Health Care Research Articles

Tracking surface charge dynamics on single nanoparticles.

Surface charges play a fundamental role in physics and chemistry, in particular in shaping the catalytic properties of nanomaterials. However, tracking nanoscale surface charge dynamics remains challenging due to the involved length and time scales. Here, we demonstrate time-resolved access to the nanoscale charge dynamics on dielectric nanoparticles using reaction nanoscopy. We present a four-dimensional visualization of the spatiotemporal evolution of the charge density on individual SiO2 nanoparticles under strong-field irradiation with femtosecond-nanometer resolution. The initially localized surface charges exhibit a biexponential redistribution over time. Our findings reveal the influence of surface charges on surface molecular bonding through quantum dynamical simulations. We performed semi-classical simulations to uncover the roles of diffusion and charge loss in the surface charge redistribution process. Understanding nanoscale surface charge dynamics and its influence on chemical bonding on a single-nanoparticle level unlocks an increased ability to address global needs in renewable energy and advanced health care.

How digital applications can facilitate knowledge sharing in health care

Purpose This paper focuses on knowledge sharing in health care. The aim of the paper is to further understand how digital applications can facilitate knowledge sharing between different care providers and health-care professionals. Design/methodology/approach The paper is based on a qualitative action case study, performed as a formative intervention study as a Change Laboratory, where a digital application concerning wound support was used. The Change Laboratory was used for knowledge sharing in the assessment and treatment process of wounds. The collected data was then thematically analyzed. Findings The findings show how digital applications can facilitate knowledge sharing, but also the need for complementary collaborative sessions. The main contribution is the rich description of how digital applications together with these sessions can facilitate knowledge sharing. Originality/value This paper shows that activities as collaborative sessions performed on the organizational level prove to support knowledge sharing and learning when a new digital application has been implemented in the work process. It also shows that these sessions contributed to identifying new knowledge that has potential for being included in the application and hence are important to keeping the application updated and relevant over time.

Sleep disturbances across two weeks predict future mental healthcare utilization.

Insufficient sleep costs the U.S. economy over $411 billion per year. However, most studies investigating economic costs of sleep rely on one-time measures of sleep, which may be prone to recall bias and cannot capture variability in sleep. To address these gaps, we examined how sleep metrics captured from daily sleep diaries predicted medical expenditures. Participants were 391 World Trade Center responders enrolled in the World Trade Center Health Program (mean age = 54.97 years, 89% men). At baseline, participants completed 14 days of self-reported sleep and stress measures. Mean sleep, variability in sleep, and a novel measure of sleep reactivity (i.e., how much people's sleep changes in response to daily stress) were used to predict the subsequent year's medical expenditures, covarying for age, race/ethnicity, sex, medical diagnoses, and body mass index. Mean sleep efficiency did not predict mental healthcare utilization. However, greater sleep efficiency reactivity to stress (b=$191.75, p=.027), sleep duration reactivity to stress (b=$206.33, p=.040), variability in sleep efficiency (b=$339.33, p=.002), variability in sleep duration (b=$260.87, p=.004), and quadratic mean sleep duration (b=$182.37, p=.001) all predicted greater mental healthcare expenditures. Together, these sleep variables explained 12% of the unique variance in mental healthcare expenditures. No sleep variables were significantly associated with physical healthcare expenditures. People with more irregular sleep, more sleep reactivity, and either short or long sleep engage in more mental healthcare utilization. It may be important to address these individuals' sleep problems to improve mental health and reduce healthcare costs.

Rethinking professional boundaries: the climate crisis and brain health.

Since climate change affects psychiatric, neurological and neuropsychological disorders, as well as brain development, the Irish Doctors for the Environment working group on mental health has changed its title and remit to brain health. Mental health professionals need to respond coherently and effectively to the climate crisis. This need challenges traditional professional, disciplinary and academic boundaries and demands a holistic, person-centred approach. We propose that meeting this challenge is vital if the public, policy-makers and legislators are to grasp the full extent of the significance of climate's impact on brain health.

"I'm here. We're here. My people and I exist": Exploring the psychopolitical experiences of Black immigrant college students attending predominantly White institutions.

Despite the ever-growing presence of Black immigrant college students in the United States, little is known about their unique campus experiences or their mental health outcomes as it relates to psychopolitical determinants of well-being. This qualitative study aimed to explore the unique psychopolitical experiences of 14, first- and second-generation Black immigrant college students attending predominately White institutions in the United States. Using the theoretical frameworks of critical race theory, intersectionality, and psychopolitical validity to guide our study, a phenomenological approach uncovered six themes and 11 subthemes: (1) collective well-being, (2) relational well-being, (3) individual well-being (purpose; health and wellness; critical consciousness), (4) collective suffering (neocolonialism, oppressive policies, and political violence; institutional oppression; barriers to mental health care), (5) relational suffering (implicit racial bias, stereotypes, and microaggressions; violence and brutality), and (6) individual suffering (ethno-racial trauma; isolation; school-related stress). We highlight implications for practitioners working with Black immigrant college students such as providing culturally responsive mental health care and advocating for decolonized and antiracist trainings at predominately White institutions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Running on Empty: Ontario Hospital Workers' Mental Health and Well-Being Deteriorating Under Austerity-Driven System.

The well-being of health care workers (HCWs) and the public in Ontario, Canada is at risk as the province's health care system is strained by neoliberal restructuring and an aging population. Deteriorating working conditions that preceded the COVID-19 pandemic further declined as the added challenges took their toll on the work force, physically and mentally. The pandemic-weary hospital staff, predominantly women, many racialized, are facing unprecedented challenges. They are experiencing stress, anxiety, and burnout from staffing shortages and the resulting increased workloads, long hours, and violence. Comprehensive telephone interviews were conducted with 26 HCWs from less highly paid occupations in a range of hospitals across the province. Thematic analysis reveals a critical need for policies and legislation ensuring increased funding, hospital capacity, and reduced wait times while providing HCWs with fair and equitable wages, increased staffing, mental health supports, greater respect and acknowledgment, and strong protections from violence and other workplace hazards.

Assessing ChatGPT as a Medical Consultation Assistant for Chronic Hepatitis B: Cross-Language Study of English and Chinese.

Chronic hepatitis B (CHB) imposes substantial economic and social burdens globally. The management of CHB involves intricate monitoring and adherence challenges, particularly in regions like China, where a high prevalence of CHB intersects with health care resource limitations. This study explores the potential of ChatGPT-3.5, an emerging artificial intelligence (AI) assistant, to address these complexities. With notable capabilities in medical education and practice, ChatGPT-3.5's role is examined in managing CHB, particularly in regions with distinct health care landscapes. This study aimed to uncover insights into ChatGPT-3.5's potential and limitations in delivering personalized medical consultation assistance for CHB patients across diverse linguistic contexts. Questions sourced from published guidelines, online CHB communities, and search engines in English and Chinese were refined, translated, and compiled into 96 inquiries. Subsequently, these questions were presented to both ChatGPT-3.5 and ChatGPT-4.0 in independent dialogues. The responses were then evaluated by senior physicians, focusing on informativeness, emotional management, consistency across repeated inquiries, and cautionary statements regarding medical advice. Additionally, a true-or-false questionnaire was employed to further discern the variance in information accuracy for closed questions between ChatGPT-3.5 and ChatGPT-4.0. Over half of the responses (228/370, 61.6%) from ChatGPT-3.5 were considered comprehensive. In contrast, ChatGPT-4.0 exhibited a higher percentage at 74.5% (172/222; P<.001). Notably, superior performance was evident in English, particularly in terms of informativeness and consistency across repeated queries. However, deficiencies were identified in emotional management guidance, with only 3.2% (6/186) in ChatGPT-3.5 and 8.1% (15/154) in ChatGPT-4.0 (P=.04). ChatGPT-3.5 included a disclaimer in 10.8% (24/222) of responses, while ChatGPT-4.0 included a disclaimer in 13.1% (29/222) of responses (P=.46). When responding to true-or-false questions, ChatGPT-4.0 achieved an accuracy rate of 93.3% (168/180), significantly surpassing ChatGPT-3.5's accuracy rate of 65.0% (117/180) (P<.001). In this study, ChatGPT demonstrated basic capabilities as a medical consultation assistant for CHB management. The choice of working language for ChatGPT-3.5 was considered a potential factor influencing its performance, particularly in the use of terminology and colloquial language, and this potentially affects its applicability within specific target populations. However, as an updated model, ChatGPT-4.0 exhibits improved information processing capabilities, overcoming the language impact on information accuracy. This suggests that the implications of model advancement on applications need to be considered when selecting large language models as medical consultation assistants. Given that both models performed inadequately in emotional guidance management, this study highlights the importance of providing specific language training and emotional management strategies when deploying ChatGPT for medical purposes. Furthermore, the tendency of these models to use disclaimers in conversations should be further investigated to understand the impact on patients' experiences in practical applications.

Ethical and Epistemological Implications of Conducting Ethnographic Fieldwork as a Researcher-cum-Clinician in Brussels, Belgium

ABSTRACT We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one’s own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers.

Gaining Trust: Lessons and Opportunities for Artificial Intelligence in Health Care.

Gaining Trust: Lessons and Opportunities for Artificial Intelligence in Health Care.

Anxiety and depression fully mediate the relationship between anger expression and quality of life in a sample of hypertensive patients

The present study aimed to verify whether psychopathological symptoms, such as anxiety and depression, among hypertensive patients mediate anger expression and mental health. To this purpose, one hundred hypertensive patients completed the State and Trait Anger Inventory-2, the Symptom Checklist-90-Revised, and the 36-Item Short Form Health Survey. Fifty percent of the participants reported higher levels of psychopathological symptoms and lower levels of quality of life. A correlation analysis described positive associations between most of the scales of anger and psychopathological symptoms, including anxiety and depression. In contrast, mental health was negatively associated with anger expression and trait anger. A serial mediation model revealed that anxiety and depression fully mediated the relationship between anger expression and mental health. Our findings highlight the importance of conducting a multidimensional and multidisciplinary assessment to describe the mental health of hypertensives and prevent their psychological distress through the management of their emotional states. Taking care of the mental health of these patients may help them reduce psychological factors that influence their medical conditions.

Ideas on how educators facilitate interprofessional learning through controversies

ABSTRACT Constructive controversies, where team members discuss their different opinions openly and politely, can stimulate interprofessional learning (IPL): the learning that occurs in the interactions between two or more different professions. However, in science-based controversies where members compete to be the expert learning becomes complicated. This paper constructs a model for a procedure of a science-based controversy and describes the conditions for IPL in such a setting. The basis for the model is an empirical study. Firstly, we describe how constructive controversies are conceptualised in the literature. We include literature on dialogic teaching and learning. Secondly, we describe how science-based controversies are conceptualised. Thirdly, we present the empirical study. Fourthly, we construct the model which focuses on mental health care professionals but is also applicable to other professionals. The findings suggest a model with three contextual factors which are connected to the use of power strategies and learning strategies. The model gives ideas for educators on why and how to use science-based controversies to facilitate IPL in teamwork. Indirectly a theory is introduced of how to strengthen IPL through controversies. The model is relevant in teaching how controversies which often concern what is best for the users/patients can be handled constructively.

The integrated behavioral model of mental health help seeking (IBM-HS): A health services utilization theory of planned behavior for accessing care.

This article introduces the integrated behavioral model of mental health help seeking (IBM-HS), a theoretical model for understanding the constructs (e.g., systemic, predisposing, and enabling factors; mental health literacy; illness perceptions; perceived need; stigma; shame; perceived benefits, motivation) that influence people's decision making around seeking professional mental health care and their ultimate access to formal treatment. The IBM-HS is a help-seeking-specific adaptation of the empirically supported integrated behavioral model and integrative model, which are themselves evolutions of the theory of planned behavior and theory of reasoned action. The IBM-HS posits that help-seeking determinants (e.g., structural forces; cultural influences; past help-seeking experience; evaluated need; mental health perceptions, knowledge, and skills; social support) influence help-seeking beliefs (i.e., outcome beliefs, experiential beliefs, beliefs about others' expectations, beliefs about others' behavior, logistical beliefs), which in turn determine their respective help-seeking mechanisms (i.e., attitude, perceived norm, personal agency). These mechanisms collectively influence help-seeking intention, which drives prospective help-seeking behavior, subject to the moderating effects of determinants. Finally, prospective behavior has reciprocal feedback loop effects on certain determinants and beliefs. This article describes the need for the IBM-HS, the model's constructs and their interrelations, measurement considerations, and how the model can be used by scholarly and applied users to systematically understand people's intention to seek professional mental health care services and what helps or hinders them from utilizing this care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Detection of Psychological Dysfunction and Suicide Risk Among Postpartum Women.

Prevalence rates of perinatal mood disorders range from 5 to 25%. Furthermore, suicide is a leading cause of death in postpartum women. Various factors have been associated with an increased risk of suicide in postpartum women, including co-occurring mental health disorders, lack of mental health care, and substance use. It is important for mental health screening and psychological assessment used within OB-GYN clinics to be current with regard to postpartum mood dysfunction and suicide risk assessment. We collected data from a sample of 78 postpartum women (0-6-month post-delivery), focusing specifically on patterns of emotional/internalizing dysfunction, using three different screening measures as predictors. Contrary to hypotheses, our sample did not produce significant elevations on target criterion scales of the Minnesota multiphasic personality inventory-3 (MMPI-3). Although the multidimensional behavioral health screen (MBHS) was better at differentially capturing MMPI-3 elevations when compared to the Edinburgh postnatal depression scale (EDPS) and patient health questionnaire-9 (PHQ-9), two of the three comparisons were not statistically significant. Statistical analyses were challenged by our extremely low base rate for elevated suicide risk. Despite this, the MBHS performed better than the EPDS and PHQ-9 at accurately capturing elevated suicide risk.

Cannabis Use and Head and Neck Cancer.

Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear. To assess the clinical association between cannabis use and HNC. This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older. Cannabis-related disorder. Diagnosis of HNC and any HNC subsite. The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group. This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.

The Association of Adverse Pregnancy Outcomes With Overactive Bladder Anticholinergics.

The pregnancy safety and teratogenicity of overactive bladder (OAB) anticholinergic medications in humans are unknown. The aim of this study was to determine if the use of OAB anticholinergics during pregnancy was associated with adverse pregnancy outcomes or congenital malformation. Using routinely collected health care data from Ontario, Canada, we conducted a retrospective cohort study and identified women aged 18-45 years who gave birth between 2004 and 2022 and were eligible for provincial drug benefits. We used gestational age and birth dates to approximate conception dates. The primary exposure was filling a prescription for an OAB anticholinergic during pregnancy (compared with nonusers). The coprimary outcomes were pregnancy complication (which included preterm birth or low birth weight) and congenital malformation. Poisson regression models with generalized estimating equations and inverse probability of treatment weighting were used to estimate risk ratios (RRs). We identified 138,271 births, of which 479 (0.3%) had exposure to an OAB anticholinergic, for a median of 60 (interquartile range, 30-120) days. The most common OAB anticholinergic was oxybutynin (84%). In the weighted cohort, the risk of a pregnancy complication was significantly elevated (RR, 1.65; 95% confidence interval [CI], 1.40-1.95; P < 0.01; absolute risk difference + 9.9% [95% CI, +5.9, +13.9]), with a dose-response relationship close to statistical significance (P = 0.07). The risk of congenital malformations with OAB anticholinergic use was not significant (RR, 1.24; 95% CI, 0.85-1.80; P = 0.26). Pregnant women who take OAB anticholinergic medications have a higher risk of pregnancy complications, but not congenital malformations, compared with non-OAB anticholinergic users. This information can be used when counseling women of child-bearing age about these medications.

Development and Validation of a Prognostic Model to Predict Late Seizures After Traumatic Brain Injury: A Retrospective Analysis.

Posttraumatic epilepsy (PTE) is considered to be one of the most severe and enduring outcomes that can arise from traumatic brain injury (TBI). The authors' study aims to create and authenticate a prognostic model for forecasting the PTE occurrence after TBI. The clinical prognostic model was developed in 475 people who had a TBI history in Nanning using a multivariate logistic regression model. The score in the authors' prognostic model participants was subjected to external validation from other cities in Guangxi and assessed its performance with the area under the receiver operating characteristic curve (area under the curve), calibration plots, and decision curve analysis. Six variables were selected to establish the nomogram for PTE, including time, Glasgow Coma Scale, location, cranial imaging (midline shift), intracranial infection, and titanium mesh cranioplasty. The area under the curve was found to be 0.860 in the training cohort and 0.735 in the validation cohort, revealing that the nomogram exhibited a satisfactory level of discriminative ability. The calibration plots exhibited a substantial degree of concordance between the prognostic predictions generated by the nomogram and the observed outcomes in both the training and validation groups. In addition, the decision curve analysis demonstrated the clinical utility of the nomogram. The cutoff value for the training cohort was determined to be 0.381, whereas for the validation cohort, it was 0.380. This suggests that patients with a probability >0.381 should be given special consideration. A prognostic nomogram was formulated and verified to aid health care clinicians in assessing the prognosis of patients with PTE.

Non-invasive myocardial work as an independent predictor of postprocedural NT-proBNP in elderly patients undergoing transcatheter aortic valve replacement.

Aortic stenosis has become the most prevalent valvular disease with increasing life expectancy and the ageing of the population, representing a significant clinical burden for health care providers. Its treatment has been revolutionized by transcatheter aortic valve replacement (TAVR) as a safe and minimally invasive option for elderly patients. Left ventricular (LV) functional measurement is of particular importance before TAVR, however, increased afterload significantly influences the conventional echocardiographic parameters. Non-invasive myocardial work examines myocardial deformation in the context of instantaneous LV pressure, thus, it might be a more reliable measure of LV function. Accordingly, we aimed to study non-invasive myocardial work and its relationship with functional outcome following TAVR.We enrolled 90 TAVR candidates (80 [75-84] years; 44% female). Using echocardiography, we quantified ejection fraction (EF), global longitudinal strain (GLS), global myocardial work index (GWI) and global constructive work (GCW) before and 12 months after the procedure. Serum NT-proBNP levels were also measured. EF did not change (52.6 ± 13.1 vs. 54.2 ± 10.5%; p = 0.199), while GLS increased (-13.5 ± 4.6 vs. -15.2 ± 3.8%; p < 0.001). GWI decreased (1913 ± 799 vs. 1654 ± 613 mmHg%; p < 0.001) and so did GCW (2365 ± 851 vs. 2177 ± 652 mmHg%; p = 0.018). History of atrial fibrillation (AF) (β = 0.349) and preprocedural GCW (β = -0.238) were independent predictors of postprocedural NT-proBNP (p< 0.001).GLS, GWI and GCW changed after TAVR while there was no alteration in EF. The preprocedural GCW and history of AF were independent predictors of postprocedural NT-proBNP. Accordingly, myocardial work indices may help patient selection and the prediction of the functional outcome in this population.

Community Integration Challenges of Men and Women After Traumatic Brain Injury: A Reflexive Thematic Analysis of Lived Experiences Through a Gender Lens.

To investigate community integration (CI) challenges following traumatic brain injury (TBI) through a gender lens. Rehabilitation research-teaching hospital. Adult participants (22 men and 20 women) with a primary diagnosis of mild or moderate-severe TBI, in the acute or chronic stages after injury, were recruited using purposive sampling. Qualitative study. Data were collected through semistructured interviews, and thematic analysis was used to identify themes of CI challenges. Three overarching themes emerged: (1) lack of a "graduated home plan": difficulty enacting gendered roles and responsibilities at home, (2) "Something that I cannot handle": mismatch between occupational demands and abilities, and (3) "Slipping away": disrupted connections with self and others. Men consistently voiced struggles with and inability to fulfill household tasks, whereas women detailed ways of adapting domestic responsibilities because of postinjury limitations. Productivity challenges resonated with a substantial number of participants, and a gendered pattern was observed: More women reported an inability, whereas more men reported a limited ability to meet occupational demands. Both genders conveyed disruptions in recreational and leisure activities, although women predominantly discussed challenges relating to social activities and men a tendency to avoid social situations because of anticipated stigma and/or shame. Across all themes, a pervasive sense of diminished community contributions and disrupted identities was observed. The incongruence between preinjury roles and responsibilities and postinjury abilities resulted in difficulties across multiple CI domains for the study participants and did not go unnoticed by them. It is important for health care professionals to assist patients in addressing gendered challenges at home, work, and in the social circle for a smoother transition back into the community.

Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants

ABSTRACT Background Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults’ profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use. Research design and methods A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use. Results A 8.9% (95% CI 0.074–0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115–1.234), diagnoses of depression (OR 2.889, 95% CI 1.785–4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003–2.729). Conclusions This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.

The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.