Faculty Bibliography

BACKGROUND/UNASSIGNED:Placenta accreta spectrum (PAS) is a leading cause of obstetric morbidity and peripartum hysterectomy. Rising cesarean delivery rates, advanced maternal age, and assisted reproductive technologies have increased its incidence. Early, standardized diagnosis is essential for multidisciplinary planning and improved outcomes, yet formal screening guidelines are lacking. OBJECTIVE/UNASSIGNED:To raise awareness of the importance of antenatal screening for PAS, summarize key clinical and imaging risk factors, and propose a standardized mid-trimester ultrasound protocol for high-risk patients. METHODS/UNASSIGNED:An expert panel convened under the Pan-American Society for the Placenta Accreta Spectrum (PAS2) reviewed available evidence, risk stratification models, and prior consensus statements to develop practical recommendations for PAS screening. RESULTS/UNASSIGNED:PAS risk rises with the number of prior cesarean deliveries, especially in the setting of concurrent placenta previa or anterior low-lying placenta. Combined transabdominal and transvaginal ultrasound using grayscale and low-flow color Doppler (<10 cm/s) best identifies characteristic markers such as loss of the clear zone, myometrial thinning, bladder-wall interruption, placental bulge, uterovesical hypervascularity, lacunae, and bridging vessels. Standardized imaging protocols and structured reporting improve detection and facilitate referral to specialized centers. CONCLUSIONS/UNASSIGNED:All patients with placenta previa or low-lying placenta and prior cesarean delivery should undergo targeted PAS screening at the time of anatomic survey. Early, systematic assessment and referral improve safety and outcomes.

INTRODUCTION/BACKGROUND:Puberty is a key transition point in adolescents' lives that plays a foundational role in shaping health behaviors and outcomes across one's life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies. OBJECTIVE:The objective of this scoping review is to systematically map and characterize the outcomes, domains, and instruments used to evaluate puberty education curricula for early adolescents aged 8-14 years. In accordance with PRISMA-ScR and JBI scoping review guidance, this review does not synthesize effect sizes or assess intervention efficacy, but maps the breadth of evidence to identify conceptual gaps and inform future framework development. METHODS:The review protocol is registered with the Open Science Framework (OSF). We will search PubMed, CINAHL, PsycInfo, ERIC, Education Source, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, and OpenAlex for relevant sources. Two reviewers will independently screen and extract studies that meet inclusion criteria using our data extraction tool. EXPECTED OUTPUTS/UNASSIGNED:Findings from the scoping review will be synthesized to create an overarching framework that can guide approaches to the development and evaluation of puberty curricula targeted to early adolescents. Focus group discussions with adolescents, parents, and school representatives will be conducted to assess the applicability and appropriateness of identified competencies and evaluation measures prior to broader dissemination. Insights from this scoping review will ultimately be used to inform the implementation and evaluation of puberty education.

IMPORTANCE/UNASSIGNED:Current pregnancy surveillance efforts in the US face substantial challenges in providing timely and accurate data on prenatal care use. Electronic health record (EHR) networks have the potential to enhance existing surveillance systems by providing near real-time, clinically documented data. OBJECTIVE/UNASSIGNED:To assess whether EHR network data could be used to define valid and reliable surveillance metrics of prenatal care use. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This longitudinal cohort study included US adults (age ≥18 years) who received prenatal care and delivered a live birth from January 1, 2023, to December 31, 2024, at a facility that used the Epic Cosmos EHR network. EXPOSURE/UNASSIGNED:Live birth at a facility that used the selected EHR network. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Prenatal care use was calculated as the proportions of patients who initiated care by the 13th week of pregnancy (early care) and who received adequate or better prenatal care (adequate care). Raking weights were applied to adjust the EHR sample to match the marginal distributions for US residents with live births by age, race and ethnicity, insurance, pregnancy risk factors, and geographic region. Electronic health records-based metrics were externally validated against published natality data estimates from National Center for Health Statistics (NCHS) using the two 1-sided test of equivalence. Patterns by demographics, state, and year were examined. RESULTS/UNASSIGNED:In total, 1 963 496 patients (mean [SD] age, 29.5 [5.7] years; 100% women) had a live birth and evidence of prenatal care at a facility using the selected EHR network during the study period. Compared with all US birthing people (n = 7 224 951), patients who gave birth at a facility using the selected EHR network had lower Medicaid coverage (40.5% vs 21.1%) and a higher prevalence of pregnancy risk factors (eg, prior preterm birth: 4.0% vs 8.8%). After weighting to the national population, EHR-based estimates of early care were consistently lower than those from NCHS data (68.0% [95% CI, 67.9%-68.2%] vs 76.1% [95% CI, 76.1%-76.1%]). However, adequacy estimates were equivalent to NCHS-based estimates (76.0% [95% CI, 75.9%-76.2%] vs 75.2% [95% CI, 75.1%-75.2%]; P < .001 at 0.01 equivalence bound), aligned with expected demographic patterns, and were stable across place and time. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cohort study, EHR network data reliably informed surveillance of prenatal care adequacy after adjusting for nonrepresentativeness of the patient population. These findings suggest that near real-time availability of EHR data has the potential to improve the timeliness of population-level pregnancy surveillance to better inform policy, public health, and clinical efforts aimed at enhancing prenatal care access and use among individuals receiving inadequate care.

OBJECTIVE:To determine the association between molecular classification and response in patients with endometrial intra-epithelial neoplasia or endometrial cancer treated with a levonorgestrel intra-uterine device. METHODS:Eligible patients were treated with a levonorgestrel intra-uterine device for endometrial intra-epithelial neoplasia or endometrial cancer for at least 6 months. Immunohistochemistry for MLH1, MSH2, MSH6, PMS2, and p53 was performed. Specimens were categorized using a modified Proactive Molecular Risk Classifier for Endometrial Cancer algorithm as deficient mismatch repair, p53 abnormal, or p53 wild-type. A subset underwent single-gene POLE sequencing. Best response was recorded as pathologic complete response, partial response, stable disease, or progressive disease. Kruskal-Wallis tests and Fisher exact tests were used for statistical analysis. RESULTS:There were 143 patients, including 83 with endometrial intra-epithelial neoplasia and 60 with endometrial cancer. Fertility preservation was desired in 35.7%, 53.8% had significant medical co-morbidities precluding hysterectomy, and 10.5% had levonorgestrel intra-uterine device placement for other indications, including patient preference, placement during the coronavirus disease 2019 pandemic, and logistical considerations for other cancer diagnoses. Molecular characterization showed 90.9% p53 wild-type, 7.0% deficient mismatch repair, and 2.1% p53 abnormal. Only 4.4% of specimens with sequencing had a POLE mutation (2 of 45). The overall response rate was 86.7% (endometrial cancer: complete response 38.3%, partial response 36.7%; endometrial intra-epithelial neoplasia: complete response 67.5%, partial response 27.7%). In patients with endometrial cancer, the response rate was 75% (45 of 60), varying by molecular sub-group: 50% in the p53 abnormal group (1 of 2) and 50% in the deficient mismatch repair group (5 of 10). Only 1 patient with endometrial intra-epithelial neoplasia had p53 abnormal expression; the remaining patients had intact MMR expression and p53 wild-type. CONCLUSIONS:The complete response to levonorgestrel intra-uterine device therapy was lower than expected for endometrial intra-epithelial neoplasia. Response rates varied by molecular classification, with worse outcomes observed in deficient mismatch repair and p53 abnormal sub-types. Although limited by sample size, these findings suggest that levonorgestrel intra-uterine device therapy may not be sufficient for all molecular sub-groups.

BACKGROUND/UNASSIGNED:Due to the COVID-19 pandemic, in 2020 the medical community modified residency and fellowship interview processes to a virtual-only format. The 2023 application cycle marked the first year that any gynecologic oncology fellowship interviews returned to an in-person format with two programs conducting in-person interviews. OBJECTIVE/UNASSIGNED:This study evaluated the perspectives of gynecologic oncology fellowship applicants on in-person and virtual interview formats to inform programs' decision-making around future interview cycles. METHODS/UNASSIGNED:Applicant lists from three gynecologic oncology fellowship programs were compiled from the 2023 application cycle. An anonymous survey regarding applicant perspectives on the interview process was electronically distributed. RESULTS/UNASSIGNED:There was a 56% (47/86) response rate. Applicants applied to a median of 50 programs (IQR 42-60), accepted 24 interviews (IQR 20-32), declined 4 interviews (IQR 2-9), and attended 24 interviews (IQR 17-24). Thirty (64%) applicants attended at least one in-person interview. Among the 30 applicants who experienced both interview formats, in-person interviews resulted in a better understanding of the program's geography, culture, and hospital facilities (p < 0.0001). Applicants who attended in-person interviews were more satisfied with their interview experience, found it easier to interpret body language, and were better able to connect with other applicants and form personal connections with interviewers (p < 0.0001). Of applicants who experienced both formats, 53% preferred in-person format. CONCLUSION/UNASSIGNED:Applicants who participated in both interview formats reported higher satisfaction and connected better with other applicants and interviewers with in-person interviews; however, there was only a slight (53%) preference for in-person format.

This study analyzed the association between self-perceived bullying and self-reported toothache among Brazilian students and evaluated the moderating role of school-based health actions, including participation in the School Health Program, oral health promotion, and bullying prevention. A cross-sectional study was conducted using data from the 2019 National School-based Health Survey, including 53,711 students aged 13-17 years. The outcome was self-reported toothache and the main exposure was self-perceived bullying. Moderating variables included school participation in the School Health Program, oral health promotion actions, and bullying prevention actions. Poisson regression models with robust variance were fitted, with standard errors adjusted for clustering by school. Overall, 23.6% of students reported toothache and 13.7% reported bullying. Moderation analyses showed no evidence that school health actions influenced the association between bullying and toothache. For bullying once or ≥2 times, prevalence ratios were: School Health Program participation (PR_once = 0.92, 95%CI 0.77-1.09; PR_ ≥ 2 = 1.07, 95%CI 0.81-1.41), bullying prevention (PR_once = 0.98, 95%CI 0.76-1.25; PR_ ≥ 2 = 0.82, 95%CI 0.72-1.09), and oral health promotion (PR_once = 1.13, 95%CI 0.96-1.33; PR_ ≥ 2 = 1.19, 95%CI 0.94-1.52). These findings indicate that school-based health actions alone may be insufficient to mitigate the impact of bullying on adolescents' oral health.

BACKGROUND:Literature reports that having fewer teeth is associated with reduced chewing capacity, which in turn may lead to weight changes due to diminished oral functionality. This study aims to assess the association between functional tooth units (FTU) and periodontal status and weight change among older adults participating in the Health, Aging, and Body Composition Study (Health ABC). METHODS:This study followed individuals with complete data on weight at years 2 and 6 of Health ABC. Variables included the number of teeth, FTU, and periodontal status, which were considered the primary exposures. The main outcome was a weight change of at least 5% during the follow-up period. Multinomial regression was used to calculate the odds ratio (OR) associated with at least 5% weight change. Independent adjusted models were built for each primary exposure (α < 5%). RESULTS:The study included 903 participants, of whom 231 (25.6%) experienced weight loss and 104 (11.5%) experienced weight gain. No significant association was found between weight loss and any of the exposures (p > 0.05). However, weight gain was associated with clinical attachment loss (CAL), number of teeth (OR: 0.97; 95%CI: 0.94-0.99), FTU/molars (OR: 0.83; 95%CI: 0.70-0.98), FTU/posterior (OR: 0.92; 95%CI: 0.84-0.99), and FTU/total (OR: 0.95; 95%CI: 0.91-0.99). CONCLUSION/CONCLUSIONS:Tooth loss was associated with weight gain over 4 years. Additional research is needed to uncover underlying mechanisms, including food choice. PLAIN LANGUAGE SUMMARY/CONCLUSIONS:Researchers studied how tooth loss and gum health affect weight changes in older adults. They followed participants from the Health, Aging, and Body Composition Study for 4 years, looking at their teeth, chewing ability, and weight changes. Out of 903 people in the study, 231 (25.6%) lost weight, and 104 (11.5%) gained weight. The results showed that having fewer teeth and poor gum health did not significantly affect weight loss. However, weight gain was linked to tooth loss and gum problems. People with fewer teeth or weaker chewing ability were more likely to gain weight. The study suggests that losing teeth may lead to changes in eating habits that result in weight gain. However, more research is needed to understand how tooth loss affects food choices and overall health.

AIM/OBJECTIVE:To evaluate whether periodontal parameters and tooth loss are associated with lung cancer incidence and mortality among older adults. MATERIALS AND METHODS/METHODS:Data are from the Health, Aging and Body Composition (Health ABC) study, which included 1136 older adults who received a periodontal examination and were followed for up to 16 years. Pocket depth and clinical attachment level were assessed for all present teeth. Adjusted Cox regression models were used to examine the relationship between periodontal parameters and number of natural teeth with lung cancer incidence and mortality. RESULTS:Lung cancer incidence was 4.4% (n = 50) and was identified as cause of death in 3.3% (n = 38). Those presenting at least 10% of sites with probing depth ≥ 6 mm demonstrated a higher risk of lung cancer and death due to lung cancer (hazard ratio [HR]: 3.12, 95% confidence interval [CI]: 1.45-6.72 and HR: 3.08, 95% CI: 1.27-7.46), respectively. Tooth loss was associated with a reduced hazard of lung cancer incidence (HR: 0.96; 95% CI: 0.93-0.99) and related mortality (HR: 0.96; 95% CI: 0.92-0.99). CONCLUSION/CONCLUSIONS:The association between severe periodontal disease parameters and tooth loss with lung cancer among older adults underscores the importance of oral health maintenance for cancer prevention strategies.

OBJECTIVE:Investigate whether depressive symptoms are linked to a higher likelihood of reporting poorer oral health conditions in older adults. THE BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD/UNASSIGNED:Understanding the potential negative effects of depressive symptoms on the perception of oral health in older adults is crucial for implementing tailored interventions and improving overall well-being in this demographic. MATERIALS AND METHODS/METHODS:This is a cross-sectional study using data from the 2019 Brazilian National Health Survey (PNS), conducted between 2019 and 2020. A total of 22,728 Brazilian older adults were analysed. A Poisson regression model was employed to examine the relationship between depressive symptoms and self-reported oral health. The selection of independent variables for statistical modelling was guided by a conceptual framework of social determinants. All analyses were performed using Stata 14.0. RESULTS:The unadjusted findings suggest that individuals with 9 or more depressive symptoms had a 68% higher prevalence (PR: 1.68 [95% CI: 1.67-1.69]) of reporting poor self-perceived oral health compared to those with fewer depressive symptoms. After adjusting for confounding factors, it was observed that individuals with 9 or more depressive symptoms had an 11% higher prevalence (PR: 1.11 [95% CI: 1.08-1.13]) compared to individuals with fewer depressive symptoms. CONCLUSION/CONCLUSIONS:Even after adjusting for factors, those with nine or more depressive symptoms were more likely to report poor oral health. This highlights the role of mental health in older adults' oral health, emphasising integrated approaches for overall well-being and addressing emotional and physical aspects.

PURPOSE/UNASSIGNED:The objective of this study was to identify temporal trends in intensity modulated radiation therapy (IMRT) use for patients with cervical cancer who received definitive chemoradiation. METHODS AND MATERIALS/UNASSIGNED:Patients diagnosed with stage IB2-IVA cervical cancer between 2004 and 2019 and treated with definitive chemoradiation were identified in the National Cancer Database. The primary outcome of interest was the use of IMRT versus 3-dimensional conformal radiation therapy (3DCRT) over time. Wilcoxon rank-sum tests, chi-square tests, and multivariable logistic regression were used to identify factors associated with the receipt of IMRT. RESULTS/UNASSIGNED:< .01). Clinical factors associated with increased IMRT use were stage III disease compared with stage I (odds ratio [OR], 1.3; CI, 1.0-1.5) and lymph node involvement (OR, 1.4; CI, 1.2-1.6). The demographic factors associated with increased IMRT receipt were treatment in the western US (OR, 1.5; CI, 1.2-1.8) and in the southern US (OR, 1.3; CI, 1.1-1.5) compared with the northeastern US, and living more than 50 miles from the treatment facility (OR, 1.2; CI, 1.0-1.5). Compared with White patients, Black patients (OR, 0.8; CI, 0.6-0.9) and patients receiving care at community hospitals compared with academic medical centers (OR, 0.7; CI, 0.6-0.7) were less likely to receive IMRT. CONCLUSIONS/UNASSIGNED:IMRT utilization for cervical cancer has increased over the last 15 years, especially for patients with advanced-stage disease or lymph node involvement. Understanding shifts in policy, demographic trends, and practice patterns may provide additional insight into the adoption of advanced technologies.