bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Access to Long-Acting Reversible Contraception in Eastern North Carolina [20I]
Authors: Gautam Amber 
Published: April 2020

INTRODUCTION:
More than half of mothers in eastern NC present with unintended pregnancy, a major contributor to infant mortality rate. LARCs have been shown to be the most effective form of reversible contraception. However, access to LARCs continues to be a challenge for many patients here. This study aims to quantify the rate of postpartum mothers who received LARCs of those who expressed a desire postpartum.

METHODS:
Over 361 women who delivered at Vidant Medical Center were included. Retrospective chart review was performed documenting desired contraception, whether the patient received it inpatient, attendance of postpartum visit, and contraceptive method received. Of 361 patients reviewed, 327 postpartum contraceptive plans were visible.

RESULTS:
Of the 327 women who were reviewed, 262 attended their postpartum visit. Of the 49 women who expressed desire for etonogestrel implantable device (Nexplanon) at the time of discharge, 27 received an etonogestrel implantable device at their postpartum visit (55.1%). Of the 69 women who expressed interest in receiving an intrauterine device at the time of discharge, 31 women received it at their postpartum visit (44.9%).

CONCLUSION:
There is a marked discrepancy in the number of women who express interest in receiving LARCs and those who actually end up receiving them. By offering placement in the immediate postpartum period, an increase in the number who receive LARCs who desire it is anticipated. Inpatient offering of both forms of LARCs started in December of 2018; data collection is currently in process with updated outcomes.
Insertion-Related Pain and Short-Term Satisfaction With Two Copper IUDs: A Randomized Trial [22I]
Authors: Burke Anne E. , Edelman Alison , Chen Beatrice A. , Castano Paula , Chen Pai-Lien 
Published: April 2020

INTRODUCTION:
Pain during intrauterine device (IUD) insertion is a barrier to uptake. We compared insertion-related pain and short-term satisfaction between two copper (Cu) IUDs.

METHODS:
We conducted a multicenter, single-blind randomized trial comparing two CuIUDs. Participants were randomized (4:1 ratio) to a smaller (Mona Lisa NT Cu380-Mini [24 mm x 30 mm]) or standard (Paragard TCu380A [32 mm x 36 mm]) CuIUD. Participants recorded maximum pain levels on a 10 cm visual analog scale at nine timepoints (pre- and immediately post-IUD insertion, daily for 7 days). At day 7, participants reported overall satisfaction (5-point scale) and whether they would recommend the product to others. For each timepoint, we computed mean pain level and mean change in pain from baseline, and stratified by parity. We used T-tests and chi-square tests to compare results between products.

RESULTS:
We enrolled 1,105 women, 84% nulliparous (n=924). Mean pain levels immediately post-insertion were 4.9 cm (SD 2.3) for both the smaller (n=886) and standard (n=219) products. Subsequent pain levels decreased equally across both products, from 2.5 cm (day 2) to 0.7 cm (day 7). Mean pain after baseline adjustment was similar between products. Nulliparous women using either IUD reported higher pain levels at all timepoints than parous women (P<.05). Among nulliparous women, 54% were highly satisfied with the smaller versus 45% with standard IUD (P<.05); over 92% using each product would recommend it. Parous women reported similar satisfaction by product.

CONCLUSION:
Reported pain was similar between IUDs. Satisfaction among nulliparous women was higher at 7 days with a smaller CuIUD. Longer-term data may elucidate possible differences between products.
Medical and Ethical Analysis of Menstrual Apps [26I]
Authors: Gross Marielle S. , Corbin Bethany , Miller Robert C. 
Published: April 2020

INTRODUCTION:
The recent explosion of digital health applications includes emergence and growing popularity of smartphone apps for women’s health, most commonly menstrual tracking apps. Meanwhile, monetization of women’s sensitive health data has led to public outcry and ethical concerns. Greater understanding of medical and ethical aspects of menstrual app use is needed.

METHODS:
We survey women’s menstrual app use, highlighting issues related to beneficence, autonomy and justice.

RESULTS:
These technologies may benefit women by empowering better control over contraceptive intentions or pregnancy desires and greater insights into reproductive health, however harms may occur when technology fails, most notably in the case of unintended pregnancies among women using apps with flawed ovulatory prediction algorithms. Autonomy may be compromised if women cannot control third-party use of highly sensitive reproductive health data (e.g., when, where and who they have sex with), particularly when ability to use apps is conditioned on “accepting the cookies” and potentially misleading small-print notice/informed consent regarding reasonable expectations of privacy and potential data uses. These apps normalize a new frontier for ubiquitous data surveillance, gathering health-relevant data outside of the traditional healthcare contexts where it is not afforded appropriate legal or ethical protection. Menstrual apps may promote commodification of women’s bodies by harnessing personal data to generate advertisement revenue.

CONCLUSION:
Current menstrual apps raise concerns regarding their effectiveness for promoting women’s health, expectations of privacy and appropriateness of monetization of inherently sensitive health data. Emerging technologies such as blockchain and privacy-preserving computation may support more woman-centric menstrual apps; further research is warranted.
Medical Crowdfunding for Abortion Services [27I]
Authors: Solotke Michael T. , Ross Joseph , Cron Julia 
Published: April 2020

INTRODUCTION:
Crowdfunding involves soliciting donations, often over internet platforms, to fundraise for a specific need. Although crowdfunding for medical expenses has grown in popularity, one important and understudied application of crowdfunding is abortion services. Given the access barriers and political nature of abortion, many women seeking these services may turn to more anonymous options for support, including crowdfunding. We therefore examined such utilization of crowdfunding in the United States.

METHODS:
This study is a cross-sectional analysis of all campaigns for abortion services on four major crowdfunding sites. Two authors reviewed all campaigns included in our study, abstracting the following information: whether the campaign was successfully funded, number of donations, number of social media shares, number of campaign updates, campaign duration, age of woman, gestational age, state abortion policy, insurance status, number of words in campaign description, narrative point of view, stated purpose of funds, and 10 campaign themes.

RESULTS:
Among 92 crowdfunding campaigns, the total amount requested was $118,272 and the total amount raised was $36,085. The median amount requested was $610 (IQR $500-$1,000), median raised was $0 (IQR $0-$444), and 19 (21%) campaigns successfully reached their fundraising goal. Campaign success was not statistically different in states with very hostile (33%), hostile (36%), middle-ground (9%), supportive (17%), and very supportive (11%) abortion policies (P=.08). Campaigns written in third person or describing maternal/fetal complications raised significantly more money.

CONCLUSION:
Although crowdfunding is used to finance abortion services, it has a low success rate and raises ethical concerns.
Men’s Condom Use at Coitarche: An Analysis of National Survey of Family Growth Data (2006-2013) [28I]
Authors: Nguyen Brian T. , Violette Caroline 
Published: April 2020

INTRODUCTION:
Interventions to prevent unplanned pregnancy cannot overlook the role of young men. Using National Survey of Family Growth data from 2006 to 2013, we characterized men reporting having not used a condom at their first intercourse (coitarche) with a non-steady partner, as well as associated factors.

METHODS:
Survey respondents who reported ever having intercourse were asked about contraception used at coitarche, inclusive of male and female methods. Analysis was restricted to respondents whose first sexual partner was an unsteady partner, thereby comprising a population for whom condoms are recommended for preventing both pregnancy and sexually transmitted infections. Demographic and behavioral factors were examined against condom use, with significant associations included in multivariable logistic regression. Bivariate associations of condom use with receipt of specific sex education topics are described.

RESULTS:
The odds of unprotected coitarche decreased by nearly 25% between 2006 and 2010 and 2011 and 2013. Older respondents had 2.0-4.0 (95% CI 1.6-5.3; P<.01) times the odds of unprotected coitarche compared to those below age 19. Other independently associated factors included coitarche before age 15 (OR 3.0; 95% CI 2.6-3.6; P<.01) and with an older-aged partner (OR 1.7; 95% CI 1.4-2.0; P<.01). Among respondents who received sex education prior to coitarche, discussion of STIs and contraception were associated with condom use at coitarche; abstinence-only education was not associated.

CONCLUSION:
Nearly 1 in 5 young men reported not using a condom at coitarche with an unsteady partner. Prevention efforts should continue to evaluate psychosocial and structural reasons why young men do not use condoms.
Vasectomy: A Survey of Urologist’s Opinions on Training Family Planning Providers [37I]
Authors: Xepoleas Meredith D. , Nguyen Brian T. , Patel Jasmine 
Published: April 2020

INTRODUCTION:
Vasectomy is one of the only forms of male-controlled contraception, yet it is the only form of contraception not generally performed by traditional family planning providers: family medicine physicians and obstetricians/gynecologists (OB/GYNs). Our study aims to assess the willingness of urologists to train family planning providers on this procedure.

METHODS:
For this IRB approved/exempt study, electronic surveys were sent to all American urology residency program directors via REDCap. In addition, in person surveys were conducted at the American Urology Association (AUA) 2019 Conference. Statistical analyses were performed using Student t-tests for continuous data and Pearson chi-squared tests for categorical data.

RESULTS:
Forty-nine AUA conference responses and 26 residency program director responses were collected. Most urologists surveyed were willing to train other urologists (85.1%), while they were less willing to train non-urologists: general surgeons (20.3%), family medicine physicians (20.3%), and OB/GYNs (10.8%). While more urologists were willing to train family medicine physicians versus OB/GYNs (P<.01), more urologists believed it would be more difficult for family medicine practitioners to learn vasectomy (P<.01). Urologists were worried about competition, that training others would decrease cases for urologists, and family planning providers would have insufficient volume. In addition, urologists were concerned that family medicine physicians had a lack of surgical skills and OB/GYNs would be unfamiliar with anatomy.

CONCLUSION:
Overall, urologists show an unwillingness to train family planning providers. In order to provide comprehensive care, family planning providers should find allies to help learn the procedure or partner with vasectomy providers.
Workflow Process Mapping: A Novel Approach to Promote Implementation of Evidence Based Practices [39I]
Authors: Bonawitz Kirsten , Finer Zoe , Heisler Michele , Wetmore Marisa , Dalton Vanessa , Moniz Michelle 
Published: April 2020

INTRODUCTION:
National guidelines recommend offering immediate postpartum long-acting reversible contraception (LARC). However, hospitals lack evidence-based approaches for embedding this care into existing workflow. We used a multiple case study to understand immediate postpartum LARC workflow at early-adopter sites and create a tool to help embed this care into practice at new sites.

METHODS:
A systematic literature search identified hospitals offering immediate postpartum contraceptive care. We purposively sampled information-rich sites. From 8/2017 to 9/2018, we conducted site visits with semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research (CFIR). Workflow process mapping was used to develop detailed workflow maps and describe drivers of observed workflow variation. Institutional IRB approval was obtained.

RESULTS:
After interviewing 79 key informants at 11 hospitals, workflow process mapping revealed variation across sites, especially related to timing and staff involved in 1) counseling, consent, and documentation of patient preferences, 2) addressing insurance coverage, 3) device ordering, 4) contraceptive insertion technique, and 5) post-insertion management. Observed variation was often driven by context (e.g., degree of integration between inpatient and outpatient teams, variation in L&D staff composition) and gaps in clinical evidence (e.g., uncertainty about the comparative effectiveness of intrauterine device insertion techniques). Only two sites prospectively designed a workflow. At other sites, workflows were often inefficient, requiring adaptations after initial implementation and clarification about roles and responsibilities.

CONCLUSION:
Pre-implementation workflow process planning using the self-assessment tool may help sites engage key stakeholders, customize workflow to local needs, and minimize need for future adaptations.
“Part Triage, Part Gatekeeping”: A Qualitative Assessment of Prescribing Gender-Affirming Hormones [40I]
Authors: Stroumsa Daphna , Moravek Molly B. , Wu Justine P. , Toman Lindsay 
Published: April 2020

INTRODUCTION:
The requirement for mental health evaluation prior to initiation of gender-affirming hormones for transgender patients is at the center of an active debate in the field. While some prescribers adhere to this requirement, which arises from historical professional guidelines, others do not require universal mental health evaluation. Current guidelines leave room for variability in clinical pathways to hormone initiation, and prescribers must navigate these variations. We aim to understand different approaches providers use in clinical decision-making regarding hormone initiation, and to assess factors that affect these approaches.

METHODS:
Semi-structured interviews were conducted with prescribers of gender affirming hormones between May and October of 2019 (n=19). Respondents were purposefully sampled to include those who indicated that they required mental health evaluation prior to hormone initiation, and those who did not. Interviews were transcribed verbatim and coded using a grounded-theory informed approach.

RESULTS:
Themes related to factors that influence clinical decision-making included patient safety; limitations of professional role and expertise; availability of resources; and concerns about patient access to care. Prescribers navigate along a continuum rather than adhering to strict rules about mental health evaluation; factors that influence these decisions include patient resources, treatment access, professional roles and ethical obligations to the patient. The role of mental health evaluation is viewed as a combination of a triage necessity to identify appropriate candidates, and as a gatekeeping practice that limits care accessibility.

CONCLUSION:
Providers practice on a continuum of care rather than divided along binary lines regarding requirement for mental health evaluation.
Breast Symptoms After Pregnancy Loss and Abortion: An Observational Study [03J]
Authors: Hagey Jill M. , Truong Tracy , Deans Elizabeth I. 
Published: April 2020

INTRODUCTION:
We aimed to determine the prevalence, duration and bother of breast symptoms (engorgement, tenderness and leakage) after 1st and 2nd trimester pregnancy loss and abortion; an under-studied area in obstetrics and gynecology.

METHODS:
We enrolled a convenience sample of 86 patients seen for pregnancy loss and abortion services at the Duke Family Planning Clinic. Participants were surveyed using the Bristol Breast Symptoms Inventory on the day of medical or surgical abortion, after three to four days, and at two weeks.

RESULTS:
Of the patients enrolled, 59 were in their 1st trimester and 27 were in their 2nd trimester. The average age was 32; the majority of patients had a prior pregnancy and were white or African American.
At time of presentation, 42% reported engorgement, 61% reported tenderness, and 6% reported leakage. The majority of patients with tenderness or engorgement reported the symptoms as bothersome and this proportion increased as time progressed. First trimester patients’ symptoms decreased over time, while symptoms persisted for 2nd trimester patients. At two weeks, 40% of 2nd trimester patients reported engorgement, 50% reported tenderness, and 20% reported leakage. There were no differences in symptoms by route of or reason for abortion.

CONCLUSION:
Breast engorgement and tenderness are common and bothersome following pregnancy loss and abortion. Breast symptoms can persist for many patients with pregnancy loss or abortion in the 2nd trimester. Determining those at higher risk for breast symptoms and adapting procedural counseling to address these symptoms may improve patient-centered care.
Changes in Young Pro-Choice Physicians' Attitudes Towards Abortion Provision in Residency and Early Practice [05J]
Authors: Payne Carolyn , Frankel Angela 
Published: April 2020

INTRODUCTION:
This study sought to identify factors in OBGYN or Family Medicine residency training that support or impede a highly motivated physician from providing abortion care after residency.

METHODS:
Residents who desired abortion training at the onset of residency were recruited via purposeful sampling and snowball sampling techniques. Participants were queried about medical training and factors influencing future abortion provision via online survey and semi-structured phone interview.

RESULTS:
Eighty-two individuals in residency and early practice completed the survey (65.6% response rate), and 26 physicians participated in phone interviews. Thirty percent felt that they received insufficient abortion training (particularly in second trimester procedures), 58% of respondents were involved with pro-choice organizations prior to residency, compared to 43.3% reported involvement during residency. While 60% considered pursuing family planning fellowship (FPF), only 22% of respondents applied. Of those who did not apply, the most commonly reported reasons were: belief that skills acquired in residency were sufficient (44%), desire to practice full-spectrum care after residency (42%), and lack of interest in conducting research (23.7%). Excluding FPF trainees, only 21% of phone interview participants were satisfied with their current level of abortion provision. Common barriers to provision included employer restrictions, competing clinical interests, lack of mentorship/community, and regional clustering of providers.

CONCLUSION:
Interventions seeking to increase abortion provider availability should be directed toward bolstering family planning mentorship and community in residency, challenging institutional restrictions that impede comprehensive training, and incentivizing trained providers to seek geographically diverse positions that enable abortion provision in practice.
Distance Traveled for Abortion at a Southern Tertiary Care Center Following Restrictive Legislation [10J]
Authors: Brenner Tara F. , Stuart Gretchen S. , Rowe Carly 
Published: April 2020

INTRODUCTION:
North Carolina enacted five statutes restricting abortion between 2011 and 2016. Our objective was to compare the proportion of women who traveled more than 25 miles to a southern tertiary care center in 2011 to the proportion of women who traveled more than 25 miles to this center in 2017.

METHODS:
We conducted a time-series retrospective cohort study of women who obtained an abortion at University of North Carolina Hospitals in 2011 and 2017. We collected data regarding residence, demographics, gestational age, indication, parity, and referral source. Our primary outcome was distance from self-reported residence to the study center.

RESULTS:
We enrolled 405 women, 143 in 2011 and 262 in 2017; groups were similar in age, parity, and ethnicity. In 2011, 72% (103/143) traveled more than 25 miles, compared with 75% (196/262) in 2017 (P=.473). In 2011, the maximum miles traveled was 290 compared to 420 in 2017. More women from neighboring states were seen in 2017 than 2011. Women seeking abortion in 2017 were four times more likely to have been referred from a freestanding abortion clinic compared with women in 2011 (38% [39/262] vs 9% [13/143]).

CONCLUSION:
In our tertiary care center, there was no difference in distance traveled for abortion before and after the legislative changes. However, the increased number of women seen from outside health centers and neighboring states following the legislative session may indicate additional barriers to abortion access, potentially related to increased time commitment, number of visits, and number of open clinics.
First-Year Side Effect Rates in Nulliparous and Parous Levonorgestrel 52 mg Intrauterine System Users [12J]
Authors: Cwiak Carrie , Blumenthal Paul D. , Kerns Jennifer , Westhoff Carolyn , Olariu Andrea I. , Creinin Mitchell D. 
Published: April 2020

INTRODUCTION:
We investigated the impact of parity on side effects during the first year after levonorgestrel 52 mg intrauterine system (IUS) placement.

METHODS:
We evaluated data from the ongoing 10-year Phase 3 Liletta® study in which 1,714 women aged 16-45 years received an IUS. Subjects reported side effects during follow-up visit interviews. For this analysis, we only included women with at least one 28-day cycle of follow-up and excluded women using a levonorgestrel IUS in the month before enrollment. Side effects evaluated at six and 12 months included abdominal pain, acne, anxiety/panic issues, depression, diarrhea, dyspareunia, fatigue, gastritis/reflux, headache, mastalgia, mood changes, nausea or vomiting, orgasm/libido problems, pelvic pain, vaginal discharge/odor, and weight changes. We used Fisher exact tests for all comparisons.

RESULTS:
The dataset included 931 nulliparous and 613 parous women. Over the first six and 12 months, the most common complaints were acne (158 [10.2%] and 193 [12.5%], respectively) and headache (87 [5.6%] and 104 [6.7%], respectively). Only acne differed by parity, being more common among nulliparous women at both six (112 [12.0%] vs 46 [7.5%], P=.005) and 12 months (134 [14.4%] vs. 59 [9.6%], P=.006). When evaluating only women who did not use combined hormonal contraception (CHC) in the month before enrollment, nulliparous (n=445) and parous (n=414) women had no significant difference in side effects at six or 12 months.

CONCLUSION:
Side effects did not differ by parity during the first year of levonorgestrel 52 mg IUS use except acne reported more frequently by nulliparous than parous women. However, this difference may be more related to CHC discontinuation than IUS initiation.