bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Papillomavirus Vaccination Hesitancy, Screening Disparities, and Associated Factors Among Sexual and Gender Minority Women: A Systematic Review of Global Literature [ID 2683547]
Authors: Skiba Bartosz , Nussbaum Abigail , Otero Christopher Acevedo , Khikmatov Murod 
Published: May 2024

INTRODUCTION:
Human papillomavirus (HPV) ranks as the most prevalent sexually transmitted infection globally, with a significant association with cervical cancer in cervix-having individuals. Understanding the epidemiological patterns of HPV vaccination rates and behaviors within the context of sexual and gender minority (SGM) women is essential in identifying factors hindering the initiation of HPV vaccination and screening.

METHODS:
A systematic review was conducted by searching five databases (PubMed, CINAHL, Embase, Web of Sciences, MedLine). Eligibility criteria included the following: reported HPV vaccination or screening outcomes, conducted among SGM women, data collected since 2010. All studies were independently screened and synthesized following PRISMA guidelines. Of 44 items, 13 studies met the criteria.

RESULTS:
Sexual and gender minority women reported substantial HPV vaccine hesitancy and decreased screening practices compared to their non-SGM peers, with the degree of vaccine hesitancy and delayed screening varying among bisexual, lesbian, and transgender individuals. Individual factors associated with HPV vaccine hesitancy and decreased screening include socioeconomic status, vaccination awareness, and SGM identity. Meanwhile, interpersonal and structural factors include community biases, family support, lack of provider LGBTQ+ health education, and structural racism.

CONCLUSION:
Sexual and gender minority women experience a substantial health care disparity surrounding HPV vaccination hesitancy and screening status. Results from this study substantiate the need for the standardization of health care practice, individual patient vaccine counseling, and the expansion of sexual and gender minority health training at all tiers of medical education. Furthermore, additional disaggregated research is needed to understand the unique health circumstances of bisexual, lesbian, and transgender individuals, as the current research landscape fails to capture the community’s health needs.
Social Determinants of Health and Patient-Reported Difficult Removal of Long-Acting Reversible Contraception [ID 2683430]
Authors: Hall Bianca E. , Atrio Jessica , Evans Thomas A. , Danvers Antoinette 
Published: May 2024

INTRODUCTION:
Lack of access to high-quality reproductive health care has been reported by persons negatively affected by social determinants of health (SDH). The inability to discontinue a contraceptive method when desired can deleteriously affect a person’s reproductive autonomy. The objective of this study is to evaluate the association of SDH with participant-reported difficult long-acting reversible contraception (LARC) removal.

METHODS:
A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal.

RESULTS:
Seven hundred fifty-four respondents reported wanting to have their LARC removed. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). 105 (11%) reported difficult LARC removal. After adjusting for age, race, education, geographic location, parity, and body mass index, persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficult LARC removal compared to respondents without any SDH (2.11 [95% CI: 1.21, 3.69]). Transportation barriers demonstrated the largest aOR of 2.90 [95% CI: 1.07, 7.87].

CONCLUSION:
Social determinants of health are unique risk factors that can negatively affect reproductive justice. Social determinants of health are associated with participant-reported difficult LARC removal. Consideration of SDH at the time of contraceptive selection may be a critical step in addressing equitable and safe access to contraceptives with attention to method discontinuation.
Evaluating Contraception Counseling and Desire for Immediate Postpartum Long-Acting Contraception in Publicly Insured Adolescents [ID 2683512]
Authors: Kaak Katherine , Zite Nikki , Mastronardi Alicia , Maples Jill M. , Young Megan Lacy 
Published: May 2024

INTRODUCTION:
Adolescent pregnancy is associated with a high prevalence of short interval birth and unplanned pregnancy, along with other risks. Immediate postpartum long-acting reversible contraception (IPP LARC) has the potential to improve these outcomes. This study aimed to examine the presence of counseling, desire, and obtainment of IPP LARC during hospitalization.

METHODS:
This retrospective cohort analysis used electronic health records to capture demographics, pregnancy details, and contraceptive discussions and plans for pregnant patients admitted for delivery in one East Tennessee hospital. Exclusion criteria included those with private insurance or received permanent sterilization during hospitalization. Adolescence was defined as age less than 20 years at the time of delivery. Data were extracted from March 2018 to June 2023. Chi-squared tests were conducted in SPSS.

RESULTS:
10,492 patients that met inclusion criteria delivered between March 2018 and June 2023. Of these, 10.8% (n=1,128) were adolescents. Desire for IPP LARC upon admission was higher among adolescents (31.6% versus 25.1%; P<.001). IPP LARC placement was significantly higher among adolescents (overall, 24.0% [n=2,523]; adolescents, 27.5%, versus age 20 and older, 23.6%; P=.005). Adolescents who self-reported receiving contraceptive counseling during prenatal care were more likely to receive IPP LARC (66.5% versus 42.4%; P<.001).

CONCLUSION:
In this study, prenatal contraception counseling increased patient obtainment of desired postpartum contraceptive plan, including IPP LARC. Adolescents both desired and obtained IPP LARC more frequently than their older counterparts. Improved contraceptive counseling and access to all contraceptive options, including IPP LARC, may improve teen pregnancy and birth rates.
Hospitals Are Closing in Tennessee: Investigating the Effect of Closures on Contraceptive Access and Short-Interval Birth [ID 2683524]
Authors: Young Megan Lacy , Mastronardi Alicia , Shelton Zachary , Maples Jill M. , Zite Nikki 
Published: May 2024

INTRODUCTION:
Access to maternity care (MC) and providers are important factors for contraception access and health outcomes for pregnant-capable individuals. After a series of hospital closures in Tennessee in the last decade, this study investigated the relationship between maternal county of residence and short-interval birth (SIB) rates statewide.

METHODS:
Tennessee birth certificate data for 2015–2020 from the Tennessee Department of Health was coded using March of Dimes 2022 definitions of access to MC overall, a hospital with obstetric (OB) care or birth center, and an OB provider (per 10k births) based on maternal county of residence. Short-interval birth was defined as birth interval 6–23 months. Nulliparous births and those with missing last living birth interval were excluded. Analysis was completed in SPSS 29.0, and Pearson χ2 tests compared SIB proportions between MC access groups.

RESULTS:
Overall, 269,908 births were analyzed. Of these, 78.1% maternal counties of residence had full MC access, 13.9% had low access, and 8.0% resided in a MC desert. Short-interval births were highest (24.4%; CI, 23.8–25.0) in MC deserts followed by areas with full access (23.7%; CI, 23.5–23.9) and low access (22.4%; CI, 22.0–22.8) (P<.001). Those with no access to an OB provider had highest rates of SIB (24.3%: CI, 23.7–24.8) compared to other categories (P<.001).

CONCLUSION:
Lacking access to maternity care likely corresponds with lacking access to contraception and higher rates of SIB in Tennessee. Prenatal and postpartum contraception counseling are important components of care for all individuals but especially those without acceptable access to OB providers and hospitals.
Evaluating the Accuracy and Utility of Large Language Models in Answering Common Contraception Questions [ID 2683633]
Authors: Patel Anisha V. , Jasani Sona , AlAshqar Abdelrahman , Panakam Aisvarya , Amin Kanhai , Sheth Sangini S. 
Published: May 2024

INTRODUCTION:
Traditional web resources that provide information on contraception produce varied results demanding user synthesis. However, direct answers provided by large language models (LLMs) can offer accessible contraception counseling. This study examines the efficacy of four LLMs, OpenAI's ChatGPT 4.0, OpenAI's ChatGPT 3.5, Google Bard, and Microsoft Bing, in answering common contraception questions.

METHODS:
Contraception questions and responses in a recent American Academy of Family Physicians (AAFP) review were used as reference text. We presented GPT-4.0, GPT-3.5, Bard, and Bing with six contraception questions from the AAFP text, ensuring no prior chat bias. Response formatting was standardized for analysis. Two ob-gyn physician reviewers (S.J. and A.A.), blinded to the source LLM, assessed responses via a 5-point Likert scale on the following criteria: response specificity, evidence basis, completeness, referrals to outside resources, and avoiding speaking in absolutes. Responses were analyzed using the Kruskal–Wallis test (SAS 9.4).

RESULTS:
The AAFP review scored highest in response specificity, evidence basis, and completeness. Large language models differed significantly on whether responses were evidence based (P<.0001), made referrals to outside resources (P<.001), or spoke in absolutes (P<.05). Notably, GPT-3.5 and Bard consistently provided referrals across all six questions, outperforming the AAFP text on this criteria. No significant differences were found across LLMs in response specificity or response completeness.

CONCLUSION:
Despite promising LLM-generated responses, the AAFP review outperformed LLMs in critical areas including evidence basis and completeness. Nonetheless, LLMs, especially GPT-3.5 and Bard, demonstrated strong potential as supplementary resources for reproductive health education.
Sterilization Surgery Trends in Texas After Passage of the Texas Heartbeat Act [ID 2683648]
Authors: Mohr-Sasson Aya , Weitzel Lindsay L. , Carlisle Steven G. , Bhalwal Asha 
Published: May 2024

INTRODUCTION:
On September 1, 2021, abortion became illegal in Texas once electric embryonic cardiac activity can be detected. Before that, elective abortions were allowed up to 20 weeks postfertilization. In order to primarily avoid unwanted pregnancy, a trend for younger women to seek a definite contraception method has been observed; however, this has not been studied yet. The aim of this study was to compare the characteristics of women requesting surgical sterilization before and after the Texas Heartbeat Act went into effect.

METHODS:
This is a retrospective study including all women who underwent bilateral salpingectomy for surgical sterilization between May 2020 and November 2022. Women who underwent surgery 15 months before the new laws (controls) were compared to women who underwent surgery 15 months after the change (study group). Demographic, clinical characteristics, operative, and postoperative data were collected from women's medical files.

RESULTS:
Two hundred five women met inclusion criteria, of them 131 (64%) in the study group and 74 (36) controls. The rate of women with managed care insurance was significantly higher in the study population (P=.04). Median age was similar between the groups (P=.98). Parity was significantly higher in the controls (P=.004); however, the rate of nulliparous women more than doubled in the study population (37 [28%] versus 8 [11%]; P=.004). Surgery as first contraception method was reported in 63 (48%) and 41 (19%) of the women in the study and control groups, respectively (P=.58). Complication rate was found higher for the study group, but the difference did not reach significance [4 (3.1%) versus 0 (0); P=.13].

CONCLUSION:
Since the passage of the Texas Heartbeat Act, more women with managed care insurance were undergoing surgical sterilization. Although the mean age to undergo the surgery did not change compared to the period before the change in the law, the rate of nulliparous women preferring this method for contraception significantly increased.
Case Report of a Large Endometrioma Precipitating a Hypertensive Emergency [ID 2683395]
Authors: Vishwanath Varnita , Marchand Greg J. , Azadi Ali 
Published: May 2024

INTRODUCTION:
This is a rare case of a 25-cm endometrioma in a woman who presented in a hypertensive emergency. The hypertension was believed to be secondary to the mass effect of the endometrioma on renal vasculature.

METHODS:
A 20-year-old female presented to the ED with diffuse abdominal pain, severe hypertension (190/121), and acute kidney injury (AKI) (Cr 2.4, GFR 38). At presentation, management of hypertension required intravenous hydralazine and adequate pain control. The workup included an abdominal CT that revealed a large 25×18×12-cm cystic mass. The mass was suspected to have a significant mass-effect on adjacent structures that caused bilateral hydroureteronephrosis secondary to distal ureteral compression. Management of this case began with the placement of bilateral nephrostomy tubes to improve renal function. The pelvic mass was removed with a minimally invasive robotic approach. The patient had an uneventful postoperative course with normalization of blood pressure and resolution of the AKI. Pathology confirmed the diagnosis of endometriosis. Prior to the removal of nephrostomy tubes, a nephrostogram was performed, which demonstrated appropriate drainage bilaterally. At 1 year follow-up, the patient was asymptomatic and was able to conceive. This case report was IRB-exempt.

CONCLUSION:
A multidisciplinary approach to the management of endometriosis is often warranted as it may affect organs outside of the reproductive system. In this case, the etiology of hypertension is believed to be due to mass effect of the cyst on the renal arteries. Low renal perfusion activates the renin–angiotensin–aldosterone system, releasing Angiotensin II and aldosterone, causing systemic vasoconstriction and secondary hypertension. In this case, a minimally invasive approach to remove the mass and ureterolysis resulted in the resolution of the pelvic pain, AKI, and normalization of blood pressure.
Case Series: Medical Versus Surgical Management of Cesarean Scar Pregnancy [ID 2683419]
Authors: Kadesh Amanda , Liao Connie , Sangal Alisha , Davis Patricia C. , Wieczorek William E. , DeFilippis David J. 
Published: May 2024

INTRODUCTION:
Although cesarean scar pregnancy (CSP) is rare, it is a potentially fatal condition, and the incidence is rising. Treatment of CSP may consist of medical management with methotrexate or surgical management; however, a consensus regarding optimal treatment has not been well defined. This series reports our experience with management of CSP.

METHODS:
Our series included a chart review that identified 10 cases of CSP from 2020 to 2023 at a high-volume, community-based, academic hospital that serves as a surgical referral center in a metropolitan area. We obtained IRB exemption.

RESULTS:
At diagnosis of CSP, gestational age by ultrasound ranged from 5 6/7 weeks to 11 4/7 weeks. None of the pregnancies had ruptured. Eight cases reported symptoms including bleeding or abdominal pain. Six underwent surgical management: one dilation and evacuation (D&E), one D&E converted to laparotomy, two combined D&Es with robotic-assisted laparoscopic excisions, and two laparotomies with excision. Four received methotrexate: one intragestational, two dual-dose intramuscular, and one single-dose intramuscular. All surgical cases resulted in definitive resolution. Of those treated with methotrexate, three of four cases required additional methotrexate treatment. Time from initial dose of methotrexate to resolution ranged from 29 to 95 days.

CONCLUSION:
In our experience, the advancement of gynecologic surgical modalities has broadened options for CSP treatment to allow for definitive and timely management. Methotrexate remains a viable option; however, treatment failures occur and may prolong a potentially life-threatening condition. Our findings strengthen the recommendation for surgical management, consistent with SMFM guidelines. Furthermore, there is an opportunity to provide surgical training to better equip gynecologists with the ability to treat this challenging condition.
Patient Experiences With Dismissal, Delay, and Uncertainty in Diagnosis of Polycystic Ovary Syndrome [ID 2683465]
Authors: Zhang Alexander , McKenney Kathryn , Ross Kaitlin V. , Sehrt Madeleine N. , Ley Sara A. , Phimphasone-Brady Phoutdavone 
Published: May 2024

INTRODUCTION:
Polycystic ovary syndrome (PCOS) affects approximately 10% of females and is underdiagnosed, undertreated, and underresearched. A majority of people with PCOS report dissatisfaction with their care experiences. We conducted focus groups to identify factors contributing to suboptimal PCOS care.

METHODS:
We conducted 60- to 90-minute virtual focus groups. Patients receiving PCOS care at a university hospital obstetrics and gynecology clinic were recruited. Participants were asked about PCOS symptoms and experiences of care. Rapid qualitative analysis was performed to identify major themes.

RESULTS:
Twenty-four participants completed focus groups. Three identified as any non-White race and eight as Hispanic or Latino; median age was 29 years. Participants' most bothersome symptoms were menstrual irregularity, unwanted hair, cystic acne, and pelvic pain. Time from symptom onset to diagnosis ranged from 2 months to 13 years. Providers’ dismissal of symptoms and failure to perform diagnostic testing contributed to diagnostic delays. Once diagnosed, participants reported feeling confused, overwhelmed, and fearful, and received little education from providers. Participants desired more information about treatment options and implications of PCOS on fertility and long-term health. Regarding initial treatment, recommendations for weight loss and prescriptions for oral contraceptives, metformin, and spironolactone were common. Referrals to nutrition and behavioral health services were rare and non-existent, respectively. Treatments focused on individual manifestations of PCOS more often than comprehensive well-being.

CONCLUSION:
Dismissal of symptoms, delays in diagnosis, and uncertainty about future health are common patient experiences in PCOS care. Our findings identify a need for improved patient resources and provider education about PCOS manifestations, diagnosis, and treatments.
Evaluating the Effect of Chronic Pelvic Pain Among Hispanic Women in Puerto Rico [ID 2683625]
Authors: Salgado-Avilés Juan , Cárdenas-Suárez Natalia , Rosado Torres Claudia S. , Seguinot-Tarafa Inevy I. , Lozada-Capriles Yolianne , Romaguera Josefina 
Published: May 2024

INTRODUCTION:
Chronic pelvic pain (CPP) substantially impairs the quality of life of women, often persisting despite treatment. This study aims to describe the clinical features and evaluate the quality of life in Hispanic patients with chronic pelvic pain.

METHODS:
This was a cross-sectional study of Hispanic women aged 21–55 diagnosed with CPP. Recruitment was performed via social media and at gynecology clinics in Puerto Rico. A self-administered questionnaire was employed to inquire about their sociodemographic profile, medical history, and details to characterize their CPP. The SF-20 survey was used to evaluate quality of life. Institutional review board approval from the University of Puerto Rico was obtained for this study.

RESULTS:
Preliminary data included 92 participants with an average age of 33 (±7.4) years. Most (57.3%, 59) reported having endometriosis, in addition to their diagnosed CPP. Most participants described their suffered pain as a range from strong (30, 33.0%) to insufferable (23, 25.3%). On average, participants reported a physical function score of 60.2% (13.2) and a pain score of 60.7% (4.0). Most noted that their ability to perform their work (76.1%, 70) and their mental health (75.0%, 69) had been affected by their condition. In addition, 55.4% (51) reported an effect on their relationships with friends and 64.1% (59) reported an effect on their relationships with their partners.

CONCLUSION:
Our study highlights the effect of CPP on the quality of life of this population with notable disruptions in various aspects of daily living, including work, social relationships, and mental health.
#PapSmear on TikTok: User Sentiments and Health Information [ID 2683630]
Authors: McElrath Madelaine E. , Robb Carolyn , Akbar Aneesah , Banerjee Ipsha , D'Ascanio Antonella M. , Stifani Bianca 
Published: May 2024

INTRODUCTION:
TikTok has emerged as a leading social media platform, with many users using the app for educational purposes, including for discussions about obstetrics and gynecology. We assessed tone, content, and quality of health information of TikTok videos tagged with #PapSmear.

METHODS:
One hundred videos tagged with #PapSmear on TikTok were collected using the data-scraping program, Apify (Prague, Czech Republic). Videos were extracted with their number of views, likes, comments, and shares, and analyzed for tone, themes, creator demographics and health information quality. Two modified standardized scales were used: DISCERN, for health information quality and Patient Education Materials Assessment Tool (PEMAT), for understandability and actionability.

RESULTS:
We reviewed 93 of 100 videos tagged with #PapSmear. Videos received 237 million views, 19 million likes, and 241 thousand comments in total. Videos were coded as positive (26.9%), negative (37.6%), and neutral (35.5%). Medical professionals created most of the positive videos (68.0%), whereas most negative video creators were not medical professionals (91.4%). Nearly half of positive videos were educational (48.0%), and most negative videos recounted personal patient experiences (60.0%). Videos scored high on understandability (average 73.4%, SD 16.3%) but low on actionability (average 31.9%, SD 34.1%) and quality of health information (2.12, SD 0.4).

CONCLUSION:
There is a discrepancy in tone between patients and medical professionals in videos tagged with #PapSmear. Videos with educational material were easy to understand, but provided low-quality health information and did not effectively highlight opportunities for patient action. Negative influence from TikTok should be considered in patient–provider communication about Pap smears.