Counseling Women About Sexual Health Effects of Contraceptives.

Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.

Frameshifting at collided ribosomes is modulated by elongation factor eEF3 and by integrated stress response regulators Gcn1 and Gcn20.

Ribosome stalls can result in ribosome collisions that elicit quality control responses, one function of which is to prevent ribosome frameshifting, an activity that entails the interaction of the conserved yeast protein Mbf1 with uS3 on colliding ribosomes. However, the full spectrum of factors that mediate frameshifting during ribosome collisions is unknown. To delineate such factors in the yeast Saccharomyces cerevisiae, we used genetic selections for mutants that affect frameshifting from a known ribosome stall site, CGA codon repeats. We show that the general translation elongation factor eEF3 and the integrated stress response (ISR) pathway components Gcn1 and Gcn20 modulate frameshifting in opposing manners. We found a mutant form of eEF3 that specifically suppressed frameshifting, but not translation inhibition by CGA codons. Thus, we infer that frameshifting at collided ribosomes requires eEF3, which facilitates tRNA-mRNA translocation and E-site tRNA release in yeast and other single cell organisms. In contrast, we found that removal of either Gcn1 or Gcn20, which bind collided ribosomes with Mbf1, increased frameshifting. Thus, we conclude that frameshifting is suppressed by Gcn1 and Gcn20, although these effects are not mediated primarily through activation of the ISR. Furthermore, we examined the relationship between eEF3-mediated frameshifting and other quality control mechanisms, finding that Mbf1 requires either Hel2 or Gcn1 to suppress frameshifting with wild-type eEF3. Thus, these results provide evidence of a direct link between translation elongation and frameshifting at collided ribosomes, as well as evidence that frameshifting is constrained by quality control mechanisms that act on collided ribosomes.

Cortical Processing of Frequency Changes Reflected by the Acoustic Change Complex in Adult Cochlear Implant Users.

The purpose of this study was to examine neural substrates of frequency change detection in cochlear implant (CI) recipients using the acoustic change complex (ACC), a type of cortical auditory evoked potential elicited by acoustic changes in an ongoing stimulus. A psychoacoustic test and electroencephalographic recording were administered in 12 postlingually deafened adult CI users. The stimuli were pure tones containing different magnitudes of upward frequency changes. Results showed that the frequency change detection threshold (FCDT) was 3.79% in the CI users, with a large variability. The ACC N1' latency was significantly correlated with the FCDT and the clinically collected speech perception score. The results suggested that the ACC evoked by frequency changes can serve as a useful objective tool in assessing frequency change detection capability and predicting speech perception performance in CI users.

Preliminary Outcomes Report for CO2 Laser Assisted Electric-Acoustic Cochlear Implantation.

OBJECTIVE: Report on the safety/efficacy of a novel, carbon dioxide (CO2) laser-assisted protocol for hearing-preservation cochlear implantation (HPCI) and electric-acoustic stimulation (EAS). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Adult patients meeting established criteria for HPCI and EAS. INTERVENTION: Therapeutic/rehabilitative. A standardized protocol used CO2 laser to achieve meticulous hemostasis and perform cochleostomy was evaluated. MAIN OUTCOME MEASURES: Audiometric assessments included low-tone pure tone average (LtPTA), consonant-nucleus-consonant (CNC), and AzBio scores. Primary outcomes were low-tone hearing-preservation (LtHP) and EAS usage rates. Secondary outcomes included change in LtPTA, outcomes durability, and the rate/onset/presentation of delayed hearing loss (DHL). Subset analyses stratified data by presenting LtPTA and surgeon experience. RESULTS: Forty-seven patients and 52 ears were included. Mean follow-up was 20.7 ±â€Š12.6 months. When adjusted for preoperative LtPTA less than 60 dB, the LtHP rate was 77%. This was significantly better than for patients with LtPTA more than 60 dB (24%; p < 0.0001). Outcomes were highly durable. EAS usage was excellent in those with LtPTA less than 60 dB (100%). Nine patients developed DHL. Three additional patients (25%) were successfully salvaged via steroids. Both CNC and AzBio scores improved significantly (p < 0.0001) at definitive testing. Speech-hearing scores did not differ significantly between patients using/not using EAS. The complication rate was 3.8%; none were caused by the laser. Surgeon experience was associated with significantly better outcomes. CONCLUSION: Use of a CO2 laser-assisted HPCI protocol was safe and effective. Outcomes were consistent with contemporary literature reporting. Patient selection and surgeon experience both significantly impacted outcomes.

Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program.

PURPOSE OF REVIEW: Minorities often lag behind in hearing loss evaluation and treatment. Our cochlear implant program aimed to identify the socioeconomic and cultural barriers that prevented our African-American cochlear implant candidates from seeking help for their hearing loss, specifically cochlear implant surgery. RECENT FINDINGS: Our pilot study surveyed 11 African-Americans with cochlear implants and identified obstacles that included patient-physician mistrust, social stigma, financial cost, and lack of education about the devices and procedures. Our experienced cochlear implant team then addressed these issues in its weekly meetings to review cases and potential cochlear implant candidates, and we partnered with community organizations to improve awareness about cochlear implants among healthcare professionals and the public. SUMMARY: During our cochlear implant team's community outreach to African-Americans with hearing loss, we initiated several actions to address the various disparities in access to care and use of services: development of patient education, patient-run support group, tracking of clinical outcomes, and opportunities for involvement in health policy making for cochlear implants. Cochlear implant teams should deepen their involvement with African-Americans and other minorities with hearing loss to better support and ultimately improve cochlear implant access, performance, and function.

Auditory cortical activity to different voice onset times in cochlear implant users.

OBJECTIVE: Voice onset time (VOT) is a critical temporal cue for perception of speech in cochlear implant (CI) users. We assessed the cortical auditory evoked potentials (CAEPs) to consonant vowels (CVs) with varying VOTs and related these potentials to various speech perception measures. METHODS: CAEPs were recorded from 64 scalp electrodes during passive listening in CI and normal-hearing (NH) groups. Speech stimuli were synthesized CVs from a 6-step VOT /ba/-/pa/ continuum ranging from 0 to 50 ms VOT in 10-ms steps. Behavioral measures included the 50% boundary point for categorical perception ("ba" to "pa") from an active condition task. RESULTS: Behavioral measures: CI users with poor speech perception performance had prolonged 50% VOT boundary points compared to NH subjects. The 50% boundary point was also significantly correlated to the ability to discriminate consonants in quiet and noise masking. Electrophysiology: The most striking difference between the NH and CI subjects was that the P2 response was significantly reduced in amplitude in the CI group compared to NH. N1 amplitude did not differ between NH and CI groups. P2 latency increased with increases in VOT for both NH and CI groups. P2 was delayed more in CI users with poor speech perception compared to NH subjects. N1 amplitude was significantly related to consonant perception in noise while P2 latency was significantly related to vowel perception in noise. When dipole source modelling in auditory cortex was used to characterize N1/P2, more significant relationships were observed with speech perception measures compared to the same N1/P2 activity when measured at the scalp. N1 dipole amplitude measures were significantly correlated with consonants in noise discrimination. Like N1, the P2 dipole amplitude was correlated with consonant discrimination, but additional significant relationships were observed such as sentence and word identification. CONCLUSIONS: P2 responses to a VOT continuum stimulus were different between NH subjects and CI users. P2 responses show more significant relationships with speech perception than N1 responses. SIGNIFICANCE: The current findings indicate that N1/P2 measures during a passive listening task relate to speech perception outcomes after cochlear implantation.

The effects of noise vocoding on gap detection thresholds.

Gap detection threshold (GDT), the shortest silent interval a person can perceive, is a commonly used measure of temporal processing resolution. The purposes of this study were: (1) to examine the effects of noise vocoding, which has been used to simulate what signals sound like through a cochlear implant, on GDTs in normal-hearing subjects, and (2) to further the understanding of neural mechanisms underlying gap detection using the Auditory Late Response (ALR). Thirteen normal listeners participated. In behavioral tests, the GDTs were determined for the original and vocoded stimuli. In ALR recordings, the subjects were presented with auditory stimuli with and without containing gaps and stimuli with and without being vocoded. Results showed that GDTs were significantly elevated for vocoded stimuli with spectral resolutions of 4 and 20 channels compared to those for the original stimuli. A gap effect was observed in the post-gap ALR. Current densities for N1 peaks evoked by stimuli with zero- vs. non-zero ms gaps, pre- vs. post-gap markers, and original vs. vocoded stimuli were obtained using the standardized low-resolution brain electromagnetic tomography (sLORETA) method. Paired comparisons of pre- and post-gap current density values were made. Results showed a statistical difference between the N1s evoked by pre- vs. post-gap markers, with the activation in the middle frontal gyrus and precentral gyrus. The results suggest that: (1) noise vocoding does affect temporal processing resolution assessed with GDTs, (2) gap detection may involve the recruitment of cognitive neural resources, and (3) the ALR has a potential value of objectively estimating temporal processing resolution.

Cochlear implantation in patients with Meniere's disease.

OBJECTIVES: Few studies have addressed the benefits of cochlear implantation for the small group of patients with bilateral, end-stage Meniere's disease, or unilateral disease with contralateral hearing loss from another cause. Our retrospective study evaluates the effectiveness and post-operative performance in these Meniere's disease patients and discusses these findings relative to other post-lingually deafened adults. METHODS: Among 456 adults who received cochlear implants, we identified eight (1.7%) patients with Meniere's disease who met clinical indications for implantation and a control group of seven non-Meniere's patients of comparable age and deafness. Data gathered included demographics, auditory and vestibular symptoms pre-implantation, and clinical course after implantation, including audiometric scores (consonant-nucleus-consonant (CNC), hearing-in-noise testing (HINT), and AzBio score) and audiologic evaluations. RESULTS: Comparing the Meniere's and non-Meniere's patients, pre- to post-implant scores averaged 15 and 16%-57 and 76% for CNC; and 4.5 and 40.5%-78 and 81% for AzBio and/or HINT tests, respectively; scores between groups did not statistically differ. Of note, five of eight patients had 0% word recognition scores pre-operatively. Fluctuations in CI performance were seen in five patients with Meniere's disease but not for those without the disease. CONCLUSIONS: Audiologic testing found a strong likelihood that CIs did benefit our subset of Meniere's patients with severe to profound sensorineural hearing loss. Fluctuations in hearing sensitivity (perhaps owing to physical changes relative to the implant array with the spiral ganglion neurons during an acute attack or changes in spiral ganglion neurons because of the hydropic state) can often be resolved by subsequent reprogramming.

Addressing tobacco use in homeless populations: recommendations of an expert panel.

A diverse group of panelists met for one day on October 21, 2009, in Washington, DC, for the purpose of addressing the high tobacco use prevalence rates in homeless populations; identifying appropriate policy, cessation practices and models for implementation in this population; and providing targeted recommendations for researchers, homeless service providers, tobacco control advocates, and policy makers. The panel was convened by Break Free Alliance, one of six national networks funded by the Centers for Disease Control and Prevention, Office on Smoking and Health. The panelists worked through a process of problem identification, generation of responses, analysis and prioritization, development of recommendations, and arrival of final decisions reached by consensus. The resulting recommendations for addressing tobacco use in homeless populations focused on tobacco non-use policy implementation, cessation programming, and expansion of partnerships and collaborations between tobacco control advocates and social service providers. The panel also identified unanswered research questions that can serve to develop a framework for future initiatives to reduce tobacco use among homeless persons. The expert panel model serves as one approach for engaging nontraditional partners and building consensus among leaders from a variety of sectors to address tobacco use in special populations.

The adaptive pattern of the late auditory evoked potential elicited by repeated stimuli in cochlear implant users.

To describe the adaptive pattern of cortically generated auditory evoked potentials elicited by repeated stimuli via cochlear implants (CIs), the late auditory evoked potential (LAEP) was collected from nine postlingually deafened adult CI users. Tone bursts were presented in 30 trains consisting of 10 tone bursts each, with inter-stimulus intervals (ISIs) of 0.7 ms and inter-train intervals (ITIs) of 15s. The response to the first stimulus and the response to later tone bursts in the train were compared. Results showed that the LAEP for the first tone burst was larger than that for later tone bursts, displaying an adaptive pattern. This pattern appeared to be more prominent in CI users with good speech perception performance than in those with poorer performance. This finding is meaningful in the context of our future research to restore normal adaptation in CI users to improve their speech perception performance.

Recovery function of the late auditory evoked potential in cochlear implant users and normal-hearing listeners.

BACKGROUND: It has been theorized that neural recovery is related to temporal coding of speech sounds. The recovery function of cortically generated auditory evoked potentials has not been investigated in cochlear implant (CI) users. PURPOSE: This study characterized the recovery function of the late auditory evoked potential (LAEP) using a masker-probe paradigm in postlingually deafened adult CI users and young normal-hearing (NH) listeners. RESEARCH DESIGN: A case-control study of the late auditory evoked potentials using electrophysiological technique was performed. The LAEP was evoked by 1 kHz tone bursts presented in pairs, with the first stimuli as the maskers and the second stimuli as the probes. The masker-probe intervals (MPIs) were varied at 0.7, 1, 2, 4, and 8 sec, with an interpair interval of 12 sec. STUDY SAMPLE: Nine CI users and nine NH listeners participated in this study. DATA COLLECTION AND ANALYSIS: The normalized amplitude from the probe response relative to the masker response was plotted as a function of the MPI to form a recovery function. The latency shift for the probe response relative to the masker response was calculated. RESULTS: The recovery function was approximately linear in log scale of the MPI in NH listeners, while it showed somewhat different recovery patterns with a large intersubject variability in CI users. Specifically, although the probe response was approximately 60 percent of the masker response for the MPI of 0.7 sec in both groups, the recovery function of CI users displayed a nonlinear pattern, with a steeper slope than that of NH listeners. The probe response completely recovered at the MPI of 4 sec in NH listeners and at the MPI of 2 sec in CI users. N1 and P2 latencies from probe responses were shorter than those from masker responses in NH listeners, while no latency difference was found between probe responses and masker responses in CI users. CONCLUSIONS: Our interpretation of these findings is that the faster recovery of the LAEP in CI users is related to abnormal adaptation mechanisms and a less prominent role of the components with longer latencies in the LAEP of CI users. Other mechanisms such as the compromised inhibitory regulation in the auditory system and the aging effect in CI users might also play a role. More research needs to be done to determine whether the slope of the LAEP recovery function is correlated with speech-perception performance.

Tobacco education in US physician assistant programs.

BACKGROUND: Few health degree programs incorporate sufficient tobacco cessation education in core curricula. METHODS: A national survey of 132 PA programs assessed the extent to which tobacco is addressed, educational methods, perceived importance and adequacy of tobacco education, and perceived barriers to enhancing tobacco-related content. RESULTS: Surveys (n = 99; 75%) revealed a median of 150 minutes of tobacco education throughout the degree program. Key barriers to enhancing training are lack of curriculum time and lack of access to comprehensive, evidence-based resources. Two-thirds expressed interest in participating in a nationwide effort to enhance tobacco cessation training. CONCLUSIONS: Similar to other disciplines, enhanced tobacco education is needed in PA programs to adequately prepare graduates to address the primary known cause of preventable death in the United States.