bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Contraception Use and Contraception Method Preference at Last Intercourse in Cisgender Women at High Risk for HIV Acquisition [ID: 1373337]
Authors: Satish Sanjana , Mantero Alejandro , Sonalkar Sarita 
Published: May 2023

INTRODUCTION:
Cisgender women account for almost 20% of new human immunodeficiency virus (HIV) infections in the United States. This study aims to assess contraception use at last intercourse in cisgender women at high risk for HIV acquisition.

METHODS:
We abstracted demographics, socioeconomic status, HIV risk, and reproductive health information from the 2017 iteration of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. We used survey-weighted logistic regression adjusted for several demographic factors to compare trends of contraception use between those at low and high risk for HIV acquisition, which was defined as those who have engaged in transactional sex practices, used injection drugs, or been treated for a sexually transmitted infection in the past year.

RESULTS:
Women at high risk for HIV acquisition had no significant difference in contraception use at last intercourse compared to those at low risk (P=.262, odds ratio [OR] 1.11 [0.93–1.32]). Among those who did not use contraception at last intercourse, women at risk for HIV acquisition were more likely to state indifference toward getting pregnant (P=.029, OR 1.79 [1.06–3.01]) and lapse in method use (P=.001, OR 4.55 [1.80–11.5]) as reasons for not using contraception. Additionally, those at high risk for HIV were more likely to have had an intrauterine device (IUD) (unknown type) at last intercourse (P<.001, OR 1.70 [1.28–2.24]) and less likely to have used hormonal shots (P=.015, OR 0.47 [0.26–0.86]).

CONCLUSION:
Women at risk for HIV are more likely to have had an IUD at last intercourse, which could indicate a role for the integration of HIV preexposure prophylaxis and family planning. Contraception method preference in this population and attitudes toward pregnancy should be further investigated.
A Descriptive Analysis of Emergency Contraception Familiarity in Postpartum People [ID: 1377163]
Authors: Wegner Lindsay , Lu Connie , Patterson Lane , Serino Maeve , Turner Ashley 
Published: May 2023

INTRODUCTION:
Ensuring access to emergency contraception (EC) is a fundamental component of comprehensive contraceptive counseling and reproductive health care. Despite this, little is known about familiarity with EC in postpartum people, a population motivated to prevent pregnancy in part because of the risk of short interpregnancy interval. This study aims to assess familiarity with EC in postpartum people.

METHODS:
After IRB approval, 76 participants choosing a lower-efficacy method of postpartum contraception were recruited from a large urban hospital on postpartum day 1. Most participants were between the ages of 25 and 34, married, employed, and have had multiple pregnancies. Familiarity with EC and reproductive health were assessed via surveys after attaining patient consent. Descriptive statistics were performed.

RESULTS:
Nearly all participants (91%) had heard of EC before. A minority of participants (18%) have brought up EC with a health care professional, while approximately half (46%) reported a health care professional bringing up EC with them. Most participants (75%) reported being at least somewhat likely to take EC if they wanted to prevent pregnancy. One-third of participants reported prior use of EC, while nearly half of participants (42%) reported having at least one unplanned pregnancy.

CONCLUSION:
A majority of participants were aware of and willing to use EC despite a minority of participants having discussed the option with a health care professional. For all patients but especially those who select a lower-efficacy postpartum contraceptive method, health care providers can supplement reproductive choice and reduce the risk of short interpregnancy interval through comprehensive counseling on when and how to use EC.
A Review of Female Sterilization in the United States in the Wake of Roe v Wade [ID: 1377581]
Authors: Shirazian Taraneh , Parker Mahdia , Zarcadoolas Christina 
Published: May 2023

INTRODUCTION:
With the anticipation of the overturning of Roe v Wade, U.S. physicians reported an increase in demand for female sterilization procedures. This literature review aims to analyze existing survey tools and how they assess sterilization motivations and postprocedure regret.

METHODS:
Keywords “female sterilization tool,” “female sterilization assessment,” “female sterilization questionnaire,” and “female sterilization survey” were entered into the National Center for Biotechnology Information PubMed search. A title screen for female human studies and an abstract screen selection for survey-based, English, and full-text studies were applied. Seventy percent intercoding agreement was reached between four researchers.

RESULTS:
Sixty-five texts were fully reviewed. The minority (15.4%) were U.S. based and 18 (27.7%) of the publications utilized pretested questionnaires. One hundred seventy-four questions across six surveys were analyzed. Comprehension of complex vocabulary and medical terms cannot be assumed to be within the health literacy abilities of most nonmedical professionals. Cultural sensitivity was deficient in questions around contraception choices and family planning, which assumed that these practices are ubiquitous among sexually active women without acknowledging cultures that do not readily use contraception in family planning. Exclusive language regarding gender and sexuality assumed heterosexual preference and cisgender identity for both participants and their partners, which alienates participants who identify LGBTQ+, transgender, or nonbinary and obscures the nuance of sterilization practices among these identities.

CONCLUSION:
Data on sterilization regret and motivations could be hindered by literacy and biased questioning. A novel, pretested survey tool oriented toward inclusive and comprehensive language is needed to capture female sterilization trends.
Elagolix With Add-Back Rapidly Improves Nonbleeding Symptoms in Individuals With Fibroid-Associated Heavy Menstrual Bleeding [ID: 1368052]
Authors: Simon James , Jewell Susan , Li Moming , Ng Juki , Pinsky Brett 
Published: May 2023

INTRODUCTION:
Elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) significantly improves heavy menstrual bleeding (HMB) in patients with uterine fibroids (UFs). Data on the effect of ELA+AB on nonbleeding symptoms in HMB-UF patients are limited.

METHODS:
Elaris UF-1 and UF-2 (NCT02654054 and NCT02691494) were duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month phase 3 studies. This post hoc analysis evaluated the Patients Global Impression of Change (PGIC) for menstrual bleeding (MB) and nonbleeding symptoms. Patients rated symptom change on a 7-point scale from “very much improved” (1) to “very much worse” (7).

RESULTS:
Among responders (6-month MBL <80 mL and ≥50% MBL reduction from baseline), mean (SD) PGIC-MB and PGIC-abdominal bloating were better for ELA+AB versus placebo as early as 1 month (2.1 [1.3], n=199 versus 2.8 [1.5], n=22; and 3.1 [1.2], n=201 versus 3.7 [1.0], n=21, respectively) through 6 months (1.3 [0.9], n=221 versus 2.9 [1.3], n=13; and 2.3 [1.3], n=221 versus 3.7 [0.9], n=13, respectively). Patients treated with ELA+AB had improvement in symptoms at 3 months compared to placebo and at 6 months reached scores in the domains abdominal/pelvic pain (1.8 [1.1] versus 3.2 [1.0]), abdominal/pelvic pressure (1.9 [1.2] versus 3.4 [0.9]), abdominal/pelvic cramping (1.8 [1.0] versus 2.9 [1.2]), and back pain (2.3 [1.3] versus 3.2 [1.0]). Similar results were observed for the total patient population.

CONCLUSION:
ELA+AB provides rapid bleeding and nonbleeding symptom improvement for patients with UF-associated HMB. Improvement for ELA+AB–treated patients was observed as early as 1 month, with nonbleeding PGIC scores consistently approaching “much and very much improved” in all domains by 6 months.
Elagolix Improves Low Hemoglobin in Women With Uterine Fibroid-Associated Heavy Menstrual Bleeding: Post Hoc Analysis of Elaris UF-1 and UF-2 [ID: 1368055]
Authors: Jewell Susan , Pinsky Brett , Schlaff William , Snabes Michael , Uribe Liz 
Published: May 2023

INTRODUCTION:
Women with uterine fibroids (UFs) often experience heavy menstrual bleeding (HMB) and anemia. We report improvement in hemoglobin (Hgb) levels over time with elagolix (ELA) with estradiol 1 mg/norethindrone acetate 0.5 mg once-daily add-back (AB) therapy in women with UF-associated HMB.

METHODS:
This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo (PBO)-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated ELA 300 mg twice daily plus AB versus PBO in women with UF-associated HMB. Hgb concentration (in grams/deciliter) was assessed monthly; no adjustment for multiple comparisons were made. All patients received ELA+AB in the pivotal and extension periods. Patients with baseline Hgb>10.5 g/dL but ≤12 g/dL were classified as “HgbLow” and Hgb≤10.5 g/dL as “Hgb≤10.5.”

RESULTS:
Baseline demographics were balanced between treatment groups. Overall, by month 1 of treatment, patients receiving ELA+AB (n=395) showed significant improvement in mean change in Hgb compared with PBO (n=196, P=.001). At month 6, 58.8% (HgbLow) and 35.7% (Hgb≤10.5) of patients reached Hgb>12 g/dL with ELA+AB versus 27.7% and 7.2% with PBO, respectively. Improvements in Hgb levels were sustained through 12 months (HgbLow, 59.6%; Hgb≤10.5, 46.3%). During the extension period, 49.3% of patients in the Hgb≤10.5 group treated with ELA+AB reached Hgb>12 g/dL at 9 months of treatment, with responses sustained through 12 months (ELA+AB/ELA+AB, 46.3%). 71.9% of patients in the HgbLow group reached Hgb>12 g/dL by 9 months, with responses sustained through 12 months (ELA+AB/ELA+AB, 59.6%).

CONCLUSION:
ELA+AB results in rapid, sustained improvement in Hgb levels in women with UF-HMB, regardless of starting Hgb levels.
Elagolix With Add-Back Therapy Improves Hemoglobin Concentration in Women With Fibroid-Associated Heavy Menstrual Bleeding Across Subgroups: Post Hoc Analysis of Elaris UF-1 and UF-2 [ID: 1368060]
Authors: Schlaff William , Jewell Susan , Kho Andrea , Snabes Michael , Uribe Liz 
Published: May 2023

INTRODUCTION:
Premenopausal patients with fibroid-associated heavy menstrual bleeding often experience anemia-related symptoms and reduced quality of life. Here, we report the effect of elagolix with estradiol/norethindrone acetate add-back therapy (ELA+AB) on hemoglobin (Hgb) concentration across subpopulations of patients at 6 months of treatment.

METHODS:
This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month phase 3 Elaris UF-1/UF-2 studies (NCT02654054/NCT02691494) evaluated Hgb improvement from baseline to 6 months of therapy by change in Hgb concentration and proportion of patients who achieved greater than 1 and greater than 2 g/dL improvement by subgroups (race, age, primary International Federation of Gynecology and Obstetrics [FIGO] score, and baseline menstrual blood loss volume) in prespecified anemic subpopulations (baseline Hgb≤10.5 and 10.5 to ≤12 g/dL).

RESULTS:
Overall, baseline demographics and clinical characteristics were balanced between groups. Regardless of subgroup, patients with mean baseline Hgb less than 10.5 g/dL receiving ELA+AB experienced significant improvements in mean Hgb concentration at 6 months, compared with placebo (P<.001; no adjustment for multiple comparisons were made). These patients had a mean Hgb concentration of 11.6 g/dL at 6 months, with a range of 11.3–12.3 g/dL depending on subgroup. At 6 months, 47% of these patients had an increase of greater than 2 g/dL with a range of 41–59% depending on subgroup.

CONCLUSION:
ELA+AB was effective in improving Hgb concentration across subgroups of premenopausal women with uterine fibroids and anemia (Hgb <10.5 g/dL), regardless of baseline demographics or clinical characteristics, which may therefore alleviate symptoms and reduce complications of anemia.
Sarcopenia in Perimenopausal and Postmenopausal Women in a Tropical Country [ID: 1377057]
Authors: Agarwal Anjoo , Asnani Mona , Singh Renu , Sridhar Aparna 
Published: May 2023

INTRODUCTION:
Improving health services worldwide has led to a gradually aging population. Sarcopenia has been identified as an important contributor to health costs in elderly women in developed countries. The lifestyle and access to medical services is vastly different in the developing countries like India. The present research was conducted to study the status of sarcopenia among perimenopausal and postmenopausal women of India.

METHODS:
Institutional review board approval for the study was obtained from institutional ethical committee. Women aged 40 years or more, having no complaints, and coming to hospital as companions were enrolled after taking consent. A detailed history was taken and activity levels were classified according to the ICATUS 2016 (International Classification for Time-Use Statistics). Muscle strength was evaluated by handgrip strength, gait speed, and appendicular skeletal mass measurement. Serum estradiol, vitamin D3, fasting plasma glucose, and fasting insulin levels were also assessed.

RESULTS:
A total of 50 women were enrolled. 80% (n=40) of women had a sedentary lifestyle while the remaining reported light activity. Sarcopenia was noted in 16% (n=8) and showed a significant association with increasing age (P<.001). None of the women less than 62 years of age had sarcopenia. All women with sarcopenia had a sedentary lifestyle. Women with low body mass index were more likely to have sarcopenia. Low serum estradiol and serum vitamin D3 levels were significantly correlated to sarcopenia (P<.001).

CONCLUSION:
Sarcopenia is an emerging problem. Counseling of women for good nutrition and an active lifestyle can help prevent or delay the onset of sarcopenia. Poor nutrition status of women in developing countries needs to be addressed to combat the problem.
Application of British Criteria for Evaluation of Pregnancies of Unknown Location [ID: 1381226]
Authors: Zhou Linlin 
Published: May 2023

INTRODUCTION:
In the United States, it is recommended that pregnancies of unknown location (PUL) are evaluated with serial β-hCG levels until undetectable or location identified. In Britain, a declining β-hCG level of greater than 50% is considered low risk for ectopic pregnancy, and serial β-hCG measurements are stopped. We sought to investigate the effectiveness of British criteria in excluding ectopic gestation in the management of PUL in an urban U.S. population.

METHODS:
Retrospective study, collection, and statistical analysis of key data points in all patients seen at Jamaica Hospital Medical Center over a 3-year period between January 1, 2019 and December 31, 2021, with PUL were performed.

RESULTS:
Of 260 patients evaluated for PUL, 52 (20%) were ultimately diagnosed with ectopic pregnancies, 72% (28%) with intrauterine pregnancies, and 136 (52%) with spontaneous or missed abortions. A greater than 50% decrease in β-hCG was identified in 62 (24%) patients and was significantly associated with nonectopic gestation (P<.001). Of these patients, only one patient (1.6%) had an ectopic gestation. The β-hCG of the patient with ectopic declined from 649 to 240 in the first 48 hours, and then rose to 546 at 96 hours. A presumptive diagnosis of ectopic was made, for which methotrexate was administered.

CONCLUSION:
Retrospective application of British criteria for PUL successfully predicted greater than 98% of patients with low-risk gestation. Using this criterion would have resulted in 19% fewer visits and 19.9% fewer β-hCG levels drawn. However, one presumptive ectopic was missed. Public health guidelines must balance cost and safety criteria. Larger prospective studies with built-in safety mechanisms and strictly defined outcome criteria are needed to better characterize the safety profile and potential cost savings of the application of the British guidelines for PUL to a U.S. population.
Evaluation of Vaginal Microbiome to Estimate Vaginal Health in Gynecology Patients Presenting With Vaginitis [ID: 1381290]
Authors: Johnson Sarah , Carroll Lisa , Ivan Nicole , Ray Margaret 
Published: May 2023

INTRODUCTION:
Approximately 50% of vaginitis cases are misdiagnosed because of human error with the current diagnostic method of light microscopy wet mount. Untreated vaginitis may lead to complications of increased risk of sexually transmitted infections or preterm birth. Use of artificial intelligence (AI) and immunofluorescence scanning microscopy can aid in determining the health of the vaginal microbiome.

METHODS:
Institutional review board approval was obtained for the study. Participants who fit the inclusion and exclusion criteria were consented for participation. Patient demographic information was de-identified and recorded. Three swabs from each patient were collected: one for traditional wet-mount diagnosis, and two for DayZ Vaginal Health Assessment Assay analysis. The targets of interest recorded were clue cells, yeast pseudohyphae, and trichomonads. The evaluation compared wet-mount findings to the automated AI algorithm results.

RESULTS:
In preliminary data analysis of 58 patient samples, AI had an accuracy of 95% in finding trichomonads, 91% in candida, and 90% in clue cells. The AI detected trichomonads on one sample that was missed by the expert reader, detected pseudohyphae on three samples that were undetected by the expert reader, and detected clue cells in 17 samples that were undetected by the expert reader. These data are preliminary as the sample collection and data analysis are ongoing.

CONCLUSION:
The assay has shown superior ability to diagnose wet-prep findings compared to standard wet-mount evaluation. This new technology could provide a reliable source to determine a quick and accurate diagnosis for patients with symptomatic or asymptomatic vaginitis.
Survival Outcomes of Kidney Transplantation Among Women of Reproductive Age in the United States [ID: 1373252]
Authors: Akinyemi Oluwasegun , Guoyang Luo , Lipscombe Christina , Ogundipe Temitayo , Weldeslase Terhas Asfiha 
Published: May 2023

INTRODUCTION:
Adult kidney transplantation in the United States has steadily increased over the years. In 2018, there were 678 kidney recipients per million people, representing a 40% growth since 2008. Different studies have shown disparities in the rate and outcomes of kidney transplantation in the United States. However, few have explored how the social determinants of health influence the outcomes of kidney transplantation among women of reproductive age. This group needs to be studied separately as factors like sexuality, contraception, and pregnancy can complicate outcomes after transplantation.

METHODS:
We utilized data from the United Network for Organ Sharing (UNOS 1987–2022) database to explore outcomes of renal transplantation among women of the reproductive-aged group (15–49 years). The outcome measures include graft survival and overall patient survival. In addition, we compared outcomes among women and men across different age groups. In the multivariate analysis, we adjusted for the patient’s body mass index, donor’s age, sex, body mass index, preexisting comorbidities such as hypertension and diabetes, and ABO group.

RESULTS:
Among the 521,797 kidney transplant recipients in the United States kidney records in the study period, 282,253 were women. Among these female kidney recipients, 6,680 (3.2%) were aged less than 15 years, 101,908 (49.4%) were between 15 and 49 years, and the remaining 97,723 (47.4%) were above the age of 50 years. The 5- and 10-year survival according to age group was less than 15 years (78.5%, 60.4%), 15–49 years (74.7%, 55.5%), and 50 years or older (74.8%, 49.8%). Across the different age groups, outcomes were better in women than men. The table shows the influence of race and ethnicity, insurance type, and education level on graft and overall patient survival.

CONCLUSION:
Women kidney recipients have better outcomes compared to men. Increasing education level and race and ethnicity are significant drivers of outcomes among women renal transplant recipients in the reproductive-aged group.
Effect of Social Determinants of Health on Advanced Stage Type 2 Endometrial Cancer at Time of Diagnosis [ID: 1376689]
Authors: Blustein Pegah , Dillon Kayla , Pereira Elena , Villella Jeannine , Werner Sarah 
Published: May 2023

INTRODUCTION:
Type 2 endometrial cancer (T2EC) accounts for 38.7% of all endometrial cancers but is responsible for 74.6% of endometrial cancer deaths. This is potentially due to advanced stage at time of diagnosis. We examine whether social determinants of health are predictors associated with T2EC diagnosed at an advanced stage.

METHODS:
Retrospective analysis of T2EC cases was performed from May 1, 2015, to March 31, 2022, at one academic site. The primary outcome was advanced stage at time of surgical diagnosis, defined as FIGO stages 3 or 4. Patient age, ethnicity, race (White versus non-White), obesity, and diabetes were evaluated. Multivariate logistic regression model was used to investigate predictors associated with increased risk of advanced-stage disease (ASD), with two-sided P value of <.05 considered significant.

RESULTS:
A total of 72 patients with T2EC were identified. Thirty-eight (52.7%) cases had early-stage disease and 34 (47.3%) cases had ASD at diagnosis. Ethnicity was the only predictor significantly associated with the primary outcome. Hispanic or Latina ethnicity was associated with 5 times higher odds (odds ratio 5.1, 95% CI 1.2–21.6, P=.028) of ASD at diagnosis, compared to non-Hispanic or Latina.

CONCLUSION:
Our results show that Hispanic or Latina ethnicity was significantly associated with advanced stage at diagnosis. Non-White race, obesity, diabetes, and age at surgery were not found to be predictors significantly associated with the primary outcome. This could be due to sample size limitations. To facilitate health equity, there is continued need for investigation into the effect of social determinants of health on ASD for T2EC.
Racial Disparities in Vaginal Hysterectomy Postoperative Outcomes: Trends Using the NSQIP Database [ID: 1377940]
Authors: Gragas Anna , Abella Maveric , Casil Paige , Cochrane Brooklyn , Collins Robert , Stafford Michelle 
Published: May 2023

INTRODUCTION:
Vaginal hysterectomies (VHs) are associated with superior outcomes in operative time, postoperative complications (PCs), and recovery, and thus VH is often the preferred approach whenever feasible. Racial disparities have previously been described for abdominal and laparoscopic hysterectomies, but not for the vaginal approach. The purpose of this study was to disaggregate racial data and evaluate variation in VH surgical outcomes by race.

METHODS:
The National Surgical Quality Improvement Program was queried to identify all VHs from 2011 to 2020 in the National Surgical Quality Improvement Project (n=59,469). Multivariable regression models were used to investigate the effect of race on 30-day PCs and same-day discharge (SDD).

RESULTS:
Compared to non-Hispanic White patients and other minority groups, American Indians and Alaskan Natives (AI/AN) had 2.6% higher odds of PC (adjusted odds ratio [AOR] 1.026, 95% CI 1.002–1.050) and 6.2% lower odds of SDD (AOR 0.938, 95% CI 0.911–0.965). Non-Hispanic Black patients had 1.1% higher odds of PC (AOR 1.011, 95% CI 1.003–1.020). Paradoxically, Native Hawaiian and Pacific Islander (NH/PI), Asian, and Hispanic patients had 30.9%, 18.7%, and 3.3% higher odds of SDD, respectively, without statistically significant increased odds of PC.

CONCLUSION:
AI/AN and Black patients were more likely to have a PC, while NH/PI, Asian, and Hispanic patients were more likely to have SDD without significantly higher odds of PC. Given these findings, it may be reasonable to encourage the VH approach especially in the NH/PI, Asian, and Hispanic patient populations.