Contraception: X最新文献_第8页

Understanding the extent of contraceptive non-use among women at risk of unintended pregnancy, National Survey of Family Growth 2011–2017 了解有意外怀孕风险的妇女不使用避孕药具的程度，2011-2017年全国家庭增长调查

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100033

Brittni N. Frederiksen , Katherine Ahrens

Objective

To describe characteristics of U.S. contraceptive non-users to inform tailored contraceptive access initiatives.

Study design

We used National Survey of Family Growth data from 2011 to 2017 to identify characteristics of contraceptive non-users compared to other women ages 15–44 at risk for unintended pregnancy. We also examined reasons for not using contraception by when non-users expected their next birth. We calculated unadjusted and adjusted prevalence ratios using two definitions of contraceptive non-use: (1) contraceptive non-use during the interview month, and (2) a more refined definition based on contraception use during the most recent month of sexual intercourse and expectation of timing of next birth. We considered p-values < 0.05 statistically significant.

Results

Approximately 20% (n = 2844) of 12,071 women at risk of unintended pregnancy were classified as standard contraceptive non-users. After adjusting for all other variables, non-users were more likely to be low-income, uninsured, never married, expect a birth within 2 years, and have zero or one parity. The top reasons for contraceptive non-use were not minding if they got pregnant (22.6%), worried about contraceptive side effects (21.0%), and not thinking they could get pregnant (17.6%). After applying the more refined non-user definition, we identified 5.7% (n = 721) of women as non-users; expecting a birth within 2–5 years and having a parity of one were associated with non-use after adjustment of all other factors.

Conclusion

Our more refined definition of non-users could be used in future studies examining the causes of unintended pregnancy and to inform programmatic interventions to reduce unintended pregnancy.

Implications

Describing contraceptive non-users and reasons for contraceptive non-use could help us better understand reasons for unintended pregnancy and inform tailored contraceptive access initiatives.

目的描述美国非避孕药使用者的特征，为量身定制的避孕措施提供信息。研究设计我们使用了2011年至2017年的全国家庭增长调查数据，以确定与其他15-44岁有意外怀孕风险的女性相比，未使用避孕药的女性的特征。我们还调查了不使用避孕措施的原因，直到不使用避孕措施的人预计下次分娩的时间。我们使用两种未使用避孕措施的定义来计算未调整和调整后的患病率:(1)访谈月份未使用避孕措施;(2)基于最近一个月性交期间的避孕措施使用情况和下一次分娩预期时间的更精确定义。我们考虑p值<0.05有统计学意义。结果12071例有意外怀孕危险的妇女中，约20% (n = 2844)被归类为标准避孕非使用者。在对所有其他变量进行调整后，不使用药物的人更有可能是低收入、无保险、未婚、预计在2 年内出生、零胎或一次胎次。不使用避孕措施的主要原因是不介意怀孕(22.6%)、担心避孕副作用(21.0%)和不认为自己能怀孕(17.6%)。在应用更精细的非用户定义后，我们确定5.7% (n = 721)的女性为非用户;在调整所有其他因素后，预期在2-5 年内出生和胎次为1与不使用相关。结论我们对非使用者的更精确定义可用于未来研究意外怀孕的原因，并为减少意外怀孕的程序性干预提供信息。描述不使用避孕措施和不使用避孕措施的原因可以帮助我们更好地了解意外怀孕的原因，并为量身定制的避孕措施提供信息。

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引用次数: 10

Out-of-pocket spending for oral contraceptives among women with private insurance coverage after the Affordable Care Act 在《平价医疗法案》之后，拥有私人保险的女性自费购买口服避孕药

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100036

Brittni Frederiksen , Matthew Rae , Alina Salganicoff

Objectives

We aimed to identify which types and brands of oral contraceptive pills have the largest shares of oral contraceptive users in large employer plans with out-of-pocket spending and which oral contraceptives have the highest average annual out-of-pocket costs.

Study design

We analyzed a sample of medical claims obtained from the 2003–2018 IBM MarketScan Commercial Claims and Encounters Database (MarketScan), which is a database with claims information provided by large employer plans. We only included claims for women between the ages of 15 and 44 years who were enrolled in a plan for more than half a year as covered workers or dependents. To calculate out-of-pocket spending, we summed copayments, coinsurance and deductibles for the oral contraceptive prescriptions.

Results

We found that 10% of oral contraceptive users in large employer plans still had out-of-pocket costs in 2018. Oral contraceptives with the largest share of users with annual out-of-pocket spending are brand-name contraceptives with generic alternatives. The three contraceptives with the highest average annual out-of-pocket spending were brand-name contraceptives without generic alternatives. Three of the 10 contraceptives with the largest shares of users who have annual out-of-pocket spending and 3 of the 10 contraceptives with the highest average annual out-of-pocket spending contain iron.

Conclusions

Women with health insurance are still paying out of pocket for oral contraception, and future research should investigate which health plans have fewer fully covered contraceptives and effective modes of educating providers and patients about how to maximize the no-cost coverage benefit that has been extended to women.

Implications

The Affordable Care Act eliminated out-of-pockets costs for contraception for most insured women. However, some women still pay out of pocket for certain oral contraceptive brands and types that may have covered alternatives. Providers and patients could benefit from more education on how to maximize the no-cost coverage benefit extended to women.

目的我们旨在确定哪些类型和品牌的口服避孕药在大型雇主自费计划中占有最大的口服避孕药用户份额，以及哪种口服避孕药的平均年自费成本最高。研究设计我们分析了2003-2018年IBM MarketScan商业索赔和遭遇数据库(MarketScan)中获得的医疗索赔样本，该数据库包含大型雇主计划提供的索赔信息。我们只包括年龄在15岁到44岁之间的女性，她们作为被覆盖的工人或家属参加了半年以上的计划。为了计算自付费用，我们总结了口服避孕药处方的共付额、共保额和免赔额。结果我们发现，2018年，在大型雇主计划中，10%的口服避孕药使用者仍然需要自付费用。每年自付费用最多的使用者使用的口服避孕药是品牌避孕药，有非专利替代品。年平均自付费用最高的三种避孕药具是没有仿制药替代的名牌避孕药具。每年自付费用最多的10种避孕药具中有3种，年平均自付费用最高的10种避孕药具中有3种含有铁。结论有健康保险的女性仍然在自费购买口服避孕药，未来的研究应该调查哪些健康计划提供的避孕药具较少，以及如何有效地教育提供者和患者如何最大限度地提高女性的无成本保险福利。意义平价医疗法案消除了大多数参保妇女的自费避孕费用。然而，一些女性仍然自掏腰包购买某些品牌和类型的口服避孕药，这些品牌和类型可能已经涵盖了替代品。医疗服务提供者和患者可以从更多的教育中受益，了解如何最大限度地扩大妇女的无成本保险福利。

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引用次数: 1

Using Google Ads to recruit and retain a cohort considering abortion in the United States 使用b谷歌广告来招募和留住在美国考虑堕胎的群体

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2019.100017

Ushma D. Upadhyay , Iris J. Jovel , Kevin D. McCuaig , Alice F. Cartwright

Objective

The objective was to develop and test the feasibility of a methodology to recruit and retain individuals in the United States (US) who were considering abortion at the point of searching for an abortion clinic.

Study design

We conducted the Google Ads Abortion Access Study, a national cohort study using a novel recruitment method — recruiting people searching for abortion care on Google. Advertisements for the study were displayed in search results. Users who clicked on the advertisement were directed to a landing page explaining the study and then to a screening form. Participants were eligible if they reported being pregnant and considering abortion. They completed an online baseline survey and 4 weeks later were invited by email or text message to complete a follow-up survey.

Results

Over the course of 8 months, we recruited a racially/ethnically and geographically diverse cohort considering an abortion using Google Ads. After removing fraudulent cases, we recruited 1706 respondents, and among these, 1464 (86%) provided contact information for follow-up. Among those providing contact information, 1005 completed the follow-up survey, resulting in a 69% follow-up rate. Older age, white race, higher education, difficulty meeting basic needs, being not religious/spiritual and having no previous births were associated with higher follow-up. Total cost of the ads was $31.99 per completed baseline + follow-up survey.

Conclusion

Researchers can use online advertising to successfully recruit populations early in their abortion-seeking process to understand the barriers they face and how to improve abortion access. Disadvantages include high cost and a small potential for fraudulent data.

Implications

Google Ads is a feasible tool to recruit and follow a diverse sample of individuals who are considering abortion for studies investigating the barriers they face in obtaining a wanted abortion.

目的目的是开发和测试一种方法的可行性，以招募和留住在美国寻找堕胎诊所时正在考虑堕胎的个人。研究设计:我们进行了b谷歌广告堕胎途径研究，这是一项全国性队列研究，采用了一种新颖的招募方法-招募在谷歌上寻找堕胎护理的人。该研究的广告显示在搜索结果中。点击广告的用户会被引导到一个解释研究的登陆页面，然后是一个筛选表格。如果参与者报告怀孕并考虑堕胎，他们就有资格。他们完成了一项在线基线调查，4 周后，通过电子邮件或短信邀请他们完成一项后续调查。结果在8个 月的时间里，我们招募了一个种族/民族和地域多样化的群体，考虑使用b谷歌广告堕胎。在剔除欺诈案例后，我们招募了1706名受访者，其中1464名(86%)提供了随访的联系方式。在提供联系方式的人中，有1005人完成了随访调查，随访率为69%。年龄较大、白种人、受过高等教育、难以满足基本需求、不信教/不信仰宗教以及没有生育史的人随访率较高。广告的总成本是31.99美元，每个完成的基线+后续调查。结论研究人员可以利用网络广告在寻求堕胎的早期成功招募人群，了解他们面临的障碍以及如何改善堕胎的可及性。缺点是成本高，数据欺诈的可能性小。谷歌广告是一个可行的工具，可以招募和跟踪考虑堕胎的不同样本，以研究他们在获得想要的堕胎时面临的障碍。

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引用次数: 19

Transgender abortion patients and the provision of transgender-specific care at non-hospital facilities that provide abortions 跨性别堕胎患者和在提供堕胎的非医院设施提供针对跨性别的护理

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100019

Rachel K. Jones , Elizabeth Witwer , Jenna Jerman

Objective

To estimate the number of transgender and gender non-binary (TGNB) individuals who obtained abortions in the United States and the extent to which abortion facilities offer transgender-specific health services.

Study design

We collected survey data from all known health care facilities that provided abortions in 2017. For the first time, the questionnaire included items about TGNB abortion patients and services.

Results

We estimate that 462 to 530 TGNB individuals obtained abortions in 2017 and that 23% of clinics provide transgender-specific care.

Conclusion

Several hundred abortions were provided to TGNB individuals in 2017, primarily at facilities that did not provide transgender-specific health services.

Implications

Findings from this study support efforts to implement and expand gender-inclusive and affirming care at health care facilities that provide abortion.

目的估计在美国获得堕胎的跨性别和性别非二元(TGNB)个体的数量以及堕胎设施提供跨性别特定保健服务的程度。我们收集了2017年所有已知提供堕胎服务的医疗机构的调查数据。问卷首次纳入TGNB人工流产患者及服务项目。结果我们估计，2017年有462至530名TGNB个体堕胎，23%的诊所提供跨性别特定护理。结论2017年为TGNB提供了数百例堕胎，主要是在不提供跨性别卫生服务的机构进行的。本研究的结果支持在提供堕胎服务的医疗机构实施和扩大性别包容和肯定护理的努力。

引用次数: 15

Comparing telemedicine to in-clinic medication abortions induced with mifepristone and misoprostol 米非司酮、米索前列醇诱导远程流产与临床用药流产的比较

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100023

Ellen R Wiebe , Mackenzie Campbell , Harani Ramasamy , Michaela Kelly

Objective

The objective was to compare the practical aspects of providing medication abortions through telemedicine and in-person clinic visits so that clinics can use this information when planning to add this service.

Study design

We conducted a comparative retrospective chart review comparing telemedicine medication abortions to a control group matched for date seen. We extracted and compared demographics, use of dating ultrasound, outcomes and unscheduled visits or communications with staff and physicians.

Results

During the study period, we provided 4340 medication abortions, of which 182 (4.2%) were provided through by telemedicine; 199 patients met the criteria to be in the control group. The mean age was 28.7 years for telemedicine patients and 28.1 years for in-person patients (p = .38). The mean gestational ages were also similar, 48.2 days for telemedicine patients and 46.5 days for in-person patients (p = .03). Only 33 (18.1%) of telemedicine patients had dating ultrasounds compared to 199 (100%) of in-clinic patients (p < .001). The proportions of documented completed abortions (164/182, 90.1% and 179/199, 89.9%, p = .76) were similar, as were the proportions of aspirations for completion (6/182, 3.3% and 9/199, 4.5%, p = .54) and the proportions lost to follow-up (5.5% and 6.6%, p = .66). There were 10 complications in each group (5.5% of telemedicine patients and 5.0% of in-clinic patients) (p > 0.5). Unscheduled communications with office assistants were greater in the telemedicine patients than the in-person patients (84/182, 46.2% vs. 43/199, 21.6% in-person, p < .001).

Conclusion

We found that telemedicine patients required more unscheduled communications and received ultrasounds far less often compared to in-clinic patients.

Implications

We could provide telemedicine without the need for ultrasound to most women. Larger studies without routine ultrasound use are needed to validate our findings. Unscheduled communication with clinic staff was more frequent with telemedicine medication abortion patients. This information may help clinics when planning to add this service.

目的比较通过远程医疗和上门就诊提供药物流产的实际情况，以便诊所在计划增加这项服务时可以使用这些信息。研究设计我们进行了一项比较回顾性的图表回顾，比较了远程医疗药物流产与对照组相匹配的日期。我们提取并比较了人口统计数据、使用约会超声、结果、计划外访问或与工作人员和医生的沟通。结果研究期间共提供药物流产4340例，其中远程医疗182例(4.2%);199例患者符合对照组标准。远程医疗患者的平均年龄为28.7 岁，现场患者的平均年龄为28.1 岁(p = .38)。平均胎龄也相似，远程医疗组为48.2 天，现场患者为46.5 天(p = .03)。只有33名(18.1%)远程医疗患者进行了约会超声检查，而199名(100%)门诊患者进行了约会超声检查(p < .001)。记录的完成流产比例(164/182,90.1%和179/199,89.9%，p = .76)相似，期望完成的比例(6/182,3.3%和9/199,4.5%，p = .54)和失去随访的比例(5.5%和6.6%，p = .66)相似。两组并发症发生率分别为10例(远程医疗为5.5%，门诊为5.0%)(p > 0.5)。远程医疗患者与办公室助理计划外沟通的比例高于现场患者(84/182,46.2% vs. 43/199, 21.6%， p < .001)。结论与门诊患者相比，远程医疗患者需要更多的非计划通信，并且接受超声检查的频率远低于门诊患者。我们可以为大多数妇女提供不需要超声波的远程医疗。需要在不使用常规超声的情况下进行更大规模的研究来验证我们的发现。远程医疗药物流产患者与临床工作人员的计划外沟通更为频繁。这些信息可以帮助诊所计划添加这项服务。

{"title":"Comparing telemedicine to in-clinic medication abortions induced with mifepristone and misoprostol","authors":"Ellen R Wiebe , Mackenzie Campbell , Harani Ramasamy , Michaela Kelly","doi":"10.1016/j.conx.2020.100023","DOIUrl":"10.1016/j.conx.2020.100023","url":null,"abstract":"<div><h3>Objective</h3><p>The objective was to compare the practical aspects of providing medication abortions through telemedicine and in-person clinic visits so that clinics can use this information when planning to add this service.</p></div><div><h3>Study design</h3><p>We conducted a comparative retrospective chart review comparing telemedicine medication abortions to a control group matched for date seen. We extracted and compared demographics, use of dating ultrasound, outcomes and unscheduled visits or communications with staff and physicians.</p></div><div><h3>Results</h3><p>During the study period, we provided 4340 medication abortions, of which 182 (4.2%) were provided through by telemedicine; 199 patients met the criteria to be in the control group. The mean age was 28.7 years for telemedicine patients and 28.1 years for in-person patients (p = .38). The mean gestational ages were also similar, 48.2 days for telemedicine patients and 46.5 days for in-person patients (p = .03). Only 33 (18.1%) of telemedicine patients had dating ultrasounds compared to 199 (100%) of in-clinic patients (p < .001). The proportions of documented completed abortions (164/182, 90.1% and 179/199, 89.9%, p = .76) were similar, as were the proportions of aspirations for completion (6/182, 3.3% and 9/199, 4.5%, p = .54) and the proportions lost to follow-up (5.5% and 6.6%, p = .66). There were 10 complications in each group (5.5% of telemedicine patients and 5.0% of in-clinic patients) (p > 0.5). Unscheduled communications with office assistants were greater in the telemedicine patients than the in-person patients (84/182, 46.2% vs. 43/199, 21.6% in-person, p < .001).</p></div><div><h3>Conclusion</h3><p>We found that telemedicine patients required more unscheduled communications and received ultrasounds far less often compared to in-clinic patients.</p></div><div><h3>Implications</h3><p>We could provide telemedicine without the need for ultrasound to most women. Larger studies without routine ultrasound use are needed to validate our findings. Unscheduled communication with clinic staff was more frequent with telemedicine medication abortion patients. This information may help clinics when planning to add this service.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"2 ","pages":"Article 100023"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.conx.2020.100023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Levonorgestrel release rates measured through analysis of two-rod contraceptive explants 双杆避孕外植体分析左炔诺孕酮释放率

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100039

Rachael Fuchs , Douglas Taylor , David W. Jenkins , Vivian Brache , Diane Luo , Laneta J. Dorflinger , Markus J. Steiner

Objective

The objective was to characterize and compare in vivo rates of levonorgestrel (LNG) release from Sino-implant (II) and Jadelle® contraceptive implants.

Study design

We sampled 48 Sino-implant (II) and 49 Jadelle® explant sets for residual LNG content from participants treated for up to 51 months in a randomized contraceptive efficacy trial in the Dominican Republic (DR). Additional Sino-implant (II) explants were obtained from 8 women who became pregnant in the DR trial and 10 who contributed 3 to 5 years of use in a cohort study in China. Baseline LNG loads were estimated from five unused implant sets per device type. Release profiles were estimated using mixture models that captured initial burst fractions and compared with efficacy and pharmacokinetics data from the DR trial.

Results

Estimated baseline LNG loads for Sino-implant (II) and Jadelle® were 142.8 mg and 150.5 mg, respectively (vs. the labeled 150 mg). There was an initial burst release of drug (5.6% and 7.9%, respectively) followed by an exponential decrease in LNG content evident for each device. Release rates were significantly lower for Sino-implant (II) throughout the treatment period, with estimated rates after 3 years of 24.2 mcg/day and 29.0 mcg/day for Sino-implant (II) and Jadelle®, respectively. The estimated Sino-implant (II) rate after 3 years was similar to the predicted rate after 5 years (23.6 mcg/day) for Jadelle® (rate ratio: 1.03; 95% confidence interval: 0.92–1.13).

Conclusions

Sino-implant (II) LNG release rates were significantly lower than Jadelle® with Sino-implant (II) rates through year 3 comparable to Jadelle® rates through year 5. These results reinforce the 3-year duration of action for which Sino-implant (II) was prequalified by the World Health Organization.

Implications

This analysis confirms the WHO prequalification of Sino-implant (II) for 3 years of use and supports different durations of action for Jadelle® and Sino-implant (II). It provides additional evidence that this approach can complement efficacy trials in determining duration of action of hormonal contraceptives in general.

目的表征和比较Sino-implant (II)和Jadelle®避孕植入物中左炔诺孕酮(LNG)的体内释放率。研究设计:我们在多米尼加共和国(DR)的一项随机避孕疗效试验中，从治疗长达51个月的参与者中取样了48组Sino-implant (II)和49组Jadelle®外植体，检测剩余LNG含量。另外的移植体来自8名在DR试验中怀孕的妇女，以及10名在中国一项队列研究中使用了3至5年的妇女。根据每种设备类型的五套未使用的植入物估计基线LNG负荷。使用混合模型估计释放曲线，该模型捕获了初始爆发分数，并比较了DR试验的疗效和药代动力学数据。结果Sino-implant (II)和Jadelle®的估计基线LNG负荷分别为142.8 mg和150.5 mg(与标记的150 mg相比)。每个装置的初始药物释放量分别为5.6%和7.9%，随后液化天然气含量呈指数下降。在整个治疗期间，Sino-implant (II)的释放率明显较低，3年后的释放率估计分别为24.2 mcg/天和29.0 mcg/天，Sino-implant (II)和Jadelle®。Jadelle®3年后的预估Sino-implant (II)率与5年后的预测率(23.6微克/天)相似(比率比:1.03;95%置信区间:0.92-1.13)。结论Sino-implant (II)的LNG释放率显著低于Jadelle®，Sino-implant (II)在第3年的释放率与Jadelle®在第5年的释放率相当。这些结果强化了Sino-implant (II)通过世界卫生组织资格预审的3年有效期。本分析证实了WHO对Sino-implant (II)使用3年的预审资格，并支持Jadelle®和Sino-implant (II)的不同作用时间。它提供了额外的证据，表明该方法可以补充药效试验，以确定一般激素避孕药的作用时间。

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引用次数: 8

Change and stability in contraceptive use patterns among US women over a 12-month period: analysis using the 2013–2015 National Survey of Family Growth life history calendar 12个月期间美国女性避孕使用模式的变化和稳定性:使用2013-2015年全国家庭成长生活史日历调查的分析

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100028

Sean M. Finn, Ayana Douglas-Hall, Rachel K. Jones

Objective

To improve understanding of contraceptive use over 1 year among women in the United States.

Study design

We used the 2013–2015 National Survey of Family Growth to examine monthly contraceptive use patterns over a 12-month period. We focused on use of contraception during months in which non-sterilized women were sexually active and not pregnant; our outcomes were contraceptive use in every month, some months, and no months. We used simple and multivariate logistic regression to examine socio-demographic and method use characteristics associated with contraceptive use patterns.

Results

Some 72% of non-pregnant, non-surgically sterile women used contraception in every sexually active month. After controlling for other demographic and individual characteristics, adolescents had higher odds (aOR = 2.45) of using contraception in each sexually active month compared to women aged 25–29. Other groups more likely to use contraception monthly included those with some college (aOR = 1.58) compared to less than high school and non-cohabiting unmarried women (aOR = 1.49) compared to married women. Those with gaps in insurance coverage during the past year (aOR = 0.70), women who were not sexually active all 12 months (aOR = 0.42), and those with more than two male sexual partners (aOR = 0.49), were less likely to use contraception every sexually active month. Nearly half (46%) of contraceptive users in our sample used more than one type of contraceptive method over the 12-month period.

Conclusions

The majority of women use contraception every month they are sexually active, although there is variation between socio-demographic groups. However, over a one-year period, many women used dynamic contraceptive strategies.

Implications

Health care providers should recognize that contraceptive use patterns are dynamic and change over a relatively short time period for many women.

目的提高美国妇女对1年以上避孕药具使用情况的了解。研究设计我们使用2013-2015年全国家庭增长调查来检查12个月期间每月使用避孕药的模式。我们关注的是未绝育的女性在性活跃且未怀孕的几个月内使用避孕措施的情况;我们的结果是每个月、几个月和没有月使用避孕药。我们使用简单和多变量逻辑回归来检查与避孕使用模式相关的社会人口统计学和方法使用特征。结果72%的非怀孕、非手术不育妇女在每个性活跃月都采取了避孕措施。在控制了其他人口统计学和个体特征后，与25-29岁的女性相比，青少年在每个性活跃月份使用避孕措施的几率更高(aOR = 2.45)。其他更有可能每月采取避孕措施的群体包括那些上过大学的女性(aOR = 1.58)与高中以下的女性相比，非同居未婚女性(aOR = 1.49)与已婚女性相比。那些在过去一年中有保险缺口的妇女(aOR = 0.70)，所有12个 月都没有性活跃的妇女(aOR = 0.42)，以及那些有两个以上男性性伴侣的妇女(aOR = 0.49)，在每个性活跃月份都不太可能使用避孕措施。在我们的样本中，近一半(46%)的避孕药具使用者在12个月期间使用了一种以上的避孕方法。结论:尽管不同社会人口统计群体之间存在差异，但大多数性活跃的女性每月都采取避孕措施。然而，在一年的时间里，许多妇女使用动态避孕策略。卫生保健提供者应认识到，对许多妇女来说，避孕药具的使用模式是动态的，在相对较短的时间内会发生变化。

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引用次数: 2

Which contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya 哪种避孕药的副作用最严重?来自肯尼亚西部目前和过去注射和植入物使用者的证据

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100030

George Odwe , Francis Obare , Kazuyo Machiyama , John Cleland

Objectives

The objectives were to assess experiences of menstrual bleeding and nonbleeding side effects among current and past users of injectables and implants and the associations between side effects and method evaluations by women — satisfaction, perceived suitability, the likelihood of future use and intended duration of use.

Study design

We used data on past and current users of injectables and implants from a survey of 1866 married or cohabiting women who participated in the third round of a 2-year prospective longitudinal study conducted in Homa Bay County, Western Kenya. Descriptive and bivariate analysis with χ² tests was used to assess statistically significant associations between experience of bleeding/nonbleeding side effects and method-specific attitudes.

Results

Self-reported method-related bleeding problems were high among current and past users of injectables (range 69%–79%) and implants (range 55%–60%) and much more common than nonbleeding side effects. For both methods, experience of either bleeding or nonbleeding side effects reduces positive evaluations, but the conjunction of both types had particularly pronounced consequences. Heavy bleeding was more strongly related to method evaluation (satisfaction and the likelihood of future use; p < .001) among past users than other forms of menstrual bleeding disorders. Even among current users, about one third regarded bleeding side effects as very serious. Care-seeking from a healthcare provider for management of contraceptive-related side effects was low among current users (less than 40%) and modest among past users (range 53%–63%).

Conclusions

The results underscore the need to strengthen programs on counseling and information on contraceptive side effects including menstrual bleeding disturbances to improve method satisfaction and reduce discontinuation.

Implication

The experience of contraceptive-related menstrual bleeding and nonbleeding side effects reduces positive evaluation of the method and deters past users from future use of the method.

目的:评估目前和过去使用注射剂和植入物的患者的月经出血和非出血副作用的经历，以及副作用与女性评估方法之间的关系——满意度、感知的适用性、未来使用的可能性和预期使用时间。研究设计:我们使用了来自1866名已婚或同居妇女的数据，这些妇女参加了在肯尼亚西部Homa Bay县进行的为期2年的前瞻性纵向研究的第三轮调查。描述性和双变量分析采用χ2检验来评估出血/非出血副作用经历与方法特异性态度之间的统计学显著相关性。结果目前和过去使用注射剂(69%-79%)和植入物(55%-60%)的患者中，自我报告的与方法相关的出血问题很高，比非出血副作用更常见。对于这两种方法，出血或不出血副作用的经历都会降低积极的评价，但两种类型的结合会产生特别明显的后果。大出血与方法评价(满意度和未来使用的可能性)的相关性更强;P < .001)比其他形式的月经出血障碍。即使在目前的使用者中，大约三分之一的人认为出血副作用非常严重。目前使用者为避孕相关副作用向卫生保健提供者求诊的比例较低(不到40%)，过去使用者的比例较低(53%-63%)。结论需要加强对包括月经紊乱在内的避孕副作用的咨询和宣传，以提高避孕方法的满意度，减少停药。与避孕药相关的月经出血和非出血性副作用的经历降低了对该方法的积极评价，并阻止过去的使用者今后使用该方法。

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引用次数: 5

A novel vaginal pH regulator: results from the phase 3 AMPOWER contraception clinical trial 一种新的阴道pH调节剂:AMPOWER避孕3期临床试验的结果

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100031

Michael A. Thomas , B. Todd Chappell , Bassem Maximos , Kelly R. Culwell , Clint Dart , Brandon Howard

Objective

The objective was to evaluate the contraceptive effectiveness, safety, and acceptability of a novel vaginal pH regulator over seven cycles of use.

Study design

A single-arm, open-label, phase 3 study was conducted across 112 sites in the United States in sexually active 18–35-year-old women at risk of pregnancy. Women administered the study treatment ≤ 1 h before each episode of intercourse. Women recorded use of study drug, coital information, and any symptoms experienced in electronic diaries. The primary outcome was the seven-cycle cumulative pregnancy rate as calculated using the Kaplan–Meier methodology; secondary outcomes included safety. Overall satisfaction was assessed via written questionnaires.

Results

A total of 1384 women were enrolled in the study from July 2017 to November 2018. Mean age was 27.7 ± 4.4 years; most women were white (69.0%). The seven-cycle cumulative pregnancy percentage was 13.7% [95% confidence interval (CI): 10.0%–17.5%], meeting the prespecified primary endpoint of having the upper bound 95% CI ≤ 21%. Most common adverse events (AEs) occurring in ≥ 2% of women were vulvovaginal burning sensation, vulvovaginal pruritus, urinary tract infection, vulvovaginal pain, mycotic infection, bacterial vaginosis, and nasopharyngitis. Of 1330 women who used the study drug at least once, fewer than 2% of women discontinued due to any AEs, and < 1% of women discontinued due to genitourinary symptoms. Overall, > 80% of women reported being “very satisfied” or “satisfied” with study treatment.

Conclusions

In this phase 3 study, the novel vaginal pH regulator demonstrated 86.3% contraceptive effectiveness, was safe and well tolerated, and was highly acceptable.

Implications

This novel vaginal pH regulator is a safe, nonhormonal, woman-controlled method of contraception that expands women's options.

目的:评价一种新型阴道pH调节剂在7个使用周期内的避孕效果、安全性和可接受性。研究设计一项单臂、开放标签、3期研究在美国112个地点进行，研究对象是性活跃的18 - 35岁有怀孕风险的女性。女性在每次性交前≤1 h接受研究治疗。女性在电子日记中记录了学习药物的使用、性交信息和任何症状。主要结局是使用Kaplan-Meier方法计算的七个周期累积妊娠率;次要结局包括安全性。总体满意度通过书面问卷进行评估。结果2017年7月至2018年11月，共有1384名女性参与了这项研究。平均年龄27.7 ± 4.4 岁;大多数女性是白人(69.0%)。7个周期累积妊娠率为13.7%[95%置信区间(CI): 10.0% ~ 17.5%]，满足预先设定的主要终点95% CI上限≤21%。≥2%的女性中最常见的不良事件(ae)是外阴阴道烧灼感、外阴阴道瘙痒、尿路感染、外阴阴道疼痛、真菌感染、细菌性阴道病和鼻咽炎。在至少使用过一次研究药物的1330名女性中，不到2%的女性因不良反应而停药。1%的妇女因泌尿生殖系统症状停药。总的来说,在80%的女性报告对研究治疗“非常满意”或“满意”。结论在这项三期研究中，新型阴道pH调节剂的避孕效果为86.3%，安全性好，耐受性好，可接受度高。这种新型阴道pH调节器是一种安全、非激素、女性控制的避孕方法，扩大了女性的选择范围。

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引用次数: 14

A qualitative exploration of women's experiences discovering pregnancies in the emergency department 在急诊科发现怀孕的妇女经历的定性探讨

Q2 Medicine

Contraception: X

Pub Date : 2020-01-01 DOI: 10.1016/j.conx.2020.100024

Sarah C.M. Roberts, Erin Wingo, Katrina Kimport

Objectives

The few studies examining pregnancy testing in emergency departments (EDs) address pregnancy-related physical risks. Here, we examine experiences of people who discover pregnancies in EDs.

Methods

Between 2015 and 2017, as part of a larger study, we conducted interviews with 29 women in Southern Louisiana (n = 13) and Baltimore, MD (n = 16), who reported discussing their pregnancy during an ED visit. We analyzed these interviews for content and themes.

Results

Respondents reported diagnosis of pregnancy as a routine and straightforward component of care received in EDs. They reported receiving diagnostic studies and therapeutic interventions to rule out and treat complications of pregnancy and care for what brought them to the ED to begin with, such as treatments for nausea and vomiting; education about physical symptoms and nutrition-related needs during pregnancy; and referrals to prenatal care. However, we find evidence of unmet needs related to patient-centered communication, such as providing emotional care to women discovering pregnancies in EDs and lack of support for transitions to abortion care.

Conclusions

While diagnosis of pregnancy in the ED may be routine for ED clinicians, it is not necessarily routine or straightforward for people receiving the diagnosis. ED clinicians should not assume that all people who discover their pregnancies in the ED want to continue their pregnancy. People who discover pregnancies in EDs may benefit from patient-centered communication and support for the range of transitions to care people might need in addition to the routinely provided diagnostic and therapeutic interventions.

Implications

ED clinicians may need additional training and support to ensure that they can meet the range of needs of people who discover their pregnancies in the ED.

目的探讨急诊妊娠检测中妊娠相关的身体风险。在这里，我们研究了在急诊室发现怀孕的人的经历。方法在2015年至2017年期间，作为一项更大规模研究的一部分，我们对路易斯安那州南部(n = 13)和马里兰州巴尔的摩(n = 16)的29名妇女进行了访谈，这些妇女报告在急诊室就诊期间讨论了自己的怀孕情况。我们分析了这些访谈的内容和主题。结果受访者报告妊娠诊断是急诊科接受护理的常规和直接组成部分。她们报告说，她们接受了诊断研究和治疗干预，以排除和治疗妊娠并发症，并照顾她们到急诊科就诊的原因，比如对恶心和呕吐的治疗;关于怀孕期间身体症状和营养相关需求的教育;以及转介到产前护理。然而，我们发现了与以患者为中心的沟通相关的未满足需求的证据，例如为在急诊室发现怀孕的妇女提供情感关怀，以及缺乏对堕胎护理过渡的支持。结论:虽然ED的妊娠诊断对于ED临床医生来说是常规的，但对于接受诊断的人来说并不一定是常规的或直截了当的。急诊科医生不应该假设所有在急诊科发现怀孕的人都想继续怀孕。在急诊科发现怀孕的人可以从以病人为中心的沟通和支持中受益，除了常规提供的诊断和治疗干预外，还可以从一系列过渡到人们可能需要的护理中获益。产科医生可能需要额外的培训和支持，以确保他们能够满足在急诊科发现怀孕的人的各种需求。

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引用次数: 3