To explore to what extent intrauterine device (IUD) expulsion is associated with demographic and clinical risk factors. The APEX-IUD (Association of Perforation and Expulsion of IntraUterine Devices) study was a U.S. cohort study using electronic health records from three integrated…
Intrauterine devices, including levonorgestrel-releasing and copper devices, are highly effective long-acting reversible contraceptives. The potential risks associated with intrauterine devices are low and include uterine perforation and device expulsion. This study aimed to evaluate the risk of perforation and expulsion…
Intrauterine devices are effective instruments for contraception, and 1 levonorgestrel-releasing device is also indicated for the treatment of heavy menstrual bleeding (menorrhagia). To compare the incidence of intrauterine device expulsion and uterine perforation in women with and without a diagnosis…
Previous studies have identified an association between traumatic brain injuries and the development of psychiatric disorders in general. However, these studies were subject to limitations that demonstrate the need for a study of a large, clearly defined mild traumatic brain…
Reports of perforation risk related to intrauterine devices (IUDs) inserted immediately post partum and among non-post-partum individuals are scarce, and previous studies with only 12-month follow-ups underestimate the risk. Breastfeeding at IUD insertion and insertion within 36 weeks post partum…
This study aims to assess the incidence of ectopic pregnancy among people wanting pregnancy compared to people seeking abortion. The specific research questions are: Are people seeking abortion at lower risk of experiencing an ectopic pregnancy compared to people not…
Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. To evaluate the association of postpartum timing of IUD insertion…
To estimate the incidence of ectopic pregnancy (EP) associated with prescription contraceptive use. We performed a retrospective cohort study of women aged 15 to 44 years at Kaiser Permanente Northern and Southern California during 2010 to 2019. We identified EPs…
The goal of this study was to evaluate the association between pregnancy intentions and substance use in early pregnancy among pregnant women receiving prenatal care in a large, integrated healthcare system. The sample comprised 29,787 Kaiser Permanente Northern California pregnant…
Intrauterine devices are effective and safe, long-acting reversible contraceptives, but the risk of uterine perforation occurs with an estimated incidence of 1 to 2 per 1000 insertions. The European Active Surveillance Study for Intrauterine Devices, a European prospective observational study…
To develop a longitudinal algorithm combining two biomarkers, CA125 and HE4, for early detection of ovarian cancer in women with BRCA mutations. Women with BRCA mutations and intact ovaries were invited to participate in a novel ovarian cancer early detection…
Surveillance of ectopic pregnancy (EP) using electronic databases is important. To our knowledge, no published study has assessed the validity of EP case ascertainment using electronic health records. We aimed to assess the validity of an enhanced version of a…
To examine trends and correlates of frequency of self-reported alcohol and nicotine use among pregnant women. Cross-sectional study of 363,240 pregnancies from 2009 to 2017 screened for self-reported substance use at their first prenatal visit in Kaiser Permanente Northern California.…
Immunohistochemistry screening is a reliable method for identifying women with endometrial cancer who are at risk for Lynch syndrome, but clinical workflows used to implement immunohistochemistry screening protocols can vary by institution. The goal of this study was to investigate…
Compare detection of Lynch syndrome in endometrial cancer between regions of a health care system with different screening strategies. A retrospective study of endometrial cancer (EC) cases from 2 regions of an integrated health care system (Kaiser Permanente Northern (KPNC)…
We assessed the feasibility, patient acceptability of and compliance of a new surveillance strategy for ovarian cancer surveillance in women with BRCA mutations, based on assessments of serum CA125 and HE4 every 4 months (Risk of Ovarian Cancer Algorithm (ROCA) arm),…
Assess sexual function, menopausal symptoms, and depression in women with BRCA mutations associated with oophorectomy and menopause status. Women age 40 and older with BRCA mutations completed a questionnaire with validated measures of sexual activity, menopausal symptoms, depression, and cancer…
The Food and Drug Administration (FDA) has required Bayer AG to conduct a post-marketing study in the U.S. to determine the incidence of uterine perforation and IUD expulsion by type of intrauterine device (IUD) used. The goal of this study…
Estimate the prevalence and identify risk factors for bone loss in women with BRCA mutations. Women, age 40 and older, with BRCA mutations identified from the Breast Cancer Surveillance database at Kaiser Permanente Northern California were invited to participate and…
Sessile serrated adenomas (SSAs) are precursors of 15% to 30% of colorectal cancers but are frequently underdiagnosed. We sought to measure the SSA detection rate (SDR) and predictors of SSA detection after educational training for community gastroenterologists and pathologists. Colonoscopy…
As an important quality measure, the rates of recommended immunizations among immunocompromised inflammatory bowel disease (IBD) patients in community practice have not been well studied. This study sought to investigate the rates and predictors of recommended immunizations and screening tests…
In 2007, high-deductible plans were added to the primarily nondeductible Kaiser Permanente Northern California (KPNC) integrated health plan, which had covered 100% of device and procedure costs of long-acting reversible contraception (LARC) for members regardless of prescription/visit copay amount. We…
The goal of the study is to compare the incidence of uterine perforation within 12 months after IUD insertion between: (1) postpartum insertions within 12 months of delivery (with breastfeeding status), (2) post abortion or pregnancy loss IUD insertions and…
To supplement published cohort data about incident cancer in Asian Americans (Asians) including risk of specific Asian ethnic groups. A cohort study in 124,193 persons (13,344 Asians) with baseline examination data in 1978-1985 used Cox proportional hazards models with seven…
To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice. This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older…
Gastric intestinal metaplasia and dysplasia are precursor lesions for adenocarcinoma. The risks of progression to malignancy from these lesions are not well characterized, particularly in the US populations. We identified 4,331 Kaiser Permanente Northern California members who were diagnosed with…
Racial and ethnic differences in gastric cancer are not well understood. This study sought to compare the clinicopathological features and survival of noncardia gastric adenocarcinoma (NCGA) patients with different racial/ethnic backgrounds in Kaiser Permanente Northern California (KPNC), a large integrated…
This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy. This study used an…
The authors studied incident cancer risk from 1978 to 1985 and through follow-up in 2012 relative to light-to-moderate and heavy drinking and to the choice of alcoholic beverage in a cohort of 124,193 persons. With lifelong abstainers as referent, heavy…
Gastric cancer often occurs in the elderly but is uncommon in young individuals. Whether young patients have different clinical behaviors and outcomes from those of older patients remain unclear. We identified 1,366 cases of newly diagnosed noncardia gastric adenocarcinoma from…
To assess the uptake of risk-reducing options for the management of ovarian and breast cancer risk in BRCA mutation carriers in a large community based integrated health system in Northern California. A retrospective cohort of deleterious BRCA mutation carriers (1995-2012)…
To determine the prevalence of autism spectrum disorders (ASD) across gestational age, examine the risk of ASD by gestational age controlling for other risk factors, and identify potential risk factors in the neonatal intensive care unit. A retrospective cohort of…
OBJECTIVE: To evaluate the relationship between Neisseria gonorrhea and Chlamydia trachomatis screening strategies and risk of pelvic inflammatory disease (PID) after intrauterine device (IUD) insertion. METHODS: We conducted a retrospective cohort study of all IUD insertions at Kaiser Permanente Northern…
Over 40% of women with a preoperative diagnosis of complex atypical hyperplasia (CAH) will have endometrial cancer at hysterectomy. CAH diagnoses are often qualified by comments indicating suspicion of cancer. We examine whether these comments correlate with cancer found at…
BACKGROUND: Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes. OBJECTIVE: To compare rates of provision of contraceptive services among women with diabetes mellitus and women without chronic medical conditions.…
OBJECTIVE: To conduct a cost-benefit analysis of Early Start, an integrated prenatal intervention program for stopping substance use in pregnancy. METHODS: A retrospective cohort study was conducted of 49,261 women who had completed prenatal substance abuse screening questionnaires at obstetric…
OBJECTIVE: To study the association of postacute care (PAC) settings and mortality outcome of patients who sustained an ischemic stroke. DESIGN: A retrospective cohort study. SETTING: An integrated health care system in northern California. PARTICIPANTS: Patients who sustained an acute…
Context: Population study data about relations of coffee drinking to arrhythmia are sparse.Objective: To study relations of coffee drinking to risk of cardiac arrhythmia in 130,054 persons with previous data about coffee habits.Design and Outcome Measure: We used Cox proportional…
OBJECTIVES: Published studies show poor pregnancy outcomes associated with unintended pregnancies are disproportionately higher than in planned pregnancies and place a burden on the health care system. This study was designed to compare pregnancy intention rates, compare sociodemographic characteristics of…
PURPOSE: Limited data suggest that alcohol drinking may have an inverse relation to risk of non-Hodgkin's lymphoma (NHL). Prospective data about alcohol, NHL, and other hematologic malignancies (HM) are sparse. METHODS: We carried out a cohort study in a multiethnic…
OBJECTIVE: To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy. METHODS: Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified…
This clinical trial compared two brief alcohol use interventions in prenatal clinics: Early Start (ES), a substance-abuse screening and treatment program integrated with prenatal care focused on abstention (n=298), and Early Start Plus (ESP), adding a computerized drink-size assessment tool…
OBJECTIVE: To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes. STUDY DESIGN: Subjects were 49 985 women who completed Prenatal Substance Abuse Screening Questionnaires at obstetric clinics between 1 January 1999…
BACKGROUND: Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. OBJECTIVE: To assess pregnancy rates and the frequency of contraceptive…
OBJECTIVE: This study was undertaken to describe long-term outcomes after uterine artery embolization for leiomyoma. STUDY DESIGN: Data from Kaiser Permanente Northern California members undergoing uterine artery embolization for leiomyoma before July 2001 were collected. Survival analysis was performed to…
OBJECTIVE: The purpose of this study was to investigate treatment of uterine leiomyoma by hysterectomy and uterine conserving procedures (UCPs). STUDY DESIGN: Data from Kaiser Permanente Northern California members undergoing hysterectomy, myomectomy, uterine artery embolization (UAE) and endometrial ablation (EA)…
BACKGROUND: Despite the medical evidence, few women of reproductive age in the United States use intrauterine contraception (IUC) in comparison with women worldwide. To reduce cost as a barrier, Kaiser Permanente removed the cost to the patient for IUC throughout…
Heavy drinking during pregnancy can cause birth defects and other alcohol-related effects. Because costs associated with fetal complications are high, health care organizations are invested in finding ways to intervene with pregnant drinkers. We describe a computerized intervention tested at…
Untreated perinatal substance abuse is associated with serious adverse maternal and neonatal outcomes. Historically, many barriers have prevented pregnant women from seeking treatment. Early Start (ES) breaks new ground by sidestepping these barriers with a fully integrated service delivery model.ES…
BACKGROUND: Newborns of 30-34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants. OBJECTIVE: To measure in-hospital outcomes and readmission…
OBJECTIVE: To investigate the annual rates, types, and indications for hysterectomies performed for benign disease in Kaiser Permanente Northern California from 1994 to 2003. METHODS: All women, 20 years or age or older, who were undergoing hysterectomy for benign indications…
AIM: To analyse rehospitalisation of newborns of all gestations. METHODS: A total of 33,276 surviving infants of all gestations born between 1 October 1998 and 31 March 2000 at seven Kaiser Permanente Medical Care Program (KPMCP) delivery services were studied…
The sparseness of prospective data about hemorrhagic stroke (HS) risk among Asian American ethnic groups led to the investigation of 128,934 persons with self-classified ethnicity at health examinations in 1978-1985. Subsequently, 431 persons were hospitalized for HS; 31% for subarachnoid…
The use of chart reviews to assess substance use one-year postpartum was examined in this pilot study by comparing interviews with chart reviews for 23 women assessed positive for risk during pregnancy. There was no indication that providers asked about…
A substantially increased risk for heavy drinkers and a slightly reduced risk for lighter drinkers results in the J-shaped alcohol-mortality curve. Limited data suggest a more favorable mortality experience for drinkers of wine than for drinkers of liquor or beer.…
PURPOSE: We compared the characteristics and outcomes of patients with 'early repolarization' electrocardiograms (ECGs) with those who had normal ECGs. METHODS: In 1983 to 1985, we collected photocopies of 2234 selected ECGs from 73088 patients undergoing health examinations. Excluding 153…
PURPOSE: Little is known about the traits of decaffeinated coffee drinkers, who are sometimes used to ascertain whether the health effects of coffee intake are due to caffeine or some other coffee ingredient. METHODS: We studied these traits in 12,467…
OBJECTIVE: To evaluate the effect of Early Start, a managed care organization's obstetric clinic-based perinatal substance abuse treatment program, on neonatal outcomes. STUDY DESIGN: Study subjects were 6774 female Kaiser Permanente members who delivered babies between July 1, 1995 and…
In view of conflicting prior reports, we prospectively studied associations between alcohol consumption and subsequent hospitalization for hemorrhagic stroke (HS) in 431 persons. Alcohol use was determined at examinations in 1978-1984 among 128,934 members of a prepaid health plan. Cox…
OBJECTIVES: To determine the incidence of neonatal dehydration leading to rehospitalization, whether clinical and health services data could predict its occurrence, and the outcome of dehydrated infants. METHODS: We employed a retrospective case-control design nested within a cohort of 51…
This study assessed utilization of health services among 1,317 adults referred to an outpatient Psychiatry Department alcohol treatment program from July, 1988 through December, 1989. The mean number of visits/year for 1 year before and 4 years after treatment referral…
Maternal substance abuse is a serious problem with significant adverse effects to mothers, fetuses, and children. The Early Start Program provides pregnant women in a managed care organization with screening and early identification of substance abuse problems, early intervention, ongoing…
BACKGROUND: Few data are available on the outcome of neonatal sepsis evaluations in an era when intrapartum antibiotic therapy is common. METHODS: We identified all newborns weighing >/=2000 g at birth who were ever evaluated for suspected bacterial infection at…
Several reports from Asian countries suggest a low prevalence of pulmonary embolism (PE) and deep venous thrombosis (DVT) in Asians, and sparse US data show that a slightly higher prevalence of PE/DVT in 'nonwhites' than in whites is evident in…
OBJECTIVES: Reference data are lacking on the frequency and duration of assisted ventilation in neonates. This information is essential for determining resource needs and planning clinical trials. As mortality becomes uncommon, ventilator utilization is increasingly used as a measure for…
OBJECTIVE: To determine the frequency and interhospital variation of bilirubin testing and identified hyperbilirubinemia in a large health maintenance organization. DESIGN: Retrospective cohort study. SETTING: Eleven Northern California Kaiser Permanente hospitals. SUBJECTS: A total of 51,387 infants born in 1995-1996…
OBJECTIVES: New interventions to prevent respiratory syncytial virus (RSV) have recently become available. Clinical decisions about the use of these interventions require a better understanding of the incidence of and risk factors for RSV. We sought to characterize the epidemiology…
BACKGROUND: High-risk newborns are known to have higher than average utilization of services after discharge from the neonatal intensive care unit (NICU). Most studies on this subject report aggregate data over periods ranging from 1 to 3 years postdischarge. Little…
OBJECTIVES: This study examined the relation between alcohol use and utilization of health services during a 3-year period in a sample of 4,264 adult respondents to a member health survey in a health maintenance organization. METHODS: Respondents were categorized as…
We sought to quantify neonatal mortality (< 28 days) in a 10-hospital system, determine what proportion was associated with suboptimal neonatal care and make recommendations on how neonatal mortality rates (NMRs) could be used in quality improvement efforts. Deaths were…
PURPOSE: To implement three aspects of developmental care: lower noise levels, decreased light levels, and flexed, midline positioning. DESIGN: Research utilization project. The developmental care interventions were implemented on a daily basis for two hours of 'quiet time' during each…
BACKGROUND: Preterm birth is a major cause of perinatal morbidity and mortality. Whether the rate of preterm birth can be reduced by frequent contact between nurses and pregnant women or home monitoring of uterine activity is not known. METHODS: We…
Risk factors for cataract extraction in a young (less than 60 years of age) urban health maintenance organization population were evaluated in a case-control study. The subjects (72 case-control pairs) subscribed to the Kaiser Permanente Medical Care Program in the…
Body mass index, alcohol and salt consumption, and parental history of hypertension were examined as possible predictors of the development of essential hypertension in 1,031 persons, ages 30-49 years at entry, with documented normotension followed by documented hypertension after a…
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