INTRODUCTION: Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies. METHODS: Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants. RESULTS: Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40). CONCLUSION: High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.

OBJECTIVE To assess the use of a portable retinal camera in diabetic retinopathy (DR) screening in multiple settings and the presence of associated risk factors among children, adolescents, and young adults with type 1 diabetes. DESIGN AND METHODS Five hundred youth with type 1 diabetes of at least 1 year’s duration were recruited from clinics, diabetes camp, and a diabetes conference and underwent retinal imaging using a nonmydriatic fundus camera. Retinal characterization was performed remotely by a licensed ophthalmologist. Risk factors for DR development were evaluated by a patient-reported questionnaire and medical chart review. RESULTS Of the 500 recruited subjects aged 9–26 years (mean 14.9, SD 3.8), 10 cases of DR were identified (nine mild and one moderate nonproliferative DR) with 100% of images of gradable quality. The prevalence of DR was 2.04% (95% CI 0.78–3.29), at an average age of 20.2 years, with the youngest affected subject being 17.1 years of age. The rate of DR was higher, at 6.5%, with diabetes duration >10 years (95% CI 0.86–12.12, P = 0.0002). In subjects with DR, the average duration of diabetes was 12.1 years (SD 4.6, range 6.2–20.0), and in a subgroup of clinic-only subjects (n = 114), elevated blood pressure in the year before screening was associated with DR (P = 0.0068). CONCLUSION This study in a large cohort of subjects with type 1 diabetes demonstrates that older adolescents and young adults (>17 years) with longer disease duration (>6 years) are at risk for DR development, and screening using a portable retinal camera is feasible in clinics and other locations. Recent elevated blood pressure was a risk factor in an analyzed subgroup.

INTRODUCTION: The American College of Obstetrics and Gynecology recommends routine oral health care during pregnancy. Despite this recommendation, many pregnant women do not receive routine dental care. The reasons for discordance are complex. This study, conducted in conjunction with the ACOG District XII Committee on Healthcare of Underserved Women, surveyed ACOG District XII Fellows regarding their perceptions of factors that impact oral health care in pregnancy. METHODS: Between May and October 2019, ACOG District XII Fellows were asked to participate in an anonymous electronic survey on their practices regarding oral health in pregnancy. IRB approval was obtained. Descriptive statistics were estimated using SPSS (V25). RESULTS: 107 ACOG Fellows completed this survey. Twenty-one percent of Fellows reported receiving education/training related to oral health in pregnancy. Less than half (48%) of Fellows reported asking oral health screening questions, 60% recommend that women undergo routine dental cleaning, and 65% reported counseling patients on the importance of oral health in pregnancy. Seventeen percent (17%) reported insufficient clinic time and 17% of Fellows reported lack of accepting dentists as reasons for not discussing oral health during prenatal care. However, 55% of Fellows reported patients would easily find an accepting dentist. CONCLUSION: District XII ACOG Fellows acknowledge the importance of routine oral health care in pregnancy. However, they perceive barriers to recommending care such as limited clinic time and patient access. Offering oral health education during provider training could improve screening rates and counseling. Additionally, increasing access to dental care could improve overall oral health in pregnant women.

Early detection of diabetic retinopathy (DR) is imperative; however, adherence to screening guidelines is poor. We hypothesized that youth and young adults with type 1 diabetes (T1D) who met American Diabetes Association criteria for recommended DR screening at the time of the study (10 years old or greater with diabetes duration of 5 years or more) would report multiple barriers to screening and that targeted barriers and subpopulations could be identified to improve access to care. 271 youth aged 10 to 26 years with T1D of at least 5 years duration were recruited from clinic, diabetes camp, and a diabetes conference and completed a patient-reported questionnaire. 113 (41.7%) reported at least one barrier to DR screening, with missed school and work being the most common (20.7%). Older participants (P = 0.007) and those with a longer diabetes duration (P = 0.018) were more likely to report barriers to screening. Recruitment location, sex, race and ethnicity, HbA1c, insulin regimen, and clinic visit frequency were not associated with reporting at least one barrier. Slightly less than two-thirds (62.1%) of participants who responded (n = 235 out of 271) adhered to recommended screening guidelines of the time and reported having an eye exam within the past year, 24.7% 12-23 months ago, 9.8% 2 years ago or more, and 3.4% had never had a DR exam. As older patients and those with longer duration of diabetes are more likely to have DR, targeted interventions to address barriers to care, such as, missed school and work should be implemented in these groups.

INTRODUCTION: Despite ACOG recommendations regarding oral health and pregnancy, many women do not receive recommended oral health care during pregnancy. This study, conducted in conjunction with ACOG DXII Committee for the Healthcare of Underserved Women, evaluated barriers to access and use of oral health care services in pregnant women. METHODS: IRB approval was obtained. Between May and July 2019, consenting women admitted to the postpartum unit at UF Health were offered a survey about oral health care utilization during pregnancy. Enrollment occurred on a rolling basis. Descriptive statistics were calculated for all responses, with chi square analysis compared by insurer. RESULTS: Two hundred women participated. The majority were insured by Medicaid (54% Medicaid, 39% private, 3% government, 2% none, 2% no response). Most women (68%) reported that their insurance covered dental care. 50% of women reported seeing a dentist within the last year. 36% of women with Medicaid saw a dentist within the last year compared to 71% of women with private insurance (P CONCLUSION: Many women are not receiving adequate oral health care during pregnancy and disparities exist among women by payer status. Increasing access to care and improving patient education regarding oral health is necessary to improve oral health care for pregnant women.