Publications

BACKGROUND

Intrauterine contraception (IUC) is safe, highly effective and has few medical contraindications. Primary care providers see many women with chronic conditions who might benefit from IUC.

STUDY DESIGN

We surveyed women aged 18-50 who visited one of four primary care clinics in Pennsylvania between October 2008 and April 2010 to investigate perceptions of IUC and to identify factors associated with accurate perceptions. Key independent variables included patient characteristics, including knowing other women who had used IUC, and having discussed IUC with a provider. Logistic regression was used to examine the association between independent variables and accurate perceptions.

RESULTS

The study population included 1626 eligible respondents. Only 19.5% of women knew that IUC is more effective than oral contraceptive pills, 57.4% knew that IUC does not increase the risk of sexually transmitted infections and 28.7% knew that IUC is more cost-effective than oral contraceptive pills. Among women who had never used IUC, accurate perceptions were associated with higher levels of education, knowing one or more women who had used IUC and having discussed IUC with a health care provider.

CONCLUSIONS

Many women seeking primary care have inaccurate perceptions of IUC and may benefit from counseling about the advantages of this approach to preventing unintended pregnancy.

To use microRNAs to downregulate mRNA targets, cells must first process these ~22 nt RNAs from primary transcripts (pri-miRNAs). These transcripts form RNA hairpins important for processing, but additional determinants must distinguish pri-miRNAs from the many other hairpin-containing transcripts expressed in each cell. Illustrating the complexity of this recognition, we show that most Caenorhabditis elegans pri-miRNAs lack determinants required for processing in human cells. To find these determinants, we generated many variants of four human pri-miRNAs, sequenced millions that retained function, and compared them with the starting variants. Our results confirmed the importance of pairing in the stem and revealed three primary-sequence determinants, including an SRp20-binding motif (CNNC) found downstream of most pri-miRNA hairpins in bilaterian animals, but not in nematodes. Adding this and other determinants to C. elegans pri-miRNAs imparted efficient processing in human cells, thereby confirming the importance of primary-sequence determinants for distinguishing pri-miRNAs from other hairpin-containing transcripts.

BACKGROUND

There is a lack of information about posttreatment care among patients with ductal carcinoma in situ (DCIS). This study compares posttreatment care by ethnicity-language and physician specialty among Latina and White women with DCIS.

METHODS

Latina and White women diagnosed with DCIS between 2002 and 2005 identified through the California Cancer Registry completed a telephone survey in 2006. Main outcomes were breast surveillance, lifestyle counseling, and follow-up physician specialty.

KEY RESULTS

Of 742 women (396 White, 349 Latinas), most (90 %) had at least one clinical breast exam (CBE). Among women treated with breast-conserving surgery (BCS; N = 503), 76 % had received at least two mammograms. While 92 % of all women had follow-up with a breast specialist, Spanish-speaking Latinas had the lowest specialist follow-up rates (84 %) of all groups. Lifestyle counseling was low with only 53 % discussing exercise, 43 % weight, and 31 % alcohol in relation to their DCIS. In multivariable analysis, Spanish-speaking Latinas with BCS had lower odds of receiving the recommended mammography screening in the year following treatment compared to Whites (OR 0.5; 95 % CI, 0.2-0.9). Regardless of ethnicity-language, seeing both a specialist and primary care physician increased the odds of mammography screening and CBE (OR 1.6; 95 % CI, 1.2-2.3 and OR 1.9; 95 % CI, 1.3-2.8), as well as having discussions about exercise, weight, and alcohol use, compared to seeing a specialist only.

CONCLUSIONS

Most women reported appropriate surveillance after DCIS treatment. However, our results suggest less adequate follow-up for Spanish-speaking Latinas, possibly due to language barriers or insurance access.

IMPLICATIONS FOR CANCER SURVIVORS

Follow-up with a primary care provider in addition to a breast specialist increases receipt of appropriate follow-up for all women.