Comparison of dental topography of marmosets and tamarins (Callitrichidae) to other platyrrhine primates using a novel freeware pipeline

Dental topographic metrics (DTMs), which quantify different aspects of the shape of teeth, are powerful tools for studying dietary adaptation and evolution in mammals. Current DTM protocols usually rely on proprietary software, which may be unavailable to researchers for reasons of cost. We address this issue in the context of a DTM analysis of the primate clade Platyrrhini (“New World monkeys”) by: 1) presenting a large comparative sample of scanned second lower molars (m2s) of callitrichids (marmosets and tamarins), previously underrepresented in publicly available datasets; and 2) giving full details of an entirely freeware pipeline for DTM analysis and its validation. We also present an updated dietary classification scheme for extant platyrrhines, based on cluster analysis of dietary data extracted from 98 primary studies. Our freeware pipeline performs equally well in dietary classification accuracy of an existing sample of platyrrhine m2s (excluding callitrichids) as a published protocol that uses proprietary software when multiple DTMs are combined. Individual DTMs, however, sometimes showed very different results in classification accuracies between protocols, most likely due to differences in smoothing functions. The addition of callitrichids resulted in high classification accuracy in predicting diet with combined DTMs, although accuracy was considerably higher when molar size was included (90%) than excluded (73%). We conclude that our new freeware DTM pipeline is capable of accurately predicting diet in platyrrhines based on tooth shape and size, and so is suitable for inferring probable diet of taxa for which direct dietary information is unavailable, such as fossil species

Identifying Opportunities to Improve the Integration of Sexual and Reproductive Health Services into Primary Care: Qualitative and Quantitative Approaches

Objectives: Unintended pregnancy is endemic in the United States. Primary care physicians (PCPs) are optimally positioned within the health care system to improve the prevention and management of unintended pregnancy by offering comprehensive contraception and abortion care. Factors at the individual, health center, health systems, and policy levels may influence whether PCPs offer these services. Current practice, knowledge, and attitudes about contraception and abortion among PCPs are poorly understood. This investigation fills these gaps using original quantitative and qualitative data. Methods: This mixed-methods investigation included: 1) a quantitative survey querying a national probability sample of practicing PCPs about contraception, abortion, and other sexual and reproductive health services; 2) a qualitative investigation of determinants of provision of long-acting reversible contraception (LARC) in community health centers (CHCs) through focus group discussions. We applied case weights to survey responses and generated population estimates of current and lifetime abortion provision and current provision of contraceptive methods. Logistic regression modeling identified factors associated with abortion and LARC provision. Qualitative data were coded inductively by multiple investigators using an iterative consensus-based method. Results: Factors at the health systems and health center levels influence provision of abortion and contraception in primary care. In the survey data, the strongest correlate of having received training in, endorsing training in, or reporting current provision of abortion and all contraceptive methods was residency training in family medicine, as compared to general internal medicine or other residency. PCPs generally support residency training in abortion and contraception. The primary reported barriers to abortion provision were lack of training and resources. Prior training, practice type, and health systems-level factors were associated with provision of abortion and contraception; most physician demographics were not. In the qualitative investigation, insurance issues, device stocking, and scheduling of LARC method placement emerged as primary influences on the pathway to care for women seeking these methods. Conclusions: PCPs are receptive to contraception and abortion training and service provision. Efforts to support delivery of these services could include enhanced clinical training and interventions at the health center and health systems levels to ensure access to requisite resources

Relationship Of Job Role And Clinic Type To Perceived Stigma And Occupational Stress Among Abortion Workers

Objective: To describe the role of worksite characteristics, job role and abortion stigma in clinical abortion workers’ occupational stress. Study design: We recruited nurses, medical assistants and counseling staff who provide abortion care at five hospitals and four freestanding clinics in Massachusetts. Study instruments assessed individual-level abortion stigma (the perception that others treat abortion as shameful, dirty and socially taboo) using the Abortion Providers Stigma Scale; job strain through the Job Content Questionnaire; and emotional burnout through the Depersonalization, Emotional Exhaustion and Personal Accomplishment subscales of the Maslach Burnout Inventory. Multivariable linear and logistic regression modeling tested for associations between job role, worksite type, stigma, job strain and burnout, accounting for demographic and job characteristics. Results: Of 205 eligible workers, 136 participated (66%). Forty-one percent were medical assistants, 50% nurses, and 9% counselors. In adjusted models, abortion workers with high stigma had increased odds of experiencing job strain [adjusted odds ratio (aOR) 3.94, 95% CI 1.19–13.05]. Compared to working in a freestanding clinic, working in a hospital was associated with lower odds of experiencing the low personal accomplishment dimension of burnout (aOR 0.49, 95% CI 0.29–0.84) and lower odds of experiencing the depersonalization dimension of burnout (aOR 0.05, 95% CI 0.01–0.28). Counselors had higher odds of depersonalization compared to nurses (aOR 4.56, 95% CI 2.3–9.0). Conclusion: Hospital-based abortion workers experience lower risk for burnout than comparable workers in freestanding clinics, accounting for abortion stigma and job characteristics. Implications: Implementing structured supports to alter workflows or improve coping among workers in freestanding abortion clinics may help mitigate risk of worker burnout and associated turnover

High-risk sexual behaviors while on depot medroxyprogesterone acetate as compared to oral contraception

Abstract Background Depot medroxyprogesterone acetate (DMPA) contraceptive use is associated with an increased risk for Chlamydia infection. However, prior studies inadequately account for potential differences in sexual behavior between users of DMPA and users of other contraceptive methods. In this study we compare sexual risk-taking behavior in women using DMPA to women using oral contraceptive pills (OCP) to assess risk of Chlamydia trachomatis infection. Methods In this cross-sectional study of 630 reproductive-aged women seeking routine gynecologic care (449 OCP and 181 DMPA users) sexual risk-taking was evaluated by use of the Safe Sex Behavior Questionnaire, a validated measure of sexual behaviors and attitudes. All women were screened for Chlamydia . Logistic regression estimated the association of contraceptive choice, sexual behaviors, and Chlamydia infection. Results Oral contraceptive pill users differed from DMPA users in age, race, marital status, education level, and pregnancy history ( p -values all <0.05). Oral contraceptive pill users had used their method of contraception for longer average duration ( p \u2009<\u20090.01) and reported greater frequency of condom use ( p \u2009<\u20090.01). Eleven (2.5%) OCP and 2 (1.1%) DMPA users had Chlamydia ( p \u2009=\u2009NS). Conclusions Oral contraceptive pill and DMPA users differed with respect to both demographic factors and frequency of condom use. Odds of current Chlamydia infection did not differ between OCP and DMPA users when controlling for sexual risk-taking or demographic factors, though due to low Chlamydia rates in our population, this study was underpowered to detect this difference

“We're called upon to be nonjudgmental”: A qualitative exploration of United States medical students’ discussions of abortion as a reflection of their professionalism

ObjectivesMedical educators may assess learners' professionalism through clinical scenarios eliciting value conflicts - situations in which an individual's values differ from others' perceived values. We examined the extent to which United States (US) medical students' discussion of abortion highlights their professionalism according to the 6 American Association of Medical Colleges (AAMC) professionalism competencies.Study designWe conducted anonymous, semistructured qualitative interviews with 74 US medical students applying to OB/GYN residency. Interviews explored attitudes toward abortion and abortion case vignettes. We analyzed interview transcripts using directed content analysis for alignment with the AAMC professionalism competencies: humanism, patient needs superseding self-interest, patient autonomy, physician accountability, sensitivity to diverse populations, and commitment to ethical principles.ResultsStudents' genders, races, religions, and geographic regions were diverse. Attitudes toward abortion varied, but all students commented on themes related to at least 1 AAMC professionalism competency when discussing abortion care. Statements demonstrating students' humanism, prioritization of patient autonomy, and sense of physician accountability were common. Most comments reflected positive professionalism practices, regardless of personal views on abortion or provision intentions; very few students made statements that were not aligned with the AAMC professionalism competencies.ConclusionsAll students in this study exhibited professionalism when discussing abortion, regardless of personal views on abortion or intention to provide this care. Case-based discussions involving abortion could be used to explore professionalism competencies among medical learners.ImplicationsDiscussing abortion has the potential to elicit values conflict, which enables learners to exhibit professionalism. Case-based abortion education should be included in medical school curricula to measure medical professionalism in future physicians, and to serve as a tool for teaching professionalism in medical school

Comparison of dental topography of marmosets and tamarins (Callitrichidae) to other platyrrhine primates using a novel freeware pipeline

Dental topographic metrics (DTMs), which quantify different aspects of the shape of teeth, are powerful tools for studying dietary adaptation and evolution in mammals. However, comparative samples of scanned mammal teeth suitable for analysis with DTMs remain limited in size and scope, with little or no representation of some major lineages, even within well-studied clades such as primates. In addition, current DTM protocols usually rely on proprietary software, which may be unavailable to many researchers for reasons of cost. We address these issues in the context of a DTM analysis of the primate clade Platyrrhini (“New World monkeys”) by: 1) presenting a large comparative sample of scanned second lower molars (m2s) of callitrichids (marmosets and tamarins), which were previously underrepresented in publicly available platyrrhine datasets; and 2) giving full details of an entirely freeware pipeline for DTM analysis. We also present an updated discrete dietary classification scheme for extant platyrrhines, based on cluster analysis of dietary data extracted from 98 primary studies. Our freeware pipeline performs equally well in dietary classification accuracy of an existing sample of platyrrhine m2s (excluding callitrichids) as a published protocol that uses proprietary software, at least when multiple DTMs are combined. Individual DTMs however, sometimes showed very different results in classification accuracies between that of our freeware pipeline and that of the proprietary protocol, most likely due to the differences in the smoothing functions used. The addition of callitrichids still resulted in high classification accuracy in predicting diet with combined DTMs, although accuracy was considerably higher when molar size was included (90%) than excluded (73%). We conclude that our new freeware DTM pipeline is capable of accurately predicting diet in platyrrhines based on tooth shape and size, and so is suitable for inferring probable diet of taxa for which direct dietary information is unavailable, such as fossil species

Contraceptive content shared on social media: an analysis of Twitter

Abstract Background Information on social media may affect peoples’ contraceptive decision making. We performed an exploratory analysis of contraceptive content on Twitter (recently renamed X), a popular social media platform. Methods We selected a random subset of 1% of publicly available, English-language tweets related to reversible, prescription contraceptive methods posted between January 2014 and December 2019. We oversampled tweets for the contraceptive patch to ensure at least 200 tweets per method. To create the codebook, we identified common themes specific to tweet content topics, tweet sources, and tweets soliciting information or providing advice. All posts were coded by two team members, and differences were adjudicated by a third reviewer. Descriptive analyses were reported with accompanying qualitative findings. Results During the study period, 457,369 tweets about reversible contraceptive methods were published, with a random sample of 4,434 tweets used for final analysis. Tweets most frequently discussed contraceptive method decision-making (26.7%) and side effects (20.5%), particularly for long-acting reversible contraceptive methods and the depot medroxyprogesterone acetate shot. Tweets about logistics of use or adherence were common for short-acting reversible contraceptives. Tweets were frequently posted by contraceptive consumers (50.6%). A small proportion of tweets explicitly requested information (6.2%) or provided advice (4.2%). Conclusions Clinicians should be aware that individuals are exposed to information through Twitter that may affect contraceptive perceptions and decision making, particularly regarding long-acting reversible contraceptives. Social media is a valuable source for studying contraceptive beliefs missing in traditional health research and may be used by professionals to disseminate accurate contraceptive information