Repeat pregnancy among urban adolescents: sociodemographic, family, and health factors

First-time adolescent mothers are at high risk for a repeat pregnancy. The present investigation, part of an ongoing longitudinal study, examined sociodemographic, family, and health factors associated with repeat Pregnancy in a clinic sample of urban, first-time adolescent mothers (ages 13 to 17 years). They were predominantly African-American and from low-income households. Repeat pregnancy within one year and between one and two years postpartum was determined from medical records. Summary statistics, point biserial correlations, and chi-square statistics were used to analyze the data. Results indicated that postpartum contraceptive method was associated with repeat pregnancy at Year 1; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were associated with repeat pregnancy at Year 2. It was concluded that efforts to prevent repeat pregnancies among first-time adolescent mothers should include the continuous monitoring of contraceptive use, as well as the promotion of long-acting contraceptives (e.g., medroxyprogesterone or progesterone implants). Further, counseling should be offered to adolescent mothers with a history offered miscarriages

A Comparison of Recruitment Strategies for a Long-Term Study at Two Maternal Stages: Effectiveness of Recruitment During Pregnancy vs. After Childbirth

Introduction. National Children’s Study (NCS) Provider Based Sampling (PBS) aims to conduct a pilot study to test cost, acceptability and feasibility of recruiting a representative sample of women/children using two recruitment strategies: through prenatal providers and hospitals. Methods. A sampling frame consisting of all providers of prenatal and delivery care within and 10-miles outside Worcester County, 16 provider and 3 hospital locations were selected as point of entry for study recruitment. During 1st prenatal care visits or post-delivery at these locations, face-to-face contact was utilized to: a) identify study eligibility and b) assess study recruitment. Preliminary Results. Certified Data Collectors made contact with prescreened women. Consent rates of women at prenatal provider locations were lower than the consent rates in hospital locations. On average, results have shown twice as many consents could be obtained per day at hospital locations than at provider locations. Preliminary Conclusions. Although both strategies utilized direct rapport, the two recruitment methods were associated with different consent rates. Consideration of preliminary results may lead one to consider recruitment after childbirth for several reasons: 1) greater likelihood of having opportunity to discuss study with the woman and partner from outset; 2) opportunity to check back with undecided women easily 3) longer periods to answer questions and conduct screening and consent; 4) support of nursing staff to foster participation; 5) daily presence of NCS staff; and 6) reality of infant’s birth to spur mother to consent. Recruitment during pregnancy visits may yield lower rates; further examination may be necessary to overcome challenges such as: 1) burden of adding recruitment session to often long and anxiety-laden1st prenatal visit; 2) need to develop rapport quickly during brief time periods; 3) making contact with potential participants outside of provider office when recruitment is not completed

Framing Hospital Engagement for the Recruitment of a Birth Cohort for the NCS: Lessons Learned for Ensuring Collaboration in Worcester County

In 2011, three designated NCS Study Centers began preparatory work for field implementation of a planned recruitment strategy called Provider Based Sampling (PBS). In each PBS primary sampling unit, three hospitals were selected to test the feasibility of recruiting a cohort of 125 women and their babies around delivery time. The selected hospitals for Worcester account for nearly 80% of County births and can be categorized into three distinct facility types and patient catchment areas: an academic medical center; a university-affiliated but independent community hospital; and a private for-profit community hospital with market share competitor of the academic medical center. Methods: We used tailored negotiations and engagement strategies to gain the cooperation and engagement of targeted hospitals/birthing centers. Preliminary Conclusions: The lessons learned from this exercise are:• Time to gain hospital engagement and clearance to initiate study activities ranges anywhere from 2 weeks to 2 months and depends largely upon the type of the institution, the profile of the Negotiator, and the nature of the scope of work.• A greater likelihood of hospital engagement in the NCS seems to be associated with the depth of existing relationships between the Study Center and targeted hospitals.• Thoughtful interactions and timely discussions with the key institutional stakeholders (either individually or in groups) are important to achieve collaboration and engagement.• Balancing sensitivity to clinical cultures and settings while preserving research integrity is essential for study implementation in busy hospital/clinical environments.• Planning for site compensation and/or the ability to support local clerical staff to help with study activities must be considered as a means to facilitate negotiations and site engagement.• Adequate resources must be planned for successful implementation and execution of research activities in settings (e.g community hospitals) unfamiliar with research activities.• Involvement of nursing personnel is crucial for successful implementation of any protocol

Assessment of Parental Mental Disorders in the National Children’s Study (NCS)

Introduction: Parental mental disorders are powerful risk factors for children’s behavioral and mental disorders, making it critical to obtain estimates of parental mental disorders in NCS baseline assessments. These disorders are usually clinically assessed and diagnosed using lengthy interview instruments. This study will validate a brief set of mental health screens against the gold-standard Composite International Diagnostic Interview (CIDI). Methods: Sample: Up to 1200 English-speaking pregnant women and their male partners, aged \u3e17 with over-sampling of racial and ethnic minorities. Instruments: A brief 25-minute set of REDCap based screening scales will be administered. Probability sub-samples of 450-600 respondents with or without DSM-IV diagnoses will be selected for clinical reappraisal using the CIDI. Patients without DSM-IV diagnoses but with subsyndromal disorders will be used to optimize the sensitivity and specificity of screening scales. Diagnostic Assessment: Major depression, bipolar spectrum disorders, generalized anxiety, panic, post-traumatic stress, and substance abuse will be assessed. Analytic Methods: Kappa statistics, Receiver Operating Curve and regression methods will be used to evaluate concordance between diagnoses from screening scales and the CIDI at the aggregate and individual levels. Sensitivity and specificity will be reported for the cohort and separately for mothers and fathers as well as racial and ethnic minorities. Significance: This is the largest investigation of the epidemiology of mental disorders in a representative sample of community based pregnant mothers and their male partners. Information will be used to study the importance of parental psychopathology in the emergence of mental disorders in children over 21 years of follow-up of the parents and their children

Vulnerability-Based Spatial Sampling Stratification for the National Children\u27s Study, Worcester County, Massachusetts: Capturing Health-Relevant Environmental and Sociodemographic Variability

Background: The National Children\u27s Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of \u3e 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits. Worcester County, Massachusetts, like other sites, stratifies according to local conditions and local knowledge, subject to probability sampling rules.Objectives: We answer the following questions: How do we divide Worcester County into viable strata that represent its health-relevant environmental and sociodemographic heterogeneity, subject to sampling rules? What potential does our approach have to inform stratification at other sites?Results: We developed a multivariable, vulnerability-based method for spatial sampling consisting of two descriptive indices: a hazards/stressors exposure index (comprising three proxy variables), and an adaptive capacity/sociodemographic character index (five variables). Multivariable, health-relevant stratification at the start of the study may improve detection power for environment-child health associations down the line. Eighteen strata capture countywide heterogeneity in the indices and have optimal relative homogeneity within each. They achieve comparable expected birth counts and conform to local concepts of space. Conclusion: The approach offers moderate to high potential to inform other sites, limited by intersite differences in data availability, geodemographics, and technical capacity. Energetic community engagement from the start promotes local stratification coherence, plus vital researcher-community trust and co-ownership for sustainability

Adolescent Medicine at the Crossroads: A Review of Fellowship Training and Recommendations for Reform

This report examines the current state of adolescent medicine fellowship programs -- including the supply and recruitment of fellows; the nature and content of clinical, research, and leadership training; and the institutional and financial challenges facing training programs today -- and offers recommendations for building the field. The report is based on findings from the first comprehensive national survey of adolescent medicine fellowship program directors, conducted in the spring of 2007 by Incenter Strategies. The document also presents selected findings from two other Incenter Strategies’ surveys conducted in 2007: one of pediatric residency program directors and the other of adolescent medicine faculty responsible for the one-month pediatric residency rotation. In addition, the report presents findings from key informant interviews and an extensive literature review

Vulnerability-based spatial sampling stratification for the National Children\u27s Study, Worcester County, Massachusetts: capturing health-relevant environmental and sociodemographic variability

BACKGROUND: The National Children\u27s Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of \u3e 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits. Worcester County, Massachusetts, like other sites, stratifies according to local conditions and local knowledge, subject to probability sampling rules. OBJECTIVES: We answer the following questions: How do we divide Worcester County into viable strata that represent its health-relevant environmental and sociodemographic heterogeneity, subject to sampling rules? What potential does our approach have to inform stratification at other sites? RESULTS: We developed a multivariable, vulnerability-based method for spatial sampling consisting of two descriptive indices: a hazards/stressors exposure index (comprising three proxy variables), and an adaptive capacity/sociodemographic character index (five variables). Multivariable, health-relevant stratification at the start of the study may improve detection power for environment-child health associations down the line. Eighteen strata capture countywide heterogeneity in the indices and have optimal relative homogeneity within each. They achieve comparable expected birth counts and conform to local concepts of space. CONCLUSION: The approach offers moderate to high potential to inform other sites, limited by intersite differences in data availability, geodemographics, and technical capacity. Energetic community engagement from the start promotes local stratification coherence, plus vital researcher-community trust and co-ownership for sustainability

The importance of weather and climate to energy systems: a workshop on next generation challenges in energy-climate modelling

Over 80 international participants, representing weather, climate, and energy systems research, joined two 4-hour remote sessions to highlight and prioritize ongoing and future challenges in energy-climate modelling. The workshop had two primary goals: to build a deeper engagement across the “energy” and “climate” research communities, and to identify and begin to address the scientific challenges associated with modelling climate risk in energy systems

Chlamydia trachomatis Infection and Anti-Hsp60 Immunity: The Two Sides of the Coin

Chlamydia trachomatis (CT) infection is one of the most common causes of reproductive tract diseases and infertility. CT-Hsp60 is synthesized during infection and is released in the bloodstream. As a consequence, immune cells will produce anti-CT-Hsp60 antibodies. Hsp60, a ubiquitous and evolutionarily conserved chaperonin, is normally sequestered inside the cell, particularly into mitochondria. However, upon cell stress, as well as during carcinogenesis, the chaperonin becomes exposed on the cell surface (sf-Hsp60) and/or is secreted from cells into the extracellular space and circulation. Reports in the literature on circulating Hsp and anti-Hsp antibodies are in many cases short on details about Hsp60 concentrations, and about the specificity spectra of the antibodies, their titers, and their true, direct, pathogenetic effects. Thus, more studies are still needed to obtain a definitive picture on these matters. Nevertheless, the information already available indicates that the concurrence of persistent CT infection and appearance of sf-Hsp60 can promote an autoimmune aggression towards stressed cells and the development of diseases such as autoimmune arthritis, multiple sclerosis, atherosclerosis, vasculitis, diabetes, and thyroiditis, among others. At the same time, immunocomplexes composed of anti-CT-Hsp60 antibodies and circulating Hsp60 (both CT and human) may form deposits in several anatomical locations, e.g., at the glomerular basal membrane. The opposite side of the coin is that pre-tumor and tumor cells with sf-Hsp60 can be destroyed with participation of the anti-Hsp60 antibody, thus stopping cancer progression before it is even noticed by the patient or physician