Characteristics of parents who think intrauterine devices or contraceptive implants are "best" for their daughter: An exploratory analysis in Dallas, Texas.

OBJECTIVE: To explore characteristics of parents who prefer an intrauterine device (IUD) or implant compared to all other contraceptive methods. STUDY DESIGN: Parents with an adolescent daughter completed a cross-sectional survey. The outcome evaluated the parent's perceived "best" contraceptive method for their daughter using bivariate statistics and multivariable modeling. RESULTS: Of 115 parents, parental willingness to use IUD or implant themselves (p = 0.014) and thinking IUD or implant is best at preventing pregnancy (p = 0.001) remained positively associated with parents thinking IUD or implant is the "best" contraceptive method for their daughter. CONCLUSIONS: Clinicians can consider integrating parents' personal experiences with IUD or implant during adolescent contraception counseling. IMPLICATIONS: Caregivers' personal contraceptive knowledge and personal willingness to use LARC influences their preferences for their daughter's contraception. Clinicians can assess and integrate caregivers' perspectives during adolescent contraception counseling.

Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence.

Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.

Parent Perspectives about Initiating Contraception Conversations with Adolescent Daughters.

OBJECTIVES: Parent-youth sexual and reproductive health (SRH) conversations are critical to reducing adolescent pregnancy, yet many parents do not discuss contraception before youth become sexually active. We aimed to describe parental perspectives about when and how to initiate contraception discussions, characterize motivators to discuss contraception, and explore the role of health care providers in supporting contraception communication with youth. METHODS: We conducted semi-structured interviews with 20 parents of female youth ages 9-20 recruited from areas of Dallas, Texas, with high rates of racial and ethnic disparities in adolescent pregnancy. We analyzed interview transcripts with a combined deductive and inductive approach, with discrepancies resolved by consensus. RESULTS: Parents were 60% Hispanic and 40% non-Hispanic Black, and 45% were interviewed in Spanish. Most identified as female (90%). Many initiated contraception discussions on the basis of age, physical development, emotional maturity, or perceived likelihood of sexual activity. Some expected their daughters to initiate SRH discussions. Cultural avoidance of SRH discussions often motivated parents to improve communication. Other motivators included reducing pregnancy risk and managing anticipated youth sexual autonomy. Some feared that discussing contraception could encourage sex. Parents trusted and wanted pediatricians to serve as a bridge to discuss contraception with youth before sexual debut through confidential, comfortable communication. CONCLUSION: Tension between the desire to prevent adolescent pregnancy, cultural avoidance, and fear of encouraging sexual behaviors causes many parents to delay contraception discussions before sexual debut. Health care providers can serve as a bridge between sexually naïve adolescents and parents by proactively discussing contraception using confidential and individually tailored communication.

Adolescents, Suicide, and the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. Stressors related to the pandemic and related lockdown measures have increased the prevalence of adolescent depression, suicidal ideation, and suicide attempts, with their mental and psychosocial development making them highly vulnerable to isolating restrictions. Research has demonstrated increased loneliness and decreased social support among adolescents during the pandemic. Increased social media usage has further affected depression among adolescents. Pandemic-related stressors such as fear of illness or life changes have negatively affected adolescent mental well-being. Health care use during the pandemic has involved disruption in primary care suicide screening, patterns of suicide-related presentations in emergency departments, and access to mental health services. Health care providers can support adolescent mental health through consistent screening, effectively coordinating referral for mental health evaluation, and providing family guidance on resiliency, pandemic-related mental health risks, and suicide prevention. [Pediatr Ann. 2022;51(4):e144-e149.].

Physician and Nurse Perceptions of Gentle Cesarean Birth.

BACKGROUND: Protocols for neonatal care and mother-baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols. PURPOSE: To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes. STUDY DESIGN AND METHODS: A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes. RESULTS: Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care. CLINICAL IMPLICATIONS: Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.

Patient Education About the Affordable Care Act Contraceptive Coverage Requirement Increases Interest in Using Long-Acting Reversible Contraception.

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) requires health insurance to cover all Food and Drug Administration-approved contraceptives at no cost to patients, including highly effective long-acting reversible contraception (LARC). Our objective was to determine whether a brief educational intervention about these provisions would increase interest in LARC use. METHODS: This is a cross-sectional survey of women seeking contraceptive care in an urban outpatient obstetrics/gynecology clinic. We collected baseline contraceptive attitudes and knowledge of the ACA's contraceptive coverage provisions before the intervention. Our primary outcome was interest in using a LARC method before and after reading a short description of the ACA's contraceptive coverage provisions. RESULTS: Surveys were completed by 316 participants. Most participants (52.8%) could not correctly identify any of the contraception coverage stipulations protected under the ACA. We observed a significant increase in LARC interest after the intervention in all participants (37.3% vs. 44.3%; p = .038), primarily among participants who did not originally identify any ACA provisions correctly (n = 167; 38.3% vs. 48.5%; p = .030). This subset also demonstrated a greater adjusted odds ratio of post-intervention LARC interest (odds ratio, 2.889; 95% CI, 1.234-6.723; p = .014). Interest in short-acting reversible contraception and contraception overall remained unchanged. CONCLUSIONS: Most women seeking birth control lack comprehensive understanding of the contraceptive coverage protected by the ACA. Incorporating patient education about the ACA's no-cost contraception provision into routine contraceptive counseling may increase interest in LARC use and better enable women to make informed family planning decisions unrestrained by financial considerations.

Studying polyglutamine aggregation in Caenorhabditis elegans using an analytical ultracentrifuge equipped with fluorescence detection.

This work explores the heterogeneity of aggregation of polyglutamine fusion constructs in crude extracts of transgenic Caenorhabditis elegans animals. The work takes advantage of the recent technical advances in fluorescence detection for the analytical ultracentrifuge. Further, new sedimentation velocity methods, such as the multi-speed method for data capture and wide distribution analysis for data analysis, are applied to improve the resolution of the measures of heterogeneity over a wide range of sizes. The focus here is to test the ability to measure sedimentation of polyglutamine aggregates in complex mixtures as a prelude to future studies that will explore the effects of genetic manipulation and environment on aggregation and toxicity. Using sedimentation velocity methods, we can detect a wide range of aggregates, ranging from robust analysis of the monomer species through an intermediate and quite heterogeneous population of oligomeric species, and all the way up to detecting species that likely represent intact inclusion bodies based on comparison to an analysis of fluorescent puncta in living worms by confocal microscopy. Our results support the hypothesis that misfolding of expanded polyglutamine tracts into insoluble aggregates involves transitions through a number of stable intermediate structures, a model that accounts for how an aggregation pathway can lead to intermediates that can have varying toxic or protective attributes. An understanding of the details of intermediate and large-scale aggregation for polyglutamine sequences, as found in neurodegenerative diseases such as Huntington's Disease, will help to more precisely identify which aggregated species may be involved in toxicity and disease.

The heat-resistant agglutinin family includes a novel adhesin from enteroaggregative Escherichia coli strain 60A.

Heat-resistant agglutinin 1 (Hra1) is an accessory colonization factor of enteroaggregative Escherichia coli (EAEC) strain 042. Tia, a close homolog of Hra1, is an invasin and adhesin that has been described in enterotoxigenic E. coli. We devised a PCR-restriction fragment length polymorphism screen for the associated genes and found that they occur among 55 (36.7%) of the enteroaggregative E. coli isolates screened, as well as lower proportions of enterotoxigenic, enteropathogenic, enterohemorrhagic, and commensal E. coli isolates. Overall, 25%, 8%, and 3% of 150 EAEC strains harbored hra1 alone, tia alone, or both genes, respectively. One EAEC isolate, 60A, produced an amplicon with a unique restriction profile, distinct from those of hra1 and tia. We cloned and sequenced the full-length agglutinin gene from strain 60A and have designated it hra2. The hra2 gene was not detected in any of 257 diarrheagenic E. coli isolates in our collection but is present in the genome of Salmonella enterica serovar Heidelberg strain SL476. The cloned hra2 gene from strain 60A, which encodes a predicted amino acid sequence that is 64% identical to that of Hra1 and 68% identical to that of Tia, was sufficient to confer adherence on E. coli K-12. We constructed an hra2 deletion mutant of EAEC strain 60A. The mutant was deficient in adherence but not autoaggregation or invasion, pointing to a functional distinction from the autoagglutinin Hra1 and the Tia invasin. Hra1, Tia, and the novel accessory adhesin Hra2 are members of a family of integral outer membrane proteins that confer different colonization-associated phenotypes.