The oncogenic potential of endometrial polyps: a systematic review and meta-analysis.

OBJECTIVE: To systematically review and summarize the medical literature regarding the association of menopausal status, uterine bleeding, and polyp size and risk of malignancy among women undergoing polyp resection. DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing the risk of malignancy for patients undergoing polypectomy. Key word searches were performed using the words "endometrial polyp," "malignancy," "ultrasound," "saline sonohysterography," "hysteroscopy," and "histopathology." METHODS OF STUDY SELECTION: We evaluated abstracted data and performed quantitative analyses in observational studies assessing the effects of menopausal status, vaginal bleeding, and polyp size on the risk of malignancy in patients undergoing polyp resection (n=1,552). For each study with binary outcomes, relative risks with 95% confidence intervals (CIs) were calculated. Estimates of relative risk were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Sensitivity analyses were performed to determine the effects of individual studies on the overall effect estimates. Publication bias was assessed using Egger test. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies met inclusion criteria for this review. Among women found to have endometrial polyps, the prevalence of premalignant or malignant polyps was 5.42% (214 of 3,946) in postmenopausal women compared with 1.7% (68 of 3,997) in reproductive-aged women (relative risk 3.86; 95% CI 2.92-5.11). The prevalence of endometrial neoplasia within polyps in women with symptomatic bleeding was 4.15% (195 of 4,697) compared with 2.16% (85 of 3,941) for those without bleeding (relative risk 1.97; 95% CI 1.24-3.14). Among symptomatic postmenopausal women with endometrial polyps, 4.47% (88 of 1,968) had a malignant polyp in comparison to 1.51% (25 of 1,654) asymptomatic postmenopausal women (relative risk 3.36; 95% CI 1.45-7.80). CONCLUSION: Based on data from observational studies, both symptomatic vaginal bleeding and postmenopausal status in women with endometrial polyps are associated with an increased risk of endometrial malignancy.

Predictors of human papillomavirus vaccination acceptability among underserved women.

OBJECTIVES: The objectives of this study were to examine underserved women's acceptability of the forthcoming human papillomavirus (HPV) vaccines and to identify correlates of HPV vaccine acceptability. STUDY DESIGN: A sample of primarily low-income minority women (n = 58) recruited from community health clinics completed a semistructured interview assessing health beliefs, vaccination attitudes, health behavior, and HPV vaccination intentions. RESULTS: Personal acceptability of the HPV vaccines was generally high. Moreover, 100% of parents were interested in having their children vaccinated. Correlates of vaccination intentions included health beliefs and attitudes (perceived risk of HPV infection, perceived safety and effectiveness of HPV vaccines, perceived physician encouragement for vaccination) and previous health behavior (HIV testing). Independent predictors of vaccine acceptability were also identified. CONCLUSIONS: The current study highlights key correlates of vaccine acceptability that may inform HPV vaccination campaigns for underserved populations.

Proliferation of electronic health records among obstetrician-gynecologists.

OBJECTIVE: To examine the current use of electronic health records (EHRs) and their key subfunctions among obstetrician-gynecologists and compare this trend with other doctors. METHODS: In this study, we examined responses to a large statewide study of EHR use among Florida physicians practicing in the ambulatory setting. For assessment purposes, we compared obstetrician-gynecologists with other primary care physicians (PCPs) and surgeons with respect to EHR utilization, the availability of key EHR functions, and time since adoption. In addition, we examined adoption intentions among non-EHR users. To compare differences among groups, the chi-square test was utilized with significance level set at P < .05. RESULTS: A total of 2428 responses (28.4% response rate), of which 454 were from obstetrician-gynecologists, were available for the current study. EHR use among obstetrician-gynecologists (18.3%) was significantly less (P < .001) than among PCPs (25.7%) and surgeons (20.5%). Among EHR users, obstetrician-gynecologists were significantly less likely than PCPs to have the following desirable EHR functions: problem lists (P < .001), medication lists (P < .001), allergy information (P = .014), electronic prescribing of medications (P = .001), electronic order entry (P = .009), electronically available laboratory results (P = .002), electronic connection to pharmacy information (P = .008), preventative service reminders (P < .001), and patient education material (P = .004). Moreover, obstetrician-gynecologists were significantly more likely to have adopted their system within the last 2 years. However, among nonusers, they were not more likely to indicate the intention to adopt EHR. CONCLUSION: Compared with peers, obstetrician-gynecologists are less likely to be using EHR in their practice. In addition, their systems tend to have fewer medical error preventing functions and fewer basic functions.