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Global Public Health. 2019 Feb; 14(2):300-308.Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil.
Cervico-vaginal inflammatory cytokine alterations after intrauterine contraceptive device insertion: A pilot study.
PloS One. 2018; 13(12):e0207266.In a prospective study of twenty sexually transmitted infection (STI)-free women, we examined the impact of an intrauterine contraceptive device (IUCD) insertion on cervico-vaginal cytokine levels. Nine women chose the levonorgestrel-containing IUCD and eight chose a copper IUCD. A cervico-vaginal swab was collected for cytokine analysis pre-insertion and four weeks post-insertion. Significant increases were noted in levels of IL-1alpha (median 483.4 versus 316.6 pg/mL, p = 0.046), IL-1beta (median 605.7 versus 147.3 pg/mL, p = 0.018), IL-6 (median 570.1 versus 157.3 pg/mL, p = 0.046), TNFalpha (median 1.19 versus 0.6 pg/mL, p = 0.029) and the chemokine MCP-1 (median 340.2 versus 135.2 pg/mL, p = 0.003). No significant changes were noted in the levels of GM-CSF, IL-8, MIG, MIP-3alpha, RANTES, IL-10, IL-17, IP-10, MIP-1beta. Whether this increase in pro-inflammatory cytokine levels decreases epithelial barrier integrity and enhances susceptibility to STIs, including HIV, merits further study.
Using the Theory of Planned Behavior to determine pharmacy students' intention to participate in hormonal contraception counseling services.
Currents In Pharmacy Teaching and Learning. 2018 Nov; 10(11):1488-1495.INTRODUCTION: Recent policies allow some pharmacists to prescribe hormonal birth control, which may improve access to hormonal contraceptives. This study explored associations between student pharmacists' hormonal contraception knowledge, attitudes, subjective norms, perceived behavioral control to counseling intentions, and preferred learning methods. METHODS: A cross-sectional online survey was developed to assess student pharmacists' hormonal contraception knowledge, perceptions, and counseling intentions. First-year student pharmacists at Auburn University Harrison School of Pharmacy were recruited from a skills course to participate. Constructs from the Theory of Planned Behavior and contraception knowledge were used. True/false questions were used for the knowledge scale and Likert-type items for remaining scales. Low vs. high counseling intention based on contraception knowledge and perceptions and controlling for student pharmacist characteristics was identified by logistic regression. One multiple-choice item explored preferences for learning about hormonal contraception. RESULTS: A response of 110/112 consented student pharmacists was achieved. Mean scores for knowledge, attitudes, subjective norms, perceived behavioral control, and intention were 76.6% (SD = 20.43%), 89.0% (SD = 12.40%), 63.9% (SD = 8.06%), 59.0% (SD = 10.46%), and 81.4% (SD = 12.87%). The contraception attitude variable was statistically significantly associated with counseling intention after controlling for respondent characteristics [Odds Ratio (OR) = 1.10 with 95% Confidence Interval (CI) = 1.05, 1.16] while knowledge, subjective norms, and perceived behavioral control were not statistically significantly associated. Most respondents (56%) preferred to learn by watching examples of counseling, while some (30%) preferred role-play with peers, reading an article (9%), or using a computer simulation (3%). CONCLUSIONS: First-year student pharmacists' attitudes towards hormonal contraception were associated with counseling intentions. Preferred learning methods were observational learning or role-playing. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Fertility and Sterility. 2018 Dec; 110(7):1274.Add to my documents.
Low-Income Texas Women's Experiences Accessing Their Desired Contraceptive Method at the First Postpartum Visit.
Perspectives On Sexual and Reproductive Health. 2018 Dec 3;CONTEXT: Early access to contraception may increase postpartum contraceptive use. However, little is known about women's experiences receiving their desired method at the first postpartum visit or how access is associated with use. METHODS: In a 2014-2016 prospective cohort study of low-income Texas women, data were collected from 685 individuals who desired a reversible contraceptive and discussed contraception with a provider at their first postpartum visit, usually within six weeks of birth. Women's experiences were captured using open- and closed-ended survey questions. Thematic and multivariate logistic regression analyses were employed to examine contraceptive access and barriers, and method use at three months postpartum. RESULTS: Twenty-three percent of women received their desired method at the first postpartum visit; 11% a prescription for their desired pill, patch or ring; 8% a method (or prescription) other than that desired; and 58% no method. Among women who did not receive their desired method, 44% reported clinic-level barriers (e.g., method unavailability or no same-day provision), 26% provider-level barriers (e.g., inaccurate contraceptive counseling) and 23% cost barriers. Women who used private practices were more likely than those who used public clinics to report availability and cost barriers (odds ratios, 6.4 and 2.7, respectively). Forty-one percent of women who did not receive their desired method, compared with 86% of those who did, were using that method at three months postpartum. CONCLUSION: Eliminating the various barriers that postpartum women face may improve their access to contraceptives. Further research is needed to improve the understanding of clinic- and provider-level barriers. Copyright (c) 2018 by the Guttmacher Institute.
Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives.
Open Access Journal of Contraception. 2018; 9:91-112.Purpose: Evidence on the association between contraceptive use and risk of sexually transmitted infections (STIs) and bacterial vaginosis (BV) is lacking, with few prospective studies. We systematically reviewed the last 10 years' evidence on the association between contraception and STI/BV, building on the most recent systematic reviews published in 2006 and 2009. Methods: We searched the MEDLINE and POPLINE databases for peer-reviewed articles p ublished between January 1, 2008 and January 31, 2018 reporting prospective studies that assessed the association between contraceptive use and incident STI and/or incident or recurrent BV. Results: We identified 33 articles that evaluated combined oral contraceptives (COC), depot medroxyprogesterone acetate (DMPA), the copper intrauterine device (Cu-IUD), the levonorgestrel intrauterine system (LNG-IUS) and other methods. The strength of the evidence for many specific contraceptive method/STI associations is limited by few prospective studies with comparably defined exposures and outcomes. Available data suggest no association of COCs and Neisseria gonorrhoeae, Trichomonas vaginalis, HSV-2 or syphilis, and mixed evidence on the association with HPV, Chlamydia trachomatis, and BV. For DMPA, none of the studies identified found an association with N. gonorrhoeae or syphilis, and data on C. trachomatis, T. vaginalis, HPV and BV were mixed. Two large studies showed a highly clinically significant increased risk of HSV-2 infection with DMPA use. Data on the effect of Cu-IUD and the LNG-IUS on the acquisition of C. trachomatis, N. gonorrhoeae and T. vaginalis are sparse, and data on HPV and BV are mixed. Conclusion: Few data are available from prospective studies, including randomized trials, to draw strong conclusions about the relationships between contraceptive methods and specific STIs. The overall evidence on the association between contraceptive use and STI/BV risk is limited by the lack of any randomized trials, few published prospective studies designed to analyze these associations, wide variability in exposure definitions and comparator groups, potential for confounding due to inaccurate sexual behavior data, differential confounder adjustment and differences in study populations and sizes. Despite these limitations, new evidence is supportive of a significantly increased risk of HSV-2 infection among DMPA users which warrants additional research to better understand this association.
Hospitals by day, dispensaries by night: Hourly fluctuations of maternal mortality within Mexican health institutions, 2010-2014.
PloS One. 2018; 13(5):e0198275.BACKGROUND: Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. OBJECTIVE: To analyze the hourly variation of maternal mortality within Mexican health institutions. METHODS: We performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010-2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies. RESULTS: Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays. CONCLUSIONS: Evidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.
Health and Human Rights. 2018 Jun; 20(1):295-301.Add to my documents.
An alert to Latin America: Current human papillomavirus vaccination trends highlight key barriers to successful implementation.
Cancer. 2017 Jun 15; 123(12):2193-2199.Add to my documents.
Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review.
Disability and Health Journal. 2018 Nov 9;BACKGROUND: Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population. OBJECTIVE: To systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use. METHODS: We searched MEDLINE, PsychINFO, the Cochrane Library, CINAHL, and ERIC databases from inception through December 2017. Two reviewers independently reviewed studies for eligibility, abstracted study data, and assessed risk of bias following PRISMA guidance. RESULTS: We reviewed 11,659 citations to identify 62 publications of 54 unique studies (total n of women with disabilities=21,246). No standard definition of disability existed across studies. The majority of studies focused on women with intellectual disabilities (ID). Women with ID and those who were deaf or hard-of-hearing had lower knowledge of contraceptive methods than women without disabilities. Estimates of contraceptive use varied widely, with some evidence that women with disabilities may use a narrower range of methods. Five of six studies evaluating educational interventions to increase contraceptive knowledge or use reported post-intervention improvements. CONCLUSIONS: Women with disabilities may use a more narrow mix of contraceptive methods and are often less knowledgeable about contraceptives than women without disabilities. Interventions to improve knowledge show some promise. A lack of data exists on contraceptive preferences among women with disabilities. Copyright (c) 2018 Elsevier Inc. All rights reserved.
The history of universal access to emergency contraception in Peru: a case of politics deepening inequalities.
Reproductive Health Matters. 2018 Nov 26; 1-4.Add to my documents.
Medicaid Family Planning Expansions: The Effect of State Plan Amendments on Postpartum Contraceptive Use.
Journal of Women's Health. 2018 Nov 28;OBJECTIVE: To determine the effect of state Medicaid family planning (FP) programs transitioning from a Section 1115 waiver to a State Plan Amendment (SPA) on reproductive health outcomes. MATERIALS AND METHODS: Data were from the Pregnancy Risk Assessment Monitoring System on 75,082 women who had a live birth between 2007 and 2013 and were living in one of nine states. We performed a difference-in-differences analysis to quantify the effect of the transition on postpartum contraceptive (PPC) use and unintended births (UBs). RESULTS: Over 80% of the sample reported using PPC; half reported an UB. The odds of PPC use among women who were living in a study state and gave birth after the transition were 1.14 times that of women who were living in a comparison state and/or gave birth before the transition (95% confidence interval: 1.04-1.24). CONCLUSIONS: Findings suggest that women living in states that transitioned from a waiver to SPA experienced an increased likelihood of PPC compared with those living in comparison states.
European Journal of Contraception and Reproductive Health Care. 2018 Nov 30; 1-7.OBJECTIVE: The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC. METHODS: A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour. RESULTS: The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users. CONCLUSION: EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.
Increasing cases of HIV/AIDS in the northern region of the Colombia-Venezuela border: The impact of high scale migration in recent years.
Travel Medicine and Infectious Disease. 2018 Sep - Oct; 25:16-17.Add to my documents.
Early diagnosis of HIV infection among men who have sex with men in Lima (Peru). A prospective cohort study.
Clinical Microbiology and Infection. 2018 Jul; 24(7):793-795.Add to my documents.
The need for contraception in patients taking prescription drugs: a review of FDA warning labels, duration of effects, and mechanisms of action.
Expert Opinion On Drug Safety. 2018 Nov 3; 1-13.INTRODUCTION: This review provides a guide for the rational use of prescription drugs in patients of reproductive age. Areas covered: A comprehensive retrieval of the labels of FDA-approved drugs was performed to identify drugs where the label recommends contraceptive use during and/or after treatment. The acquired data were analyzed and organized into a table. Contraception was recommended or mandated for 268 single-ingredient drugs. These could be divided into four main categories, with many having effects across several categories: 177 drugs required contraception because they were associated with pregnancy loss or stillbirth, 177 drugs were associated with teratogenesis, 136 were associated with non-teratogenic adverse peri- or postnatal effects on the fetus (e.g. low birth weight), and 44 were associated with decreased efficacy of contraception or a change in ovulatory cycle. We also discuss the period of time contraception is required, as well as the known or hypothesized reasons for the reproductive toxicity of these agents. Expert opinion: We have provided a comprehensive overview of the FDA-approved drugs where the warning labels currently stipulate that contraception should be used. Although other references are available for clinicians, this review provides a useful source of information regarding the single-ingredient prescription drugs that may affect the outcome of pregnancy. This information is particularly relevant for researchers, as it provides an overview of the different drugs with reproductive toxicity, and because it highlights the specific needs for future research. In particular, more work (especially epidemiological studies) is needed to clarify the clinical relevance of these findings, most of which were obtained through animal studies.
Journal of Addiction Medicine. 2018 Nov 2;OBJECTIVES: The aim of the study was to evaluate pregnancy intention, risk perception, and contraceptive utilization among women reporting substance use during pregnancy. METHODS: Data were obtained from the 2009 to 2011 Tennessee Pregnancy Risk Assessment Monitoring System (PRAMS), an annual cross-sectional survey which assesses behaviors before, during and after pregnancy. Substance use during pregnancy and contraceptive use at the time of conception and after delivery were captured by self-report in the postpartum period. Pregnancy intention was categorized as intended (pregnancy desired then or earlier) or unintended (pregnancy desired later or not at all). Weighted descriptive and multivariable analyses were performed. RESULTS: A total of 3042 women completed the PRAMS survey, with 168 (5.4%) reporting substance use during pregnancy. Compared with women who did not report drug use, women who used drugs were more likely to have an unintended pregnancy (65.6% vs 48.4%, P = 0.003), were more ambivalent towards pregnancy planning or prevention (69.7% vs 46.2%, P < 0.001) and were less likely to report contraceptive use before pregnancy (31.3% vs 46.8%, P = 0.022) or in the postpartum period (79.6% vs 88.1%, P = 0.019). Finally, women reporting substance use in pregnancy had 2 times higher odds of reporting that they did not think they could get pregnant at the time of conception after adjusting for age, race, income, education, insurance, and smoking status (adjusted OR 2.18, 95% confidence interval 1.07-4.49, P = 0.033). CONCLUSIONS: Women who report substance use in pregnancy have unique reproductive health needs and would benefit from additional education and counseling concerning their pregnancy intention, contraceptive use, and ability to conceive.
Intentions to use emergency contraception: The role of accurate knowledge and information source credibility.
American Journal of Health Education. 2018; 49(4):264-270.Background: Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information. Purpose: The purpose of this study was to determine the sources from which young women learn about EC (including health care providers, friends/interpersonal sources, media sources, or no information sources), and to examine source credibility with the accuracy of EC knowledge and intentions to use EC. Method: Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC. Results: In total, 97% of participants had heard of EC from at least one source and 49% indicated they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC. Discussion: This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC. Translation to Health Education Practice: Future EC promotion efforts should target health education sources instead of media or interpersonal sources to promote EC knowledge and use among young, sexually at-risk populations.
International Journal of Reproductive Medicine. 2018; 2018:2785839.Emergency contraceptives play a major role in preventing unwanted pregnancy. The use of emergency contraceptives is characterized by myths and lack of knowledge by both health professionals and users. The main objective of this paper is to summarize the clinical pharmacology of hormonal methods of emergency contraception. A literature review was done to describe in detail the mechanism of action, efficacy, pharmacokinetics, safety profile, and drug interactions of hormonal emergency contraceptive pills. This information is useful to healthcare professionals and users to fully understand how hormonal emergency contraceptive methods work.
It seems kinda like a different language to us: Homeless youths' attitudes and experiences pertaining to condoms and contraceptives.
Social Work in Health Care. 2018 Nov 8; 1-21.Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources.
WMJ. 2018 Oct; 117(4):149-155.INTRODUCTION: Long-acting reversible contraceptives (LARC), specifically implants and intrauterine devices (IUD), are highly effective, low maintenance forms of birth control. Practice guidelines from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics recommend that LARC be considered first-line birth control for most women; however, uptake remains low. In this study, we sought to understand practices and barriers to provision of LARC in routine and immediate postpartum settings as they differ between specialties. METHODS: We surveyed 3,000 Wisconsin physicians and advanced-practice providers in obstetrics-gynecology/women's health (Ob-gyn), family medicine, pediatrics, and midwifery to assess practices and barriers (56.5% response rate). This analysis is comprised of contraceptive care providers (n=992); statistical significance was tested using chi-square and 2-sample proportions tests. RESULTS: More providers working Ob-gyn (94.3%) and midwifery (78.7%) were skilled providers of LARC methods than those in family medicine (42.5%) and pediatrics (6.6%) (P < .0001). Lack of insertion skill was the most-cited barrier to routine provision among family medicine (31.1%) and pediatric (72.1%) providers. Among prenatal/delivery providers, over 50% across all specialties reported lack of device availability on-site as a barrier to immediate postpartum LARC provision; organizational practices also were commonly reported barriers. CONCLUSIONS: Gaps in routine and immediate postpartum LARC practice were strongly related to specialty, and providers' experience heightened barriers to immediate postpartum compared to routine insertion. Skills training targeting family medicine and pediatric providers would enable broader access to LARC. Organizational barriers to immediate postpartum LARC provision impact many providers. Copyright(c) Wisconsin Medical Society.
WMJ. 2018 Oct; 117(4):156-159.Unplanned pregnancies are a serious health concern in Wisconsin. Increasing access to contraception is a proven method to reduce unplanned pregnancies while giving patients greater agency. Long-acting reversible contraception (LARC) methods, such as subdermal implants and intrauterine devices (IUD), are among the most effective contraception methods available and have high patient satisfaction. However, relatively few Wisconsin patients use these methods. Lack of provider skill in inserting and counseling about LARCs, inability to perform same-day LARC insertion, and absent hospital protocols for immediate postpartum insertion represent barriers to LARC access. Centralized efforts are required to remove these barriers so that all patients in Wisconsin can access highly effective contraception. Copyright(c) Wisconsin Medical Society.
Cross design analysis of randomized and observational data - application to continuation rates for a contraceptive intra uterine device containing Levonorgestrel in adolescents and adults.
BMC Women's Health. 2018 Nov 9; 18(1):180.BACKGROUND: To combine results from a randomized controlled study (RCT) and an observational study (OS) to evaluate discontinuation rate of a levonorgestrel-containing intrauterine contraceptive device (LNG IUD) in a real-life setting. METHODS: We included 253 parous and nulliparous women aged 21-40 years from our own phase II RCT. A total of 1607 women of all ages (including adolescents, < 20 years) were recruited from an OS. We applied the cross design synthesis (CDS) method recommended by the United States General Accounting Office. This method combines the different strengths of RCTs and OSs into one single estimate. RESULTS: Combined continuation rates for parous vs nulliparous women could be estimated more precisely as well as overall continuation rates after one (86.6%) and two years (78.5%), irrespective of age and parity. CONCLUSION: Cross design synthesis allowed more precise estimation of continuation rates of an intrauterine device.
Cancer Cytopathology. 2018 Sep; 126(9):751-752.Add to my documents.
Child. 2018 Jan; 44(1):1-3.Add to my documents.