bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between BMI and Adherence After the Insertion of Etonogestrel-Releasing Implant [ID: 1376766]
Authors: Mohr-Sasson Aya , Bhalwal Asha , Dalal Leanne 
Published: May 2023

INTRODUCTION:
The aim of this study is to learn the association between body mass index (BMI) to the incidence of side effects and adherence to treatment of etonogestrel-releasing implant.

METHODS:
This is a retrospective cohort study, conducted at a single university-affiliated medical clinic, including all women that underwent etonogestrel-releasing implant (Nexplanon, Merck and Co.) insertion between January 2019 to December 2021. Information on patients’ demographic, medical history, obstetrical and gynecological history, and follow-up were collected from women’s electronic medical files. Primary outcome was defined as the rate of implant removal in the obesity classes. The study was IRB approved.

RESULTS:
Study population included 1,318 women; of them, 466 (35%) requested early removal of the implant. Women’s demographic and clinical characteristics were comparable between women who requested early removal to those with full-length treatment. The median time for removal was 12 (6–20) months from insertion. Irregular bleeding was the most frequent reason for early removal in both groups and more prevalent in the early removal group (239 [51.29%] versus 193 [22%], P=.001). The rate of women with obesity (BMI ≥30 kg/m2) was found lower in the early removal group (163 [35%] versus 350 [41.1%], P=.03) with comparable rates between the groups in class 3 obesity (BMI ≥40 kg/m2) (P=.68). Side effects rate as a compound parameter (including irregular bleeding, heavy bleeding, weight gain, and mood changes) was higher in the group who didn’t have obesity (39.1% versus 32.7%, P=.02). Multi-regression logistic analysis including age, BMI, parity, and side effects found the presence of side effects as the only independent predictor significantly associated with early implant removal (B=1.74, P=.04).

CONCLUSION:
Adherence to etonogestrel-releasing implant contraception treatment is associated to the presence of side effects that is reported more often in women who do not have obesity. Body mass index was not found to be a significant factor influencing adherence to treatment.
Unmet Need for Safe Contraceptive Use Among Hypertensive Women at Risk for Unintended Pregnancy [ID: 1376928]
Authors: Panushka Katherine , Danvers Antoinette , Evans Thomas , Gurney Elizabeth , Peskin Melissa 
Published: May 2023

INTRODUCTION:
The prevalence of hypertension among reproductive-aged women in the United States is increasing, and hypertension increases risks of adverse pregnancy and fetal outcomes. Cardiovascular events are the leading cause of pregnancy-related death in the United States. Therefore, contraceptive counseling should be an essential aspect of hypertension management. Our objective was to compare contraceptive counseling and use among hypertensive and nonhypertensive people at risk of unintended pregnancy.

METHODS:
Using the 2015–2017 and 2017–2019 National Survey of Family Growth (NSFG) Female Respondent Files, we compared contraceptive counseling and contraceptive use in the previous 12 months among people with and without hypertension. Linear probability models were used to estimate the adjusted probability of receiving contraceptive counseling and using contraception.

RESULTS:
Among 8,625 participants, 771 (8.7%) were hypertensive. 26.2% (95% CI 20.4–31.9) with hypertension and 20.7% (95% CI 19.3–22.2) without hypertension reported receiving contraceptive counseling. 39.8% (95% CI 33.2–46.5) with and 35.3% (95% CI 33.3–37.2) without hypertension reported using contraception. Adjusted results indicate hypertensive participants were 8.0% (95% CI 2.4–13.6) more likely to receive counseling, and 9.4% (95% CI 2.7–16.1) more likely to receive birth control. The most used contraceptive method by hypertensive participants was combined oral contraceptive pills (54.0% [95% CI 44.3–63.5%]).

CONCLUSION:
Among people at risk for unintended pregnancy, only 26.2% with hypertension received contraceptive counseling, and less than 40% used a contraceptive method. These results illuminate a large, unmet need for contraceptive access. Given the association of hypertension and maternal health, improving contraceptive delivery to this group provides an opportunity to prevent pregnancy-related morbidity.
Prescribing Patterns for Postpartum Contraception Among Breastfeeding Patients Insured Under Medicaid [ID: 1375071]
Authors: Whelan Anna , Amanullah Siraj , Gjelsvik Annie 
Published: May 2023

INTRODUCTION:
The United States has a long history of reproductive coercion with people of color and lower socioeconomic status more likely to receive contraception/sterilization counseling than White, affluent patients. Contraceptive choice is important postpartum, particularly among people who plan to breastfeed. This study assessed postpartum contraception/sterilization prescription among breastfeeding people in Rhode Island insured under Medicaid compared to other insurances.

METHODS:
Secondary analysis of data from the Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2019 was performed. Participants who answered yes to “having ever breastfed” were included and dichotomized based on insurance into “Medicaid” or “other insurances.” Primary outcome was postpartum contraception/sterilization prescription. Stata 15 was used to perform multivariable logistic regression accounting for complex survey design and weighting.

RESULTS:
Of 3,686 participants, 868 (24.4%) were insured under Medicaid. Medicaid participants were younger, had higher body mass indexes, and were more likely to identify as Black or mixed race or Hispanic ethnicity than those with other insurers. Those insured under Medicaid were 1.5 times more likely to be prescribed postpartum contraception than those with other insurers (95% CI: 1.26, 1.78). After adjusting for race and ethnicity, education level, marital status, and preterm delivery, those with Medicaid were 1.34 times more likely to be prescribed contraception (95% CI: 1.05, 1.72). Postpartum contraception prescription was inversely related to length of breastfeeding (P<.04).

CONCLUSION:
In this study, breastfeeding participants with Medicaid were more likely to be prescribed postpartum contraception than those with other insurances. Future research should be focused on assessing provider bias and initiatives to provide equitable and patient-centered counseling in this population.
Fezolinetant Treatment of Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: Effect of Intrinsic and Extrinsic Factors in Two Phase 3 Studies [ID: 1356963]
Authors: Santoro Nanette , King Deanna , Nappi Rossella , Neal-Perry Genevieve , Ottery Faith , Yamaguchi Yusuke 
Published: May 2023

INTRODUCTION:
Fezolinetant was well tolerated and effective in reducing the frequency and severity of menopause-associated, moderate-to-severe vasomotor symptoms (VMSs) in SKYLIGHT 1 and 2. This analysis investigated the relationship between intrinsic (individual-related) and extrinsic (outside-influence) factors and fezolinetant efficacy.

METHODS:
In these phase 3, double-blind, placebo-controlled, IRB-approved studies (NCT04003155 and NCT04003142), women aged 40 through 65 years with moderate-to-severe VMSs (seven or more hot flushes/day) were randomized to once-daily placebo, fezolinetant 30 mg, or fezolinetant 45 mg. For this pooled analysis, the influence of intrinsic and extrinsic factors on change from baseline to week 12 in the frequency of moderate-to-severe VMSs was assessed by subgroups using a mixed model for repeated measurement.

RESULTS:
One thousand twenty-two women took one or more dose (placebo, n=342; fezolinetant 30 mg, n=339; fezolinetant 45 mg, n=341). Consistent improvements in VMS frequency over placebo were observed across subgroups with fezolinetant 45 mg. For intrinsic factors, least-square mean differences (95% CI) between fezolinetant 45 mg and placebo were as follows: age less than 55 years, −2.78 (−3.74, −1.82); 55 years or older, −2.24 (−3.23, −1.24); White race, −2.17 (−2.93, −1.41); Black race, −3.67 (−5.32, −2.01); and body mass index of 30 kg/m2 or higher, −2.87 (−4.11, −1.63). Extrinsic factors showed the following differences: current smoker, −3.48 (−5.19, −1.77); former/never smoker, −2.32 (−3.08, −1.57); European resident, −1.50 (−2.73, −0.26); and North American resident, −2.95 (−3.78, −2.13). Similar efficacy trends were observed with fezolinetant 30 mg.

CONCLUSION:
Fezolinetant was efficacious in treating moderate-to-severe VMSs associated with menopause across the intrinsic and extrinsic factors investigated, demonstrating its potential utility in a broad population.
Long-Term Safety of Elagolix With Add-Back in Women With Endometriosis-Associated Pain: 36-Month Results [ID: 1368036]
Authors: Simon James , Kim Jin Hee , Miller Paul , Ng Juki , Snabes Michael , Thomas James 
Published: May 2023

INTRODUCTION:
Herein, we report updated safety results to 36 months from an ongoing phase 3, 48-month study evaluating the long-term safety of elagolix (ELA) with add-back (AB) for endometriosis-associated pain (EAP) (NCT03213457).

METHODS:
Premenopausal women with moderate-to-severe EAP were randomized in this IRB-approved study 4:1:2 to receive 12-month blinded treatment with ELA 200 mg twice daily (BID)+AB, ELA 200 mg BID for 6 months followed by 6-month ELA+AB, or placebo; followed by open-label ELA+AB for all patients for 36 months. This 36-month analysis assessed long-term safety, including bone mineral density (BMD).

RESULTS:
Throughout the open-label treatment period up to 36 months, BMD mean percent change from baseline measurements remained relatively stable at the total hip and lumbar spine and showed a decrease between 1% and 2% in the femoral neck over the open-label period. At 36 months, mean percent change from baseline in BMD for patients treated with ELA+AB throughout the study was −0.77% (spine, n=94); −0.36% (total hip, n=92); and −1.39% (femoral neck, n=92). The overall safety profile of ELA+AB, including AEs and SAEs, observed up to 36 months of treatment continues to be consistent with that previously observed at 12 and 24 months.

CONCLUSION:
This was the longest evaluation of ELA+AB to date. ELA+AB continued to maintain a favorable safety profile with minimal long-term effect on BMD and no newly identified safety events to 36 months. Combined with previously reported efficacy data, these safety data suggest ELA+AB may provide a long-term therapeutic option for women with EAP beyond 24 months.
Efficacy of Gonadotropin-Releasing Hormone Agonist (GnRH-a) in Ovarian Preservation in Females With Systemic Lupus Erythematosus (SLE) Receiving Cyclophosphamide (CYC) [ID: 1375370]
Authors: Abid Dania , Chu Jun , Hasni Sarfaraz , Manna Zerai , Abbas Naqvi Syed Ali 
Published: May 2023

INTRODUCTION:
Systemic lupus erythematosus (SLE) female patients with severe disease manifestations are treated with cyclophosphamide (CYC), which causes ovarian cytotoxicity. Gonadotropin-releasing hormone agonist (GnRH-a) is often co-administered with CYC to preserve ovarian function and reproductive potential. However, there is a lack of evidence to support this use of GnRH-a. We conducted a retrospective study and questionnaire of SLE patients who received CYC with or without GnRH-a to evaluate its efficacy in preserving ovarian function.

METHODS:
This study was approved by the IRB of the National Institutes of Health (IRB#:001011). Review of medical records resulted in 50 female SLE patients treated with CYC who were less than 40 year old at the time of treatment: CYC only (n=20, group 1), CYC and GnRH-a (n=30, group 2). These patients were age/gender-matched with 50 SLE patients not treated with CYC (group 3). Data about demographics, SLE disease activity, damage accrual, cumulative CYC exposure, and pregnancy outcomes were collected by chart review. Self-reported questionnaires were used to collect data assessing menses cycles, pregnancies and their outcome, or infertility.

RESULTS:
There was no significant difference in SLE disease activity, baseline demographics, total damage accrual, or other clinical parameters between groups 1 and 2. The mean cumulative CYC dose was 1.2 g (group 1) and 1.5 g (group 2) (P=.16). Number of pregnancies were similar: mean (SD) group 1=2 (1.6); group 2=1.2 (1.4); group 3=1.3 (1.4) (P=.18). There were more miscarriages in group 1 compared to groups 2 and 3 (P=.015).

CONCLUSION:
Our data suggest use of GnRH-a improves pregnancy outcomes in SLE patients on CYC, but prospective studies are needed to establish its safety and efficacy.
Comparing Early COVID-19 Abortion Care Innovations in Hospital Versus Nonhospital Clinics: Data From a Nationwide Survey of Abortion Providers [ID: 1370918]
Authors: Silva Luisa , Lee Jessica 
Published: May 2023

INTRODUCTION:
We examined differences between hospital-affiliated clinics and non-hospital-affiliated (independent of Planned Parenthood) clinics regarding abortion service innovation in response to the early COVID-19 pandemic.

METHODS:
We analyzed data from the third phase of a longitudinal nationwide survey of abortion providers conducted by the Society of Family Planning (collected August to October 2020). We analyzed adoption of abortion service innovation, comparing hospital-affiliated clinics to non-hospital-affiliated clinics that included adoption of no- or low-test or low-touch practices for medication abortion and first-trimester surgical abortion.

RESULTS:
Sixty-one clinics completed the survey (30 hospital affiliated, 31 non-hospital affiliated). We found hospital-affiliated clinics were more likely to be in the Northeast and West (P<.01). We found evidence of adoption, but no significant difference between clinic type in changes in gestational limit, changes in Rh testing policy, or adoption or expansion of telehealth services for pre-abortion counseling. Hospital-affiliated clinics were more likely to have reported making any change to abortion services in response to the pandemic (100% versus 87%, P<.04). Hospital-affiliated clinics were also significantly more likely to start/expand telemedicine visits for follow-up visits for medication abortion (odds ratio [OR] 6.63, 95% CI 1.6–26.8) and first-trimester surgical abortion (OR 12.75, 95% CI 3.1–51.9).

CONCLUSION:
Abortion care changed quickly, regardless of setting, when the stresses of COVID-19 hit the U.S. health care system. System-wide abortion care changes suggest successful information sharing regarding best practices and recommendations in abortion provision, which should continue to be promoted as the pandemic continues.
Racial Disparities in National Emergency Department Utilization and Admissions for Pelvic and Perineal Pain (2016–2019) [ID: 1376522]
Authors: Richardson Darington , Caldwell Martina , Jiang Charley , Lim Courtney , Marsh Erica , Mehari Kathleen 
Published: May 2023

INTRODUCTION:
Pelvic/perineal pain encompasses a wide spectrum of diseases. Despite its high prevalence, there are little national data on emergency department utilization for its management.

METHODS:
Analysis of data from the Nationwide Emergency Department Sample from 2016 to 2019 was performed. Women between 15 and 44 year old with a primary diagnosis of pelvic/perineal pain (PPP) were included (ICD-10 R10.2). Race was available for 2019 only. This study was deemed exempt by the University of Michigan IRB.

RESULTS:
There were 923,300 ED visits for PPP (0.672% of all ED visits) with an admission rate of 0.16% versus 6.60% for all other diagnoses (P<.001). ED visits for PPP cost $4.7 billion USD over the 4 years. The average cost per visit was $5,136, compared to $4,143 for other diagnoses (P<.001). Patients from the lowest income quartile by zip code accounted for 37% of ED visits. Medicaid was the largest single payment type representing 44.4% of visits. In 2019, White women represented 47% of visits but accounted for 69.4% of admissions. Admission rates were 0.2% for White patients and 0.1% for Black patients (P<.001).

CONCLUSION:
While visits for PPP represent a small percentage of total ED visits, they reveal potential racial disparities with White women being admitted at twice the rate of Black women. Studies are needed to elucidate the etiologies of pelvic pain within different demographic groups and the potential contributions of structural inequities so that a goal of equitable care for all patients can be achieved.
Racial Disparities in Total Abdominal Hysterectomy Postoperative Outcomes: Analysis Including American Indian or Alaska Natives and Native Hawaiian or Pacific Islanders [ID: 1377744]
Authors: Shirriff Ashley , Abella Maveric , Collins Robert , Manayan Olivia , Pawar Deepraj 
Published: May 2023

INTRODUCTION:
Racial disparities in total abdominal hysterectomy outcomes among individuals in Black and Hispanic populations are well described in the literature. However, disparities in such outcomes for American Indians or Alaskan Natives (AI/AN) and Native Hawaiians or Pacific Islanders (NH/PI) remain understudied. Thus, the aim of our study is to assess total abdominal hysterectomy outcomes in Black, Hispanic, Asian, AI/AN, and NH/PI populations.

METHODS:
The National Surgical Quality Improvement Program was queried to identify all total abdominal hysterectomy procedures in the 2011 to 2020 National Surgical Quality Improvement Project (n=81,655). Multivariable regression models were used to investigate the effect of race and ethnicity on 30-day postoperative complications, readmission, and mortality.

RESULTS:
Compared to non-Hispanic White patients, Black patients had 0.7% higher odds of readmission (adjusted odds ratio [AOR] 1.007, 95% CI 1.003–1.011) and 2.3% higher odds of postoperative complications (AOR 1.023, 95% CI 1.016–1.030). Hispanic patients had 1.3% higher odds of a postoperative complication (AOR 1.013, 95% CI 1.004–1.021). AI/AN patients had 5.6% higher odds of a postoperative complication (AOR 1.056, 95% CI 1.020–1.093). NH/PI patients had the highest odds of a postoperative complication, 9.1% higher odds compared to non-Hispanic White patients (AOR 1.091, 95% CI 1.056–1.126), and were the only minority group associated with higher odds of mortality (AOR 1.007, 95% CI 1.004–1.010).

CONCLUSION:
AI/AN and NH/PI, which have been underrepresented in past research, experienced the highest rates of postoperative complications in total abdominal hysterectomy, highlighting the importance of including these patients in the discussion of policy and hysterectomy research studies.
Standard Opioid Prescribing in Pediatric and Adolescent Gynecology [ID: 1381154]
Authors: Fowler Kylie , Miller Rachel , O’Flynn O’Brien Kate , Reimche Paige 
Published: May 2023

INTRODUCTION:
Enhanced Recovery After Surgery principles reduce opioid use postoperatively. There are no recommendations for optimal opioid dose prescribing for postoperative pain. The aim of this quality improvement project was to assess postoperative opioid use after pediatric gynecologic surgeries and establish standard opioid prescriptions across all surgeons based on procedural type.

METHODS:
Counseling on postoperative care including pain management was provided preoperatively and postoperatively. At the 2-week postoperative visit, patients were asked the number of opioid doses used and their pain control satisfaction. Baseline data were collected for 6 months with surgeons prescribing opioid doses via personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established with 10 doses provided for laparotomy with incision greater than or equal to 5 cm, 5 doses for laparoscopy or mini-laparotomy with incision(s) 4 cm or less, 5 doses for combined laparoscopic/vaginal approach, and 0 doses for vaginal cases. Data collection was repeated after implementation of standard opioid dose prescriptions.

RESULTS:
Complete data were recorded for 30 cases prior to implementation and 29 cases after implementation. Standard opioid dosing resulted in 30% decrease in total opioid doses (252–176 doses; P=.014) and 15% reduction in unused doses (162–137 doses). Forty-three percent of patients used no opioid doses. There was no significant difference in patient satisfaction (P=.014) in pain control.

CONCLUSION:
Application of standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient satisfaction. This quality improvement project suggests further reduction in standard dose prescriptions is possible.
Delays in Diagnosis and Treatment of Appendicitis in Females [ID: 1375790]
Authors: Dosaj Ankita , Class Quetzal A. , George Jessica 
Published: May 2023

INTRODUCTION:
Sex disparities in a perioperative emergency warrant investigation to improve equitable patient care. We investigated whether differences exist in care of appendicitis across patient sex.

METHODS:
We performed a retrospective cohort study of patients with appendicitis between 2011 and 2020 at an inner-city academic hospital. We collected demographic data and time records of key milestones in clinic care. We used chi-square, paired t test, ANOVA, and Cox proportional hazard analyses to examine differences between sex and other factors.

RESULTS:
A total of 385 patients were included, 182 (47.3%) females and 203 (52.7%) males. Patients were similar across sex, age, race, reason for visit, and number of emergency room visits. The time to admission for females was longer as compared to males (t(304)=–2.82, P<.05). Cox proportional hazard analysis predicting time to admission based on sex while controlling for age and race showed that females have a longer time to admission (HR 0.73 [95% CI 0.58–0.92]), youngest patients (<15 years) were admitted faster than older-aged patients (HR 2.13 [95% CI 1.45–3.13]), and as compared with Black patients, White patients were admitted faster (HR 1.56 [95% CI 1.06–2.29]).

CONCLUSION:
Reproductive-aged females had significantly longer times to admission than male peers with the same indication, and White patients were admitted more expeditiously than Black patients. There was a trend of slower surgical consult and admission for females with gynecological disorders. This study suggests that sex biases exist within our system. This highlights that an active effort must be taken to rule out differentials that are not sex based.