo PJM, Chodosh J, Jacobs DS, Saeed HN. Diphtheroids as Corneal Pathogens in Chronic Ocular Surface Disease in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Cornea 2021; 40:774-779. [PMID: 33758140 PMCID: PMC8102355 DOI: 10.1097/ico.0000000000002696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize diphtheroid corneal infections in eyes in the chronic phase of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS Observational case series. RESULTS Four eyes of 3 patients were included in this review. Each eye presented with persistent corneal epithelial defect with corneal thinning in the chronic phase of SJS/TEN. None of the epithelial defects were associated with stromal infiltration. The corneas were cultured at the time of workup of persistent epithelial defect (3 eyes) or at time of tectonic penetrating keratoplasty after perforation (1 eye). Cultures yielded abundant growth of Corynebacterium spp., including Corynebacterium jeikeium (n = 2), Corynebacterium glucuronolyticum (n = 1), and a multidrug-resistant Corynebacterium striatum isolate (n = 1). The ocular surface was stabilized with surgical intervention (1 eye) or with introduction of fortified topical antibiotic based on laboratory identification and susceptibility testing of the isolated organisms (3 eyes). Numerous risk factors for microbial keratitis were present in all 4 eyes. CONCLUSIONS In eyes with a persistent corneal epithelial defect in the chronic phase of SJS/TEN, even in the absence of an infiltrate, corneal culture should be undertaken. Recognition and treatment of Corynebacterium spp. as opportunistic pathogens may lead to favorable outcomes in cases of clinically sterile ulceration during the chronic phase of SJS/TEN.
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Affiliation(s)
- Swapna S. Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- The Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India
| | - Grace Shih
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J. M. Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah S. Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Hajirah N. Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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11
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Shih G, Lindley AR, Zhang Y, Evans DV. Reaching Out While Staying In: Underrepresented in Medicine Recruitment at the University of Washington Family Medicine Residency. J Grad Med Educ 2021; 13:441. [PMID: 34178283 PMCID: PMC8207910 DOI: 10.4300/jgme-d-21-00261.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Grace Shih
- Associate Professor, Department of Family Medicine, University of Washington
| | - Alexa R Lindley
- Acting Assistant Professor, Department of Family Medicine, University of Washington
| | - Ying Zhang
- Assistant Professor, Department of Family Medicine, University of Washington
| | - David V Evans
- Rosenblatt Family Endowed Professor of Rural Health, Department of Family Medicine, University of Washington
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Shih G, Deer JD, Lau J, Loveland Baptist L, Lim DJ, Lockman JL. The impact of the COVID-19 pandemic on the education and wellness of U.S. Pediatric Anesthesiology Fellows. Paediatr Anaesth 2021; 31:268-274. [PMID: 33341983 DOI: 10.1111/pan.14112] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The global coronavirus disease 2019 (COVID-19) pandemic caused state-wide shutdowns of elective surgical activities in March and April of 2020 forcing graduate medical education program directors and their trainees in the United States to quickly adapt to new rules and circumstances. AIM The aim of this study was to determine the effect of the current pandemic on pediatric anesthesiology fellow education and wellness nationally in order to guide creation of optimal support systems for fellows during the ongoing pandemic. METHODS In July 2020, an electronically distributed survey was sent to all United States-based pediatric anesthesiology fellowship program directors who were asked to distribute the survey to all current/graduating fellows. RESULTS A total of 75 out of 184 pediatric anesthesiology fellows (41%) responded to the survey. Major domains identified include reduction of clinical time, financial impact, mental health/wellness effects, and concerns about the overall quality of the fellowship educational experience. Respondents indicated that the pandemic has led to personal quarantine (and/or illness) leave time (21.3%), changes in finances (42.7%) and career opportunities (37.3%), decreased clinical education/experience (28%), and a dissatisfaction with the modified didactic experience (22.7%). In addition, a majority of respondents (97.3%) experienced increased stressors during this pandemic, including worry for family members (80%), stress due to changes in certifying examinations (76%), and fear of contracting COVID-19 from a patient (72%). CONCLUSION While the results of this survey are only one snapshot in time during an evolving pandemic, these results highlight important domains where program directors and other departmental leaders might focus limited resources to maximize the educational experiences and overall wellness for pediatric anesthesiology fellows.
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Affiliation(s)
- Grace Shih
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy D Deer
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Jennifer Lau
- Department of Anesthesiology Critical Care, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lindsey Loveland Baptist
- Department of Anesthesiology, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Doyle J Lim
- Department of Anesthesiology and Perioperative Medicine, Nemours / Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Petrini LA, Thottathil P, Shih G, Henderson A, Pasquariello C, Black SA. Ask the question, be the solution: Fostering well-being through contextualized assessment and strategy development. Paediatr Anaesth 2021; 31:68-73. [PMID: 33217761 DOI: 10.1111/pan.14087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
In recent years, optimizing provider well-being and mitigating the effects of physician burnout have become increasingly important in the field of medicine. These efforts are in part of consequence because of significant costs associated with provider burnout, for both individuals and their workplace. Accordingly, robust work has focused on development of strategies to decrease the incidence of burnout or mitigate its effects, including both individual efforts and systematic organizational change. This article describes the development and implementation of a unique assessment strategy to identify the driving factors hindering well-being in our general anesthesiology division. We describe how collected data allowed us to identify important areas for improvement, build community, and target novel interventions to ultimately improve the well-being of our division for all members. This manuscript does not describe survey results in any detail, but rather aims to present a creative application of the Hawthorne Effect as it applies to understanding physician well-being.
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Affiliation(s)
- Laura A Petrini
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Princy Thottathil
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Grace Shih
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alicia Henderson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol Pasquariello
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stephanie A Black
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Shih G, Wu JP, Harper DM. Awareness and Attitudes Around the New Subspecialty Within Ob/Gyn Called Complex Family Planning: A CERA Survey of Family Medicine Chairs. Fam Med 2020; 52:702-706. [PMID: 33151529 DOI: 10.22454/fammed.2020.157121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Family physicians play an important role in delivery of family planning services, but many factors impact scope of practice. One important factor is the development of subspecialties, such as the new subspecialty within obstetrics and gynecology called complex family planning (CFP). METHODS In 2019, we conducted a survey of family medicine department chairs as part of the Council of Academic Family Medicine Educational Research Alliance survey. We used descriptive statistics and logistic regression to test for associations between program and chair characteristics, knowledge of CFP, and attitudes regarding family planning services (complex contraceptive counseling, pregnancy options counseling, first trimester miscarriage management, and pregnancy termination). RESULTS The survey response rate was 54% (105/193). Only 8% of respondents were aware of the CFP subspecialty. The majority of chairs considered all queried family planning services as part of family medicine's scope of practice, including pregnancy termination by medication abortion (77%) and by uterine aspiration (60%). Chairs of departments with a faculty champion in family planning had higher odds of advocating for all queried family planning services as part of family medicine scope of practice (OR 3.0, 1.1-8.2) than those without a faculty champion. CONCLUSIONS Few chairs are aware of the new subspecialty of CFP, but most would advocate to maintain some form of abortion care in family medicine's scope of practice. Given family medicine's role in the health care safety net, supporting faculty champions in family planning is important to preserve access to family planning services for marginalized communities.
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Affiliation(s)
- Grace Shih
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Justine P Wu
- University of Michigan, Michigan Medicine, Department of Family Medicine, Ann Arbor, MI
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
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Weidner A, Stevens N, Shih G. Associations Between Program-Level Abortion Training and Graduate Preparation for and Provision of Reproductive Care. Fam Med 2019; 51:750-755. [PMID: 31596932 DOI: 10.22454/fammed.2019.219951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of training in the declining rate of family physicians' provision of women's reproductive health care is unclear. No requirements for abortion training exist, and curricula vary widely. This study assessed the impact of program-level abortion training availability on graduates' feelings of training adequacy and their postgraduate practice in reproductive health. METHODS We conducted secondary analysis of graduate survey data from 18 family medicine residency programs in the Northwest categorized by whether or not their program routinely offered abortion training (opt out or elective rotation). We used bivariate analyses and logistic regression to compare groups on preparation for training and current clinical practice of women's health procedures. RESULTS Six of 18 programs included in the study had routinely available abortion training for graduates (N=408). In bivariate analysis, these programs with routine abortion training had significantly more graduates who report feeling prepared to perform abortions (19% vs 10%; P=.01), but no difference in likelihood to provide abortion care postresidency compared to programs without routine abortion training. In adjusted analyses, graduates of programs with routine abortion training were significantly less likely to feel prepared for performing colposcopies (OR=0.45, 95% CI, 0.26-0.78; P<.01) and to actually perform them in practice (OR=0.32, 95% CI, 0.18-0.57; P<.001); all other differences are attenuated. CONCLUSIONS Program-level abortion training alone is not enough to overcome the systems- and individual-level barriers to increasing the numbers of trained family medicine residency graduates who provide abortion care and other reproductive care in practice. More must be done to create opportunities for family physicians interested in providing full-spectrum care in their postgraduate practices to be able to do so.
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Affiliation(s)
- Amanda Weidner
- Association of Departments of Family Medicine, Leawood, KS, and University of Washington School of Medicine, Family Medicine Residency Network
| | - Nancy Stevens
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Grace Shih
- Department of Family Medicine, University of Washington, Seattle, WA
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Shah A, Wyatt M, Gourneau B, Shih G, De Ruyter M. Emotional exhaustion among anesthesia providers at a tertiary care center assessed using the MBI burnout survey. PSYCHOL HEALTH MED 2018; 24:620-624. [DOI: 10.1080/13548506.2018.1546019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Abha Shah
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew Wyatt
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bethany Gourneau
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Grace Shih
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin De Ruyter
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Abstract
Many women prefer to receive abortion care with their primary care provider; yet, prior studies have suggested that women do not know or assume that their provider does not offer abortion care. Our objective was to explore if, when, and how women wish to be informed of available abortion services at their primary care clinics. We conducted interviews with 21 women at their primary care site during June-July 2014. Vignettes were used to identify clinic visit types in which information regarding abortion services would be welcome and appropriate and inappropriate ways for providers to inform patients of these services. All participants were open to provider-initiated discussion of available abortion services, particularly during women's wellness exams or contraception visits. Themes associated with appropriate communication of abortion services included: 1) using sensitive language, 2) respect for and assessment of patient beliefs, and 3) contextualizing abortion services within reproductive health. Advantages to discussing available abortion services included strengthening the patient-provider relationship and improved awareness of the spectrum of services offered. Routine inclusion of abortion services counseling may help educate patients about available services, strengthen the patient-provider relationship, and reduce the stigma surrounding abortion care.
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Affiliation(s)
- Megan Hatcher
- a Department of Family Medicine , University of Washington , Seattle , Washington , USA
| | - Carie Muntifering Cox
- a Department of Family Medicine , University of Washington , Seattle , Washington , USA
| | - Grace Shih
- a Department of Family Medicine , University of Washington , Seattle , Washington , USA
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Berry JL, Shih G, Moysidis SN, Jubran R, Wong K, Lee TC, Murphree AL, Kim JW. Patterns of subretinal fluid resolution in Group D eyes treated with chemoreduction: Experience from the Children’s Hospital Los Angeles/University of Southern California. Ophthalmic Genet 2016; 37:400-403. [DOI: 10.3109/13816810.2015.1115881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jesse L. Berry
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California, USA
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Grace Shih
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Stavros N. Moysidis
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Rima Jubran
- The Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Kenneth Wong
- Radiation Oncology Program, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas C. Lee
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California, USA
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - A. Linn Murphree
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California, USA
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jonathan W. Kim
- The Vision Center at Children’s Hospital Los Angeles, Los Angeles, California, USA
- The USC Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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McNeil S, Shih G, Gardner S, Goodman S. Lessons learned from an advanced training and leadership curriculum in abortion care. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Glaser TS, Doss LE, Shih G, Nigam D, Sperduto RD, Ferris FL, Agrón E, Clemons TE, Chew EY. The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37. Ophthalmology 2015; 122:1471-9. [PMID: 25972257 DOI: 10.1016/j.ophtha.2015.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate whether dietary intake of luteiin/zeaxanthin and B vitamins is associated with cataract prevalence and incidence. DESIGN Clinic-based, baseline cross-sectional and prospective cohort study designs. PARTICIPANTS Three thousand one hundred fifteen patients (6129 eyes) enrolled in the Age-Related Eye Disease Study 55 to 80 years of age followed up for mean of 9.6 years. METHODS Participants completed baseline food frequency questionnaires. Baseline and annual lens photographs were graded centrally. Multivariate models controlling for previously identified risk factors for cataracts tested for the association of cataracts with reported dietary intake, using the lowest quintile as reference. MAIN OUTCOME MEASURES Cataract surgery, cataract status (type and severity) at baseline, and development of cataracts. RESULTS At baseline, increased dietary riboflavin and B12 were associated inversely with nuclear and cortical lens opacities. In comparisons of persons with and without cataract, persons with the highest riboflavin intake versus those with the lowest intake had the following associations: mild nuclear cataract: odds ratio (OR), 0.78; 95% confidence interval (CI), 0.63-0.97; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.90; and mild cortical cataract: OR, 0.80; 95% CI, 0.65-0.99. For B12, the results were: mild nuclear cataract: OR, 0.78; 95% CI, 0.63-0.96; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.88; and mild cortical cataract: OR, 0.77; 95% CI, 0.63-0.95. Highest dietary B6 intake was associated with a decreased risk of moderate nuclear lens opacity developing compared with the lowest quintile (OR, 0.67; 95% CI, 0.45-0.99). Highest dietary intake levels of niacin and B12 were associated with a decreased risk of development of mild nuclear or mild cortical cataracts in participants not taking Centrum (Pfizer, New York, NY) multivitamins. For participants taking multivitamins during the study, the highest intake of dietary folate was associated with an increased risk of mild posterior subcapsular lens opacity development. No statistically significant associations were found between lutein plus zeaxanthin intake and presence at baseline or development of nuclear or cortical lens opacity outcomes. CONCLUSIONS These findings are consistent with earlier studies suggesting that dietary intake of B vitamins may affect the occurrence of age-related lens opacities. Further investigations are warranted.
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Affiliation(s)
- Tanya S Glaser
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Lauren E Doss
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Grace Shih
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Divya Nigam
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Lambert WS, Carlson BJ, van der Ende AE, Shih G, Dobish JN, Calkins DJ, Harth E. Nanosponge-Mediated Drug Delivery Lowers Intraocular Pressure. Transl Vis Sci Technol 2015; 4:1. [PMID: 25599009 DOI: 10.1167/tvst.4.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We examined the efficacy of an extended-release drug delivery system, nanosponge (NS) encapsulated compounds, administered intravitreally to lower intraocular pressure (IOP) in mice. METHODS Bilateral ocular hypertension was induced in mice by injecting microbeads into the anterior chamber. Hypertensive mice received NS loaded with ocular hypotensive drugs via intravitreal injection and IOP was monitored. Retinal deposition and retinal ganglion cell (RGC) uptake of Neuro-DiO were examined following intravitreal injection of Neuro-DiO-NS using confocal microscopy. RESULTS Brimonidine-loaded NS lowered IOP 12% to 30% for up to 6 days (P < 0.02), whereas travoprost-NS lowered IOP 19% to 29% for up to 4 days (P < 0.02) compared to saline injection. Three bimatoprost NS were tested: a 400-nm NS and two 700-nm NS with amorphous (A-NS) or amorphous/crystalline (AC-NS) crosslinkers. A single injection of 400 nm NS lowered IOP 24% to 33% for up to 17 days compared to saline, while A-NS and AC-NS lowered IOP 22% to 32% and 18% to 26%, respectively, for up to 32 days (P < 0.046). Over time retinal deposition of Neuro-DiO increased from 19% to 71%; Neuro-DiO released from NS was internalized by RGCs. CONCLUSIONS A single injection of NS can effectively deliver ocular hypotensive drugs in a linear and continuous manner for up to 32 days. Also, NS may be effective at targeting RGCs, the neurons that degenerate in glaucoma. TRANSLATIONAL RELEVANCE Patient compliance is a major issue in glaucoma. The use of NS to deliver a controlled, sustained release of therapeutics could drastically reduce the number of patients that progress to vision loss in this disease.
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Affiliation(s)
- Wendi S Lambert
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Carlson
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Grace Shih
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia N Dobish
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David J Calkins
- The Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA ; Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eva Harth
- Department of Chemistry, Vanderbilt University, Nashville, TN, USA
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Kerns J, Brown B, Sokoloff A, Shih G, DerSimonian K. Copper IUD compared to oral medication for emergency contraception: a study of patient choice and satisfaction. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roth MY, Shih G, Ilani N, Wang C, Page ST, Bremner WJ, Swerdloff RS, Sitruk-Ware R, Blithe DL, Amory JK. Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial. Contraception 2014; 90:407-12. [PMID: 24981149 DOI: 10.1016/j.contraception.2014.05.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method. STUDY DESIGN As part of a three-arm, 6-month, double-blind, randomized controlled trial of testosterone and nestorone gels at two academic medical centers, subjects completed a questionnaire to assess the acceptability of the regimen. Of the 99 men randomized, 79 provided data for analysis. RESULTS Overall, 56% (44/79) of men were satisfied or extremely satisfied with this gel-based method of contraception, and 51% (40/79) reported that they would recommend this method to others. One third of subjects (26/79) reported that they would use this as their primary method of contraception if it were commercially available today. However, men with concerns about sexually transmitted disease were significantly less satisfied than men without such concerns (p=0.03). CONCLUSIONS A majority of the men who volunteered to participate in this trial of an experimental male hormonal contraceptive were satisfied with this transdermal male hormonal contraceptive. If commercially available, a combination of topical nesterone and testosterone gels could provide a reversible, effective method of contraception that is appealing to men. IMPLICATIONS A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy.
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Affiliation(s)
- Mara Y Roth
- University of Washington, Department of Medicine and Center for Research in Reproduction and Contraception.
| | - Grace Shih
- University of Washington, Department of Family Medicine
| | - Niloufar Ilani
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Department of Medicine, Torrance, CA
| | - Christina Wang
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Department of Medicine, Torrance, CA
| | - Stephanie T Page
- University of Washington, Department of Medicine and Center for Research in Reproduction and Contraception
| | - William J Bremner
- University of Washington, Department of Medicine and Center for Research in Reproduction and Contraception
| | - Ronald S Swerdloff
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Department of Medicine, Torrance, CA
| | | | - Diana L Blithe
- Contraceptive Discovery and Development Branch, NICHD, Bethesda, MD
| | - John K Amory
- University of Washington, Department of Medicine and Center for Research in Reproduction and Contraception
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA.
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Goodman S, Shih G, Hawkins M, Feierabend S, Lossy P, Waxman NJ, Gold M, Dehlendorf C. A long-term evaluation of a required reproductive health training rotation with opt-out provisions for family medicine residents. Fam Med 2013; 45:180-186. [PMID: 23463431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Family physicians are critical to reproductive health care provision. Previous studies have evaluated the immediate impact of training family physicians in abortion and reproductive health care but have not conducted long-term follow-up of those trained. METHODS In a cross-sectional survey performed in 2009, all 2003--2008 graduates from four family medicine residency programs with a required abortion training rotation with opt-out provisions were asked to participate in a confidential online follow-up survey that was linked to rotation evaluations. The follow-up surveys addressed current reproductive health practice, desire to integrate services in ideal practice, perceived barriers, and desired support for provision of services. RESULTS Of 183 eligible graduates, 173 had contact information, and 116 completed the survey. The majority of respondents had provided a range of reproductive health services since residency. Of full training participants, many had performed IUD insertion (72%), endometrial biopsies (55%), miscarriage management (52%), and abortion (27%), compared to 39%, 22%, 17%, and 0% of opt-out training participants, respectively. Of those residents intending future abortion provision, 40% went on to do so. In multivariate analysis among full participants, procedural volume was positively correlated with future abortion provision after controlling for intention to provide abortions, gender, and residency program (adjusted OR=1.42 [95% CI=1.03--1.94]). While most respondents considered comprehensive reproductive health services including miscarriage management and abortion as important to include in their ideal practice, many faced barriers to providing all the services they desired. CONCLUSIONS Family medicine residency graduates fully participating in abortion training reported increased provision of most reproductive health services compared to opt-out graduates. Many intending to provide abortions reported a variety of barriers to provision. Training programs that provide assistance for overcoming obstacles to practice initiation may improve comprehensive reproductive health provision among graduates.
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Affiliation(s)
- Suzan Goodman
- Department of Family and Community Medicine, University of California, San Francisco. San Francisco, CA 94110, USA.
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King E, Shih G, Ratnapradipa D, Quilliam DN, Morton J, Magee SR. Mercury, lead, and cadmium in umbilical cord blood. J Environ Health 2013; 75:38-43. [PMID: 23397648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study described in this article aimed to determine if measurable levels of mercury, lead, and cadmium are detected in the umbilical cord blood specimens collected in a community hospital in Rhode Island and if prenatal exposure correlates with prematurity or fetal growth indicators. Total mercury, lead, and cadmium concentrations were measured in 538 specimens of cord blood and correlated with demographic characteristics and pregnancy outcomes for each mother-infant pair. Lead concentrations determined in the cord blood of Rhode Island women (geometric mean 0.99 microg/dL) were similar to those reported in U.S. biomonitoring studies. The overall geometric mean for mercury concentration (0.52 microg/L) was slightly lower than in other comparable studies. Cadmium concentrations were generally below the limit of detection. A statistically significant correlation was detected between elevated mercury concentrations and racial and ethnic characteristics of the study participants. Non-Hispanic African-American mothers were 9.6 times more likely to have a mercury concentration > or = 5.8 microg/L compared to women of other racial/ethnic backgrounds. No association was detected between elevated mercury levels and adverse birth outcomes.
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Affiliation(s)
- Ewa King
- State Health Laboratories, Rhode Island Department of Health, Providence, RI 02904, USA.
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Abstract
Vasectomy has advantages with respect to safety and cost when compared with female sterilization. The reasons underlying the overall low use of vasectomy, particularly among Black and Latinos, have not been adequately explored. The goals of this study were to (a) explore the social context of vasectomy decisions and (b) generate hypotheses about the social factors contributing to differences in vasectomy use by race/ethnicity. Fourteen group and nine couples interviews were conducted. Participants were 37 heterosexual couples aged 25 to 55 years who had reached their desired family size and self-identified as Black, Latino, or White. Participants discussed reasons that men and women would or would not select male sterilization. Reasons to select vasectomy included a desire to care for their current family, sharing contraceptive responsibility, and infidelity. Reasons not to select vasectomy included negative associations with the term sterilization, loss of manhood, and permanence. Misconceptions about vasectomy included misunderstandings about the vasectomy procedure and adverse postvasectomy sexual function. In addition, Black and Latino participants cited perceived ease of reversibility of female sterilization and lack of support around vasectomy as reasons not to choose it. Improving communication and social support for vasectomy, particularly among Black and Latino communities, may improve vasectomy utilization. Misconceptions regarding female and male sterilization should be targeted in counseling sessions to ensure men, women, and couples are making informed contraceptive decisions.
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Affiliation(s)
- Grace Shih
- University of California San Francisco, San Francisco, CA, USA
| | - Kate Dubé
- University of California San Francisco, San Francisco, CA, USA
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28
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Durand M, Robinson B, Aronowitz E, Fish J, Srivastava A, Sooriakumaran P, Mtui J, Brooks D, Leung R, Gumpeni N, Shih G, Ng A, Tu J, Arnaud P, Bensaid R, Mentine N, Rouscoff Y, Carpentier X, Chevallier D, Amiel J, Tewari A, Ballon D. L’IRM 7 Tesla de la prostate : une imagerie haute définition prometteuse pour assister l’analyse histologique des pièces de prostatectomie radicale. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Shih G, Vittinghoff E, Steinauer J, Dehlendorf C. Racial and ethnic disparities in contraceptive method choice in California. Perspect Sex Reprod Health 2011; 43:173-80. [PMID: 21884385 PMCID: PMC4487743 DOI: 10.1363/4317311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
CONTEXT Unintended pregnancy, an important public health issue, disproportionately affects minority populations. Yet, the independent associations of race, ethnicity and other characteristics with contraceptive choice have not been well studied. METHODS Racial and ethnic disparities in contraceptive use among 3,277 women aged 18-44 and at risk for unintended pregnancy were assessed using 2006-2008 data from of the California Women's Health Survey. Sequential logistic regression analyses were used to examine the independent and cumulative associations of racial, ethnic, demographic and socioeconomic characteristics with method choice. RESULTS Differences in contraceptive use persisted in analyses controlling for demographic and socioeconomic characteristics. Blacks and foreign-born Asians were less likely than whites to use high-efficacy reversible methods-that is, hormonals or IUDs (odds ratio, 0.5 for each). No differences by race or ethnicity were found specifically for IUD use in the full model. Blacks and U.S.-born Hispanics were more likely than whites to choose female sterilization (1.9 and 1.7, respectively), while foreign-born Asians had reduced odds of such use (0.4). Finally, blacks and foreign-born Asians were less likely than whites to rely on male sterilization (0.3 and 0.1, respectively). CONCLUSIONS Socioeconomic factors did not explain the disparities in method choice among racial and ethnic groups. Intervention programs that focus on improving contraceptive choice among black and, particularly, Asian populations need to be developed, as such programs have the potential to reduce the number of unintended pregnancies that occur among these high-risk groups.
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Affiliation(s)
- Grace Shih
- Department of Family and Community Medicine, University of California, San Francisco, USA.
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30
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Choksi S, Lin Y, Pobezinskaya Y, Chen L, Park C, Morgan M, Li T, Jitkaew S, Cao X, Kim YS, Kim HS, Levitt P, Shih G, Birre M, Deng CX, Liu ZG. A HIF-1 target, ATIA, protects cells from apoptosis by modulating the mitochondrial thioredoxin, TRX2. Mol Cell 2011; 42:597-609. [PMID: 21658601 DOI: 10.1016/j.molcel.2011.03.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/04/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
The regulation of apoptosis is critical for controlling tissue homeostasis and preventing tumor formation and growth. Reactive oxygen species (ROS) generation plays a key role in such regulation. Here, we describe a HIF-1 target, Vasn/ATIA (anti-TNFα-induced apoptosis), which protects cells against TNFα- and hypoxia-induced apoptosis. Through the generation of ATIA knockout mice, we show that ATIA protects cells from apoptosis through regulating the function of the mitochondrial antioxidant, thioredoxin-2, and ROS generation. ATIA is highly expressed in human glioblastoma, and ATIA knockdown in glioblastoma cells renders them sensitive to hypoxia-induced apoptosis. Therefore, ATIA is not only a HIF-1 target that regulates mitochondrial redox pathways but also a potentially diagnostic marker and therapeutic target in human glioblastoma.
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Affiliation(s)
- Swati Choksi
- Cell and Cancer Biology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Bethesda, MD 20892, USA
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31
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Turok DK, Shih G, Parker WJ. Reversing the United States sterilization paradox by increasing vasectomy utilization. Contraception 2011; 83:289-90. [DOI: 10.1016/j.contraception.2010.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 08/11/2010] [Accepted: 08/25/2010] [Indexed: 11/26/2022]
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32
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Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception 2010; 83:310-5. [PMID: 21397087 DOI: 10.1016/j.contraception.2010.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 11/30/2022]
Abstract
Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.
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Affiliation(s)
- Grace Shih
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
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33
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Shih G, Dehlendorf C. Understanding the attitudes of black, Latino, and white couples towards sterilization. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Affiliation(s)
- Grace Shih
- Department of Family and Community Medicine, University of California-San Francisco, San Francisco, California
| | - Merlin Njoya
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec City, Quebec, Canada
| | - Marylène Lessard
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec City, Quebec, Canada
| | - Michel Labrecque
- Department of Family and Emergency Medicine, Laval University, Québec City, Québec, Canada
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35
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Magee SR, King E, Shih G, Ratnapradipa D, Quilliam D, Morton J. Biomonitoring in Rhode Island. Med Health R I 2008; 91:88-90. [PMID: 18438100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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36
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Abstract
Gastric bypass surgery, by definition, changes the absorption capabilities of the stomach and small intestine. The use of oral medications in patients post gastric bypass may need to be adjusted by medical providers to account for this absorption change. The following case exemplifies this dilemma in a pregnant patient status post gastric bypass surgery with a complicated urinary tract infection.
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37
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Paquette RL, Hsu N, Said J, Mohammed M, Rao NP, Shih G, Schiller G, Sawyers C, Glaspy JA. Interferon-alpha induces dendritic cell differentiation of CML mononuclear cells in vitro and in vivo. Leukemia 2002; 16:1484-9. [PMID: 12145689 DOI: 10.1038/sj.leu.2402602] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2001] [Accepted: 02/21/2002] [Indexed: 11/08/2022]
Abstract
The ability of interferon-alpha (IFN-alpha) to induce dendritic cell (DC) differentiation in chronic myeloid leukemia (CML) was evaluated. Peripheral blood mononuclear cells from CML patients cultured with IFN-alpha and granulocyte-macrophage colony-stimulating factor (GM-CSF) developed a dendritic morphology. Fluorescence in situ hybridization demonstrated that the DCs harbored the bcr/abl translocation. The DCs prepared with IFN-alpha/GM-CSF expressed significantly higher levels of class I and II HLA than those grown in interleukin-4 (IL-4) and GM-CSF. The DCs prepared from newly diagnosed CML patients using IFN-alpha/GM-CSF expressed immunoregulatory proteins at levels comparable to normal DCs. In contrast, DCs cultured from CML patients who did not achieve a cytogenetic response to IFN-alpha expressed significantly lower levels of class I HLA, CD40, CD54, CD80 and CD86 than normal DCs. The expression of CD86 by CML DCs was enhanced when they were cultured with IFN-alpha/IL-4/GM-CSF, or when IFN-alpha/GM-CSF-treated cells were induced to mature by CD40 ligand. The DCs from IFN-alpha failures were less stimulatory than normal DCs in the allogeneic mixed leukocyte reaction. CML patients who had a cytogenetic response to IFN-alpha initially had low numbers of bone marrow DCs that increased significantly with treatment, while nonresponders had more prevalent DCs at baseline that showed no consistent change with treatment. Therefore, IFN-alpha can induce DC differentiation from CML progenitor cells both in vitro and in vivo. The therapeutic activity of IFN-alpha in CML may be due to its ability to stimulate the generation of DCs that can present CML-specific antigens. Resistance to IFN-alpha may result when DC differentiation becomes impaired.
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MESH Headings
- Antigen Presentation
- Antigens, CD/analysis
- Antigens, CD/biosynthesis
- Antigens, CD/genetics
- Biomarkers, Tumor/genetics
- Blood Cells/pathology
- Bone Marrow Cells/pathology
- CD40 Ligand/pharmacology
- Cell Differentiation/drug effects
- Dendritic Cells/drug effects
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Leukemic/drug effects
- Granulocyte-Macrophage Colony-Stimulating Factor/pharmacology
- HLA Antigens/analysis
- HLA Antigens/biosynthesis
- HLA Antigens/genetics
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Interferon alpha-2
- Interferon-alpha/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Lymphocyte Culture Test, Mixed
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/pathology
- Recombinant Proteins
- Tumor Cells, Cultured/drug effects
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Affiliation(s)
- R L Paquette
- UCLA Department of Medicine, Division of Hematology/Oncology, Los Angeles, CA 90095-1678, USA
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38
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Abstract
OBJECTIVE To estimate whether the cesarean delivery rate differs between women with severe preeclampsia who receive intrapartum epidural analgesia versus patient-controlled intravenous opioid analgesia. METHODS Women with severe preeclampsia at at least 24 weeks' gestation were randomly assigned to receive either intrapartum epidural (n = 56) versus patient-controlled intravenous opioid analgesia (n = 60), and each was administered by a standardized protocol. The sample size was selected to have 80% power to detect at least a 50% difference in the predicted intergroup cesarean delivery rates. Data were analyzed by intent to treat. RESULTS Selected maternal characteristics and neonatal outcomes were similar in the two groups. The cesarean delivery rates in the epidural group (18%) and the patient-controlled analgesia group (12%) were similar (P =.35). Women who received epidural analgesia were more likely to require ephedrine for the treatment of hypotension (9% versus 0%, P =.02), but their infants were less likely to require naloxone at delivery (9% versus 54%, P <.001). Epidural analgesia provided significantly better pain relief as determined by a visual analogue intrapartum pain score (P <.001) and a postpartum pain management survey (P =.002). CONCLUSION Compared with patient-controlled intravenous opioid analgesia, intrapartum epidural analgesia did not significantly increase the cesarean delivery rate in women with severe preeclampsia at our level III center, and it provided superior pain relief.
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Affiliation(s)
- Barbara B Head
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35249-7333, USA
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39
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Yoshinaga SK, Whoriskey JS, Khare SD, Sarmiento U, Guo J, Horan T, Shih G, Zhang M, Coccia MA, Kohno T, Tafuri-Bladt A, Brankow D, Campbell P, Chang D, Chiu L, Dai T, Duncan G, Elliott GS, Hui A, McCabe SM, Scully S, Shahinian A, Shaklee CL, Van G, Mak TW, Senaldi G. T-cell co-stimulation through B7RP-1 and ICOS. Nature 1999; 402:827-32. [PMID: 10617205 DOI: 10.1038/45582] [Citation(s) in RCA: 597] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
T-cell activation requires co-stimulation through receptors such as CD28 and antigen-specific signalling through the T-cell antigen receptor. Here we describe a new murine costimulatory receptor-ligand pair. The receptor, which is related to CD28 and is the homologue of the human protein ICOS, is expressed on activated T cells and resting memory T cells. The ligand, which has homology to B7 molecules and is called B7-related protein-1 (B7RP-1), is expressed on B cells and macrophages. ICOS and B7RP-I do not interact with proteins in the CD28-B7 pathway, and B7RP-1 co-stimulates T cells in vitro independently of CD28. Transgenic mice expressing a B7RP-1-Fc fusion protein show lymphoid hyperplasia in the spleen, lymph nodes and Peyer's patches. Presensitized mice treated with B7RP-1-Fc during antigen challenge show enhanced hypersensitivity. Therefore, B7RP-1 exhibits co-stimulatory activities in vitro and in vivo. ICOS and B7RP-1 define a new and distinct receptor-ligand pair that is structurally related to CD28-B7 and is involved in the adaptive immune response.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antigens, Differentiation, T-Lymphocyte/genetics
- Antigens, Differentiation, T-Lymphocyte/metabolism
- B7-1 Antigen/genetics
- B7-1 Antigen/metabolism
- CHO Cells
- COS Cells
- Cells, Cultured
- Cricetinae
- DNA, Complementary
- Dermatitis, Contact/immunology
- Female
- Gene Expression
- Humans
- Inducible T-Cell Co-Stimulator Ligand
- Inducible T-Cell Co-Stimulator Protein
- Ligands
- Lymph Nodes/immunology
- Lymph Nodes/metabolism
- Lymphocyte Activation
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Transgenic
- Molecular Sequence Data
- Protein Binding
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/metabolism
- Sequence Homology, Amino Acid
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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40
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Zügel U, Wang R, Shih G, Sette A, Alexander J, Grey HM. Termination of Peripheral Tolerance to a T Cell Epitope by Heteroclitic Antigen Analogues. The Journal of Immunology 1998. [DOI: 10.4049/jimmunol.161.4.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Treating mice with an immunodominant T cell epitope from moth cytochrome c (MCC88–103) can induce T cell unresponsiveness under certain conditions of administration. In this report, we determined whether T cell tolerance to MCC88–103 in adult animals can be overcome by immunization with cross-reactive analogues of the tolerizing Ag. A panel of analogues of the tolerogen were tested for their capacity to terminate the tolerant state following in vivo immunization. As analyzed by their stimulatory capacity for a representative MCC88–103-specific T cell clone, this panel covered a wide range of cross-reactivity, including nonantigenic, antagonistic, weakly, and strongly antigenic peptides. Interestingly, only heteroclitic analogues, as measured in vitro by their enhanced antigenicity for the T cell clone that was specific for MCC88–103, were capable of breaking tolerance. Thus, an immune response to the cross-reactive, heteroclitic analogues of tolerized self Ags may represent a mechanism by which Ag molecular mimicry operates.
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Affiliation(s)
- Ulrich Zügel
- *La Jolla Institute for Allergy and Immunology, San Diego, CA 92121; and
| | - Rongfang Wang
- *La Jolla Institute for Allergy and Immunology, San Diego, CA 92121; and
| | - Grace Shih
- *La Jolla Institute for Allergy and Immunology, San Diego, CA 92121; and
| | | | | | - Howard M. Grey
- *La Jolla Institute for Allergy and Immunology, San Diego, CA 92121; and
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41
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Zügel U, Wang R, Shih G, Sette A, Alexander J, Grey HM. Termination of peripheral tolerance to a T cell epitope by heteroclitic antigen analogues. J Immunol 1998; 161:1705-9. [PMID: 9712034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Treating mice with an immunodominant T cell epitope from moth cytochrome c (MCC(88-103)) can induce T cell unresponsiveness under certain conditions of administration. In this report, we determined whether T cell tolerance to MCC(88-103) in adult animals can be overcome by immunization with cross-reactive analogues of the tolerizing Ag. A panel of analogues of the tolerogen were tested for their capacity to terminate the tolerant state following in vivo immunization. As analyzed by their stimulatory capacity for a representative MCC(88-103)-specific T cell clone, this panel covered a wide range of cross-reactivity, including nonantigenic, antagonistic, weakly, and strongly antigenic peptides. Interestingly, only heteroclitic analogues, as measured in vitro by their enhanced antigenicity for the T cell clone that was specific for MCC(88-103), were capable of breaking tolerance. Thus, an immune response to the cross-reactive, heteroclitic analogues of tolerized self Ags may represent a mechanism by which Ag molecular mimicry operates.
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Affiliation(s)
- U Zügel
- La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
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42
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Abstract
Caloric utilization is an important aspect of the clinical management of eating disorders. Caloric intake and body weight of 32 inpatient bulimic and anorectic girls and 30 normal adolescents were measured. Normal weight bulimics ate fewer calories while anorectics ate more calories per kilogram body weight compared with the control group. Anorectics have greater difficulty to eat sufficient calories to maintain their weight. These findings indicate that treatment should be extended beyond the point of time where normal weight is reached.
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43
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La Face DM, Couture C, Anderson K, Shih G, Alexander J, Sette A, Mustelin T, Altman A, Grey HM. Differential T cell signaling induced by antagonist peptide-MHC complexes and the associated phenotypic responses. J Immunol 1997; 158:2057-64. [PMID: 9036949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Certain changes in TCR contact residues have been shown to have profound effects on the capacity of a peptide Ag to stimulate a T cell response. Although some of these changes apparently lead to a complete loss of the ability to interact with the TCR, others result in partial agonist activity (e.g., cytokine production without proliferation) or antagonist activity (i.e., the capacity to inhibit the engagement to the TCR by Ag). We show MHC class II-restricted antagonist activity was associated with a differential pattern of early tyrosine phosphorylation events that was characterized by a preponderance of phosphorylation of low molecular mass TCRzeta and the failure to phosphorylate Zap-70. These early tyrosine phosphorylation patterns are the same as those previously described for partial agonists. Thus, a partial agonist phenotype such as anergy induction cannot be ascribed in a causal manner to this pattern of tyrosine phosphorylation. We further extend the studies of signal transduction elicited by agonist and antagonist peptides by characterizing differential recruitment of Zap-70 associated with TCRzeta isoforms and differential phosphorylation of p120 proto-oncogene c-Cbl. Another early event following TCR engagement by Ag, down-modulation of the TCR, was studied with antagonist peptides. We show that antagonist peptides do not cause TCR down-modulation. This failure may represent a mechanism by which antagonists inhibit antigen-mediated stimulation of T cells.
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Affiliation(s)
- D M La Face
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
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44
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La Face DM, Couture C, Anderson K, Shih G, Alexander J, Sette A, Mustelin T, Altman A, Grey HM. Differential T cell signaling induced by antagonist peptide-MHC complexes and the associated phenotypic responses. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.158.5.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Certain changes in TCR contact residues have been shown to have profound effects on the capacity of a peptide Ag to stimulate a T cell response. Although some of these changes apparently lead to a complete loss of the ability to interact with the TCR, others result in partial agonist activity (e.g., cytokine production without proliferation) or antagonist activity (i.e., the capacity to inhibit the engagement to the TCR by Ag). We show MHC class II-restricted antagonist activity was associated with a differential pattern of early tyrosine phosphorylation events that was characterized by a preponderance of phosphorylation of low molecular mass TCRzeta and the failure to phosphorylate Zap-70. These early tyrosine phosphorylation patterns are the same as those previously described for partial agonists. Thus, a partial agonist phenotype such as anergy induction cannot be ascribed in a causal manner to this pattern of tyrosine phosphorylation. We further extend the studies of signal transduction elicited by agonist and antagonist peptides by characterizing differential recruitment of Zap-70 associated with TCRzeta isoforms and differential phosphorylation of p120 proto-oncogene c-Cbl. Another early event following TCR engagement by Ag, down-modulation of the TCR, was studied with antagonist peptides. We show that antagonist peptides do not cause TCR down-modulation. This failure may represent a mechanism by which antagonists inhibit antigen-mediated stimulation of T cells.
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Affiliation(s)
- D M La Face
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - C Couture
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - K Anderson
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - G Shih
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - J Alexander
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - A Sette
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - T Mustelin
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - A Altman
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
| | - H M Grey
- Division of Immunochemistry, La Jolla Institute for Allergy and Immunology, San Diego, CA 92121, USA
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