Physician care patterns and adherence to postpartum glucose testing after gestational diabetes mellitus in Oregon.

OBJECTIVE: This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. RESEARCH DESIGN AND METHODS: In November-December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. RESULTS: Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69-7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65-11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. CONCLUSIONS: Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.

Relationship between sexual orientation and quality of life in female breast cancer survivors.

BACKGROUND: Some groups of breast cancer survivors bear a greater burden of diminished quality of life than others. Self-identified lesbians, or women who partner with other women in romantic and spousal relationships, are one group of women that has been hypothesized to experience and report poorer quality of life compared with heterosexual breast cancer survivors. METHODS: A convenience sample of 204 breast cancer survivors (143 heterosexual and 61 self-identified lesbians) participated in this cross-sectional, online study by completing electronic surveys regarding their quality of life. RESULTS: Multivariate linear regression indicated that quality of life was not related to sexual orientation (ß=0.13, p=0.30). Quality of life scores were similar between heterosexual and self-identified lesbian breast cancer survivors. CONCLUSION: Quality of life scores were similar between heterosexual and lesbian breast cancer survivors. Future survivorship research should include population-based sampling of lesbian breast cancer survivors for testing quality of life and reducing the healthy volunteer effect, and population-based methodologies should be made available to enhance researcher ability to study this rare population.

Breast cancer survivorship: the role of perceived discrimination and sexual orientation.

Breast cancer disproportionately affects sexual minority women (SMW) compared to heterosexual women and a small but growing literature indicates that SMW may have diminished survivorship outcomes; outcomes that are measurably and importantly different from heterosexual breast cancer survivors. However, it remains unknown how sexual orientation influences breast cancer survivorship outcomes such as quality of life. One possible route of influence is SMW's perceived discrimination in the health care setting. This cross-sectional study examines SMW perceptions of discrimination as one of the multiple facets of the breast cancer survivorship process. This study assessed SMW breast cancer survivor's perceptions of discrimination during their breast cancer treatment experience and secondarily, examined the role of this perceived discrimination on SMW's quality of life. Sixty-eight purposefully sampled sexual minority breast cancer survivors completed assessments of quality of life, perceived discrimination, perceived social support and perceived stress via an online survey. Statistical analyses point to perceived discrimination and perceived social support as important indicators for predicting SMW's quality of life. Future research on SMW's breast cancer survivorship should include measures of perceived discrimination.

Racial/ethnic disparities in gestational diabetes mellitus: findings from a population-based survey.

PURPOSE: We sought to explore racial/ethnic disparities in the prevalence of gestational diabetes mellitus (GDM) in a population-based sample. METHODS: Data from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS), a stratified, random sample of postpartum women who delivered in Oregon in 2004 and 2005 (n = 3,883; weighted response rate, 75.2%) and linked birth certificates were analyzed. Hispanic, non-Hispanic Black, non-Hispanic American Indian, and non-Hispanic Asian/Pacific Islander (API) women were oversampled. We categorized women as having had GDM if they gave an affirmative answer on the birth certificate or the PRAMS survey. RESULTS: Non-Hispanic API women had the highest prevalence of GDM (14.8%); this was true for women with both a normal and a high body mass index (BMI). Asian women were more likely to have had GDM than Pacific Islander women. On multivariate analysis, non-Hispanic APIs were significantly more likely to have a pregnancy complicated by GDM (adjusted odds ratio, 2.26; 95% confidence interval, 1.23-4.13) than non-Hispanic White women. CONCLUSION: Non-Hispanic API women, especially Asian women with both normal and high BMI, have increased risk of GDM. Future research should examine the unique risk factors experienced by Asians and health practitioners should be vigilant in screening for GDM regardless of BMI.

School counselors and student self-injury.

BACKGROUND: The purpose of this study was to examine the experience, knowledge, and needs of school counselors in relation to students' self-injurious behaviors. METHODS: One thousand members of the American School Counselor Association were randomly selected to receive a questionnaire on the study of self-injury. Four hundred forty-three school counselors returned usable questionnaires. RESULTS: Most (81%) reported working with a self-injurer during their career, and 51% reported working with a self-injurer during the 2002-2003 school year. Findings suggest that counselors feel they are the appropriate person to work with students who self-injure but need more training to identify self-injurers and refer them to appropriate resources outside of the school. Counselors identified a number of barriers to successfully working with students who self-injure, such as lack of training, lack of cooperation with school personnel, and lack of policy on school injury. CONCLUSIONS: The authors suggest a model where the school counselor acts as a liaison to ensure the coordination of education about self-injury for students, parents, and school staff and as a conduit to refer students to therapists in the community.

Complementary and alternative medicine use by women after completion of allopathic treatment for breast cancer.

CONTEXT: A growing number of women are being diagnosed and successfully treated for breast cancer. Therefore, many women are living with a history of breast cancer. The use of complementary and alternative therapies within this patient population has increased. OBJECTIVE: To determine post breast cancer treatment health behaviors with regard to use of complementary and alternative therapies. DESIGN: Survey participants were asked about their use of 15 complementary and alternative medicine (CAM) therapies. In order to determine the relative importance of the hypothesized predictor variables, standard logistic regression was performed with CAM use as the dependent variable. PARTICIPANTS: 551 women who had been diagnosed with breast cancer and were post treatment. INTERVENTION: Telephone Survey. RESULTS: Telephone interviews were conducted with 551 females in the Portland, Oregon, metropolitan area who had been diagnosed with breast cancer an average of 3.5 years earlier. Two-thirds (66%) of the women used at least one CAM therapy during the previous 12 months, and the majority of them perceived that their CAM use was without the recommendation of their doctor. Relaxation/meditation, herbs, spiritual healing, and megavitamins were used most often. Significant predictors of CAM use included younger age, higher education, and private insurance. The majority of the CAM therapies were perceived by their users to be at least "moderately important" in remaining free of cancer. The reasons given for using CAM were to enhance overall quality of life, to feel more in control, to strengthen the immune system, and to reduce stress. CONCLUSIONS: Two-thirds of women in this study followed conventional treatment for breast cancer with one or more CAM therapies, which, they believed, could prevent cancer recurrence and/or improve their quality of life. CAM use did not reflect negative attitudes towards conventional medical care, but rather an orientation to self-care in the optimization of their health and well being.

The relationship between cancer locus of control and complementary and alternative medicine use by women diagnosed with breast cancer.

Research has shown that perceptions of control influence health-related behavior and outcomes. This study explored the influence of the control constructs in the context of the theory of cognitive adaptation to the use of complementary and alternative medicine (CAM) among 551 women diagnosed with breast cancer in Portland, Oregon. The majority of these women had high perceptions of cancer control and used one or more types of CAM therapy. Multinomial logistical regression indicated that higher perceptions of control over the course and cause of cancer significantly predicted CAM use. The model combining sociodemographic variables (age, education and type of health insurance) and control variables explained more variation (R(2)=0.23) in predicting CAM use than the model with only sociodemographic variables (R(2)=0.14), indicating that perceptions of control over the cause and the course of cancer had an independent significant influence. It was concluded that the assessment of control constructs from the theory of cognitive adaptation is useful for studying CAM use among women diagnosed with breast cancer and that understanding the meanings that lie behind the decisions to use these therapies are essential for health care providers who are promoting the health and well-being of their patients.