Desired, Expected, and Received Support: How Support Gaps Impact Affect Improvement and Perceived Stigma in the Context of Unintended Pregnancy.

Unintended pregnancies constitute potentially stigmatizing moments that mobilize desires for several types of support from multiple members of people's networks. This study examines gaps among the support people desire, expect, and receive when coping with an unintended pregnancy. The support gaps people experience can influence their feelings about the pregnancy and their perceptions of stigma surrounding it. People (N = 203) who recently experienced an unintended pregnancy reported in an online survey the supportive communication they experienced from their romantic partner, mother/maternal figure, and close friend at the time of the unintended pregnancy. People experienced gaps among the amounts of support they desired, expected, and received, and the nature of gaps varied by the provider and type of support under consideration. Males and females perceived different gaps that varied according to their roles associated with an unintended pregnancy. The gaps people experienced contributed to their perceptions of stigma and affect improvement surrounding the pregnancy.

"Baby? Baby Not?": Exploring Women's Narratives About Ambivalence Towards an Unintended Pregnancy.

Unintended pregnancy among adult women is a significant public health challenge in the United States. Research has identified ambivalence as a risk factor for not using contraceptives. The qualitative study presented here examined women's narratives about ambivalence toward unintended pregnancy. In-depth interviews were conducted in 2012 with 28 women aged 20-45 years old who were recruited primarily via flyers in family planning clinics in a rural, Midwestern state. The interviews were coded for salient themes. Almost 40 percent of the women said that they had experienced an unintended pregnancy. All but two women expressed ambivalence, stating that they had both good and bad feelings about getting pregnant unintentionally. Women expressed if a pregnancy did occur, they would just have to step up and "deal with it." They recognized a baby was something special but not without negative aspects. Those who were less ambivalent (and more negative) had compelling reasons why, but even those women expressed some positive feelings. At times, ambivalence was expressed by negative reactions about having a child that coincided with believing that becoming a parent or having another child would have a positive impact on themselves. This study provides an examination of women's narratives about ambivalence toward pregnancy. Overall, women's narratives constructed ambivalence as arising from both positive and negative emotions, as well as beliefs about costs and benefits, associated with unintended pregnancy. Given its association with a lack of contraceptive use, understanding the components of ambivalence (e.g., feelings, beliefs) is important to bolstering interventions aimed toward decreasing ambivalence and increasing contraceptive use.

Stories of postpartum depression: exploring health constructs and help-seeking in mothers' talk.

This article explores behavioral constructs derived from the Integrative Model of Behavioral Prediction (Fishbein, 2009) that emerged from unsolicited, online stories from 30 mothers about their experiences with postpartum depression. Five constructs (i.e., social norms; severity; barriers to help-seeking; facilitators to, and cues to action for, help-seeking; and self-efficacy) were prevalent and were connected with help-seeking behaviors in the stories that were analyzed after a single data collection in March 2011. Recommendations are offered for how the findings can be integrated into postpartum depression-related health promotion interventions.

Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism.

OBJECTIVE: To explore the feasibility for a set of hormone replacement therapy (HRT) eligibility guidelines that follow a similar structure and appearance to the UKMEC guidance for contraception. To enable non-specialists to feel confident in safely prescribing HRT and to aid selection of the most appropriate first line treatment. METHODS: A literature review was undertaken with evidence summarised on the topic of venous thromboembolism (VTE) which is an area frequently considered a barrier to prescribing. Medical eligibility tables which separated HRT by type were then produced for a set of VTE-related topics. RESULTS: The literature search confirmed the importance of distinguishing between different types and routes of administration when considering the suitability of HRT. Much of the evidence has been based on older synthetic types of HRT and whilst they still have a role in management, these medications carry different risks to the now more accepted use of body identical types. The search also highlighted the nuances involved, increasing the complexity of forming guidelines, with the need for consideration to be given to an individual's own perception of risks and benefits. CONCLUSION: The demand for HRT has risen in recent years and there is a need for this to be managed effectively, particularly for patients in primary care. The production of this type of guidance will enable the non-specialist to feel confident in safe and evidence-based prescribing. The guidelines are also designed to demonstrate to prescribers which complex patients should be referred onto menopause specialists.

Sudden death due to spontaneous acute dissection of the left subclavian artery with rupture during postpartum period: a case report.

Subclavian artery dissection is usually associated with coexisting aortic disease. Isolated and spontaneous acute subclavian artery dissection is uncommon and rarely reported. In addition, no case of left subclavian artery dissection during pregnancy and early puerperium has been described. We report the autopsy case of a 24-year-old female who died suddenly 3 days after delivery due to a spontaneous left subclavian artery dissection with rupture.

An evaluation of a multi-component adult weight management on referral intervention in a community setting.

BACKGROUND: National Institute for Health and Care Excellence (NICE) guidance on adult weight management recommends interventions are multi-component. We aimed to assess the implementation and health benefits of a primary care referral to an adult multi-component weight management intervention in a community setting. The intervention was offered through Primary care in National Health Service (NHS) South Gloucestershire, UK, from Oct 2008 to Nov 2010, in partnership with statutory, community and commercial providers. The scheme offered 12 weeks' community based concurrent support of dietary (Weight Watchers, WW), physical activity (Exercise on Prescription, EOP) and behavioural change (motivational interviewing) components to obese adults. Funding was available for 600 places. RESULTS: Five hundred and fifty nine participants engaged with the intervention, mean age 48 years, 88% female. Mean weight loss for all engagers was 3.7 kg (95 % confidence interval 3.4, 4.1). Participants completing the intervention achieved the largest weight reduction (mean loss 5.9 kg; 5.3, 6.6). Achievement of 5% weight loss was higher in completers (58%; 50, 65) compared to non-completers (19%; 12, 26) and people who only participated in one commercial component of the intervention (either WW or EOP; 19%; 13, 24). CONCLUSION: A multi-component weight management programme may be beneficial for weight loss, but a randomized controlled trial is needed to establish effectiveness and to evaluate cost.

Use of argatroban and catheter-directed thrombolysis with alteplase in an oncology patient with heparin-induced thrombocytopenia with thrombosis.

PURPOSE: The case of an oncology patient who developed heparin-induced thrombocytopenia with thrombosis (HITT) and was treated with argatroban plus catheter-directed thrombolysis (CDT) with alteplase is presented. SUMMARY: A 63-year-old Caucasian man with renal amyloidosis undergoing peripheral blood stem cell collection for an autologous stem cell transplant developed extensive bilateral upper-extremity deep venous thrombosis (DVT) and pulmonary embolism secondary to heparin-induced thrombocytopenia. A continuous i.v. infusion of argatroban was initiated, and the patient was managed on the general medical floor. After one week of therapy, he was transferred to the intensive care unit with cardiopulmonary compromise related to superior vena cava (SVC) syndrome. A percutaneous mechanical thrombectomy and CDT with alteplase were attempted, but the procedure was aborted due to epistaxis. The epistaxis resolved the next day, and the patient was restarted on argatroban. A second percutaneous mechanical thrombectomy was performed six days later and resulted in partial revascularization of the SVC and central veins. Postthrombectomy continuous CDT with alteplase was commenced while argatroban was withheld, and complete patency of the SVC and central veins was achieved after three days of therapy. Alteplase was discontinued, and the patient was reinitiated on argatroban; ultimately, he was transitioned to warfarin for long-term anticoagulation. Although the patient recovered, he experienced permanent vision and hearing loss, as well as end-stage renal disease. CONCLUSION: A 63-year-old man with renal amyloidosis and SVC syndrome secondary to HITT was successfully treated with argatroban and CDT with alteplase.

Effect of sexual coercion proclivity and cognitive priming on sexual aggression in the laboratory.

This research follows from the "rape proclivity" literature to evaluate whether proclivity actually predicts sexual coercion. One hundred forty-two heterosexual males attending a Canadian university participated. Participants completed the sexual coercion proclivity questionnaire packet to determine high or low sexual coercion proclivity, and were randomly assigned to complete either an innocuous or a sexually aggressive cognitive priming task. Sexual coercion was operationalized by having men read increasingly graphic sexual material to an increasingly uncomfortable confederate. Regardless of condition, high sexual coercion proclivity males were more likely to engage in sexual coercion than low sexual coercion proclivity males. When the effects of discomfort were controlled, a significant interaction emerged between sexual coercion proclivity and the priming condition on sexual coercion. Although engaging in significantly less sexual coercion than the high sexual coercion proclivity males when assigned to the innocuous cognitive priming task, the low sexual coercion proclivity males assigned to the sexually aggressive cognitive priming task were indistinguishable from the high sexual coercion proclivity group. The nature of this relationship differed for Caucasian and Chinese men. These findings suggest that even those not previously inclined toward sexual coercion can do so under opportunistic circumstances, following an increase in discomfort associated with exposure to and involvement with sexually aggressive material. The prevention implications associated with this are discussed.

Superiority of postmortem liver fentanyl concentrations over peripheral blood influenced by postmortem interval for determination of fentanyl toxicity.

OBJECTIVE: The current study was undertaken to determine the relationship between postmortem (PM) peripheral blood (PB) and liver fentanyl concentrations and the role of measuring liver fentanyl concentrations in cause of death investigations in medical examiner cases in which fentanyl was identified. DESIGN AND METHODS: FB and liver tissue were routinely collected at autopsy from 4 Minnesota medical examiners' offices in 2010-2011. Samples were analyzed by gas chromatography-mass spectrometry (GC-MS). RESULTS: PB fentanyl ranged from <2-15µg/L in non-drug related deaths (n=5), <2-22µg/L from mixed drug toxicity (n=26) and 3.7-56µg/L from fentanyl toxicity (n=33). Liver fentanyl ranged from 11 to 104µg/kg, 6 to 235µg/kg, and 18 to 365µg/kg, respectively. PB and liver fentanyl showed a modest correlation (r=0.67). PM interval to the liver/blood ratio showed a decreasing ratio over increasing PM interval in cases from fentanyl and mixed drug toxicity. Liver fentanyl concentrations best define therapeutic use at <23µg/kg and fatal toxicity at >56µg/kg, without substantial overlap as found in blood fentanyl concentrations. CONCLUSION: Discriminatory liver fentanyl concentrations suggestive of therapeutic or toxic drug levels may better assist cause of death determination in cases of suspected fentanyl toxicity than postmortem PB concentrations. Peripheral blood fentanyl concentrations appear to undergo postmortem redistribution, associated with an increasing PM interval.

Effect of sexual coercion proclivity, insult and fantasy on emotional reactivity and appeal of sexual aggression.

Fifty-nine heterosexual university males were assessed for Sexual Coercion Proclivity (SCP) and randomly assigned to one of three conditions: Insult/nonsexually coercive fantasy material; no insult/sexually coercive fantasy material; or, insult/sexually coercive fantasy material. Although not differing in terms of anger or anxiety, the high SCP became more frustrated than the low group, particularly when exposed to both insult and sexually coercive (SC) fantasy material. Changes in negative affect predicted anticipated likelihood of engaging in SC among the low SCP group and anticipated enjoyment of SC in the high SCP group. Acculturation accounted for differences observed between Caucasian and Chinese men.

Poisoning and suicide by cyanide jewelry cleaner in the US Hmong community: a case series.

Over 200 000 persons of Hmong ethnicity live in the United States. The majority of this Southeast Asian ethnic group live in California, Minnesota and Wisconsin. Tradition plays a strong role in the Hmong population, and difficulty in assimilation into "Western ways" has been reported to result in depression and suicide attempts. Some products sold at Southeast Asian ethnic markets are well-known within the Hmong community to be lethal but are essentially unknown to the outside community. We describe eight cases in which cyanide-containing products were ingested by Hmong patients. Seven cases were suicide attempts involving the ingestion of a locally-purchased substance intended for cleaning metal, coins, or jewelry. One case involved the fatal ingestion of a cyanide-containing "herbal" cure. In the majority of the cases, cyanide was not initially suspected, and treatment was delayed due to lack of information regarding the product ingested. In the two patients who survived, the cyanide antidote kit (sodium nitrite, amyl nitrite, and sodium thiosulfate) was administered early. Clinicians should be aware that unusual and potentially lethal products are easily available at ethnic markets. Cyanide toxicity should be suspected, and empiric antidote therapy initiated early, in patients of Hmong or Southeast Asian descent who present with sudden and unexplained cardiovascular collapse and metabolic acidosis, especially in the setting of a suspected suicidal ingestion.