Psychological side effects of hormonal contraception: a disconnect between patients and providers.

BACKGROUND: Existing literature about the psychological side effects of hormonal contraception (HC) is limited. The goal of this study is to better characterize patients' subjective experiences with HC, its side effects, and contraception counseling. METHODS: This is a cross-sectional, survey-based study using a convenience sample of patients who had used HC at some point in their lives. Recruitment occurred from June 2021-February 2022. RESULTS: Of the 188 responses included in the analysis, 43.6% reported experiencing mood changes as a side effect of HC at some point in their lives. The most common reason participants cited for discontinuing or switching contraception methods was side effects (48.3%). Participants with a history of psychiatric illness were significantly more likely to report mood changes as a side effect of their HC (61.2%) compared to participants with no history of psychiatric illness (29.5%). Among patients with a history of psychiatric illness, 38.8% responded that their psychiatric symptoms worsened with HC while only 11.2% responded that their symptoms improved with HC. The majority (83%) of participants responded that their provider never mentioned the possibility of psychological side effects during contraception counseling. If/when they experienced side effects associated with their HC, 22.7% of participants disagreed that their provider adequately addressed their concerns. CONCLUSION: These findings suggest that mood changes may be among the most common perceived side effects of HC and speak to a disconnect between patients and providers when it comes to discussing the possibility of psychological side effects with HC.

Perceptions of Female Genital Mutilation/Cutting (FGM/C) among Asylum Seekers in New York City.

Female Genital Mutilation/Cutting (FGM/C) affects millions of girls and women globally each year despite widespread criminalization of the practice. Eradication efforts have focused on the health risks associated with FGM/C however, it is important to understand the sociocultural context in which this practice exists. We conducted a cross-sectional study using retrospective chart review and structured interviews with women recruited through the Bellevue/New York University Program for Survivors of Torture. Of the 43 participants enrolled in the study, 88.4% initially indicated there is no benefit of undergoing FGM/C but when prompted, agreed that social acceptance (16.3%), religious approval (11.6%), and better marriage prospects (9.3%) are possible benefits. More sexual pleasure for the women (46.5%), avoiding pain (30.2%), and fewer medical problems (16.3%) were stated as benefits of not undergoing FGM/C. Overall, 40 (93%) participants believed the practice should be discontinued. This study highlights that there may be a perception of social benefit of undergoing FGM/C. Although most participants believed the practice should be discontinued, the complex social milieu within which this practice exists must be addressed.

Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience.

To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2. DESIGN: Retrospective cohort study. SETTING: Data were collected from a large tertiary care public hospital ICU that is part of the largest public healthcare network in the United States. PATIENTS: One-hundred thirty-seven adult (≥ 18 yr old) ICU patients admitted between March 10, 2020, and April 7, 2020, with follow-up collected through May 18, 2020. INTERVENTIONS: None. MEASUREMENTS: Demographic, clinical, laboratory, treatment, and outcome data extracted from electronic medical records. MAIN RESULTS: The majority of patients were male (99/137; 72.3%) and older than 50 years old (108/137; 78.9%). The most reported ethnicity and race were Hispanic (61/137; 44.5%) and Black (23/137; 16.7%). One-hundred six of 137 patients had at least one comorbidity (77.4%). One-hundred twenty-one of 137 (78.1%) required mechanical ventilation of whom 30 (24.8%) moved to tracheostomy and 46 of 137 (33.6%) required new onset renal replacement therapy. Eighty-two of 137 patients (59.9%) died after a median of 8 days (interquartile range 5-15 d) in the ICU. Male sex had a trend toward a higher hazard of death (hazard ratio, 2.1 [1.1-4.0]) in the multivariable Cox model. CONCLUSIONS: We report a mortality rate of 59.9% in a predominantly Hispanic and Black patient population. A significant association between comorbidities and mortality was not found in multivariable regression, and further research is needed to study factors that impact mortality in critical coronavirus disease 2019 patients. We also describe how a public hospital developed innovative approaches to safely manage a large volume of interhospital transfers and admitted patients.

The tidal remnant of an unusually metal-poor globular cluster.

Globular clusters are some of the oldest bound stellar structures observed in the Universe1. They are ubiquitous in large galaxies and are believed to trace intense star-formation events and the hierarchical build-up of structure2,3. Observations of globular clusters in the Milky Way, and a wide variety of other galaxies, have found evidence for a 'metallicity floor', whereby no globular clusters are found with chemical (metal) abundances below approximately 0.3 to 0.4 per cent of that of the Sun4-6. The existence of this metallicity floor may reflect a minimum mass and a maximum redshift for surviving globular clusters to form-both critical components for understanding the build-up of mass in the Universe7. Here we report measurements from the Southern Stellar Streams Spectroscopic Survey of the spatially thin, dynamically cold Phoenix stellar stream in the halo of the Milky Way. The properties of the Phoenix stream are consistent with it being the tidally disrupted remains of a globular cluster. However, its metal abundance ([Fe/H] = -2.7) is substantially below the empirical metallicity floor. The Phoenix stream thus represents the debris of the most metal-poor globular clusters discovered so far, and its progenitor is distinct from the present-day globular cluster population in the local Universe. Its existence implies that globular clusters below the metallicity floor have probably existed, but were destroyed during Galactic evolution.

The influence of hydrofluoric acid etching processes on the photocatalytic hydrogen evolution reaction using mesoporous silicon nanoparticles.

H2 has been identified as one of the potential energy vectors that can provide a sustainable energy supply when produced through solar-driven water-splitting reaction. Si is the second most abundant element in the Earth's crust and can absorb a significant fraction of the solar spectrum while presenting little toxicity risk, making it an attractive material for photocatalytic H2 production. Hydrogen-terminated mesoporous Si (mp-Si) nanoparticles can be utilized to effectively drive the hydrogen evolution reaction using UV-to-visible light. In this work, the response of the photocatalytic activity of mp-Si nanoparticles to a series of HF acid treatments was investigated. A two-step magnesiothermic reduction method was used to prepare crystalline mp-Si nanoparticles with a specific surface area of 573 m2 g-1. The HF etching process was optimized as a function of the amount of acid added and the reaction time. The reaction time did not influence the H2 evolution rate substantially. However, the amount of HF used did have a significant effect on the photocatalytic activity. In the presence of ≥1.0 mL HF acid per 0.010 g of Si, morphological damage was observed using electron microscopy. N2 adsorption measurements indicated that the pore size and surface area were also altered. Solution-phase 19F{1H} NMR studies indicated the formation of SiF5- and SiF62- when larger volumes of HF were used. Both factors, morphological damage and the presence of byproducts in the pores, likely result in a lowering of the photocatalytic H2 evolution rate. Under the optimized HF treatment conditions (0.5 mL of HF per 0.010 g of Si), a H2 evolution rate of 1398 ± 30 µmol g-1 h-1 was observed.