Confidentiality, insurance, and provider-based barriers to sexual and reproductive health services

This dissertation consists of three studies that examine barriers to sexual and reproductive health care among commercially insured young adults and women. Study 1 investigates differences in insurance use behavior for confidential SRH care by young adults with parental versus policyholder coverage. Findings demonstrate that individuals with parental insurance coverage are less likely than their counterparts with policyholder coverage to use their insurance to pay for pap testing, contraception, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Study 2 builds on this work to evaluate the role of the national dependent coverage expansion on insurance use for sexual and reproductive health services. Findings demonstrate an aggregate reduction in insurance use for pap testing, contraception, and STI testing among young adult women newly eligible for parental coverage under the expansion. Study 3 examines prevalence and trends in non-indicated pelvic examinations performed during contraceptive visits, along with variations by provider specialty and patient age. Results show a substantial increase in the number of pelvic examinations performed during contraceptive encounters from 2007 – 2017, and higher rates of non-indicated exams performed by obstetrician-gynecologists. Together, this research provides evidence of barriers to sexual and reproductive health care among commercially insured young adults and women, highlighting ongoing issues of patient privacy and autonomy in health care financing and service delivery.2022-05-14T00:00:00

Parental attitudes toward disclosure of the mode of conception to their child conceived by in vitro fertilization

OBJECTIVES: To survey the level of disclosure of conception method within families of children conceived using conventional IVF or ICSI and to examine the factors that may influence parental attitudes and plans for disclosure. DESIGN: An in-depth questionnaire. SETTING: Participants recruited through UK fertility clinics. PATIENTS: Parents of IVF/ICSI children aged 5-6 years (n=181, 51%). INTERVENTION: Mothers and fathers of IVF/ICSI children were sent questionnaires to complete and return in a reply paid envelope. MAIN OUTCOME MEASURES: Completion of the questionnaire. RESULTS: Most parents had told somebody about their child’s method of conception, mostly close friends and family. Fewer (26% mothers/17% fathers) had already discussed the child’s mode of conception with their child. 58% mothers/57% fathers intended to tell their child at some point. 16% mothers/21% fathers were undecided. 4% fathers never wanted to discuss the subject with their child. Children were more likely to be told if conception was ICSI, rather than conventional IVF, and if an only child. 29% undecided fathers and 36% undecided mothers stated that they would tell their child if appropriate child-friendly explanatory literature was available. CONCLUSIONS: The majority of parents wish to tell their child at some point but are unsure about the most appropriate timing and method of disclosure. Fertility clinics may have a role in providing the necessary support. Child-friendly literature may be helpful

Loss of foundation species revisited: conceptual framework with lessons learned from eastern hemlock and whitebark pine

Ecologists and conservation biologists often prioritize the study of species that are declining, threatened, or endangered over species that are abundant and ecologically important, such as foundation species (FS ). Because entire ecosystems and their biodiversity depend on FS , we argue that they have high conservation priority. A citation analysis reveals that FS are studied, but often are characterized ambiguously. More effort is needed to identify FS before they, and the ecosystems they define, are at risk of decline or loss. We suggest a new conceptual framework that includes: informed identification of FS in ecosystems; documentation of ecosystem services provided by FS ; a long‐term monitoring strategy to detect threats to FS within specified ecosystems; and, if threats are identified, a comprehensive conservation and adaptive management strategy for FS . We use two widely distributed, rapidly declining North American foundation tree species (Tsuga canadensis [eastern hemlock] and Pinus albicaulis [whitebark pine]) to illustrate this framework. These species exemplify the importance of identifying FS early and conserving or restoring them when they are threatened

Health and support service needs of individuals with disability from culturally and linguistically diverse backgrounds : a scoping review protocol

Background: All individuals should have the right to engage meaningfully in occupations that meet their aspirations and life goals as well as promote their health and well-being. For individuals with disability, meaningful engagement in occupations is supported by timely, effective, and adaptive health and support services. However, research has revealed multiple barriers preventing utilization of these services by individuals with disability from culturally and linguistically diverse (CALD) backgrounds. This review aims to identify gaps and solutions in health and support services of individuals with disability from CALD backgrounds to meaningfully engage in occupations. Methods: A scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A detailed search strategy will be used to search CINAHL, PubMed, Embase, Scopus, PsycInfo, JBI, and Cochrane Library, as well as grey literature in Trove, Mednar, and OpenGrey from January 1974 onwards. Two reviewers will independently screen all citations and full-text articles for eligibility against specific inclusion and exclusion criteria. Potential conflicts will be resolved through discussion. Data will be extracted and presented in a diagrammatic or tabular form accompanied by a narrative summary. Discussion: The scoping review will present the health and support service needs of individuals with disability from CALD backgrounds and will extend the current reviews as it focuses the engagement in meaningful occupation. Findings from this review have the potential to inform local policy discussions and practice-based disability care. Systematic review registration: Open Science Framework (10.17605/OSF.IO/HW2FB)

A novel retinoblastoma therapy from genomic and epigenetic analyses.

Retinoblastoma is an aggressive childhood cancer of the developing retina that is initiated by the biallelic loss of RB1. Tumours progress very quickly following RB1 inactivation but the underlying mechanism is not known. Here we show that the retinoblastoma genome is stable, but that multiple cancer pathways can be epigenetically deregulated. To identify the mutations that cooperate with RB1 loss, we performed whole-genome sequencing of retinoblastomas. The overall mutational rate was very low; RB1 was the only known cancer gene mutated. We then evaluated the role of RB1 in genome stability and considered non-genetic mechanisms of cancer pathway deregulation. For example, the proto-oncogene SYK is upregulated in retinoblastoma and is required for tumour cell survival. Targeting SYK with a small-molecule inhibitor induced retinoblastoma tumour cell death in vitro and in vivo. Thus, retinoblastomas may develop quickly as a result of the epigenetic deregulation of key cancer pathways as a direct or indirect result of RB1 loss

Bodyweight Perceptions among Texas Women: The Effects of Religion, Race/Ethnicity, and Citizenship Status

Despite previous work exploring linkages between religious participation and health, little research has looked at the role of religion in affecting bodyweight perceptions. Using the theoretical model developed by Levin et al. (Sociol Q 36(1):157–173, 1995) on the multidimensionality of religious participation, we develop several hypotheses and test them by using data from the 2004 Survey of Texas Adults. We estimate multinomial logistic regression models to determine the relative risk of women perceiving themselves as overweight. Results indicate that religious attendance lowers risk of women perceiving themselves as very overweight. Citizenship status was an important factor for Latinas, with noncitizens being less likely to see themselves as overweight. We also test interaction effects between religion and race. Religious attendance and prayer have a moderating effect among Latina non-citizens so that among these women, attendance and prayer intensify perceptions of feeling less overweight when compared to their white counterparts. Among African American women, the effect of increased church attendance leads to perceptions of being overweight. Prayer is also a correlate of overweight perceptions but only among African American women. We close with a discussion that highlights key implications from our findings, note study limitations, and several promising avenues for future research

Integrated Genomics Identifies Five Medulloblastoma Subtypes with Distinct Genetic Profiles, Pathway Signatures and Clinicopathological Features

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. Despite recent improvements in cure rates, prediction of disease outcome remains a major challenge and survivors suffer from serious therapy-related side-effects. Recent data showed that patients with WNT-activated tumors have a favorable prognosis, suggesting that these patients could be treated less intensively, thereby reducing the side-effects. This illustrates the potential benefits of a robust classification of medulloblastoma patients and a detailed knowledge of associated biological mechanisms. METHODS AND FINDINGS: To get a better insight into the molecular biology of medulloblastoma we established mRNA expression profiles of 62 medulloblastomas and analyzed 52 of them also by comparative genomic hybridization (CGH) arrays. Five molecular subtypes were identified, characterized by WNT signaling (A; 9 cases), SHH signaling (B; 15 cases), expression of neuronal differentiation genes (C and D; 16 and 11 cases, respectively) or photoreceptor genes (D and E; both 11 cases). Mutations in beta-catenin were identified in all 9 type A tumors, but not in any other tumor. PTCH1 mutations were exclusively identified in type B tumors. CGH analysis identified several fully or partly subtype-specific chromosomal aberrations. Monosomy of chromosome 6 occurred only in type A tumors, loss of 9q mostly occurred in type B tumors, whereas chromosome 17 aberrations, most common in medulloblastoma, were strongly associated with type C or D tumors. Loss of the inactivated X-chromosome was highly specific for female cases of type C, D and E tumors. Gene expression levels faithfully reflected the chromosomal copy number changes. Clinicopathological features significantly different between the 5 subtypes included metastatic disease and age at diagnosis and histology. Metastatic disease at diagnosis was significantly associated with subtypes C and D and most strongly with subtype E. Patients below 3 yrs of age had type B, D, or E tumors. Type B included most desmoplastic cases. We validated and confirmed the molecular subtypes and their associated clinicopathological features with expression data from a second independent series of 46 medulloblastomas. CONCLUSIONS: The new medulloblastoma classification presented in this study will greatly enhance the understanding of this heterogeneous disease. It will enable a better selection and evaluation of patients in clinical trials, and it will support the development of new molecular targeted therapies. Ultimately, our results may lead to more individualized therapies with improved cure rates and a better quality of life

Testate amoebae in pollen slides

Among the non-pollen micro-fossils commonly encountered in Quaternary sediment samples prepared for pollen analysis are many shells of testate amoebae. Testate amoebae are eukaryotic micro-organisms which are increasingly used in ecological and palaeoecological studies, particularly as indicators of hydrological change in Sphagnum-dominated peatlands. In this study we address the extent to which testate amoebae are used in palynological research, the key challenges to more widespread use, and the extent to which ecological information is retained in the testate amoeba assemblages of standard palynological slides. To achieve this we review the literature on the use of testate amoebae in palynology, compare testate amoeba records produced by palynological and water-based preparation methods and carry out simulations using previously-derived datasets. Our results show that testate amoebae are widely encountered in Quaternary palynological studies, primarily in peatlands, but the information which they can provide is undermined by limited taxonomic knowledge. Many taxa are destroyed in pollen preparations, but for taxa that are retained patterns of abundance parallel those determined using water-based preparation methods. Although the loss of sensitive taxa limits the ecological information contained in testate amoeba assemblages the information preserved is likely to be useful in a multiproxy approach to palaeoenvironmental reconstruction. To help improve taxonomic awareness and encourage the use of testate amoebae in palynology we present a basic introduction to testate amoeba taxonomy and a guide to the taxonomic literature