Contraceptive confidence and timing of first birth in Moldova: an event history analysis of retrospective data

Objectives: To test the contraceptive confidence hypothesis in a modern context. The hypothesis is that women using effective or modern contraceptive methods have increased contraceptive confidence and hence a shorter interval between marriage and first birth than users of ineffective or traditional methods. We extend the hypothesis to incorporate the role of abortion, arguing that it acts as a substitute for contraception in the study context.Setting: Moldova, a country in South-East Europe. Moldova exhibits high use of traditional contraceptive methods and abortion compared with other European countries.Participants: Data are from a secondary analysis of the 2005 Moldovan Demographic and Health Survey, a nationally representative sample survey. 5377 unmarried women were selected.Primary and secondary outcome measures: The outcome measure was the interval between marriage and first birth. This was modelled using a piecewise-constant hazard regression, with abortion and contraceptive method types as primary variables along with relevant sociodemographic controls.Results: Women with high contraceptive confidence (modern method users) have a higher cumulative hazard of first birth 36?months following marriage (0.88 (0.87 to 0.89)) compared with women with low contraceptive confidence (traditional method users, cumulative hazard: 0.85 (0.84 to 0.85)). This is consistent with the contraceptive confidence hypothesis. There is a higher cumulative hazard of first birth among women with low (0.80 (0.79 to 0.80)) and moderate abortion propensities (0.76 (0.75 to 0.77)) than women with no abortion propensity (0.73 (0.72 to 0.74)) 24?months after marriage.Conclusions: Effective contraceptive use tends to increase contraceptive confidence and is associated with a shorter interval between marriage and first birth. Increased use of abortion also tends to increase contraceptive confidence and shorten birth duration, although this effect is non-linear—women with a very high use of abortion tend to have lengthy intervals between marriage and first birth

Functional and Psychiatric Correlates of Comorbid Post-Traumatic Stress Disorder and Alcohol Use Disorder.

Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are common comorbid conditions that affect large segments of the population. Individuals with comorbid PTSD/AUD face greater clinical and functional stressors than those with diagnoses of either PTSD or AUD alone. The purpose of this article is to review the phenomenology and functional associations of PTSD/AUD and address the common social, occupational, and psychological concerns associated with both disorders. Given the increased problems associated with comorbid PTSD/AUD, clinical and research efforts should focus on targeting functional and psychosocial problems in conjunction with psychiatric symptoms

Shame, Stigma and Medicine

This is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.We thank all those who participated in the initial conference and subsequent four workshops, for the Wellcome Trust Small Grant and subsequent Seed Award project Shame and Medicine

Health-related shame: an affective determinant of health?

ArticleThis is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.Despite shame being recognised as a powerful force in the clinical encounter, it is underacknowledged, under-researched and undertheorised in the contexts of health and medicine. In this paper we make two claims. The first is that emotional or affective states, in particular shame, can have a significant impact on health, illness and health-related behaviours. We outline four possible processes through which this might occur: (1) acute shame avoidance behaviour; (2) chronic shame health-related behaviours; (3) stigma and social status threat and (4) biological mechanisms. Second, we postulate that shame's influence is so insidious, pervasive and pernicious, and so critical to clinical and political discourse around health, that it is imperative that its vital role in health, health-related behaviours and illness be recognised and assimilated into medical, social and political consciousness and practice. In essence, we argue that its impact is sufficiently powerful for it to be considered an affective determinant of health, and provide three justifications for this. We conclude with a proposal for a research agenda that aims to extend the state of knowledge of health-related shame.The funding was from the Wellcome Trust Seed Award 201518/Z/16/Z

The approach to criticality in sandpiles

A popular theory of self-organized criticality relates the critical behavior of driven dissipative systems to that of systems with conservation. In particular, this theory predicts that the stationary density of the abelian sandpile model should be equal to the threshold density of the corresponding fixed-energy sandpile. This "density conjecture" has been proved for the underlying graph Z. We show (by simulation or by proof) that the density conjecture is false when the underlying graph is any of Z^2, the complete graph K_n, the Cayley tree, the ladder graph, the bracelet graph, or the flower graph. Driven dissipative sandpiles continue to evolve even after a constant fraction of the sand has been lost at the sink. These results cast doubt on the validity of using fixed-energy sandpiles to explore the critical behavior of the abelian sandpile model at stationarity.Comment: 30 pages, 8 figures, long version of arXiv:0912.320

The correlates of natural method use in Moldova: is natural method use associated with poverty and isolation?

Natural method use is often associated with high levels of unwanted births and induced abortions. This study investigates the correlates of natural method use in Moldova, a country with one of the highest proportions of natural contraceptive users in Europe. We hypothesize that economic and spatial disadvantage increase the reliance on natural methods whereas exposure to FP programs decreases the probability of natural method use. The analysis considers a sub-sample of 5860 sexually-active women from the 2005 Demographic and Health Survey. Results from multilevel multinomial models, controlling for relevant characteristics and data structure, show that economic disadvantage increases the probability of natural method use; but the overall effect is small. Higher FP media exposure reduces natural method use; however this effect attenuates with age. We conclude that FP efforts directed towards the poorest may have limited impact, but interventions targeted at older women could reduce the burden of unwanted pregnancies

Comparison of FDMA and CDMA for second generation land-mobile satellite communications

Code Division Multiple Access (CDMA) and Frequency Division Multiple Access (FDMA) (both analog and digital) systems capacities are compared on the basis of identical link availabilities and physical propagation models. Parameters are optimized for a bandwidth limited, multibeam environment. For CDMA, the benefits of voice activated carriers, antenna discrimination, polarization reuse, return link power control and multipath suppression are included in the analysis. For FDMA, the advantages of bandwidth efficient modulation/coding combinations, voice activated carriers, polarization reuse, beam placement, and frequency staggering were taken into account

A comparison between word analysis and prompting in oral reading.

Thesis (Ed.M.)--Boston Universit

Renormalized energy concentration in random matrices

We define a "renormalized energy" as an explicit functional on arbitrary point configurations of constant average density in the plane and on the real line. The definition is inspired by ideas of [SS1,SS3]. Roughly speaking, it is obtained by subtracting two leading terms from the Coulomb potential on a growing number of charges. The functional is expected to be a good measure of disorder of a configuration of points. We give certain formulas for its expectation for general stationary random point processes. For the random matrix $\beta$-sine processes on the real line (beta=1,2,4), and Ginibre point process and zeros of Gaussian analytic functions process in the plane, we compute the expectation explicitly. Moreover, we prove that for these processes the variance of the renormalized energy vanishes, which shows concentration near the expected value. We also prove that the beta=2 sine process minimizes the renormalized energy in the class of determinantal point processes with translation invariant correlation kernels.Comment: last version, to appear in Communications in Mathematical Physic