Trends and regional variations in provision of contraception methods in a commercially insured population in the United States based on nationally proposed measures.

OBJECTIVES: Three measures to assess the provision of effective contraception methods among reproductive-aged women have recently been endorsed for national public reporting. Based on these measures, this study examined real-world trends and regional variations of contraceptive provision in a commercially insured population in the United States. STUDY DESIGN: Women 15-44years old with continuous enrollment in each year from 2005 to 2014 were identified from a commercial claims database. In accordance with the proposed measures, percentages of women (a) provided most effective or moderately effective (MEME) methods of contraception and (b) provided a long-acting reversible contraceptive (LARC) method were calculated in two populations: women at risk for unintended pregnancy and women who had a live birth within 3 and 60days of delivery. RESULTS: During the 10-year period, the percentages of women at risk for unintended pregnancy provided MEME contraceptive methods increased among 15-20-year-olds (24.5%-35.9%) and 21-44-year-olds (26.2%-31.5%), and those provided a LARC method also increased among 15-20-year-olds (0.1%-2.4%) and 21-44-year-olds (0.8%-3.9%). Provision of LARC methods increased most in the North Central and West among both age groups of women. Provision of MEME contraceptives and LARC methods to women who had a live birth within 60days postpartum also increased across age groups and regions. CONCLUSIONS: This assessment indicates an overall trend of increasing provision of MEME contraceptive methods in the commercial sector, albeit with age group and regional variations. If implemented, these proposed measures may have impacts on health plan contraceptive access policy.

Caracterización del nivel de desarrollo de la función simbólica en niños preescolares / Characterization of development level of the symbolic function in preschool children

Resumen El objetivo de este estudio es caracterizar el nivel de adquisición de la función simbólica en niños preescolares colombianos. Participaron 39 niños a quienes se les aplicó el protocolo de evaluación psicológica cualitativa que permite caracterizar la adquisición de la función simbólica en los niveles materializado, perceptivo y verbal; basado en el concepto de la zona del desarrollo próximo lo cual implica la participación activa del niño, y diversas formas de ayuda por parte del evaluador. Los resultados señalan un bajo nivel de desarrollo de la función simbólica al final de la edad preescolar; además posibilitan conocer cómo el niño preescolar realiza tareas simbólicas a partir de apoyos verbales del adulto. Se discute la importancia del espacio de colaboración entre el adulto y los niños en el que se usa el lenguaje como medio de apoyo para la ejecución de acciones simbólicas y para la creación independiente de diversas formas de representación materializada, perceptiva y verbal.

Abstract The aim of this study is to characterize the acquisition level of the symbolic function in Colombian preschool children in the city of Bogotá. The study involved 39 children. Children were assessed by a protocol of qualitative psychological evaluation to characterize the acquisition of the symbolic function in materialized, perceptual and verbal levels. The protocol is based on the zone of proximal development concept, which involves the active participation of children and the use of various forms of assistance from the evaluator. The results of the protocol evaluation indicate a low development level of the symbolic function at the end of preschool age. The findings of this study are useful in both education and psychology fields, as it possible to know how the preschool child performs symbolic tasks from the adult's verbal support. The importance of cooperation space between adult and children in which language is used as a means of support for the implementation of symbolic actions and for independent creation of various forms of materialized, perceptual, and verbal representation is discussed.