A new study leveraging observational and genetic data from more than 100,000 patients provides clinicians with an overview of the relationship between markers of 

, including body fat and metabolic parameters, and risk of developing 

Presented at the European Congress of Endocrinology 2022, results of the study demonstrate increased BMI, body fat percentage, fasting insulin, and sex-hormone-binding globulin (SHBG), were all associated with an increased likelihood of developing PCOS.

"This study shows that obesity during childhood and teenage years are key factors in the development of PCOS. This opens a way to support women’s health by investing in nutritional and weight management programs for younger people. This also has the potential to prevent the condition’s consequences which include poorer quality of life, infertility, diabetes, and pregnancy complications. Future research should focus on developing new ways to help women affected by PCOS manage their weight”, said Laurence Dobbie, MBChB, of the Royal Liverpool University Hospital in the United Kingdom, in a 

statement from the European Society of Endocrinology.

A common endocrine condition impacting up to 10% of women of childbearing age, research surrounding risk factors for development of PCOS have come into the spotlight of endocrine research efforts in recent years. The current study, which was conducted by Dobbie and colleagues at the Royal Liverpool University Hospital in the United Kingdom, was launched with the intent of investigating whether obesity and diabetes markers were associated with an increased likelihood of PCOS development. To do so, investigators designed their study to include a Mendelian randomization analysis as well as a systematic review and meta-analysis of studies assessing the impact of overweight and obesity on development of PCOS.

For the purpose of analysis, investigators conducted a 2-sample Mendelian randomization study to determine the impact of body composition and metabolic parameters on odds of PCOS. This PCOS genome-wide association study meta-analysis data, which included 10,074 people with PCOS and 103,164 controls, were interrogated using the inverse-variance weight method. After a search of relevant databases, investigators had identified 71 studies for inclusion in their systematic review and 63 for the meta-analysis that assessed the role of overweight, obesity, and central obesity on odds of PCOS in adults and adolescents.

In their Mendelian randomization analysis, significant associations were observed between body composition metrics and odds of developing PCOS, with every SD increase in BMI, which correlated to a BMI increase of 4.8 kg/m2, odds of PCOS more than doubled (OR, 2.76 [95% CI, 2.27-3.35]). Similar trends were observed with risk of PCOS and SD increases for body fat percentage (OR, 3.05 [95% CI, 2.24 - 4.15]), whole-body fat mass (OR, 2.53 [95% CI, 2.04-3.14]), fasting insulin (OR, 6.98 [95% CI, 2.02-24.13]) and sex-hormone binding globulin (OR, 0.74 [95% CI, 0.64-0.87]). Of note single SD increases for body fat percentage, whole-body fat mass, fasting insulin, and SHBG were 8.5%, 9.6 kg, 0.79 pmol/L, and 28 nmol/L, respectively. Investigators pointed out results indicated genetically determined childhood body size also increased odds of PCOS after adjustment for adult body size (OR, 2.56 [95% CI, 1.57-4.20]).

In their meta-analysis, investigators found women with overweight (OR, 3.80 [95% 2.87-5.03]), women with obesity (OR, 4.99 [95% CI, 3.74-6.67]), and women with central obesity (OR, 2.93 [95% CI, 2.08-4.12]) all had increased likelihood of developing PCOS. Additionally, results suggested presence of overweight (OR, 5.32) or obesity (OR, 7.86) in adolescence was associated with greater odds of PCOS than overweight (OR, 3.57) or obesity (OR, 4.66) in adulthood.

This study, “Body Composition during Childhood, Adolescence and Adulthood influences the odds of developing Polycystic Ovary Syndrome: A Mendelian Randomization Study with a Systematic Review and Meta-analysis,” was presented at the 

European Congress of Endocrinology 2022 annual meeting

This article originally appeared on Endocrinology Network®. 

Articles

Data presented at the European Congress of Endocrinology detail genetic and observational associations between obesity, and markers of body composition on the likelihood of developing PCOS later in life.

Body composition, obesity increase odds of developing PCOS

 is continuously updated source where you can find the latest news on COVID-19. Data on vaccination comes from the 

Centers for Disease Control and Prevention

Here’s the latest data, updated on May 24:

Total vaccine doses distributed: 741,676,155

Patients who’ve received the first dose: 258,174,992

Patients who’ve received the second dose: 220,933,970

This article originally appeared on Medical Economics®. 

How many novel coronavirus (COVID-19) cases were announced today?

Coronavirus Omicron variant, vaccine, and case numbers in the United States: May 24, 2022

Here’s the latest data, updated on May 23:

Patients who’ve received the first dose: 258,149,591

Patients who’ve received the second dose: 220,914,142

Coronavirus Omicron variant, vaccine, and case numbers in the United States: May 23, 2022

You can reach her a lcarr@mjhlifesciences.com.

Health care systems start program to ensure equity in patient care

AMA, Joint Commission aim to improve outcomes for marginalized patients.

Check back soon for additional highlights. 

This week on Contemporary OBGYN®: May 23 to May 27

 into patient care is the goal of new program of the American Medical Association (AMA) and eight health care systems around the nation.

The Advancing Equity Through Quality and Safety Peer Network is a collaboration with AMA, 

 accrediting organization to “apply an equity lens to all aspects of quality and safety practices.” The goal is to improve health outcomes for historically marginalized populations, according to a 

“For the past two years, the COVID-19 pandemic has further exposed systemic inequities in the quality and safety of the patient care experience—including gaps in interpretation services, telemedicine access, and crisis standards of care,” AMA President Gerald E. Harmon, MD, said in the press release. “Through collaborations like the Peer Network, the AMA continues its work to remove the social and structural factors that interfere with patient-centered care—providing health systems with guidance to inform equitable solutions, dismantle inequities, and improve health outcomes for our patients from historically marginalized communities.”

Data illustrate the contrast in health care experience and outcomes for historically marginalized patients. For example, studies show Black, Latinx, and Asian American patients are at a significantly higher risk of contracting — and in many cases, dying from — preventable hospital-acquired infections such as MRSA, Clostridioides difficile, or catheter-associated UTIs, than non-Latinx white patients, according to AMA.

Peer Network subject matter experts will use individual consultations and group learning to develop strategies that identify and address 

 of inequities. Participating health care systems also will use a system-wide framework developed at Brigham and Women’s Hospital and the Institute of Healthcare Improvement to reduce health inequities. The 

 will analyze racism and equity to support an overall mission of delivering equitable, high-quality care to all patients, according to AMA.

“Every patient deserves the right to safe, equitable healthcare,” Joint Commission President and CEO Jonathan B. Perlin, MD, PhD, said in the press release. “The COVID-19 pandemic placed sharp focus on the unacceptable disparities in health outcomes, demonstrating significant work that must be done. All healthcare organizations have a responsibility to identify and address the disparities that their unique patient populations face. We look forward to working with others in the Peer Network in implementing sustainable solutions for equitable excellence in healthcare.”

The first phase of the Peer Network’s approach will begin with:

The University of Texas MD Anderson Cancer Center

University of Wisconsin Hospitals & Clinics

The announcement comes as the latest step for the health care organizations to address racial inequity and social justice. AMA, Brigham and Women’s Hospital and the Joint Commission joined in July 2019 to 

 and in January 2022 launched the Advancing Equity Through Quality and Safety Peer Network.

Local community needs for obstetric care trump financial viability and staffing challenges at rural hospitals, according to a national survey in 

“Rural hospitals and rural obstetric units have been closing at alarming rates over the last decade,” said study team member Lindsay Admon, MD, MSc, an assistant professor of ob-gyn at the University of Michigan in Ann Arbor. “Rural communities that have lost local access to obstetric care face reduced access to prenatal care and higher rates of preterm birth.”

Safely maintaining access to obstetric care is a clinical and policy priority, according to Admon. “We sought to understand rural hospital perspectives on criteria for maintaining safe provision of obstetric care,” she said of her work on the survey.

The investigators used the American Hospital Association Annual Survey to identify a national sample of rural hospitals that provided obstetric services in 2021. Obstetric unit managers or administrators at 93 rural hospitals with obstetric services were surveyed between March and August of 2021.

Of the hospitals in the study sample, 35.5% were critical access hospitals and 64.5% were located in micropolitan rural counties.

Overall, the hospitals had a median average daily census of 22 total inpatients. Half (52.2%) of hospitals reported a decline in births over the past 3 years and a median of 274 births in 2019.

Respondents reported that the minimum number of annual births needed to safely provide obstetric care was 200, which was the same number of births needed to ensure financial stability.

“A full 40% of participants reported they did not have enough births annually to breakeven financially, yet they continue to offer obstetric services,” Admon told 

When making decisions about maintaining obstetric care, 64.6% of hospitals cited meeting local community needs as their highest priority, compared to 16.5% that listed financial considerations and 12.7% that considered staffing as the most important factor.

Overall, 25% of hospitals were unsure they would continue providing obstetrics, or they expected to stop offering the service.

“Many rural hospitals continue to operate obstetric units, despite operating at a financial loss,” Admon said. “It is likely that the availability of rural obstetric care will continue to decline in coming years, and that this will exacerbate longstanding rural maternal and child health disparities.”

Rural hospitals that lack obstetric units often have births that occur in their emergency departments—along with unanticipated adverse birth outcomes, delays in urgent transport—and report the need for additional resources for emergency obstetrics.

Admon noted that urgent policy solutions are needed to continue the safe provision of obstetric care in rural America.

“To support rural hospitals in continuing to safely provide obstetric services, attention to financing of maternity care ought to include discussion of low-volume adjustments,” she said.

Medicaid is a major lever for policy change because its programs fund more than half of rural births. “Hence, Medicaid payment policies and reimbursement rates play a key role in the financial viability of rural obstetric care,” Admon said. “However, Medicaid pays substantially lower rates for childbirth than commercial insurance.”

Furthermore, pregnant Medicaid beneficiaries living in rural areas are less likely than those who are privately insured to give birth at an urban hospital or at a hospital with neonatal intensive care.

Rural representation in policy decision-making bodies is crucial for providing the distinct perspective of rural residents, communities and healthcare delivery systems, according to Admon. “This will help ensure that policy changes and safety resources are relevant and useful in rural settings,” she said.

Kozhimannil KB, Interrante JD, Admon LK, et al. Rural hospital administrators’ beliefs about safety, financial viability, and community need for offering obstetric care. 

. Published online March 25, 2022. doi:10.1001/jamahealthforum.2022.0204

Local community needs for obstetric care trump financial viability and staffing challenges at rural hospitals, according to a national survey in JAMA Health Forum.

Rural obstetric care continues to operate at financial loss

underscores the need to support women who are unable to breastfeed and to educate women about the benefits of contraception for the newborn.

“Women are routinely presented with counseling on breastfeeding and contraception throughout their prenatal and postpartum care, but little is published on patients’ own priorities, desires and experiences of this peripartum counseling,” the authors wrote.

The study comprised individual semi-structured interviews with 20 mothers who gave birth at Montefiore Medical Center in the Bronx—a New York City borough north of Manhattan and Queens. It is the poorest congressional district in the country. Overall, 90% of the women in this study used Medicaid for insurance and 15% were concerned about food security in the past month.

Interviews were conducted between July and October 2017.

All participants received contraceptive counseling, including being offered postpartum long-acting reversible contraception (LARC) on admission to the labor and delivery unit by medical providers, as well as counseling about breastfeeding during their admission.

A full 80% of women also had some counseling about postpartum contraception during their prenatal care.

In addition, all participants had been offered a postplacental intrauterine device (IUD) at the time of admission, and about one-third had received postplacental IUDs.

Interestingly, though, 35% of participants were still undecided about using a contraceptive method postpartum at the time of the interview.

The interview guide explored the timing and content of contraceptive counseling; breastfeeding goals and expectations; reasons for contraceptive choices; and recommendations for counseling.

Three themes emerged from the interviews—the new mothers described contraceptive use as a selfish decision, without benefit to the newborn; women felt pressure to breastfeed and viewed the inability to breastfeed as a personal failure; and medical providers were considered to be more trustworthy for breastfeeding information than contraceptive decisions that relied on anecdotes from friends or family.

Many participants did not consider contraception as a resource for birth spacing, but rather as a way to engage in intercourse while avoiding pregnancy. Most women also did not believe birth control was beneficial for their child. When asked if they would theoretically prioritize contraception or breastfeeding, nearly all women believed breastfeeding was more important because it directly benefited their children.

The majority of mothers also described feeling immense pressure from their medical providers to breastfeed their newborn infants or defined formula upon request. When mothers were unable or unwilling to breastfeed, they experienced feelings of guilt and failure.

During formal counseling from healthcare providers, the women reported being told that breastfeeding was the healthiest option for their baby and often cited that reason for why they chose to breastfeed.

Many women described disregarding their family’s recommendations to use formula and embracing breastfeeding instead after learning the advantages.

“Perhaps the most surprising finding of the study was that the participants did not connect breastfeeding and contraception counseling to each other at all, particularly given their distinctive reactions to the counseling,” wrote the authors.

Study results reinforce the need for the healthcare system to reframe the conversation around birth spacing, emphasizing the benefits to the newborn and maternal health, according to the authors.

Shapiro MP, Avila K, Levi EE. Breastfeeding and contraception counseling: a qualitative study. 

. Published online February 25, 2022. doi.org/10.1186/s12884-022-04451-2

Interviews with mothers in the immediate postpartum period revealed that most decisions on breastfeeding and contraception were based on the personal experiences of participants and their friends and family. 

What impacts a woman’s contraceptive decisions while breastfeeding? 

Morgan Petronelli is assistant managing editor of 

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

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Bassem Maximos, MD, MPH, FACOG, discusses 2 recent studies investigating nonhormomal contraceptive gel Phexxi (Evofem Biosciences) for the potential treatment of UTIs and improvement in sexual satisfaction. 

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Tracy MacNeal, president and CEO of Materna Medical, sits down to discuss the company's recently FDA-cleared Milli Vaginal Dilator for vaginismus and associated dyspareunia, as well as a potential new use for the device currently being studied.

Materna Medical discusses new vaginal dilator 

 has raged on despite the development of evidence-based treatment for opioid use disorders,” explained Kimberly Hu, MD, at the 

2022 American Psychiatric Association Annual Meeting

. “About 70% of the nearly 71,000 drug overdose deaths in 8 states involved opioids. That's a huge, staggering number.”

Recognizing the role that insufficient access to medications plays in this epidemic, Hu and colleagues at the 

Ohio State University Wexner Medical Center

, designed and implemented an opioid use disorder (OUD) curriculum for third-year medical students. The students (n=405) were provided with in-person or virtual buprenorphine waiver training and in-person clinical experiences between January 2019 and April 2021. Pre- and post-intervention tests,along with self-reported clinical management surveys,assessedthe students’ability to screen patients with OUD and manage acute and chronic pain. Paired sample t-tests were estimated to assess improvement in knowledge and approach to clinical management principles.

Kimberly Hu, MD, presented new research at the 2022 American Psychiatric Association Annual Meeting.

Hu, a resident at the Ohio State University Wexner Medical Center, and colleagues found a statistically significant increase in both their knowledge as seen in the pre- and post-test scores as well as their self-reported understanding of management principles. A follow-up study at the end of the year also provided positive feedback. Hu reported: “83% [of the participants] said that they felt they knew how to manage acute pain, about 62% felt that they knew how to manage 

, and about 77% said that they knew how to screen the patient for opioid use disorder.” This is important no matter which specialty the students pursue, as these students will be able to “link patients with resources early and make sure that there aren’t patients slipping through the cracks,” Hu explained.

She noted that educating third-year medical students gives them—and their future patients—an advantage. “They're a little over halfway through medical school, and then they'll go into residency in a number of different specialties. So giving them this knowledge early helps them to incorporate [the information and skills] as they continue their training.”

Hu noted that the educational program is ongoing and supported by the 

Substance Abuse and Mental Health Services Administration

. Her study co-authors included Julie Niedermier, MD; Amanda Start, PhD;Casia Horseman, MD; and Julie Teater, MD.

“If we can educate the next generation physicians and increase access to care, this is one way we can combat the opioid crisis,” Hu concluded.

Are you attending the 2022 American Psychiatric Association Annual Meeting? We want to hear your thoughts! Share recaps, reflections, and experiences with us at PTEditor@mmhgroup.com. Be sure to visit us at booth 1852.

This article originally appeared on Psychiatric Times®. 

New research presented at the 2022 American Psychiatric Association Annual Meeting evaluated program to help address the opioid epidemic.