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Although often presenting as a self-limiting childhood disease, chickenpox can have serious consequences if acquired in pregnancy. Until April 2022, the UK recommendations were that varicella immunoglobulin (VZIG) should be administered intramuscularly to susceptible pregnant women exposed to chickenpox prior to 20 weeks gestation. Oral aciclovir or VZIG was recommended if exposure occurred at 20+ weeks gestation. Our objective was to compare the effectiveness of oral aciclovir to VZIG in preventing maternal and neonatal chickenpox.We identified and followed up 186 pregnant women who were exposed to chickenpox and compared their outcomes.171/186 (91.9%) of these women received either VZIG or oral aciclovir. Of the 145 women who received VZIG, 53/145 (36.6%) went on to develop chickenpox compared to 8 of the 26 (30.8%) women who received oral aciclovir (p = 0.32). No statistical difference was found between the oral aciclovir and VZIG groups even after controlling for maternal age, gestational stage, type of exposure and IgG titre (adjusted OR:0.83; 95%CI:0.26-2.65; p = 0.75).These findings support the use of oral aciclovir as first-line prophylaxis in pregnant women exposed to varicella as they suggest its effectiveness at preventing maternal chickenpox is either better or equal to VZIG.

Barriers to women's reproductive health care access, particularly for termination of pregnancy, are increasing at the local, regional, and national levels through numerous institutional, legislative, and regulatory restrictions. Lack of access to reproductive health care has negative consequences for women's health. Twelve women's health care organizations affirm their support for access to comprehensive reproductive health care, including abortion.

Background: von Willebrand disease (vWD) is a heterogeneous hereditary bleeding disorder and is associated with risk of primary postpartum haemorrhage (PPH). Design and methods: An observational study at a tertiary referral centre in Australia of 16 women with 23 deliveries with a median age of 27.5 years (range, 21-39; IQR = 9). Median gestational age at delivery was 39 weeks (range, 35-41; IQR = 1.1). Results: All cases had type 1 vWD, apart from one case with type 2. Patients were managed in combined obstetrics and haematology clinics. PPH occurred in ten deliveries (44%). Intravenous desmopressin was administered in 6 cases, and IV human vWF was administered in 4 cases. Two cases with mild vWD had received oral tranexamic acid. The median Apgar score at 1 and 5 min was 9 (IQR = 1.0), while the median Apgar score at 10 min was 10.0 (IQR = 0.0). One case required transfusion of blood products postdelivery. There were no other significant complications observed. Conclusions: was associated with a high incidence of primary PPH. Individualised treatment to restore haemostasis, according to the severity of the disease, could achieve as possible, normal haemostasis with favourable outcomes for both mothers and their infants. Further studies to confirm our findings are warranted.

Objective(s) We studied women's experiences seeking and receiving second-trimester abortion care in two geographically and legislatively different settings to inform ways to improve abortion care access and services. Study design We conducted in-depth interviews with women who obtained second-trimester abortion care. Themes from the interviews were then used to inform a self-administered survey, which was completed by 108 women who received second-trimester abortion care in the Northeast and Midwest. We calculated descriptive statistics and used chi-squared and t-tests to compare responses. Results We interviewed eight women and surveyed 108 women. Most interviewees and 65.2% of survey respondents reported difficulties accessing care. Although most interview and survey respondents had insurance, a slight majority reported difficulty funding care. All interviewees and 57.9% of survey respondents reported positive experiences with providers, with many interviewees and 62.0% of survey respondents saying their abortion care was better than their usual health care. Most interviewees and 75.8% of survey respondents reported pain as low to moderate, and the majority of participants reported it was the same or less than expected. Knowledge about abortion restrictions was low. Most interviewees and 68.4% survey respondents disagreed with restrictions on insurance coverage of abortion. Common recommendations to improve experiences were to ensure travel and financial support and to decrease wait times at clinics. There were few regional differences among outcomes. Conclusion(s) Women seeking second-trimester abortion in these locations reported positive abortion experiences. However, they had to overcome significant obstacles to obtain care. Implications This is the first study to systematically research women's second-trimester care experiences in two different regions of the United States. Regardless of location, women experienced barriers due to policies that impose gestational age restrictions, limit provider availability (consequently increasing wait times), and increase costs. Policy change to reduce these barriers is critical to improve access to and experiences with second trimester abortion care.

The Society of Family Planning Research Fund (SFPRF) provides grants for research on abortion and contraception. In 2017, SFPRF conducted a retrospective evaluation of its investment in family planning research. Using a developmental evaluation approach, we created a framework for assessing research impact in family planning and applied it to an analysis of our grantmaking between 2007 and 2017. Our framework consists of 30 indicators of research impact, which span nine impact categories from building researchers’ capacity to influencing individuals, communities, and systems. Through application of this framework to our grantmaking, we learned that our grantmaking has helped build the research capacity of emerging and established family planning scholars and advance the field of family planning by supporting the creation of a robust scholarly evidence base. At the same time, we identified less evidence of impact on policy and practice. The results of this analysis directed SFPRF to move towards more focused funding opportunities, including longer-term and larger investments, and to prioritize partnerships between researchers and knowledge brokers.

Background Gestational diabetes mellitus (GDM) is associated with life-long increased risk of type 2 diabetes: affected women are advised to undergo oral glucose tolerance testing (OGTT) at 6–12 weeks postpartum, then glucose screening every 1–3 years. Aims We investigated whether in women with GDM, antenatal clinical factors predicted postpartum abnormal glucose tolerance and compliance with screening. Materials and methods In women with GDM delivering 2007 to mid-2009 in a single hospital, antenatal/obstetric data and glucose tests at 6–12 weeks postpartum and during 5.5 years post-pregnancy were retrospectively collected. Predictors of return for testing and abnormal glucose tolerance were identified using multivariate analysis. Results Of 165 women, 117 (70.9%) returned for 6–12 week postpartum OGTT: 23 (19.6%) were abnormal. Smoking and parity, independent of socioeconomic status, were associated with non-return for testing. Fasting glucose ≥5.4 mmol/L on pregnancy OGTT predicted both non-return for testing and abnormal OGTT. During 5.5 years post-pregnancy, 148 (89.7%) women accessed glucose screening: nine (6.1%) developed diabetes, 33 (22.3%) had impaired fasting glucose / impaired glucose tolerance. Predictors of abnormal glucose tolerance were fasting glucose ≥5.4 mmol/L and 2-h glucose ≥9.3 mmol/L on pregnancy OGTT (~2.5-fold increased risk), and polycystic ovary syndrome (~3.4 fold increased risk). Risk score calculation, based on combined antenatal factors, did not improve predictions. Conclusions Antenatal clinical factors were modestly predictive of return for testing and abnormal glucose tolerance post-pregnancy in women with GDM. Risk score calculations were ineffective in predicting outcomes: risk scores developed in other populations require validation. Ongoing glucose screening is indicated for all women with GDM.

Background At a time when most states are working to restrict abortion, Massachusetts stands out as one of the few states with multiple state-level policies in place that support abortion access for low-income women. In 2006, Massachusetts passed health care reform, which resulted in almost all residents having insurance. Also, almost all state-level public and subsidized insurance programs cover abortion and there are fewer restrictions on abortion in Massachusetts compared with other states. Methods We explored low-income women's experiences accessing abortion in Massachusetts through 27 in-depth telephone interviews with a racially diverse sample of low-income women who obtained abortions. Interviews were digitally recorded, transcribed, coded, and analyzed thematically. Results Most women described having access to timely, conveniently located, affordable, and highly acceptable abortion care. However, a sizable minority of women had difficulty enrolling in or staying on insurance, making abortion expensive. A small minority of women said their abortion care could be improved by increasing emotional support and privacy, and decreasing appointment times. Some limited data also suggest that young women and immigrant women face specific barriers to care. Conclusion This study provides important, novel information about the need for state-level policies that support access to health insurance and comprehensive abortion coverage. Such policies, along with a well-functioning health care environment, help to ensure that low-income women have access to abortion. However, not all abortion access challenges have been resolved in Massachusetts. More work is needed to ensure that all women can access affordable, confidential care that is responsive to their specific needs and preferences.

CONTEXT Miscarriage care can safely and effectively be offered in appropriately equipped offices and emergency departments. However, it is often treated in the operating room, which limits access to timely, cost-effective and high-quality care. METHODS Between May 2013 and January 2014, in-depth interviews were conducted with 30 staff holding diverse roles at 15 medical offices and emergency departments with the aim of exploring barriers to and facilitators of offering miscarriage care, and identifying methods for expanding care. On-site observations were also conducted at four facilities. All data were transcribed, iteratively coded and analyzed using qualitative techniques. RESULTS Similar barriers to and facilitators of providing miscarriage care were identified across facility types. Barriers were physician preference for providing care in the operating room, the similarity of miscarriage management and abortion procedures, the limited availability of support staff, difficulties integrating miscarriage management into patient scheduling and flow, and uncertainty about responding to women's emotional needs. Facilitators were a commitment to evidence-based medicine, insurance coverage of miscarriage, offering other procedures of similar complexity and the minimal resources needed for miscarriage care. Resources needed to expand miscarriage services included a medically trained “champion,” best practices for implementing services, persistence and patience, training, clear protocols, and systems for tracking equipment and supplies. CONCLUSIONS Miscarriage care was viewed as neither resource-intensive nor technically complex to provide. Although it may be emotionally and politically challenging to offer, effective strategies are available for expanding the scope of miscarriage care offered in multiple settings.

We explored how low-income abortion clients in states where public funding was and was not available perceived the role of public funding for abortion. From October 2010 through February 2011, we conducted 71 semi-structured in-depth telephone interviews with low-income abortion clients in Arizona, Florida, New York, and Oregon. Women reported weighing numerous factors when determining which circumstances warranted public funding. Though most women generally supported coverage, they deviated from their initial support when asked about particular circumstances. Respondents felt most strongly that abortion should not be covered when a woman could not afford another child or was pregnant outside of a romantic relationship. Participants used disparaging language to describe the presumed behavior of women faced with unintended pregnancies. In seeking to discredit "other" women's abortions, women revealed the complex nature of abortion stigma. We propose that women's abortion experiences and subsequent opinions on coverage indicated three distinct manifestations of abortion stigma: women (1) resisted the prominent discourse that marks women who have had abortions as selfish and irresponsible; (2) internalized societal norms that stereotype women based on the circumstances surrounding the abortion; and (3) reproduced stigma by distancing themselves from the negative stereotypes associated with women who have had abortions.

Purpose We explored the contraceptive experiences of female teens with epilepsy, including their knowledge and perceptions of interactions between antiepileptic drugs and hormonal contraception and contraceptive decision-making processes. Method From November 2012 to May 2013, we conducted one online survey ( n =114) and 12 online focus group discussions ( n =26) with female teens with epilepsy about their contraceptive experiences and unmet needs. Survey data were analyzed using descriptive statistics and focus group transcripts were analyzed thematically using modified grounded theory methods. Results Both survey and focus group participants reported believing that interactions between epilepsy medications and hormonal contraceptives could lead to reductions in contraceptive efficacy and seizure control. However, their knowledge about these types of medication interactions was often incomplete. Many study participants viewed contraceptive decision making as a difficult process, and some participants reported avoiding hormonal contraceptives because of potential interactions with antiepileptic drugs. Study participants reported relying on health care providers and parents for contraceptive decision-making support. Focus group participants also reported they wanted health care providers to provide more in-depth and comprehensive counseling about contraception, and that they desired peer support with contraceptive decisions. Conclusion The ability to make informed contraceptive decisions is important for teens with epilepsy as interactions between anti-epileptic drugs and hormonal contraceptives can impact seizure occurrence and lead to an increased risk of unplanned pregnancy. Guidance for providers offering contraceptive care to this population is needed, as well as a contraceptive support tool that empowers teens with epilepsy to advocate for desired health care.

Cancers are initiated as a result of changes that occur in the genome. Identification of gains and losses in the structure and expression of tumor-suppressor genes and oncogenes lies at the root of the understanding of cancer cell biology. Here, we show that the mitogen–activated protein kinase (MAPK) MKK3 suppresses the growth of breast cancer, in which it varies in copy number. A pervasive loss of MKK3 gene copy number in patients with breast cancer is associated with an impairment of MKK3 expression and protein level in malignant tissues. To assess the functional role of MKK3 in breast cancer, we showed in an animal model that MKK3 activity is required for suppression of tumor growth. Active MKK3 enhanced expression of the cyclin-dependent kinase inhibitors p21Cip1/Waf1 and p27Kip1, leading to increased cell-cycle arrest in G1 phase of the cell cycle. Our results reveal the functional significance of MKK3 as a tumor suppressor and improve understanding of the dynamic role of the MAPK pathway in tumor progression. Cancer Res; 74(1); 162–72. ©2013 AACR.

We investigated the impact of Massachusetts health care reform on low-income women's experiences accessing insurance and health services, specifically reproductive health services such as contraception. Our findings suggest that concentrated efforts are needed to make sure that health services are available and accessible to populations who fall through the cracks of health care reform, including immigrants, minors and young adults, and women living outside urban areas. In addition, systems changes are needed to ensure that women going through common life transitions, such as pregnancy, marriage, moving, or graduating from school, have continuous access to insurance, and therefore health services, as their lives change. These groups face barriers enrolling in and maintaining their insurance coverage as well as obtaining timely health care benefits they are eligible for through their insurance benefits or public health programs. Without intervention, many in these groups may delay or avoid seeking health care altogether, which may increase health care disparities in the long term. Family planning providers in Massachusetts have played a critical role in mitigating barriers to insurance and health care. However, recent threats to defund family planning providers call into question the ability of these providers to continue providing much-needed services.

Medicaid, a jointly funded federal-state insurance program, was designed to provide comprehensive coverage of health care for low-income U.S. residents. Women make up three-quarters of the adult Medicaid population, and in 2005, almost 7.5 million reproductive-aged women were enrolled in the program (Guttmacher Institute 2007). Although women insured by Medicaid make up nearly one-third of annual abortion clients (Jones, Finer, and Singh 2010), federal and state policies limit their ability to use their insurance for abortion. The Hyde Amendment, which prohibits the use of federal funds for abortion, was passed in 1976 and has been re-approved every year since. Currently, federal funds can only be used to cover abortion when the pregnancy is a result of rape or incest, or threatens the life of the woman (hereafter referred to as Hyde-qualifying cases). Thirty-two states and the District of Columbia follow the federal example and restrict the use of Medicaid funds to Hyde-qualifying cases. South Dakota, in direct violation of federal law, only covers abortion when a woman's life is endangered. Seventeen states use their own funds to cover all or most abortions (Guttmacher Institute 2011a). Little is known about how Medicaid abortion coverage policies are realized in practice or influence service delivery. We compared abortion providers' experiences securing Medicaid reimbursement in states with policies that limit abortion coverage to Hyde-qualifying cases to states with policies indicating broad coverage of abortion. We then investigated how the daily workings of these policies impacted abortion providers and women.

CONTEXT: Barriers to contraceptive access encourage nonuse and gaps in use which contribute to the high prevalence of unintended pregnancy in the United States. One strategy to improve access to oral contraceptives is to make them available without a prescription. METHODS: From March 2007 to January 2009 focus group discussions and in-depth interviews were conducted with 45 low-income women in the Boston area to explore how they obtain contraceptives and their opinions about making oral contraceptives available over the counter. Transcripts of the discussions and interviews were deductively and inductively coded. Data were analyzed thematically and illustrative quotes were extracted. RESULTS: Overall participants reported ease in obtaining contraceptives which were available at multiple accessible locations throughout Boston. However various barriers-unaffordable copays and clinic visits the time required for clinic visits restrictions on the number of packs of prescription contraceptives (e.g. the ring the pill) purchased monthly and the limited time frame in which to purchase them-deterred consistent use of preferred methods. Most participants supported over-the-counter access to oral contraceptives; however they raised concerns about cost as well as the safety of such access for minors first-time users and women with medical conditions. CONCLUSION: Womens concerns about over-the-counter access to contraceptives must be addressed if this approach is to improve use and potentially help reduce the unintended pregnancy rate. Copyright (c) 2012 by the Guttmacher Institute.

Background In 2006, Massachusetts passed sweeping health care reform legislation aimed at improving access to health care for residents. This study investigates how this landmark legislation affected contraceptive access for low-income women. Study Design This study included (a) 16 in-depth interviews with family planning providers, (b) 9 focus group discussions with 52 low-income English- and Spanish-speaking women, (c) 10 self-administered surveys of family planning administrators and (d) a systematic review of Web sites for government-subsidized insurance plans. Results Findings from all study components were highly consistent. We found that while most low-income women in Massachusetts continue to regularly obtain contraception, challenges such as maintaining insurance coverage, understanding benefits, securing an appointment with a provider and obtaining prescriptions were identified post reform. Findings about contraceptive affordability under reform were mixed. Conclusion Though health care reform legislation has benefited many women, barriers remain to ensuring consistent access to contraception for low-income women.

This fact sheet describes PATHs work to expand access to family planning products and services in low-resource settings.

Nutritional iron-deficiency anaemia (IDA) is the most common disorder in the world, affecting more than two billion people. The World Health Organization’s global database on anaemia has estimated a prevalence of 14% based on a regression-based analysis. Recent data show that the prevalence of IDA in pregnant women in industrialized countries is 17.4% while the incidence of IDA in developing countries increases significantly up to 56%. Although oral iron supplementation is widely used for the treatment of IDA, not all patients respond adequately to oral iron therapy. This is due to several factors including the side effects of oral iron which lead to poor compliance and lack of efficacy. The side effects, predominantly gastrointestinal discomfort, occur in a large cohort of patients taking oral iron preparations. Previously, the use of intravenous iron had been associated with undesirable and sometimes serious side effects and therefore was underutilised. However, in recent years, new type II and III iron complexes have been developed, which offer better compliance and toleration as well as high efficacy with a good safety profile. In summary, intravenous iron can be used safely for a rapid repletion of iron stores and correction of anaemia during and after pregnancy.

Background Provision of emergency contraceptive pills (ECPs) is widely recognized as the standard of care to prevent pregnancy after a sexual assault. However, previous research has shown that hospitals do not routinely counsel sexual assault patients about or provide sexual assault survivors with ECPs or accurate referrals. Methods We undertook a mixed methods study to assess policies and practices regarding the provision of ECPs for sexual assault survivors in South Carolina. The study includes four components: An analysis of the South Carolina Victims' Rights Amendment, in-depth interviews with rape crisis agency and state agency representatives, a survey of hospital emergency department staff, and a survey of hospital emergency department administrators. Findings Our findings indicate that hospital policies and practices regarding ECP-related services for sexual assault patients are generally consistent with the standard of care. According to hospital staff and administrators, requiring a police report and/or undergoing a rape kit examination before providing ECPs do not seem to be significant access barriers. However, hospitals that do not conduct rape kit examinations transfer patients to other facilities, and these initial hospitals do not routinely provide patients with ECPs before transfer. Conclusion Our findings suggest that further research to document whether transfer practices and reporting requirements impede access to ECPs is warranted. Furthermore, our results support the recommendation that any woman reporting sexual assault should be immediately offered dedicated, progestin-only ECPs. Last, our results suggest that key stakeholders in the sexual assault community could be engaged to improve sexual assault and ECP-related services in South Carolina.

Medicaid is designed to ensure low-income populations can afford health care. However, not all health services are covered by the program. Most state Medicaid programs restrict abortion coverage, though a small number of state programs offer such coverage. Little is known about how low-income women are affected by differing Medicaid coverage policies regarding abortion. We conducted in depth interviews with 98 low-income women who had abortions. We found that women's impressions about abortion costs and the availability of Medicaid coverage are generally accurate and that women rely predominantly on abortion facilities for confirmatory cost and coverage information. Additionally, when abortion is out of financial reach, women and the people in their lives experience numerous emotional and financial harms. Policies that aim to ensure abortion is affordable largely prevent these harms, though the availability of Medicaid coverage does not always guarantee access to affordable care. Findings can help advance evidence-based policies

Consistent condom use and the substitution of condoms with potential HIV prevention methods of lower or unknown effectiveness are important concerns in the development of new prevention technologies. This qualitative study explored obstacles to consistent condom use with the diaphragm in MIRA, an HIV prevention trial in South Africa and Zimbabwe. We conducted 26 focus group discussions (FGDs) with 206 women and 7 FGDs and 10 in-depth interviews with 41 male partners of intervention-arm women. The belief that the diaphragm/gel prevented HIV, women's difficulties negotiating condom use, and men's unawareness that using the products together was recommended were obstacles to consistent condom use with the diaphragm/gel. Concerns about protection from HIV and pregnancy, recognition that the diaphragm was not yet proven to prevent HIV or sexually transmitted infections, and the trial context were facilitators. Understanding selective study product use in HIV prevention trials may inform improved adherence counseling and male involvement strategies.

Background To date there is minimal data available on D-Dimer levels at different stages of pregnancy. Patients and methods We prospectively measured D-Dimer levels in 632 consecutive pregnant women from March 2007 to January 2009. The median age of the participants was 31 years (range; 18–42) with a median weight of 78 kilograms (range; 46–137). All subjects were investigated during each trimester with two different immunoturbidimetric assays; D-Dimer PLUS and INNOVANCE D-Dimer. D-Dimer levels were determined using a Sysmex® CA 1500 analyser. Results Our data demonstrate that D-Dimer levels in pregnancy show different patterns of rise within the first trimester, depending on the assay used; D-Dimer PLUS = 0.88 (SD: mean ratio), INNOVANCE D-Dimer = 0.72 (SD: mean ratio). Furthermore, the rise in mean results was greater for the INNOVANCE D-Dimer assay compared to the D-Dimer PLUS assay as shown by the ratio of third to first trimester results of 3.68 and 1.96 respectively. Both D-Dimer assays demonstrated moderate levels of intra-subject variability, with overall mean CVs of 16.5% (D-Dimer PLUS) and 16.9% (INNOVANCE D-Dimer). Furthermore, we studied the association between D-Dimer levels and occurrence of diseases of pregnancy. For both assays, there was no consistently interpretable evidence of an association between raised mean D-Dimer levels or rising D-Dimer levels and any of the diseases or conditions associated with pregnancy. Conclusion Our data suggest that the INNOVANCE D-Dimer assay increases significantly with the advancement of pregnancy, and is more sensitive than D-Dimer PLUS assay in the pregnant population.

Objectives. We investigated systematic barriers, identified by previous research, that prevent women from obtaining Medicaid coverage for an abortion even when it should legally be available: when the pregnancy resulted from rape or incest or threatens the mother's life. We also aimed to document strategies to improve access to federal Medicaid funding in qualifying cases. Methods. We conducted in-depth interviews from 2007 to 2009 with representatives of 49 facilities that provided abortions in 11 states. Interviews focused on participants’ experiences and strategies in seeking federal Medicaid funding for abortions. We coded data both inductively and deductively and analyzed them thematically. Results. Common strategies described by the few participants who secured Medicaid funding for abortions in cases of rape, incest, and life endangerment were facility-level interventions, such as developing relationships with Medicaid staff, building savvy billing departments, and encouraging clients to advocate for themselves, as well as broader legal and collaborative strategies. Conclusions. Multipronged state-level interventions that combine advocacy, legal, and on-the-ground resources show the most promise of increasing access to federal Medicaid funding for abortion care.

Objectives: The Hyde Amendment prohibits federal Medicaid funding for abortion except when a woman is seeking an abortion for a pregnancy that is the result of rape or incest, or that threatens her life. We investigated how Medicaid staff in 17 states responded to inquiries about coverage for abortion in the few circumstances that qualify for federal Medicaid funding. Methods: Using a mystery caller approach, we surveyed Medicaid staff about the availability of abortion coverage, the process for obtaining coverage, and the associated costs for an abortion in circumstances of rape and life endangerment in five states where Medicaid coverage should be available to cover most abortions and in 12 states with restrictions on the circumstances under which Medicaid funding can be used for abortion. Findings: We were able to complete 82% of surveys. Medicaid staff definitively provided information about the availability of coverage that was consistent with state policies in 64% of surveys. However, 52% of staff reported that coverage could be difficult to obtain and that rigorous documentation of the circumstances of the abortion was required. Information about copays for abortion was given in 78% of surveys. We subjectively rated the caller’s experience with Medicaid staff as excellent during 32% of the surveys, adequate in 61% of surveys, and poor in 7% of surveys. Conclusion: Medicaid staff provided inconsistent information that was often discouraging of women seeking abortion coverage, suggesting that women may have difficulties obtaining accurate information about Medicaid coverage of abortion, which may deter access to care. Copyright 2012 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.

Introduction In the United States, ectopic pregnancies are relatively common and associated with significant maternal morbidity and mortality. The Ethical and Religious Directives for Catholic Health Care Services (the Directives ) govern the provision of care in Catholic-affiliated hospitals and prohibit the provision of abortion in almost all circumstances. Although ectopic pregnancies are not viable, some Catholic ethicists have argued that the Directives preclude physicians at Catholic hospitals from managing tubal pregnancies with methods and procedures that involve "direct" action against the embryo. Methods We undertook this qualitative study to explore the relationship between the Directives , hospital policies regarding ectopic pregnancy management, and clinical practices. We recruited participants at non-Catholic, longstanding Catholic, and recently merged facilities and conducted focused interviews with 24 physicians at 16 hospitals in 10 states. Findings Participants from three Catholic facilities reported that medical therapy with methotrexate was not offered because of their hospitals' religious affiliation. The lack of methotrexate resulted in changes in counseling and practice patterns, including managing ectopic pregnancies expectantly, providing the medication surreptitiously, and transferring patients to other facilities. Further, several physicians reported that, before initiating treatment, they were required to document nonviability through what they perceived as unnecessary paperwork, tests, and imaging studies. Conclusion Our findings suggest that some interpretations of the Directives are precluding physicians from providing women with ectopic pregnancies with information about and access to a full range of treatment options and are resulting in practices that delay care and may expose women to unnecessary risks.

Dual-task methodology has been increasingly used to assess cognitive motor interference while walking. However, whether the observed dual-task-related gait changes are systematically related to methodological variations remains unclear and researchers still lack knowledge of what cognitive task to use in different groups for clinical purposes or for research. We systematically reviewed experimental studies that measured gait performance with and without performing concurrent cognitive task. Our results suggest that cognitive tasks that involve internal interfering factors seem to disturb gait performance more than those involving external interfering factors. Meta-analysis results show that the overall effect of different cognitive tasks was prominent in gait speed. In healthy participants, meta-regression analysis suggests strong associations between age and speed reduction under dual-task conditions and between the level of cognitive state and speed reduction under dual-task conditions. Standardizing research methodologies, as well as improving their ecological validity, enables better understanding of dual-task-related gait changes in different populations and improves, in turn, our understanding of neural mechanisms and gait control in general in content.