Self-managed Medication Abortion in the United States.

Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.

Avoiding unintended pregnancy during transition from copper intrauterine device to etonogestrel contraceptive implant: A case report.

We present a patient who experienced an unintended pregnancy after transitioning from the copper intrauterine device to the etonogestrel subdermal implant. When switching from contraceptive methods that do not reliably suppress ovulation, clinicians should consider backup contraception and additional counseling, depending on the specific timing of removal.

Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings.

OBJECTIVES: To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county. STUDY DESIGN: A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin. RESULTS: We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9). CONCLUSIONS: The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.

Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services.

The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.

Cute Kid? Patient Obesity Status and the Use of Nonmedical Descriptors in Presentations by Pediatric Residents.

Nonmedical descriptors, adjectives that are not related to a medical condition, such as "cute," are often used in presentations in pediatrics. We hypothesize that patterns of their use may reflect obesity bias. Descriptors used by pediatric residents presenting cases of children <9 years in an outpatient clinic during the 2018-2019 and 2019-2020 academic years were recorded. The primary outcome was the association of the use of positive nonmedical descriptors with children's obesity status using logistic regression. Positive descriptors were used in 14% of 994 presentations. Most addressed the appearance of the child with variations of "cute" and "adorable." There was no variation in use of positive descriptors by obesity status. On multivariate logistic regression, the odds of using positive descriptors were higher among female residents, and positive descriptor use declined with patient age. Negative descriptors were rare and often focused on weight.

Patient perspectives on barriers in obtaining timely abortion care in Los Angeles, California.

OBJECTIVES: Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing literature focusing on restrictive and hostile states, we sought to understand the patient perspectives of barriers to timely abortion care in Los Angeles, California. STUDY DESIGN: We recruited participants from two, high-volume urban clinical sites and conducted semi-structured interviews with 17 individuals who visited three or more clinics and/or encountered more than 2 weeks between seeking and obtaining their abortion. Using thematic analysis, we analyzed deidentified transcripts by first developing and applying codes, then identifying overarching themes to describe barriers to timely abortion care. RESULTS: Participants described three primary barriers leading to abortion care delay: (1) difficulties in ensuring insurance coverage or securing authorization for abortion care from private/employer-sponsored insurance, (2) inadequate screening resulting in multiple appointments where desired care could not be provided, and (3) difficulties with expeditious referrals to appropriate clinical sites. Participants also described accumulated fatigue from facing layers of resistance when pursuing avenues for care. CONCLUSIONS: Even in supportive abortion policy states, barriers to abortion care from insurance, screening, and referral-related issues may result in delayed or unaccessed care, negatively impacting patient experience. Understanding and mitigating reasons for delays are critical to improving patient experience with abortion care. IMPLICATIONS: Standardized telephone triage at local clinic facilities and streamlined MediCal authorization of abortion services may mitigate barriers to timely abortion care.

Abortion Care in the United States - Current Evidence and Future Directions.

Abortion Care in the United StatesAbortion services are a vital component of reproductive health care. Jung and colleagues review medication abortion and procedural abortion as well as implications of increasing restrictions on access in the United States.

Type 2 Diabetes and Chronic Conditions Disparities in Medicare Beneficiaries in the State of Michigan.

BACKGROUND: This study aimed to describe the prevalence of type 2 diabetes and combinations of multiple chronic conditions (MCCs) that are leading causes of death (LCD) and confirm that disparities exist between groups based on race and sex. MATERIALS AND METHODS: We conducted a retrospective cohort study using 2012 Medicare claims data from beneficiaries with type 2 diabetes over the age of 65 in the state of Michigan. RESULTS: Female beneficiaries have type 2 diabetes and 1 or more MCCs that are LCD more often than males. Most type 2 diabetes patients have diabetes alone without MCCs, while a large proportion have at least 1 additional chronic condition that is a LCD. One in 3 patients have 3 or more chronic conditions. The most prevalent type 2 diabetes coexisting MCCs are congestive heart failure (CHF), chronic obstructive pulmonary disease and chronic kidney disease. Asian/Pacific Islanders have the highest prevalence of type 2 diabetes without MCCs, and the highest prevalence of diabetes plus CHF. While fewer black beneficiaries have diabetes alone or 1 additional MCC, the prevalence of 3 or more MCCs in blacks generally exceeds the prevalence in other races. In beneficiaries with newly diagnosed type 2 diabetes, chronic obstructive pulmonary disease and CHF are the first new chronic conditions to be diagnosed after an initial type 2 diabetes diagnosis. CONCLUSIONS: Race and sex disparities occur in the prevalence of type 2 diabetes and MCCs that are LCD in Medicare beneficiaries in the state of Michigan.

Relationship between treatment-seeking behaviour and artemisinin drug quality in Ghana.

BACKGROUND: Artemisinin-based combination therapy (ACT) is currently the recommended first-line treatment for uncomplicated malaria infections. However, a significant proportion of ACT is assumed to be of poor quality, particularly in Africa. In addition, little is known about how treatment-seeking behaviour of individuals or drug price is associated with drug quality. METHODS: Caregivers of children less than 5 years of age were interviewed on their knowledge of malaria and their choices for treatment. Artemisinin drugs were then purchased from sellers that caregivers preferred or had previously patronized. The active ingredients were quantified by nuclear magnetic resonance spectroscopy. RESULTS: A negative relationship was anticipated between the education level of caregivers and the quality of anti-malarial drugs purchased. However, of the 33 drugs collected from 16 different shops, only one contained less than 80% of its purported active ingredient, and most drugs were within 90% of their listed amounts. No link was found between drug quality and price. Nonetheless, while ACT is the recommended first-line treatment in Ghana, 21% of the drugs collected were artemisinin monotherapy, and 27% of the ACT was not co-formulated. Among caregivers, higher education was found to be associated with both an increased likelihood of seeking treatment in a clinic first, as opposed to visiting drug shops or using herbal remedies, and with purchasing drugs from licensed sellers. CONCLUSION: Surprisingly, drug quality was found to be uniformly high and thus no significant relationship between price, treatment-seeking behaviour and the content of the active ingredients was observed. However, artemisinin monotherapy, which the WHO considers inappropriate therapy, was still widely available in Ghana in 2010. Monotherapy was more likely to be available in unlicensed vendors where less-educated caregivers generally shopped. This linkage between education, treatment-seeking behaviour and drug availability suggests that the global subsidy to reduce the cost of co-formulated ACT can play a significant role in increasing its availability.

Covert motor activity on NoGo trials in a task sharing paradigm: evidence from the lateralized readiness potential.

Previous studies on task sharing propose that a representation of the co-actor's task share is generated when two actors share a common task. An important function of co-representation seems to lie in the anticipation of others' upcoming actions, which is essential for one's own action planning, as it enables the rapid selection of an appropriate response. We utilized measures of lateralized motor activation, the lateralized readiness potential (LRP), in a task sharing paradigm to address the questions (1) whether the generation of a co-representation involves motor activity in the non-acting person when it is other agent's turn to respond, and (2) whether co-representation of the other's task share is generated from one's own egocentric perspective or from the perspective of the actor (allocentric). Results showed that although it was the other agent's turn to respond, the motor system of the non-acting person was activated prior to the other's response. Furthermore, motor activity was based on egocentric spatial properties. The findings support the tight functional coupling between one's own actions and actions produced by others, suggesting that the involvement of the motor system is crucial for social interaction.

Sharing a bimanual task between two: evidence of temporal alignment in interpersonal coordination.

In recent years, researchers have made many new discoveries in the field of social interaction and have attempted to understand the mechanisms of interpersonal coordination. This research is marked by two streams: On the one hand, there are attempts to explain spontaneous, incidental interpersonal coordination in terms of the behavioral dynamics perspective, and on the other, to explain instructed, intentional interpersonal coordination in terms of joint action. Other paradigms fall somewhere between incidental and intentional coordination, e.g. task sharing paradigms. The present study has two major objectives. First, we wanted to explore to what extent a dyadic scenario for bimanual coordination mimics typical signatures of bimanual coordination performance as obtained in the classical individual scenario. Second, if such mimicking is obtained, we wanted to investigate the kind of information on which the coordination between the two individuals may be grounded. To do so, we used a bimanual aiming task, which enabled us to assess measurements of two levels of coordination: global (operating over longer periods of time) and local (operating on each particular trial). In Experiment 1, this task was performed in an individual and in a dyadic setting. In the dyadic scenario, we observed strong global coordination and weak local coordination. In Experiment 2, we replicated this pattern and showed that different kinds of feedback had no impact on interpersonal coordination. Based on these findings, we propose that interpersonal coordination in a non-rhythmic choice response task is based on weak interpersonal coordination.

Monitoring the marketing, distribution, and use of Sprinkles micronutrient powders in rural western Kenya.

BACKGROUND: In 2007, the US Centers for Disease Control and Prevention partnered with local Kenyan institutions to implement the Nyando Integrated Child Health and Education Project, an effectiveness study that used social marketing and a community-based distribution program to promote the sale of Sprinkles and other health products. OBJECTIVE: To describe monitoring of wholesale sales, household demand, promotional strategies, and perceived factors influencing Sprinkles sales among vendors. METHODS: Ongoing quantitative and qualitative monitoring of Sprinkles sales began in May 2007 in 30 intervention villages. Data sources included baseline and follow-up cross-sectional surveys; office records of Sprinkles sales to vendors; biweekly household monitoring of Sprinkles use; and qualitative data collection, including vendor focus groups and key informant interviews. RESULTS: A total of 550 children aged 6 to 35 months were enrolled at baseline, and 451 were available at 12-month follow-up. During this period, nearly 160,000 sachets were sold wholesale to vendors, with variability in sales influenced by the social, political, and economic context. Vendors living closer to the wholesale office purchased more Sprinkles, so a second office was opened closer to remote vendors. On average, 33% of households purchased Sprinkles during household monitoring visits. Training sessions and community launches were important for community support and raising awareness about Sprinkles. Vendor incentives motivated vendors to sell Sprinkles, and consumer incentives promoted purchases. CONCLUSIONS: Sprinkles program monitoring in Kenya was critically important for understanding sales and distribution trends and vendor perceptions. Understanding these trends led to strategic changes to the intervention over time.

Intra-hepatic splenosis as an unexpected cause of a focal liver lesion in a patient with hepatitis C and liver cirrhosis: a case report.

INTRODUCTION: Splenosis is the heterotopic autotransplantation of splenic tissue, mostly found after splenic trauma or surgery in the abdominal, pelvic or thoracic cavity. Here we report a patient with a history of splenectomy after polytrauma with chronic hepatitis C and liver cirrhosis presenting with an hepatic mass of unknown origin. CASE PRESENTATION: The lesion could not be exactly classified by ultrasound, computed tomography, angiography and biopsy, classical features of malignancy were not fulfilled, and on the other hand a neoplastic process could neither be excluded. After revision of a MRI performed in our centre it appeared that the liver mass contrasted in the same way as the remaining accessory spleens in the left upper quadrant. A selective Tc-99m-labelled heat-denatured autologous red blood cells scintigraphy of the spleen was performed and showed both the accessory spleens in the left upper quadrant and spleen-typical tissue in projection to the left liver lobe and confirmed the diagnosis of splenosis. CONCLUSION: Although intrahepatic splenosis represents an extremely rare condition, this diagnosis should always be taken into consideration in patients with history of abdominal trauma with splenic involvement presenting with an indeterminate focal liver lesion. The diagnosis of splenosis may then be reliably confirmed by Tc-99m-DRBC scintigraphy.