Objective We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Methods Drawing upon formative work around women’s preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Results Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool’s content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Conclusion Our decision support tool appears acceptable to women in the family planning setting. Practice implications Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial.

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Key Points Question What are the overall burden and temporal trends in the rate of hospitalizations for worsening heart failure (WHF)? Findings This cohort study of 118 002 patients found that applying rigorous and prespecified diagnostic criteria to electronic health record data was associated with a more than 2-fold increase in the number of hospitalizations for WHF identified compared with estimates using a principal discharge diagnosis alone. There has been a gradual increase in the rate of hospitalizations for WHF over time, with a more noticeable increase observed among patients with heart failure with a preserved ejection fraction. Meaning These findings suggest that population temporal trends based on a principal hospital discharge diagnosis of heart failure may underreport the increasing burden of hospitalizations for WHF, particularly among those with heart failure with a preserved ejection fraction, compared with a comprehensive approach using structured and unstructured electronic health record data.

The relationships between bone health and various lifestyle factors were examined in a cross-sectional study in 775 Chinese women aged 35-75 years. Bone mass was significantly positively associated with body weight, height, body mass index (BMI) and duration of breastfeeding, but was not significantly associated with other lifestyle variables, including alcohol consumption, parity, age at menarche and age at menopause after adjusting for age and body weight. A positive association was observed in premenopausal women (but not in postmenopausal women) for bone density with current cigarette smoking and plasma and urinary cotinine (the major metabolite of smoking). However, the confounding effects of other unknown factors present in this cross-sectional study may not be excluded. Daily physical activity, as indicated by time spent working in the fields, was found consistently to be positively associated with bone mass (p < 0.0001). When these women were grouped into three physical activity levels on the basis of occupation and daily work intensity, those undertaking heavy labor also had significantly higher radial bone mass than women undertaking light or medium labor. These results suggest a protective effect of daily physical activity on bone health in both pre- and postmenopausal women.

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