Reasons for and Logistical Burdens of Judicial Bypass for Abortion in Illinois

This paper examines the extent to which Pennsylvania county courts are prepared to implement the judicial bypass provision of the state's abortion statute. Under the Pennsylvania Abortion Control Act it is illegal for physicians to perform abortions on pregnant minors without parental consent. The constitutionality of this requirement has been upheld, but only when states provide a mechanism allowing a minor to bypass parental involvement. The Pennsylvania statute includes a judicial bypass provision that is formally consistent with legal precedent. However, based on a study of how county courts respond to inquiries into the judicial bypass procedure, this paper demonstrates that most courthouses are not prepared to implement or provide accurate information on bypass proceedings. Since the constitutionality of parental involvement requirements is conditioned on the availability of a bypass option, the paper argues that the courts' lack of readiness poses a significant threat to the rights of pregnant minors.

(Abstracted from Obstet Gynecol 2019;133:978–986) Thirty-seven states mandate parental consent or notification before providing abortion care to minors. In Massachusetts' parental consent law, a minor (17 years old or younger) requires parental approval before a legal abortion is permitted, but parental involvement can be bypassed through some mechanism, such as a petition to a judge (“judicial bypass”).

This study aims to evaluate parental knowledge, acceptability, and involvement in the use of Applied Behavior Analysis (ABA) for the treatment of children with autism spectrum disorder (ASD) in Jordan. A descriptive cross-sectional study was conducted with a sample of 157 parents of children with ASD who had been exposed to ABA. Data were collected using self-administered paper-based and online questionnaires, which included demographic characteristics and instruments measuring parental knowledge, involvement, and treatment acceptability. The majority of participants were mothers (73.5%). A significant proportion of participants' children exhibited problematic behaviors, with aggression being the most common issue (34.3%). Parental acceptability of ABA was generally high, with 96.4% reporting moderate to high acceptance. The study also found a positive correlation between ABA knowledge, acceptability, and parental involvement in ABA programs. Enhancing parents' knowledge of autism and ABA is crucial for effective treatment. To increase parental acceptance and involvement in their child's ABA, practitioners should implement educational programs that provide parents with a deeper understanding of ABA principles and their practical benefits.

This study uses a weighted least squares model and a fixed-effects model to estimate the impact of parental consent laws and laws governing Medicaid funding of abortions on the adolescents demand for abortion in the United States during 1978-90. The focus is on adolescent pregnancy because 12% of total legal abortions in 1987 were to adolescents aged under 18 years. The rate of abortion and types of abortion law range widely between states. Data are obtained from the US Center for Disease Control on reported abortions from the NARAL Foundation on the dates of actual enforcement restrictions and from the Alan Guttmacher Institute on abortion providers. The empirical model is based on a model developed by Grossman and Joyce. Proxy measures are used to represent abortion sentiment. Fixed effects models indicated that there was a decline of 13-17% in adolescents demand for abortion in states with enforced parental involvement laws compared to states without enforced laws. The results implied a 9-15% decline in adolescents demand for abortion in states that restricted Medicaid funding of abortion compared to states that did not. There was a positive association between abortion demand and income and between abortion demand and the availability of abortion providers. The inclusion of the abortion sentiment proxies did not change the signs and magnitudes of the impact very much in the fixed-effects models. It is posited that the negative impacts of abortion restrictions on adolescent abortion demand cannot be attributed to unobserved heterogeneity. Four methods of modeling are used to account for the potential role of unobserved heterogeneity.

Effect of TeamBirth on Patient Trust and Autonomy During Childbirth in Oklahoma.

Many have conjectured that people in the IT occupation are different from non-IT business users and that such differences can lead to negative organizational outcomes. This study investigates how to measure these differences by developing a new, expanded theoretical framework of IT occupational culture (ITOC). This framework includes: Artifacts, Values, and Tacit Assumptions. Values form the core of any culture, and a cohesive set of cultural values is termed an "ideology." Using a mixed methodology, research was conducted in two parts to develop and measure an ideology of ITOC. A qualitative investigation based on interview data provided evidence of six core values in the ideology: Autonomy in Decision-Making, Structure in Environment, Precision in Communication, Innovation in Technology, Reverence for Technical Knowledge, and Enjoyment at the Workplace (ASPIRE). The quantitative investigation sought to validate the values and ultimately reduced the number of values to five based on factor analysis of survey data: Autonomy in Decision-Making, Structure/Precision, Innovation in Technology, Reverence for Technical Knowledge, and Enjoyment at the Workplace. IT respondents rated these values significantly higher than non-IT business personnel. Our findings have implications for practitioners and researchers and can provide a path to bridge the gap between IT and business users.

The aim of this study was twofold: one was to test the impact of the involvement on the parental outcome bias, and the second was to refine the measurement of outcome bias, normally reported as the difference between evaluations of a single decision, with different outcomes assigned to it. We introduced the evaluation of a decision without an outcome, to induce theoretically normative evaluation, unbiased by outcome, from which the evaluation shift could be calculated in either direction. To test this refinement in the parental decision-making context, we produced childcare dilemmas with varying levels of complexity, since the rise of complexity induces stronger bias. Complexity was determined by the particular combination of two factors: parental involvement in a decision - the amount of motivation, interest and drive evoked by it – and whether the decision was health-related or not. We presented parents with the decisions for evaluation, followed by a positive and a negative outcome, and without an outcome. The results confirm the interaction between involvement and domain on decision evaluation. Highly involving decisions yielded weaker outcome bias than low-involvement decisions in both health and non-health domain. Results also confirm the validity of the proposed way of measuring OB, revealing that in some situations positive outcomes skew evaluations more than negative outcomes. Also, a highly-involving dilemma followed by negative outcome did not produce significantly different evaluation compared to evaluation of a decision without outcome. Thus, adding a neutral position rendered OB measurement more precise and our involvement-related insights more nuanced.

BackgroundAmong the factors contributing to the high maternal morbidity and mortality in Uganda is the high proportion of pregnant women who do not deliver under supervision in health facilities. This study aimed to identify the independent predictors of health facility delivery in Busia a rural district in Uganda with a view of suggesting measures for remedial action.MethodsIn a cross sectional survey, 500 women who had a delivery in the past two years (from November 16 2005 to November 15 2007) were interviewed regarding place of delivery, demographic characteristics, reproductive history, attendance for antenatal care, accessibility of health services, preferred delivery positions, preference for disposal of placenta and mother’s autonomy in decision making. In addition the household socio economic status was assessed. The independent predictors of health facility delivery were identified by comparing women who delivered in health facilities to those who did not, using bivariate and binary logistic regression analysis.ResultsEight independent predictors that favoured delivery in a health facility include: being of high socio-economic status (adjusted odds ratio [AOR] 2.8 95% Confidence interval [95% CI]1.2–6.3), previous difficult delivery (AOR 4.2, 95% CI 3.0–8.0), parity less than four (AOR 2.9, 95% CI 1.6–5.6), preference of supine position for second stage of labour (AOR 5.9, 95% CI 3.5–11.1) preferring health workers to dispose the placenta (AOR 12.1, 95% CI 4.3–34.1), not having difficulty with transport (AOR 2.0, 95% CI 1.2–3.5), being autonomous in decision to attend antenatal care (AOR 1.9, 95% CI 1.1–3.4) and depending on other people (e.g. spouse) in making a decision of where to deliver from (AOR 2.4, 95% CI 1.4–4.6). A model with these 8 variables had an overall correct classification of 81.4% (chi square = 230.3, P < 0.001).ConclusionsThese data suggest that in order to increase health facility deliveries there is need for reaching women of low social economic status and of higher parity with suitable interventions aimed at reducing barriers that make women less likely to deliver in health units such as ensuring availability of transport and involving spouses in the birth plan.

Intervene earlier to help women maintain control of reproductive decision making

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

IntroductionResponse rates in health research are declining, and low response rates could result in biased outcomes when population characteristics of participants systematically differ from the non-respondents. Few studies have examined key factors of non-response beyond demographic characteristics, such as behavioral and psychological factors. The aim of the current study was to identify predictors of non-response and loss to follow-up in a longitudinal sexual health study.Materials and methodsA longitudinal cohort study (iMPaCT) was conducted from November 2016 to July 2018 among heterosexual STI clinic visitors aged 18–24 years. At four different time points in one year, data was collected on sexual behavior, psychological determinants and chlamydia infections. The national STI surveillance database provided data on demographic, behavioral and sexual health-related characteristics for non-respondents. Predictors of non-response at baseline and of loss to follow-up were identified using multivariable logistic regression analyses.ResultsIn total, 13,658 STI clinic visitors were eligible to participate, of which 1,063 (8%) participated. Male gender, low/medium education level, young age (≤ 20 years) and having a non-Dutch migration background were significant predictors of non-response at baseline. Furthermore, non-respondents at baseline were more likely to report STI-related symptoms, to have been notified by a partner, to have had condomless sex, and to have had ≤ 2 partners in the past six months, compared to participants. Psychological predictors of loss to follow-up differed between STI clinic regions, but low perceived importance of health at baseline was associated with loss to follow-up in all regions. The baseline chlamydia positivity rate was significantly higher in the non-respondents (17%) compared to the participants (14%), but was not a predictor of loss to follow-up.DiscussionTargeted recruitment aimed at underrepresented groups in the population based on demographic, behavioral and psychological characteristics, might be necessary to decrease loss to follow-up, and to prevent non-response bias in health research.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, had a profound impact on global health, and society and become one of the deadliest in history. Knowledge of risk factors for mortality is critically important in the formation of organizational, methodological and clinical decisions to limit disease progression and reduce the number of fatal outcomes. However, it is still unclear whether generally accepted risk factors can be equally useful in identifying risk groups in a diverse population of patients in small cities.Aim: To evaluate the utility of demographic, clinical, and laboratory characteristics in the prediction of negative outcome of patients with COVID-19 admitted to the intensive care unit (ICU) of the multidisciplinary COVID-19 hospital in the city of Saransk.Material and Methods. Medical records of 153 patients (including 134 recovered and 19 dead) with laboratory-confirmed SARS-CoV-2 infection treated in the intensive care unit of the S.V. Katkov Republican Clinical Hospital between March and December of 2020 were included in this retrospective, single-center, clinical trial. Demographic, clinical, and laboratory characteristics, complications and therapeutic interventions were compared between deceased and recovered patients. The primary endpoint was in-hospital all-cause mortality. Risk factors for mortality were analyzed using logistic regression.Results. Multivariate regression analysis showed that in the population studied, included both therapeutic and surgical patients, a history of coronary artery disease, chronic non-specific lung disease, acute surgical conditions, plasma creatinine at ICU admission ≥ 106 µmol/L had a negative effect on in-hospital mortality, whereas fever at admission had a protective effect. Patients who died had lower oxygen saturation upon the admission to ICU and were more likely to receive invasive mechanical ventilation and higher doses of dexamethasone in treatment.Conclusion. The present study identified predictors to mortality of patients with COVID-19, treated in the ICU of a Mordovia Republic hospital (Russia), which were somewhat different from those previously reported for larger cities and indicate a large contribution of concomitant diseases to the negative outcome. We did not identify a significant contribution of many proposed laboratory markers to predicting mortality. These findings may help authorities and clinicians optimize organizational, methodological, and clinical approaches to medical care of patients to reduce the risk of a negative outcome from COVID-19.

Breast cancer incidence is increasing globally, and it is the third leading cause of morbidity and mortality among women in Cambodia. This study explores how access to digital tools, media exposure, transportation, travel time to health facilities, and autonomy in health decisions relate to breast cancer screening among Cambodian women aged 15-49. The study used nationally representative, cross-sectional data from the Cambodia Demographic and Health Survey (CDHS) 2021-2022. After excluding 204 women who were unaware of breast or cervical cancer screening, the final weighted sample comprised 19,292 participants. The outcome was whether a woman had ever received a breast examination from a healthcare provider, encompassing clinical breast examinations (CBEs) and imaging techniques, such as mammograms. Multivariable logistic regression, adjusted for demographic and socioeconomic characteristics, was used. Only 10.9% (95% CI: 9.7%-11.6%) of women had undergone a breast exam. Exposure to multiple forms of media was associated with a higher odds of screening (AOR = 1.47; 95% CI: 1.13-1.91). Phone ownership-both non-smartphone (AOR = 1.35; 95% CI: 1.03-1.78) or smartphone (AOR = 1.37; 95% CI: 1.03-1.82)-was also positively associated. In contrast, longer travel times of over 30 minutes (AOR = 0.55; 95% CI: 0.39-0.78) and a lack of autonomy in healthcare decisions (AOR = 0.70; 95% CI: 0.52-0.94) were associated with reduced screening. Wealthier women had greater odds of being screened (AOR = 1.86; 95% CI: 1.40-2.48). These findings highlight the need for health initiatives that use digital communication to reach and emphasize the importance of improving transportation, and support women's decision-making to increase screening rates in Cambodia.

There are salient outcomes beyond A1c, including patient-reported outcomes, in the current era of diabetes interventions. The current study assessed psychosocial effects over 1 year in the Teenwork Study, an RCT utilizing text-messaging (TM) and problem solving (PS) interventions in a 2x2 factorial design, in teens with T1D. Teens ages 13-17 from 2 U.S. clinical sites were randomized to 4 groups: PS, TM, PS+TM, or usual care. The PS and PS+TM groups had quarterly intervention sessions with study staff targeting barriers and strategies to improve self-care related to BG monitoring and insulin administration. The TM and PS+TM groups received reminders to check BG levels at self-selected times from 1-4 times/day. All teens completed measures of affect around BG monitoring, depressive symptoms, self-efficacy, parent involvement in diabetes care, diabetes-specific family conflict, diabetes distress, and general quality of life at baseline and 1 year. Changes in survey scores from 0 to 12 months were analyzed by group assignment, controlling for baseline scores. The sample included 281 teens ([M±SD] age 15.0±1.3 years, T1D duration 6.6±3.8 years, 4.6±1.9 BG checks/day, A1c 8.5±1.1%). Teens were 51% male, 78% white, and 80% from 2-parent families; 64% used pump therapy. At entry, groups had similar demographic and diabetes characteristics. After 1 year, all 4 groups had a significant increase in independent care behaviors (less parent involvement) (p&amp;lt;.001). Teens in the PS+TM group had decreases in diabetes family conflict (p=.009) and diabetes distress (p=.01). There were no changes in other psychosocial measures. Increased independent self-care across groups was likely developmentally driven. Combined PS+TM reduced teen-reported diabetes family conflict and diabetes distress. Providing problem-solving skills at quarterly visits with text reminders between visits together may serve to encourage and empower teens with T1D, thus improving their psychosocial outcomes. Disclosure P.V. Commissariat: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..

Background: E-cigarette use has increased rapidly in the past decade despite studies showing their negative health outcomes. There is limited knowledge on the characteristics of users and possible interventions. Purpose: This study presents the demographic characteristics of e-cigarette users in California, propose tailored interventions, and advocate for policies changes. Methods: We used secondary data from the California Health Interview Survey 2018 with 925 participants ages 18–84. Descriptive statistics and Pearson’s chi-square cross-tabulations were conducted to determine if associations existed between demographics and other covariates. Results: Among participants, the majority were male (67.6%) and the largest age group was 18–25-year-olds (38.9%). Many participants had some college, vocational training, or an associate degree (56.4%), never married (59.4%), and earned below 300% the federal poverty level. Reasons identified for engaging in e-cigarette consumption were to quit tobacco cigarette smoking, the perception that e-cigarettes were healthier, to reduce tobacco cigarette smoking, for social enjoyment, and to satisfy curiosity. Discussion: These findings demonstrate is a difference in e-cigarette consumption depending on users’ demographic characteristics. Translation to Health Education Practice: Results support the need for tailored interventions that include school-based interventions, public education, community, provider interventions, advocacy, and policy restrictions to reduce e-cigarettes consumption. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars