Influence of Hormonal Contraceptive Use and Health Beliefs on Sexual Orientation Disparities in Papanicolaou Test Use

Objectives. Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization.Methods. We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS).Results. Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization.Conclusions. Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians.Reproductive health screenings, such as Papanicolaou (Pap) tests, are a necessary part of quality health care.1 These screenings can detect precancerous conditions that may lead to cervical cancer if not treated. Despite the health benefits, sexual minority (e.g., lesbian, bisexual) female adolescents and young adults underutilize Pap tests.2–7 In a previous study with the cohort employed in this study, sexual minorities, compared to heterosexuals, were less likely to have had a Pap test within the last year or in their lifetime.8 We now extend this finding by exploring how hypothesized determinants of Pap testing intentions and behaviors help to explain sexual orientation disparities. A more thorough understanding of factors that explain underutilization may enable targeted clinical care and public health messages.It has been proposed that lesbians are less likely than heterosexuals to regularly visit a gynecologist because of their lower likelihood of hormonal contraceptive use.6,7 Other factors that may explain screening disparities include lower risk perception3 of cervical cancer and negative attitudes and beliefs toward Pap tests.9 Previous studies report that lesbians, in contrast to heterosexuals, perceive themselves to be at lower risk for contracting the human papillomavirus (HPV) and subsequently developing cervical cancer. Common reasons include the belief that sex between women is intrinsically safe because of limited fluid transmission, feeling invisible in gay male-focused sexual health promotions and therefore feeling “safe” because of a lack of messaging, and the emphasis in the “safer sex” discourse that one needs to only worry about penile penetrative sex.10 Physician recommendations have proved to be the strongest factor associated with Pap test utilization among all women.11 However, 10% of bisexuals and lesbians report being discouraged by physicians from getting a Pap test.12 Sexual minority adolescents may be particularly at risk because negative perceptions and attitudes about HPV are associated with lower screening rates among adolescents.13The Health Belief Model (HBM) is a psychological model that aims to explain and predict health behaviors. To our knowledge, it has yet to be applied to Pap test use within various sexual orientation groups but has effectively explained health disparities in other populations.14 The model includes 4 constructs focused on an individual’s attitudes and beliefs: susceptibility, severity, benefits, and barriers.15 An additional concept, cues to action, is thought to further motivate behavior,16 as are normative beliefs.The Institute of Medicine states that more data on Pap test use among sexual minority women are needed to better inform medical, governmental, and educational policies.17 Therefore, we examined sexual orientation group disparities in hormonal contraceptive use and HBM constructs (i.e., risk perception, attitudes and beliefs, cues to action) as they relate to Pap testing among adolescents and young adults. We hypothesized that unlike completely heterosexuals, sexual minorities

1. use hormonal contraceptives less frequently (and therefore may not see a health care provider as frequently who could provide a Pap test);
2. perceive themselves to be at lower risk for cervical cancer;
3. perceive themselves to be at lower severity of cervical cancer, if a diagnosis did occur;
4. believe there are fewer benefits to Pap test use;
5. believe there are more barriers to Pap test use;
6. hold fewer normative beliefs about Pap test use;
7. receive fewer cues to action for Pap test use; and
8. perceive fewer other individuals utilizing Pap tests.

Additionally, we hypothesized that these factors would partially explain (i.e., mediate) sexual orientation group disparities in Pap test intention and utilization.     

Validating administratively derived frailty scores for use in Veterans Health Administration emergency departments

Objectives

Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. Veterans Health Administration (VA) emergency departments (ED) are the primary venue of care for Veterans with acute illness and represent key sites for frailty recognition. As questionnaire-based frailty instruments can be cumbersome to implement in the ED, we examined two administratively derived frailty scores for use among VA ED patients.

Methods

This national retrospective cohort study included all VA ED visits (2017–2020). We evaluated two administratively derived scores: the Care Assessment Needs (CAN) score and the VA Frailty Index (VA-FI). We categorized all ED visits across four frailty groups and examined associations with outcomes of 30-day and 90-day hospitalization and 30-day, 90-day, and 1-year mortality. We used logistic regression to assess the model performance of the CAN score and the VA-FI.

Results

The cohort included 9,213,571 ED visits. With the CAN score, 28.7% of the cohort were classified as severely frail; by VA-FI, 13.2% were severely frail. All outcome rates increased with progressive frailty (p-values for all comparisons < 0.001). For example, for 1-year mortality based on the CAN score frailty was determined as: robust, 1.4%; prefrail, 3.4%; moderately frail, 7.0%; and severely frail, 20.2%. Similarly, for 90-day hospitalization based on VA-FI, frailty was determined as prefrail, 8.3%; mildly frail, 15.3%; moderately frail, 29.5%; and severely frail, 55.4%. The c-statistics for CAN score models were higher than for VA-FI models across all outcomes (e.g., 1-year mortality, 0.721 vs. 0.659).

Conclusions

Frailty was common among VA ED patients. Increased frailty, whether measured by CAN score or VA-FI, was strongly associated with hospitalization and mortality and both can be used in the ED to identify Veterans at high risk for adverse outcomes. Having an effective automatic score in VA EDs to identify frail Veterans may allow for better targeting of scarce resources.     

Neurocognitive impairment associated with predominantly early stage HIV infection in Abuja,Nigeria

Detailed neuropsychological testing was performed on 133 human immunodeficiency virus (HIV) seropositive (SP) and 77 HIV seronegative (SN) individuals, 86 % with early stage HIV infection in Nigeria, to determine the frequency of HIV-related neurocognitive impairment among the HIV-infected group. The tests were administered to assess the following seven ability domains: speed of information processing, attention/working memory, executive functioning, learning, memory, verbal fluency, and motor function motor. Demographically corrected individual test scores and scores for each domain or reflecting a global deficit (a global deficit score, or GDS) were compared for the SP and SN groups. SP participants were older, had fewer years of education, were more likely to be married, differed in ethnicity, and had higher depression scores than SN individuals. Within the seven ability domains, SP performed worse than SN with respect to speed of information processing, executive function, learning, memory, and verbal fluency and also on the global measure. SP were also more frequently impaired on tests of SIP, and there was a borderline increase in the frequency of global impairment. On the individual tests, SP performed worse than SN on four tests that assessed learning, verbal fluency, memory, and motor function (the Timed Gait). SP subjects, however, performed better than SN on the Finger-tapping test, also a motor task. Performance by SP subjects was not associated on the timed gait which showed a borderline statistically significant correlation with CD4 counts. However, there were significant correlations between viral load measurements and individual tests of speed of information processing, executive function, learning, and verbal fluency and with overall executive function and a borderline correlation with the GDS. Depression scores for SP were associated with impairment on only a single test of executive function. These results demonstrate the ability of these assessments to identify areas of impairment that may be specifically linked to a history of HIV infection among individuals in Nigeria. Confirmation of these findings awaits analyses using data from a larger number of control subjects.     

Assessment of rat sciatic nerve function following acute implantation of high density utah slanted electrode array (25 electrodes/mm2) based on neural recordings and evoked muscle activity

Introduction: High density Utah slanted electrode arrays (HD‐USEAs) have been developed recently for intrafascicular access to submillimeter neural structures. Insertion of such high electrode density devices may cause nerve crush injury, counteracting the intended improved selective nerve fiber access. Methods: HD‐USEAs were implanted into sciatic nerves of anesthetized rats. Nerve function was assessed before and after HD‐USEA implantation by measuring changes in evoked muscle and nerve compound action potentials and single unit neuronal recordings. Results: Neural activity was recorded with over half of all implanted electrodes. Average decreases of 38%, 36%, and 13% in nerve, medial gastrocnemius, and tibialis anterior compound action potential amplitudes, respectively, were observed following array implantation. Only 1 of 8 implantations resulted in loss of all signals. Conclusions: These studies demonstrate that HD‐USEAs provide a useful neural interface without causing a nerve crush injury that would otherwise negate their use in acute preparations (<12 h). Muscle Nerve 50 : 417–424, 2014     

Disease spread through contiguity and axonal tracts in primary lateral sclerosis

Our goal in this report was to determine whether symptom progression in primary lateral sclerosis (PLS) was consistent with disease spread through axonal pathways or contiguous cortical regions. The date of symptom onset in each limb and cranial region was obtained from 45 PLS patient charts. Each appearance of symptoms in a new body region was classified as axonal, contiguous, possibly contiguous, or unrelated, according to whether the somatotopic representations were adjacent in the cortex. Of 152 spread events, the first spread event was equally divided between axonal (22) and contiguous (23), but the majority of subsequent spread events were classified as contiguous. Symptom progression in PLS patients is consistent with disease spread along axonal tracts and by local cortical spread. Both were equally likely for the first spread event, but local cortical spread was predominant thereafter, suggesting that late degeneration does not advance through long axonal tracts. Muscle Nerve 49 :439–441, 2014