Abortion method preference among people presenting for abortion care

ObjectiveTo explore abortion method preference, interpersonal and cultural factors associated with preference, and whether, among people with a preference for medication abortion, those presenting past 10 weeks gestation had experienced more obstacles to care.MethodsIn 2019, we invited people aged 15 to 45 years presenting to 4 U.S. abortion clinics to complete a self-administered, anonymous iPad survey prior to seeing the health care provider. Questions focused on their pregnancy, including self-reported gestational age and experiences accessing abortion care, including abortion method preference. We used multivariate logistic regression to assess associations between worry about perceived pregnancy-related stigma or abortion-related health myths and abortion method preference.ResultsThe majority (784 [77%]) of those approached (1092) initiated the survey and 712 responded to the preference question. Most (597 [84%]) preferred a method: 246 (41%) preferred medication abortion and 351 (59%) an in-clinic procedure. About one-third (110 [32%]) of those preferring medication abortions exceeded 10 weeks gestation and 83% (n = 91) had experienced delay-causing obstacles to care. In multivariate analyses, we found a greater odd of preference for medication abortion over in-clinic procedure among those very worried about people's reaction to the pregnancy (adjusted OR [aOR] 1.95, 95% CI 1.16–3.28), judgment from God or religion (aOR 1.93, 95% CI 1.17–3.19) and abortion affecting mental health (aOR 2.51, 95% CI 1.45–4.34) or ability to get pregnant later (aOR 1.80, 95% CI: 1.09–2.97).ConclusionsMany people seeking abortion have a method preference; delayed presentation to care may impede ability to obtain desired method. Pregnancy-related stigma and misinformation are associated with preference for medication abortion.Implications statementPregnancy-related stigma and misinformation, such as health and safety myths promulgated by state-mandated abortion counseling, may motivate preference for medication abortion. Abortion access obstacles may impede individuals’ ability to obtain their preferred method. Removing barriers to clinic access may enhance people's ability to obtain their preferred abortion method.     

Abortion providers,stigma and professional quality of life

ObjectivesThe Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops.Study DesignSeventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics).ResultsCompared to other healthcare workers, abortion providers reported higher compassion satisfaction (t= 2.65, p=.009) and lower burnout (t= 5.13, p<.0001). Repeated-measures analysis revealed statistically significant decreases in stigma over time. Regression analysis identified abortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue.ConclusionsParticipants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma.ImplicationsStigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time.     

Abortion Knowledge Among Advanced Practice Clinicians in Colorado

IntroductionOur objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians.MethodsWe conducted a stratified random survey of advanced practice clinicians, oversampling women’s health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores.ResultsA total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, “I don’t know” was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, “I don’t know” was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women’s health. Providing options counseling was positively associated with abortion knowledge (law, β = 0.44; 95% confidence interval [CI], 0.10–0.78; care, β = 0.52; 95% CI, 0.08–0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (β = ?0.03; 95% CI, ?0.65 to 0.59), but lower abortion care knowledge (β = ?1.85; 95% CI, ?2.34 to ?1.36).ConclusionsAbortion knowledge is low among Colorado advanced practice clinicians and education is needed.     

Differences in Financial and Social Burdens Experienced by Patients Traveling for Abortion Care

ObjectiveWe compared perceived stress between women traveling 50 or fewer miles and more than 50 miles for abortion care. Secondary objectives were to compare individual-level stigma and hardship scores in patients by distance traveled to the clinic.MethodsWe performed a cross-sectional study of patients presenting for care at an independent abortion clinic in southern Illinois. Participants completed a self-administered, tablet computer-based survey asking about their experiences seeking abortion, including the Perceived Stress Scale (PSS) and Individual Level Abortion Stigma (ILAS) scale. We created a composite score to characterize patient hardship regarding abortion care (range, 0–4). We examined responses stratified by the patients’ self-reported one-way distance traveled to the clinic (group 1, ≤50 miles; group 2, >50 miles).ResultsA total of 308 women completed the survey. There was no significant difference in mean PSS scores (p = .71) or median ILAS scores (p = .40) between groups. A majority of the cohort reported moderate or high stress (68.2%). The median hardship score was significantly higher in the greater than 50 mile group (median, 1 [interquartile range, 0–2] vs. 2 [interquartile range 1–3]; p < .001). Patients who traveled more than 50 miles reported difficulties related to missing work (58.3%), delays in obtaining an abortion owing to financial costs (35.7%), lodging (13.9%), and transportation (11.3%).ConclusionsThere was no difference in PSS or ILAS scores by distance traveled among patients seeking an abortion; however, patients who traveled more than 50 miles had a higher hardship score, suggesting greater difficulty accessing abortion. The most common difficulties encountered included missing time from work and financial costs associated with the abortion.     

Abortion providers,stigma and professional quality of life

Objectives

The Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops.

Study Design

Seventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics).

Results

Compared to other healthcare workers, abortion providers reported higher compassion satisfaction (t= 2.65, p=.009) and lower burnout (t= 5.13, p<.0001). Repeated-measures analysis revealed statistically significant decreases in stigma over time. Regression analysis identified abortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue.

Conclusions

Participants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma.

Implications

Stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time.     

Association between history of abortion and nonalcoholic fatty liver disease in middle-aged and elderly Chinese women

PurposeTo evaluate the possible relationship between self-reported history of abortion and nonalcoholic fatty liver disease (NAFLD) in middle-aged and elderly Chinese women.MethodsA cross-sectional study was performed in 5911 women aged 40 years or older in Jiading District, Shanghai, China. Reproductive histories, including miscarriage and induced abortion, were collected using a validated questionnaire by trained physicians. Abdominal B-mode ultrasound evaluation and serum liver enzymes levels were used in the diagnosis of NAFLD.ResultsThe percentage reporting history of abortion in women with NAFLD was higher than in those without NAFLD (72.4% vs. 69.3%, age-adjusted P = .001). Compared with women without a history of abortion, the fully adjusted odds ratio (OR) for NAFLD in those with a history of abortion was increased by 28% (OR, 1.28 and 95% confidence interval [CI], 1.06–1.55). Histories of miscarriage and induced abortion were also associated with increased risk of prevalent NAFLD in fully adjusted models (OR, 1.84 and 95% CI, 1.24–2.72; OR, 1.23 and 95% CI, 1.02–1.50, respectively).ConclusionsBoth miscarriage and induced abortion are associated with prevalent NAFLD in middle-aged and elderly Chinese women.     

Estimating Prevalence of Abortion Using List Experiments: Findings from a Survey of Women in Delaware and Maryland

BackgroundWidespread underreporting of abortion persists in survey data. The list experiment, a measurement tool designed to elicit truthful responses to sensitive questions, may alleviate underreporting.MethodsUsing The Statewide Survey of Women of Reproductive Age in Delaware and Maryland (n = 2,747), we estimate the prevalence of abortion in Maryland and Delaware using a double list experiment.ResultsWe find 21% (95% confidence interval [CI]: 16.8%–25.3%) of respondents aged 18 to 44 ever had an abortion and we identify disparities in abortion prevalence by age, race, education, income, marital status, and insurance status. Respondents who were Black (37.0%; 95% CI: 27.1%–46.8%), had less than a college degree (24.8%; 95% CI: 18.3%–31.3%), were in a cohabiting relationship (39.0%; 95% CI: 29.1%–48.9%), were living in households with incomes less than $50,000 (28.6%; 95% CI: 19.7%–37.5%), and were currently covered by Medicaid (42.8%; 95% CI: 27.6%–58.0%) were more likely than their counterparts to have ever had an abortion.ConclusionsList experiments yield estimates of abortion substantially higher than those obtained from direct questions. Findings demonstrate external validity through consistency with estimates from administrative data sources and gold standard abortion provider survey data.     

Variation in Restrictive Abortion Policies and Adverse Birth Outcomes in the United States from 2005 to 2015

BackgroundSince 2011, U.S. states have enacted more than 400 policies restricting abortion access. As structural determinants, abortion policies have the potential to influence maternal and child health access, outcomes, and equity through multiple mechanisms. Limited research has examined their implications for birth outcomes.MethodsWe created a state-level abortion restrictiveness index composed of 18 restrictive abortion policies and evaluated the association between this index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW) within the United States and by Census Region, using data from the 2005–2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files. We used logistic multivariable regression modeling, adjusting for individual- and state-level factors and state and year fixed effects.ResultsAmong 2,500,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average from 2005 to 2015, states had approximately seven restrictive abortion policies enacted, with more policies enacted in the Midwest and South. Nationally, relationships between state restrictiveness indices and adverse birth outcomes were insignificant. Regional analyses revealed that a 1 standard deviation increase in a state's restrictiveness index was associated with a 2% increase in PTB in the Midwest (marginal effect [ME], 0.25; 95% confidence interval [CI], 0.04–0.45; p < .01), a 15% increase in LBW in the Northeast (ME, 1.24; 95% CI, 0.12–2.35; p < .05), and a 2% increase in LBW in the West (ME, 0.12; 95% CI, 0.01–0.25; p < .05).ConclusionVariation in restrictive abortion policy environments may have downstream implications for birth outcomes, and increases in abortion restrictions were associated with adverse birth outcomes in three out of four Census Regions.     

Contraception After Surgical Abortion in Patients With Opioid Use Disorder

ObjectivesThis study describes the prevalence of medications for opioid use disorder (MOUD) among surgical abortion patients, evaluates long-acting reversible contraception (LARC) uptake after surgical abortion among patients on MOUD, and identifies predictors of immediate postabortion LARC uptake among individuals on MOUD.MethodsWe performed a secondary analysis of data from a retrospective observational cohort study of LARC uptake immediately after surgical abortion up to 21^0/7 weeks gestation at Planned Parenthood League of Massachusetts between October 2012 and April 2017. We estimated proportions and analyzed predictors of LARC uptake among women on MOUD using logistic regression analysis to control for possible confounders.ResultsDuring the study period, 26,858 patients had an abortion procedure; 768 (2.9%; 95% confidence interval, 2.7%–3.1%) used MOUD. In the primary study, controlling for demographic factors, MOUD was not an independent predictor of LARC uptake. In this analysis, patients on MOUD differed demographically from non-MOUD users and were significantly more likely to initiate a LARC method immediately after their procedure: 30.1% versus 25.3% (p = .002), including 22.7% who obtained an intrauterine device and 7.4% who obtained an implant. Among patients on MOUD, a prior live birth and public insurance predicted LARC uptake at the time of abortion.ConclusionWomen on MOUD had higher postabortion LARC uptake compared with those not on MOUD in a setting with easy access to postabortion LARC. Public insurance coverage for abortion was associated with LARC uptake among women on MOUD.     

Prayer frequency and COVID-19 vaccine hesitancy among older adults in Europe

AimDifferences in levels of vaccine uptake have emerged across Europe, and this may partly be explained by religious beliefs. Our aim is to study the association between religiosity, measured by prayer frequency, and vaccine hesitancy, and to examine how this association varies across European countries and regions.MethodsThis study was based on 42,583 adults aged 50 years and above from 27 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE), waves 1–8, and the 2nd SHARE COVID-19 Survey. Logistic regression models were used to investigate the associations.ResultsParticipants were more likely to be vaccine-hesitant when praying ‘weekly or less’ (odds ratio (OR) 1.32 95 % confidence interval (CI) 1.23–1.42) or daily (OR 1.78 95 % CI 1.65–1.92). Praying ‘weekly or less’ was associated with increased vaccine hesitancy in Southern Europe (OR 1.48 95 % CI 1.17–1.87) and Central and Eastern (OR 1.35 95 % CI 1.24–1.47) Europe, while daily praying was associated with vaccine hesitancy in Western (OR 1.77 95 % CI 1.51–2.08), Southern (OR 1.30 95 % CI 1.03–1.64), Central and Eastern (OR 1.89 95 % CI 1.73–2.06) and Northern (OR 2.75 95 % CI 1.54–4.89) Europe.ConclusionsThese findings provide support for an association between daily prayer frequency and COVID-19 vaccine hesitancy, with a consistent pattern across European regions.     

Stigma,discrimination and HIV outcomes among people living with HIV in Rio de Janeiro,Brazil: The intersection of multiple social inequalities

Limited research has examined the social context surrounding stigma and discrimination and HIV outcomes among people living with HIV (PLHIV). We surveyed 900 PLHIV in Brazil and examined the relationship between stigma, discrimination and HIV outcomes utilising multivariable logistic regression. HIV stigma and discrimination were inversely associated with age (AOR Stigma 0.65, 95% CI 0.49–0.88; AOR Discrimination 0.72, 95% CI 0.54–0.95) and income (AOR Stigma 0.74, 95% CI 0.55–0.99; AOR Discrimination 0.62, 95% CI 0.46–0.82). Stigma was inversely associated with education (AOR 0.71, 95% CI 0.52–0.96) and no history of sex work (AOR 0.56, 95% CI 0.35–0.90), and positively associated with having children (AOR 1.71, 95% CI 1.18–2.48). Discrimination was inversely associated with no history of drug use (AOR 0.63, 95% CI 0.42–0.95). Stigma and discrimination were found to be inversely associated with overall health (AOR Stigma 0.54, 95% CI 0.40–0.74; AOR Discrimination 0.71, 95% CI 0.52–0.97). Discrimination was associated with having a sexually transmitted infection since HIV diagnosis (AOR 1.63, 95% CI 1.14–2.32). Findings suggest that future interventions should address multiple social inequalities faced by PLHIV to reduce HIV stigma and discrimination and improve health and HIV outcomes.     

Factors Associated With Social Isolation in Older Adults: A Systematic Review and Meta-Analysis

ObjectiveSocial isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in older adults.DesignSystematic review and meta-analysis.Setting and ParticipantsAdults aged 60 years and older.MethodsWe searched for observational studies without language restrictions in 11 databases from inception to August 2022. Pooled odds ratio (OR) and 95% CI were calculated using the R software (version 4.2.1). The modified Newcastle-Ottawa Scale was used to evaluate the risk of bias.ResultsEighteen factors were grouped into 5 themes. The following 13 factors were statistically significant: (1) demographics theme: aged 80 years and older (OR: 2.41; 95% CI: 1.20–4.85), less than or equal to a high school degree (OR: 1.68; 95% CI: 1.44–1.97), smoking (OR: 1.43; 95% CI: 1.18–1.73), and male (OR: 1.38; 95% CI: 1.01–1.89); (2) environment theme: low social support (OR: 7.77; 95% CI: 3.45–17.50) and no homeownership (OR: 1.38; 95% CI: 1.25–1.51); (3) role theme: no social participation (OR: 3.18; 95% CI: 1.30–7.80) and no spouse (OR: 2.61; 95% CI: 1.37–4.99); (4) physical health: hearing loss (OR: 2.78; 95% CI: 1.54–5.01), activities of daily living impairment (OR: 2.38; 95% CI: 1.57–3.61), and poor health status (OR: 1.52; 95% CI: 1.32–1.74); and (5) mental health: cognitive decline (OR: 1.85; 95% CI: 1.40–2.45) and depression (OR: 1.72; 95% CI: 1.21–2.44).Conclusions and ImplicationsSocial isolation in older adults is associated with various factors. Hence, focused intervention should be adopted for older adults. In addition, further longitudinal studies are required to confirm a direct link between multiple factors and social isolation.     

Impact of Comorbidities on Hospital-Acquired Infections in a Geriatric Rehabilitation Unit: Prospective Study of 252 Patients

ObjectivesHospital-acquired infections (HAIs) remain a major source of morbidity and mortality in long-term care units, despite advances in antimicrobial therapy and preventive measures. Our aim was to investigate risk factors for HAIs, especially in the elderly, and to describe the relationship between comorbidities (number, severity, and specific diseases) and HAIs using a comprehensive inventory of comorbidities.DesignProspective cohort studySettingGeriatric rehabilitation unit in a university hospital in the Paris metropolitan area.ParticipantsParticipants were 252 consecutive patients aged 75 years or older (mean age, 85 ± 6.2 years) and admitted between 2006 and 2008.MeasurementsSurveillance of HAI was conducted. A complete inventory of comorbidities was done using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Potential risk factors were evaluated in 2 risk models, one with HAI acquisition, CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure (yes/no) and the other with HAI acquisition and specific invasive procedures and diseases.ResultsOf the 252 patients, 97 experienced HAIs, for an incidence of 5.6 infections per 1000 bed-days. The most common HAI sites were the respiratory tract (48%; 65/136) and urinary tract (37%; 51/136). The CIRS-G global score and comorbidity index were higher in patients with than without HAIs. Among HAI categories, respiratory and urogenital diseases were more prevalent in the group with HAIs. In the model combining CIRS-G, activities of daily living score less than 10, and at least 1 invasive procedure, independent risk factors for HAI were CIRS-G index (odds ratio [OR], 1.55; 95% confidence interval [95% CI], 1.13–2.11; P = .005) and invasive procedures (OR, 5.18; 95% CI, 2.77–9.71; P < .001). In the model including specific procedures and diseases, independent risk factors for HAI were intravenous catheter (OR, 7.39; 95% CI, 2.94–18.56; P < .001), urinary catheter (OR, 3.33; 95% CI, 1.40–7.88; P = .006), gastrointestinal endoscopy (OR, 3.69; 95% CI, 1.12–12.16; P = .03), pressure sores (OR, 2.52; 95% CI, 1.04–6.10; P = .03), and swallowing impairment (OR, 3.37; 95% CI, 1.16–9.74; P = .02).ConclusionsThis study identified several important risk factors for HAIs. There is a need for HAI prevention via the implementation of infection-control programs, including surveillance, in rehabilitation units.     

Parent reported outcomes to measure satisfaction,acceptability, and daily life impact after vaccination with whole-cell and acellular pertussis vaccine in Chile

AimTo compare parental satisfaction and impact on daily life among parents of children receiving whole-cell pentavalent + oral polio vaccine (Arm 1) with an acellular hexavalent vaccine (Hexaxim; Arm 2).MethodsSelf-administered electronic questionnaire at vaccination and one week later in six community health clinics of metropolitan Santiago, Chile, exploring parent-reported outcomes on satisfaction, acceptability, and impact on daily life after immunization. Univariate and multivariate analyses were conducted to determine differences in the responses in both groups (α = 0.05).ResultsThe study enrolled 800 participants and 65% (222 in Arm 1, 296 in Arm 2) were included for according-to-protocol analysis. Demographic characteristics were comparable, except for a higher proportion of mothers answering the questionnaire at the 6-month visit. Regardless of the study arm, parental knowledge and perception of the immunization practices were good, and there were no differences in vaccination experiences in the prior 5 years. However, satisfaction with vaccination and intention to vaccinate were statistically significantly higher in Arm 2 after the 6-month visit. Also, more parents in Arm 2 reported no disruption in several aspects of the everyday activities of the parent, the child, and other children in the household. Parents in Arm 2 were more likely to be satisfied with the vaccine received (OR 2.82; 95% CI, 1.22–7.07); return for other vaccine dose (OR 2.62; 95% CI, 1.45–4.84); follow a healthcare professional recommendation (OR 2.24; 95% CI, 1.57–3.21); and, to be confident that the vaccine will not disrupt the family’s daily routine (OR 1.89; 95% CI, 1.32–2.71).ConclusionsOverall, satisfaction, intention for future vaccination, and lower impact on the family daily routine were significantly better in the group receiving the hexavalent vaccine. We also found that health care providers’ recommendations to vaccinate and participants’ access to health services were important factors favoring immunization.     

Association of Medicaid Expansion With Access to Abortion Services for Women With Low Incomes in Oregon

BackgroundThe Affordable Care Act allowed states to expand Medicaid eligibility for women with low incomes before pregnancy. Women who experience an unintended pregnancy may encounter fewer delays in accessing abortion services if they are already enrolled in Medicaid. In states where the Medicaid program includes coverage for abortion services, Medicaid expansion may increase timely access to abortion services. Oregon has expanded Medicaid and is 1 of 16 states in which the Medicaid program covers abortion services. We explored how Medicaid expansion in Oregon was associated with Medicaid-financed abortion rates and receipt of medication abortion relative to surgical abortion.MethodsUsing Medicaid claims and eligibility data we identified women ages 19 to 43 (n = 30,367) who had abortions before the expansion period (2008–2013) and after the expansion period (2014–2016). We used American Community Survey data to estimate the annual number of Oregon women aged 19 to 43 with incomes below 185% of the federal poverty level who would be eligible for a Medicaid-financed abortion. We conducted interrupted time series analyses using negative binomial and logistic regression models.ResultsIncidence of Medicaid-financed abortion increased from 13.4 in 1,000 women in 2008 to 16.3 in 2016. Medication abortion receipt increased from 11.5% of abortions in 2008 to 31.7% in 2016. For both outcomes, we identified an increasing time trend after Medicaid expansion, followed by a subsequent leveling off of the trend. By the end of 2016, incidence of Medicaid-financed abortion was 4.5 abortions per 1,000 women-years (95% confidence interval, 3.3–5.7) higher than it would have been without expansion and medication abortions comprised a 7.4 percentage point (95% confidence interval, 4.4–10.4) greater share of all abortions.ConclusionsMedicaid expansion was associated with increased receipt of Medicaid-financed abortions and may have reduced out-of-pocket payment among women with low incomes. Increased receipt of medication abortion may indicate that expansion enhanced earlier access to services, possibly as a result of increased prepregnancy Medicaid enrollment, and this earlier access may increase reproductive autonomy and safety.     

Malnutrition According to GLIM Criteria and Adverse Outcomes in Community-Dwelling Chinese Older Adults: A Prospective Analysis

ObjectivesThe Global Leadership Initiative on Malnutrition (GLIM) has proposed a consensus scheme for classifying malnutrition. This study examined the prevalence of malnutrition according to GLIM criteria and evaluated if these criteria were associated with adverse outcomes in community-dwelling older adults.DesignThis was a prospective cohort study.Setting and ParticipantsCommunity-dwelling Chinese men and women aged ≥65 years in Hong Kong.MethodsA health check including questionnaire interviews and physical measurements was conducted at baseline and 14-year follow-up. Participants were classified as malnourished at baseline according to the GLIM criteria based on 2 phenotypic components (low body mass index and reduced muscle mass) and 1 etiologic component (inflammation). Adverse outcomes including sarcopenia, frailty, falls, mobility limitation, hospitalization, and mortality were assessed at 14-year follow-up. Adjusted multiple logistic regression and Cox proportional hazards model were performed to examine the associations between malnutrition and adverse outcomes and presented as odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI).ResultsData of 3702 participants [median age: 72 years (IQR 68–76)] were available at baseline. Malnutrition was present in 397 participants (10.7%). Malnutrition was significantly associated with higher risk of sarcopenia (n = 898, OR 2.25; 95% CI 1.04–4.86), frailty (Fried (n = 971, OR 2.83; 95% CI 1.47–5.43), FRAIL scale (n = 985, OR 2.30; 95% CI 1.06–4.98)) and all-cause mortality (n = 3702, HR: 1.62; 95% CI 1.39–1.89). There was no significant association between malnutrition and falls (n = 987, OR 1.09; 95% CI 0.52–2.31), mobility limitation (n = 989, OR 0.98; 95% CI 0.36–2.67), and hospitalization (n = 989, OR 1.37; 95% CI 0.67–2.77).Conclusions and ImplicationsAmong community-dwelling Chinese older adults, malnutrition according to selected GLIM criteria was a predictor of sarcopenia, frailty, and mortality at 14-year follow-up; whereas no association was found for falls, mobility limitation, and hospitalization. Clinicians may consider applying the GLIM criteria to identify malnourished community-dwelling older adults.     

Coffee consumption and cancer risk: a Mendelian randomisation study

BackgroundCoffee contains many bioactive chemicals and associations with cancer have been reported in observational studies. In this Mendelian randomisation (MR) study we investigated the causal associations of coffee consumption with a broad range of cancers.Materials and methodsTwelve independent genetic variants proxied coffee consumption. Genetically-predicted risk of any cancer (59,647 cases) and 22 site-specific cancers was estimated in European-descent individuals in UK Biobank. Univariable and multivariable MR analyses were conducted.ResultsGenetically-predicted coffee consumption was not associated with risk of any cancer in the main analysis (OR 1.05, 95% CI 0.98–1.14, p = 0.183) but was associated with an increased risk of digestive system cancer (OR 1.28, 95% CI 1.09–1.51, p = 0.003), driven by a strong association with oesophageal cancer (OR 2.79, 95% CI 1.73–4.50, p = 2.5×10^?5). This association was consistent after adjustment for genetically-predicted body mass index, smoking and alcohol consumption. There was no strong evidence supporting a causal relationship between genetically-predicted coffee consumption and the majority of cancers studied. However, genetically-predicted coffee consumption was associated with increased risk of multiple myeloma (OR 2.25, 95% CI 1.30–3.89, p = 0.004) and reduced ovarian cancer risk (OR 0.63, 95% CI 0.43–0.93, p = 0.020).ConclusionsThis MR study provides strong support for a causal association of coffee consumption with oesophageal cancer, but not for the majority of cancer types, and the underlying mechanisms require investigation.     

The association between fruit and vegetable consumption and mental health disorders: Evidence from five waves of a national survey of Canadians

ObjectiveThe objective of this study was to examine the association between fruit and vegetable intake (FVI) and mental health disorders.MethodThis study used data from the Canadian Community Health Survey (CCHS), a repeated cross-sectional study of Canadians with five waves between 2000 until 2009 (n = 296,121 aged 12 years or older). FVI was assessed based on frequency of consumption. The primary outcome was a major depressive episode over the previous 12 months. Logistic regression models adjusted for age, gender, household income, education, physical activity, chronic illness and smoking.ResultsIn the first wave, greater FVI was significantly associated with lower odds of depression (OR: 0.85 95% CI:0.78–0.92). A combined estimate of all 5 waves demonstrated similar results (OR: 0.72; 95% CI: 0.71–0.75). Relative to those with the lowest FVI, those with the greatest FVI also had significantly lower odds of suffering from distress (OR: 0.87 95% CI: 0.78–0.98). These results were consistent across other waves. Perceived poor mental health status and previous diagnosis of a mood disorder and anxiety disorder also demonstrated statistically significant inverse associations with FVI (all p < 0.05).ConclusionThese findings suggest a potentially important role of a healthy diet in the prevention of depression and anxiety.