INTRODUCTION: Half of all pregnancies in South Carolina are unintended (mistimed or unwanted) and are associated with a higher risk for adverse maternal and infant health outcomes. South Carolina has a wide network of publicly supported clinics providing reproductive health services, including the Department of Health and Environmental Control, Federally Qualified Health Centers, and Rural Health Clinics. Having a better understanding of the geographic distribution of women in need of publicly funded contraceptive services is crucial for health planning and improving health delivery systems. METHODS: The total number of reproductive-aged women (15-44 years) in South Carolina was drawn from the 2017 American Community Survey (ACS) 5-Year Estimate files housed by the U.S. Census Bureau. A four-step process was used to estimate the number of reproductive-aged women in need of publicly funded contraceptive services at the county-level. First, the number of women between 15-19 years of age in each county was established. Next, the number of women with family incomes <100% of the federal poverty level in each county was identified. Data from the South Carolina Statewide Survey of Women, conducted by NORC at the University of Chicago, were used to estimate the number of reproductive-aged women (18-44) at-risk for experiencing an unintended pregnancy. The proportion of the women who were not sterile, not currently pregnant or not trying to get pregnant in the next 3 months was considered at-risk (76.24% of the total sample). The proportion of women at-risk was used to adjust the estimates of the total number of low-income women between 20-44 years of age in need of publicly funded contraceptive services in each county. The adjusted number of low-income women and the number of women less than 20 years of age were combined to estimate number of women in need of publicly funded contraceptive services. FINDINGS: There are an estimated 950,978 women of reproductive age living in South Carolina; of these women, about 40% (N=374,000) are considered in need of publicly funded contraceptive services. County-level need estimates ranged from 33.5% to 57.8% (M = 42.2%, SD = 4.8%) of the total reproductive-aged female population. While the number of women in need followed a typical population density pattern, rural communities had higher proportions of women in need of publicly funded contraceptive services, relative to the total population of reproductive-aged women. Rural counties comprised 91% of counties with the greatest need for publicly funded contraceptive services. CONCLUSIONS: Proportionally, the need for publicly funded contraceptive services is greater in rural and low-resource counties. While ensuring services are available among large population centers is certainly warranted, these findings also suggest that access to contraceptive services in rural counties is also needed and should be considered in health planning and service allocation policies and practices.

Twenty years ago, a seminal study on adverse childhood experiences (ACEs) and subsequent increased health risks catapulted ACEs into the zeitgeist of research and application. Though a validated construct, the questionnaire, particularly the child sexual abuse (CSA) item is not without limitation and yet is used by the Centers for Disease Control and state agencies to quantify need and allocate resources to services accordingly. Currently, CSA is counted only when the perpetrator is 5-years or older than the victim. This requirement makes neglect of sibling and peer assault very likely. Accordingly, this study aimed to assess whether individuals with CSA experiences within an age gap smaller than 5 years are missed by the 5-year modifier embedded in CSA assessment wording and whether this missed group would otherwise qualify for services if detected. The study also aimed to assess whether this missed group has equivalently poor health outcomes to CSA groups currently captured by the 5-year modifier and whether outcomes for all CSA groups were higher than those who did not have a CSA history. An international sample of 974 women aged 18 to 50 completed an online survey hosted by Reddit regarding their substance use, multiple domains of current health, and CSA history using the original ACEs questionnaire and an experimental version of the CSA item without the 5-year modifier. All statistical analyses were completed in R. Results indicated there was a group of survivors with CSA experiences missed by the 5-year modifier and this had implications for reducing their total ACE scores. This group was nearly equal in size to CSA groups captured by the 5-year modifier and demonstrated equivalently poor health and substance use outcomes. On nearly all variables, CSA groups demonstrated poorer health outcomes than those who had never experienced CSA. These findings suggest the language of how CSA is assessed must be thoughtfully revised to include all CSA experiences as all are equally at risk for adverse outcomes and thus all warrant consideration for services currently afforded those with CSA histories and high ACE scores.

Introduction: Gestational diabetes (GDM) affects one in three pregnancies and women with GDM have a 10-fold higher risk of developing type-2 diabetes during their lifetime. Similarly, hypertensive disorders (HPD) of pregnancy affect up to one in seven pregnancies and have a 4-fold increase in the risk of hypertension and a 2-fold risk of cardiovascular diseases (CVD) over the lifetime. Primary care (PC) transitions are critical for the management of GDM and HDP to reduce the long-term risk of developing type-2 diabetes, hypertension, and CVD. Despite clinical guidelines recommending PC follow-up for continuous and sustainable care practice, only 50% of postpartum mothers transition to PC within 12 months. Few studies examine this issue and none in South Carolina. Therefore, our study uses Medicaid Claims data to examine the extent to which postpartum mothers with GDM and HDP transition to PC within 12 months of childbirth. Methods: We examined cross-sectional data of Medicaid women with a live birth in the years 2017 and 2018 in South Carolina. Women above the age of 20, receiving postpartum services within 12 months of delivery were included in the study. Primary care visits was the outcome variable of interest. Any women with at least one primary care visit (Family/General Practice Physician visit) claim in the 12 months following birth were considered as a primary care transition. GDM, HDP, and both (GDM &HDP) were the primary independent variables of interest. Results: In 14,273 postpartum mothers, the prevalence of GDM, HDP, and both (GDM & HDP) were found to be 10.02%, 15.05%, and 3.60% respectively. Among the women with GDM, 47.02% had visited PC compared to 35.02% of women without GDM (p<0.001). Similarly, 48.12% of women with HDP visited PC compared to 34.23% of women without HDP (p<0.001). In addition, 52.66% of women with both (GDM & HDP) visited PC compared to 35.72% of women without both (GDM & HDP) (p<0.001). After adjusting for maternal age, ethnicity, residence, and pay category, women with GDM were 1.43 times more likely to visit PC as compared to the women with no GDM (95% CI: 1.27–1.61). Similarly, the odds of visiting PC by women with HDP was 1.67 times higher as compared to women without HDP (95% CI: 1.51 – 1.84). Conclusion: In this study, postpartum mothers with GDM and HDP had higher odds of PC visits compared with those without GDM and without HDP respectively. This is positive. However, the overall percentage of women visiting PC with chronic disease was lower than 50%. To change health outcomes among women with chronic diseases like GDM and HDP, lifelong screening and disease management are needed. It is necessary to link postpartum mothers with PC to improve illness management and raise screening adherence. However, more barriers preventing under-resourced women from receiving PC should be analyzed and addressed.

Introduction The U.S. South has higher rates of unintended pregnancy than other regions of the nation. Rurality and limited supply of medical providers and reproductive health services contribute to these disparities. Layered on this are restrictive reproductive health policies that are changing rapidly. Many rural areas in the South are "maternity care deserts” with no OB/GYNs, midwives, or obstetric care. In these areas, family physicians are often the only providers of reproductive health services. While family physicians commonly counsel about and prescribe oral contraceptives, little is known about their counseling practices for long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. This study examines attitudes and practices of family physicians in two Southern states related to counseling for IUDs and implants. Methods Statewide representative surveys of family physicians (FPs) were administered in South Carolina and Alabama in 2018. The survey questionnaire, informed by in-depth interviews with providers and a systematic literature review, collected data about providers’ knowledge, attitudes and practices related to contraceptive counseling and provision. The questionnaire was pilot tested, revised and finalized. Random samples of FPs from each state were selected, with oversampling of rural providers. Sampled providers were web traced and phone screened to verify eligibility and contact information. The IRB-approved survey protocol involved mixed-mode administration (electronic and mail surveys), participation incentives for providers and office managers, and extensive follow-up with non-respondents. Survey data were weighted to account for the sampling design and to generate robust estimates. Data were cleaned and analyzed in STATA using t-tests and chi-square tests for independence. Results Five hundred and ten (510) FPs responded to the survey. The majority of FPs (70%) were in private medical practice and one-fourth in rural areas. Among FPs in Alabama, 39.3% reported not counseling any of their reproductive-aged female patients in the past year about IUDs, and 53.1% reported not counseling about the implant. Prevalence of counseling did not differ significantly between AL and SC providers. While a majority of FPs in both states (88.7%) reported general training in contraceptive counseling during their formal education, fewer reported training specific to IUDs (61.7%) and implants (43.9%), and only 28% had received recent training in contraceptive counseling in the past 2 years. Risk perceptions of providers varied. Contrary to medical eligibility criteria, the majority of FPs considered IUDs unsafe for women who had an STI (sexually transmitted infection) in the past 2 years (62.4%) and unsafe immediately post-partum (69.4%). Contraceptive training was positively associated with counseling provision, whereas risk perceptions were negatively associated with counseling provision. Conclusion Substantial training gaps and needs were noted among FPs. While the scope of practice of FPs is broad and demanding, their engagement in comprehensive contraceptive counseling is essential for their patients’ health and well-being. This is particularly true in the U.S. south where contraceptive services are not always available or accessible. FPs must be supported through evidence-based training programs and clinic-level interventions that facilitate their contraceptive counseling and, ultimately, their patients’ contraceptive choices and outcomes.

Introduction: Health service organizations and their partners are increasingly under pressure to collaborate to deliver integrated patient care. The Collective Impact framework aligns well with respectful engagement and decision making between an organization and its partners, ensuring long-term change at the systems level. Shared vision, mutually reinforcing activities, and continuous communication are key components of a collective impact effort. Communication, in particular, plays an important role in all aspects of an organization, both internally and externally. Thoughtful feedback from partners and collaborative efforts can achieve collective impact and improved patient and population outcomes. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, was developed using Collective Impact principles. CW launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. This study examined the perceptions of CW staff towards shared vision for contraceptive access, mutually reinforced activities, and communication strategies between CW and its partners. Methods: Data were collected in 2022 via exit key-informant interviews with CW staff to reflect across-all-years of their involvement with the initiative. A semi-structured interview guide was used, and the interviews were recorded, transcribed, and coded. A codebook was developed based on the interview guide. Data from questions related to 1) shared vision, 2) communication, and 3) mutually reinforcing activities between CW staff and partners were analyzed for this study. Coding was conducted with NVivo software version 1.7. Results: A total of eight CW staff participated in the interviews. Findings indicate that participants were very satisfied with the shared vision for contraceptive access between CW and its partners. The most prevalent facilitators for shared vision were constant and ongoing communication, collaboration with partners, and CW changes in framing for the initiative. Regarding communication, most participants perceived that the level of communication and coordination among various CW partners was consistent and streamlined. Integration of communication into daily processes, open communication with partners, and use of an online communication tool were mentioned as strategies that facilitated communication. Lack of administrative and partner buy-in among some partners, staff turnover, and pandemic-related challenges were commonly mentioned by participants as barriers to communication. Most participants perceived mutually reinforcing activities to be adaptability to partner needs, funding for the full range of contraceptive methods, collaboration efforts, and feedback from the partners. Conclusion: While lack of buy-in among some partners and the pandemic posed challenges, most participants perceived that constant and consistent communication facilitated a shared vision among the CW partners. Through adaptability, collaboration, and open communication with partners, CW adjusted its work to align with their partners’ goals. The findings of this study indicate that CW has coordinated their efforts around a common goal that aligns with their partners. CW maintained effective and consistent communication and integrated partner feedback as a Collective Impact approach towards improving contraceptive access and provision in SC. Shared vision and understanding of the health issue between the organization and partners can lead to a collective impact towards solving community health problems such as contraceptive access.

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Background: Sexually transmitted infection (STI) rates represent a significant health disparity among young adult African American women. A major factor contributing to this issue is inconsistent condom use. This is especially a challenge for the state of Georgia, which has a high incidence of STI among the southern states. STI prevention counseling delivery through primary care providers is the primary recommendation from the Centers for Disease Control and Prevention and U.S. Preventive Services Taskforce. However, knowledge, attitudes, and practices of STI prevention counseling by advanced practice registered nurses (APRN) who care for young adult African American women are unknown in Georgia.Purpose: This doctor of nursing practice project investigated knowledge, attitudes, and practices of STI prevention by Georgia APRNs caring for young adult African American women on an outpatient basis and determined congruency of their counseling with primary prevention guide-lines. Methods: The design was descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs and postal mail to eligible Georgia APRNs currently in practice. Participants' knowledge of STI, STI prevention, and current practice guidelines and recommendations were assessed using knowledge questionnaires including true/false and multiple choice questions. Participants' attitudes regarding STI prevention counseling with young African American women and current APRN behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: The final sample size included 22 participants. Forty initiated the survey, ten did not meet eligibility criteria, six ended the survey during eligibility screening, and two ended the survey after completing less than seven percent of it. In general, participants were knowledgeable of STI and the majority of participants were knowledgeable of the CDC and USPSTF guidelines. The majority of participants felt comfortable discussing sexual practices with patients and providing feedback and advice on reducing STI risk behavior. However, the majority of participants did not believe that their current practice setting actively supported their delivery of STI prevention counseling. Overall, participants' practices were more congruent with the CDC guidelines compared to the USPSTF guidelines. This was reflected in knowledge and practice behaviors, specifically assessing for STI, providing feedback on risk behavior, and advising on behavior change with STI-infected patients and those at risk for STI. Fewer chose the USPSTF as their established practice guideline. This was revealed in practice behaviors pertaining to 'high-risk' counseling, as few tended to set goals for STI risk behavior change, document behavior goals, refer to STI resources, or follow up with referrals made to other STI risk reduction programs. Practice implications: Although overall APRN knowledge of STI was high, there were some knowledge deficits relating to appropriate barrier methods for viral-based STI and high-risk sexual behaviors associated with HBV. There was also a lack of knowledge and practice behaviors of the USPSTF STI prevention counseling guidelines. Therefore, future studies and interventions should aim to educate APRNs about these knowledge and practice insufficiencies.

Purpose: The purpose of this study was to assess if the topic of eating disorders is a part of post-graduate pediatric dental residency training curriculum. This study examined if there is a need for increased training of pediatric dental residents regarding the oral manifestations and treatment of patients with eating disorders.Methods: A cross-sectional online survey was used to compare data from all 66 post-graduate pediatric dental residency program directors. After thirty days a second emailing was conducted, with an additional thirty days to reply. Univariate distributions were obtained and percents for all items were based on the total number of respondents. The university-based programs and the hospital-based programs were compared and analyzed using chi-square analysis based on their percentages. Results: University-based programs were significantly less likely to offer curriculum on anorexia nervosa than hospital-based programs (13% versus 50%, pConclusion: An increase of clinically applicable eating disorder curriculum in post-graduate pediatric training is needed to enable residents to be more knowledgeable and effective practitioners.

INTRODUCAO: Os sintomas de climaterio podem perturbar intensamente a vida, sendo o fogacho o sintoma de maior incidencia. Aromaterapia e yogaterapia podem oferecer tratamentos eficazes para sintomas de climaterio, em especial o fogacho, por apresentarem mecanismos terapeuticos semelhantes ao eixo fisiologico do fogacho. OBJETIVO PRINCIPAL: Verificar e analisar os desfechos clinicos fisiologicos e psicologicos da aromaterapia olfativa e de exercicios respiratorios de yogaterapia, associados e individualmente, na qualidade de vida, nos niveis de stress subjetivo e na intensidade e frequencia do fogacho de mulheres na fase do climaterio. METODO: Foram avaliadas 85 mulheres na fase do climaterio, das quais 64 participaram da Fase 1 (somente avaliacao) do estudo e 34 participaram da Fase 2 (tratamento). A coleta foi realizada no CEPE-USP. O estudo consiste de um ensaio clinico pragmatico com randomizacao restrita, controlado por grupo controle e placebo, duplo-cego, com intervencao baseada no modelo psiconeuroendocrinoimunologico. Foram realizados tratamentos com inalacao de sinergia aromaterapeutica com ou sem exercicios respiratorios de yogaterapia, durante 12 semanas, duas vezes por semana em sessoes de uma hora. O estudo foi aprovado pelo Comite de Etica em Pesquisa da Escola de Educacao Fisica e Esporte da Universidade de Sao Paulo e foi inscrito no clinicaltrials.gov. RESULTADOS E DISCUSSAO: Os resultados da pesquisa mostraram melhora estatisticamente significante dos sintomas de climaterio para os tres grupos de intervencao. Houve diminuicao significativa do sintoma de fogacho, assim como da queixa de fogacho, sendo que o fogacho foi eliminado em cinco sujeitos. A intensidade e a frequencia de fogacho diminuiram em todos os grupos de intervencao e se mantiveram constantes no grupo controle. O tratamento proposto de aromaterapia se mostrou mais eficaz do que o tratamento proposto de yogaterapia na diminuicao do sintoma de fogacho, quando esses tratamentos eram aplicados isoladamente. A associacao das duas terapias se mostrou benefica, aumentando a eficacia e intensificando a melhora do sintoma de fogacho. Os efeitos globais dos tratamentos variaram intensamente quanto aos outros dominios de sintomas do climaterio. A melhora dos sintomas vasomotores do climaterio (fogacho e suor noturno), foi acompanhada de melhora significativa nos niveis de stress subjetivo, na qualidade do sono e da qualidade de vida em todos os grupos de intervencao. Esse trabalho tambem permitiu discussoes secundarias sobre o climaterio e as terapias, permitindo a sua compreensao a partir do modelo psiconeuroendocrinoimunologico. CONCLUSAO: Esse estudo serviu como um delineamento geral dos sintomas de climaterio, da aromaterapia e da yogaterapia a partir do modelo psiconeuroendocrinoimunologico. Os resultados apresentados nao podem ser generalizados para a populacao por causa da amostra pequena, mas podem indicar os resultados mais promissores e, com isso, esse trabalho pode ser o ponto de partida para novos estudos, auxiliando na elaboracao de questoes de pesquisa claras e metodos de pesquisa adequados para estuda-las / INTRODUCTION: Climacteric symptoms can disturb life considerably. Hot flashes are the symptom with highest incidence. Aromatherapy and yogatherapy can offer efficient treatments for climacteric symptoms, specially hot flashes, because their therapeutic mechanisms are similar to the physiological mechanism of hot flashes. MAIN OBJECTIVE: To analyze the psychological and physiological clinical outcomes of olfactory aromatherapy and breathing exercises of yogatherapy, associated or individually, on the quality of life, subjective stress levels and intensity and frequency of hot flashes in women in the climacteric period. METHODS: 85 women in the climacteric period were evaluated, 64 of these subjects participated in Phase 1 (assessment) and 34 participated in Phase 2 (treatment) . Data collection was performed at CEPE-USP. The study consists of a doubleblind, pragmatic clinical trial with restricted randomization, controlled by control and placebo groups. The intervention was based on the psychoneuroendocrineimmunological model. Treatments were performed with inhalation of an aromatherapeutic synergy developed for the study with or without yogatherapy breathing exercises for 12 weeks, twice per week in one hour sessions. The study was approved by the ethics comitte Comite de Etica em Pesquisa da Escola de Educacao Fisica e Esporte da Universidade de Sao Paulo and was registered in clinicaltrials.gov. RESULTS AND DISCUSSION: The results showed statistically significant improvement in symptoms of menopause for the three intervention groups. There was significant decrease in symptom of hot flashes, as well as complaints of hot flashes and this symptom was eliminated in five subjects. The intensity and frequency of hot flashes decreased in all intervention groups and remained constant in the control group. Aromatherapy was more effective than yogatherapy to decrease the symptoms of hot flashes, when these treatments were applied separately. The combination of the two therapies proved beneficial, increasing the effectiveness and enhancing the improvement of the symptom of hot flashes. The overall effects of the treatments varied intensely for other climacteric symptoms. The improvement of vasomotor symptoms of menopause (hot flashes and night sweats), was accompanied by a significant improvement in stress levels, quality of sleep and quality of life in all intervention groups. This research also permitted secondary discussions about climacterium and the therapies, permiting their understanding through the psychoneuroendocrineimmunological model. CONCLUSION: This study served as a general outline of climacteric symptoms, aromatherapy and yogatherapy through the psychoneuroendocrineimmunological model. The results cannot be generalized to the population because of the small sample size. However, the most promissing results can be indicated and this research can be the starting point for further studies, assisting in the preparation of clear research questions and suitable research methods to study them