Browsing by Author "Cote, Michelle L."

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    Impact of positive cytology in uterine serous carcinoma: A reassessment
    (Elsevier, 2021-07-12) Corey, Logan; Fucinari, Juliana; Elshaikh, Mohamed; Schultz, Daniel; Musallam, Rami; Zaiem, Feras; Daaboul, Fayez; Fehmi, Omar; Dyson, Greg; Ruterbusch, Julie; Morris, Robert; Cote, Michelle L.; Ali-Fehmi, Rouba; Bandyopadhyay, Sudeshna; Medicine, School of Medicine
    Objectives: The aim of this study was to evaluate the prognostic value of peritoneal cytology status among other clinicopathological parameters in uterine serous carcinoma (USC). Methods: A retrospective study of 148 patients diagnosed with uterine serous carcinoma from 1997 to 2016 at two academic medical centers in the Detroit metropolitan area was done. A central gynecologic pathologist reviewed all available slides and confirmed the histologic diagnosis of each case of USC. We assessed the prognostic impact of various clinicopathological parameters on overall survival (OS) and endometrial cancer-specific survival (ECSS). Those parameters included race, body mass index (BMI), stage at diagnosis, tumor size, lymphovascular invasion (LVSI), peritoneal cytology status, receipt of adjuvant treatment, and comorbidity count using the Charlson Comorbidity Index (CCI). We used Cox proportional hazards models and 95% confidence intervals for statistical analysis. Results: Positive peritoneal cytology had a statistically significant effect on OS (HR: 2.09, 95% CI: [1.19, 3.68]) and on ECSS (HR: 2.02, 95% CI: [1.06 - 3.82]). LVSI had a statistically significant effect on both OS (HR: 2.27, 95% CI: [1.14, 4.53]) and ECSS (HR: 3.45, 95% CI: [1.49, 7.99]). Black or African American (AA) race was also found to have a significant effect on both OS (HR: 1.92, 95% CI: [1.07, 3.47]) and ECSS (HR: 2.01, 95% CI: [1.02, 3.98]). Other factors including BMI and tumor size > 1 cm did not show a statistically significant impact on OS or ECSS. Conclusions: Peritoneal washings with positive cytology and LVSI are important prognostic tools that may have a significant impact on overall survival in USC and can be used as independent negative prognosticators to help guide adjuvant treatment.
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    Using a Social Ecological Framework to Understand Healthy Relationships and Unintended Pregnancy Risk Among Youth in Rural Communities and Youth Engaged in Systems
    (2023-11) Imburgia, Teresa Marie; Zhang, Jianjun; Cote, Michelle L.; Hensel, Devon J.; Ott, Mary A.
    Nearly 75% of adolescent pregnancies are unintended, putting those adolescents at risk for long-term physical, social, and mental health outcomes. Youth who live in rural areas and youth with system involvement are at increased risk of unplanned pregnancies and births. We used the social ecological framework to investigate the following known risks for unplanned pregnancies: early sexual onset, contraception non-use, and dating violence. First, we examined the behaviors and attitudes associated with early sexual onset and the intention to delay sex in rural middle school youth. Being older, having less agency for sexual refusal, system involvement, and more parent communication were associated with having sex and planning to have sex. This highlights the importance of early, comprehensive, and trauma-informed pregnancy prevention programs for younger adolescents. Second, we examined the impact of positive youth development (PYD) on the use of effective contraceptives for sexually active youth who are system involved. Only 13.9% used condoms alone and 41.5% hormonal contraception (+/- condoms) in the past three months. Multivariate ordinal logistic regression revealed that older age, female gender, and higher PYD skills were associated with the use of more effective contraceptives. The final study identified risk and protective factors for perpetration and victimization of dating violence among youth with system involvement. We observed high rates of dating violence across all participants, and gender differences in perpetration and victimization. Using Poisson regression models, both perpetration and victimization were related to higher levels of trauma, lower healthy relationship scores, having recent sex, and being a sexual minority. These studies indicate a need for early delivery of pregnancy prevention programs and services for higher risk youth that are trauma informed, sexually inclusive, and promote PYD and healthy relationships.