Sex, contraception, or abortion? Explaining class gaps in unintended childbearing

There are wide class gaps in unintended childbearing among single women in the United States, resulting from different contraceptive and abortion choices across income groups. In this paper, we use data from the National Survey of Family Growth (NSFG 2011-2013) to estimate how sexual activity, contraceptive use, and abortion use vary across income lines. Though rates of sexual activity are comparable for all women, low-income women are less likely to use contraception and are less likely to have an abortion once pregnant. We use a shift-share analysis to simulate the effect of equalizing, at the rates of affluent women, the use of the contraception and abortion services across income groups. We find that equalizing contraceptive use reduces the ratio of unintended births between affluent and poor women by half, and that equalizing abortion rates reduces the ratio by one-third

RELIABILITY OF PASSIVE LOWER LIMB FLEXIBILITY IN RUGBY SEVENS PLAYERS MEASURED WITH A NEW HAND HELD DYNAMOMETER: A PILOT STUDY

This study assessed the within-day reliability of five passive lower extremity flexibility measures using a unique hand held dynamometer (HHD) that simultaneously detects dynamic force applied via a force pad and alteration in orientation in space between start and end points of range of motion via a tilt sensor. Hip extensor flexibility in the passive straight leg raise, hip internal and external rotation and hip flexion in two Modified Thomas test positions were conducted on 21 elite male athletes from a rugby sevens training squad using the HHD. There was very good to excellent within-day reliability for the flexibility measures ICC 0.79-0.96 and standardised typical error 0.21-0.48. The HHD facilitated a consistent applied force across trials for each player helping to provide high within-day reliability for the flexibility measures

POTENTIAL INFLUENCE OF FOOTWEAR ON ANKLE INVERSION INJURY RISK DURING LATERAL JUMPS IN OLDER ADULTS

The purpose of this study was to explore the effect of footwear on the ankle inversion and plantar pressure experienced by older females performing change of direction tasks. Eight older female tennis players performed five lateral side jumps and five 180° turns in a running shoe and tennis shoe. Time of peak plantar pressure and peak ankle inversion angle were recorded. Individual differences revealed reduced magnitude and duration of rearfoot loading and increased forefoot loading of two participants in the running shoe compared to the tennis shoe when performing the lateral side jumps. Greater peak inversion angle was also recorded in the running shoe compared to the tennis shoe for these participants. While the cushioning properties of running shoes may be appealing for some older tennis players, wearing running shoes during tennis may increase the risk of incurring an ankle sprain

Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort

Objective To examine the hypothesis that risk of oesophageal, but not of gastric or colorectal, cancer is increased in users of oral bisphosphonates

Location-specific cutaneous electrical stimulation of the footsole modulates corticospinal excitability to the plantarflexors and dorsiflexors during standing

Non-noxious electrical stimulation to distinct locations of the foot sole evokes location-specific cutaneous reflex responses in lower limb muscles. These reflexes occur at latencies that may enable them to be mediated via a transcortical pathway. Corticospinal excitability to the plantarflexors and dorsiflexors was measured in 16 participants using motor evoked potentials (MEPs). Spinal excitability was measured in eight of the original participants using cervicomedullary motor evoked potentials (CMEPs). Measurements were collected with and without preceding cutaneous stimulus to either the heel (HEEL) or metatarsal (MET) locations of the foot sole, and evoked potentials were elicited to coincide with the arrival of the cutaneous volley at either the motor cortex or spinal cord. Plantarflexor MEPs and CMEPs were facilitated with cutaneous stimulation to the HEEL for MEPs (soleus p = 0.04, medial gastrocnemius (MG) p = 0.017) and CMEPs (soleus p = 0.047 and MG p = 0.015), but they were unchanged following MET stimulation for MEPs or CMEPs. Dorsiflexor MEPs were unchanged with cutaneous stimulation at either location, but dorsiflexor CMEPs increased with cutaneous stimulation (p = 0.05). In general, the increase in CMEP amplitudes was larger than the increase in MEP amplitudes, indicating that an increase in spinal excitability likely explains most of the increase in corticospinal excitability. The larger change observed in the CMEP also indicates that excitability from supraspinal sources likely decreased, which could be due to a net change in the excitability of intracortical circuits. This study provides evidence that cutaneous reflexes from foot sole skin are likely influenced by a transcortical pathway

The footwear needs and preferences of adults over 55 years of age participating in court sports

Court sports like tennis are popular with older adults and important for maintaining physical and mental health. Footwear can influence player experience and injury risk in sports. Previous preliminary work using interviews and focus groups identified key themes regarding comfort (including cushioning), functionality (including a wide width) and choice (including appearance) that are important aspects of footwear for older adults. The purpose of this study was to explore the attitudes towards athletic footwear and the footwear features considered important in older adults playing court sports across the population. An online survey was conducted of older adults in the UK/Ireland who participated in court sports at least once a week. Questionnaire items included descriptive information on age, gender, playing level and sport played and Likert item questions regarding attitudes and important footwear features. Using a mixed methods approach, percentage agreement and importance was combined with qualitative comments. Comfort, appropriate grip, good cushioning and overall support were all important for over 95% of respondents. Width, durability and reducing the likelihood of injury were also important to over 80% of respondents. Around 20% of female participants agreed they had difficulty in purchasing sports shoes with their desired aesthetics compared to around 10% of male participants. Some women reported needing to buy men’s shoes for adequate width, while 12% of respondents reported wearing non-specific footwear like running shoes, often for extra cushioning or to avoid foot pain, which could put them at greater risk of injuries such as ankle sprains. It would appear the athletic footwear industry in the UK/Ireland could do more to improve player comfort and safety of older adults in court sports

Returning to leisure activity post-stroke: barriers and facilitators to engagement

Objectives: To identify barriers and facilitators to engagement when returning to, or participating in, leisure activity post-stroke or TIA. Design: Sequential explanatory, mixed methods study Setting: 21 hospital sites across England, Wales and Northern Ireland Participants: Adults with a clinical diagnosis of first/recurrent stroke or TIA. Patients approaching end of life were excluded. Participants were recruited as in-patients or at first clinic appointment and a baseline questionnaire was completed. A 6-month follow-up questionnaire was sent to participants for self-completion. Open-text questions were asked about barriers and facilitators when returning to, or participating in, leisure activity. Responses were thematically analysed and explored by participant characteristics, including type of leisure activity undertaken. Characteristics also included measures of socioeconomic deprivation, mood, fatigue and disability. Results: 2000 participants returned a 6-month follow-up questionnaire (78% stroke, 22% TIA); 1045 participants responded to a question on barriers and 820 on facilitators. Twelve themes were identified and the proportion of responses were reported (%). Barriers: physical difficulties (69%), lower energy levels (17%), loss of independence (11%), psychological difficulties (10%), hidden disabilities (7%), and delay or lack of healthcare provision (3%). Facilitators: family support (35%), healthcare support (27%), well-being and fitness (22%), friendship support (20%), self-management (19%), and returning to normality (9%). ‘Physical difficulties’ was the most reported barrier across all participant characteristics and activity types. Family support was the most reported facilitator except for those with greater disability, where it was healthcare support and those without fatigue where it was well-being and exercise. Conclusions: Physical difficulties and lack of energy are problematic for stroke and TIA survivors who want to return to or participate in leisure activity. Healthcare support alone cannot overcome all practical and emotional issues related to leisure activity engagement. Family support and improving well-being are important facilitators and future research should explore these mechanisms further

StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR):Study protocol for a randomized controlled clinical trial

BACKGROUND: The standard of care for neovascular age-related macular degeneration (nAMD) involves ongoing intravitreal injections of anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF). The most commonly used anti-VEGF drugs are ranibizumab, bevacizumab and aflibercept. The main objective of the STAR trial is to determine if stereotactic radiotherapy can reduce the number of anti-VEGF injections that patients with nAMD require. METHODS/DESIGN: STAR is a multicentre, double-masked, randomised, sham-controlled clinical trial. It evaluates a new device (manufactured by Oraya, Newark, CA, USA) designed to deliver stereotactic radiotherapy (SRT) to nAMD lesions. The trial enrols participants with chronic, active nAMD. Participants receive a single SRT treatment (16 Gy or sham) with a concomitant baseline intravitreal injection of 0.5 mg ranibizumab. Thereafter, they attend every month for 24 months, and ranibizumab is administered at the visit if retreatment criteria are met. The primary outcome is the number of pro re nata ranibizumab injections during the first 24 months. Secondary outcomes include visual acuity, lesion morphology, quality of life and safety. Additional visits occur at 36 and 48 months to inspect for radiation retinopathy. The target sample size of 411 participants (randomised 2:1 in favour of radiation) is designed to detect a reduction of 2.5 injections against ranibizumab monotherapy, at 90% power, and a significance level (alpha) of 0.025 (one-sided two-sample t test). This gives 97% power to detect non-inferiority of visual acuity at a five-letter margin. The primary analyses will be by intention to treat. DISCUSSION: The safety and efficacy outcomes will help determine the role of SRT in the management of chronic, active nAMD. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN12884465. Registered on 28 November 2014. ClinicalTrials.gov: NCT02243878. Registered on 17 September 2014

Abortion policy implementation in Ireland : lessons from the community model of care

BACKGROUND: In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020-2021 to examine the barriers and facilitators of the Irish abortion policy implementation. METHODS: We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. RESULTS: We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. CONCLUSIONS: We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain