Search

Rationale: Young people with epilepsy of childbearing potential (YPWECP) are vulnerable to a variety of adverse health outcomes due to teratogenic antiseizure medications (ASMs) and drug-drug interactions between ASMs and contraceptives that can lead to breakthrough seizures and/or contraceptive failure. To better understand reproductive healthcare provision for YPWECP, we conducted a retrospective analysis of relevant prescription patterns., Methods: We analyzed procedural and medication data for YPWECP ages 13-21 years (n = 1525) from 2011 through 2021 at a single tertiary-care pediatric medical center to investigate rates of (1) prescription of folic acid, (2) prescription of an enzyme-inducing ASM<6 months before or after hormonal contraception initiation (or < 3 years after subdermal implant placement), (3) prescription of lamotrigine < 6 months before or after an estrogen-containing contraceptive that could affect lamotrigine serum concentrations, and (4) documentation of any contraceptive medication or device that overlaps initiation of a patient's first teratogenic ASM. We performed statistical analyses with sample proportion z-tests. We then used logistic regression and generalized estimating equations to evaluate for associations between patient characteristics and prescription patterns., Results: Among 1525 YPWECP, less than half (41 %, n = 629) were prescribed folic acid during the study period (95 % CI 38.8-43.7). Of YPWECP prescribed an enzyme-inducing ASM, 24 % (186/766) were co-prescribed a hormonal contraceptive that adversely interacts with the ASM (95 % CI 21.2-27.3 %). Of those prescribed lamotrigine during the study period, 24 % (111/472) had documentation of an estrogen-containing medication that could affect lamotrigine serum concentrations < 6 months before or after that prescription (95 % CI 19.7-27.3 %). Of those prescribed a teratogenic ASM, only 13 % (82/638) had documentation of contraception prior to (or within the same month as) starting their first teratogenic ASM (95 % CI 10.3-15.5 %). Older age was associated with increased odds of contraceptive coverage prior to initiation of the first teratogenic ASM and was also associated with increased odds of having contraceptives co-prescribed with ASMs that could interact. No significant associations were found between race/ethnicity and any outcomes., Conclusions: YPWECP experience low rates of folic acid prescription and low rates of contraceptive coverage while prescribed teratogenic ASMs. Many YPWECP, particularly older adolescents, are at increased risk for contraceptive failure and/or breakthrough seizures due to drug-drug interactions. Results demonstrate a need for increased focus on reproductive healthcare for YPWECP. Future studies should evaluate interventions aimed at improving these outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: As part of a larger study about pregnancy options counseling with adolescents, we interviewed women in the United States who chose abortion during adolescence about preferences and experiences regarding communication from healthcare professionals during abortion care., Design, Setting, and Participants: We conducted individual semi-structured interviews with women ages 18-35 years old who were pregnant before age 20 years old and chose abortion. We recruited participants through social media, a research registry, and flyers in healthcare facilities. We recorded and transcribed interviews. Two investigators coded interview transcripts using thematic analysis., Results: We conducted interviews with 17 US women (median age 32 years old, range 20-35 years old) from 11/2020-4/2021. The median age at time of abortion was 18 years old (range 14-19 years). The sample was 58% (n = 10) Caucasian and 65% (n = 11) heterosexual. Themes included: 1) Participants perceived options counseling before abortion as important and necessary but did not always feel they personally needed it. 2) Participants reported that clinicians including nurses, physicians, and other staff sometimes had poor bedside manner, which was not aligned with their perceived need for gentleness due to their adolescence. 3) Participants valued nonjudgmental communication including normalization of abortion care. 4) Participants desired privacy and confidentiality throughout their clinic appointment, but clinic logistics led to concerns about limited privacy. 5) Participants appreciated medically accurate information about abortion in plain language balancing safety and risk information for reducing fear before the procedure., Conclusion: Responses suggested specific best practices that healthcare providers can adopt to improve care for youth considering abortion., Competing Interests: Conflicts of Interest The authors have no conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: This study aimed to enable clinical researchers without expertise in natural language processing (NLP) to extract and analyze information about sexual and reproductive health (SRH), or other sensitive health topics, from large sets of clinical notes., Methods: (1) We retrieved text from the electronic health record as individual notes. (2) We segmented notes into sentences using one of scispaCy's NLP toolkits. (3) We exported sentences to the labeling application Watchful and annotated subsets of these as relevant or irrelevant to various SRH categories by applying a combination of regular expressions and manual annotation. (4) The labeled sentences served as training data to create machine learning models for classifying text; specifically, we used spaCy's default text classification ensemble, comprising a bag-of-words model and a neural network with attention. (5) We applied each model to unlabeled sentences to identify additional references to SRH with novel relevant vocabulary. We used this information and repeated steps 3 to 5 iteratively until the models identified no new relevant sentences for each topic. Finally, we aggregated the labeled data for analysis., Results: This methodology was applied to 3,663 Child Neurology notes for 971 female patients. Our search focused on six SRH categories. We validated the approach using two subject matter experts, who independently labeled a sample of 400 sentences. Cohen's kappa values were calculated for each category between the reviewers (menstruation: 1, sexual activity: 0.9499, contraception: 0.9887, folic acid: 1, teratogens: 0.8864, pregnancy: 0.9499). After removing the sentences on which reviewers did not agree, we compared the reviewers' labels to those produced via our methodology, again using Cohen's kappa (menstruation: 1, sexual activity: 1, contraception: 0.9885, folic acid: 1, teratogens: 0.9841, pregnancy: 0.9871)., Conclusion: Our methodology is reproducible, enables analysis of large amounts of text, and has produced results that are highly comparable to subject matter expert manual review., Competing Interests: Watchful provided our team free use of their application for the purposes of academic research. Otherwise, the authors report no proprietary or commercial interest in Watchful or any other product mentioned or concept discussed in this article., (Thieme. All rights reserved.)

Rationale The American Academy of Neurology (AAN) recommends annual sexual and reproductive health (SRH) counseling for all people with epilepsy of gestational capacity (PWEGC). Child neurologists report discussing SRH concerns infrequently with adolescents. Limited research exists regarding documentation of such counseling., Methods: We retrospectively studied clinical notes using natural language processing to investigate child neurologists' documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen's kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use., Results: Data comprised 971 PWEGC age 13-21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = [1.04,1.54]; OR = 1.27, p = 0.027, 95% CI = [1.03,1.58]). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = [1.21,1.35]; OR = 1.26, p < 0.001, 95% CI = [1.19,1.32]; OR = 1.26, p = 0.004, 95% CI = [1.08,1.47]). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = [0.20,0.78])., Conclusion: Child neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Watchful provided our team free use of their application for the purposes of academic research. Otherwise, the authors report no proprietary or commercial interest in Watchful or any other product mentioned or concept discussed in this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

In contexts that increasingly demand brief self-report measures (e.g., experience sampling, longitudinal and field studies), researchers seek succinct surveys that maintain reliability and validity. One such measure is the 12-item Brief Aggression Questionnaire (BAQ; Webster et al., 2014), which uses 4 3-item subscales: Physical Aggression, Verbal Aggression, Anger, and Hostility. Although prior work suggests the BAQ's scores are reliable and valid, we addressed some lingering concerns. Across 3 studies (N = 1,279), we found that the BAQ had a 4-factor structure, possessed long-term test-retest reliability across 12 weeks, predicted differences in behavioral aggression over time in a laboratory experiment, generalized to a diverse nonstudent sample, and showed convergent validity with a displaced aggression measure. In addition, the BAQ's 3-item Anger subscale showed convergent validity with a trait anger measure. We discuss the BAQ's potential reliability, validity, limitations, and uses as an efficient measure of aggressive traits.

A key problem facing aggression research is how to measure individual differences in aggression accurately and efficiently without sacrificing reliability or validity. Researchers are increasingly demanding brief measures of aggression for use in applied settings, field studies, pretest screening, longitudinal, and daily diary studies. The authors selected the three highest loading items from each of the Aggression Questionnaire's (Buss & Perry, 1992) four subscales--Physical Aggression, Verbal Aggression, anger, and hostility--and developed an efficient 12-item measure of aggression--the Brief Aggression Questionnaire (BAQ). Across five studies (N = 3,996), the BAQ showed theoretically consistent patterns of convergent and discriminant validity with other self-report measures, consistent four-factor structures using factor analyses, adequate recovery of information using item response theory methods, stable test-retest reliability, and convergent validity with behavioral measures of aggression. The authors discuss the reliability, validity, and efficiency of the BAQ, along with its many potential applications., (© 2013 Wiley Periodicals, Inc.)

Mechanical properties and microstructure characterization of a series of graded commercial rigid polyurethane foams commonly used to mimic trabecular bone in testing orthopaedic devices is reported. Compressive testing conducted according to ASTM standard F1839-08, which requires large specimens (50.8 mm x 50.8 mm x 25.4 mm blocks) gave elastic modulus and compressive strength values ranging from 115 to 794 MPa and 4.7 to 24.7 MPa, respectively, for foams having densities of 0.240-0.641 g/cm(3). All these results were within the requirements of the specification for the corresponding grades. Compression testing using smaller specimens (7.5 mm diameter x 15 mm) typical of testing bone, gave results in good agreement with those obtained in the standard tests. Microstructural measurements showed the average pore size ranged from 125 to 234 microm for densities ranging from 0.641 to 0.159 g/cm(3), respectively. The relative modulus as a function of relative density of the foams fit well to the model of Gibson and Ashby. Cyclic testing revealed hysteresis in the lower density foams with a loading modulus statistically equivalent to that measured in monotonic testing. Shore DO durometry (hardness) measurements show good correlations to elastic modulus and compressive strength. The results suggest additional parameters to consider for the evaluation of polyurethane foams for bone analog applications.

On the basis of an evolutionary theory of self-esteem (SE), it was hypothesized that the SE-aggression relationship differs across functionally distinct domains of SE and across contexts. In 2 experiments, participants had the opportunity to aggress against the evaluator of an essay they had written. In Study 1, self-perceived superiority was positively related to aggression, whereas social inclusion was inversely related to aggression. In Study 2, in which the context was altered to simulate a mating competition, only a measure of self-perceived mate value emerged as a (positive) predictor of aggression. Global SE failed to contribute to the prediction of aggression in either experiment. Statistically controlling for narcissism did not eliminate either set of findings. Implications for the conceptualization and measurement of SE and narcissism are discussed.

Research on romantic jealousy is consistent with the idea that jealousy is, at least in part, the product of threats to attachment relationships. Attachment theory was used as a framework for examining individual differences in the ways in which people experience and express jealousy. Emotional, behavioral, and cognitive concomitants of romantic jealousy were related to differences in attachment style in ways consistent with attachment theory. For example, anxious participants were relatively more likely than others to resist expressing their anger, avoidant participants were especially likely to turn their anger and blame against the interloper, and securely attached participants were especially likely to express anger toward the partner and to maintain their relationship. Differences in attachment style, not just differences in level of security, are predictive of qualitative individual differences in jealousy experiences.

The effects of presence vs. absence of a romantic partner on psychophysiological responses to a stressful laboratory situation were examined in a sample of 35 college women involved in serious dating relationships. Participants performed a standard psychological stress task both in the presence and in the absence of their romantic partners, with order counterbalanced across participants. Heart rate and blood pressure were measured in each of these conditions during both baseline and task performance periods. Avoidant (but not secure) and anxious (but not nonanxious) participants displayed heightened physiological responses across all conditions and periods if the partner-absent condition came first rather than second. Discussion focuses on 2 explanations for the findings in terms of (a) the anxiety-reducing function of attachment relationships and (b) the anxiety-producing effect of separation in a stressful situation.

Adult attachment styles in 354 heterosexual couples in serious dating relationships were examined. Principal findings included the following: (a) male and female attachment styles were nonrandomly paired, for example, no anxious-anxious or avoidant-avoidant pairs were found; (b) male and female styles related to concurrent relationship ratings of both partners in different but theoretically meaningful ways; (c) male and female styles contributed significantly to longitudinal prediction of relationship stability and status, even when prior duration and commitment to the relationship were statistically controlled; (d) specifically, relationships of avoidant men and of anxious women were surprisingly stable over 3 years, particularly in light of the relatively poor ratings of these relationships by both partners at Time 1. Discussion focuses on the need to integrate gender role considerations and relationship dynamics and processes into theorizing on adult attachment.

Three experiments (N = 1,331) demonstrated that research findings on suspiciousness about coincidences (Miller, Turnbull, & McFarland, 1989) can be accounted for in terms of subjective probability, as predicted by cognitive-experiential self-theory (CEST) but in contrast with the norm theory (NT) account offered by Miller et al. (1989). Ss participated in a hypothetical (Experiments 1 and 2) or real (Experiment 3) lottery game in which they chose between 2 bowls offering equivalent probabilities of winning or losing but differing with respect to absolute numbers (e.g., 1 in 10 vs. 10 in 100). Responses across 4 conditions (2 probability levels x 2 outcome types) and across the 3 experiments supported predictions derived from CEST but not those derived from NT. Results are discussed in terms of 2 conceptual systems, rational and experiential, that operate by different rules of inference.