Contraception最新文献_第7页

ESTIMATING EMERGENCY CONTRACEPTION EFFICACY WITH LEVONORGESTREL AND COPPER INTRAUTERINE DEVICES 估算左炔诺孕酮和铜质宫内节育器的紧急避孕效果

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110565

SE Nourse, AL Woodcock, KS Brown, DK Turok, A Gero, LM Gawron

Objectives

We aimed to determine observed vs. expected pregnancy risk among levonorgestrel 52 mg and copper T380A intrauterine device (IUD) emergency contraception (EC) users.

Methods

This is a secondary analysis of participants in a 1:1 randomized controlled trial comparing levonorgestrel 52 mg IUD and copper T380A IUD EC users who reported all episodes of unprotected intercourse in the two weeks prior to enrollment. We estimated number of expected pregnancies via two established approaches (Trussell, 2003 and modified Wilcox, 2015) to create a range of expected pregnancy risk among methods using risk estimates per menstrual cycle day. With both approaches, we calculated the proportion of pregnancies prevented based on those expected using both the day of most recently reported unprotected intercourse and all reported current menstrual cycle unprotected intercourse.

Results

One pregnancy occurred among the 327 participants assigned to the levonorgestrel IUD with 137 (41.9%) reported multiple episodes of unprotected intercourse. No pregnancies occurred among the 328 participants randomized to the copper IUD with 142 (43.2%) reporting multiple episodes of unprotected intercourse. In the levonorgestrel IUD group, expected pregnancies ranged from 12.4 (Trussell)-14.8 (Wilcox) using only the most recent episode of unprotected intercourse to 22.0 (T)-26.3 (W) accounting for all episodes. In the copper IUD group, there were 12.6 (T)-15.0 (W) and 24.8 (T)-29.6 (T) expected pregnancies respectively. Levonorgestrel IUD users prevented 92.0 (T)-96.2 (W)% of pregnancies and copper IUD users experienced 100% pregnancy prevention.

Conclusions

Levonorgestrel IUDs for EC prevented 92% of expected pregnancies, approaching the 100% prevention rate observed in the copper IUD group.

方法：这是对一项 1:1 随机对照试验的参与者进行的二次分析，该试验比较了左炔诺孕酮 52 mg 宫内节育器和铜 T380A 宫内节育器使用者，他们报告了入组前两周内所有无保护性交的情况。我们通过两种既定方法（Trussell，2003 年和修改后的 Wilcox，2015 年）估算了预期妊娠数，利用每个月经周期日的风险估算值创建了不同方法的预期妊娠风险范围。通过这两种方法，我们根据最近报告的无保护性交日和所有报告的当前月经周期无保护性交的预期怀孕比例计算出了预防怀孕的比例。结果在被分配使用左炔诺孕酮宫内节育器的 327 名参与者中，有 137 人（41.9%）报告了多次无保护性交，其中一人怀孕。在被随机分配使用铜质宫内节育器的 328 名参与者中，有 142 人（43.2%）报告了多次无保护性交，其中没有人怀孕。在左炔诺孕酮宫内节育器组中，仅使用最近一次无保护性交的预期怀孕率为 12.4（Trussell）-14.8（Wilcox），而使用所有无保护性交的预期怀孕率为 22.0（T）-26.3（W）。铜质宫内节育器组的预期怀孕率分别为 12.6（T）-15.0（W）和 24.8（T）-29.6（T）。左炔诺孕酮宫内节育器使用者预防了 92.0（T）-96.2（W）% 的妊娠，而铜宫内节育器使用者的妊娠预防率为 100%。

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引用次数: 0

PATIENT OUTCOMES WITH EARLY PREGNANCY COMPLICATIONS AFTER EXPOSURE TO AN EARLY PREGNANCY ASSESSMENT CLINIC 患者在接受早孕评估门诊后的早孕并发症治疗效果

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110630

SI Amaya, J Zhang, A Chen, SK Mulwa, E Booker, TS Gémesi, A Henkel, K Shaw, J Shorter

Objectives

We aimed to evaluate the healthcare burden experienced by patients with early pregnancy complications seen in an early pregnancy assessment clinic (EPAC) and those never seen in an EPAC.

Methods

We performed a retrospective cohort study evaluating patients 18 years and older who presented during the first 12 weeks of pregnancy with a complication including vaginal bleeding or pain, early pregnancy loss (EPL), pregnancy of unknown location (PUL), ectopic, or molar pregnancy. The primary outcome was the healthcare burden for patients seen in an EPAC compared to patients never seen in an EPAC. Healthcare burden was defined as the total number of encounters and the average time spent in the healthcare system.

Results

We obtained data from 241 patients between January 2021 and June 2022. Patients never seen in EPAC were more likely to be of Hispanic ethnicity (52% vs 30%, p<0.001), have public or no insurance (59% vs 25%, p<0.001), and report a non-English primary language (33% vs 10%, p<0.001) compared with patients seen in an EPAC. The median (range) total number of healthcare encounters was 4 (2, 5.5) and 3 (2,5) in the EPAC and non-EPAC groups, respectively (p=0.3). The mean in-person healthcare encounter time (hours) was significantly higher in the non-EPAC group (327 vs 120, p<0.001).

Conclusions

Patients never seen in an EPAC were more likely to have socioeconomic and language barriers compared to those seen in an EPAC. Increasing access to expedited evaluation and management of early pregnancy complications may improve patients’ healthcare experience.

方法我们开展了一项回顾性队列研究，对妊娠 12 周内出现阴道出血或疼痛、早孕丢失（EPL）、位置不明妊娠（PUL）、异位妊娠或臼齿妊娠等并发症的 18 岁及以上患者进行了评估。主要结果是与从未在 EPAC 就诊的患者相比，在 EPAC 就诊的患者的医疗负担。医疗负担定义为就诊总次数和在医疗系统中花费的平均时间。结果我们获得了2021年1月至2022年6月期间241名患者的数据。与在EPAC就诊的患者相比，从未在EPAC就诊的患者更有可能是西班牙裔（52% vs 30%，p<0.001）、拥有公共保险或无保险（59% vs 25%，p<0.001），并且报告的主要语言为非英语（33% vs 10%，p<0.001）。在 EPAC 组和非 EPAC 组中，总就诊次数的中位数（范围）分别为 4（2，5.5）次和 3（2，5）次（p=0.3）。结论与在 EPAC 就诊的患者相比，从未在 EPAC 就诊的患者更有可能存在社会经济和语言障碍。增加早期妊娠并发症的快速评估和管理可改善患者的医疗体验。

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引用次数: 0

DOES PSYCHOSOCIAL BURDEN DIFFER WHEN ACCESSING MEDICATION ABORTION USING NO-TEST, TELEHEALTH CARE COMPARED TO IN-PERSON CARE WITH ULTRASOUND? 与使用超声波的面对面护理相比，使用免测试远程保健进行药物流产时的社会心理负担是否有所不同？

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110622

MA Biggs, C Baba, LJ Ralph, R Schroeder, C McNicholas, A Hagstrom Miller, D Grossman

Objectives

We aimed to explore whether no-test, telehealth abortion care reduces the psychosocial burden of abortion care-seeking.

Methods

As part of a study on the safety and effectiveness of telehealth abortion care, from May 2021-March 2023, we surveyed and abstracted medical record data for 583 patients obtaining medication abortion ≤ 70 days gestation, English- or Spanish-speaking, ages ≥ 15 years at four abortion clinic organizations in six US states. We assessed three psychosocial burden dimensions (structural challenges, five items, α=0.80; lack of autonomy, three items, α=0.73; and others’ reactions to the pregnancy, two items, α=0.88, range 0–3) by study group (1) telehealth and mailing medications, (2) no-test and pick-up medications, and (3) in-person with ultrasound.

Results

A total 403 enrolled participants completed psychosocial burden items. In adjusted analyses, telehealth by mail was associated with fewer structural challenges than in-person care (-0.12, 95% CI -0.23,-0.00), mostly due to less difficulty traveling for care (24% vs 32%, p<0.05). While mean lack of autonomy scores did not differ by study group, the telehealth by mail (11%) and no-test and pick-up (12%) groups were less likely to feel forced to wait for the abortion after making the decision, when compared to the in-person with ultrasound group (22%, p<0.05). The no-test and pick-up group (35%) was also less likely to be worried about friends/family members’ reaction to the pregnancy than the in-person care group (42%, p<0.05).

Conclusions

No-test, telehealth medication abortion care may reduce the psychosocial burden of abortion-seeking, in particular the burden of travel and feeling forced to wait for care.

作为远程医疗流产护理安全性和有效性研究的一部分，我们在 2021 年 5 月至 2023 年 3 月期间调查并摘录了美国 6 个州 4 家流产诊所机构中 583 名妊娠期≤70 天、讲英语或西班牙语、年龄≥15 岁的药物流产患者的病历数据。我们评估了三个社会心理负担维度（结构性挑战，5 个项目，α=0.80；缺乏自主权，3 个项目，α=0.73；他人对妊娠的反应，2 个项目，α=0.88，范围 0-3），按研究组（1）远程医疗和邮寄药物，（2）免检和取药，以及（3）当面超声检查。在调整后的分析中，邮寄远程医疗比面对面医疗面临更少的结构性挑战（-0.12，95% CI -0.23,-0.00），这主要是由于旅行就医的困难较少（24% vs 32%，p<0.05）。虽然缺乏自主权的平均得分在不同研究组之间没有差异，但邮寄远程保健组（11%）和免检取件组（12%）与超声波当面检查组（22%，p<0.05）相比，在做出决定后感到被迫等待流产的可能性较低。免检和取药组（35%）担心朋友/家人对怀孕的反应的可能性也低于亲自护理组（42%，p<0.05）。

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引用次数: 0

POSTPARTUM PERMANENT CONTRACEPTIVE PROCEDURES: A 360-DEGREE QUALITATIVE INVESTIGATION 产后永久避孕程序：360 度定性调查

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110628

K Crofton, A Johnston, S Kaszubinski, S Betstadt, E Tal, R Flink-Bochacki

Objectives

We aimed to explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures after vaginal delivery.

Methods

We conducted a multi-center qualitative study on completion or non-completion of postpartum permanent contraceptive procedures at three academic institutions from July 2023-March 2024. We recruited postpartum patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. We double-coded transcripts using Dedoose and performed inductive thematic content analysis, concluding data collection after thematic saturation.

Results

We interviewed 19 patients (11 completed and 9 non-completed procedures) and 47 staff (mean 2.5/patient). We identified three major themes: (1) Standard perioperative counseling can be overshadowed by a focus on overcoming obstacles to completion (“What did [your doctors] tell you to expect?” “Really nothing, they just asked if I was sure I want it…”); (2) Healthcare workers’ personal values influence the prioritization of these procedures (“I believe that some are elective and some are more urgent”); (3) Procedure completion often relies on one champion to optimize interdisciplinary communication and push past barriers (“We could not get a slot for her on day 1…and then we did on day 2, mostly because [attending] advocated for her”).

Conclusions

Unlike most surgeries, the completion of postpartum permanent contraceptive procedures centers around overcoming barriers to access rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient factors.

目的我们旨在探讨影响阴道分娩后完成产后永久避孕手术的跨学科因素。方法我们于 2023 年 7 月至 2024 年 3 月在三所学术机构开展了一项关于产后永久避孕手术完成或未完成情况的多中心定性研究。我们招募了希望在阴道分娩后接受永久避孕手术的产后患者。我们对患者及其护理、产科和麻醉团队进行了半结构化访谈。我们使用 Dedoose 对记录誊本进行了双重编码，并进行了归纳式主题内容分析，在主题饱和后结束了数据收集。我们确定了三大主题：(1) 标准的围手术期咨询可能会被对克服手术完成障碍的关注所掩盖（"（医生）告诉你要注意些什么？"真的没什么，他们只是问我是否确定要做......"）；（2）医护人员的个人价值观影响了这些手术的优先顺序（"我认为有些是选择性的，而有些则更紧急"）；（3）手术的完成往往依赖于一位倡导者来优化跨学科沟通并克服障碍（"我们在第一天没能为她争取到一个名额......然后我们在第二天争取到了，主要是因为[主治医生]为她做了宣传"）。结论与大多数手术不同，产后永久性避孕手术的完成主要围绕克服获得手术机会的障碍，而不是病人的需求。临床医生的宣传倾向会影响围手术期的患者护理，这是一个新的发现，它维持了一种文化，即避孕要求的实现是基于护理团队的因素而非患者的因素。

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引用次数: 0

ATTRIBUTES OF PROVIDER COUNSELING ASSOCIATED WITH CONTRACEPTIVE SATISFACTION 与避孕满意度相关的提供者咨询属性

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110646

N Luche, E Mosley, N Zite, S Borrero

Objectives

High-quality contraceptive counseling is associated with increased use of contraception. However, little is known about how counseling influences patient satisfaction with contraceptive method. This study sought to assess characteristics of counseling associated with method satisfaction.

Methods

Pregnant participants aged 21-45 years considering postpartum tubal sterilization were recruited from three sites and randomized to receipt of the MyDecision/MiDecisión decision aid tool vs. standard care. Surveys at three months postpartum included eight Likert scale items characterizing perinatal contraceptive counseling quality, and one item assessing current contraceptive method satisfaction. Response options of “strongly agree” (positively worded items) or “strongly disagree” (negatively worded items) were considered optimal. We examined bivariate associations between optimal counseling and optimal method satisfaction. Logistic regression models were then conducted, adjusted for randomization arm and confounding variables (p<0.10) identified in bivariate analysis (age, site).

Results

Of 244 participants, 160 (65.6%) reported optimal method satisfaction. In bivariate analysis, optimal ratings on feeling respected, feeling pressured into sterilization or other methods, receiving adequate explanations regarding sterilization or other methods, receiving answers to questions, and counseling satisfaction were all associated with optimal method satisfaction (all p<0.01). In adjusted analysis, optimal ratings on feeling respected (adjusted OR (aOR):5.80;95%CI:2.32-14.49), receiving adequate explanations regarding non-sterilization contraception (aOR:2.14;95%CI:1.07-4.30), feeling minimally pressured into non-sterilization methods (aOR:2.30;95%CI:1.01-5.22), receiving answers (aOR:3.35;95%CI:1.43-7.83), and counseling satisfaction (aOR:4.61;95%CI:2.18-9.74) remained significantly associated with method satisfaction.

Conclusions

Aspects of provider contraception counseling that are aligned with patient-centered care are significantly associated with contraceptive method satisfaction. Provision of high-quality contraceptive counseling may have implications both for uptake and continued use of methods.

目标高质量的避孕咨询与避孕药具使用率的提高有关。然而，人们对咨询如何影响患者对避孕方法的满意度知之甚少。本研究试图评估与避孕方法满意度相关的咨询特点。方法从三个地点招募考虑产后输卵管绝育的 21-45 岁孕妇，随机分配接受 MyDecision/MiDecisión 决策辅助工具与标准护理。产后三个月的调查包括八个李克特量表项目，描述围产期避孕咨询质量的特点，以及一个评估当前避孕方法满意度的项目。我们认为 "非常同意"（正面表述项目）或 "非常不同意"（负面表述项目）是最佳的回答选项。我们研究了最佳咨询与最佳避孕方法满意度之间的二元关联。结果在 244 名参与者中，160 人（65.6%）报告了最佳方法满意度。在双变量分析中，感觉受到尊重、感觉受到绝育或其他方法的压力、得到有关绝育或其他方法的充分解释、问题得到解答以及咨询满意度的最佳评分均与最佳方法满意度相关（均为 p<0.01）。在调整分析中，感觉受到尊重（调整 OR (aOR):5.80;95%CI:2.32-14.49）、获得有关非绝育避孕的充分解释（aOR:2.14;95%CI:1.07-4.30）、感觉在非绝育方法上压力最小（aOR:2.30;95%CI:1.01-5.22）、获得解答（aOR:3.结论服务提供者的避孕咨询与以患者为中心的护理相一致，与避孕方法满意度显著相关。提供高质量的避孕咨询可能会对避孕方法的接受和持续使用产生影响。

{"title":"ATTRIBUTES OF PROVIDER COUNSELING ASSOCIATED WITH CONTRACEPTIVE SATISFACTION","authors":"N Luche, E Mosley, N Zite, S Borrero","doi":"10.1016/j.contraception.2024.110646","DOIUrl":"10.1016/j.contraception.2024.110646","url":null,"abstract":"<div><h3>Objectives</h3><div>High-quality contraceptive counseling is associated with increased use of contraception. However, little is known about how counseling influences patient satisfaction with contraceptive method. This study sought to assess characteristics of counseling associated with method satisfaction.</div></div><div><h3>Methods</h3><div>Pregnant participants aged 21-45 years considering postpartum tubal sterilization were recruited from three sites and randomized to receipt of the MyDecision/MiDecisión decision aid tool vs. standard care. Surveys at three months postpartum included eight Likert scale items characterizing perinatal contraceptive counseling quality, and one item assessing current contraceptive method satisfaction. Response options of “strongly agree” (positively worded items) or “strongly disagree” (negatively worded items) were considered optimal. We examined bivariate associations between optimal counseling and optimal method satisfaction. Logistic regression models were then conducted, adjusted for randomization arm and confounding variables (p<0.10) identified in bivariate analysis (age, site).</div></div><div><h3>Results</h3><div>Of 244 participants, 160 (65.6%) reported optimal method satisfaction. In bivariate analysis, optimal ratings on feeling respected, feeling pressured into sterilization or other methods, receiving adequate explanations regarding sterilization or other methods, receiving answers to questions, and counseling satisfaction were all associated with optimal method satisfaction (all p<0.01). In adjusted analysis, optimal ratings on feeling respected (adjusted OR (aOR):5.80;95%CI:2.32-14.49), receiving adequate explanations regarding non-sterilization contraception (aOR:2.14;95%CI:1.07-4.30), feeling minimally pressured into non-sterilization methods (aOR:2.30;95%CI:1.01-5.22), receiving answers (aOR:3.35;95%CI:1.43-7.83), and counseling satisfaction (aOR:4.61;95%CI:2.18-9.74) remained significantly associated with method satisfaction.</div></div><div><h3>Conclusions</h3><div>Aspects of provider contraception counseling that are aligned with patient-centered care are significantly associated with contraceptive method satisfaction. Provision of high-quality contraceptive counseling may have implications both for uptake and continued use of methods.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110646"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

DISTANCES TRAVELLED FOR ABORTIONS AND INEQUITIES FOR RURAL RESIDENTS IN OREGON 俄勒冈州农村居民的堕胎路程和不公平现象

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110616

EC Nacev, A Mandelbaum, MF Fuerst, MI Rodriguez

Objectives

Abortion access is dire in most rural areas of the US. Recent studies have shown that most reproductive-aged women live greater than a 30 minute drive from the nearest abortion clinic. True travel distances to abortion care may be even higher, given restrictions in availability by type of abortion and gestational age. This study aims to describe the burden of travel to abortion care for residents of Oregon, a state with no legal restrictions on abortion, by rurality of residence.

Methods

We conducted a descriptive study of vital statistics from the Oregon Health Authority of all abortions in Oregon from 2015 to 2021. We calculated distances between county of residence and county of abortion occurrence.

Results

Of 57,533 abortions, 90% (n=51,781) were to Oregon residents. Individuals from every county in Oregon needed abortion care during our study period, however abortions were provided in only 25% of counties (n=9). Those that travelled outside their county for abortion care (n=21,808, 37.4%) travelled an average of 56 miles for abortion care. Residents of rural counties (n=4,284) had an average travel distance of 103 miles, with maximum distance travelled of 432 miles.

Conclusions

This recent, real-world study describes a high burden of travel for rural residents, even in a state where abortion is legal. This data can support efforts to creatively, strategically, and equitably increase access to abortion, particularly for those with geographic challenges to access.

目标在美国大多数农村地区，堕胎的机会非常渺茫。最近的研究表明，大多数育龄妇女的居住地距离最近的人工流产诊所有 30 分钟以上的车程。由于人工流产类型和妊娠年龄的限制，人工流产护理的实际路程可能更远。俄勒冈州是一个对人工流产没有法律限制的州，本研究旨在描述俄勒冈州居民前往人工流产医疗机构的旅行负担，并按居住地的偏远程度进行分类。方法我们对俄勒冈州卫生局提供的 2015 年至 2021 年俄勒冈州所有人工流产的生命统计数据进行了描述性研究。我们计算了居住地所在县与堕胎发生地所在县之间的距离。在我们的研究期间，俄勒冈州每个县的居民都需要人工流产护理，但只有 25% 的县（n=9）提供了人工流产服务。到县外接受人工流产治疗的患者（人数=21,808，占 37.4%）平均需要走 56 英里才能接受人工流产治疗。农村县居民（n=4,284）的平均旅行距离为 103 英里，最远旅行距离为 432 英里。结论这项最新的真实世界研究描述了农村居民的高旅行负担，即使在堕胎合法的州也是如此。这些数据可为创造性地、战略性地、公平地增加堕胎机会提供支持，尤其是那些在地理位置上难以获得堕胎机会的人。

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引用次数: 0

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) FOR PAIN CONTROL DURING FIRST-TRIMESTER PROCEDURAL ABORTION: A BLINDED RANDOMIZED CONTROLLED TRIAL 经皮神经电刺激（Tens）用于控制第一胎程序性流产期间的疼痛：一项盲法随机对照试验

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110617

A Henkel, EP Cahill, S Chavez, JM Shorter, SM Liu, SI Amaya, S Kaur, KA Shaw

Objectives

We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) to manage pain during first-trimester procedural abortion for those not eligible for or otherwise foregoing sedation.

Methods

This is a double-blinded, block-randomized superiority trial (IRB approved, NCT05320432) comparing TENS (placed posteriorly, T10-L1 and S2-S4) to sham for pain management during first-trimester procedural abortion. We enrolled pregnant people less than 12 weeks gestation, English- or Spanish-speaking at two outpatient clinics who were not receiving sedation. The primary outcome was self-reported pain by visual analog scale (VAS, 100 mm) with passage of largest cervical dilator. We planned to enroll 70 patients to show a 15 mm difference in median pain score (80% power, α = 0.05).

Results

Between January 2023 and March 2024, we enrolled 70 participants. Baseline demographics were balanced between groups: median (range) gestational duration 6.8 (5.1-11.8) weeks, 35.7% nulliparous. Median (range) reported pain with passage of largest dilator was 44mm (0–88) and 50mm (0–96) in the TENS and sham groups, respectively (p=0.56). We did not find a difference in median pain at any collected time point including placement of tenaculum, paracervical block, aspiration, or recovery. The active TENS group was more likely to say they would recommend this method of pain control to others (94mm vs 73mm, p=0.01). More participants receiving TENS unit correctly identified their group allocation (91.4% vs 63.6%, p<0.001).

Conclusions

While we did not demonstrate a difference in pain during the procedure, TENS is a non-pharmacologic alternative that may improve patient experience during uterine aspiration.

方法这是一项双盲、整群随机优效试验（IRB 批准，NCT05320432），比较了 TENS（置于后方，T10-L1 和 S2-S4）和假TENS 在第一胎人工流产术中的止痛效果。我们在两家门诊诊所招募了妊娠不足 12 周、讲英语或西班牙语且未接受镇静剂治疗的孕妇。主要结果是通过视觉模拟量表（VAS，100 毫米）显示最大宫颈扩张器通过时的自述疼痛。我们计划招募 70 名患者，以显示中位疼痛评分有 15 毫米的差异（80% 功率，α = 0.05）。结果在 2023 年 1 月至 2024 年 3 月期间，我们招募了 70 名参与者。各组的基线人口统计学特征均衡：中位数（范围）妊娠持续时间为 6.8（5.1-11.8）周，35.7% 为单胎。TENS 组和假阴道组报告的最大扩张器通过时的疼痛中位数（范围）分别为 44 毫米（0-88）和 50 毫米（0-96）（P=0.56）。我们没有发现在任何收集的时间点，包括放置腱膜、宫颈旁阻滞、抽吸或恢复时，疼痛中位数存在差异。主动接受 TENS 治疗组更有可能表示会向他人推荐这种疼痛控制方法（94 毫米 vs 73 毫米，P=0.01）。更多接受 TENS 装置的参与者正确识别了他们的组别分配（91.4% vs 63.6%，p<0.001）。结论虽然我们没有证明手术过程中疼痛的差异，但 TENS 是一种非药物替代方法，可能会改善子宫吸引术中患者的体验。

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引用次数: 0

“IMAGINE A PREGNANCY”: PERSPECTIVES ON PREGNANCY, ABORTION, AND PARENTING OF LATINE EMERGING ADULTS IN AN AGRICULTURAL COMMUNITY IN CALIFORNIA "想象怀孕"：加利福尼亚一个农业社区的拉丁裔新成人对怀孕、堕胎和养育子女的看法

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110585

AE Bryson, PS Nordstrom Miranda, MS Zerofsky, AB Baez De Luna, AM Minnis, M Raymond-Flesch

Objectives

We aimed to describe perspectives on pregnancy, abortion, and parenting among Latine emerging adults.

Methods

In a mixed-methods prospective cohort study of emerging adults followed since eighth grade, interviews were conducted (5/2023-1/2024) with a subset selected to achieve variation in current relationship experience. Directed content and inductive analyses of transcripts were completed.

Results

Forty-one participants (ages 18-21 years; n=21 female, n=18 male, n=2 non-binary; 12% first generation, 71% second generation, and 17% third generation immigrants) were interviewed. Participant-reported reasons to prevent pregnancy currently included educational goals, maturity, “not ready”, finances, desire not to disappoint parents, and other personal goals. When asked to imagine if they (or their partner) were pregnant now, many reported negative feelings (“…being pregnant would be the worst thing right now”), while few reported positive feelings. Participants were split between preferring abortion (“…I just feel like I would have to abort it just because I can’t even take care of myself”) and parenting (“I think if I had a child, I would really want to raise it and be involved in its life”). Adoption was rarely discussed and arose as a second-tier option if abortion was not available. Family values, support systems, and future goals were critical factors driving imagined pregnancy decisions.

Conclusions

We captured perspectives on pregnancy, abortion, and parenting of those typically underrepresented in abortion research, including emerging adults, male and non-binary individuals, and those with immigrant identities. Such research is critical to understanding how these populations are navigating their sexual and reproductive health in an evolving abortion policy landscape.

方法在一项混合方法的前瞻性队列研究中，对从八年级开始跟踪调查的新兴成年人进行了访谈（5/2023-1/2024），选择了一个子集以实现当前关系经历的变化。结果 41 名参与者（18-21 岁；女性 21 人，男性 18 人，非二元性 2 人；第一代移民 12%，第二代移民 71%，第三代移民 17%）接受了访谈。参与者报告的目前避孕的原因包括教育目标、成熟度、"还没准备好"、经济状况、不想让父母失望以及其他个人目标。当被要求想象自己（或伴侣）现在是否怀孕时，许多人表示有负面情绪（"......怀孕是现在最糟糕的事情"），而很少有人表示有正面情绪。参与者在堕胎（"......我只是觉得我必须堕胎，因为我甚至不能照顾好自己"）和养育孩子（"我想如果我有了孩子，我会非常想养育他并参与他的生活"）之间各执一词。领养很少被讨论，只是在无法堕胎的情况下作为第二选择出现。家庭价值观、支持系统和未来目标是驱动想象中的怀孕决定的关键因素。结论我们捕捉到了那些通常在堕胎研究中代表性不足的人对怀孕、堕胎和养育子女的观点，包括新兴成人、男性和非二元个体以及具有移民身份的人。此类研究对于了解这些人群如何在不断变化的人工流产政策环境中驾驭其性健康和生殖健康至关重要。

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引用次数: 0

ASSESSING EXPERIENCES OF DISCRIMINATION IN FAMILY PLANNING SETTINGS: AN EXPLORATORY FACTOR ANALYSIS 评估计划生育环境中的歧视经历：探索性因素分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110647

AA Luke, M Livingston, AM Gómez, AH Bennett, JM Sales, SK Redd, WS Rice

Objectives

Given the importance of high-quality, person-centered care, particularly for communities who have experienced reproductive oppression, this study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Bird and Bogart (2001).

Methods

Data came from the nationally representative Person-Centered Contraceptive Access Metrics survey (unweighted n=3,059). We performed an exploratory factor analysis using principal axis extraction and Promax rotation. We assessed reliability using the coefficient omega. To assess known-groups validity, we employed weighted linear regression with survey sampling weights, using race as the predictor and the discrimination scale score as the outcome variable.

Results

The factor analysis resulted in a two-factor solution using 7/9 discrimination items: (1) Interpersonal Discrimination in Family Planning Care, including items reflecting differential treatment and disrespect; and (2) Racial Stereotyping in Family Planning Care, capturing assumptions based on race/ethnicity about welfare status, family size, sexual behavior, and sexually transmitted diseases. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI=0.988, RMSEA=0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to White respondents.

Conclusions

The validation of this measure assessing experiences of discrimination in family planning settings provides a tool to support research on the prevalence of racial discrimination and its impact on reproductive autonomy, including preferred method use, and access to care. Understanding these impacts can inform interventions promoting access to high-quality, equitable, and just reproductive healthcare.

目标鉴于高质量、以人为本的医疗保健的重要性，尤其是对经历过生殖压迫的群体而言，本研究旨在测试 Bird 和 Bogart（2001 年）开发的九个项目的计划生育环境中终生受歧视经历测量方法的心理测量特性。方法数据来自具有全国代表性的 "以人为本的避孕普及度量调查"（未加权 n=3059）。我们使用主轴提取和 Promax 旋转法进行了探索性因子分析。我们使用欧米茄系数评估了可靠性。为了评估已知群体的有效性，我们采用了调查抽样加权线性回归，将种族作为预测因子，将歧视量表得分作为结果变量。结果因子分析使用 7/9 个歧视项目得出了一个双因子解决方案：（1）计划生育关怀中的人际歧视，包括反映区别对待和不尊重的项目；（2）计划生育关怀中的种族刻板印象，包括基于种族/民族对福利状况、家庭规模、性行为和性传播疾病的假设。该测量结果显示出很强的可靠性（Ω系数为 0.97）和拟合度（TLI=0.988，RMSEA=0.066）。已知群体有效性测试表明，与白人受访者相比，有色人种在计划生育环境中遭受歧视的程度更高。结论这项评估计划生育环境中歧视经历的测量方法的验证为研究种族歧视的普遍性及其对生殖自主权（包括首选方法的使用）和获得护理的影响提供了支持工具。了解这些影响可以为促进获得高质量、公平和公正的生殖保健服务的干预措施提供依据。

{"title":"ASSESSING EXPERIENCES OF DISCRIMINATION IN FAMILY PLANNING SETTINGS: AN EXPLORATORY FACTOR ANALYSIS","authors":"AA Luke, M Livingston, AM Gómez, AH Bennett, JM Sales, SK Redd, WS Rice","doi":"10.1016/j.contraception.2024.110647","DOIUrl":"10.1016/j.contraception.2024.110647","url":null,"abstract":"<div><h3>Objectives</h3><div>Given the importance of high-quality, person-centered care, particularly for communities who have experienced reproductive oppression, this study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Bird and Bogart (2001).</div></div><div><h3>Methods</h3><div>Data came from the nationally representative Person-Centered Contraceptive Access Metrics survey (unweighted n=3,059). We performed an exploratory factor analysis using principal axis extraction and Promax rotation. We assessed reliability using the coefficient omega. To assess known-groups validity, we employed weighted linear regression with survey sampling weights, using race as the predictor and the discrimination scale score as the outcome variable.</div></div><div><h3>Results</h3><div>The factor analysis resulted in a two-factor solution using 7/9 discrimination items: (1) Interpersonal Discrimination in Family Planning Care, including items reflecting differential treatment and disrespect; and (2) Racial Stereotyping in Family Planning Care, capturing assumptions based on race/ethnicity about welfare status, family size, sexual behavior, and sexually transmitted diseases. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI=0.988, RMSEA=0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to White respondents.</div></div><div><h3>Conclusions</h3><div>The validation of this measure assessing experiences of discrimination in family planning settings provides a tool to support research on the prevalence of racial discrimination and its impact on reproductive autonomy, including preferred method use, and access to care. Understanding these impacts can inform interventions promoting access to high-quality, equitable, and just reproductive healthcare.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110647"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CHANGES IN CONTRACEPTIVE METHOD CHOICES FOLLOWING DOBBS IN A STATEWIDE CONTRACEPTIVE ACCESS INITIATIVE: PATH4YOU 在全州范围内开展的 "避孕药具普及行动：Path4you "中，多布斯之后避孕方法选择的变化情况

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110645

M Ruggles, BT Edmonds, J Peipert, R Evans, M Fernandez, K Wendholt, SS Bhamidipalli, TA Wilkinson, C Bernard

Objectives

The Dobbs v Jackson Women’s Health Organization decision significantly impacted abortion access, and Indiana was the first state to legislate an abortion ban in August 2022. The objective of this study was to evaluate changes in contraceptive method choice among participants using our statewide contraceptive access initiative, PATH4YOU. Our hypothesis was that more people would choose contraceptive methods with higher effectiveness due to concern for lack of abortion access in case of unintended pregnancy.

Methods

We analyzed programmatic data of 1,224 reproductive-aged people receiving care through PATH4YOU from September 2021 to September 2023, including 178 pre-Dobbs and 1,034 post-Dobbs. All participants received pregnancy intention screening, comprehensive contraceptive counseling/decision support, and same-day, free reversible method access. We analyzed the study population via age and zip code, including the social deprivation index (SDI), and the method mix before and after the Dobbs decision.

Results

The average age of participants was 28 years; 77% received care in-person, 23% via telehealth. Based on zip code, 88% were urban and were evenly split among the SDI quartiles (22% in the most vs 26% in the least deprived quartiles). Overall, participants chose 35% LARC, 31% pill/patch/ring, 12% injectable, 3% barrier/EC, and 11% other/none. After the Dobbs decision, significantly more participants chose more effective methods, including LARC (37% vs 24%, p<0.001) and injectables (13% vs 5%, p=0.003), while fewer chose pill/patch/ring (29% vs 41%, p=0.03).

Conclusions

The Dobbs decision and concerns about abortion access appear to have influenced contraceptive method choice for participants in PATH4YOU.

目标多布斯诉杰克逊妇女健康组织案的判决极大地影响了堕胎机会，印第安纳州于 2022 年 8 月成为第一个立法禁止堕胎的州。本研究的目的是评估使用全州避孕药具获取计划 PATH4YOU 的参与者在避孕方法选择上的变化。我们的假设是，由于担心意外怀孕时无法获得堕胎服务，更多的人会选择有效性更高的避孕方法。方法我们分析了 2021 年 9 月至 2023 年 9 月期间通过 PATH4YOU 接受护理的 1,224 名育龄人群的项目数据，其中包括多布斯法案前的 178 人和多布斯法案后的 1,034 人。所有参与者都接受了怀孕意愿筛查、综合避孕咨询/决策支持以及当天免费可逆避孕方法的使用。我们通过年龄和邮政编码对研究人群进行了分析，包括社会贫困指数（SDI）以及多布斯决定前后的避孕方法组合。根据邮政编码，88%的参与者为城市居民，在 SDI 四分位数中平均分布（22% 在最贫困的四分位数中，26% 在最不贫困的四分位数中）。总体而言，35% 的参与者选择了 LARC，31% 选择了避孕药/避孕贴/避孕环，12% 选择了注射，3% 选择了屏障/EC，11% 选择了其他/无。在多布斯决定之后，明显有更多的参与者选择了更有效的方法，包括 LARC（37% vs 24%，p<0.001）和注射剂（13% vs 5%，p=0.003），而选择药/贴/环的人数则较少（29% vs 41%，p=0.03）。

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引用次数: 0