Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study

Background: Vulvodynia has been considered to be a chronic disorder. We sought to estimate the probability of and risk factors for remission, relapse, and persistence among women screening positive for vulvodynia. Methods: Survey-based assessment in a longitudinal population-based study of women (the Woman to Woman Health Study) who screened positive for vulvodynia and completed at least four follow-up surveys. Outcome measures included remission without relapse, relapse (after remission), and persistence of a positive vulvodynia screen. Multinomial regression was used to assess factors associated with outcomes. Results: Of 441 women screening positive for vulvodynia during the study, 239 completed 4 additional surveys. Of these, 23 (9.6%) had consistently positive vulvodynia screens, 121 (50.6%) remitted without relapse, and 95 (39.7%) relapsed following remission. Overall, factors associated with both relapse and persistence (compared with remission alone) included increased severity of pain ever (p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140139/1/jwh.2015.5397.pd

Genetic Differences May Reflect Differences in Susceptibility to Vulvodynia in General or in Spontaneous Remission Propensity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110555/1/jsm12775.pd

Use of Reversible Contraceptive Methods Among U.S. Women with Physical or Sensory Disabilities

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138241/1/psrh12031.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138241/2/psrh12031_am.pd

A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care.

OBJECTIVES: We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. METHODS: A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. RESULTS: Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). CONCLUSIONS: Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care

Impact of hands‐on care on infant sleep in the neonatal intensive care unit

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135460/1/ppul23513_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135460/2/ppul23513.pd

Advice given by community members to pregnant women: a mixed methods study

Background Smoking and excess weight gain during pregnancy have been shown to have serious health consequences for both mothers and their infants. Advice from friends and family on these topics influences pregnant women’s behaviors. The purpose of our study was to compare the advice that community members give pregnant women about smoking versus the advice they give about pregnancy weight gain. Methods A survey was sent via text messaging to adults in a diverse, low-income primary care clinic in 2015. Respondents were asked what advice (if any) they have given pregnant women about smoking or gestational weight gain and their comfort-level discussing the topics. Descriptive statistics were used to characterize the sample population and to determine response rates. Open-ended responses were analyzed qualitatively using grounded theory analysis with an overall convergent parallel mixed methods design. Results Respondents (n = 370) were 77 % female, 40 % black, and 25 % reported education of high school or less. More respondents had spoken to pregnant women about smoking (40 %, n = 147) than weight gain (20 %, n = 73). Among individuals who had not discussed either topic (n = 181), more reported discomfort in talking about weight gain (65 %) compared to smoking (34 %; p < 0.0001). Advice about smoking during pregnancy (n = 148) was frequently negative, recommending abstinence and identifying smoking as harmful for baby and/or mother. Advice about weight gain in pregnancy (n = 74) revealed a breadth of messages, from reassurance about all weight gain (“Eat away” or “It’s ok if you are gaining weight”), to specific warnings against excess weight gain (“Too much was dangerous for her and the baby.”). Conclusions Many community members give advice to pregnant women. Their advice reveals varied perspectives on the effects of pregnancy weight gain. Compared to a nearly ubiquitous understanding of the harms of smoking during pregnancy, community members demonstrated less awareness of and willingness to discuss the harms of excessive weight gain. Beyond educating pregnant women, community-level interventions may also be important to ensure that the information pregnant women receive supports healthy behaviors and promotes the long-term health of both moms and babies

Family physicians’ knowledge, attitudes, and behaviors regarding the weight effects of added sugar

Background and objectives: Added sugar consumption is a major risk factor for negative health outcomes and family physicians play an important role in educating patients regarding nutrition behaviors, such as consumption of added dietary sugar. The aim of this study was to describe the knowledge, attitudes, and behaviors of family physicians regarding added dietary sugar. Methods: An online questionnaire was administered to family physician members of the Council of Academic Family Medicine organizations, which support teaching physicians that train family physicians throughout the United States. Survey items underwent rigorous pilot and cognitive testing prior to administration. Descriptive statistics and Pearson’s chi-square test were performed to evaluate physician’s dietary counseling for patients with overweight and obesity. Results: Among practicing family physician members (n = 1196), 72% reported providing dietary counseling to the majority (⩾50%) of their patients with overweight and obesity. Most (90%) believed that their counseling was ineffective for the majority of patients. Frequency of counseling was significantly associated with beliefs about counseling effectiveness (p-value < 0.001). Nearly all physicians (97%) advised against consuming sugary beverages, while advising patients to limit foods with added sugar was less common (82%). Discussion: Dietary counseling is often, but not always, provided to patients with overweight and obesity by family physicians in our sample, though most physicians believed their counseling is ineffective. National attention to added sugar as a risk for poor health should serve as a catalyst for renewed efforts from primary care educators and clinicians to engage in innovative practices to empower at-risk patients to improve their nutrition

Characteristics of women age 15-24 at risk for excess weight gain during pregnancy.

PURPOSE:Excess weight gain during pregnancy is a serious health concern among young pregnant women in the US. This study aimed to characterize young women at highest risk for gaining over the recommended amount of weight during pregnancy. METHODS:Using a database that is representative of births in large U.S. cities, The Fragile Families and Child Wellbeing Study, we identified mothers of singleton term-infants age 15-24 years at the time of delivery. Institute of Medicine guidelines were used to categorize each mother's weight gain as less than, within, or more than recommended during pregnancy. Multinomial logistic regression models for weight gain category were performed, controlling for age, race/ethnicity, federal poverty level (FPL), health status, and prepregnancy BMI. RESULTS:Among the weighted sample (n = 1,034, N = 181,375), the mean (SD) age was 21 (3) years, 32% were black, 39% were Hispanic, 44% reported income under the Federal Poverty Level, 45% were overweight or obese before pregnancy, and 55% gained more weight than recommended during pregnancy. Women who were overweight or obese before pregnancy were at increased risk for gaining more pregnancy weight than recommended, compared to normal-weight women (adjusted Relative Risk Ratio (RRR) = 3.82, p = 0.01; RRR = 3.27, p = 0.03, respectively). Hispanics were less likely than non-Hispanics to gain more weight than recommended (RRR = 0.39, p = 0.03). CONCLUSIONS:The majority of mothers ages 15-24 gained excess weight during pregnancy, a strong risk factor for later obesity. Prepregnancy overweight or obesity and non-Hispanic ethnicity predicted excess pregnancy weight gain. Interventions and policies should target these high-risk young women to prevent excess weight gain