bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Women Undergoing Surgical Abortion Versus Medical Abortion Choose Different Methods of Contraception? [9A]
Authors: Bogdanov Anton , Molaei Michael , Schubert Finn , Kesavan Meera 
Published: May 2017

INTRODUCTION:
Elective termination of pregnancy (TOP) is an option for unwanted pregnancy. Effective contraception can prevent these unplanned pregnancies and terminations. The purpose of this study was to identify differences in post-abortion contraception among women who underwent surgical and medical abortion. Contraceptive choices were reviewed based on patient demographics.

METHODS:
A retrospective cohort study was conducted on 330 patients receiving abortions from January 1st through 15th, 2014 by review of electronic medical records from a private outpatient family planning clinic specializing in abortion services. Data analysis was conducted using Chi Square test.

RESULTS:
The 330 reviewed procedures were 53 medical TOPs, 219 1st trimester, and 58 2nd trimester surgical abortions. Of all patients 4.2% desired LARC, 78.2% desired other methods, 17.6% declined contraception. Patients with a medical TOP were most likely to have received a LARC method (22.6%) followed by those having first trimester procedures (10.5%) and second trimester procedures (8.6%), p=0.003. Significant loss of follow up was observed with medical TOPs (38.2%), 1st trimester surgical TOPs (68.0%) and 2nd trimester surgical TOPs (82.8%). Other factors influencing these choices are age, parity, prior abortion, insurance, and education. 18.2% of all patients returned pregnant within 18 months.

CONCLUSION:
Differences are seen in contraceptive choice and type of abortion. Age, parity, and a history of prior abortions may influence these choices. High follow-up failure and return pregnancy rates may suggest immediate contraception at time of procedure should be considered. Comparing these demographics with multivariate analysis could provide further understanding about these influencing factors.
Access to Abortion for Minors Following Implementation of the Illinois Parental Notice of Abortion Act in 2013 [13A]
Authors: Dries Alissa , Cowett Allison , York Sloane 
Published: May 2017

INTRODUCTION:
With 85% of adolescent pregnancies unintended, access to safe abortion is vital for teens. Several social, economic and legal barriers impede this access. In August 2013, Illinois implemented the Parental Notice of Abortion Act, requiring providers to notify an adult family member of women under the age of 18 seeking abortion 48 hours prior to the procedure.

METHODS:
We performed a retrospective charts review to assess changes in care of a randomly selected sample of 180 minors seeking abortion at a freestanding clinic in Chicago for one year before and one year following implementation of the law. The primary outcome was mean gestational age at presentation.

RESULTS:
Mean gestational age at presentation did not differ before and after implementation (15.9 versus 14.8 weeks, respectively, P=0.8833). No difference was found between the distance travelled for care (42.1 before versus 51.2 miles after, P=0.73) or the number of out-of-state subjects (n=14 before versus n=18 after, P=0.40). Fewer teens presenting following the law obtained an abortion (95.6% before versus 78.4% after, P=0.001). The number of teens unable to obtain an abortion for advanced gestational age increased from 2 prior to 10 following implementation.

CONCLUSION:
While our study did not find a difference in gestational age at presentation or distance traveled to the clinic, we noted a decrease in the percentage of presenting teens who obtained an abortion and an increase in the number of teens who were turned away secondary to advanced gestational age following the implementation of parental notice in Illinois.
Sterilization Procedures: A Missed Opportunity to Prevent Cancer in Patients Treated at U.S. Residency Programs? [16A]
Authors: Redfern Tiffany , Levine Lyuba , Richardson Gwyn 
Published: May 2017

INTRODUCTION:
A recent paradigm shift indicates that the origin of ovarian high grade papillary serous carcinoma is the fallopian tube. The American College of Obstetricians and Gynecologists and Society of Gynecologic Oncology now recommend prophylactic salpingectomies as a preferred method of sterilization. This study sought to evaluate current practices of sterilization across U.S. Obstetrics and Gynecology (OB/Gyn) residency programs.

METHODS:
This is an IRB-approved study. An electronic cross-sectional survey of 13 questions was sent to all OB/Gyn program coordinators for distribution to their residents. There are 5,258 filled residency slots in OB/Gyn for the 2016-2017 academic year.

RESULTS:
Response rate was 6.4%, with even distribution across years. The majority of residents are in an academic setting (64.8%). For patients undergoing post-partum sterilization, 55% of patients were counselled about bilateral salpingectomy and tubal ligation. Postpartum tubal ligation only is offered at 51% of programs. For non-pregnant patients, 40.6% of residents counsel patients about bilateral tubal ligation, hysteroscopic sterilization and bilateral salpingectomy. The most common procedure performed is a bilateral salpingectomy (47.4%), followed by bipolar coagulation (21.8%), spring clips (19.3%), Silicone band method (6.9%) and hysteroscopic sterilization(4.7%). The most common reason cited for performing ligation instead of salpingectomy was perceived increased surgical risk such as bleeding or infection (45.2%).

CONCLUSION:
Though limited in our response rates, this study has several important implications. Despite recommended practice changes, prophylactic salpingectomy to prevent ovarian cancer has not gained widespread acceptance for either postpartum or interim sterilization. Many patients treated in residency are uninsured or socioeconomically disadvantaged and such procedures may offer a unique opportunity for cancer prevention.
Generic or Branded? Oral Contraception Prescription Patterns in an Academic Medical Center [18A]
Authors: Zhang Shiliang , Sridhar Aparna 
Published: May 2017

INTRODUCTION:
Oral contraceptive pills (OCPs) are the most widely used form of reversible contraception in the United States. Most OCPs are no longer patent-protected and are available in FDA-approved generic forms, demonstrating bioequivalence and interchangeability with branded OCPs. This study analyzes OCP prescription patterns within the University of California Los Angeles (UCLA) Health System.

METHODS:
Information on electronically-generated OCP prescriptions within UCLA Health was collected and de-identified. The data was then analyzed using univariate statistics for prescription patterns based on physician specialty, estrogen dose, progestin dose and type.

RESULTS:
43,719 prescriptions for OCPs were generated by physicians from 7/1/14-6/30/15. Physicians most frequently prescribing OCPs belonged to internal medicine, family medicine and obstetrics and gynecology. 63-65% of these prescriptions were generic. Outside of these three primary care departments, other departments accounted for 8% of total OCP prescriptions. These other specialties prescribed generics 57% of the time. The most common progestin forms were norethindrone acetate, norgestimate, and levonorgestrel. 99% of all OCPs prescribed contained ethinyl estradiol and 56% were low dose (from 0.01mg to 0.025 mg) while 44% were high dose pills (0.03 mg to 0.05mg).

CONCLUSION:
The proportion of generic OCP prescriptions was similar in all three of the departments that accounted for the majority of all OCP prescriptions. In specialties with lesser volumes of OCP prescription, physicians tend to prescribe generic OCPs at a lower rate. Regulations establishing bioequivalence between generic and branded OCPs have been in place for over 20 years, yet lack of awareness over bioequivalence continues.
High Self-Efficacy Correlates With Use of Long-Acting Reversible Contraceptives [20A]
Authors: Hamidi Odessa , Deimling Timothy , Lehman Erik , Weisman Carol , Cynthia Chuang 
Published: May 2017

INTRODUCTION:
The American College of Obstetrics and Gynecology recommends long-acting reversible contraceptives (LARCs) as the safest and most effective reversible contraceptives. In the US, only 7% of women use LARCs, and 45% of pregnancies continue to be unintended. Barriers to LARC use can be intrinsic or extrinsic. While previous studies focus on extrinsic barriers to LARC use, our study evaluates intrinsic barriers. We hypothesize that two psychological traits, locus of control (LOC) and contraceptive self-efficacy (SE), influence use of LARCs.

METHODS:
Data are from the baseline survey of an IRB-approved randomized control trial. The study population was 874 privately insured Pennsylvania residents aged 18-40, who were not intending pregnancy for 12 months. LOC (internal vs external) and contraceptive SE (high vs low) were measured using composite scores from 5 and 8-item scales respectively. The association of LOC and SE with LARC use was determined using multivariable logistic regression adjusting for future pregnancy intention, education, and history of unintended pregnancy.

RESULTS:
LARC use was predicted by high SE (Adjusted OR 1.90, 95% CI 1.13, 3.19), but not by internal LOC (Adjusted OR 0.86, 95% CI 0.53-1.42). LARC use was also predicted by ambivalence about future pregnancy and history of previous unintended pregnancy.

CONCLUSION:
Women with high SE had an increased use of LARCs. Efforts to identify patients with low self-efficacy may provide opportunity for increased counseling and interventions to promote use of LARCs.
Results From the SECURE Trial, a Phase 3 Study of the AG200-15 Investigational Transdermal Contraceptive Patch [22A]
Authors: Garner Elizabeth , Chiodo Joseph 
Published: May 2017

INTRODUCTION:
AG200-15 is an investigational low-dose transdermal contraceptive patch being developed for prevention of pregnancy. AG200-15 is designed to deliver approximately 120 µg of LNG and 30 µg of EE per day, comparable to current low-dose oral contraceptives. AG200-15 is a 21-7 regimen, with patches applied once a week for three weeks, followed by a patch-free week. The Phase 3 Study to Evaluate Contraceptive Use, Reliability and Effectiveness (SECURE) was designed to assess efficacy, safety and tolerability of AG200-15.

METHODS:
SECURE was a single-arm, open-label, multicenter Phase 3 study of AG200-15 that enrolled approximately 2,000 reproductive-aged women to use the patch for up to one year. Primary efficacy was assessed using the Pearl Index in women 35 years of age and under. Cycles in which an alternate method of contraception was used or no sexual activity occurred were excluded. Safety and tolerability were assessed via adverse event reporting. An electronic diary was utilized for subject reporting of bleeding, patch site irritation, itching, and adhesion.

RESULTS:
Enrollment in SECURE began in September, 2014 and ended in October, 2015. Approximately 2,000 women were enrolled at 102 sites in the United States. The study population demographics were broadly representative of the population intended to use AG200-15. New users to hormonal contraception represented fewer than 20% of enrolled subjects. Top-line results including demographics, subject disposition, efficacy and safety will be available for ACOG 2017.

CONCLUSION:
The AG200-15 patch has the potential, if approved by the FDA, to provide women with a new low-dose combined hormonal contraceptive option.
An EPIC Hierarchical Data Collection Schema to Assess Contraceptive Counseling in Primary Care [24A]
Authors: Roser Brittany , Rubin Susan , Nagarajan Nisha , Benfield Nerys 
Published: May 2017

INTRODUCTION:
In 2011 the Institute of Medicine designated contraceptive counseling and provision an essential service. Electronic medical record (EMR) systems provide large volumes of clinical data but the quality of this data varies, especially when no billing, lab or prescription is given. As part of a quality improvement initiative, we sought to develop a reliable algorithm using EPIC EMR to measure rates of contraception counseling at outpatient primary care sites.

METHODS:
We constructed an initial hierarchical data collection schema using prescription data, ICD and CPT codes, and text searching, in this order. We refined the schema through an iterative validation process including three cycles of manual chart review. We applied the schema to eight outpatient urban family medicine, general obstetrics and gynecology, and family planning sites affiliated with one academic medical center.

RESULTS:
From August 2015 to May 2016, the eight sites averaged 2500 unique monthly visits by women aged 14-45. Among visits where contraception counseling and/or provision was documented, 18.6% were captured by prescriptions, 8.9% by ICD and CPT codes, and 69.7% by text search. Among visits where contraceptive counseling was documented but no method was provided, 15.7% were captured by diagnosis codes and 84.3% by text search.

CONCLUSION:
This hierarchical data collection schema allowed us to obtain robust measures of contraception counseling and provision in primary care practices. Inclusion of text search in addition to prescription and ICD/CPT coding is crucial for data accuracy and comprehensiveness. This schema could be adapted by other EPIC EMR users interested in real-time quality assessment.
Racial and Ethnic Disparities in Contraceptive Use in Young Women [27A]
Authors: Bahamon Cecilia , Leung Katherine , Ireland Luu 
Published: May 2017

INTRODUCTION:
Young women have the highest rates of unintended pregnancies among reproductive-aged women. Black and Latina women are at highest risk. Few studies have examined reasons for these differences. In this study, we examined disparities in contraceptive use and contraceptive counseling by race and ethnicity among young women.

METHODS:
Using the 2011-2013 National Survey of Family Growth (NSFG), a cross-sectional, nationally representative database, our analysis included women aged 15-24 years who had sexual intercourse within the past year, and were not pregnant or seeking pregnancy. The primary outcomes were contraceptive use and receipt of contraceptive services within the past 12 months.

RESULTS:
We found no difference in overall contraceptive use or rates of contraceptive counseling. However, Hispanics (H) and Non-Hispanic Blacks (NHB) primarily relied on Tier 3 methods of contraception (H: 56.7%, NHB: 60.2%, Non-Hispanic Whites (NHW): 45.1%, Non-Hispanic Others (NHO): 40.2%), despite being more likely than NHW and NHO to use Tier 1 methods (H: 9.2%, NHB: 9.9%, NHW: 8.2%, NHO: 8.3%). NHW and NHO were most likely to use Tier 2 methods (H: 34.1%, NHB: 29.8%, NHW: 46.7%, NHO: 51.48%; p=0.026). Additionally, NHW and NHO were most likely to have been prescribed contraception within the last 12 months (H: 49.6%, NHB: 49.0%, NHW: 60.1%, NHO: 64.8; p=0.047).

CONCLUSION:
Black and Latina women are more likely to rely on Tier 3 methods for pregnancy prevention despite similar rates of contraceptive counseling. Future studies should explore reasons for the predominance of the use of less effective contraceptive methods among young black and Latina women.
Cost-effectiveness of State Policies Banning Pregnancy Termination After Down Syndrome Diagnosis [28A]
Authors: Scrivner Karen , Rodriguez Maria , Savitsky Leah , Zwerling Blake , Bullard Kimberley , Caughey Aaron 
Published: May 2017

INTRODUCTION:
Three states have passed recent laws prohibiting abortion in cases of fetal abnormality, most notably Down syndrome. Data to demonstrate the impact of these restrictions are lacking. Our study sought to evaluate the cost-effectiveness of these policies for pregnancies affected by Down syndrome.

METHODS:
A decision-analytic model was constructed using TreeAge 2016 software. Probabilities, costs and utilities were derived from the literature. Our primary outcome was cost, and our secondary outcomes included: cost per quality adjusted life year (QALY), procedure-related fetal loss (PRL), births affected by Down syndrome, intrauterine fetal demise (IUFD), and pregnancy termination. The cost-effectiveness threshold was set to $100,000 per QALY. Sensitivity analysis was performed to determine the robustness of the model.

RESULTS:
In a theoretical cohort of 159,936 women representing annual live births in states affected by this ban, this policy results in an additional annual cost of $340 million, which corresponds to $2,124 per pregnant woman. It also results in a greater number of live births affected by Down syndrome—223 compared to 124 with no policy. The policy would not be expected to change the rates of PRL and IUFD, while 99 fewer abortions would be expected with a decrease of 494 QALYs.

CONCLUSION:
Although policies restricting abortion in cases of a Down syndrome diagnosis result in fewer pregnancy terminations, they do lead to a greater economic burden. States should keep this in mind along with the ethical implications of these policies when deciding whether to enact them.
Prevalence and Attitudes Regarding Withdrawal Use for Pregnancy and HIV Prevention in HIV-Positive Youth [31A]
Authors: Powell Anna , Vessa Blake , Law Sarah , Lazenby Gweneth 
Published: May 2017

INTRODUCTION:
The use of withdrawal is undervalued as a means of preventing pregnancy and sexually transmitted infections. Withdrawal use among high-risk sexually active youths may be as high as 48%. Withdrawal has not been well investigated as a method for HIV transmission prevention.

METHODS:
This is an interval analysis of a survey-based study of sexually active 18-25 year old HIV-infected individuals. Inclusion criteria was self-selection for survey participation. Statistical analysis was performed using SAS 9.4 (Cary, NC). Continuous variables were compared with Student’s t-test and Wilcoxon Rank Sum Tests. Categorical variables were compared using χ2 test and Fisher’s exact test. Multi-logistic regression was performed to investigate variables associated with withdrawal for HIV prevention.

RESULTS:
36 males and 34 females of 88 responded to date. Users of withdrawal for HIV prevention (WU) did not significantly differ from non-users in age, race, engagement in sexual activity within the last 3 months, reports of taking HIV medications, partner disclosure of HIV serostatus, condom use, or duration of monogamous relationship. WU were significantly more likely to report 100% compliance with HIV therapy (86% vs 65%, p=0.05), and to use a condom with additional sex partners (68.4% vs 51%, p= 0.038). In multivariable logistic regression, withdrawal use for HIV prevention was predicted by ever use of withdrawal as contraception after adjusting for additional factors.

CONCLUSION:
Better risk reduction counseling can be targeted to at-risk youths once more information is available about the prevalence of withdrawal use and its application towards pregnancy and HIV prevention.
Prenatal Patient Knowledge of the Interpregnancy Interval [33A]
Authors: Bergin Ashlee , Rankin Kristin , Stumbras Katrina , Handler Arden , Haider Sadia 
Published: May 2017

INTRODUCTION:
Short and long interpregnancy intervals (IPIs) are associated with adverse perinatal and maternal outcomes. While patients receive contraceptive counseling, it is unclear if they receive counseling about the IPI. Because little is known about women's knowledge regarding pregnancy spacing, this survey study aimed to determine whether pregnant women are familiar with the IPI.

METHODS:
Among patients greater than 24 weeks’ gestation seeking prenatal care at the University of Illinois at Chicago Center for Women’s Health between November 2014 and April 2015, 330 patients were approached and 281 completed the survey. Chi-square tests and multivariable logistic regression were used for data analysis.

RESULTS:
Forty-nine of the 281 women (17.8%) reported knowing that the recommended IPI is between 18 and 24 months. Women with a high school education or less were less likely to be familiar with the IPI (OR 0.38 95% CI 0.17-0.82) or know the recommended IPI (OR 0.4 95% CI 0.19-0.86) compared to women that have completed some college, a bachelor's, or a graduate degree. Compared to non-Hispanic White race/ethnicity, non-Hispanic Black race/ethnicity was associated with a decreased likelihood of familiarity with the IPI (0.33 95% CI 0.14-0.76) and knowledge that short IPIs can adversely affect maternal health (OR 0.23 95% CI 0.09-0.62).

CONCLUSION:
Women receiving prenatal care did not know the recommended IPI nor the potential for adverse outcomes with short IPIs. Prenatal care providers should discuss reproductive life plans, and include discussion about the IPI to help women achieve optimal birth spacing, improved birth outcomes, and fewer unintended pregnancies.
Understanding Adolescent Sexual & Reproductive Health Behavior & Care Access in a Rwandan Community [36A]
Authors: Pitotti Jennifer A. , McGuire Chelsea , Chhabra Rosy , Bakundukize Emmanuel , Peskin-Stolze Melissa R. , Nathan Lisa M. 
Published: May 2017

INTRODUCTION:
The prevalent sexual norms and behaviors of rural Rwandan adolescents, including barriers to accessing and utilizing reproductive healthcare services, were explored qualitatively.

METHODS:
Focus groups were conducted with adolescents in the rural community of Kibogora, Rwanda. Participants included students from local secondary schools and adolescents not in school. Interview guides were adapted from validated World Health Organization guides. Trained midwives conducted focus groups in the local language. All were recorded, interpreted, transcribed and coded for themes. Interviewers were matched in gender with interviewees. Each subject completed a demographic survey with questions pertaining to sex and personal relationships.

RESULTS:
One hundred twenty-six adolescents (14-24 years) participated. Fourteen focus groups were conducted. Predominant themes include prevalence of transactional sex, need for sexual and reproductive health knowledge, need for increased access to condoms and services, fear of pregnancy and sexually transmitted infections, and confidentiality issues related to obtaining care. Adolescents correctly identify risks of having unsafe sex (infectious disease and pregnancy) but feel obtaining services is socially prohibitive. Adolescents consistently overestimate the number of sexually active peers when compared to the low number of adolescents reporting sexual activity on anonymous surveys.

CONCLUSION:
It is not only important to involve the local community, including adolescents, in designing and implementing any sexual and reproductive health educational program but it is also important to create safe and comfortable avenues for adolescents to access confidential services.