http://hdl.handle.net/2027.42/64343 2013-05-22T23:59:12Z http://hdl.handle.net/2027.42/64344 Emergent Behaviors in a Deterministic Model of the Human Uterus Barclay, Mel L.; Andersen, H. Frank; Simon, Carl P. A cellular automaton designed to mimic the geometry, and physiologic function of the human uterus in labor produces patterns of activity which provide insight into how the human uterus functions in the birth process. 2009-11-10T00:00:00Z http://hdl.handle.net/2027.42/63439 Emergency Contraception Provision: A Survey of Michigan Physicians from Five Medical Specialties Xu, Xiao; Vahratian, Anjel; Patel, Divya A.; McRee, Annie-Laurie; Ransom, Scott B. Objective: Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians′ attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians′ practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP. Methods: A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents′ ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses. Results: Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( ≥50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively). Conclusions: Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients′ timely access. 2007-05-01T00:00:00Z http://hdl.handle.net/2027.42/63435 College Students' Perceptions of Emergency Contraception Provision Vahratian, Anjel; Patel, Divya A.; Wolff, Kristen; Xu, Xiao ABSTRACT Background and objective: The authors examined college students' perceptions regarding emergency contraception (EC) provision in light of the then pending U.S. Food and Drug Administration (FDA) decision about the over-the-counter (OTC) status of EC. Methods: We randomly sampled 7000 male and female students who were enrolled full-time at the University of Michigan during the winter 2006 semester. A total of 1585 (22.6%) students responded to our web-based survey and were included in these descriptive analyses. Results: Nearly all (94%) respondents knew of EC. When asked whether EC should be made available OTC, 60% of respondents agreed, 23% disagreed, and 17% were unsure. If EC were to be made available OTC, 34% of respondents indicated that they (or their partner) would purchase EC in advance of need, and 44% stated that they would purchase it only after unprotected sexual intercourse or contraceptive failure. Advance discussion and provision of EC is underused. Only 10% of all female respondents indicated that their current healthcare provider had spoken to them about EC in a routine health visit, and just 5% of female respondents were offered a supply of EC in advance of need. Conclusions: Continued efforts are needed to ensure timely access to EC in this population. 2008-01-01T00:00:00Z http://hdl.handle.net/2027.42/63394 Stress Urinary Incontinence in Women with a History of Gestational Diabetes Mellitus Kim, Catherine; McEwen, Laura N.; Sarma, Aruna V.; Piette, John D.; Herman, William H. ABSTRACT Objective: Stress urinary incontinence may serve as a barrier to lifestyle modification among women at high risk for diabetes, but the prevalence of stress urinary incontinence among women with histories of gestational diabetes mellitus (hGDM) is unknown. The purpose of this study was to examine the prevalence of stress incontinence among women with hGDM and to examine its association with their current physical activity. Methods: We surveyed women with hGDM within the past 5 years who were currently enrolled in a managed care plan (n = 228). In a cross-sectional analysis, self-reported weekly or more frequent stress incontinence was the primary independent variable and measures of physical activity and body mass index (BMI) were the outcomes of interest. We constructed multivariable models that adjusted for participant characteristics associated with the measure of incontinence or outcomes in bivariate analyses. Results: Of the 228 women with hGDM, 49% reported weekly or more frequent incontinence during pregnancy, and 28% reported that incontinence affected their activities during pregnancy. Fifty percent reported weekly or more frequent incontinence after delivery, with 27% reporting interference of incontinence with activity. Less than a third of women reported optimal physical activity, and 42% were obese. After adjustment for characteristics associated with measures of activity and incontinence, there was minimal association between levels of activity and stress urinary incontinence; similarly, there was no association between BMI and measures of stress incontinence. Conclusions: Stress urinary incontinence is common among women with hGDM but does not appear to be associated with physical activity levels or BMI. 2008-06-01T00:00:00Z