Documentation of reproductive health counseling and contraception in women with inflammatory bowel diseases

Objective

Inflammatory bowel diseases (IBD) are commonly diagnosed during women's reproductive years. Counseling is important to avoid unintended pregnancy in a disease-poor state. We sought to determine reproductive counseling documentation by gastroenterologists in women with IBD.

Methods

An electronic query identified women, age 18–45, with IBD in an academic gastroenterology practice from 2010 to 2012. A random sample (15%) chart review determined contraception documentation and content/frequency of reproductive counseling.

Results

100 patients were analyzed. Median age was 35 (range 19–45), 53% were married, and 69% had Crohn's disease. Median time since IBD diagnosis was 9 years (range 1–32) with a 5 visit median (range 1–45) over 31 months (range 1–105). A contraceptive method was identified in 24% of all patients.Nineteen patients (19%) had documentation of reproductive counseling. Only 1/100 patients had a specific reference to using contraception to avoid pregnancy. The remaining counseling included (1) medication effects on pregnancy, (2) disease control before pregnancy, or (3) mode of delivery planning.

Conclusions

Outside of listing contraception as a “current medication”, documentation of reproductive counseling at gastroenterology visits for IBD is sparse.

Practice implications

In light of the importance of reproductive planning for women with IBD, future research on incentives and barriers to counseling is warranted.     

Dynamic photoacoustic imaging of neurovascular coupling in salivary glands

The purpose of this study was to apply photoacoustic imaging (PAI), a relatively new imaging method, to non-invasively map neurovascular dynamics in salivary glands. Dynamic PAI with co-registered ultrasound (US) was performed in mice to monitor salivary gland hemodynamics in response to exogenous muscarinic receptor stimulation (pilocarpine) and blockade (atropine). Pilocarpine increased salivary gland oxygen saturation (%sO₂) within minutes after administration, which was abrogated by atropine. A significant correlation was observed between change in %sO₂ measured by PAI and saliva secretion. PAI is a novel imaging method that can be used for functional assessment of neurovascular dynamics in salivary glands.     

Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation

Hodgkin lymphoma (HL) relapsing after allogeneic stem cell transplantation (alloSCT) presents a major clinical challenge. In the present investigation, we evaluated brentuximab vedotin, a CD30-directed Ab-drug conjugate, in 25 HL patients (median age, 32 years; range, 20-56) with recurrent disease after alloSCT (11 unrelated donors). Patients were > 100 days after alloSCT, had no active GVHD, and received a median of 9 (range, 5-19) prior regimens. Nineteen (76%) had refractory disease immediately before enrollment. Patients received 1.2 or 1.8 mg/kg of brentuximab vedotin IV every 3 weeks (median, 8 cycles; range, 1-16). Overall and complete response rates were 50% and 38%, respectively, among 24 evaluable patients. Median time to response was 8.1 weeks, median progression-free survival was 7.8 months, and the median overall survival was not reached. Cough, fatigue, and pyrexia (52% each), nausea and peripheral sensory neuropathy (48% each), and dyspnea (40%) were the most frequent adverse events. The most common adverse events ≥ grade 3 were neutropenia (24%), anemia (20%), thrombocytopenia (16%), and hyperglycemia (12%). Cytomegalovirus was detected in 5 patients (potentially clinically significant in 1). These results support the potential utility of brentuximab vedotin for selected patients with HL relapsing after alloSCT.     

Hand preferences in preschool children: Reaching,pointing and symbolic gestures

Manual asymmetries emerge very early in development and several researchers have reported a significant right-hand bias in toddlers although this bias fluctuates depending on the nature of the activity being performed. However, little is known about the further development of asymmetries in preschoolers. In this study, patterns of hand preference were assessed in 50 children aged 3–5 years for different activities, including reaching movements, pointing gestures and symbolic gestures. Contrary to what has been reported in children before 3 years of age, we did not observe any difference in the mean handedness indices obtained in each task. Moreover, the asymmetry of reaching was found to correlate with that of pointing gestures, but not with that of symbolic gestures. In relation to the results reported in infants and adults, this study may help deciphering the mechanisms controlling the development of handedness by providing measures of manual asymmetries in an age range that has been so far rather neglected.     

Impact of body mass index on neuronal fiber bundle lengths among healthy older adults

Increased body mass index (BMI) has been linked to various detrimental health outcomes, including cognitive dysfunction. Recent work investigating associations between obesity and the brain has revealed decreased white matter microstructural integrity in individuals with elevated BMI, independent of age or comorbid health conditions. However, the relationship between high BMI and white matter fiber bundle length (FBL), which represents a novel metric of microstructural brain integrity, remains unknown. The present study utilized quantitative tractography based on diffusion tensor imaging (DTI) to investigate the relationship between BMI and FBL in 72 otherwise healthy older adults (24 males, 48 females). All participants were between 51 and 85 years of age (M?=?63.26, SD?=?8.76). Results revealed that elevated BMI was associated with shorter FBL in the temporal lobe, independent of age (p?<?.01). In addition, increased age was associated with shorter frontal, temporal, and whole brain FBL (all p values?<?.01). These findings indicate that, while increased age is an important factor associated with reduced FBL, high BMI is uniquely associated with reduced FBL in the temporal lobe. These data offer evidence for additive adverse effects of high BMI on the brain, especially in areas already vulnerable to aging processes and age-related neurodegenerative diseases. Further research is necessary to determine the physiological mechanisms associated with the shortening of FBL in individuals with high BMI.     

Impact of early vs. late childhood early life stress on brain morphometrics

Previous studies of early life trauma suggest that in addition to its emotional impact, exposure to early life stress (ELS) is associated with alterations in brain structure. However, little attention has been devoted to the relationship between emotional processing and brain integrity as a function of age of ELS onset. In the present study we examined whether ELS onset in older ages of youth rather than younger ages is associated with smaller limbic and basal ganglia volumes as measured by magnetic resonance imaging (MRI). We hypothesized that later age of manifestation during youth is associated with smaller volumetric morphology in limbic and basal ganglia volumes in adulthood. A total of 173 individuals were divided into three groups based on the age of self-reported ELS. The three groups included individuals only experiencing early childhood ELS (1 month–7 years, n = 38), those only experiencing later childhood ELS (8 years –17 years, n = 59), and those who have not experienced ELS (n = 76). Anterior cingulate cortex (ACC), hippocampus, amygdala, insula and caudate volumes were measured using a T1-weighted MRI. Analyses confirmed that later childhood ELS was associated with volumetric reductions in the ACC and insula volumes, while ELS experienced between the ages of 1 month and 7 years was not associated with lower brain volumes in these regions. The results may reflect the influence of more fully developed emotional processing of ELS on the developing brain and reinforce a body of research implicating both the ACC and insula in neuropsychiatric disorders and emotional regulation.