2009 Final Presentations
Summer Student Research & Clinical Assistantship Presentations
- Genitourinary tract infections during pregnancy and birth outcomes: A retrospective chart review study of African Americans in Dane County
- Infant Mortality Investigation in Dane County
- Analyzing the Feasibility of Group Prenatal Visits at Wingra Clinic
- Gender and Authorship of Papers in Family Medicine Journals 2006-2008
- Survey of Nipple Shield Use Among Knowledgeable Health Professionals
1. Genitourinary tract infections during pregnancy and birth outcomes: A retrospective chart review study of African Americans in Dane County
Qi Zhang
Background: Dane County has experienced a decrease in BIMR by approximately 70% from 19.4 during the period between 1990-2001 to 6.4 in 2002-2007 (1). Genitourinary tract infections (GUTI) such as gonorrhea, trichomoniasis, bacterial vaginosis (BV) and urinary tract infections (UTI) during pregnancy have all been associated with pre-term pre-labor rupture of membranes (PPROM), low birth-weight, and or premature deliveries (2; 3). The goal of this study is to explore whether increased screening, diagnosis, or treatment for GUTI in the last 10 years has led to improved African American birth outcomes in Dane County.
Methods: We examined labor and delivery records of African Americans residing in Dane County from 1997 and 2007. Data obtained included information about demographics, prenatal care, past OB/GYN history, maternal health risks, and complications during labor. Our outcome measures included the rates of infant mortality, premature delivery, PPROM and low birth weights (<2500g) among African American births in 1997 and 2007. Evidence of GUTI was typically documented in prenatal lab reports, prenatal notes, and delivery summaries. Using T-tests, we compared the differences in infection, treatment and positive test of cure rates of these infections in 1997 and 2007.
Results: Pending
References:
1. Centers for Disease Control and Prevention (CDC). Apparent disappearance of the black-white infant mortality gap - Dane County, Wisconsin, 1990-2007. MMWR Morb Mortal Wkly Rep. 2009;58(20):561-5.
2. Moddley P, Sturm AW. Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. Semin Neonatol 2000;5:255-269
3. Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med. 2009;22(2):124-8.
2. Infant Mortality Investigation in Dane County
Taya Schairer, Leah Haglund, and Lee Dresang, MD
Background: In 2004, the US infant mortality rate was 6.78 per 1000 live births while the black infant mortality rate (BIMR) was 13.25 per 1000 live births. In Dane county, African American infant mortality has decreased 70% since the 1990's while in other areas, such as Racine County, have not seen such declines. To try to reduce infant mortality disparities in Wisconsin, the project aims to identify factors related to birth outcome.
Methods: A clinical chart review was performed at the Wingra and Northeast clinics in Dane County, which compared births from 1997/1998 and 2007. Study participants were selected based on records from Data Warehouse, which identified them as African Americans who gave birth within the designated years. Information on prenatal factors, including maternal age, obstetric history, medical conditions, and substance use, was collected from the patient's medical chart and recorded using Websurvey. Two reviewers looked at each chart and agreed on recorded data.
Results: Data analysis is pending.
3. Analyzing the Feasibility of Group Prenatal Visits at Wingra Clinic
Emily Holtan, Suhani Bora, MD, and Beth Potter, MD
Background: The traditional method of one-on-one prenatal visits is often inadequate for the patient and the provider due to time constraints and other factors. Our aim is to assess the feasibility, knowledge, attitudes, and barriers to a pilot group prenatal visit program at Wingra Clinic, and to determine the content of the pilot program and whether to invest in the Centering Pregnancy. The aims of the program are to analyze the downsides of current traditional method and support evidence for prenatal group visits. A third aim is to decide whether prenatal group visits improve residency education and satisfaction in providing prenatal care.
Methods: Surveys to be given to patients and Family Medicine residents assessing their current attitudes, confidence, and knowledge regarding prenatal care. Residents receive electronic survey, patients receive survey during routine OB visit. Electronic survey also sent to physicians in residency clinics throughout U.S. regarding their experiences with group prenatal visits and with Centering Pregnancy.
Results: Surveys to patients and residents are still pending IRB approval. 21 responses from surveys sent to physicians in residency clinics. Barriers to implementing a group visit program included money, staff, time, patient interest, recruitment, and maintaining resident continuity. Positives included the strengths of the patient-provider relationship, patient education, provider confidence in delivering care, and the creation of support networks.
Conclusions: These preliminary responses from other prenatal professionals, though still pending on survey responses from patient and resident, suggest the benefits for both patients and residents. While there are limitations to implementation, there are meaningful advantages for patient and provider.
4. Gender and Authorship of Papers in Family Medicine Journals 2006-2008
Carla J. Bouwkamp, MS and Sarina B. Schrager, MD, MS
Background: Despite increasing numbers of women attending medical school and completing residencies, women continue to lag behind men in academic achievement. This lag may be due to women authoring fewer articles since writing articles is an integral part of academic medicine. The aim of this paper is to look at family medicine to see if female authorship is equivalent to that of their male counterparts.
Methods: The five main family medicine journals from 2006 to 2008 were reviewed for gender of lead author and type of article. Gender was confirmed by internet research. Data was entered and analyzed using excel. A current issue of each of the five journals was reviewed to determine the make up of the editorial boards.
Results: There were 2,126 article reviewed. In total from 2006 to 2008 females authored 33.4% of all articles. In 2006, 32% of the authors were female; in 2007, 34.6% were female; and in 2008 34.1% were female. From 2006 to 2008 33.3% of the authors were female in the JFP; 28.9% were female in the AFP; 36.8% were females in the FMJ; 39.3% were female in the JABFP; and 32.5% were female in the Annals of Family Medicine. The editorial board composition was 27% female in JFP, 50% in FMJ, 25.9% in JABFP, 39.3% in the Annals of Family Medicine, and 10% AFP.
Conclusion: There is a large difference in male and female authorship in family medicine and little has change over the past three years. There is also a large difference in the composition of the editorial boards of family medicine journals.
5. Survey of Nipple Shield Use Among Knowledgeable Health Professionals
Anna Ziemer and Anne Eglash, MD
Background: Nipple shields have been used by breastfeeding mothers for decades but professional guidelines for their use have never been developed. Studies have shown that the shield may be beneficial for pre-term infants, but use with term and near-term infants has not been evaluated.
Methods. Health care professionals who work with lactating mothers were contacted by email and asked to complete the survey. The goals of the survey questions were to identify the most common reasons respondents recommend nipple shields to breastfeeding mothers, to determine respondents' concerns about nipple shield use and to identify mothers' responses to nipple shields.
Results: Respondents most commonly used nipple shields to help latch infants born less than 35 weeks gestation. The second most common response was to help latch infants born greater than 35 weeks gestation when 3-7 days old. Most respondents listed lack of follow-up by those handing out the shield as their greatest concern about shield use. The maternal response most commonly articulated was that the shield is helpful. Mothers using shields also commonly express that they cannot wait to get rid of the shield, that the shield is convenient and, conversely, that the shield is inconvenient.
Discussion: The researchers recommend further research into the effect of shield use with term and near-term infants to determine whether this application is safe and effective. Other techniques to help latch infants should be attempted before the shield is implemented. Mothers should be made aware of the importance of follow-up with a knowledgeable clinician.
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