Additional research is needed to explore whether quality clinician referral improves abortion access and whether increased resources should be dedicated to improving referral patterns.

Women who estimated the date of their LMP and who frequently used drugs may benefit from strategies to help them recognize their pregnancies earlier and link them to care when they discover their pregnancies later.

Acanthosis nigricans (AN) is a cutaneous marker associated with elevated risk of type 2 diabetes. This study assesses mother-father differences in perception of child's bodyweight and health by Mexican-American parents with AN-positive children. The study used medical records in conjunction with survey data collected between 2011 and 2012 for 309 Mexican-American children with AN in South Texas. Multivariate logit models were estimated to assess mother-father differences in perception of child bodyweight and health controlling for selected child- and parent-level covariates. About 91 % of the children in the sample were obese and 6.5 % were overweight. One fifth of mothers and 38.5 % of fathers in the sample expressed no concern of their children's bodyweight. After adjusting for selected explanatory variables at both the child and parent level, the odds for fathers, relative to mothers, to be concerned about child's bodyweight were 82 % lower (OR = 0.18, p < 0.05). Similar findings also hold for parental awareness of child's AN (OR = 0.19, p < 0.05). Among Mexican-American families with AN-positive children, the lack of concern over child's bodyweight, unawareness of AN, and misconception of child's health on the part of many parents, especially of fathers, constitutes a challenge to diabetes prevention. Health education programs targeting Mexican-American families with AN-positive children might be more cost effective to consider mother-father differences in perception of child health and bodyweight.

Background:Little is known about whether US clinicians feel obligated to provide referrals for women desiring abortion. We assessed attitudes about and correlates of abortion referral among clinicians in a rural US state. Methods:We surveyed family medicine and ob-gyn clinicians in the rural state of Nebraska about referral for in vitro fertilization, high-risk prenatal care, abortion and suspected gynecologic malignancy. We asked whether clinicians have a professional obligation to refer and whether they would indeed refer. We assessed correlates of obligation and referral using multivariate logistic regression. Results:We analyzed 501 respondents who reported an obligation to refer for abortion least often (52%) compared with in vitro fertilization (78%), suspected gynecologic malignancy (96%), and high-risk prenatal care (98%). High religiosity was independently, negatively correlated with an obligation for abortion referral (OR 0.39, 95% CI 0.24-0.63, p <0.001). Sixty-four percent of respondents would refer for abortion. In multivariate analysis, women were more likely to refer for abortion (OR 1.97, 95% CI 1.13-3.44, p=0.02), while Catholic and more religious clinicians were less likely to refer (OR 0.22, 95% CI 0.06-0.79, p=0.02 and OR 0.17, 95% CI 0.10-0.28, p<0.001, respectively). Conclusion:Many clinicians in a rural US state believe they are not professionally obligated to and would not refer for abortion. This may lead to delayed care and increased morbidity for women.

We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.