Pubertal maturation and affective symptoms in adolescence and adulthood: evidence from a prospective birth cohort

The higher prevalence of affective symptoms among women compared to men emerges in adolescence, and it has been associated with pubertal maturation. However, it remains unclear whether pubertal timing has long-term influences on affective symptoms. Using data from the British 1946 birth cohort, we investigated whether pubertal timing was associated with affective symptoms over the life course, distinguishing those with symptoms in adolescence only, symptoms in adulthood only, and symptoms in both adolescence and adulthood. In females, there was no evidence that early pubertal maturation was a risk factor for affective symptoms. However, those with particularly late menarche (≥15 years) showed a lower risk of adult-onset affective symptoms (OR = 0.54, 95% CI: 0.31, 0.95). This effect of late pubertal timing was not explained by a range of socio-behavioural factors. In contrast, in males, late pubertal timing was associated with increased risk of adolescent-onset affective symptoms that tracked into adulthood (OR = 2.10, 95% CI: 1.44, 3.06). This effect was partly explained by low pre-pubertal BMI. Sex-specific effects of pubertal timing on the long-term risk of affective symptoms might be due to different effects of gonadal hormonal on the CNS, as well as different social experiences during puberty

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Background The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. Objectives To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. Data sources We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. Review methods To address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. Results We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. Limitations Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. Conclusions We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. Study registration This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. Funding The National Institute for Health Research Health Technology Assessment programme

Community-based research: Barriers to recruitment of African Americans

The elimination of health disparities for African Americans requires culturally relevant, empirical knowledge, which in turn requires including African Americans in research studies. However, power-difference barriers and conceptual barriers continue to inhibit the recruitment of African Americans. The purpose of this article is to define and discuss certain barriers to the recruitment of African Americans into research studies and to present culturally and contextually sensitive strategies to overcoming these barriers. Power-difference barriers reflect unequal authority and often generate mistrust. Conceptual barriers reflect researchers’ need for better understanding about African Americans. Effective strategies include collaboration with the community through a community advisory board and conducting community-based participatory action research. Also, integrating alternative conceptual frameworks with mainstream frameworks may reduce researchers’ ideological assumptions about African Americans. To promote optimal recruitment of African Americans, researchers must be aware of power difference barriers and conceptual barriers and move toward active collaboration with African American communities.http://www.sciencedirect.com/science/article/pii/S002965540400099

The Context of Risky Behaviors for Latino Youth

Background and significance: Alarming numbers of Latino teens continue to engage in behaviors that place them at risk for pregnancy and sexually transmitted infections including HIV. Design: This study includes data from six focus groups with 38 Latinas. The primary purpose of the focus groups was to elicit antecedents to unsafe sex to guide the development of an HIV-prevention intervention for adult Latinas. The data were reanalyzed using the rich content that had been elicited about community teens. Findings: Six major themes were identified surrounding teen issues and concerns. These are (a) the culture of risky behaviors; (b) romance: illusion and reality; (c) parental involvement: a protective factor; (d) HIV: knowledge versus ignorance; (e) HIV among youth: fear, stigma, and anger; and (f) saving our youth. Implications: A multimodal approach is required to help teens adopt healthy life styles, remain in school, and have a positive relationship with their parents

Microsoft Word - SPE 115142.doc

Abstract This paper estimates injectivity losses associated with injection of EOR polymer solutions if fractures are not open and considers the degree of fracture extension if fractures are open. Three principal EOR polymer properties are examined that affect injectivity: (1) debris in the polymer, (2) polymer rheology in porous media, and (3) polymer mechanical degradation. Using Berea sandstone cores (100-600 md) and various filters and filter combinations, an improved test was developed of the tendency for EOR polymers to plug porous media. The new test demonstrated that plugging tendencies varied considerably among both partially hydrolyzed polyacrylamide (HPAM) and xanthan polymers. Rheology and mechanical degradation in porous media were quantified for a xanthan and an HPAM polymer. Consistent with previous work, we confirmed that xanthan solutions show pseudoplastic behavior in porous rock that closely parallels that in a viscometer. Xanthan was remarkably resistant to mechanical degradation, with a 0.1% xanthan solution (in seawater) experiencing only a 19% viscosity loss after flow through 102-md Berea sandstone at a pressure gradient of 24,600 psi/ft. For 0.1% HPAM in both 0.3% NaCl brine and seawater in 573-md Berea sandstone, Newtonian behavior was observed at low to moderate fluid fluxes, while pseudodilatant behavior was seen at moderate to high fluxes. No evidence of pseudoplastic behavior was seen in the porous rock, even though one solution exhibited a power-law index of 0.64 in a viscometer. For this HPAM in both brines, the onset of mechanical degradation occurred at a flux of 14 ft/d in 573-md Berea. Considering the polymer solutions investigated, satisfactory injection of more than 0.1 PV in field applications could only be expected for the cleanest polymers (i.e., that do not plug before 1,000 cm 3 /cm 2 throughput), without inducing fractures (or formation parts for unconsolidated sands). Even in the absence of face plugging, the viscous nature of the solutions investigated requires that injectivity must be less than one-fifth that of water if formation parting is to be avoided (unless the injectant reduces the residual oil saturation and substantially increases the relative permeability to water). Since injectivity reductions of this magnitude are often economically unacceptable, fractures or fracture-like features are expected to open and extend significantly during the course of most polymer floods. Thus, an understanding of the orientation and growth of fractures may be crucial for EOR projects where polymer solutions are injected