Development of a Pediatric Fertility Preservation Program: A Report From the Pediatric Initiative Network of the Oncofertility Consortium

Infertility is known to decrease quality of life among adults. In some cases, infertility is caused by medical conditions and/or treatments prescribed in childhood, and using methods to protect or preserve fertility may expand future reproductive possibilities. Structured programs to offer counseling about infertility risk and fertility preservation options are essential in the care of pediatric patients facing fertility-threatening conditions or treatments, yet multiple barriers to program development exist. This report was developed from the institutional experiences of members of the Pediatric Initiative Network of the Oncofertility Consortium, with the intent of providing guidance for health care providers aiming to establish programs at institutions lacking pediatric fertility preservation services. The mechanics of building a fertility preservation program are discussed, including essential team members, target populations, fertility preservation options (both established and experimental), survivorship issues, research opportunities, and ethical considerations. Common barriers to program development and utilization, including low referral rates and financial concerns, are also discussed, and recommendations made for overcoming such barriers.     

Clinical Application of Body Composition Methods in Premature Infants

Monitoring whole body composition (fat mass and fat-free mass) in preterm infants may assist in optimizing nutrition and promoting growth and neurodevelopment in the neonatal intensive care unit. Currently, body composition assessment is not part of routine clinical evaluation of premature infants. Instead, weight and length are used to assess growth but are known to be poor predictors of adiposity shortly after birth. Although body composition methods, such as magnetic resonance imaging, stable-isotope dilution, and dual-energy x-ray absorptiometry, have been examined in infants, they involve exposure to radiation and are invasive, expensive, and/or unsuitable for repeated measurements in a medically fragile population. Several body composition methods with potential for clinical use have been explored in premature infants, including air displacement plethysmography, bioimpedance, skinfold measurements, and ultrasound. In this review, we examine each method and evaluate its feasibility for incorporation into clinical care. Although these methods show promise for use in premature infants, further research is needed before they can be recommended for routine body composition assessment in the clinical setting.     

Effects of weight stigma in news media on physical activity,dietary and weight loss intentions and behaviour

ObjectivesTo investigate the effect of weight stigma in news media on (a) intentions to increase physical activity (PA), improve diet quality and lose weight, and (b) changes in PA, diet quality and body mass index (BMI) over one month, in (i) women of all weight categories and (ii) a subsample of women living with obesity.MethodsUK-based women (N = 172; subgroup with obesity N = 81) were assigned to read an experimental (weight stigma; N = 75) or control (smoking stigma; N = 97) news article. Questionnaires were administered immediately after, and one month subsequently to collect information on BMI, PA, diet quality, intentions, past stigma, and diet and PA self-efficacy. Logistic and linear regression analyses were used to assess the effect of weight stigma on all outcome variables.ResultsIn the whole sample, there was no significant effect of weight stigma on any primary or secondary outcome. In women with obesity, there was no significant effect of weight stigma on diet quality (0.26 units, 95% CI: ?0.36 to 0.87) or PA (?1.83 units, 95% CI: ?11.11 to 7.44) at follow up, but exposure to weight stigma was associated with a significant increase in BMI at 1-month follow-up (1.15 kg/m², 95% CI: 0.38 to 1.92) compared with the control group.ConclusionsIn people with obesity, exposure to weight-stigmatising media may contribute to increased BMI over time. Larger trials with longer follow-up are needed to confirm these findings.     

Trends in hepatitis B prevalence and associated risk factors among Indigenous and non‐Indigenous prison entrants in Australia, 2004 to 2013

Objective : This study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non‐Indigenous prison entrants. Methods : A cross‐sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. Results : The study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti‐HBc) prevalence than non‐Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti‐HBc prevalence to non‐Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)^?. Being more than 30 years old and coming from an area classified as ‘non‐highly accessible’ were associated with anti‐HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti‐HBc positivity. For non‐Indigenous participants, a history of injecting drug use and body piercings was associated with anti‐HBc positivity. Conclusion : There are unique risk factors associated with HBV prevalence for both Indigenous and non‐Indigenous prison entrants. Implications for public health : In developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non‐Indigenous offenders is required.     

What is the evidence base for public involvement in health‐care policy?: results of a systematic scoping review

Background

Public involvement in health‐care policy has been advocated as a means to enhance health system responsiveness, yet evidence for its impact has been difficult to ascertain.

Objectives

To review the peer‐reviewed empirical evidence on outcomes of public involvement in health‐care policy.

Methods

We systematically searched PsychINFO and PubMed from November 2000 to April 2010 for empirical studies that reported on original research only; studies in languages other than English, German or French were excluded. Data were extracted using a standardized evidence table with a priori determined headings.

Main results

Nineteen studies were identified as eligible for inclusion in our review. We found that sound empirical evidence of the outcomes of public involvement activities in health care remains underdeveloped. The concept and the indicators used to examine and determine outcomes remain poorly specified and inconsistent, as does the reporting of the evidence. There was some evidence for the developmental role of public involvement, such as enhancing awareness, understanding and competencies among lay participants. Evidence for instrumental benefits of public involvement initiatives was less well documented.

Conclusions

Despite the growing body of work on public involvement in health‐care policy, evidence of its impact remains scarce; thus, firm conclusions about involvement activities that are appropriate and effective for policy development are difficult to draw. However, focus on outcomes risks missing the normative argument that involving the public in the health‐care policy process may be seen to be of intrinsic value.     

Peer Reviewed: Cancer Risk Communication in Mainstream and Ethnic Newspapers

Introduction

We wanted to understand how cancer risks are communicated in mainstream and ethnic newspapers, to determine whether the 2 kinds of newspapers differ and to examine features of news stories and sources that might predict optimal risk communication.

Methods

Optimal risk communication was defined as presenting the combination of absolute risk, relative risk, and prevention response efficacy information. We collected data by conducting a content analysis of cancer news coverage from 2003 (5,327 stories in major newspapers, 565 stories in ethnic newspapers). Comparisons of mainstream and ethnic newspapers were conducted by using cross-tabulations and Pearson χ² tests for significance. Logistic regression equations were computed to calculate odds ratios and 95% confidence intervals for optimal risk communication.

Results

In both kinds of newspapers, cancer risks were rarely communicated numerically. When numeric presentations of cancer risks were used, only 26.2% of mainstream and 29.5% of ethnic newspaper stories provided estimates of both absolute and relative risk. For both kinds of papers, only 19% of news stories presented risk communication optimally. Cancer risks were more likely to be communicated optimally if they focused on prostate cancer, were reports of new research, or discussed medical or demographic risks.

Conclusion

Research is needed to understand how these nonnumeric and decontextualized presentations of risk might contribute to inaccurate risk perceptions among news consumers.     

Effects of Appraisal of Sexual Stimuli on Sexual Arousal in Women with and Without Superficial Dyspareunia

This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (d = 0.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (d = 0.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (d = 1.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (d = 0.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.     

Keep that magic going in 2015!

Greetings and welcome to ASHRM's 35th anniversary year! As I begin my term as president, I acknowledge and appreciate the richness and depth of our organization's history and value the wisdom of our many members and volunteers who have been actively involved in ASHRM from the beginning, as well as those of us who haven't been around that long!