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Lori A Boardman

Publications and source records attributed to Lori A Boardman.

15 recordsLinked to original sources
PubMed2006

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents.

PURPOSE: Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy. METHODS: The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group. RESULTS: In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy. CONCLUSIONS: Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Adolescent↗
PubMed2006

Atypical squamous cells of undetermined significance, human papillomavirus, and cervical intraepithelial neoplasia 2 or 3 in adolescents: ASC-US, age, and high-grade cervical neoplasia.

OBJECTIVE: To determine rates of and factors associated with cervical intraepithelial neoplasia (CIN) 2 or 3 among women with atypical squamous cells of undetermined significance (ASC-US) and oncogenic human papillomavirus (HPV) infection. MATERIALS AND METHODS: This is a retrospective review of 357 women with ASC-US and known high-risk HPV infection. To be eligible for inclusion, patients had to have subsequently undergone colposcopic-directed cervical biopsy and/or endocervical sampling. Univariate and multivariable regression analyses were used to estimate crude and adjusted odds ratios of CIN 2 or 3 by risk factors associated with HPV and CIN. RESULTS: Thirty-three of 215 (15%) women with ASC-US and oncogenic HPV who underwent histological sampling demonstrated CIN 2 or 3. In the adjusted model, only nulliparity (adjusted odds ratio = 2.2, 95% CI = 1.0-4.8) retained a marginal association with the outcome. No significant age-related differences in the prevalence of high-grade disease emerged. The high-grade lesions seen in adolescents consisted of single, small lesions. CONCLUSIONS: In the light of these findings, and in conjunction with the high rate of oncogenic HPV infection among adolescents with ASC-US, both reflex HPV testing and immediate colposcopy do not appear to be of benefit in the initial management of teenagers with this cytological diagnosis.

Adolescent↗
PubMed2006

Abortion training in United States obstetrics and gynecology residency programs.

OBJECTIVE: To identify characteristics of programs which provide training in abortion, to calculate the number of procedures done during training, and to compare the availability of abortion training in 2004 with that of prior national surveys. METHODS: An investigator-designed questionnaire about abortion training in obstetrics and gynecology residency programs was mailed to all U.S. residency directors. Collected data included program information, abortion training, and numbers of residents trained. Data were analyzed to estimate differences in abortion training by region, program size, and type of training offered. RESULTS: Of the 252 questionnaires mailed, 185 (73%) were returned. Of the 185, 94 (51%) program directors reported routine instruction in elective abortion, 72 (39%) optional training, and 19 (10%) no training. Large programs and programs located in the Northeast and West Coast were significantly more likely to offer routine training in terminations (P < .01). In the programs offering routine training, more than 50% of residents received instruction in termination practices. Of those practices, the most common were first-trimester surgical abortion (85% of programs), followed by medical abortion (59%), second-trimester induction (51% of programs), and dilation and extraction (36%). As compared with those in programs with optional training, residents in programs with routine training were significantly more likely to receive instruction in all modalities of abortion provision and performed proportionally more first- and second-trimester terminations (P < .01). CONCLUSION: Routine training in elective abortion resulted in greater exposure to abortion practices and greater experience in more complicated abortion techniques during residency.

Abortion, Therapeutic↗
PubMed2005

Early age at menarche and allostatic load: data from the Third National Health and Nutrition Examination Survey.

PURPOSE: To examine whether there is an association between early age at menarche and allostatic load-a measure of cumulative biologic risk-using data from the Third National Health and Nutrition Examination Survey (NHANES III). METHODS: A total of 2470 (weighted N=25,544,838) women aged between 17 and 30 years with interview and examination data who did not report oral contraceptive use before menarche and were not missing data on the exposure or outcome were included. Early menarche was defined as menarche at age 10 or younger. The allostatic load score was the sum of the number of 11 components for which an individual had a value within the high-risk range. RESULTS: The prevalence of early menarche was 7%. Although the overall allostatic load scores were low when compared with older adults, the mean allostatic load score was higher among those with menarche at ages 10 or younger compared with those with later ages at menarche (1.99 vs. 1.33). After adjusting for age, race/ethnicity, level of education, household poverty income ratio, smoking, and depression history, women with high allostatic load scores had more than 2 times the odds as those with low scores of experiencing menarche at age 10 or earlier (OR=2.18; 95% CI, 1.29-3.68). CONCLUSIONS: This study is the first to report and examine the relationship between age at menarche and allostatic load. Future studies involving prospective measurement of allostatic load biomarkers may prove essential for disentangling the association between allostatic load and early age at menarche.

Adolescent↗
PubMed2005

Atypical squamous cells of undetermined significance: human papillomavirus testing in adolescents.

OBJECTIVE: To estimate the age-stratified prevalence of oncogenic human papillomavirus (HPV) infection and to evaluate risk factors for HPV acquisition among women with atypical squamous cells of undetermined significance (ASC-US). METHODS: This was a chart review of all women with ASC-US smears who underwent oncogenic HPV testing between July 2002 and February 2004. To be eligible, HPV DNA results had to be available. Data extracted from charts included demographic information as well as certain patient characteristics historically associated with HPV acquisition or carriage. RESULTS: Of 527 eligible women with ASC-US, 357 (68%, 95% confidence interval [CI] 64-72%) tested positive for oncogenic HPV. As compared with women who tested negative, this population was significantly younger and less likely to be married. When stratified by age, 77% of the women aged younger than 20 years were positive for high-risk subtypes, compared with 58% of women aged older than 25 years (P < .01). In the multivariate analysis, young age (relative risk [RR] 1.30, 95% CI 1.14.-1.49), current smoking (RR 1.14, 95% CI 1.03-1.25) and a history of chlamydial infection (RR 1.20, 95% CI 1.09-1.32) were associated with an increased likelihood of HPV infection, while oral contraceptive use (RR 0.86, 95% CI 0.72-1.03) had a marginal protective effect. The protective effect of oral contraceptives was most pronounced among adolescent women (RR 0.57, 95% CI 0.31-1.03). CONCLUSION: Given that the rate of oncogenic HPV infection approached 80% in our population of adolescent women with ASC-US, the usefulness of HPV testing in this age group requires further investigation. LEVEL OF EVIDENCE: II-3.

Adolescent↗
PubMed2005

CIN in pregnancy: antepartum and postpartum cytology and histology.

OBJECTIVE: To determine the rates of antepartum and postpartum cervical intraepithelial neoplasia (CIN) 2 or worse in pregnant women with abnormal cervical cytology. STUDY DESIGN: A prospective, cohort study of 283 pregnant women referred for colposcopy between 1992 and 1999 for the evaluation of abnormal Pap smears. In this analysis, the population was stratified by severity of referral cytology (atypical squamous cells of undetermined significance [ASCUS] or low grade squamous intraepithelial lesion [LSIL] versus high grade squamous intraepithelial lesion [HSIL] and atypical glandular cells of undetermined significance [AGUS]). RESULTS: Sixty-seven women (24%) had ASCUS, 147 (52%) LSIL, 67 (24%) HSIL and 2 (0.7%) AGUS. As compared to women with HSIL or AGUS, women with ASCUS or LSIL were less likely to undergo antepartum biopsy (relative risk [RR] .34, 95% CI .23-.51) and if biopsied, less likely to have CIN 2 or worse (OR .49, 95% CI .24-.99). Women with antepartum ASCUS or LSIL were less likely to have postpartum HSIL (OR .29, 95% CI, .17-.52) and tended to have fewer histologically severe biopsies as compared to women with antepartum HSIL (OR .55, 95% CI .31-1.05). CONCLUSION: Among those biopsied, pregnant women with mildly abnormal cytology (ASCUS or LSIL), as compared to pregnant women with HSIL, were less likely to have either antepartum or postpartum CIN 2 or worse.

Adolescent↗
PubMed2005

Rates of voluntary paternity establishment for infants born to unmarried adolescents.

OBJECTIVE: To investigate factors associated with voluntary paternity establishment for infants born to teenagers. STUDY DESIGN: The medical records of 402 unmarried women aged 13-19 years and delivering between January 1 and July 31, 2000, were reviewed, including prenatal charts, delivery records, birth worksheets, affidavits of parentage and infant birth certificates. The primary outcome was voluntary paternity establishment, as defined by having the father's name on the infant's birth certificate. RESULTS: Separate documents from the medical records of teen mothers had different rates of identifying the father of the infant: 80% of prenatal records had the father's name, as did 76% of birth worksheets and 60% of birth certificates. Maternal age < 16 years was associated with lower rates of paternity establishment as compared with 18-19-year-old mothers (OR 2.9, 95% CI 1.2, 6.7). CONCLUSION: A significant proportion of birth certificates on children born to teenagers do not identify the father of the infant; however, the majority of mothers identified them, on either the prenatal record or birth worksheet. In order to develop effective programs that will affect rates of paternity establishment, we must understand barriers inherent in the process itself.

Adolescent↗
PubMed2005

HPV testing and cervical cancer screening: recommendations and practice patterns.

In summary, guidelines for cervical cancer screening continue to evolve, as knowledge of the pathogenesis of the disease as well as the role of HPV expands. Oncogenic HPV typing has proven effective in cancer screening and follow-up in certain situations, and its uses will undoubtedly increase. Patients and providers may be reassured with negative HPV testing, but long term management of positive HPV testing (especially in conjunction with negative cytology) is unclear. At present, however, numerous worldwide, prospective studies involving HPV testing and cervical cancer screening will, we hope, provide some of the answers regarding optimal management of women who remain persistently HPV positive.

DNA, Viral↗
PubMed2004

A randomized trial of the Fischer cone biopsy excisor and loop electrosurgical excision procedure.

OBJECTIVE: To compare specimens obtained with the Fischer cone biopsy excisor or loop electrosurgical excision procedure (LEEP) with respect to number of specimens obtained, margin interpretability, adequacy of excision, and ease of use. METHODS: One hundred eligible patients aged 13 years and older were randomly assigned to treatment with the Fischer cone biopsy excisor or LEEP. Eligibility criteria included: (1) cervical intraepithelial neoplasia (CIN) 2 or 3, (2) persistent CIN 1, or (3) cytologic/histologic discrepancy. Following excision, providers ranked ease of use on a scale of 1 to 10. A pathologist blinded to procedure type analyzed specimens for margin interpretability and adequacy of excision. Before study initiation we calculated that a total of 100 patients would be required to demonstrate a significant difference in the interpretable margin rate of 80% for LEEP and 99% for cone biopsy excisor (power 80%, alpha =.05). RESULTS: After adjustment for ease of use, lesion size, and degree of neoplasia, the cone biopsy excisor was no more likely to result in a single specimen than LEEP (74% versus 63%, relative risk [RR] 0.93, 95% confidence interval [CI] 0.79 -1.11), to result in a specimen with interpretable margins (65% versus 73%, RR 0.97, 95% CI 0.78-1.22), or to result in a fully excised cervical lesion (72% versus 62% for LEEPs, RR 1.08, 95% CI 0.77-1.52). Providers found their experiences with both Fischer cone biopsy excisor and LEEP cone biopsies to be similar, even after adjustment for year of training and previous experience (RR 0.95, 95% CI 0.72-1.24). CONCLUSION: The Fischer cone biopsy excisor and LEEP performed similarly with respect to the number of final specimens, margin interpretability, and ease of use. LEVEL OF EVIDENCE: I

Adolescent↗
PubMed2004

HPV, cervical neoplasia and smoking: knowledge among colposcopy patients.

OBJECTIVE: To assess colposcopy patients' knowledge of human papillomavirus (HPV) infection and the role of smoking in cervical neoplasia and, if patients were current smokers, their willingness to quit smoking. STUDY DESIGN: Between January and June 2001, 250 women seen in a colposcopy clinic for the evaluation of an abnormal Pap smear or previously diagnosed cervical neoplasia participated in a survey designed to evaluate knowledge of HPV infection, smoking and neoplasia. Participants who smoked were questioned regarding their smoking behaviors and readiness to quit. In the analysis, the population was stratified by age (< 25 years versus > or = 25 years) to determine differences in knowledge, perception of risk and behaviors. RESULTS: The study population was in general young and racially/ethnically diverse. Fifty-seven percent (143 of 250) thought that HPV was a risk factor in cervical neoplasia, and 58% (146 of 250) associated smoking with neoplasia. Among smokers who discussed risk reduction with their providers, 75% (50 of 66) were advised to stop smoking. Of the 39% (98 of 250) who were current smokers, 63% (62 of 98) agreed that having an abnormal Pap smear would make them consider smoking cessation, and 58% (57 of 98) reported that they would use medical therapy (nicotine replacement or medication) to aid in that process. There were age-related differences in smoking behaviors and attitudes toward cessation (e.g., younger smokers were less likely to desire nicotine replacement). CONCLUSION: Given the high prevalence of smoking and a demonstrated desire by many of the colposcopy patients to stop smoking in the context of a cervical abnormality, further efforts at encouraging cessation are warranted.

Adolescent↗
PubMed2003

A randomized trial of the sleeved cytobrush and the endocervical curette.

OBJECTIVE: To compare endocervical specimens obtained with the endocervical curette to those obtained with the sleeved cytobrush. METHODS: All nonpregnant women undergoing either cervical conization or hysterectomy were eligible for this randomized, split-sample trial. Both endocervical curette and cytobrush sampling were performed on all 62 participants before surgery, with randomization designating the order of the sampling procedures. A pathologist blinded to sampling order reviewed study specimens. The endocervical canals of the surgical specimens were evaluated against endocervical curette and brush samples. Odds ratios (ORs), relative risks (RRs), and risk differences were used to compare the sensitivity and specificity of each procedure in unmatched and matched analyses. RESULTS: There was a significantly higher rate of inadequate specimens in the endocervical curette group (22% versus 2% in the brush group; 95% confidence interval [CI] for the difference: 9%, 31%). Unmatched analysis showed the two tests to be comparable in terms of sensitivity and specificity. Whereas the specificities of both tests were high (100% for the endocervical curette, 88% for the brush; RR 1.13, 95% CI 1.00, 1.28), the sensitivities were poor (44% for the sleeved brush and 32% for the endocervical curette; RR 1.38, 95% CI 0.65, 2.94). Matched analysis showed the sleeved endocervical brush to be a more sensitive sampling method compared with the curette (OR 2.04, 95% CI 0.98, 4.22). Sparse data prevented a matched analysis on the specificity of the two tests. CONCLUSION: Endocervical sampling with the sleeved cytobrush achieves similar sensitivity and specificity to that of traditional endocervical curettage. Given the much greater rate of inadequate specimens when using the endocervical curette, the sleeved cytobrush is a reasonable alternative to this technique.

Adult↗
PubMed2002

Fatal clostridial sepsis after spontaneous abortion.

BACKGROUND: Although obstetric mortality due to complications of Clostridium perfringens infection is rare at present, we report a case of fatal clostridial sepsis secondary to a septic spontaneous abortion. CASE: A woman at 6-8 weeks' gestation presented with vaginal bleeding and abdominal pain. Although afebrile, the patient was hypotensive, tachycardic, and tachypneic. Physical examination was remarkable for a 10-weeks'-gestation-size uterus, mild pelvic tenderness, a closed cervix without signs of trauma, and moderate vaginal bleeding. Laboratory studies were consistent with infection, hemolysis, and coagulopathy. Sonography demonstrated echolucencies consistent with gas formation in the endometrial cavity. Despite fluid resuscitation, transfusions, antibiotic therapy, and a dilation and curettage, persistent vaginal bleeding required an emergency hysterectomy. Hypotension ensued, and despite aggressive resuscitation attempts, the patient died. CONCLUSION: Rare cases of fatal sepsis secondary to pelvic infection with Clostridium perfringens continue to occur. Hemolysis, anuria, coagulopathy, and characteristic sonographic findings should heighten suspicion of this potentially fatal infection.

Abortion, Septic↗
PubMed2002

Clinical predictors of cervical intraepithelial neoplasia 2 or greater in women with mildly abnormal Pap smears.

OBJECTIVE: To evaluate clinical predictors of cervical intraepithelial neoplasia (CIN) 2 or greater in women with mildly abnormal Pap smears. STUDY DESIGN: Using a computerized colposcopy database of 2,200 women, we identified 1,494 with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSILs). Of the 1,494, 1,016 (68%) underwent biopsy and formed the cohort for this retrospective review. Clinical variables associated with CIN 2 or greater in a univariate analysis (P < .10) were included in a multivariate regression analysis. RESULTS: Of the 1,016 women biopsied, 195 (19%) had CIN 2 or greater. In the initial analysis, age (< 35 years), race (Caucasian and African American), marital status (unmarried) and smoking status (current and former) were found to be significantly associated with more severe histologic disease. In the regression analysis, a history of smoking remained a statistically significant clinical predictor of CIN 2 or greater (odds ratio 1.57, 95% confidence intervals 1.09-2.27). CONCLUSION: A significant predictor of CIN 2 or greater in a large cohort of women with mildly abnormal Pap smears was a history of current or former smoking.

Adult↗
PubMedDate not supplied

Context of care and contraceptive method use.

OBJECTIVES: We assessed the relationship between context of care (incorporates insurance status with clinical setting) on contraceptive use among a national sample of reproductive-aged women. Our hypothesis is that compared to privately insured women who receive their health care in private doctors' offices, women who are publicly insured or self-pay and/or receive their health care in a clinic are more likely to use permanent or long-acting contraceptive methods. METHODS: The study population, consisting of 4,358 women surveyed as part of the 1995 National Survey of Family Growth (NSFG) who were both at risk of unintended pregnancy and currently sexually active, was analyzed using polytomous logistic regression. RESULTS: Following adjustment for age, race/ethnicity, marital status, education, income, parity and smoking, there was a trend toward long-acting contraceptive use among women with public insurance or who were self-pay, regardless of clinical setting compared to privately insured women seen in private clinics. Self-pay and publicly insured women of low parity tended to use long-acting contraception, as did privately insured women seen in clinics. CONCLUSIONS: Insurance information, as well as clinical setting, may guide clinicians' contraceptive decision-making.

Adult↗