Faculty Bibliography

INTRODUCTION: The impact of sexual violence (SV) on mental health, self-care, and interpersonal relationships is profound and poses special challenges to health care delivery. Reproductive health care merits special attention because the care required may be linked to reminders of past abuse. We explored facilitators and barriers affecting the use of reproductive health services among women veterans with a history of SV. METHOD: Between June and September 2015, we conducted 2 focus groups and 3 general education sessions with 27 female veterans with a history of SV at 1 medical center. We analyzed transcripts according to applied thematic analysis and used Nvivo software for data management and retrieval. RESULTS: Three main themes emerged from the focus groups and education sessions. PARTICIPANTS: (a) expressed a desire for greater agency in relation to the control they have over their bodies and medical care; (b) described how posttraumatic stress symptoms are retriggered during medical care; and (c) expressed needs for additional education, peer and provider support within the medical system. DISCUSSION: For women with a history of SV, multiple individual and systemic barriers complicate how they utilize reproductive health services. Group education sessions were an effective mode of support, information and connection to other women within the Veterans Health Administration. (PsycINFO Database Record

Women with a history of sexual violence may face obstacles to obtaining preventive health services. Group education models have been used in other settings to improve knowledge and uptake of care. Focus groups were conducted to solicit the concerns and input of the subject population. Interdisciplinary group education sessions (GESs) were designed specifically to address concerns voiced in focus groups. GESs were conducted, addressing mammograms, pelvic examinations, and menopause, and emphasized preventive health education, as well as shared decision-making. GESs were audio recorded and qualitative feedback was collected immediately after each GES. Surveys were administered before and after each GES to evaluate attitude and knowledge change. A total of 18 women attended the focus groups, and 27 women attended at least one GES, with 12 women attending both. GESs were well received, and participants cited the education, group support, and healing dynamic as benefits of participation. Content knowledge improved after all three GESs. Attitude change showed a trend toward improvement, but the sample size was not large enough to detect statistical significance. Group education is an acceptable and feasible model among survivors of sexual violence. GESs improved knowledge among this small group of participants. GESs could be made available in a wide range of topics, as requested by our participants. Larger studies are warranted to examine long-term knowledge and attitude change after GESs.

OBJECTIVES: Clinicians and researchers need an accurate tool assessing contraceptive knowledge in order to understand the effectiveness of teaching efforts. However, most widely used indices are outdated. The objective of this study is to create an evidence-based assessment tool and determine its validity and reliability for measuring contraceptive knowledge. STUDY DESIGN: The study team developed the 25-question multiple-choice tool entitled the Contraceptive Knowledge Assessment (CKA). Expert reviewers examined content validity and semi-structured patient interviews acquired feedback on subject matter and comprehension. A two-tiered approach explored criterion validity via (1) comparison with the gold standard (Contraceptive Knowledge Inventory) and (2) comparison between groups with lower and higher contraceptive knowledge. Repeat testing after 2-4 weeks evaluated test-retest reliability. RESULTS: Six experts and 7 patients provided feedback on the initial CKA. One hundred and two reproductive-aged male and female patients and 27 medical students completed the final CKA with an overall mean patient score of 9.0/25 (36%). The mean score on the CKA was higher than the mean score on the gold standard (9.1 vs. 5.8, p<.001). Patients scored lower on the CKA than did medical students (9.1 [36.4%] vs.19.4 [77.6%], p<.005). There were no differences within patients' results with repeat testing over time (p=.667). CONCLUSIONS: The CKA is a valid and reliable tool to measure a patient's level of knowledge regarding contraception. This research tool may allow for the assessment of baseline knowledge, educational gaps, and improvement after an intervention. Knowledge may be lower than previous studies suggest, signifying need for improved education on contraception and better understanding of the relationship between knowledge and behavior change. IMPLICATIONS: The Contraceptive Knowledge Assessment provides an evidence-based, reliable, and validated assessment of contraceptive knowledge. This modern tool may help to determine the effectiveness of interventions to improve education on contraception.

BACKGROUND: Monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is crucial owing to increasing SP resistance in sub-Saharan Africa. METHODS: Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birthweight (LBW) were assessed among HIV-negative participants in 8 sites in 6 countries. Sites were classified as high, medium or low resistance after measuring mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted. RESULTS: Among 1,222 parasitaemic pregnant women, overall PCR-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6,099 women at delivery, each incremental dose of IPTp-SP was associated with a 22% reduction in the risk of LBW (prevalence ratio [PR]=0.78 [95% CI 0.69-0.88], p<0.001). This association was not modified by insecticide-treated net use or gravidity, and remained significant in areas with SP resistance (PR=0.81 [0.67-0.97], p=0.02). CONCLUSIONS: The efficacy of SP to clear peripheral parasites and prevent new infections during pregnancy is compromised in areas with >90% prevalence of Pfdhps-K540E. Nevertheless, in these high resistance areas, IPTp-SP use remains associated with increases in birthweight and maternal haemoglobin. The effectiveness of IPTp in eastern and southern Africa is threatened by further increases in SP-resistance and reinforces the need to evaluate alternative drugs and strategies for the control of malaria in pregnancy.

Background: The United States has an estimated 400,000 residing survivors of torture. The Program for Survivors of Torture (PSOT) at Bellevue Hospital is the only comprehensive torture treatment center in New York City. PSOT offers both medical and mental health treatment to its clients, who are ethnically diverse. There has to date been no comprehensive assessment of the gynecological needs of this population. This study affords a novel opportunity to investigate reproductive health needs of women who have experienced torture. Methods: This is a cross-sectional descriptive study conducted through structured interviews. All women enrolling in PSOT were eligible for inclusion. Data was collected in a REDCap database and analyzed using Stata v14. Outcomes were evaluated using descriptive statistics. Outcomes of interest include obstetric history, contraceptive knowledge and use, and prevalence of prior gender based violence (GBV) and female genital cutting (FGC). Findings: The majority (71.4%) were French-speaking West Africans. All participants reported prior experience of GBV; perpetrators were more likely to be from outside the family (64.3%), but violence from an intimate partner (35.0%) or family member (33.3%) was also common. Prior sexual violence and history of FGC was reported in 66.7% and 25.0% of subjects, respectively. The mean gravidity was 2.1 pregnancies (SD = 1.1) and, of those who have been pregnant (64.3%), 77.8% reported having received antenatal care at some point in pregnancy. While 85.7% reported any prior pregnancy-related complications, 57.1% of them reported seeking medical attention. Current contraception use was only reported in 15.4%, even though over half of women expressed a desire to delay pregnancy (spacers). Moreover, among all spacers, current use of contraception (28.6%) is lower than past use (78.6%). Participants had a better basic knowledge of traditional contraceptive methods (77.5%) compared to modern ones (56.1%). Interpretation: This is the first comprehensive review of gynecologic needs of survivors of torture in NYC. Prior history of GBV is common. It appears that while many have had prenatal care, overall knowledge and use of contraception in this population is very low compared to the general population