Contraceptive content shared on social media: an analysis of Twitter

BACKGROUND

Information on social media may affect peoples' contraceptive decision making. We performed an exploratory analysis of contraceptive content on Twitter (recently renamed X), a popular social media platform.

METHODS

We selected a random subset of 1% of publicly available, English-language tweets related to reversible, prescription contraceptive methods posted between January 2014 and December 2019. We oversampled tweets for the contraceptive patch to ensure at least 200 tweets per method. To create the codebook, we identified common themes specific to tweet content topics, tweet sources, and tweets soliciting information or providing advice. All posts were coded by two team members, and differences were adjudicated by a third reviewer. Descriptive analyses were reported with accompanying qualitative findings.

RESULTS

During the study period, 457,369 tweets about reversible contraceptive methods were published, with a random sample of 4,434 tweets used for final analysis. Tweets most frequently discussed contraceptive method decision-making (26.7%) and side effects (20.5%), particularly for long-acting reversible contraceptive methods and the depot medroxyprogesterone acetate shot. Tweets about logistics of use or adherence were common for short-acting reversible contraceptives. Tweets were frequently posted by contraceptive consumers (50.6%). A small proportion of tweets explicitly requested information (6.2%) or provided advice (4.2%).

CONCLUSIONS

Clinicians should be aware that individuals are exposed to information through Twitter that may affect contraceptive perceptions and decision making, particularly regarding long-acting reversible contraceptives. Social media is a valuable source for studying contraceptive beliefs missing in traditional health research and may be used by professionals to disseminate accurate contraceptive information.

Reproductive Justice: A Case-Based, Interactive Curriculum

INTRODUCTION

Reproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education.

METHODS

We designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group.

RESULTS

Sixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases.

DISCUSSION

This interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students' comfort and self-reported knowledge on several RJ topics.

Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study

OBJECTIVES

While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery.

METHODS

We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18 years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission.

RESULTS

Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found.

DISCUSSION

After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.

A simplified, data-constrained approach to estimate the permafrost carbon-climate feedback

We present an approach to estimate the feedback from large-scale thawing of permafrost soils using a simplified, data-constrained model that combines three elements: soil carbon (C) maps and profiles to identify the distribution and type of C in permafrost soils; incubation experiments to quantify the rates of C lost after thaw; and models of soil thermal dynamics in response to climate warming. We call the approach the Permafrost Carbon Network Incubation-Panarctic Thermal scaling approach (PInc-PanTher). The approach assumes that C stocks do not decompose at all when frozen, but once thawed follow set decomposition trajectories as a function of soil temperature. The trajectories are determined according to a three-pool decomposition model fitted to incubation data using parameters specific to soil horizon types. We calculate litterfall C inputs required to maintain steady-state C balance for the current climate, and hold those inputs constant. Soil temperatures are taken from the soil thermal modules of ecosystem model simulations forced by a common set of future climate change anomalies under two warming scenarios over the period 2010 to 2100. Under a medium warming scenario (RCP4.5), the approach projects permafrost soil C losses of 12.2-33.4 Pg C; under a high warming scenario (RCP8.5), the approach projects C losses of 27.9-112.6 Pg C. Projected C losses are roughly linearly proportional to global temperature changes across the two scenarios. These results indicate a global sensitivity of frozen soil C to climate change (γ sensitivity) of -14 to -19 Pg C °C(-1) on a 100 year time scale. For CH4 emissions, our approach assumes a fixed saturated area and that increases in CH4 emissions are related to increased heterotrophic respiration in anoxic soil, yielding CH4 emission increases of 7% and 35% for the RCP4.5 and RCP8.5 scenarios, respectively, which add an additional greenhouse gas forcing of approximately 10-18%. The simplified approach presented here neglects many important processes that may amplify or mitigate C release from permafrost soils, but serves as a data-constrained estimate on the forced, large-scale permafrost C response to warming.

Backing and forthing: the process of decision making by women considering participation in a breast cancer prevention trial

PURPOSE/OBJECTIVES

To describe the process of decision making by women considering participation in a breast cancer prevention trial (BCPT).

DESIGN

Qualitative.

SETTING/SAMPLE

Twenty-six women considering participation in a BCPT in the Northeastern United States.

METHODS

Women were interviewed one or two times over a period of one year, with each interview averaging 40 minutes in length. The grounded theory method was used to collect and analyze the data. In-depth interviews were conducted with each participant. Data were analyzed using the constant comparative method. MAIN RESEARCH CONCEPTS: Context, decision making, meaning.

FINDINGS

The core variable of backing and forthing is a nonlinear complex process of decision making that includes reviewing life, wanting to be sure, chancing and deciding within the contexts of fear, view of self in the world, transgenerational issues, and social support.

CONCLUSIONS

The process of decision making for women considering participation in a BCPT is complex. Women tend to make decisions based on what is in their heads and hearts. They often are concerned more about others than they are about themselves.

IMPLICATIONS FOR NURSING PRACTICE

Trust in the provider and active involvement in the process is critical to women making a decision to participate in a BCPT. Decision making is unique for each woman; however, understanding the context, the core variables, and the process will help healthcare providers to support decision making.

Caring for women living with ovarian cancer: recommendations for advanced practice nurses

This article summarizes advice for advanced practice nurses (APNs) that grew out of research with women living with premenopausal ovarian cancer. We claim that the process of diagnosis and being told, battle metaphors, treatment expectations, the patient's sense of normalcy, her sense of being heard, her ability to make sense of her new world, her inability to have children, issues of sexuality, and the irrelevance of most support groups are important considerations in the treatment of such women. The APN's major role in caring for these women is understanding the experience as it informs the APN's practice and serving as advocates for the women.

Source levels and estimated yellowfin tuna (Thunnus albacares) detection ranges for dolphin jaw pops, breaches, and tail slaps

Tuna fishers in the eastern Pacific Ocean often exploit an association between a few genus of dolphin (Stenella and Delphinus) and yellowfin tuna (Thunnus albacares) to locate and capture the tuna. Identification of a mechanism which facilitates the tuna/dolphin bond may provide a means of exploiting the bond and capturing tuna without catching dolphin. To investigate if tuna may be attracted to low-frequency sounds produced by dolphins, source levels of bottlenose dolphin (Tursiops truncatus) jaw pops, breaches, and tail slaps were experimentally measured and used to estimate the maximum range at which yellowfin could detect similar sounds produced by pelagic species. The effective acoustic stimulus to the tuna was defined as the maximum one-third-octave level between 200 and 800 Hz, the frequency range where T. albacares is most sensitive. Spherical spreading was assumed to predict transmission loss with range. Breaches and jaw pops produced maximum one-third-octave source levels between 200 and 800 Hz of 153 (+/-4) and 163 (+/-2) dB re: 1 microPa-m, respectively, which resulted in estimated detection ranges of 340-840 and 660-1040 m, respectively. Tail slaps had lower source levels [max. 141 (+/-3) dB re: 1 microPa-m] and a maximum detection range of approximately 90-180 m.

In your skin you are different: women living with ovarian cancer during childbearing years

The purpose of this study was to understand what it is like to live with ovarian cancer during childbearing years. The primary researcher (PR) conducted three to four in-depth interviews, lasting 60 to 90 minutes each, with five women living with ovarian cancer for 1 to 10 years. Van Manen's method of reflection and writing guided the inquiry. The process of existential investigation expanded the inquiry. Trustworthiness was assured through member checking, reflective journaling, coinvestigators checking the logic of the PR's analysis, and the achievement of consensus through dialogue. Analysis of the data revealed the themes of serendipitous diagnosis, managing treatment, horrible hair experience, hysterectomy violating one's sense of being, unfairness of menopause, body changes, intimate dreaming, being with others, being normal/different, being vigilant, being heard, and trying to make sense of it. The stories revealed provide us with a window into the experience of women with ovarian cancer.

Health patterns of women with fibromyalgia

Using diaries, eight women documented how they were living with their fibromyalgia on a daily basis for 3 months. Aches and pains were the most common symptoms experienced on nine to 81 of the 84 days of data collection. Cross-correlations revealed significant patterns related to pain, sleep and weather conditions for individual women. The narrative portion of their diaries supports that pain is physical and mental, knowing the self helps to control the intensity of the illness, and distraction helps to decrease the associated discomforts. Use of diaries and active listening (validation) are supported as interventions for these women.

Women living in paradox: loss and discovery in chronic illness

Six women with chronic illness engaged in multiple conversations with the investigator to help her understand what it is like to live with chronic illness. Phenomenologic writing and reflection were used to analyze the data. The story is guided by an integrating theme: Living in paradox circumscribes one's loss while enabling one to embrace new discoveries of self in the life world through unfolding awareness.

Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome

OBJECTIVE

To determine the relationship between sleep disturbances and fatigue in women with fibromyalgia (FM) and those with chronic fatigue syndrome (CFS) and to assess whether any differences existed between the two groups.

DESIGN

Descriptive comparative.

SETTING

Community program on chronic fatigue syndrome and related disorders.

PARTICIPANTS

Sixty-three women who attended the program; 13 had CFS, and 50 had FM.

MAIN OUTCOME MEASURES

A moderately strong relationship between fatigue and sleepiness was found (r = .63, p < .01). Trouble staying asleep was the highest rated sleep disturbance, and fatigue was the most common subjective feeling reported. Women with CFS reported significantly more trouble staying asleep than women with FM, t(61) = 1.81, p < .03.

CONCLUSIONS

Data from this study support that women with FM and CFS encounter problems sleeping. Clinicians are encouraged to assess women with FM and CFS for their quality of sleep rather than amount of sleep. Researchers are encouraged to continue study of sleep disturbances in women with FM and CFS to improve understanding of the disturbances and to test the effectiveness of sleep interventions.

Struggling to maintain balance: a study of women living with fibromyalgia

Thirty-six women with fibromyalgia (FM) were asked to describe how they live with their FM. Data were analysed using the constant comparative method. The goal was understanding the process of living with FM through theory development. The women described living with FM as struggling to maintain balance; this involves recalling perceived normality, searching for a diagnosis, finding out and moving on (transcending the illness). Several women relinquished the struggle because of situations that may or may not be under their control (e.g. depression and feeling imprisoned by treatment). Over time the illness moves from being a primary life focus to being part of the backdrop of the lives of women with FM.

Designing a product evaluation project using research principles

Critical care nurses are frequently involved in the evaluation of products used to enhance patient care. The authors discuss how research principles can be incorporated into the design for product evaluation to provide reliable information for purchasing decisions and add to the existing body of nursing knowledge. Because of the increasing number of products available to critical care nurses, the authors describe how to use research principles to design a product evaluation study for several examples.

The brain-dead pregnant woman: finding meaning to help cope

Caring for brain-dead pregnant women is a new critical care challenge. Rather than the usual life/death situations involving catastrophic events, critical care nurses have the added burden of caring for a life in suspension to maintain the viability of the fetus. Nurses struggle with keeping the brain-dead patient alive and yet know that as soon as the infant is delivered the mother will be allowed to die. These authors use interviews with clinical nurses to show how they used the coping strategy of creating meaning to successfully cope with this difficult situation.

Fatigue associated with congestive heart failure: use of Levine's Conservation Model

This study aimed to refine and extend the findings of an original study which focused on the description of fatigue associated with congestive heart failure. A descriptive approach based on Levine's Conservation Model provided both quantitative and qualitative data. Qualitative data addressed personal integrity and quantitative data measured energy conservation, structural and social integrity. Patients described fatigue as being tired and exhausted and containing both physical and emotional components. Fatigue occurred as a result of stress, physical activity and disease. Patient-identified interventions included rest, distraction, medicine, and physical and spiritual activities. Age, pH and oxygen saturation were significantly related to fatigue. The findings are examined using the concept of adaptation as defined by Levine. Implications for nursing are discussed within the framework of the Conservation Model with emphasis on a holistic approach to patient care.

Effectiveness of coping strategies among critical care nurses

Although research on job stress has focused on the extent or causes of stress in critical care, few studies have focused on the effects of stress reduction strategies by the critical care staff. The results of a study that examined the strategies critical care nurses used to manage job stress and the effectiveness of these techniques are described.

Taking care of the caretakers: a partial explanation of clinical nurse specialist practice

The purpose of this study was to describe the clinical practice of clinical nurse specialists (CNSs). Data were collected from three recorded case studies and interviews from a theoretical sample of 17 masters-prepared CNSs who had functioned in the CNS role for a minimum of 1 year. Using the constant comparative method, transcribed interviews were line-coded and clustered to form groups of data that could be labelled as constructs. Caring was validated as the basic psychological process. Scientific caring included investigating and teaching; humanistic caring included creating the new, showing the way, working with others, and taking care of the environment. It was found that CNSs took care of the caretakers as well as the patients and their families.

Clinical research: gaining access to patients

Gaining access to patients to conduct nursing research can be a difficult problem, especially in a critical care setting. This author describes techniques that can be used to select and establish research in your own or other hospitals.

Retention technique #3. Research: future impact on image and retention

The recruitment, retention, utilization, and image of nursing are critical issues facing nurses today. Critical care nursing research will assist us in dealing with these problems to prepare for a twenty-first century in which nursing is a valued profession. This author takes an optimistic view of the future and explains how she believes nursing research will help solve these recruitment and retention problems.