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Deep-Sea Octopus (Graneledone boreopacifica) Conducts the Longest-Known Egg-Brooding Period of Any Animal

July 31, 2014 Comments off

Deep-Sea Octopus (Graneledone boreopacifica) Conducts the Longest-Known Egg-Brooding Period of Any Animal
Source: PLoS ONE

Octopuses typically have a single reproductive period and then they die (semelparity). Once a clutch of fertilized eggs has been produced, the female protects and tends them until they hatch. In most shallow-water species this period of parental care can last from 1 to 3 months, but very little is known about the brooding of deep-living species. In the cold, dark waters of the deep ocean, metabolic processes are often slower than their counterparts at shallower depths. Extrapolations from data on shallow-water octopus species suggest that lower temperatures would prolong embryonic development periods. Likewise, laboratory studies have linked lower temperatures to longer brooding periods in cephalopods, but direct evidence has not been available. We found an opportunity to directly measure the brooding period of the deep-sea octopus Graneledone boreopacifica, in its natural habitat. At 53 months, it is by far the longest egg-brooding period ever reported for any animal species. These surprising results emphasize the selective value of prolonged embryonic development in order to produce competitive hatchlings. They also extend the known boundaries of physiological adaptations for life in the deep sea.

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Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States

July 30, 2014 Comments off

Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States
Source: Morbidity and Mortality Weekly Report (CDC)

Since mid-2006, a licensed human papillomavirus (HPV) vaccine has been available and recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescent girls at ages 11 or 12 years (1). Two vaccines that protect against HPV infection are currently available in the United States. Both the quadrivalent (HPV4) and bivalent (HPV2) vaccines protect against HPV types 16 and 18, which cause 70% of cervical cancers; HPV4 also protects against HPV types 6 and 11, which cause 90% of genital warts (1,2). In 2011, the ACIP also recommended HPV4 for the routine vaccination of adolescent boys at ages 11 or 12 years (3). HPV vaccines can be safely co-administered with other routinely recommended vaccines, and ACIP recommends administration of all age-appropriate vaccines during a single visit (4). To assess progress with HPV vaccination coverage among adolescents aged 13–17 years,* characterize adherence with recommendations for HPV vaccination by the 13th birthday, and describe HPV vaccine adverse reports received postlicensure, CDC analyzed data from the 2007–2013 National Immunization Survey-Teen (NIS-Teen) and national postlicensure vaccine safety data among females and males. Vaccination coverage with ≥1 dose of any HPV vaccine increased significantly from 53.8% (2012) to 57.3% (2013) among adolescent girls and from 20.8% (2012) to 34.6% (2013) among adolescent boys. Receipt of ≥1 dose of HPV among girls by age 13 years increased with each birth cohort; however, missed vaccination opportunities were common. Had HPV vaccine been administered to adolescent girls born in 2000 during health care visits when they received another vaccine, vaccination coverage for ≥1 dose by age 13 years for this cohort could have reached 91.3%. Postlicensure monitoring data continue to indicate that HPV4 is safe. Improving practice patterns so that clinicians use every opportunity to recommend HPV vaccines and address questions from parents can help realize reductions in vaccine-preventable infections and cancers caused by HPV.

Use of phytoestrogens and effects perceived by postmenopausal women: result of a questionnaire-based survey

July 28, 2014 Comments off

Use of phytoestrogens and effects perceived by postmenopausal women: result of a questionnaire-based survey
Source: BMC Complementary and Alternative Medicine

Background
Use of food supplements-containing phytoestrogens among postmenopausal women is rapidly increasing. Although phytoestrogens are often perceived as safe, evidence for overall positive risk-benefit profile is still inconclusive. The chance to buy them by user’s initiative does not facilitate surveys on their prevalence and pattern of use. The aim of this study was to describe the pattern of use and self-reported positive and negative perceptions of phytoestrogens in post-menopausa.

Methods
A questionnaire was administered to women who were buying food supplements containing phytoestrogens in 22 pharmacies located in the Bologna area (400,000 inhabitants). Questionnaire was structured into 3 sections: (a) socio-demographic information; (b) pattern of use, (c) positive and negative perceptions.

Results
Data on 190 peri- and post-menopausal women (aged 38-77) were collected. Women stated to use phytoestrogens to reduce hot flushes (79%), insomnia (15%), mood disturbances (14%) and prevent osteoporosis (15%). The majority (59%) took phytoestrogens routinely, whereas 28% in 3-month cycles. Among positive perceptions between short- and long-term users, a not negligible difference was reported for relief of hot-flushes (68% in short-term vs. 81% in long-term users; p = 0.04). Negative perceptions were reported more frequently in the long-term group, and this difference was statistically significant for edema (6% in short-term vs. 17% in long-term users; p = 0.04), but not for other effects: e.g., swelling sensation (10% vs. 21%; p = 0.09), somnolence (7% vs. 10% p = 0.62), fatigue (4% vs.11% p = 0.15).

Conclusions
In the Bologna area, the pattern of use of phytoestrogens for menopausal symptoms is heterogeneous, and women overall find these substances to be beneficial, especially for relief of hot-flushes. Other positive perceptions decreased with long-term use. Negative perceptions, especially estrogen-like effects, seem to be infrequent and increase with long-term therapy. Physicians should pay attention to effects perceived by post-menopausal women and routinely monitor the use of phytoestrogens, in order to recognize possible adverse effects and actual benefits.

Two Decades After Emergency Contraceptive Pills Became Available, Few Women Use Them

July 24, 2014 Comments off

Two Decades After Emergency Contraceptive Pills Became Available, Few Women Use Them
Source: Guttmacher Institute

In many developing countries, most women have never heard of or used emergency contraceptive pills, according to “Knowledge and Use of Emergency Contraception: A Multicountry Analysis,” by Tia Palermo of Stony Brook University. Although the method can help women avoid unplanned pregnancies, in every country surveyed but Colombia, fewer than 50% of women have ever heard of it and fewer than 6% have ever used it. In general, the more educated women were or the wealthier they were, the more likely they were to have known about or used emergency contraception.

The researchers analyzed national survey data from 2000–2010 of women aged 15–49 in 45 countries in four regions.Women’s knowledge and use of the method varied widely within each region. In Latin America and the Caribbean, for example, Colombia had the highest proportions of women who knew about the method (66%) and had used it (12%), while Haiti had the lowest (13% and 0.4%, respectively).

Wide ranges in knowledge and use were also seen in the other three regions. In Africa, women’s awareness of emergency contraception ranged from 2% in Chad to 40% in Kenya and use ranged from less than 0.1% in Chad to 4% in Ghana. In Asia, awareness ranged from 3% of women in Timor-Leste to 29% in the Maldives, and use ranged from a low of 0.1% (Cambodia, Nepal and Timor-Leste) to 0.9% (Pakistan). In Eastern Europe and West Asia, Ukraine had the highest rates of awareness and use (49% and 6%, respectively), while Azerbaijan had the lowest (5% and 0.5%).

According to the authors, rates of emergency contraception use in the countries studied tended to be much lower than in countries where the method has been on the market longer, such as France and the United States (17% and 11%, respectively). The exceptionally high levels of knowledge and use found in Colombia, reflect, among other things, a commercial sector that makes nine brands of emergency contraceptive pills easily available.

Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation

July 23, 2014 Comments off

Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation
Source: Journal of the American Medical Association

Our data demonstrate that uterine cancers occurred in 27 per 10 000 women undergoing morcellation. Other malignancies and precancerous abnormalities were also detected. Although morcellators have been in use since 1993, few studies have described the prevalence of unexpected pathology at the time of hysterectomy.2- 4 Prevalence information is the first step in determining the risk of spreading cancer with morcellation. Although data are limited, women with apparent uterine-confined neoplasms at the time of morcellation have been found to have intraperitoneal tumor dissemination at the time of reexploration.3,6

We recognize a number of limitations including the inability to verify pathological findings, possible misclassification of pathology, potential undercapture of morcellation, and the fact that our findings may not be generalizable to all hospitals. Last, we lack data on long-term follow-up, and the outcome of women with pathological abnormalities who underwent morcellation requires further study. Patients considering morcellation should be adequately counseled about the prevalence of cancerous and precancerous conditions prior to undergoing the procedure.

A Practitioner’s Toolkit for Managing the Menopause

July 22, 2014 Comments off

A Practitioner’s Toolkit for Managing the Menopause
Source: Climacteric

Objective
A number of learned societies, including the International Menopause Society, have produced position statements pertaining to the use of postmenopausal hormone therapy. These documents are highly informative but are not designed for use by primary-care physicians and nurse practitioners during routine consultations. Our aim was to produce a toolkit for practitioners that could be used during office consultations to assist them in the assessment and management of the menopause.

Methods
We used clinical experience in primary care, combined with published diagnostic algorithms, positions statements from learned medical societies and relevant peer-reviewed literature to develop assessment and management algorithms relevant to the primary care of women age 40 years and older.

Results
The resultant ‘Practitioner’s Toolkit for Managing the Menopause’ comprises algorithms for the reasons why a woman might present, determination of menopausal status, key information that should be ascertained, issues that may influence treatment decision-making, hormonal and non-hormonal treatment options, symptom management and patient review, and a brief supporting document.

Conclusions
We believe these algorithms and supporting document provide an accessible desktop tool for health-care practitioners caring for women at midlife. The toolkit has been endorsed by the International Menopause Society for global use.

NSCAW Child Well-Being Spotlight: Teenage Girls in the Child Welfare System Report High Rates of Risky Sexual Activity and Pregnancy

July 21, 2014 Comments off

NSCAW Child Well-Being Spotlight: Teenage Girls in the Child Welfare System Report High Rates of Risky Sexual Activity and Pregnancy
Source: U.S. Department of Health and Human Services (Administration for Children & Families)

This National Survey of Child and Adolescent Well-Being (NSCAW) spotlight describes the high rates of risky sexual activity and pregnancy among teenage girls in the second cohort of NSCAW (NSCAW II). According to data from the National Survey of Child and Adolescent Well-Being (NSCAW), 16.8% of girls ages 14-17, and 45.1% of girls ages 18-20, had experienced at least one pregnancy.

The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012

July 18, 2014 Comments off

The Cost of Abortion, When Providers Offer Services, and Harassment of Abortion Providers All Remained Stable Between 2008 And 2012
Source: Guttmacher Institute

Access to abortion services is affected by a variety of factors, including the cost of the procedure, the gestational age limits at which providers offer services and antiabortion harassment. According to “Secondary Measures of Access to Abortion Services in the U.S., 2011-2012: Gestational Age Limits, Cost and Harassment,” by Jenna Jerman and Rachel Jones of the Guttmacher Institute, there was relatively little change in any of these measures between 2008 and 2011–2012. The new analysis relies on data from the Institute’s 16th census of all known abortion providers in the United States.

In 2011–2012, the median cost of a surgical abortion at 10 weeks’ gestation was $495, and an early medication abortion cost $500. By comparison, the inflation-adjusted charge in 2009 for the same procedures was $503 and $524, respectively. The cost varied by facility size: facilities with the largest caseloads charged the least ($450), while those that performed fewer than 30 procedures per year charged the most ($650). Because women were more likely to obtain abortions at facilities that charged less, on average, women paid $480 for a surgical procedure at 10 weeks in 2011–2012, compared with $483 in 2009 (adjusted for inflation).

Sexting and Sexual Behavior Among Middle School Students

July 3, 2014 Comments off

Sexting and Sexual Behavior Among Middle School Students
Source: Pediatrics

OBJECTIVE:
It is unknown if “sexting” (ie, sending/receiving sexually explicit cell phone text or picture messages) is associated with sexual activity and sexual risk behavior among early adolescents, as has been found for high school students. To date, no published data have examined these relationships exclusively among a probability sample of middle school students.

METHODS:
A probability sample of 1285 students was collected alongside the 2012 Youth Risk Behavior Survey in Los Angeles middle schools. Logistic regressions assessed the correlates of sexting behavior and associations between sexting and sexual activity and risk behavior (ie, unprotected sex).

RESULTS:
Twenty percent of students with text-capable cell phone access reported receiving a sext and 5% reported sending a sext. Students who text at least 100 times per day were more likely to report both receiving (odds ratio [OR]: 2.4) and sending (OR: 4.5) sexts and to be sexually active (OR: 4.1). Students who sent sexts (OR: 3.2) and students who received sexts (OR: 7.0) were more likely to report sexual activity. Compared with not being sexually active, excessive texting and receiving sexts were associated with both unprotected sex (ORs: 4.7 and 12.1, respectively) and with condom use (ORs: 3.7 and 5.5, respectively).

CONCLUSIONS:
Because early sexual debut is correlated with higher rates of sexually transmitted infections and teen pregnancies, pediatricians should discuss sexting with young adolescents because this may facilitate conversations about sexually transmitted infection and pregnancy prevention. Sexting and associated risks should be considered for inclusion in middle school sex education curricula.

Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study

July 3, 2014 Comments off

Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study
Source: PLoS Medicine

Background
With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication.

Methods and Findings
We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested cesarean section, as well as lack of data on antepartum/intrapartum stillbirth and gestational age for stillbirth and miscarriage.

Conclusions
This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery.

Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians

July 1, 2014 Comments off

Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians
Source: Annals of Internal Medicine

Description:
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the utility of screening pelvic examination for the detection of pathology in asymptomatic, nonpregnant, adult women.

Methods:
This guideline is based on a systematic review of the published literature in the English language from 1946 through January 2014 identified using MEDLINE and hand-searching. Evaluated outcomes include morbidity; mortality; and harms, including overdiagnosis, overtreatment, diagnostic procedure–related harms, fear, anxiety, embarrassment, pain, and discomfort. The target audience for this guideline includes all clinicians, and the target patient population includes asymptomatic, nonpregnant, adult women. This guideline grades the evidence and recommendations using the ACP’s clinical practice guidelines grading system.

Recommendation:
ACP recommends against performing screening pelvic examination in asymptomatic, nonpregnant, adult women (strong recommendation, moderate-quality evidence).

Supreme Court — Contraception– Burwell v. Hobby Lobby Stores, Inc.

July 1, 2014 Comments off

Burwell v. Hobby Lobby Stores, Inc. (PDF)
Source: Supreme Court of the United States

The Religious Freedom Restoration Act of 1993 (RFRA) prohibits the “Government [from] substantially burden[ing] a person’s exercise of religion even if the burden results from a rule of general applicability” unless the Government “demonstrates that application of the burden to the person—(1) is in furtherance of a compelling govern – mental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.” 42 U. S. C. §§2000bb–1(a), (b). As amended by the Religious Land Use and Institutionalized Persons Act of 2000 (RLUIPA), RFRA covers “any exercise of religion, whether or not compelled by, or central to, a system of religious be – lief.” §2000cc–5(7)(A).

At issue here are regulations promulgated by the Department of Health and Human Services (HHS) und er the Patient Protection and Affordable Care Act of 2010 (ACA), which, as relevant here, requires specified employers’ group health plans to furnish “preventive care and screenings” for women without “a ny cost sharing requirements,” 42 U. S. C. §300gg–13(a)(4). Congress did not specify what types of preventive care must be covered; it authorized the Health Resources and Services Administration, a component of HHS, to decide. Ibid . Nonexempt employers are generally required to provide coverage for the 20 contraceptive methods approv ed by the Food and Drug Administration, including the 4 that may have the effect of preventing an already fertilized egg from developing any further by inhibiting its attachment to the uterus. Religious employers, such as churches, are exempt from this contraceptive ma ndate. HHS has also effectively exempted religious nonprofit organi zations with religious objections to providing coverage for contraceptive services. Under this accom – modation, the insurance issuer must exclude contraceptive coverage from the employer’s plan and provide plan partic ipants with separate payments for contraceptive services without imposing any cost – sharing requirements on the employer, its insurance plan, or its em – ployee beneficiaries.

In these cases, the owners of th ree closely held for-profit corporations have sincere Christian beliefs th at life begins at conception and that it would violate their religion to facilitate access to contraceptive drugs or devices that operate after th at point. In separate actions, they sued HHS and other federal officials and agencies (collectively HHS) under RFRA and the Free Exerci se Clause, seeking to enjoin application of the contraceptive mandate insofar as it requires them to provide health coverage for the four objectionable contraceptives. In No. 13–356, the District Court denied the Hahns and their compa – ny—Conestoga Wood Specialties—a preliminary injunction. Affirm – ing, the Third Circuit held that a for-profit corporation could not “engage in religious exercise” under RFRA or the First Amendment, and that the mandate imposed no requ irements on the Hahns in their personal capacity. In No. 13–354, the Greens, their children, and their companies—Hobby Lobby Stores and Mardel—were also denied a preliminary injunction, but the Tent h Circuit reversed. It held that the Greens’ businesses are “persons ” under RFRA, and that the corporations had established a likelih ood of success on their RFRA claim because the contraceptive mandate substantially burd ened their exercise of religion and HHS had not demonstrated a compelling interest in enforcing the mandate against them; in the alternative, the court held that HHS had not proved that the mandate was the “least restrictive means” of furthering a compelling governmental interest.

Held : As applied to closely held corp orations, the HHS regulations im – posing the contraceptive mandate violate RFRA. Pp. 16–49.

New Study Documents Reasons Married Women in Developing Nations Who Wish To Avoid Pregnancy Do Not Use Contraceptives

June 24, 2014 Comments off

New Study Documents Reasons Married Women in Developing Nations Who Wish To Avoid Pregnancy Do Not Use Contraceptives
Source: Guttmacher Institute

Increasing women’s access to modern contraceptive methods alone will not satisfy their unmet need for contraception, according to “Reasons for Contraceptive Nonuse Among Women Having Unmet Need for Contraception in Developing Countries,” a new study by Gilda Sedgh and Rubina Hussain of the Guttmacher Institute. The most common reasons married women give for not using a contraceptive method—despite wanting to avoid a pregnancy—have less to do with whether they can obtain contraceptives and much more to do with concerns about possible health risks and side effects or their belief that they don’t have sex frequently enough to warrant using a method.

Among married women who were not using contraceptives, on average 4-8% of those in Asia, Africa and Latin America attributed their non-use to lack of access. However, in a few countries, lack of access was a significant barrier. This reason for nonuse was cited by 18–23% of women in Benin, Cameroon, Congo-Brazzaville, Côte d’Ivoire and Guinea, and by 17% of women in the Philippines (more than twice the proportion of women in any other Asian country).

The researchers found that 23–28% of married women in all three regions who had an unmet need for contraception said they were not using a method because they had experienced or were worried about side effects or health risks. These concerns were especially prevalent in Southeastern Asia (36%) and Eastern Africa (32%). Concerns about side effects and health risks were significantly more common in countries with high levels of unmet need than in countries with the lowest levels of unmet need.

Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study

June 24, 2014 Comments off

Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study
Source: Environmental Health Perspectives

Background:
Gestational exposure to several common agricultural pesticides can induce developmental neurotoxicity in humans, and has been associated with developmental delay and autism.

Objectives:
To evaluate whether residential proximity to agricultural pesticides during pregnancy is associated with autism spectrum disorders (ASD) or developmental delay (DD) in the Childhood Autism Risks from Genetics and Environment (CHARGE) Study.

Methods:
The CHARGE study is a population-based case-control study of ASD, developmental delay (DD), and typical development. For 970 participants, commercial pesticide application data from the California Pesticide Use Report (1997-2008) were linked to the addresses during pregnancy. Pounds of active ingredient applied for organophophates, organochlorines, pyrethroids, and carbamates were aggregated within 1.25km, 1.5km, and 1.75km buffer distances from the home. Multinomial logistic regression was used to estimate the odds ratio (OR) of exposure comparing confirmed cases of ASD (n = 486) or DD (n = 168) with typically developing referents (n = 316).

Results:
Approximately one-third of CHARGE Study mothers lived, during pregnancy, within 1.5 km (just under one mile) of an agricultural pesticide application. Proximity to organophosphates at some point during gestation was associated with a 60% increased risk for ASD, higher for 3rd trimester exposures [OR = 2.0, 95% confidence interval (CI) = (1.1, 3.6)], and 2nd trimester chlorpyrifos applications: OR = 3.3 [95% CI = (1.5, 7.4)]. Children of mothers residing near pyrethroid insecticide applications just prior to conception or during 3rd trimester were at greater risk for both ASD and DD, with OR’s ranging from 1.7 to 2.3. Risk for DD was increased in those near carbamate applications, but no specific vulnerable period was identified.

Conclusions:
This study of ASD strengthens the evidence linking neurodevelopmental disorders with gestational pesticide exposures, and particularly, organophosphates and provides novel results of ASD and DD associations with, respectively, pyrethroids and carbamates.

Complicating Conditions Associated With Childbirth, by Delivery Method and Payer, 2011

June 24, 2014 Comments off

Complicating Conditions Associated With Childbirth, by Delivery Method and Payer, 2011
Source: Agency for Healthcare Research and Quality

Childbirth is the most prevalent reason for hospitalization in the United States. Of the 4.1 million hospital stays in 2009 involving childbirth, 91.3 percent of vaginal and 99.9 percent of cesarean section deliveries had at least one complicating condition. These conditions range in severity and may include those that are preexisting, such as mental health disorders; those that create risk factors, such as multiple gestation; and those that may lead to complications of care, such as an abnormality of fetal heart rate or rhythm.

In the United States, childbirth accounts for about 10 percent of all maternal hospital stays and $12.4 billion in hospitalization costs for live births; it represents, in the aggregate, one of the most costly conditions for inpatient hospital care. The average cost of a vaginal birth in 2008 was $2,900 without complications and $3,800 with complications. The average cost of a cesarean section was $4,700 without complications and $6,500 with complications.

A recent report from the Centers for Disease Control and Prevention analyzed and compared 2010 payment source data from U.S. birth certificates and the National Hospital Discharge Survey. Results showed that the most common payment source for deliveries was private insurance. However, in the past decade, privately insured deliveries have declined by 16 percent, while Medicaid-covered deliveries have increased by 40 percent.6 Type of insurance may influence the prevalence of interventions (e.g., induction of labor, cesarean section) associated with a complicating condition and mode of delivery.

This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) on the source of payment for pregnancy and childbirth hospitalizations with complicating conditions versus without complicating conditions by mode of delivery in 2011. We examine stays for vaginal and cesarean section deliveries and compare rates of complicating conditions by expected payer type (Medicaid versus private insurance). All data are reported from the maternal perspective (i.e., reflecting the experience of the mother, not the newborn) among women who had a hospital delivery in 2011.

Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2009

June 21, 2014 Comments off

Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection — Medical Monitoring Project, United States, 2009
Source: Morbidity and Mortality Weekly Report (CDC)

Problem:
As of December 31, 2009, an estimated 864,748 persons were living with human immunodeficiency virus (HIV) infection in the 50 U.S. states, the District of Columbia, and six U.S.-dependent areas. Whereas HIV surveillance programs in the United States collect information about persons with a diagnosis of HIV infection, supplemental surveillance systems collect in-depth information about the behavioral and clinical characteristics of persons receiving outpatient medical care for HIV infection. These data are needed to reduce HIV-related morbidity and mortality and HIV transmission.

Reporting Period Covered:
Data were collected during June 2009–May 2010 for patients receiving medical care at least once during January–April 2009.

Description of the System:
The Medical Monitoring Project (MMP) is an ongoing surveillance system that assesses behaviors and clinical characteristics of HIV-infected persons who have received outpatient medical care. For the 2009 data collection cycle, participants must have been aged ≥18 years and have received medical care during January–April 2009 at sampled facilities that provide HIV medical care within participating MMP project areas. Behavioral and selected clinical data were collected using an in-person interview, and most clinical data were collected using medical record abstraction. A total of 23 project areas in 16 states and Puerto Rico were funded to collect data during the 2009 data collection cycle. The data were weighted for probability of selection and nonresponse to be representative of adults receiving outpatient medical care for HIV infection in the United States and Puerto Rico. Prevalence estimates are presented as weighted percentages. The period of reference is the 12 months before the patient interview unless otherwise noted.

Results:
The patients in MMP represent 421,186 adults who received outpatient medical care for HIV infection in the United States and Puerto Rico during January–April 2009. Of adults who received medical care for HIV infection, an estimated 71.2% were male, 27.2% were female, and 1.6% were transgender. An estimated 41.4% were black or African American, 34.6% were white, and 19.1% were Hispanic or Latino. The largest proportion (23.1%) were aged 45–49 years. Most patients (81.1%) had medical coverage; 40.3% had Medicaid, 30.6% had private health insurance, and 25.7% had Medicare.

An estimated 69.6% of patients had three or more documented CD4+ T-lymphocyte cell (CD4+) or HIV viral load tests. Most patients (88.7%) were prescribed antiretroviral therapy (ART), and 71.6% had a documented viral load that was undetectable or ≤200 copies/mL at their most recent test. Among sexually active patients, 55.0% had documentation in the medical record of being tested for syphilis, 23.2% for gonorrhea, and 23.9% for chlamydia.

Noninjection drugs were used for nonmedical purposes by an estimated 27.1% of patients, whereas injection drugs were used for nonmedical purposes by 2.1% of patients. Overall, 12.9% of patients engaged in unprotected sex with a partner of negative or unknown HIV status.

Unmet supportive service needs were prevalent, with an estimated 22.8% in need of dental care and 12.0% in need of public benefits, including Social Security Income or Social Security Disability Insurance. Fewer than half of patients (44.8%) reported receiving HIV and sexually transmitted disease prevention counseling from a health-care provider.

Interpretation:
The findings in this report indicate that most adults living with HIV who received medical care in 2009 were taking ART, had CD4+ and HIV viral load testing at regular intervals, and had health insurance or other coverage. However, some patients did not receive clinical services and treatment in accordance with guidelines. Some patients engaged in behaviors, such as unprotected sex, that increase the risk for transmitting HIV to sex partners, and some used noninjection or injection drugs or both.

Public Health Actions:
Local and state health departments and federal agencies can use MMP data for program planning to determine allocation of services and resources, guide prevention planning, assess unmet medical and supportive service needs, inform health-care providers, and help focus intervention programs and health policies at the local, state, and national levels.

Health of Hispanic Moms and Babies a Growing Concern, New Report Says

June 19, 2014 Comments off

Health of Hispanic Moms and Babies a Growing Concern, New Report Says
Source: March of Dimes

Hispanic women are significantly more likely to have a baby with a neural tube birth defect, and nearly a quarter of all preterm births in the United States are Hispanic, according to a new report from the March of Dimes.

Debate on Ways to Reduce U.S. Abortion Rate Intensifies Even as Abortion Rate Continues to Decline

June 18, 2014 Comments off

Debate on Ways to Reduce U.S. Abortion Rate Intensifies Even as Abortion Rate Continues to Decline
Source: Guttmacher Institute

A new Guttmacher policy analysis notes that, paradoxically, the sharp divide over the means to make abortion rare has only grown more pronounced even as the U.S. abortion rate in 2011 reached its lowest level since 1973. The debate centers on whether the United States should strive to reduce abortion at all costs, or focus instead on reducing the need for it.

“The rival policy approaches of the antiabortion and prochoice movements have become mutually exclusive,” says Joerg Dreweke, author of the analysis. “Antiabortion activists, starting in 2011, have enacted an unprecedented wave of coercive state laws that will likely force growing numbers of women to give birth rather than end an unwanted pregnancy. By contrast, reproductive health advocates back policies like the Affordable Care Act that expand access to contraceptive services to help women prevent unintended pregnancies in the first place, along with the abortions that often follow.”

The analysis details the opposing explanations of why the U.S. abortion rate declined 13% between 2008 and 2011. Antiabortion activists argued that state-level abortion restrictions were responsible and dismissed the idea of contraception playing a role. However, not only did the abortion decline mostly predate the wave of new abortion restrictions, but it was also accompanied by a steep drop in the birthrate, indicating that pregnancy was down overall. This leads to the conclusion that improved contraceptive use, including use of highly effective methods like the IUD and implant, was likely the main driver of the abortion decline by helping to reduce women’s need for the service.

Studies in Family Planning — Special Issue — Unmet Need for Family Planning

June 17, 2014 Comments off

Unmet Need for Family Planning
Source: Studies in Family Planning
From press release (EurekAlert!)

Studies in Family Planning, a leading journal published by the Population Council, released “Unmet Need for Family Planning”—a special issue featuring ten articles, including a comprehensive introduction to the topic of unmet need. Distinguished researchers explore trends related to unmet need for contraception, and many articles point to practical strategies for increasing contraceptive knowledge and uptake, and for overcoming barriers that prevent women from practicing contraception.

“Unmet need has been an important indicator for measuring the progress of family planning programs for more than 25 years,” said John Bongaarts, vice president and Distinguished Scholar at the Population Council. “This issue features work from some of the leading minds in family planning. It explores trends, identifies issues, and proposes solutions to ensure that sexual and reproductive health programs and policies are structured to meet the changing needs of women and men over the course of their reproductive lives.”

The FP2020 goal of expanding family planning services to an additional 120 million women invites interest in exploring the reasons for nonuse of contraceptives among women with a desire to postpone or end childbearing (unmet need). The articles in “Unmet Need for Family Planning” advance understanding of these reasons by discovering cross-national as well as locally specific explanations that can aid efforts to improve family planning programs and reduce unintended pregnancy. The studies call attention to the importance of concerns regarding perceived side effects, use of less-effective methods of contraception, insufficient integration of family planning with other services, social pressure to bear children, and other important factors that may lead to suboptimal family planning practices.

The articles in the special issue represent updated versions of a selection of papers presented at an international seminar organized by the IUSSP (International Union for the Scientific Study of Population) in collaboration with the Population Council-led STEP-UP (Strengthening Evidence for Programming on Unintended Pregnancy) consortium, and AFIDEP (African Institute for Development Policy) in Nanyuki, Kenya in 2013. The Population Council extends its gratitude toward those participants who provided their insights and expertise during the seminar, as well as to the seminar organizers and guest editors of the special issue: John Cleland, Sarah Harbison, and Iqbal H. Shah. Financial support for the seminar was generously provided by USAID, DFID, the Wellcome Trust, and WHO.

The full table of contents and a synopsis of each article are included below. All of the articles in “Unmet Need for Family Planning” are available online, free of charge.

Youth Risk Behavior Surveillance—United States, 2013

June 13, 2014 Comments off

Youth Risk Behavior Surveillance—United States, 2013 (PDF)
Source: Morbidity and Mortality Weekly Report (CDC)
From press release:

Cigarette smoking rates among high school students have dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, according to the 2013 results released today by the Centers for Disease Control and Prevention.

By achieving a teen smoking rate of 15.7 percent, the United States has met its national Healthy People 2020External Web Site Icon objective of reducing adolescent cigarette use to 16 percent or less.

Despite this progress, reducing overall tobacco use remains a significant challenge. For example, other national surveys show increases in hookah and e-cigarette use. In the YRBS, no change in smokeless tobacco use was observed among adolescents since 1999, and the decline in cigar use has slowed in recent years, with cigar use now at 23 percent among male high school seniors.

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