Prescription contraception use and adherence by women with substance use disorders.

BACKGROUND AND AIMS: Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be explained partly by lower use of and adherence to contraception. We aimed to test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection and adherence; (2) whether practices participating in the Patient-Centered Medical Home Initiative (PCMHI) had better contraceptive use and adherence for patients with SUD; and (3) for differences in the association of SUD with adherence by type of contraceptive used. DESIGN: Retrospective cohort analysis of claims and encounter data. SETTING: Massachusetts, USA. PARTICIPANTS: A total of 47 902 women aged 16-45 years enrolled in Medicaid or Commonwealth Care in Massachusetts between 2010 and 2014. MEASUREMENTS: We examined three dependent variables: (1) use of a reversible prescription contraceptive during 2012; (2) the contraceptive methods used; and (3) the proportion of days covered by a prescription contraceptive in the year following the first prescription contraceptive claim. The primary predictor was diagnosed SUD, defined as at least one claim for an alcohol or drug use disorder. FINDINGS: SUD was associated with lower rates of prescription contraceptive use during 2012 [19.2 versus 23.9%; adjusted odds ratio (aOR) = 0.79, P < 0.001]. SUD was associated with decreased selection of long-acting reversible contraception (LARC) compared with short-acting contraception (SARC) (42.8 versus 44.5%; aOR = 0.83, P = 0.011). There was no significant association between SUD and adherence (aOR = 0.84, P = 0.068). PCMHI enrollment did not alter the relationship between SUD and contraceptive use or adherence. Contraceptive method did not impact the relationship between SUD and adherence. CONCLUSION: Women with substance use disorders are less likely to use prescription contraceptives, especially long-acting methods, but are not significantly less likely to adhere to them once prescribed than women without substance use disorders.

Successful facial artery pseudoaneurysm coiling and pedicle preservation following free tissue transfer.

Patients undergoing free tissue reconstruction are at risk for development of an anastomotic pseudoaneurysm, which may present as delayed neck hemorrhage or a pulsatile neck mass. Diagnosis may be achieved by noninvasive imaging, angiography, and exploration. Management strategies for head and neck pseudoaneurysms have included open vessel ligation, open direct vessel repair, endovascular parent vessel embolization, and, most recently, endovascular pseudoaneurysm embolization. In patients with anastomotic pseudoaneurysms where adequate flap inosculation is doubted, endovascular pseudoaneurysm embolization with pedicle preservation may be an appropriate primary treatment approach. We discuss the successful endovascular coiling of an external carotid artery branch anastomotic pseudoaneurysm in a patient one month after free tissue reconstruction of a total laryngopharyngectomy and partial glossectomy defect.

Yin-yang1 is required in the mammalian oocyte for follicle expansion.

The multifaceted polycomb group gene Yin-Yang1 (Yy1) has been implicated in a variety of transcriptional regulatory roles both as an activator and silencer of gene expression. Here we examine the role of Yy1 during oocyte growth by conditional deletion of the locus in the growing oocyte. Our results indicate that YY1 is required for oocyte maturation and granulosa cell expansion. In mutant oocytes, we observe severely reduced expression of both Gdf9 and Bmp15, suggesting a mechanism underlying the failure of granulosa cell expansion. Consequently, we observe infertility, failure of estrus cycling, and altered reproductive hormone levels in mutant females. Additionally, we find that YY1-deficient oocytes exhibit altered levels of several oocyte-specific factors, including Pou5f1, Figla, Lhx8, Oosp1, and Sohlh2. These results document YY1's involvement in folliculogenesis and ovarian function in the mouse and indicate that YY1 is required specifically in the oocyte for oocyte-granulosa cell communication.

Implementation of smoke free workplaces: challenges in Latin America.

Latin America is at the forefront of global progress in smoke free workplaces. Comprehensive smoke free laws have been implemented in four countries, and in many cities, states and provinces. More than 130 million people in Latin America are now protected from secondhand tobacco smoke. Nevertheless, a survey of tobacco control advocates and governments in Latin America found several challenges to progress in smoke free workplaces: the need for voluntary workplace programs where there is no smoke free legislation; weak legislation or lack of comprehensive national smoke free laws; tobacco industry attempts to undermine progress with smoke free laws or overturn existing laws via litigation; lack of compliance with laws; the need for monitoring and evaluation of smoke free laws; the need to make better use of mass media campaigns; and strengthening civil society. However, much progress has already been achieved to address these challenges, in particular through collaborations and the exchange of experience and expertise across Latin America.

Implementation of smokefree workplaces: challenges in Latin America / Implementación de lugares de trabajo libres de humo de tabaco: desafíos en América Latina

Latin America is at the forefront of global progress in smokefree workplaces. Comprehensive smokefree laws have been implemented in four countries, and in many cities, states and provinces. More than 130 million people in Latin America are now protected from secondhand tobacco smoke. Nevertheless, a survey of tobacco control advocates and governments in Latin America found several challenges to progress in smokefree workplaces: the need for voluntary workplace programs where there is no smokefree legislation; weak legislation or lack of comprehensive national smokefree laws; tobacco industry attempts to undermine progress with smokefree laws or overturn existing laws via litigation; lack of compliance with laws; the need for monitoring and evaluation of smokefree laws; the need to make better use of mass media campaigns; and strengthening civil society. However, much progress has already been achieved to address these challenges, in particular through collaborations and the exchange of experience and expertise across Latin America.

América Latina está a la vanguardia del movimiento en favor de lugares de trabajo libres de humo de tabaco. Se han implementado leyes integrales de ambientes libres de humo en cuatro países, y en muchas ciudades, estados y provincias. Gracias a la implementación de estas políticas, más de 130 millones de personas en América Latina están ahora protegidas del humo de tabaco ajeno. Sin embargo, existen varios desafíos para un continuo progreso en la implementación de lugares de trabajo libres de humo de tabaco. A partir de una encuesta realizada con activistas y funcionarios gubernamentales de América Latina, se indentificaron los siguientes desafíos principales: necesidad de adoptar programas voluntarios en los lugares del trabajo cuando no exista legislación; legislación débil o falta de leyes nacionales integrales de ambientes libres de humo de tabaco; intentos de la industria tabacalera por dificultar el progreso de las leyes de ambientes libres de humo o anular leyes existentes a través del litigio; falta de cumplimiento de las leyes; necesidad de monitoreo y evaluación de las leyes de ambientes libres de humo; necesidad de utilizar más eficientemente las campañas de medios masivos de comunicación; y fortalecimiento de la sociedad civil. No obstante, se ha alcanzado ya un gran progreso para enfrentar estos desafíos, particularmente a través de colaboraciones y el intercambio de experiencias entre los países latinoamericanos.