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Background Abortion may be medically indicated to avert death or permanent harm of the pregnant person. However, some US states now prevent access to abortion for these patients. To evaluate the population for whom this may cause harm, we aimed to estimate the prevalence of severe chronic conditions and pregnancy complications for which induced abortion is indicated, the odds of pregnancy for patients with severe chronic conditions, and compare pregnancy outcomes including induced abortion for pregnancies where such indications are present with pregnancies where they are not. Methods In a retrospective observational study using the Virginia All-Payer Claims Database (2018–2019), we identified 1,502,965 female patients aged 14–55 with ≥ 6 months insurance coverage. Medical codes identified severe chronic conditions and pregnancy complications. Pregnancy outcomes were classified using an established algorithm. Results Among reproductive-aged people, 2.9% had severe chronic conditions that could threaten life with pregnancy. Among 101,582 people who experienced pregnancy, 5.6% had life-threatening complications before their third trimester. Severe chronic conditions were associated with reduced risk of pregnancy (OR: 0.44 [95% CI: 0.41–0.46]), but sickle cell disease patients had increased odds of pregnancy (OR: 2.42 [95% CI: 2.10–2.78]). Compared to pregnancies with neither early complications or severe conditions present, pregnancies involving severe chronic conditions had fewer live births (68.2% vs. 75.3%), more spontaneous abortions (16.9% vs. 12.2%), and more induced abortions (3.7% vs. 2.2%), while pregnancies with early complications also had fewer live births (61.7%) and more spontaneous abortions (25.2%; p  < 0.01 for all comparisons). Abortion ratios (induced abortions per 1000 live births) in these data were 5–6 times lower than in Center for Disease Control abortion surveillance data for Virginia 2018–2019, indicating under-ascertainment of induced abortion. Conclusions In a state with some abortion restrictions and some protections, thousands of patients experience severe chronic conditions or pregnancy complications for which induced abortion is indicated.

PurposeLong-acting reversible contraception (LARC) is encouraged as a strategy to address racial disparities in birth outcomes. Black woman-led organizations and stakeholders recommend a thoughtful integration of Reproductive Justice for any LARC programs. This paper will describe how one state-funded maternal and child health program reconceptualized an evidence-based strategy (EBS) focused on increasing access to LARC, to a broader strategy that incorporated principles of Reproductive Justice to improve birth outcomes.Description:In 2016, North Carolina established the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program. As part of this program, five county health departments were awarded funding to “increase access to LARC”. Noting community partners’ concerns with this strategy, ICO4MCH leadership revised the strategy to focus on using the Reproductive Justice framework to improve utilization of reproductive life planning and access to LARC. Leaders modified the strategy by changing performance measures and scope of work/deliverables required by grantees.AssessmentUsing quarterly reports and focus group data from ICO4MCH grantees, we identified key steps communities have taken to prioritize Reproductive Justice. Key findings include that sites hosted Reproductive Justice trainings for team members and changed language describing family planning services. These activities were tailored to fit community context and existing perceptions about reproductive health services.ConclusionThe ICO4MCH program was able to modify a LARC EBS to better emphasize Reproductive Justice. Local agencies desiring to shift their LARC programs should include and value feedback from those with lived experience and partner with organizations committed to Reproductive Justice.

Background. Health equity impact assessments (HEIAs) inform the reduction of health inequities by evaluating programs or policies that affect target populations. Local health departments (LHD) receiving funding through the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) Program conducted HEIAs for evidence-based strategies (EBSs). This paper describes the impact of HEIAs on the implementation of EBSs and highlights lessons learned during implementation of HEIA modifications. Methods. We conducted a content analysis using data from the HEIA Modification Tracker and focus groups to identify themes and lessons learned. Results. Fifteen HEIAs were conducted by five LHDs between 2016 and 2020. The most common modifications to EBS implementation were 1) increasing education and training for community members and 2) altering messaging mediums and language to reach intended audiences. Discussion. Health equity impact assessments serve as a systematic and tangible way to center health equity, reflect on past processes, and inform improvements.

To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results. Systematic searches of PubMed and Google Scholar were undertaken in November 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs. Data charting was performed by 1 author and confirmed by a separate author. Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation. Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.

IntroductionThe Wilder Collaboration Factors Inventory is a free, publicly available questionnaire about the quality and context of community collaboration. The purpose of this article is to share lessons from using this questionnaire in a North Carolina maternal and child health initiative.MethodsIn 2015, the State’s General Assembly funded five local health departments to implement evidence-based strategies for improving maternal and child health. Each health department formed a community action team for this purpose. Members of each community action team completed the Wilder Collaboration Factors Inventory (Inventory) in the first year of funding and again 1 and 2 years later. Technical assistance coaches also asked community action team conveners to complete a brief questionnaire annually, and used these as well as Inventory results to plan for improvements.ResultsDuring the first year, community action teams emerged as strong in seeing collaboration in their self-interest. A primary challenge noted by conveners was engaging consumers on the community action teams. Strategies to address this included using social media and compensating consumers for attending meetings. By the second year, teams’ average scores in engaging multiple layers of participation increased, and eight additional factors became strengths, which generally continued in year three. The most consistent challenge was supporting community action teams administratively.DiscussionThe Wilder Collaboration Factors Inventory provided a feasible tool for identifying opportunities for improvement in several local, cross-sector partnerships, suggesting promise for other communities seeking to enhance their collective impact on maternal and child health.

Ensuring access to contraception, including long-acting reversible contraception (LARC) is key to helping women achieve their reproductive health goals. Long-acting reversible contraception is the most effective contraceptive method. However, many women, particularly those with low incomes, experience barriers to accessing LARC during the postpartum period. Immediate postpartum LARC, the placement of LARC after the birth of an infant, but prior to hospital discharge, removes access barriers to LARC for some women. To increase access to immediate postpartum LARC, North Carolina (NC) Medicaid policy improved reimbursement for this service. Yet reproductive health advocates remain concerned about equitable access to immediate postpartum LARC, including coercive practices aimed at women with low incomes. To better understand these inequities and possible underlying causes, we examine racial differences in immediate postpartum LARC in NC. In our first study, we used NC Medicaid claims data to estimate the relationship between race and hospital characteristics on racial differences in immediate postpartum LARC uptake. We found that uptake of immediate postpartum LARC among women with Medicaid remains low across NC but is higher among Black women with Medicaid compared to White women with Medicaid. In our second and third studies we interviewed NC maternal health providers and women with Medicaid who delivered at an NC hospital to assess postpartum contraception counseling and underlying causes of racial differences in immediate postpartum LARC uptake. Providers recognized important root causes related to racial differences in postpartum contraception uptake, but reimbursement policies as well as some perceptions prohibit providers from delivering patient-centered counseling to all women about immediate postpartum LARC. Patients we interviewed stated they received prenatal and immediate postpartum counseling; however, counseling only aided approximately half of participants with their postpartum contraception decision-making, while some Black women described feeling pressured to choose specific contraception methods.As Medicaid policies improve reimbursement and lead to the implementation of more immediate postpartum LARC programs, monitoring racial differences in immediate postpartum LARC uptake is warranted. Stakeholders considering improving access to LARC through immediate postpartum placement should consider their individual and complementary roles in contributing to racial differences in immediate postpartum LARC uptake.

Additional forms of pre-exposure prophylaxis are needed to prevent HIV-1 infection. 3BNC117 and 10-1074 are broadly neutralizing anti-HIV-1 antibodies that target non-overlapping epitopes on the HIV-1 envelope. We investigated the safety, tolerability, pharmacokinetics, and immunogenicity of the intravenous administration of the combination of 3BNC117 and 10-1074 in healthy adults. This randomized, double-blind, placebo-controlled, single center, phase 1 study enrolled healthy adults aged 18-65 years to receive one infusion of 3BNC117 immediately followed by 10-1074 at 10 mg/kg, three infusions of 3BNC117 followed by 10-1074 at 3 mg/kg or 10 mg/kg every 8 weeks, or placebo infusions. The primary outcomes were safety and pharmacokinetics. This trial is registered with ClinicalTrials.gov, number NCT02824536. Twenty-four participants were enrolled in a 3:1 ratio to receive the study products or placebo. The combination of 3BNC117 and 10-1074 was safe and generally well tolerated. There were no serious adverse events considered related to the infusions. The mean elimination half-lives of 3BNC117 and 10-1074 were 16.4 ± 4.6 days and 23.0 ± 5.4 days, respectively, similar to what was observed in previous studies in which each antibody was administered alone. Anti-drug antibody responses were rare and without evidence of related adverse events or impact on elimination kinetics. Single and repeated doses of the combination of 3BNC117 and 10-1074 were well tolerated in healthy adults. These data support the further development of the combination of 3BNC117 and 10-1074 as a long-acting injectable form of pre-exposure prophylaxis for the prevention of HIV-1 infection.

Objective To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and main results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m 2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p  < 0.001). Multivariate linear regression (model adjusted R 2  = 0.68, p  < 0.001) demonstrates mechanical ventilation (β = − 0.86, p  = 0.001), average mobility score in first three sessions (β = 2.6, p  < 0.001) and physical rehabilitation dosage (β = 0.22, p  = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS. Conclusions Greater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.

Background An important factor that can lead to drug relapse is to re-associate with drug-using social peers, but there is little literature on the effect of social peers on relapse in animal models. Methods The current study used a dual-compartment operant conditioning apparatus that allowed adult male rats to respond for cocaine in the presence of a conspecific. In experiment 1, rats were trained to self-administer cocaine in the presence of a social peer that was separated by a wire screen partition and then that peer was used as a reinstatement cue following a period of extinction. In the next experiments, rats were trained on alternating sessions to self-administer cocaine in the presence of one peer and to self-administer saline in the presence of a different peer using either a single-active lever procedure (experiment 2) or a double-active lever procedure (experiment 3). Following extinction of responding in the absence of the peers, the effect of re-exposure to the cocaine- and saline-associated peers on reinstatement of drug seeking was determined. This was tested using both single- and double-active lever procedures. Results In experiment 1, a peer that was present throughout cocaine self-administration was able to reinstate cocaine seeking following a period of extinction. In experiments 2 and 3, drug seeking was reinstated by the cocaine-associated peer (S+), but not the saline-associated peer (S−). This discrimination occurred when using either the single-active lever procedure or double-active lever procedure. Conclusion These results indicate that a social peer can be used as a discriminative stimulus to signal cocaine availability and that re-introduction of a peer previously paired with cocaine can reinstate cocaine seeking, confirming clinical reports that peer affiliation among abstinent cocaine users is an important determinant of relapse.