Barriers to and Enablers of Abortion Provision for Family Physicians Trained in Abortion During Residency.

CONTEXT: Although some family medicine residency programs include routine opt-out training in early abortion, little is known about abortion provision by trainees after residency graduation. A better understanding of the barriers to and enablers of abortion provision by trained family physicians could improve residency training and shape other interventions to increase abortion provision and access. METHODS: Twenty-eight U.S. family physicians who had received abortion training during residency were interviewed in 2017, between two and seven years after residency graduation. The doctors, identified using databases of abortion-trained physicians maintained by residency programs, were recruited by e-mail. In phone interviews, they described their postresidency abortion provision experiences. All interviews were transcribed, coded and analyzed using Dedoose, and a social-ecological framework was employed to guide investigation and analysis. RESULTS: Although many of the physicians were motivated to provide abortion care, only a minority did so. Barriers to and enablers of abortion provision were found on all levels of the social-ecological model-legal, institutional, social and individual-and included state-specific laws and restrictions on federal funding; religious affiliation or policies prohibiting abortion within particular health systems; mentorship, colleagues' support and the stigma of being an abortion provider; and geographic location, time management and individuals' prioritization of abortion provision. CONCLUSIONS: Clinical training alone may not be sufficient for family medicine physicians to overcome the barriers to postresidency abortion provision. To increase abortion provision and access, organizations and advocates should work to strengthen enablers of provision, such as strong mentorship and support networks.

Sexual Closeness Discrepancies: What They Are and Why They Matter for Sexual Well-Being in Romantic Relationships.

This study examined the impact of sexual closeness on sexual well-being. We developed a nuanced and multifaceted conceptualization of sexual closeness in the form of a constellation of ideal sexual closeness with a partner, actual sexual closeness, and the discrepancy between the two. Data were obtained from a diverse sample of N = 619 participants who took part in the Lives and Relationships Study: A longitudinal survey of men and women in relationships living in the U.S. and Canada. Increases in sexual closeness discrepancies over a period of 1 year predicted concomitant decreases in two indicators of sexual well-being: sexual satisfaction and orgasm frequency evaluations. Decreases in sexual closeness discrepancies resulted in improvement in sexual well-being. Individuals who reported no sexual closeness discrepancies and experienced no changes in sexual closeness discrepancies tended to have the highest levels of sexual well-being. Importantly, sexual closeness discrepancies were robust predictors of sexual well-being, above and beyond individuals' actual sexual closeness, general relationship closeness, and other demographic and relationship characteristics known to be associated with sexual well-being. The present findings demonstrate that how close people feel sexually to their relationship partners is part of a general constellation of factors related to relationship closeness that, only when considered together, sufficiently explain the ways in which experiences of closeness impact sexual well-being in romantic relationships.

Acupressure as a non-pharmacological intervention for traumatic brain injury (TBI).

Acupressure is a complementary and alternative medicine (CAM) treatment using fingertips to stimulate acupoints on the skin. Although suggested to improve cognitive function, acupressure has not been previously investigated with a controlled design in traumatic brain injury (TBI) survivors, who could particularly benefit from a non-pharmacological intervention for cognitive impairment. A randomized, placebo-controlled, single-blind design assessed the effects of acupressure (eight treatments over 4 weeks) on cognitive impairment and state of being following TBI, including assessment of event-related potentials (ERPs) during Stroop and auditory oddball tasks. It was hypothesized that active acupressure treatments would confer greater cognitive improvement than placebo treatments, perhaps because of enhanced relaxation response induction and resulting stress reduction. Significant treatment effects were found comparing pre- to post-treatment change between groups. During the Stroop task, the active-treatment group showed greater reduction in both P300 latency (p = 0.010, partial η² = 0.26) and amplitude (p = 0.011, partial η² = 0.26), as well as a reduced Stroop effect on accuracy (p = 0.008, partial η² = 0.21) than did the placebo group. Additionally, the active-treatment group improved more than did the placebo group on the digit span test (p = 0.043, Cohen's d = 0.68). Together, these results suggest an enhancement in working memory function associated with active treatments. Because acupressure emphasizes self-care and can be taught to novice individuals, it warrants further study as an adjunct treatment for TBI.