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Physical accessibility at colleges and universities is a perennial and challenging issue. Some campuses have made efforts to address these challenges through a variety of advocacy initiatives, while others have used disability simulations to bring greater awareness of physical accessibility to campus communities. An alternative approach to disability simulations and other accessibility awareness exercises is the Accessibility Expedition (AE). The AE engages participants in an exploration of campus spaces facilitated by disabled individuals and individuals knowledgeable of ADA Standards for Accessible Design and/or universal design (UD). The exploration is followed by a debriefing session to discuss barriers to equitable participation, as well as evidence of accessible or universal design practices. The description, rationale, steps for implementation, and observed outcomes of the AE practice are discussed.

ObjectiveTo compare associations between interpregnancy intervals (IPIs) and adverse perinatal outcomes in deliveries following IVF with deliveries following spontaneous conception or other (non-IVF) fertility treatments.DesignCohort using linked birth certificate and assisted reproductive technology surveillance data from Massachusetts and Michigan.SettingNot applicable.Patient(s)1,225,718 deliveries.Intervention(s)None.Main outcomes measure(s)We assessed associations between IPI and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) according to live birth or nonlive pregnancy outcome in the previous pregnancy.Result(s)In IVF deliveries following previous live birth, risk of PTB was 22.2% for IPI 12 to

ObjectiveTo characterize population-level surgical treatment patterns for cervical carcinoma in situ (CIS) reported to the Michigan Cancer Surveillance Program (MCSP), and to inform data collection strategies.MethodsAll cases of cervical carcinoma in situ (CIS) (including cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ [AIS]) reported to the MCSP during 1998-2003 were identified. First course of treatment (ablative procedure, cone biopsy, loop electrosurgical excisional procedure [LEEP], hysterectomy, unspecified surgical treatment, no surgical treatment, unknown if surgically treated) was described by histology, race, and age at diagnosis.ResultsOf 17,022 cases of cervical CIS, 82.8 percent were squamous CIS, 3 percent AIS/adenosquamous CIS, and 14.2 percent unspecified/other CIS. Over half (54.7 percent) of cases were diagnosed in women under age 30. Excisional treatments (LEEP, 32.3 percent and cone biopsy, 17.3 percent) were most common, though substantial proportions had no reported treatment (17.8 percent) or unknown treatment (21.1 percent). Less common were hysterectomy (7.2 percent) and ablative procedures (2.6 percent). LEEP was the most common treatment for squamous cases, while hysterectomy was the most treatment for AIS/adenosquamous CIS cases. Across histologic types, a sizeable proportion of women diagnosed ≤30 years of age underwent excision, either LEEP (20 percent-38.7 percent) or cone biopsy (13.7 percent-44 percent).ConclusionDespite evidence suggesting it may be safer and equally effective as excision, ablation was rarely used for treating cervical squamous CIS. These population-based data indicate some notable differences in treatment by histology and age at diagnosis, with observed patterns appearing consistent with consensus guidelines in place at the time of study, but favoring more aggressive procedures. Future data collection strategies may need to validate treatment information, including the large proportion of no or unknown treatment.

Objective This study aimed to compare trends and characteristics of assisted reproductive technology (ART) and non-ART perinatal deaths and to evaluate the association of perinatal mortality and method of conception (ART vs. non-ART) among ART and non-ART deliveries in Florida, Massachusetts, and Michigan from 2006 to 2011. Study Design Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. Results During 2006 to 2011, a total of 570 ART-conceived perinatal deaths and 25,158 non-ART conceived perinatal deaths were identified from the participating states. Overall, ART perinatal mortality rates were lower than non-ART perinatal mortality rates for both singletons (7.0/1,000 births vs. 10.2/1,000 births) and multiples (22.8/1,000 births vs. 41.2/1,000 births). At <28 weeks of gestation, the risk of perinatal death among ART singletons was significantly lower than non-ART singletons (adjusted risk ratio [aRR] = 0.46, 95% confidence interval [CI]: 0.26–0.85). Similar results were observed among multiples at <28 weeks of gestation (aRR = 0.64, 95% CI: 0.45–0.89). Conclusion Our findings suggest that ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation, which may be explained by earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies. These findings provide valuable information for health care providers, including infertility specialists, obstetricians, and pediatricians when counseling ART users on risk of treatment. Key Points ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation. ART perinatal mortality rates were lower than that for non-ART perinatal mortality. This study used linked data to examine associations between use of ART and perinatal deaths. [ABSTRACT FROM AUTHOR]

Physical accessibility at colleges and universities is a perennial and challenging issue. Some campuses have made efforts to address these challenges through a variety of advocacy initiatives, while others have used disability simulations to bring greater awareness of physical accessibility to campus communities. An alternative approach to disability simulations and other accessibility awareness exercises is the Accessibility Expedition (AE). The AE engages participants in an exploration of campus spaces facilitated by disabled individuals and individuals knowledgeable of ADA Standards for Accessible Design and/or universal design (UD). The exploration is followed by a debriefing session to discuss barriers to equitable participation, as well as evidence of accessible or universal design practices. The description, rationale, steps for implementation, and observed outcomes of the AE practice are discussed. [ABSTRACT FROM AUTHOR]

American Indians living in Michigan experience disproportionately high rates of infant mortality. This 11-year (1998-2008) cohort study evaluated impacts of a Healthy Start (HS) program administered by the Inter-Tribal Council of Michigan (ITCM) on perinatal outcomes. Women who enrolled in ITCM's HS program ('exposed') were compared with non-enrolled ('unexposed') for four outcomes: low birth weight (LBW), small for gestational age, preterm birth, and inadequate prenatal care. To classify exposed and unexposed women and their children, Michigan vital records data were linked with HS enrollment records to identify participants and non-participants among all American Indian births. Logistic regression was used to calculate odds ratios for the four outcomes of interest. Analyses were stratified for high and low access to care based on Medically Underserved Area (MUA) designation for a woman's county of residence. Of 4,149 American Indian births during the period, 872 were to women who enrolled prenatally in HS. Although unstratified analysis showed no differences between HS participants and non-participants, stratified analyses demonstrated that participants from MUA counties had decreased odds of LBW and inadequate prenatal care. Results suggest that in MUA counties where participants and non-participants are at similar risk for poor outcomes, HS may be reducing barriers and improving outcomes. In non-MUA counties participants had similar outcomes as non-participants. These results may reflect a wider disparity in risk factors between the two groups in non-MUA counties. The complex interplay among need, access, and benefit complicates analyses and suggests the importance of more in-depth and focused studies. Keywords Healthy Start evaluation * Low birth weight * Inadequate prenatal care * American Indian * Medically Underserved Area, Introduction American Indians experience significant racial (1) disparities in rates of infant mortality and perinatal outcomes [1-6]. In Michigan, during 1998 through 2009, the infant mortality rate for American Indians [...]

The study of health outcomes and the reduction in health disparities is at the forefront of the nation's health care agenda. A theme in the disparities literature is the call [...]