State-Level Variation in Abortion Stigma and Women and Men's Abortion Underreporting in the USA.
Ontology highlight
ABSTRACT:
SUBMITTER: Maddow-Zimet I
PROVIDER: S-EPMC8547795 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BACKGROUND:Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. METHODS:The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. RESULTS:Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach's ?, .83-.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. LIMITATION:Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. CONCLUSIONS:The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures.
| S-EPMC5997354 | biostudies-literature
Project description:Abortion stigma may cause psychological distress in women who are considering having an abortion or have had one. This phenomenon has been relatively underexplored in low-income women, who may already be at an increased risk for poor abortion-related outcomes because of difficulties accessing timely and safe abortion services.A qualitative study conducted between 2010 and 2013 used semistructured interviews to explore pregnancy intentions among low-income women recruited from six reproductive health clinics in Western Pennsylvania. Transcripts from interviews with 19 participants who were planning to terminate a pregnancy or had had an abortion in the last two weeks were examined through content analysis to identify the range of attitudes they encountered that could contribute to or reflect abortion stigma, the sources of these attitudes and women's responses to them.Women commonly reported that partners, family members and they themselves held antiabortion attitudes. Such attitudes communicated that abortion is morally reprehensible, a rejection of motherhood, rare and thus potentially deviant, detrimental to future fertility and an irresponsible choice. Women reacted to external and internal negative attitudes by distinguishing themselves from other women who obtain abortions, experiencing negative emotions, and concealing or delaying their abortions.Women's reactions to antiabortion attitudes may perpetuate abortion stigma. Further research is needed to inform interventions to address abortion stigma and improve women's abortion experiences.
| S-EPMC5572656 | biostudies-other
Project description:ObjectiveIt has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients.DesignRetrospective cohort study.SettingCommercial insurance claims data.Participants98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019.ExposurePatients who filled an opioid prescription within 3 days of a knee arthroscopy.Outcome measuresOpioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity.ResultsOverall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates.ConclusionWide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.
| S-EPMC7440827 | biostudies-literature
Project description:OBJECTIVES:The aim of this study was to assess the reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale. SETTING:Three hospitals affiliated to Public Hospitals Union General Secretariat in Manisa, a city located in Western Turkey. DESIGN:This was a methodological study. PARTICIPANTS:A total of 230 women aged 22-49 years who previously underwent abortion and volunteered to participate in the study. PRIMARY AND SECONDARY OUTCOME MEASURES:Data analysis was performed using the SPSS and LISREL software. The Content Validity Index was calculated based on the values obtained from expert opinions. In the reliability analysis, Cronbach's alpha values were calculated for the overall scale and its subscales. To test the stability of the scale over time, the scale was readministered to 30 women in the study 15 days later and the test-retest values (Pearson's correlation coefficients) were determined. In the validity analysis, the exploratory and confirmatory factor analyses were performed. In the exploratory factor analysis, the principal component analysis was performed using the varimax rotation and the factor loading of the scale was examined. Confirmatory factor analysis was performed to investigate the item-factor construct of the scale. RESULTS:The Content Validity Index was calculated as 0.86. The Cronbach's alpha values ranged between 0.83 and 0.94. The item-total correlation coefficients ranged between 0.36 and 0.72, and the test-retest reliability was 0.96 for the overall scale and its subscales (p<0.05). The total variance revealed by five factors was 75%. Confirmatory factor analysis of the scale revealed an acceptable compliance level (root mean square error of approximation=0.092, χ2/df=2.91, Goodness of Fit Index=0.831, Comparative Fit Index=0.928, p<0.001). CONCLUSIONS:The results suggest that this scale has the potential for use in research and clinical settings to measure abortion stigma among women.
| S-EPMC6500284 | biostudies-other
Project description:ImportanceNeuraxial labor analgesia is recognized as the most effective method of providing pain relief during labor. Little is known about variation in the rates of neuraxial analgesia across US states. Identifying the presence and extent of variation may provide insights into practice variation and may indicate where access to neuraxial analgesia is inadequate.ObjectiveTo test the hypothesis that variation exists in neuraxial labor analgesia use among US states.Design, setting, and participantsRetrospective, population-based, cross-sectional analysis using US birth certificate data. Participants were 2?625?950 women who underwent labor in 2015.Main outcomes and measuresState-specific prevalence of neuraxial analgesia per 100 women who underwent labor and variability in neuraxial analgesia use among states, assessed using multilevel multivariable regression modeling with the median odds ratio and the intraclass correlation coefficient to evaluate variation by state.ResultsIn the study population of 2?625?950 women, 0.1% (n?=?2010) were younger than 15 years, 7.0% (n?=?183 546) were between the ages of 15 and 19 years, 23.6% (n?=?620 118) were between the ages of 20 and 24 years, 29.6% (n?=?777 957) were between the ages of 25 and 29 years, 26.0% (n?=?683 656) were between the ages of 30 and 34 years, 11.4% (n?=?298 237) were between the ages of 35 and 39 years, 2.2% (n?=?57 130) were between the ages of 40 and 44 years, and 0.1% (n?=?3296) were between the ages of 45 and 54 years. More than 90% were privately insured or insured with Medicaid. Neuraxial analgesia was used by 73.1% (n?=?1?920?368) of women. After adjustment for antepartum, obstetric, and intrapartum factors, Maine had the lowest neuraxial analgesia prevalence (36.6%; 95% CI, 33.2%-40.1%) and Nevada the highest (80.1%; 95% CI, 78.3%-81.7%). The adjusted median odds ratio was 1.5 (95% CI, 1.4-1.6), and the intraclass correlation coefficient was 5.4% (95% CI, 4.0%-7.9%).Conclusions and relevanceResults of this study suggest that a small portion of the overall variation in neuraxial analgesia use is explained by US states. Unmeasured patient-level and hospital-level factors likely account for a large portion of the variation between states. Efforts should be made to understand what the main reasons are for this variation and whether the variation influences maternal or perinatal outcomes.
| S-EPMC6324365 | biostudies-literature
Project description:ObjectiveTo report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA.BackgroundUncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.MethodsAs part of the COVIDSurg multicenter study, all patients aged ≥17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.ResultsA total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age ≥70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]).ConclusionsPatients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks.
| S-EPMC8745946 | biostudies-literature
Project description:Integrated Assessment Models (IAMs) characterize the interactions among human and earth systems. IAMs typically have been applied to investigate future energy, land use, and emission pathways at global to continental scales. Recent directions in IAM development include enhanced technological detail, greater spatial and temporal resolution, and the inclusion of air pollutant emissions. These developments expand the potential applications of IAMs to include support for air quality management and for coordinated environmental, climate, and energy planning. Furthermore, these IAMs could help decision makers more fully understand tradeoffs and synergies among policy goals, identify important cross-sector interactions, and, via scenarios, consider uncertainties in factors such as population and economic growth, technology development, human behavior, and climate change. A version of the Global Change Assessment Model with U.S. state-level resolution (GCAM-USA) is presented that incorporates U.S.-specific emission factors, pollutant controls, and air quality and energy regulations. Resulting air pollutant emission outputs are compared to U.S. Environmental Protection Agency 2011 and projected inventories. A Quality Metric is used to quantify GCAM-USA performance for several pollutants at the sectoral and state levels. This information provides insights into the types of applications for which GCAM-USA is currently well suited and highlights where additional refinement may be warranted. While this analysis is specific to the U.S., the results indicate more generally the importance of enhanced spatial resolution and of considering national and sub-national regulatory constraints within IAMs.
| S-EPMC6054859 | biostudies-literature
Project description:The COVID-19 pandemic brings to light the reality of the Brazilian health system. The underreporting of COVID-19 deaths in the state of Minas Gerais (MG), where the second largest population of the country is concentrated, reveals government unpreparedness, as there is a low capacity of testing in the population, which prevents the real understanding of the general panorama of SARS-CoV-2 dissemination. The goals of this research are to analyze the causes of deaths in different Brazilian government databases (Civil Registry Transparency Portal and InfoGripe) and to assess whether there are sub-records showing an unexpected increase in the frequency of deaths from causes clinically similar to COVID-19. A descriptive and quantitative analysis of the number of deaths by COVID-19 and similar causes was performed in different databases. Our results demonstrate that different official sources had a discrepancy of 109.45% between these data referring to the same period. There was also a 758.57% increase in SARI deaths in 2020, when compared to the average of previous years. Finally, it was shown that there was an increase in the rate of pneumonia and respiratory insufficiency (RI) by 6.34 and 6.25%, respectively. In conclusion, there is an underreporting of COVID-19 deaths in MG due to the unexplained excess of deaths caused by SARI, respiratory insufficiency, and pneumonia compared to previous years.
| S-EPMC7769942 | biostudies-literature
Project description:In many plant species, flower stigma secretions are important in early stages of sexual reproduction. Previous chemical analysis and proteomic characterization of these exudates provided insights into their biological function. Nevertheless, the presence of nucleic acids in the stigma exudates has not been previously reported. Here we studied the stigma exudates of Pyrus communis, Pyrus pyrifolia and Pyrus syriaca, and showed them to harbor extracellular RNAs of various sizes. RNA sequencing revealed, for the first time, the presence of known Rosaceae mature micro-RNAs (miRs), also abundant in the stigma source tissue. Predicted targets of the exudate miRs in the Arabidopsis thaliana genome include genes involved in various biological processes. Several of these genes are pollen transcribed, suggesting possible involvement of exudate miRs in transcriptional regulation of the pollen. Moreover, extracellular miRs can potentially act across kingdoms and target genes of stigma interacting organisms/microorganisms, thus opening novel applicative avenues in HortSciences.
2023-11-15 | GSE225720 | GEO
Project description:BACKGROUND:Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion. METHODS:A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson's correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach's alpha. RESULTS:For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p?=?0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach's alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach's alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale. CONCLUSIONS:The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.
| S-EPMC6731583 | biostudies-literature