Understanding facilitators and barriers to contraception screening and referral in young women with cancer

BACKGROUND: Young women with cancer often worry about impaired fertility after treatment but can experience devastating consequences from an unplanned pregnancy during treatment. Contraception screening and referral appear to occur infrequently in cancer care. OBJECTIVES: We sought to understand oncologic providers’ current practices, perceptions of facilitators and barriers to screening for adequate contraception during cancer treatment, and to understand patient perspectives on these processes. METHODS: We interviewed 19 oncologic providers and 20 female reproductive-aged oncology patients stable on treatment or who had completed therapy within the last 24 months. We recruited participants from an urban, northeast medical center where they worked or received oncologic care. Semi-structured interview questions examined components of the Promoting Action on Research Implementation in Health Services (PARiHS) framework, and subsequent constant comparative analysis identified similar themes. FINDINGS: Providers vary significantly in their current contraception screening practices with many focusing on diagnosing pregnancy rather than prevention. Providers identified many institutional and organizational barriers, including lack of education and lack of clear provider responsibility. Providers also identified resources and supports that would assist with contraception screening and referral, including education and enhanced interdisciplinary collaboration with gynecologic providers. Patients infrequently recalled contraception conversations with oncology providers and expressed challenges determining the most appropriate provider with whom to discuss contraception. CONCLUSION: Cancer centers should address barriers to contraception screening and referral locally in future implementation of contraception screening and referral. National organizations should work to develop guidelines to inform and support this process in clinical practice.2019-10-23T00:00:00

The effect of demographic changes on saving for life cycle motives in developing countries

If developing countries follow the same paths that industrialized countries have followed, saving for retirement will initially become more important as the population growth rate declines. To calculate the potential importance of life-cycle savings (saving for retirement), the paper presents a simulation model that translates demographic projections into savings-rate projections. It simulated aggregate rates for life-cycle savings for Brazil, China, Korea, Mexico, Nigeria, Pakistan and Turkey. The savings rates increase 5 or 6 percentage points when the last baby boomers enter the work force and begin to save after their children leave home. The effect on life-cycle savings is dramatic; the effect on total savings rates which are often three or four times as high, is not. Simulated life-cycle savings rates peak at an absolute 10 percent or less in all cases. The patterns of these projections seem robust with regard to assumptions about productivity growth, interest rates, and age-specific participation in the labor force.Banks&Banking Reform,Environmental Economics&Policies,Economic Theory&Research,Health Monitoring&Evaluation,Inequality

The impact of origin region and internal migration on Italian fertility

We examine the impact of population distribution on fertility in a nationally representative sample. We exploit detailed life-history data to conduct an event-history analysis of transition to first birth, examining mechanisms that might link migration and fertility: socialization, adaptation, selection, and disruption. Our multivariate analysis examines various socio-demographic traits, the place of birth, and interregional migration. Differences by region and migration stream are partly explained by compositional factors, such as female employment, union type, and education. The analysis presents much evidence for demographic selection and socialization and less for adaptation or disruption. The persistence of the region of origin differentials points to the continuing importance of the context.adaptations, event history analysis, fertility, international migration, selection

Birth Spacing and Neonatal Mortality in India: Dynamics, Frailty and Fecundity

fertility;birth spacing;childhood mortality;health;dynamic panel data models;siblings

Birth Spacing and Neonatal Mortality in India: Dynamics, Frailty and Fecundity

A dynamic panel data model of neonatal mortality and birth spacing is analyzed, accounting for causal effects of birth spacing on subsequent mortality and of mortality on the next birth interval, while controlling for unobserved heterogeneity in mortality (frailty) and birth spacing (fecundity). The model is estimated using micro data on about 30000 children of 7000 Indian mothers, for whom a complete retrospective record of fertility and child mortality is available. Information on sterilization is used to identify an equation for completion of family formation that is needed to account for right-censoring in the data. We find clear evidence of frailty, fecundity, and causal effects of birth spacing on mortality and vice versa, but find that birth interval effects can explain only a limited share of the correlation between neonatal mortality of successive children in a family.fertility, birth spacing, childhood mortality, health, dynamic panel data models, siblings.

Sibling-Linked Data in the Demographic and Health Surveys

This paper highlights an aspect of the enormous and little-exploited potential of the Demographic and Health Surveys, namely the use of data on siblings. Such data can be used to control for family-level unobserved heterogeneity that might confound the relationship of interest and to study correlations in sibling outcomes. These uses are illustrated with examples. The paper ends with a discussion of potential problems associated with the sibling data being derived from retrospective fertility histories of mothers.siblings, unobserved heterogeneity, retrospective fertility histories, state dependence, DHS, India.

Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances.

Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65-84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing. Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health

Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners

<p>Abstract</p> <p>Background</p> <p>Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.</p> <p>Methods</p> <p>Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.</p> <p>Results</p> <p>Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.</p> <p>Conclusions</p> <p>The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.</p

Health outcomes for children born to teen mothers in Cape Town, South Africa

This paper analyzes the effect of being born to a teen mother on child health outcomes in South Africa using propensity score reweighting. Exploiting the longitudinal nature of the Cape Area Panel Study, we estimate the probability of being a teen mother conditional on pre-childbirth characteristics. We use this score to construct a weighted counterfactual group of children born to mothers over nineteen whose pre-childbirth characteristics are very similar to the teen mother sample except for their age at the birth of their first child. Our reweighted regressions indicate that being born to a teen mother has some significant adverse effects on child health, especially among Coloured children. In particular, children born to teens are more likely to be underweight at birth and to be stunted with the negative effect being double the size for Coloureds than Africans. No negative impact of teenage childbearing is found on head circumference at birth or the incidence of incomplete first year immunizations. These results remain robust even when we simulate influential unobservable effects in both the reweighting equation and the outcome equation.

The complementarity of MDG achievements : the case of child mortality in Sub-Saharan Africa

This paper analyzes complementarities between different Millennium Development Goals, focusing on child mortality and how it is influenced by progress in the other goals, in particular two goals related to the expansion of female education: universal primary education and gender equality in education. The authors provide evidence from eight Sub-Saharan African countries using two rounds of Demographic and Health Surveys per country and applying a consistent micro-econometric methodology. In contrast to the mixed findings of previous studies, for most countries the findings reveal strong complementarities between mothers’ educational achievement and child mortality. Mothers’ schooling lifts important demand-side constraints impeding the use of health services. Children of mothers with primary education are much more likely to receive vaccines, a crucial proximate determinant of child survival. In addition, better educated mothers tend to have longer birth intervals, which again increase the chances of child survival. For the variables related to the other goals, for example wealth proxies and access to safe drinking water, the analysis fails to detect significant effects on child mortality, a finding that may be related to data limitations. Finally, the study carries out a set of illustrative simulations to assess the prospects of achieving a reduction by two-thirds in the under-five mortality rate. The findings indicate that some countries, which have been successful in the past, seem to have used their policy space for fast progress in child mortality, for example by extending vaccination coverage. This is the main reason why future achievements will be more difficult and explains why the authors have a fairly pessimistic outlook.Population Policies,Health Monitoring&Evaluation,Early Child and Children's Health,Early Childhood Development,Adolescent Health