Is use of Long-Acting Reversible Contraceptives (LARC) associated with reduced well-woman visits and STI testing? Evidence from female Medicaid clients aged 15-24 in Delaware.

OBJECTIVE: Contraceptive method type matters to sexually transmitted infection (STI) prevention, but contraceptive counseling often emphasizes method efficacy and the benefits of "forgettable" methods, including long-acting reversible contraceptives (LARCs). We aimed to explore associations between prescription method type and annual STI testing and investigated whether these associations relate to annual well-woman visits. METHODS: We constructed a panel of 20,949 young women (<25) enrolled in Delaware's Medicaid program from 2012 through 2019. Conditional logit regressions measured associations between contraceptive method type and annual testing for gonorrhea, chlamydia, or syphilis. We stratified contraceptive methods into LARC, short-acting reversible methods (SARC; pills, patch, ring, and injectable), or no prescription method. We estimated three models examining STI testing in year of method initiation, in years afterwards, and attendance to a well-woman visit as a potential mediator of these associations. RESULTS: STI testing rates did not differ between LARC versus SARC users in the year of method initiation. In the two years after method initiation, LARC versus SARC users were less likely to be tested (OR = 0.73 to OR = 0.87) and less likely to have a well-woman visit (OR = 0.65 to OR = 0.79). In models controlling for attendance to well-woman visits, the decreased likelihood of STI testing in years after initiating LARC versus SARC is largely eliminated, indicating that well-woman visits mediate the relationship between method type and STI testing. CONCLUSIONS: LARC use relates to reduced STI testing in years after method initiation due to reduced attendance to well-women visits. These findings can inform clinical practice and STI prevention.

Mothers with borderline personality and their young children: Adult Attachment Interviews, mother-child interactions, and children's narrative representations.

Borderline personality disorder (BPD) involves disruptions in attachment, self, and self-regulation, domains conceptually similar to developmental tasks of early childhood. Because offspring of mothers with BPD are at elevated risk of developing BPD themselves (White, Gunderson, Zanarini, & Hudson, 2003), studying them may inform precursors to BPD. We sampled 31 children age 4-7 whose mothers have BPD and 31 normative comparisons. We examined relationships between mothers' Adult Attachment Interview (AAI) representations (George, Kaplan, & Main, 1984), mothers' observed parenting, and children's narrative representations. Replicating previous studies, mothers with BPD were more likely to be classified as preoccupied and unresolved on the AAI. In a larger sample, which included the current one, we also replicated two underlying AAI dimensions found in normative samples (Roisman, Fraley, & Belsky, 2007; Whipple, Bernier, & Mageau, 2011). Controlling for current mood, anxiety, and other personality disorders, mothers with BPD were significantly higher than were comparisons on the preoccupied/unresolved, but not the dismissive, dimension. Children's narrative representations relevant to disruptions in attachment (fear of abandonment and role reversal), self (incongruent child and self/fantasy confusion), and self-regulation (destruction of objects) were significantly correlated with the preoccupied/unresolved, but not the dismissive, dimension. Furthermore, mothers' parenting significantly mediated the relationship between the preoccupied/unresolved dimension and their children's narrative representations of fear of abandonment.

Exploring career choices of pharmacy graduates over 15 years: A cross-sectional evaluation.

INTRODUCTION: Career opportunities for pharmacists beyond those commonly associated with the degree continue to emerge. A paucity of literature regarding evaluation of pharmacy graduate career paths over extended periods is apparent. Considering international pharmacy workforce capacity pressures, the primary study aim was to evaluate trends in career paths of pharmacy graduates. METHODS: This study utilised a multimethod approach to access graduate career data using publicly accessible information from LinkedIn® profiles and an online survey. The survey was distributed to all pharmacy graduates of a university (2007-2022). Data from both methods was combined, cross-checked, coded and analysed quantitatively using descriptive and inferential statistics. RESULTS: Data from 69.7% of the university's pharmacy graduates was collected. Community pharmacy was the most prevalent employment sector (47.7%), followed by industry (21.5%) and hospital (17.7%). A higher proportion of more recent graduates (≤5 years post-graduation) work in a community or hospital pharmacy role versus those who graduated greater than five years ago (χ2 = 8.44, df = 2, p < 0.05). Post-graduate education was undertaken by 41.3% of graduates. Career satisfaction was high (88.2%) but was lower (χ2 = 11.31, df = 1, p < 0.05) for those in community and hospital (82%) versus other sectors (97.5%). CONCLUSION: This study provides the first analysis of graduate career paths over an extended period, highlighting a novel approach to track pharmacist workforce. While almost two thirds of pharmacy graduates occupy community or hospital roles, a trend of leaving these settings five years post-graduation was evident. Accordingly, this work represents a springboard for additional research to inform future pharmacist workforce planning worldwide.

Are LARC Users Less Likely to Use Condoms? An Analysis of U.S. Women Initiating LARC in 2008-2018.

INTRODUCTION: Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods. METHODS: With the 2011-2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15-44 years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders. RESULTS: The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20-34 years. CONCLUSIONS: Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles-particularly in terms of parity and teenage childbearing-the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.

Financial and Safety Impact of Simulation-based Clinical Systems Testing on Pediatric Trauma Center Transitions.

Simulation offers multiple tools that apply to medical settings, but little is known about the application of simulation to pediatric trauma workflow changes. Our institution recently underwent significant clinical changes in becoming an independent pediatric trauma center. We used a simulation-based clinical systems testing (SbCST) approach to manage change-associated risks. The purpose of this study was to describe our SbCST process, evaluate its impact on patient safety, and estimate financial costs and benefits. Methods: SbCST consisted of the following steps: (1) change-based needs assessment, in which stakeholders developed relevant simulation scenarios; (2) scenario implementation; and (3) postsimulation failure mode and effects analysis (FMEA) to identify latent safety threats (LSTs). LSTs were prioritized for mitigation based on the expected probability and severity of adverse event occurrences. We calculated the costs associated with the simulation process. We conservatively estimated SbCST cost savings using 3 approaches: (1) FMEA-based avoidance of adverse events; (2) avoidance of trauma readmissions; and (3) avoidance of medical liability lawsuits. Results: We implemented 2 simulation scenarios prechange. FMEA revealed 49 LSTs, of which 9 were highest priority (catastrophic severity and high likelihood of occurrence). These were prioritized and mitigated using the hospital's quality/safety framework. Cost-benefit analysis based on FMEA event avoidance demonstrated net cost savings to the institution ranging from $52,000-227,000 over the 3-month postchange period. Readmission-based and liability-based estimates also produced favorable results. Conclusions: The SbCST approach identified multiple high-impact safety risks and financially benefited the institution in managing significant pediatric trauma clinical process changes.

Vpu antagonizes BST-2-mediated restriction of HIV-1 release via beta-TrCP and endo-lysosomal trafficking.

The interferon-induced transmembrane protein BST-2/CD317 (tetherin) restricts the release of diverse enveloped viruses from infected cells. The HIV-1 accessory protein Vpu antagonizes this restriction by an unknown mechanism that likely involves the down-regulation of BST-2 from the cell surface. Here, we show that the optimal removal of BST-2 from the plasma membrane by Vpu requires the cellular protein beta-TrCP, a substrate adaptor for a multi-subunit SCF E3 ubiquitin ligase complex and a known Vpu-interacting protein. beta-TrCP is also required for the optimal enhancement of virion-release by Vpu. Mutations in the DSGxxS beta-TrCP binding-motif of Vpu impair both the down-regulation of BST-2 and the enhancement of virion-release. Such mutations also confer dominant-negative activity, consistent with a model in which Vpu links BST-2 to beta-TrCP. Optimal down-regulation of BST-2 from the cell surface by Vpu also requires the endocytic clathrin adaptor AP-2, although the rate of endocytosis is not increased; these data suggest that Vpu induces post-endocytic membrane trafficking events whose net effect is the removal of BST-2 from the cell surface. In addition to its marked effect on cell-surface levels, Vpu modestly decreases the total cellular levels of BST-2. The decreases in cell-surface and intracellular BST-2 are inhibited by bafilomycin A1, an inhibitor of endosomal acidification; these data suggest that Vpu induces late endosomal targeting and partial degradation of BST-2 in lysosomes. The Vpu-mediated decrease in surface expression is associated with reduced co-localization of BST-2 and the virion protein Gag along the plasma membrane. Together, the data support a model in which Vpu co-opts the beta-TrCP/SCF E3 ubiquitin ligase complex to induce endosomal trafficking events that remove BST-2 from its site of action as a virion-tethering factor.

Pedagogia crítica e neoliberalismo / Critical pedagogy and neoliberalism / Pedagogía crítica y neoliberalismo

Neste artigo, nós refletimos sobre as possibilidade e responsabilidades da pedagogia crítica em relação ao neoliberalismo e a Educação Física. Ao explorar essas ideias, nós também discutimos os problemas da definição, bem como o colapso e confusão de termos como pedagogia crítica, pesquisa crítica e saúde crítica e Educação Física, bem como a problemática posição do neoliberalismo nos estudos críticos. Embora exista um crescente corpo de pesquisas que iluminam as nuanças e onipresença das políticas e práticas neoliberais em HPE -tanto em contextos globais e em contextos sociais específicos ­ nós argumentamos que ainda existe mais trabalho a ser feito para identificar como o trabalho pedagógico crítico pode dirigir-se (ou ao menos tentar) aos efeitos do neoliberalismo. Ao fim, continua a existir o perigo de que a pedagogia crítica em tempos neoliberais possa transmitir, em vez de contestar, os piores efeitos da escolarização neoliberal e do neoliberalismo em saúde e Educação Física

In this article, we reflect on the possibilities and responsibilities of critical pedagogy in relation to neoliberalism and physical education. In exploring these ideas, we also discuss problems of definition, such as the collapse and confusion of terms like critical pedagogy, critical research, and critical health and PE, as well the problematic positioning of 'neoliberalism' in critical scholarship. Although there is a growing body of research that illuminates the nuances and pervasiveness of neoliberal HPE policies and practices ­ both globally and in specific social contexts ­ we argue that there is still more work to be done to identify how critical pedagogical work may address (or at least attend to) the effects of neoliberalism. After all, there remains a 'danger' that critical pedagogy in neoliberal times may forward, rather than contest, the worst effects of neoliberal schooling and neoliberal HPE

En este artículo, reflexionamos sobre las posibilidades y las responsabilidades de la pedagogía crítica en relación al neoliberalismo y la Educación Física. Además de explorar estas ideas, debatimos los problemas de la definición, así como el colapso y la confusión de los términos como pedagogía crítica, investigación crítica, salud crítica y Educación Física, así como la problemática del neoliberalismo en los estudios críticos. Si bien hay un creciente cuerpo de investigaciones que iluminan los matices y la omnipresencia de las políticas y practicas neoliberales en HPE ­ tanto en los contextos globales como sociales específicos ­ nosotros argumentamos que ha todavia más trabajo por hacer para identificar como el trabajo pedagógico puede dirigirse (o por lo menos intentar) a los efectos del neoliberalismo. Al ultimo, sigue existiendo el peligro de que la pedagogía crítica en tiempos neoliberales pueda transmitir, en lugar de cuestionar, los peores efectos de la escolarización neoliberal y del neoliberalismo en salud y Educación Física

Independent influences upon mother-toddler role reversal: infant-mother attachment disorganization and role reversal in mother's childhood.

In role reversal a child takes an inappropriate parental, spousal, or peer role with the caregiver. The study assessed attachment disorganization with mother in infancy in the Strange Situation (Ainsworth, Blehar, Waters, & Wall, 1978) and role reversal at 2 years old in videotaped mother-child interactions. By closely observing role reversal at this early age, results fill in the picture concerning the link between disorganized infant-mother attachment and controlling role reversal at 6 years old (Main & Cassidy, 1988; Main, Kaplan, & Cassidy, 1985). As hypothesized, infant-mother disorganization significantly predicted mother-toddler role reversal. The study also deepened research that predicted role reversal from parent Adult Attachment Interview (AAI) role reversal assessed before the child was born (Macfie, McElwain, Houts, & Cox, 2005). As hypothesized, mother AAI role reversal with her mother in childhood significantly predicted mother-toddler role reversal over and above infant-mother disorganization. Results are discussed within a developmental psychopathology framework including opportunities for developmentally sensitive interventions.