Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-30 (of 41 Records) |
Query Trace: Gavin L [original query] |
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Pan-viral serology implicates enteroviruses in acute flaccid myelitis.
Schubert RD , Hawes IA , Ramachandran PS , Ramesh A , Crawford ED , Pak JE , Wu W , Cheung CK , O'Donovan BD , Tato CM , Lyden A , Tan M , Sit R , Sowa GA , Sample HA , Zorn KC , Banerji D , Khan LM , Bove R , Hauser SL , Gelfand AA , Johnson-Kerner BL , Nash K , Krishnamoorthy KS , Chitnis T , Ding JZ , McMillan HJ , Chiu CY , Briggs B , Glaser CA , Yen C , Chu V , Wadford DA , Dominguez SR , Ng TFF , Marine RL , Lopez AS , Nix WA , Soldatos A , Gorman MP , Benson L , Messacar K , Konopka-Anstadt JL , Oberste MS , DeRisi JL , Wilson MR . Nat Med 2019 25 (11) 1748-1752 Since 2012, the United States of America has experienced a biennial spike in pediatric acute flaccid myelitis (AFM)(1-6). Epidemiologic evidence suggests non-polio enteroviruses (EVs) are a potential etiology, yet EV RNA is rarely detected in cerebrospinal fluid (CSF)(2). CSF from children with AFM (n = 42) and other pediatric neurologic disease controls (n = 58) were investigated for intrathecal antiviral antibodies, using a phage display library expressing 481,966 overlapping peptides derived from all known vertebrate and arboviruses (VirScan). Metagenomic next-generation sequencing (mNGS) of AFM CSF RNA (n = 20 cases) was also performed, both unbiased sequencing and with targeted enrichment for EVs. Using VirScan, the viral family significantly enriched by the CSF of AFM cases relative to controls was Picornaviridae, with the most enriched Picornaviridae peptides belonging to the genus Enterovirus (n = 29/42 cases versus 4/58 controls). EV VP1 ELISA confirmed this finding (n = 22/26 cases versus 7/50 controls). mNGS did not detect additional EV RNA. Despite rare detection of EV RNA, pan-viral serology frequently identified high levels of CSF EV-specific antibodies in AFM compared with controls, providing further evidence for a causal role of non-polio EVs in AFM. |
Access to long-acting reversible contraception among US publicly funded health centers
Bornstein M , Carter M , Zapata L , Gavin L , Moskosky S . Contraception 2018 97 (5) 405-410 OBJECTIVES: Access to a full range of contraceptive methods, including long-acting reversible contraception (LARC), is central to providing quality family planning services. We describe health center-related factors associated with LARC availability, including staff training in LARC insertion/removal and approaches to offering LARC, whether onsite or through referral. STUDY DESIGN: We analyzed nationally representative survey data collected during 2013-2014 from administrators of publicly funded U.S. health centers that offered family planning. The response rate was 49.3% (n=1615). In addition to descriptive statistics, we used multivariable logistic regression to identify health center characteristics associated with offering both IUDs and implants onsite. RESULTS: Two-thirds (64%) of health centers had staff trained in all three LARC types (hormonal IUD, copper IUD, implant); 21% had no staff trained in any of those contraceptive methods. Half of health centers (52%) offered IUDs (any type) and implants onsite. After onsite provision, informal referral arrangements were the most common way LARC methods were offered. In adjusted analyses, Planned Parenthood (AOR=9.49) and hospital-based (AOR=2.35) health centers had increased odds of offering IUDs (any type) and implants onsite, compared to Health Departments, as did Title X-funded (AOR=1.55) compared to non-Title X-funded health centers and centers serving a larger volume of family planning clients. Centers serving mostly rural areas compared to those serving urbans areas had lower odds (AOR 0.60) of offering IUD (any type) and implants. CONCLUSIONS: Variation in LARC access remains among publicly funded health centers. In particular, Health Departments and rural health centers have relatively low LARC provision. IMPLICATIONS: For more women to be offered a full range of contraceptive methods, additional efforts should be made to increase availability of LARC in publicly-funded health centers, such as addressing provider training gaps, improving referrals mechanisms, and other efforts to strengthen the health care system. |
Structural Characterization and Absolute Quantification of Microcystin Peptides Using Collision-Induced and Ultraviolet Photo-Dissociation Tandem Mass Spectrometry.
Attard TJ , Carter MD , Fang M , Johnson RC , Reid GE . J Am Soc Mass Spectrom 2018 29 (9) 1812-1825 Microcystin (MC) peptides produced by cyanobacteria pose a hepatotoxic threat to human health upon ingestion from contaminated drinking water. While rapid MC identification and quantification in contaminated body fluids or tissue samples is important for patient treatment and outcomes, conventional immunoassay-based measurement strategies typically lack the specificity required for unambiguous determination of specific MC variants, whose toxicity can significantly vary depending on their structures. Furthermore, the unambiguous identification and accurate quantitation of MC variants using tandem mass spectrometry (MS/MS)-based methods can be limited due to a current lack of appropriate stable isotope-labeled internal standards. To address these limitations, we have systematically examined here the sequence and charge state dependence to the formation and absolute abundance of both "global" and "variant-specific" product ions from representative MC-LR, MC-YR, MC-RR, and MC-LA peptides, using higher-energy collisional dissociation (HCD)-MS/MS, ion-trap collision-induced dissociation (CID)-MS/MS and CID-MS(3), and 193 nm ultraviolet photodissociation (UPVD)-MS/MS. HCD-MS/MS was found to provide the greatest detection sensitivity for both global and variant-specific product ions in each of the MC variants, except for MC-YR where a variant-specific product uniquely formed via UPVD-MS/MS was observed with the greatest absolute abundance. A simple methodology for the preparation and characterization of (18)O-stable isotope-labeled MC reference materials for use as internal standards was also developed. Finally, we have demonstrated the applicability of the methods developed herein for absolute quantification of MC-LR present in human urine samples, using capillary scale liquid chromatography coupled with ultra-high resolution / accurate mass spectrometry and HCD-MS/MS. Graphical abstract . |
Referral practices among U.S. publicly funded health centers that offer family planning services
Carter MW , Robbins CL , Gavin L , Moskosky S . J Womens Health (Larchmt) 2018 27 (8) 994-1000 BACKGROUND: Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. MATERIALS AND METHODS: We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. RESULTS: In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). CONCLUSIONS: Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care. |
Trends in health insurance coverage of Title X Family Planning Program clients, 2005-2015
Decker EJ , Ahrens KA , Fowler CI , Carter M , Gavin L , Moskosky S . J Womens Health (Larchmt) 2017 27 (5) 684-690 BACKGROUND: The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. METHODS: Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. RESULTS: We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. CONCLUSIONS: Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance. |
Update: Providing quality family planning services - Recommendations from CDC and the U.S. Office of Population Affairs, 2017
Gavin L , Pazol K , Ahrens K . MMWR Morb Mortal Wkly Rep 2017 66 (50) 1383-1385 In April 2014, CDC published "Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs" (QFP), which describes the scope of services that should be offered in a family planning visit and how to provide those services (e.g., periodicity of screening, which persons are in need of services, etc.) (1). The sections in QFP include the following: Determining the Client's Need for Services; Contraceptive Services; Pregnancy Testing and Counseling; Clients Who Want to Become Pregnant; Basic Infertility Services; Preconception Health Services; Sexually Transmitted Disease Services; and Related Preventive Health Services. In addition, the QFP includes an appendix entitled Screening Services for Which Evidence Does Not Support Screening. |
Receipt of selected preventive health services for women and men of reproductive age - United States, 2011-2013
Pazol K , Robbins CL , Black LI , Ahrens KA , Daniels K , Chandra A , Vahratian A , Gavin LE . MMWR Surveill Summ 2017 66 (20) 1-31 PROBLEM/CONDITION: Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. PERIOD COVERED: 2011-2013. DESCRIPTION OF THE SYSTEM: Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011-2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia). The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced using weights that account for the sampling design, nonresponse, and poststratification adjustments. This report uses data from the 2013 NHIS for women aged 18-44 years. RESULTS: Many preventive health services recommended in QFP were not received by all women and men of reproductive age. For contraceptive services, including contraceptive counseling and advice, 46.5% of women aged 15-44 years at risk for unintended pregnancy received services in the past year, and 4.5% of men who had vaginal intercourse in the past year received services in that year. For sexually transmitted disease (STD) services, among all women aged 15-24 years who had oral, anal, or vaginal sex with an opposite sex partner in the past year, 37.5% were tested for chlamydia in that year. Among persons aged 15-44 years who were at risk because they were not in a mutually monogamous relationship during the past year, 45.3% of women were tested for chlamydia and 32.5% of men were tested for any STD in that year. For preconception care and related preventive health services, data from selected states indicated that 33.2% of women with a recent live birth (i.e., 2-9 months postpartum) talked with a health care professional about improving their health before their most recent pregnancy; of selected preconception counseling topics, the most frequently discussed was taking vitamins with folic acid before pregnancy (81.2%), followed by achieving a healthy weight before pregnancy (62.9%) and how drinking alcohol (60.3%) or smoking (58.2%) during pregnancy can affect a baby. Nationally, among women aged 18-44 years irrespective of pregnancy status, 80.9% had their blood pressure checked by a health care professional and 31.7% received an influenza vaccine in the past year; 54.5% of those with high blood pressure were tested for diabetes, 44.9% of those with obesity had a health care professional talk with them about their diet, and 55.2% of those who were current smokers had a health professional talk with them about their smoking in the past year. Among all women aged 21-44 years, 81.6% received a Papanicolaou (Pap) test in the past 3 years. Receipt of certain preventive services varied by age and race/ethnicity. Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy increased with age (range: 25.9% and 25.2% for women aged ≤19 and 20-24 years, respectively, to 35.9% and 37.8% for women aged 25-34 and ≥35 years, respectively). Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy was higher for non-Hispanic white (white) (35.2%) compared with non-Hispanic black (black) (30.0%) and Hispanic (26.0%) women. Conversely, across most STD screening services evaluated, testing was highest among black women and men and lowest among their white counterparts. Receipt of many preventive services recommended in QFP increased consistently across categories of family income and continuity of health insurance coverage. Prevalence of service receipt was highest among women in the highest family income category (>400% of federal poverty level [FPL]) and among women with insurance coverage for each of the following: contraceptive services among women at risk for unintended pregnancy; medical services beyond advice to help achieve pregnancy; vaccinations (hepatitis B and human papillomavirus [HPV], ever; tetanus, past 10 years; influenza, past year); discussions with a health care professional about improving health before pregnancy and taking vitamins with folic acid; blood pressure and diabetes screening; discussions with a health care professional in the past year about diet, among those with obesity; discussions with a health care professional in the past year about smoking, among current smokers; Pap tests within the past 3 years; and mammograms within the past 2 years. INTERPRETATION: Before 2014, many women and men of reproductive age were not receiving several of the preventive services recommended for them in QFP. Although differences existed by age and race/ethnicity, across the range of recommended services, receipt was consistently lower among women and men with lower family income and greater instability in health insurance coverage. PUBLIC HEALTH ACTION: Information in this report on baseline receipt during 2011-2013 of preventive services for women and men of reproductive age can be used to target improvements in the use of recommended services through the development ofresearch priorities, information for decision makers, and public health practice. Health care administrators and practitioners can use the information to identify subpopulations with the greatest need for preventive services and make informed decisions on resource allocation. Public health researchers can use the information to guide research on the determinants of service use and factors that might increase use of preventive services. Policymakers can use this information to evaluate the impact of policy changes and assess resource needs for effective programs, research, and surveillance on the use of preventive health services for women and men of reproductive age. |
New clinical performance measures for contraceptive care: Their importance to healthcare quality
Gavin L , Frederiksen B , Robbins C , Pazol K , Moskosky S . Contraception 2017 96 (3) 149-157 OBJECTIVES: The National Quality Forum (NQF) recently endorsed the first clinical performance measures for contraceptive care. We present data demonstrating the measures meet the NQF's criterion 'importance to measure and report'. STUDY DESIGN: We summarized national contraceptive care initiatives, epidemiologic data documenting the health burden of teen and unintended pregnancy and short inter-birth intervals, and the scientific literature examining the association between contraceptive use and unintended pregnancy. Additionally we analyzed contraceptive use data from the National Survey of Family Growth (2013-2015) and the Pregnancy Risk Assessment Monitoring System (2012-2013). RESULTS: Five Federal agencies lead national initiatives and two Institute of Medicine reports highlight the centrality of these outcomes for the health of women and infants. Two literature reviews demonstrate the type of contraception used is associated with risk of unintended pregnancy. Fifty-three percent of adolescents (15-19years) and 40% of adult women (20-44years) at risk of unintended pregnancy are not using a most or moderately effective contraceptive method; in the postpartum period one-third of adolescents (≤19years) and 44% of adult women (≥20years) are not using these methods. CONCLUSIONS: The new contraceptive care measures meet the NQF criterion for 'importance to measure and report.' The measures are based on evidence that contraceptive use is associated with reproductive health outcomes, and there is a substantial performance gap in the use of most and moderately effective methods. IMPLICATIONS: Using the new contraceptive care measures may motivate providers to increase access to contraceptive care, thereby improving health outcomes. |
Use of clinical performance measures for contraceptive care in Iowa, 2013
Frederiksen BN , Kane DJ , Rivera M , Wheeler D , Gavin L . Contraception 2017 96 (3) 158-165 OBJECTIVES: To assess feasibility of calculating clinical performance measures for contraceptive care for National Quality Forum submission: the percentage of women aged 15-44 provided: 1) a most or moderately effective contraceptive method (MME), and 2) a long-acting reversible contraceptive (LARC) method. METHODS: We used 2013 Iowa Department of Public Health (IDPH) Title X and Iowa Medicaid data. We stratified Title X data by age and Medicaid data by age and benefit type (family planning waiver (FPW) vs. general Medicaid), and examined variation by residence, public health region, and health plan based on program interest. FINDINGS: Among women attending IDPH Title X clinics in 2013 (N=11,584), 86% of women ages 15-20years and 83% of women ages 21-44years were provided MME; 20% of women ages 15-20years and 20% of women ages 21-44years were provided LARC. Estimates varied across Title X sub-recipient agencies, which receive federal funds from IDPH. Among Medicaid FPW clients (N=30,013), 79% of women ages 15-20years and 73% of women ages 21-44years were provided MME; 12% of women ages 15-20years and 11% of women ages 21-44years were provided LARC. Among general Medicaid clients (N=14,737), 40% of women ages 15-20years and 28% of women ages 21-44years were provided MME; 5% of women ages 15-20years and 5% of women ages 21-44years were provided LARC. CONCLUSION: A high percentage of IDPH Title X and FPW clients were provided a MME method. No reporting entity had a LARC percentage less than 1-2%. IMPLICATIONS: Measure calculation using Title X and Medicaid data is feasible and can potentially be used to identify ways to increase access to contraceptive methods. |
The link between reproductive life plan assessment and provision of preconception care at publicly funded health centers
Robbins CL , Gavin L , Carter MW , Moskosky SB . Perspect Sex Reprod Health 2017 49 (3) 167-172 CONTEXT: Federal and clinical guidelines recommend integrating reproductive life plan assessments into routine family planning encounters to increase provision of preconception care. Yet, the prevalence of clinical protocols and of relevant practices at publicly funded health centers is unknown. METHODS: Administrators and providers at a nationally representative sample of publicly funded health centers that provide family planning services were surveyed in 2013-2014; data from 1,039 linked pairs were used to explore the reported prevalence of reproductive life plan protocols, frequent assessment of patients' reproductive life plan and frequent provision of preconception care. Chi-square tests and multivariable general linear models were used to examine differences in reports of protocols and related practices. RESULTS: Overall, 58% of centers reported having reproductive life plan assessment protocols, 87% reported frequently assessing reproductive life plans and 55% reported frequently providing preconception care. The proportions reporting protocols were lower in community health centers than in other center types (32% vs. 52-91%), in primary care centers than in those with another focus (33% vs. 77-80%) and in centers not receiving Title X funding than in those with such support (36% vs. 77%). Reported existence of a written protocol was positively associated with reported frequent assessment (prevalence ratio, 1.1), and the latter was positively associated with reported frequent preconception care (1.4). CONCLUSION: Further research is needed on associations between written protocols and clinical practice, and to elucidate the preconception care services that may be associated with reproductive life plan assessment. |
Plasmodium malariae and P. ovale genomes provide insights into malaria parasite evolution.
Rutledge GG , Bohme U , Sanders M , Reid AJ , Cotton JA , Maiga-Ascofare O , Djimde AA , Apinjoh TO , Amenga-Etego L , Manske M , Barnwell JW , Renaud F , Ollomo B , Prugnolle F , Anstey NM , Auburn S , Price RN , McCarthy JS , Kwiatkowski DP , Newbold CI , Berriman M , Otto TD . Nature 2017 542 (7639) 101-104 Elucidation of the evolutionary history and interrelatedness of Plasmodium species that infect humans has been hampered by a lack of genetic information for three human-infective species: P. malariae and two P. ovale species (P. o. curtisi and P. o. wallikeri). These species are prevalent across most regions in which malaria is endemic and are often undetectable by light microscopy, rendering their study in human populations difficult. The exact evolutionary relationship of these species to the other human-infective species has been contested. Using a new reference genome for P. malariae and a manually curated draft P. o. curtisi genome, we are now able to accurately place these species within the Plasmodium phylogeny. Sequencing of a P. malariae relative that infects chimpanzees reveals similar signatures of selection in the P. malariae lineage to another Plasmodium lineage shown to be capable of colonization of both human and chimpanzee hosts. Molecular dating suggests that these host adaptations occurred over similar evolutionary timescales. In addition to the core genome that is conserved between species, differences in gene content can be linked to their specific biology. The genome suggests that P. malariae expresses a family of heterodimeric proteins on its surface that have structural similarities to a protein crucial for invasion of red blood cells. The data presented here provide insight into the evolution of the Plasmodium genus as a whole. |
Importance of performance measurement and MCH epidemiology leadership to quality improvement initiatives at the national, state and local levels
Rankin KM , Gavin L , Moran JW Jr , Kroelinger CD , Vladutiu CJ , Goodman DA , Sappenfield WM . Matern Child Health J 2016 20 (11) 2239-2246 Purpose In recognition of the importance of performance measurement and MCH epidemiology leadership to quality improvement (QI) efforts, a plenary session dedicated to this topic was presented at the 2014 CityMatCH Leadership and MCH Epidemiology Conference. This paper summarizes the session and provides two applications of performance measurement to QI in MCH. Description Performance measures addressing processes of care are ubiquitous in the current health system landscape and the MCH community is increasingly applying QI processes, such as Plan-Do-Study-Act (PDSA) cycles, to improve the effectiveness and efficiency of systems impacting MCH populations. QI is maximally effective when well-defined performance measures are used to monitor change. Assessment MCH epidemiologists provide leadership to QI initiatives by identifying population-based outcomes that would benefit from QI, defining and implementing performance measures, assessing and improving data quality and timeliness, reporting variability in measures throughout PDSA cycles, evaluating QI initiative impact, and translating findings to stakeholders. MCH epidemiologists can also ensure that QI initiatives are aligned with MCH priorities at the local, state and federal levels. Two examples of this work, one highlighting use of a contraceptive service performance measure and another describing QI for peripartum hemorrhage prevention, demonstrate MCH epidemiologists' contributions throughout. Challenges remain in applying QI to complex community and systems-level interventions, including those aimed at improving access to quality care. Conclusion MCH epidemiologists provide leadership to QI initiatives by ensuring they are data-informed and supportive of a common MCH agenda, thereby optimizing the potential to improve MCH outcomes. |
What women and their physicians need to know about the UKCTOCS study and ovarian cancer screening
Balas C , Barley D , Baugh E , Berchuck A , Boyd J , Chiuzan C , DeFeo S , Ebell M , Ellis A , Gavin K , Levin B , Matteson K , Moran A , Narod S , Ramsey C , Seiden M , Stewart SL . Am Fam Physician 2016 93 (11) 903-904 In February 2016, the Ovarian Cancer Research Fund Alliance convened a group of 25 scientists, clinicians, and advocates to meet at the Banbury Center, Cold Spring Harbor Laboratory, to discuss the recent results from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and implications for clinical practice and public health. | Ovarian cancer is a relatively rare type of cancer that affects approximately 1.5% of U.S. women during their lifetime, but it is the fifth most common cause of cancer death among women.1 The five-year survival rate is only about 45% because most women present with advanced-stage disease.1 There has not been an accepted early detection test because of a lack of evidence that any screening approach reduces death from ovarian cancer. At the time of the conference, no organization had issued a guideline recommending screening for ovarian cancer in women not at increased risk. | The current recommendations against screening for ovarian cancer are based on the large U.S. prospective randomized Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.2 The PLCO trial demonstrated that an annual cancer antigen (CA) 125 measurement (using a fixed cutoff value for a positive test result) and ultrasonography were not associated with a reduction in mortality from ovarian cancer. Furthermore, screening was associated with significant harms resulting from surgeries that were triggered by false-positive findings. |
Four aspects of the scope and quality of family planning services in US publicly-funded health centers: Results from a survey of health center administrators
Carter MW , Gavin L , Zapata LB , Bornstein M , Mautone-Smith N , Moskosky SB . Contraception 2016 94 (4) 340-7 OBJECTIVES: To describe aspects of the scope and quality of family planning services provided by US publicly-funded health centers before the release of relevant federal recommendations. STUDY DESIGN: Using nationally-representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols, and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each. RESULTS: Half of the sample received Title X funding, and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past three months. Service provision to males was substantially lower except for STD screening. Sixty-three percent and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all 5 recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients, and being a Planned Parenthood clinic were associated with higher scores on most indices. CONCLUSION: Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types. Implications statement. As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess change as implementation of recent family planning service recommendations continues. |
Preconception care in publicly funded U.S. clinics that provide family planning services
Robbins CL , Gavin L , Zapata LB , Carter MW , Lachance C , Mautone-Smith N , Moskosky SB . Am J Prev Med 2016 51 (3) 336-43 INTRODUCTION: Federal recommendations for providing quality family planning services were published in 2014 and included preconception care (PCC). This paper aims to describe the prevalence of PCC delivery among publicly funded clinics, prior to the recommendations. METHODS: Prevalence of providing occasional or frequent PCC in the last 3 months and having written protocols for recommended PCC screenings were estimated in 2015 using survey data collected from a nationally representative sample of publicly funded clinic administrators (2013-2014, N=1,615). Analyses included examination of differential distributions of outcomes by clinic characteristics (p<0.05) and multivariable regression. RESULTS: Prevalence of occasional or frequent PCC delivery was 81% for women and 38% for men. The percentage of clinics with written protocols for specific PCC screenings ranged from 74% to 88% (women) and 66% to 83% (men). Prevalence of having written protocols for all PCC screenings was 29% for women and 22% for men. Characteristics negatively associated with having written protocols for all PCC screenings for women and men (respectively) were as follows: not receiving Title X funding (adjusted prevalence ratio [APR]=0.6, 95% CI=0.50, 0.76; APR=0.6, 95% CI=0.47, 0.77) and being a community health center (APR=0.5, 95% CI=0.37, 0.72; APR=0.5, 95% CI=0.30, 0.67); health department (APR=0.7, 95% CI=0.61, 0.87; APR=0.6, 95% CI=0.49, 0.76); or hospital/other (APR=0.6, 95% CI=0.50, 0.79; APR=0.6, 95% CI=0.43, 0.75) (versus Planned Parenthood). CONCLUSIONS: Provision of PCC appears to differ by clinic characteristics and by interpretation of the phrase "preconception care," suggesting opportunities for education and improvement. |
Update: Providing quality family planning services - Recommendations from CDC and the U.S. Office of Population Affairs, 2015
Gavin L , Pazol K . MMWR Morb Mortal Wkly Rep 2016 65 (9) 231-234 In 2014, CDC published Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP), which describes the scope of services that should be offered in a family planning visit, and how to provide those services (e.g., periodicity of screening, which persons are considered to be at risk, etc.). The sections in QFP include Contraceptive Services, Pregnancy Testing and Counseling, Clients Who Want to Become Pregnant, Basic Infertility Services, Preconception Health Services, Sexually Transmitted Disease Services, Related Preventive Health Services, and Screening Services for Which Evidence Does Not Support Screening. |
Projecting the unmet need and costs for contraception services after the Affordable Care Act
August EM , Steinmetz E , Gavin L , Rivera MI , Pazol K , Moskosky S , Weik T , Ku L . Am J Public Health 2015 106 (2) e1-e8 OBJECTIVES: We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. METHODS: We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. RESULTS: The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states' current Medicaid expansion plans. CONCLUSIONS: The Affordable Care Act increases women's insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed. (Am J Public Health. Published online ahead of print December 21, 2015: e1-e8. doi:10.2105/AJPH.2015.302928). |
Impact of contraceptive counseling in clinical settings: a systematic review
Zapata LB , Tregear SJ , Curtis KM , Tiller M , Pazol K , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S31-45 CONTEXT: This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Multiple databases were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies that evaluated contraceptive counseling interventions in clinical settings. Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U.S., Canada, Europe, Australia, or New Zealand. EVIDENCE SYNTHESIS: The initial search identified 12,327 articles, of which 22 studies (from 23 articles) met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a significant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations (adults and adolescents), with 11 finding a significant positive impact on at least one outcome of interest. CONCLUSIONS: Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another. The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention. |
Impact of contraceptive education on contraceptive knowledge and decision making: a systematic review
Pazol K , Zapata LB , Tregear SJ , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S46-56 CONTEXT: Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively. This systematic review evaluated contraceptive education interventions to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Three databases (CINAHL, PubMed, and PsycINFO) were searched from 1985 through 2012 for peer-reviewed articles on educational interventions, with supplemental searches conducted through 2015. Primary outcomes were knowledge, participation in and comfort with decision making, and attitudes toward contraception. Secondary outcomes included contraceptive use behaviors and unintended pregnancy. EVIDENCE SYNTHESIS: Database searches in 2011 identified 5,830 articles; 17 met inclusion criteria and were abstracted into evidence tables. Searches in 2012 and 2015 identified four additional studies. Studies used a wide range of tools (decision aids, written materials, audio/videotapes, and interactive games), with and without input from a healthcare provider or educator. Of 15 studies that examined the impact of educational interventions on knowledge, 14 found significant improvement using a range of tools, with and without input from a healthcare provider or educator. Fewer studies evaluated outcomes related to decision making, attitudes toward contraception, contraceptive use behaviors, or unintended pregnancy. CONCLUSIONS: Results from this systematic review are consistent with evidence from the broader healthcare field suggesting that a range of educational interventions can increase knowledge. Future studies should assess what aspects of educational interventions are most effective, the extent to which it is necessary to include a healthcare provider or educator, and the extent to which educational interventions can impact behaviors. |
Impact of reminder systems in clinical settings to improve family planning outcomes: a systematic review
Zapata LB , Tregear SJ , Tiller M , Pazol K , Mautone-Smith N , Gavin LE . Am J Prev Med 2015 49 S57-64 CONTEXT: This systematic review evaluated the evidence on the impact of family planning reminder systems-interventions intended to remind patients of behaviors to achieve reproductive health goals (e.g., daily text messages reminding oral contraceptive [OC] users to take a pill)-to provide information to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION: Multiple databases including PubMed were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies evaluating reminder systems to improve family planning outcomes. Studies were excluded if they focused primarily on HIV or sexually transmitted infection prevention, focused solely on men, or were conducted outside the U.S., Europe, Australia, or New Zealand. EVIDENCE SYNTHESIS: The initial search identified 16,129 articles, five of which met the inclusion criteria. Three studies examined the impact of OC reminder systems; two found a statistically significant positive impact on correct use. Two studies examined the impact of reminder systems among depot medroxyprogesterone acetate (DMPA) users; one found a statistically significant positive impact on correct use. CONCLUSIONS: Although mixed support was found for the effectiveness of reminder system interventions on correct use of OCs and DMPA, the highest-quality evidence yielded null findings. The evidence base would be strengthened by the development of additional studies, especially RCTs, which objectively measure outcomes, examine additional contraceptive methods, and have sufficient sample sizes to detect behavioral outcomes at least 12 months post-intervention. |
Introduction to the supplement: development of federal recommendations for family planning services
Gavin LE , Moskosky SB , Barfield WD . Am J Prev Med 2015 49 S1-5 In 2014, the U.S. CDC and the Office of Population Affairs (OPA) released clinical recommendations for providing family planning services, entitled “Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs.”1 Family planning services help women and their male partners achieve the number and spacing of children they desire, and increase the likelihood that those children are born healthy. As such, family planning includes contraceptive services to prevent pregnancy, services to help clients achieve pregnancy, and preconception services to improve the health of infants and their parents. | The purpose of this journal supplement is to describe the process by which the CDC–OPA recommendations were developed. This effort is consistent with recent calls for more rigorous processes for guideline development and more thorough and transparent articulation of that process. For example, WHO has defined a rigorous process for developing clinical guidelines,2,3 and IOM recently published standards for how to develop “trust-worthy” clinical practice guidelines.4 Yet, many guidelines are still developed without following the WHO and IOM procedures and—perhaps even more important—without clearly articulating the process by which they were developed.5 |
Client and provider perspectives on quality of care: a systematic review
Williams JR , Gavin LE , Carter MW , Glass E . Am J Prev Med 2015 49 S93-S106 CONTEXT: A central premise of the literature on healthcare quality is that improving the quality of care will lead to improvements in health outcomes. A systematic review was conducted to better inform quality improvement efforts in the area of family planning. The objective of this systematic review is to update a previous review focused on the quality of family planning services, namely, the impact of quality improvement efforts and client perspectives about what constitutes quality family planning services. In addition, this review includes new literature examining provider perspectives. EVIDENCE ACQUISITION: Multiple databases from January 1985 through January 2015 were searched within the peer-reviewed literature that described the quality of family planning services. The retrieval and inclusion criteria included full-length articles published in English, which described studies occurring in a clinic-based setting to include family planning services. EVIDENCE SYNTHESIS: Search strategies identified 16,145 articles, 16 of which met the inclusion criteria. No new intervention studies addressing the impact of quality improvement efforts on family planning outcomes were identified. Sixteen articles provided information relevant to client or provider perspectives about what constitutes quality family planning services. Clients and providers mostly identified the need for services that were accessible, client-centered, and equitable. Themes related to effectiveness, efficiency, and safety were mentioned less frequently. CONCLUSIONS: Family planning services that account for both patient and provider perspectives may be more effective. Further research is needed to examine the impact of improved quality on provider practices, client behavior, and health outcomes. |
Developing federal clinical care rRecommendations for women
Godfrey EM , Tepper NK , Curtis KM , Moskosky SB , Gavin LE . Am J Prev Med 2015 49 S6-S13 The provision of family planning services has important health benefits for the U.S. POPULATION: Approximately 25 million women in the U.S. receive contraceptive services annually and 44 million make at least one family planning-related clinical visit each year. These services are provided by private clinicians, as well as publicly funded clinics, including specialty family planning clinics, health departments, Planned Parenthoods, community health centers, and primary care clinics. Recommendations for providing quality family planning services have been published by CDC and the Office of Population Affairs of the DHHS. This paper describes the process used to develop the women's clinical services portion of the new recommendations and the rationale underpinning them. The recommendations define family planning services as contraceptive care, pregnancy testing and counseling, achieving pregnancy, basic infertility care, sexually transmitted disease services, and preconception health. Because many women who seek family planning services have no other source of care, the recommendations also include additional screening services related to women's health, such as cervical cancer screening. These clinical guidelines are aimed at providing the highest-quality care and are designed to establish a national standard for family planning in the U.S. |
Programs to strengthen parent-adolescent communication about reproductive health: a systematic review
Gavin LE , Williams JR , Rivera MI , Lachance CR . Am J Prev Med 2015 49 S65-72 CONTEXT: When caring for an adolescent client, providers of contraceptive services must consider whether and how to encourage parent/guardian-child communication about the adolescent's reproductive health. The objective of this systematic review was to summarize the evidence on the effectiveness of programs designed to increase parent-child communication about reproductive health. The review was used to inform national recommendations on quality family planning services. Data analysis occurred from mid-2011 through 2012. EVIDENCE ACQUISITION: Several electronic bibliographic databases were used to identify relevant articles, including PubMed, CINAHL, PsycINFO, and Popline, published from January 1985 through February 2011. EVIDENCE SYNTHESIS: Sixteen articles met the inclusion criteria: all studies examined the impact on at least one medium- or short-term outcome, and two studies assessed the impact on teen pregnancy. One study examined the impact of a program conducted in a clinic setting; the remainder examined the impact of programs in community settings. All studies showed a positive impact on at least one short-term outcome, and 12 of 16 studies showed an increase in parent-child communication about reproductive health. Four of seven studies found an impact on sexual risk behavior. CONCLUSIONS: Most programs increased parent-child communication, and several resulted in reduced sexual risk behavior of adolescents. This suggests that delivering a clinic-based program that effectively helps parents/guardians talk to their adolescent child(ren) about reproductive health, or referring parents/guardians to an evidence-based program in the community, may be beneficial. However, further rigorous research on delivery of these programs in clinical settings is needed. |
Nomenclature updates resulting from the evolution of avian influenza A(H5) virus clades 2.1.3.2a, 2.2.1, and 2.3.4 during 2013-2014.
Donis RO , Smith GJ . Influenza Other Respir Viruses 2015 9 (5) 271-6 The divergence of the A(H5) hemagglutinin (HA) gene of highly pathogenic avian influenza (HPAI) viruses (A/goose/Guangdong/96 lineage) was analyzed by phylogenetic and average pairwise distance methods to identify new clades that merit nomenclature changes. Three new clade designations were recommended based on division of clade 2.1.3.2a (Indonesia), 2.2.1 (Egypt) and 2.3.4 (widespread detection in Asia, Europe and North America) that includes newly emergent HPAI virus subtypes H5N2, H5N3, H5N5, H5N6 and H5N8. |
Vital Signs: trends in use of long-acting reversible contraception among teens aged 15-19 years seeking contraceptive services - United States, 2005-2013
Romero L , Pazol K , Warner L , Gavin L , Moskosky S , Besera G , Loyola Briceno AC , Jatlaoui T , Barfield W . MMWR Morb Mortal Wkly Rep 2015 64 (13) 363-369 The teen birth rate in the United States has continued to decline during the past two decades, from 61.8 births per 1,000 teens aged 15-19 years in 1991 to an all-time low of 26.5 births per 1,000 teens in 2013. Improved contraceptive use has contributed substantially to this decline; however, there were approximately 273,000 births to teens in 2013, and the U.S. teen pregnancy rate remains up to seven times higher than in some developed countries. Teen childbearing has potential negative health, economic, and social consequences for mothers and their children, and each year costs the United States approximately $9.4 billion. |
Receipt of reproductive health services among sexually experienced persons aged 15-19 years - National Survey of Family Growth, United States, 2006-2010
Tyler CP , Warner L , Gavin L , Barfield W . MMWR Suppl 2014 63 (2) 89-98 The prevention of pregnancy, childbirth, and sexually transmitted diseases (STDs) among teenagers has garnered recent attention both from public health and clinical organizations. In 2011, the U.S. birth rate among teenagers reached a historic low of 31.3 births per 1,000 females aged 15-19 years and has decreased 49% percent from 1991 to 2011. Despite recent decreases, U.S. birth rates among teenagers remain higher than those in other industrialized countries. For example, in 2009, the U.S. teenage birth rate was approximately 1.5 times the birth rate in the United Kingdom, nearly 3 times the birth rate in Canada, and nearly 8 times the birth rate of Denmark. Approximately 20% of births to teenagers aged 15-19 years are repeat births, and significant disparities by race and ethnicity persist. |
Developing new federal guidelines on family planning for the United States
Gavin L , Moskosky S . Contraception 2014 90 (3) 207-10 In April 2014, the US Centers for Disease Control and Prevention (CDC) and the HHS Office of Population Affairs (OPA) published clinical recommendations for providing family planning services, titled Providing Quality Family Planning Services (QFP) [1]. The recommendations were developed jointly and the collaboration drew on the strengths of both agencies. CDC has a long-standing history of developing evidence-based recommendations for clinical care, and OPA’s Title X Family Planning Program has served as the national leader in direct family planning service delivery since the Title X program was established in 1970. The publication of QFP should help take the field of family planning another step closer to the ultimate goal of helping individuals and couples achieve their desired number and spacing of healthy children. | The recommendations were published at a time when there are substantial challenges to Americans’ reproductive health. One-half (49%) of the 6.7 million pregnancies each year (3.2 million) are unintended [2]. In 2006–2010, 6.7 million women aged 15–44 years had impaired fecundity (that is, had an impaired ability to get pregnant or carry a baby to term), and 1.5 million married women aged 15–44 years were infertile (that is, were unable to get pregnant after at least 12 consecutive months of unprotected sex with their husband/partner) [3]. Approximately one of every eight pregnancies in the United States results in preterm birth, and infant mortality rates remain high relative to other developed countries [4–6]. By using contraceptive services to space births and by offering preconception health services as part of family planning, the health of the infant — as well as the woman and man — can be improved [7–14]. |
Improving the quality of family planning services: the role of new federal recommendations
Gavin L , Moskosky S . J Womens Health (Larchmt) 2014 23 (8) 636-41 This article provides a brief overview of Federal guidelines developed by the Centers for Disease Control and Prevention and the United States Office of Population Affairs on how to deliver quality family planning services. This article describes how the recommendations were developed, summarizes key points, and outlines steps that will be taken to disseminate and increase the use of the recommendations by primary care providers. |
Cryptococcus gattii in North American Pacific Northwest: whole-population genome analysis provides insights into species evolution and dispersal.
Engelthaler DM , Hicks ND , Gillece JD , Roe CC , Schupp JM , Driebe EM , Gilgado F , Carriconde F , Trilles L , Firacative C , Ngamskulrungroj P , Castaneda E , Lazera Mdos S , Melhem MS , Perez-Bercoff A , Huttley G , Sorrell TC , Voelz K , May RC , Fisher MC , Thompson GR 3rd , Lockhart SR , Keim P , Meyer W . mBio 2014 5 (4) e01464-14 The emergence of distinct populations of Cryptococcus gattii in the temperate North American Pacific Northwest (PNW) was surprising, as this species was previously thought to be confined to tropical and semitropical regions. Beyond a new habitat niche, the dominant emergent population displayed increased virulence and caused primary pulmonary disease, as opposed to the predominantly neurologic disease seen previously elsewhere. Whole-genome sequencing was performed on 118 C. gattii isolates, including the PNW subtypes and the global diversity of molecular type VGII, to better ascertain the natural source and genomic adaptations leading to the emergence of infection in the PNW. Overall, the VGII population was highly diverse, demonstrating large numbers of mutational and recombinational events; however, the three dominant subtypes from the PNW were of low diversity and were completely clonal. Although strains of VGII were found on at least five continents, all genetic subpopulations were represented or were most closely related to strains from South America. The phylogenetic data are consistent with multiple dispersal events from South America to North America and elsewhere. Numerous gene content differences were identified between the emergent clones and other VGII lineages, including genes potentially related to habitat adaptation, virulence, and pathology. Evidence was also found for possible gene introgression from Cryptococcus neoformans var. grubii that is rarely seen in global C. gattii but that was present in all PNW populations. These findings provide greater understanding of C. gattii evolution in North America and support extensive evolution in, and dispersal from, South America. IMPORTANCE: Cryptococcus gattii emerged in the temperate North American Pacific Northwest (PNW) in the late 1990s. Beyond a new environmental niche, these emergent populations displayed increased virulence and resulted in a different pattern of clinical disease. In particular, severe pulmonary infections predominated in contrast to presentation with neurologic disease as seen previously elsewhere. We employed population-level whole-genome sequencing and analysis to explore the genetic relationships and gene content of the PNW C. gattii populations. We provide evidence that the PNW strains originated from South America and identified numerous genes potentially related to habitat adaptation, virulence expression, and clinical presentation. Characterization of these genetic features may lead to improved diagnostics and therapies for such fungal infections. The data indicate that there were multiple recent introductions of C. gattii into the PNW. Public health vigilance is warranted for emergence in regions where C. gattii is not thought to be endemic. |
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