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ObjectivesPreventive health care between pregnancies may benefit future pregnancies and women’s long-term health, yet such care is frequently incomplete. We used Andersen’s Model of Health Services Use to identify factors associated with receipt of interconception care.MethodsThis secondary analysis uses data from a trial that recruited women from four health centers in the Baltimore metropolitan area. We used data on factors associated with Andersen’s model reported up to 15 months postpartum. Factors included health history (diabetes, hypertension, prematurity), self-rated health, demographics (age, race/ethnicity, education, marital status, employment, income, parity), predisposing factors (depression, stress, social support), and enabling factors (usual place of care, personal doctor or nurse, insurance). Relative risk regression modeled the relationship between these factors and a dependent variable defined as completing both a postpartum visit and one subsequent health care visit. Models also accounted for time since birth, clustering by site, and trial arm.ResultsWe included 376 women followed a mean of 272 days postpartum (SD 57), of whom 226 (60%) completed a postpartum and subsequent visit. Women were predominantly non-Hispanic Black (84%) and low income (50% household income < $20,000/year). In regression, two enabling factors were associated with increased receipt of care: having a personal doctor or nurse (RR 1.38, 95% CI 1.11–1.70) and non-Medicaid insurance (RR 1.64, 95% CI 1.09–2.56).Conclusions for PracticeEnabling factors were associated with receipt of recommended care following birth. These factors may be modifiable components of efforts to improve care during this critical life course period.

Remarkable public health achievements to reduce infant and child mortality as well as improve the health and well-being of children worldwide have successfully resulted in increased survival and a growing population of young people aged 10–24 years. Population trends indicate that the current generation of 1.8 billion young people is the largest in history. However, there is a scarcity of dedicated resources available to effectively meet the health needs of adolescents and young adults worldwide. Growing recognition of the pivotal roles young people play in the cultures, societies, and countries in which they live has spurred an expanding global movement to address the needs of this special population. Building an effective global workforce of highly-skilled adolescent health professionals who understand the unique biological, psychological, behavioral, social, and environmental factors that affect the health of adolescents is a critical step in addressing the health needs of the growing cohort of young people. In this review, we aim to: 1) define a global assessment of the health needs for adolescents around the world; 2) describe examples of current training programs and requirements in adolescent medicine; 3) identify existing gaps and barriers to develop an effective adolescent health workforce; and 4) develop a call for targeted actions to build capacity of the adolescent health workforce, broaden culturally relevant research and evidence-based intervention strategies, and reinforce existing interdisciplinary global networks of youth advocates and adolescent health professionals to maximize the opportunities for training, research, and care delivery.

IntroductionDespite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods.Methods and analysisWe will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card and decision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15–49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later.Ethics and disseminationWe will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes.Trial registration numberClinicalTrials.gov Identifier: NCT02759939.

Introduction: Vitamin D is a fat-soluble vitamin present in two isoforms: vitamin D3 and D2. Along with many essential functions, it also acts as a neurosteroid that plays a vital role in brain development and functioning. Vitamin D deficiency (VDD) is globally seen as associated with risk factors resulting in multiorgan dysfunctions and disorders. The need and demand for nutrition increases during pregnancy and lactation, and a lack of it hampers fetal growth. This review aims to investigate the association between maternal vitamin D levels and the neurodevelopmental health of the offspring. Materials and methods: This review utilised articles published in PubMed and Scopus from 2010 onwards, using specific keywords: maternal, vitamin D deficiency, and neurodevelopment. Systematic reviews, meta-analyses and non-English literature were excluded. A total of 98 articles were retrieved for the review. Discussion: Varying rates of vitamin D deficiency during pregnancy were noticed globally based on geography, race, income, and education. The impact of vitamin D deficiency leading to cognitive disorders such as Schizophrenia, specifically found to be associated with a decrease in GABAergic interneurons, was also reported by various authors. Cortical thickening, decreased surface area of the brain, and decreased expression of GAD proteins associated with VDD have also been reported recently. Conclusion: Vitamin D deficiency has been linked to a host of various neurodevelopmental disorders, including autism spectrum disorder, attention deficit hyperactivity disorder, and schizophrenia. This necessitates the importance of ensuring adequate maternal vitamin D levels to support offspring's cognitive and psychological well-being, thereby fostering healthier communities.

The gold standard for central arch defects of the mandible is reconstruction with vascularized bone free flap. Free flap repair is always not an option due to lack of resources and in patients who are not healthy enough for lengthy surgery. In these situations, a standardized method of repair is by reconstruction plate and wrapping it with a regional flap like pectoralis major myocutaneous flap (PMMC). However, this method of repair has increased risk of plate exposure, plate fracture, partial or complete flap necrosis, and delayed decannulation, swallowing, adjuvant treatment. Hence, we describe a new technique of incorporating titanium  econstruction plate n the ubstance of PMMC (RISP technique) and address the drawbacks of the conventional method. The aim of the study is (1) to assess the feasibility of a novel method for mandibular reconstruction that incorporates a reconstruction plate within the substance of PMMC and (2) to compare the conventional method of repair of wrapping the reconstruction plate with RISP technique. Our case series of 22 patients who had arch mandibulectomy for cancer of oral cavity serves as the basis for our description of a novel technique of Recon plate in the Substance of PMMC (RISP technique) in 15 cases and comparison with 7 cases of old conventional technique for arch defects. A total of 22 eligible patients were included in the study. Of the 22 patients, 8 were males and 14 were females. Majority of the patients were above 55 years (  = 15, 68.1%); median age in RISP technique cohort is 64 years and 57 years in conventional technique. The mean duration of follow-up for the cohort was 27 months (7-47 months). The most common subsite was the buccal mucosa (  = 9, 40.9%). Majority of the patients had squamous cell carcinoma as histology except one had osteosarcoma. Plate-related morbidities were more commonly seen with conventional method (6 out of 7 had plate exposure). Flap-related morbidities were similar in both techniques. On multivariate analysis, technique of plating was the only factor predictive of plate-related complications (  < 0.001). The average time to starting oral feeds was 15 to 25 days for patients who have undergone plating with new technique as compared to 19-90 days for patients with conventional method. Patients operated with the newer technique had earlier decannulation and shorter duration of hospital stay when compared to conventional method. The average Functional Oral Intake Score was 5 to 6 in RISP technique. Our novel technique of inserting reconstruction plate within the substance of PMMC is a feasible alternative for mandibular arch defects with less complications and better functional outcome.

The gold standard for central arch defects of the mandible is reconstruction with vascularized bone free flap. Free flap repair is always not an option due to lack of resources and in patients who are not healthy enough for lengthy surgery. In these situations, a standardized method of repair is by reconstruction plate and wrapping it with a regional flap like pectoralis major myocutaneous flap (PMMC). However, this method of repair has increased risk of plate exposure, plate fracture, partial or complete flap necrosis, and delayed decannulation, swallowing, adjuvant treatment. Hence, we describe a new technique of incorporating titanium  R econstruction plate i n the S ubstance of PMMC (RISP technique) and address the drawbacks of the conventional method. The aim of the study is (1) to assess the feasibility of a novel method for mandibular reconstruction that incorporates a reconstruction plate within the substance of PMMC and (2) to compare the conventional method of repair of wrapping the reconstruction plate with RISP technique. Our case series of 22 patients who had arch mandibulectomy for cancer of oral cavity serves as the basis for our description of a novel technique of Recon plate in the Substance of PMMC (RISP technique) in 15 cases and comparison with 7 cases of old conventional technique for arch defects. A total of 22 eligible patients were included in the study. Of the 22 patients, 8 were males and 14 were females. Majority of the patients were above 55 years ( n  = 15, 68.1%); median age in RISP technique cohort is 64 years and 57 years in conventional technique. The mean duration of follow-up for the cohort was 27 months (7–47 months). The most common subsite was the buccal mucosa ( n  = 9, 40.9%). Majority of the patients had squamous cell carcinoma as histology except one had osteosarcoma. Plate-related morbidities were more commonly seen with conventional method (6 out of 7 had plate exposure). Flap-related morbidities were similar in both techniques. On multivariate analysis, technique of plating was the only factor predictive of plate-related complications ( p  < 0.001). The average time to starting oral feeds was 15 to 25 days for patients who have undergone plating with new technique as compared to 19–90 days for patients with conventional method. Patients operated with the newer technique had earlier decannulation and shorter duration of hospital stay when compared to conventional method. The average Functional Oral Intake Score was 5 to 6 in RISP technique. Our novel technique of inserting reconstruction plate within the substance of PMMC is a feasible alternative for mandibular arch defects with less complications and better functional outcome.

Erythrocyte antioxidant glutathione and malondialdehyde levels in erythrocytes and plasma glutathione S-transferase levels were estimated in patients with colorectal cancer and compared to controls. Further, the patients underwent four weeks of radiotherapy with adjuvant chemotherapy. The same parameters were estimated after four weeks of radiotherapy and compared with pretreatment levels. It was observed that there was a decrease in erythrocyte glutathione and malondialdehyde levels in patients with colorectal cancer compared to controls, but not in case of GST. However, after chemoradiotherapy, there were no statistically significant differences in all the parameters studied.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5-10% of women of reproductive age. The health risks associated with PCOS include infertility, diabetes, metabolic syndrome and endometrial cancer. In this article, we review the tools used to assess health-related quality of life (HRQL) and the current state of knowledge of the effects of PCOS on HRQL in adult women and adolescent girls. A significant body of evidence consistently demonstrates that PCOS has a negative impact on women s HRQL. This impact does not necessarily correlate with clinical measures of disease severity. There is evidence that the effect on HRQL may be mediated by obesity, infertility concerns and menstrual dysfunction. Cross-cultural studies suggest that the effect of PCOS on the HRQL of an individual patient may be specific to the perception, values and culture of that patient.