Feasibility and acceptability of using a web-based contraceptive support tool in a university health clinic

Abstract

Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18–29) seeking contraceptive care at the UHC were enrolled in September 2015 (n?=?46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2–4?weeks later. Electronic health records through 6?weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women’s selection of more effective contraceptive methods, including LARCs.     

Quite an encumbrance? Work-related obstacles to Finnish fathers’ take-up of parental leave

ABSTRACT

An ideal of involved fatherhood has become popular in the developed countries, but even countries like Finland that have introduced an individual father’s quota to parental leave are far from gender equality in parents’ leave practices. Lack of support and negative attitudes at workplaces or pressure at work are among the obstacles to fathers’ leave take-up. The study used survey data from fathers and interviews at workplaces to explore the role of work and workplaces among the many aspects related to fathers’ possibilities of taking leave. The results showed that fathers’ income and workplace characteristics were associated with taking leave. Few fathers mentioned employers’ objection as a hinder. Father’s recent unemployment and anticipated difficulty of taking a long time off played a more important role. At workplaces, the obstacles to taking long leave were related to fathers’ ideals about a committed worker and to the nature and organizing of work. Additionally, the leave exceeding fathers’ quota might not be understood as ‘for fathers’. The spouse’s situation and fathers’ gendered perceptions about parental responsibilities were also important for leave practices. The findings suggest that policy development towards a longer father’s quota could make fathers’ care responsibilities visible also at workplaces.     

A Quantitative Microbial Risk Assessment Model for Legionnaires'' Disease: Animal Model Selection and Dose-Response Modeling

Legionnaires' disease (LD), first reported in 1976, is an atypical pneumonia caused by bacteria of the genus Legionella, and most frequently by L. pneumophila (Lp). Subsequent research on exposure to the organism employed various animal models, and with quantitative microbial risk assessment (QMRA) techniques, the animal model data may provide insights on human dose-response for LD. This article focuses on the rationale for selection of the guinea pig model, comparison of the dose-response model results, comparison of projected low-dose responses for guinea pigs, and risk estimates for humans. Based on both in vivo and in vitro comparisons, the guinea pig (Cavia porcellus) dose-response data were selected for modeling human risk. We completed dose-response modeling for the beta-Poisson (approximate and exact), exponential, probit, logistic, and Weibull models for Lp inhalation, mortality, and infection (end point elevated body temperature) in guinea pigs. For mechanistic reasons, including low-dose exposure probability, further work on human risk estimates for LD employed the exponential and beta-Poisson models. With an exposure of 10 colony-forming units (CFU) (retained dose), the QMRA model predicted a mild infection risk of 0.4 (as evaluated by seroprevalence) and a clinical severity LD case (e.g., hospitalization and supportive care) risk of 0.0009. The calculated rates based on estimated human exposures for outbreaks used for the QMRA model validation are within an order of magnitude of the reported LD rates. These validation results suggest the LD QMRA animal model selection, dose-response modeling, and extension to human risk projections were appropriate.     

Bivariate modelling of longitudinal measurements of two human immunodeficiency type 1 disease progression markers in the presence of informative drop-outs

Summary.  The main statistical problem in many epidemiological studies which involve repeated measurements of surrogate markers is the frequent occurrence of missing data. Standard likelihood-based approaches like the linear random-effects model fail to give unbiased estimates when data are non-ignorably missing. In human immunodeficiency virus (HIV) type 1 infection, two markers which have been widely used to track progression of the disease are CD4 cell counts and HIV–ribonucleic acid (RNA) viral load levels. Repeated measurements of these markers tend to be informatively censored, which is a special case of non-ignorable missingness. In such cases, we need to apply methods that jointly model the observed data and the missingness process. Despite their high correlation, longitudinal data of these markers have been analysed independently by using mainly random-effects models. Touloumi and co-workers have proposed a model termed the joint multivariate random-effects model which combines a linear random-effects model for the underlying pattern of the marker with a log-normal survival model for the drop-out process. We extend the joint multivariate random-effects model to model simultaneously the CD4 cell and viral load data while adjusting for informative drop-outs due to disease progression or death. Estimates of all the model's parameters are obtained by using the restricted iterative generalized least squares method or a modified version of it using the EM algorithm as a nested algorithm in the case of censored survival data taking also into account non-linearity in the HIV–RNA trend. The method proposed is evaluated and compared with simpler approaches in a simulation study. Finally the method is applied to a subset of the data from the 'Concerted action on seroconversion to AIDS and death in Europe' study.     

HOW DOES HEALTH INSURANCE AFFECT WORKERS’ COMPENSATION FILING?

About half of injured workers choose not to file workers' compensation claims. This is thought to result from their use of health insurance instead of workers' compensation. However, the data suggest that insured workers are actually less likely to file than their more vulnerable uninsured counterparts. We found that this relationship emerges as the result of employer characteristics and, in particular, that employers who offer health insurance to employees are more likely to have workers who file claims; this is much more important than the insurance status of workers themselves or fixed worker characteristics. ( JEL I1, J3)     

Perfect Simulation for Length-interacting Polygonal Markov Fields in the Plane

Abstract.  The purpose of this paper was to construct perfect samplers for length-interacting Arak–Clifford–Surgailis polygonal Markov fields in the plane with nodes of order 2 ( V -shaped nodes). This is achieved by providing for the polygonal fields a hard core marked point process representation with individual points carrying polygonal loops as their marks, so that the coupling from the past and clan of ancestors routines can be adopted.