Faculty Bibliography

Abstract Objective: Chinese women have been shown to have a higher incidence of severe perineal laceration compared to other ethnic groups. We sought to test the hypothesis that this risk is related to body mass index (BMI) or to a relative fetal-maternal size disproportion as measured by the ratio of the newborn birthweight to maternal BMI (BW:BMI). Methods: A retrospective cohort study was performed using a pre-existing obstetric database. Third- and fourth-degree perineal lacerations served as the primary outcome of interest. Logistic regression was used to compare Chinese women to other ethnic groups and adjust for confounders. Results: Three thousand and eighty-five singleton vaginal deliveries were identified, with BMI data available for 2281. Chinese women had a greater risk for severe perineal laceration compared to Caucasian (OR: 3.22; 95% CI: 0.73-14.32) and Hispanic women (OR: 2.88; 95% CI: 1.92-4.30). Multivariate analysis found that newborn birth weight plays a role (OR: 1.0012; 95% CI: 1.0007-1.0016), but BMI alone did not explain the discrepancy (P=0.89). However, the BW:BMI ratio appears to be a stronger predictor of laceration rate than either variable alone (OR: 1.011; 95% CI: 1.003-1.020). Conclusion: The higher risk of severe perineal laceration in Chinese women compared to other ethnicities can be attributed, in part, to a relative fetal-maternal size disproportion

We conducted a nested case-control study within two prospective cohorts, the New York University Women's Health Study and the Northern Sweden Health and Disease Study, to examine the association between prediagnostic circulating levels of 25-hydroxy vitamin D (25(OH)D) and the risk of subsequent invasive epithelial ovarian cancer (EOC). The 25(OH)D levels were measured in serum or plasma from 170 incident cases of EOC and 373 matched controls. Overall, circulating 25(OH)D levels were not associated with the risk of EOC in combined cohort analysis: adjusted OR for the top tertile versus the reference tertile, 1.09 (95% CI, 0.59-2.01). In addition, there was no evidence of an interaction effect between VDR SNP genotype or haplotype and circulating 25(OH)D levels in relation to ovarian cancer risk, although more complex gene-environment interactions may exist

Pregnancy hormones are believed to be involved in the protection against breast cancer conferred by pregnancy. The authors explored the association of maternal breast cancer with human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP). In 2001, a case-control study was nested within the Northern Sweden Maternity Cohort, an ongoing study in which blood samples have been collected from first-trimester pregnant women since 1975. Cases (n = 210) and controls (n = 357) were matched for age, parity, and date of blood donation. Concentrations of hCG and AFP were measured by immunoassay. No overall significant association of breast cancer with either hCG or AFP was observed. However, women with hCG levels in the top tertile tended to be at lower risk of breast cancer than women with hCG levels in the lowest tertile in the whole study population and in subgroups of age at sampling, parity, and age at cancer diagnosis. A borderline-significant decrease in risk with high hCG levels was observed in women who developed breast cancer after the median lag time to cancer diagnosis (> or =14 years; odds ratio = 0.53, 95% confidence interval: 0.27, 1.03; P = 0.06). These findings, though very preliminary, are consistent with a possible long-term protective association of breast cancer risk with elevated levels of circulating hCG in the early stages of pregnancy

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional study was performed at Bellevue Hospital. A questionnaire was given to women in the gynecology outpatient clinics asking about: oral contraceptive pills (OCP's), injectable contraception (DMPA), the Intrauterine device (IUD) and the Ortho-Evra Patch (Patch). In the 102 complete surveys, self identified Latina women were not convinced of the safety of OCPs and DMPA (less than 50% perceived them to be safe) and largely uncertain about the Patch and IUD. Latinas also demonstrated more negative beliefs about the side effects of OCPs and DMPA. In particular, they were concerned about weight gain, method reversibility, and bleeding. There was no substantial correlation between religiosity and contraceptive beliefs. Low level acculturated women were more likely to believe that the IUD and OCPs were harmful, as opposed to their more acculturated counterparts who demonstrated more negative beliefs about the Patch. Overall, Latina women in this study tended to overrate the risks associated with contraceptive use, particularly OCPs and DMPA. The markedly low method confidence suggested by high rates of 'unsure' answers is a possible explanation for why Latinas are less adherent with birth control than their white counterparts

Endogenous pituitary hormones are commonly used in clinical and epidemiologic studies and some of them are thought to influence the risk of several diseases in women. In most studies, endogenous levels of pituitary hormones are usually assessed at a single point in time, assuming that this single measurement represents the long-term biomarker status of the individual. Such an assumption is rarely tested and may not always be valid. This study examined the reproducibility of the following pituitary hormones: adrenocorticotropic hormone (ACTH), growth hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin, measured using the Luminex xMap method in sera of healthy premenopausal and postmenopausal women. The study included 30 premenopausal women with three yearly samples and 35 postmenopausal women with two repeated yearly samples randomly selected from an existing prospective cohort. Analysis of intraclass correlation coefficients suggested higher reproducibility in postmenopausal women compared with premenopausal women for the following hormones: FSH (0.72 and 0.37, respectively), LH (0.83 and 0.44, respectively), and growth hormone (0.60 and 0.35, respectively). The intraclass correlation coefficients were relatively high and similar between postmenopausal and premenopausal women for ACTH (0.95 and 0.94, respectively), TSH (0.85 and 0.85, respectively), and prolactin (0.72 and 0.69, respectively). This study found that serum concentrations of FSH, LH, and growth hormone are stable in postmenopausal women and that ACTH, TSH, and prolactin are stable in both premenopausal and postmenopausal women, suggesting that a single measurement may reliably categorize average levels over at least a 2-year period

BACKGROUND: Passive educational techniques (such as lectures) are thought to be less productive than active learning. PURPOSE: We examined whether preparing for and participating in a debate would be an effective, active way to learn about a controversial topic. METHODS: We compared quiz performance in residents who attended a lecture to residents who prepared for/participated in a debate. Twelve residents each participated in one lecture session and one debate session. Learning was evaluated via a quiz. Quizzes were given twice: before the debate/lecture and 1 week after the debate/lecture. Quiz scores were compared using repeated measures analysis of variance, with a p value of < .05 considered significant. A survey evaluating the usefulness of debating was given to all participants. RESULTS: There was a statistically significant difference in the pretest mean quiz score between the debate and lecture groups: 78.3% and 52.5%, respectively (p = .02). Similarly, on posttest quizzes, the average debater scored 85.8%, versus 61.7% for the lecture group (p = .003). Although no one in the debate group scored lower on a follow-up quiz, 3 residents in the lecture group did worse on follow-up. CONCLUSIONS: When learning about a controversial topic, residents who prepared for/participated in a debate achieved higher quiz scores and were better at retaining information than those who attended a lecture. When faced with teaching a controversial topic, organizing a debate may be more effective than giving a lecture

To evaluate the associations of breast cancer risk with polymorphisms in the XPC and XPD/ERCC2 DNA nucleotide excision repair genes, a case-control study nested within a prospective cohort of 14,274 women was conducted. Genotypes were characterized for 612 incident, invasive breast cancer cases and their 1:1 matched controls. The homozygous variant of a poly(AT) insertion/deletion polymorphism in intron 9 of the XPC gene (XPC-PAT+/+), was associated with breast cancer risk [odds ratio (OR) = 1.45, 95% confidence interval: 1.07-1.97], after adjustment for other breast cancer risk factors. The breast cancer risk associated with XPC-PAT+/+ did not differ by age at diagnosis. There was an indication of an interaction (p = 0.08) between the XPC-PAT+/+ genotype and cigarette smoking. Ever smokers with the XPC-PAT+/+ genotype were at elevated risk of breast cancer (OR = 1.56, CI: 0.95-2.58), but no differences were observed among never smokers. Analyses of the ERCC2 Lys751Gln polymorphism did not show an association with breast cancer risk, either overall or at younger ages. The results suggest that breast cancer risk is related to the XPC haplotype tagged by the XPC-PAT+/+ insertion-deletion polymorphism in intron 9. Further study of the XPC haplotypes and their interactions with smoking in relation to breast cancer risk is needed