Reproductive health indicators: Moving forward

This report is designed to help researchers, program managers, policymakers, and advocates sift through and evaluate which potential indicators might be useful in a particular programmatic context. It was initially prepared as a background manuscript for a Population Council meeting on reproductive health indicators held in Cairo in March 1998. The manuscript has since been modified to incorporate ideas and comments expressed at that meeting, as well as to include input from other Population Council colleagues

The Problem of Unwelcome Epistemic Company

Many of us are unmoved when it is objected that some morally or intellectually suspect source agrees with our belief. While we may tend to find this kind of guilt by epistemic association unproblematic, I argue that this tendency is a mistake. We sometimes face what I call the problem of unwelcome epistemic company. This is the problem of encountering agreement about the content your belief from a source whose faults give you reason to worry about the belief’s truth, normative status, etiology, or implications. On the basis of an array of cases, I elaborate four distinct kinds of problems that unwelcome epistemic company poses. Two of these are distinctly epistemic, and two are moral. I canvass possible responses, ranging from stubbornness to an epistemic prudishness that avoids unwelcome company at all costs. Finally, I offer preliminary lessons of the problem and distinguish it from the problem of peer disagreement

Opinion: Ensure access to high-quality abortion care during and after the COVID-19 pandemic

As the COVID-19 pandemic continues to reshape our lives and health systems, Council Program Director Thoai Ngo and President of Ibis Reproductive Health Kelly Blanchard share their views on abortion care during these unprecedented times in an opinion piece for Thomson Reuters Foundation News. Citing two new evidence reviews on women’s ability to manage abortions with safe and effective medicines during early pregnancy, the authors support self-managed abortion during—and after—this pandemic as a method that puts less strain on health systems and allows women access who might be hampered by isolation and distancing mandated in response to COVID-19

Mutual information between geomagnetic indices and the solar wind as seen by WIND : implications for propagation time estimates

The determination of delay times of solar wind conditions at the sunward libration point to effects on Earth is investigated using mutual information. This measures the amount of information shared between two timeseries. We consider the mutual information content of solar wind observations, from WIND, and the geomagnetic indices. The success of five commonly used schemes for estimating interplanetary propagation times is examined. Propagation assuming a fixed plane normal at 45 degrees to the GSE x-axis (i.e. the Parker Spiral estimate) is found to give optimal mutual information. The mutual information depends on the point in space chosen as the target for the propagation estimate, and we find that it is maximized by choosing a point in the nightside rather than dayside magnetosphere. In addition, we employ recurrence plot analysis to visualize contributions to the mutual information, this suggests that it appears on timescales of hours rather than minutes

Review of UK microgeneration. Part 1 : policy and behavioural aspects

A critical review of the literature relating to government policy and behavioural aspects relevant to the uptake and application of microgeneration in the UK is presented. Given the current policy context aspiring to zero-carbon new homes by 2016 and a variety of minimum standards and financial policy instruments supporting microgeneration in existing dwellings, it appears that this class of technologies could make a significant contribution to UK energy supply and low-carbon buildings in the future. Indeed, achievement of a reduction in greenhouse gas emissions by 80% (the UK government's 2050 target) for the residential sector may entail substantial deployment of microgeneration. Realisation of the large potential market for microgeneration relies on a variety of inter-related factors such as microeconomics, behavioural aspects, the structure of supporting policy instruments and well-informed technology development. This article explores these issues in terms of current and proposed policy instruments in the UK. Behavioural aspects associated with both initial uptake of the technology and after purchase are also considered

Incidence of sexually transmitted infections during pregnancy

Prevalence of sexually transmitted infections (STI) is high among pregnant women in certain settings. We estimated STI incidence and compared STI risk in pregnant and non-pregnant women. Data came from the Methods for Improving Reproductive Health in Africa (MIRA) study conducted in South Africa and Zimbabwe 2003–2006. Women aged 18–50 years with at least one follow-up visit within 6 months of enrollment were included. Follow-up visits included laboratory testing for pregnancy, chlamydia, gonorrhea, trichomoniasis, and HIV, as well as self-report of hormonal contraceptive (HC) use, sexual behaviors and intravaginal practices. All visits were classified according to pregnancy status. Incidence of each STI was calculated using follow-up time. Cox proportional hazards models were fitted using pregnancy as a time-varying exposure and sexual behaviors and intravaginal practices as time-varying covariates. Among 4,549 women, 766 (16.8%) had a positive pregnancy test. Median follow-up time was 18 months [IQR: 12–24]. The overall incidence rate of chlamydia was 6.7 per 100 person years (py) and 9.9/100py during pregnancy; gonorrhea incidence was 2.7/100py and 4.9/100py during pregnancy; trichomoniasis incidence was 7.1/100py overall and 9.2/100py during pregnancy. Overall HIV incidence was 3.9/100py and 3.8/100py during pregnancy. In crude models, pregnancy increased risk for chlamydia (hazard ratio (HR) 1.5, 95%CI: 1.1–1.2), however there was no increased risk of any measured STI in adjusted models. STI Incidence was high during pregnancy however pregnancy did not increase STI risk after adjustment for sexual behaviors. Greater efforts are needed to help pregnant women avoid STIs

A nationally representative survey of healthcare provider counselling and provision of the female condom in South Africa and Zimbabwe

Objectives: Female condoms are the only female-initiated HIV and pregnancy prevention technology currently available. We examined female condom counselling and provision among providers in South Africa and Zimbabwe, high HIV-prevalence countries. Design: A cross-sectional study using a nationally representative survey. Setting: All facilities that provide family planning or HIV/sexually transmitted infection (STI) services. Participants: National probability sample of 1444 nurses and physicians who provide family planning or HIV/STI services. Primary and secondary outcome measures Female condom practices with different female patients, including adolescents, married women, women using hormonal contraception and by HIV status. Using multivariable logistic analysis, we measured variations in condom counselling by provider characteristics. Results: Most providers reported offering female condoms (88%; 1239/1415), but perceived a need for novel female barrier methods for HIV/STI prevention (85%; 1191/1396). By patient type, providers reported less frequent female condom counselling of adolescents (55%; 775/1411), women using hormonal contraception (65%; 909/1409) and married women (66%; 931/1416), compared to unmarried (74%; 1043/1414) or HIV-positive women (82%; 1161/1415). Multivariable results showed providers in South Africa were less likely to counsel women on female condoms than in Zimbabwe (OR=0.48, 95% CI 0.35 to 0.68, p≤0.001). However, South African providers were more likely to counsel women on male condoms (OR=2.39, 95% CI 1.57 to 3.65, p≤0.001). Nurses counselled patients on female condoms more frequently than physicians (OR=5.41, 95% CI 3.26 to 8.98, p≤0.001). HIV training, family planning training, location (urban vs rural) and facility type (hospital vs clinic) were not associated with greater condom counselling. Conclusions: Female condoms were integrated into provider counselling and care, although providers reported a need for new female-initiated multipurpose prevention technologies, suggesting female condoms do not meet all patient/provider needs or are not adequately well known or accessible. Providers should be included in HIV training efforts to raise awareness of new and existing products, and encouraged to educate all women

Pneumocystis pneumonia, a COVID-19 mimic, reminds us of the importance of HIV testing in COVID-19

While clinical environments are highly focused on COVID-19, reports of missed or delayed treatment for conditions that imitate COVID-19, such as pneumonia caused by the fungus Pneumocystis jirovecii, are emerging. Given the uncertain spectrum of COVID-19 presentations and variable sensitivity of laboratory tests for SARS-CoV-2, there is a risk that, without a high index of suspicion, alternative aetiologies may be overlooked while pursuing a diagnosis of COVID-19. The British HIV Association has been calling for the inclusion of HIV testing in all patients admitted to hospital with suspected COVID-19. In this article we reflect on the importance of including HIV testing to prevent avoidable morbidity and mortality in our patients.Publisher PDFPeer reviewe

Draws and windfalls: Comparing patient experiences in inpatient telehealth and non-telehealth acute care units

The global COVID-19 pandemic has challenged health care delivery in many ways. One solution from the pandemic that offers potential upside is the expansion of telehealth as a means to provide high quality, cost-effective, and safe care while also maintaining excellence in patient and family experience. While most examinations of the use of telehealth over the pandemic have focused on the expansion of outpatient telehealth, few have explored the use of telehealth for hospitalized patients. This article will examine the influence of telehealth use on patient experiences among acute care patients. Inpatient telehealth acute care (ITAC) is a novel modality for hospitalized patients that enables providers to engage with a remote medical unit to ask questions regarding the care plan, medications, and discharge instructions. This case study will compare the experiences of two inpatient hospital units within the same institution to determine the degree to which patient experiences are influenced by telehealth capabilities. The results find that the telehealth unit has negligible differences in patient evaluations of provider communication but shows significant differences in patients’ experiences of staff responsiveness and the environmental aspects of care captured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey (quietness and cleanliness of care). Future scholarship should seek to determine the extent to which these capabilities influence nurses and other care providers. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age

In 2003, psychology professor and sex researcher J. Michael Bailey published a book entitled The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. The book’s portrayal of male-to-female (MTF) transsexualism, based on a theory developed by sexologist Ray Blanchard, outraged some transgender activists. They believed the book to be typical of much of the biomedical literature on transsexuality—oppressive in both tone and claims, insulting to their senses of self, and damaging to their public identities. Some saw the book as especially dangerous because it claimed to be based on rigorous science, was published by an imprint of the National Academy of Sciences, and argued that MTF sex changes are motivated primarily by erotic interests and not by the problem of having the gender identity common to one sex in the body of the other. Dissatisfied with the option of merely criticizing the book, a small number of transwomen (particularly Lynn Conway, Andrea James, and Deirdre McCloskey) worked to try to ruin Bailey. Using published and unpublished sources as well as original interviews, this essay traces the history of the backlash against Bailey and his book. It also provides a thorough exegesis of the book’s treatment of transsexuality and includes a comprehensive investigation of the merit of the charges made against Bailey that he had behaved unethically, immorally, and illegally in the production of his book. The essay closes with an epilogue that explores what has happened since 2003 to the central ideas and major players in the controversy