Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act

Background: Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Methods: Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18?55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Results: Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03?0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17?0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10?0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35?0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12?32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Conclusions: Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140134/1/jwh.2014.5175.pd

U.S. Women's Intended Sources for Reproductive Health Care

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd

Nonhuman Primate Models Used to Study Pelvic Inflammatory Disease Caused by Chlamydia trachomatis

Pelvic inflammatory disease (PID) is a global health concern that is associated with significant morbidity and is a major cause of infertility. Throughout history animals have been used for anatomical studies and later as models of human disease. In particular, nonhuman primates (NHPs) have permitted investigations of human disease in a biologically, physiologically, and anatomically similar system. The use of NHPs as human PID models has led to a greater understanding of the primary microorganisms that cause disease (e.g., Chlamydia trachomatis and Neisseria gonorroheae), the pathogenesis of infection and its complications, and the treatment of people with PID. This paper explores historical and contemporary aspects of NHP modeling of chlamydial PID, with an emphasis on advantages and limitations of this approach and future directions for this research

Ultrasound Investigations of Orbital Quadrupolar Ordering in UPd_3

For a high-quality single crystal of UPd_3 we present the relevant elastic constants and ultrasonic attenuation data. In addition to the magnetic phase transition at T_2=4.4 +/- 0.1K and the quadrupolar transition at T_1~6.8K, we find orbital ordering at T_0=7.6 +/- 0.1K concomitant with a symmetry change from hexagonal to orthorhombic. A striking feature is the splitting of the phase transition at T_1 into a second-order transition at T_{+1}=6.9 +/- 0.05K and a first-order transition at T_{-1}=6.7 +/- 0.05K. For the four phase transitions, the quadrupolar order parameters and the respective symmetry changes are specified.Comment: 14 pages (RevTex), 3 eps-figures, accepted by PR

Human Papillomavirus Vaccine Uptake After a Tailored, Online Educational Intervention for Female University Students: A Randomized Controlled Trial

Background: Educational interventions may be a strategy to increase human papillomavirus (HPV) vaccination among female university students, but studies to date have shown mixed results. This study evaluated the effect of MeFirst, an individually tailored, online educational intervention, on HPV vaccine-related knowledge, vaccination intention, and uptake among previously unvaccinated female university students. Methods: All female students aged 18?26 years who reported being unvaccinated against HPV at a midwestern university were invited via email to enroll. Participants completed an online survey that assessed baseline HPV vaccine-related knowledge, attitudes and vaccination intention. Participants (n?=?661) were then randomized to receive either an educational website automatically tailored to their baseline survey responses (MeFirst intervention) or a standard CDC information factsheet on HPV vaccine (control). Vaccine uptake and repeat knowledge and attitude measures were assessed with online surveys 3 months following the intervention and analyzed using logistic regression models. Results: HPV vaccine uptake was similar in both the MeFirst and control groups at 3 months following the intervention (p?=?0.98). Three months after the intervention, the proportion of participants with high knowledge regarding HPV vaccination increased from baseline (32% to 50%; p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140136/1/jwh.2015.5251.pd

An experimental study of the large deformation of plastic hinges

Recent applications of structural plasticity to areas such as vehicle crashworthiness has led to interest in the large deformation plastic collapse of general frames. Even when displacements are comparable to the original structural dimensions, the plasticity is confined to localized regions or "hinges". This paper reports an experimental study of the behavior of such hinges in thin walled structural members. Due to local deformation the load carrying capacity of the hinge significantly decreases at large rotations. In a companion paper [4] a structural constitutive theory is proposed to account for this behavior. Numerical data for this theory is obtained in the present paper. Finally test results are given for a large deformation combined loading test designed to validate the theory of [4]. The experimental results are in good agreement with the theoretical predictions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23017/1/0000586.pd

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women’s family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents’ use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide

Synchronous Symmetry Breaking in Neurons with Different Neurite Counts

As neurons develop, several immature processes (i.e., neurites) grow out of the cell body. Over time, each neuron breaks symmetry when only one of its neurites grows much longer than the rest, becoming an axon. This symmetry breaking is an important step in neurodevelopment, and aberrant symmetry breaking is associated with several neuropsychiatric diseases, including schizophrenia and autism. However, the effects of neurite count in neuronal symmetry breaking have never been studied. Existing models for neuronal polarization disagree: some predict that neurons with more neurites polarize up to several days later than neurons with fewer neurites, while others predict that neurons with different neurite counts polarize synchronously. We experimentally find that neurons with different neurite counts polarize synchronously. We also show that despite the significant differences among the previously proposed models, they all agree with our experimental findings when the expression levels of the proteins responsible for symmetry breaking increase with neurite count. Consistent with these results, we observe that the expression levels of two of these proteins, HRas and shootin1, significantly correlate with neurite count. This coordinated symmetry breaking we observed among neurons with different neurite counts may be important for synchronized polarization of neurons in developing organisms

The Resonance Frequency Shift, Pattern Formation, and Dynamical Network Reorganization via Sub-Threshold Input

We describe a novel mechanism that mediates the rapid and selective pattern formation of neuronal network activity in response to changing correlations of sub-threshold level input. The mechanism is based on the classical resonance and experimentally observed phenomena that the resonance frequency of a neuron shifts as a function of membrane depolarization. As the neurons receive varying sub-threshold input, their natural frequency is shifted in and out of its resonance range. In response, the neuron fires a sequence of action potentials, corresponding to the specific values of signal currents, in a highly organized manner. We show that this mechanism provides for the selective activation and phase locking of the cells in the network, underlying input-correlated spatio-temporal pattern formation, and could be the basis for reliable spike-timing dependent plasticity. We compare the selectivity and efficiency of this pattern formation to a supra-threshold network activation and a non-resonating network/neuron model to demonstrate that the resonance mechanism is the most effective. Finally we show that this process might be the basis of the phase precession phenomenon observed during firing of hippocampal place cells, and that it may underlie the active switching of neuronal networks to locking at various frequencies