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Gavin L, Pazol K. Update: Providing Quality Family Planning Services - Recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:231-4. [PMID: 26963363 DOI: 10.15585/mmwr.mm6509a3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 2014, CDC published Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP), which describes the scope of services that should be offered in a family planning visit, and how to provide those services (e.g., periodicity of screening, which persons are considered to be at risk, etc.). The sections in QFP include Contraceptive Services, Pregnancy Testing and Counseling, Clients Who Want to Become Pregnant, Basic Infertility Services, Preconception Health Services, Sexually Transmitted Disease Services, Related Preventive Health Services, and Screening Services for Which Evidence Does Not Support Screening.
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Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting. Contraception 2016; 94:81-6. [PMID: 26948183 DOI: 10.1016/j.contraception.2016.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation. STUDY DESIGN A retrospective chart review identified adolescent females aged 12 to 22years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12months) and ENG continuers (continued for ≥12months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ(2)/Fisher's Exact Tests and backwards stepwise logistic regression. RESULTS Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12months of use. The mean length of implant use for those who discontinued was 7.5months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive (p<.01) of method discontinuation. CONCLUSION The vast majority of adolescents continued the ENG implant at 12months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers. IMPLICATIONS The ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.
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153
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Miller MK, Randell KA, Barral R, Sherman AK, Miller E. Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department. J Adolesc Health 2016; 58:154-9. [PMID: 26802990 PMCID: PMC4724387 DOI: 10.1016/j.jadohealth.2015.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization. METHODS We used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long-acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually experienced females aged 14-19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the chi-square test. RESULTS A total of 168 adolescents participated (82% of approached; mean age 16.6 years; 41% white; 48% black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n = 96). Among those using non-LARC contraception (n = 59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p < .06) and concerns about cost (p < .01), privacy (p = .03), and where to obtain contraception (p < .01). Nearly all planned on avoiding pregnancy, although many (23%) used no contraception at last intercourse. One third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost). CONCLUSIONS Many reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same-day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of nontraditional sites such as EDs.
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Affiliation(s)
- Melissa K Miller
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
| | - Kimberly A Randell
- Division of Emergency and Urgent Care, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Romina Barral
- Division of Adolescent Medicine, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Ashley K Sherman
- Center for Health Services Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Iacovides S, Polo-Kantola P, Baker FC. Reply: LNG-IUDs in treating dysmenorrhea. Hum Reprod Update 2016; 22:405-6. [PMID: 26754089 DOI: 10.1093/humupd/dmv062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stella Iacovides
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paivi Polo-Kantola
- Department of Obstetrics and Gynaecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Fiona C Baker
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Human Sleep Research Program, SRI International, San Francisco, CA, USA
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155
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Gibson EJ. All Adolescents Deserve Routine Conversations About Sexual Activity and Pregnancy Prevention. Pediatrics 2016; 137:peds.2015-3826. [PMID: 26676051 DOI: 10.1542/peds.2015-3826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Erica J Gibson
- Adolescent Medicine, Department of Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont
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156
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Harris K, Byrd K, Engel M, Weeks K, Ahlers-Schmidt CR. Internet-Based Information on Long-Acting Reversible Contraception for Adolescents. J Prim Care Community Health 2015; 7:76-80. [PMID: 26643120 DOI: 10.1177/2150131915621058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-acting reversible contraception (LARC) is safe, effective, and recommended as first-line contraception for adolescents. Despite clear medical recommendations, the type and quality of Internet information regarding LARC for teenagers is unknown. METHODS Data were collected through web queries. Resulting websites were assessed for quality criteria and a priori content themes based on the leading medical societies' recommendations for adolescent LARC. RESULTS Of the 238 websites evaluated, 77% made no recommendation of LARC for adolescent females. Of the 55 websites that did recommend LARC, only 40% specifically discussed its use in the adolescent population. Of note, 16% of websites recommending LARC discouraged their use in adolescents. Quality varied among LARC-discussing websites, ranging from 3 to 13 of the 15 criteria assessed. DISCUSSION Few websites offer up-to-date information regarding the use of LARC, and most fail to discuss LARC use at all. As LARC is highly effective in preventing unplanned pregnancies in adolescents, incomplete or inaccurate information on the Internet present a barrier to promoting its utilization in this at-risk population.
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Affiliation(s)
- Kari Harris
- The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Kelly Byrd
- The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Matt Engel
- The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Kerri Weeks
- The University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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The Cost of Unintended Pregnancies in Canada: Estimating Direct Cost, Role of Imperfect Adherence, and the Potential Impact of Increased Use of Long-Acting Reversible Contraceptives. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:1086-97. [DOI: 10.1016/s1701-2163(16)30074-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hubacher D. The Levonorgestrel Intrauterine System: Reasons to Expand Access to the Public Sector of Africa. GLOBAL HEALTH, SCIENCE AND PRACTICE 2015; 3:532-7. [PMID: 26681701 PMCID: PMC4682579 DOI: 10.9745/ghsp-d-15-00178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
Abstract
The levonorgestrel intrauterine system has: (1) excellent effectiveness, (2) high satisfaction levels, (3) non-contraceptive benefits, and (4) potential to help reinvigorate interest in intrauterine contraception. The time is ripe for ministries and donor agencies to work together to make the product widely available across Africa.
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Schmidt EO, James A, Curran KM, Peipert J, Madden T. Adolescent Experiences With Intrauterine Devices: A Qualitative Study. J Adolesc Health 2015; 57:381-6. [PMID: 26126950 PMCID: PMC4583802 DOI: 10.1016/j.jadohealth.2015.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD). METHODS We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach. RESULTS Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening. CONCLUSIONS Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.
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Affiliation(s)
- Elizabeth O. Schmidt
- Department of Obstetrics and Gynecology, North Shore-LIJ Hofstra School of Medicine
| | - Aimee James
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine
| | - K. Michele Curran
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
| | - Jeffrey Peipert
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
| | - Tessa Madden
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine
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Post TM, Gerrits M, Kerbusch T, de Greef R. Prediction of nomegestrol acetate pharmacokinetics in healthy female adolescents and adults by whole-body physiology-based pharmacokinetic modelling and clinical validation. Contraception 2015; 93:133-8. [PMID: 26365792 DOI: 10.1016/j.contraception.2015.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 06/02/2015] [Accepted: 08/29/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nomegestrol acetate (NOMAC), a selective progestogen, and 17β-estradiol (E2), which is identical to endogenous oestrogen, are components of a new monophasic combined oral contraceptive--NOMAC/E2. This study aimed to compare pharmacokinetics (PK) of NOMAC in adolescent and adult women following a single dose of NOMAC/E2. STUDY DESIGN Healthy postmenarcheal adolescent (14-17years) and adult (18-50years) women received a single dose of NOMAC/E2 (2.5mg/1.5mg) in this single-centre, open-label, parallel-group Phase 1 study (EudraCT# 2008-002142-38). Blood samples were obtained for PK analysis, and concentrations of NOMAC, E2 and its metabolite estrone (E1) were determined for up to 129h following dosing to obtain PK data. An independent whole-body physiology-based pharmacokinetic (WB-PBPK) simulation model of NOMAC based on an independent Phase 3 dataset was used to scale NOMAC concentration-time plots to adolescents. RESULTS Overall, 52 women were screened, of whom 30 (15 adolescents and 15 adults) were enrolled. No statistically significant differences were observed between the adolescent and adult groups for the clinically evaluated NOMAC PK parameters [maximum concentration (Cmax), area under the curve (AUC) and half-life (t1/2)]. The PK of E2 and E1 showed extensive overlap between both age groups. The WB-PBPK model accurately predicted NOMAC AUC and Cmax values in both groups. CONCLUSIONS No differences were observed in the clinically evaluated PK parameters for NOMAC between adolescent and adult women after a single dose of NOMAC/E2. The WB-PBPK model accurately predicted NOMAC PK data (EudraCT# 2008-002142-38). IMPLICATIONS PK studies in adolescents are challenging because of ethical considerations. The whole-body physiology-based model described here complements classic noncompartmental and population PK approaches. The utility of this method is its ability to expand to adolescent postmenarcheal girls by using virtual postmenarcheal adolescent population data and applying physiological scaling.
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Abstract
The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB.
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Abstract
Menstrual suppression--the use of hormones to delay or eliminate menses--is often used in adolescents to manage conditions associated with the menstrual cycle and to accommodate lifestyle preferences. Reducing the frequency of menstrual bleeding does not cause any known physiologic harm and has potential short-term and long-term advantages. Different methods used for menstrual suppression, however, have associated risks and side effects that need to be weighed against the benefits of controlling menses. This article reviews the advantages and disadvantages of menstrual suppression and the different methods available for adolescents.
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Klaus H, Cortés ME. Psychological, social, and spiritual effects of contraceptive steroid hormones. LINACRE QUARTERLY 2015; 82:283-300. [PMID: 26912936 PMCID: PMC4536622 DOI: 10.1179/2050854915y.0000000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Governments and society have accepted and enthusiastically promoted contraception, especially contraceptive steroid hormones, as the means of assuring optimal timing and number of births, an undoubted health benefit, but they seldom advert to their limitations and side effects. This article reviews the literature on the psychological, social, and spiritual impact of contraceptive steroid use. While the widespread use of contraceptive steroid hormones has expanded life style and career choices for many women, their impact on the women's well-being, emotions, social relationships, and spirituality is seldom mentioned by advocates, and negative effects are often downplayed. When mentioned at all, depression and hypoactive sexual desire are usually treated symptomatically rather than discontinuing their most frequent pharmacological cause, the contraceptive. The rising incidence of premarital sex and cohabitation and decreased marriage rates parallel the use of contraceptive steroids as does decreased church attendance and/or reduced acceptance of Church teaching among Catholics. Lay summary: While there is wide, societal acceptance of hormonal contraceptives to space births, their physical side effects are often downplayed and their impact on emotions and life styles are largely unexamined. Coincidental to the use of "the pill" there has been an increase in depression, low sexual desire, "hook-ups," cohabitation, delay of marriage and childbearing, and among Catholics, decreased church attendance and reduced religious practice. Fertility is not a disease. Birth spacing can be achieved by natural means, and the many undesirable effects of contraception avoided.
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165
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Lopez LM, Bernholc A, Zeng Y, Allen RH, Bartz D, O'Brien PA, Hubacher D. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev 2015. [PMID: 26222246 PMCID: PMC9580985 DOI: 10.1002/14651858.cd007373.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fear of pain during insertion of intrauterine contraception (IUC) is a barrier to use of this method. IUC includes copper-containing intrauterine devices and levonorgestrel-releasing intrauterine systems. Interventions for pain control during IUC insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES To review randomized controlled trials (RCTs) of interventions for reducing IUC insertion-related pain SEARCH METHODS We searched for trials in CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov, and ICTRP. The most recent search was 22 June 2015. We examined reference lists of pertinent articles. For the initial review, we wrote to investigators to find other published or unpublished trials. SELECTION CRITERIA We included RCTs that evaluated an intervention for preventing IUC insertion-related pain. The comparison could have been a placebo, no intervention, or another active intervention. The primary outcomes were self-reported pain at tenaculum placement, during IUC insertion, and after IUC insertion (up to six hours). DATA COLLECTION AND ANALYSIS Two authors extracted data from eligible trials. For dichotomous variables, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For continuous variables, we computed the mean difference (MD) with 95% CI. In meta-analysis of trials with different measurement scales, we used the standardized mean difference (SMD). MAIN RESULTS We included 33 trials with 5710 participants total; 29 were published from 2010 to 2015. Studies examined lidocaine, misoprostol, NSAIDs, and other interventions. Here we synthesize results from trials with sufficient outcome data and moderate- or high-quality evidence.For lidocaine, meta-analysis showed topical 2% gel had no effect on pain at tenaculum placement (two trials) or on pain during IUC insertion (three trials). Other formulations were effective compared with placebo in individual trials. Mean score for IUC-insertion pain was lower with lidocaine and prilocaine cream (MD -1.96, 95% CI -3.00 to -0.92). Among nulliparous women, topical 4% formulation showed lower scores for IUC-insertion pain assessed within 10 minutes (MD -15.90, 95% CI -22.77 to -9.03) and at 30 minutes later (MD -11.10, 95% CI -19.05 to -3.15). Among parous women, IUC-insertion pain was lower with 10% spray (median 1.00 versus 3.00). Compared with no intervention, pain at tenaculum placement was lower with 1% paracervical block (median 12 versus 28).For misoprostol, meta-analysis showed a higher mean score for IUC insertion compared with placebo (SMD 0.27, 95% CI 0.07 to 0.46; four studies). In meta-analysis, cramping was more likely with misoprostol (OR 2.64, 95% CI 1.46 to 4.76; four studies). A trial with nulliparous women found a higher score for IUC-insertion pain with misoprostol (median 46 versus 34). Pain before leaving the clinic was higher for misoprostol in two trials with nulliparous women (MD 7.60, 95% CI 6.48 to 8.72; medians 35.5 versus 20.5). In one trial with nulliparous women, moderate or severe pain at IUC insertion was less likely with misoprostol (OR 0.30, 95% CI 0.16 to 0.55). In the same trial, the misoprostol group was more likely to rate the experience favorably. Within two trials of misoprostol plus diclofenac, shivering, headache, or abdominal pain were more likely with misoprostol. Participants had no vaginal delivery. One trial showed the misoprostol group less likely to choose or recommend the treatment.Among multiparous women, mean score for IUC-insertion pain was lower for tramadol 50 mg versus naproxen 550 mg (MD -0.63, 95% CI -0.94 to -0.32) and for naproxen versus placebo (MD -1.94, 95% CI -2.35 to -1.53). The naproxen group was less likely than the placebo group to report the insertion experience as unpleasant and not want the medication in the future. An older trial showed repeated doses of naproxen 300 mg led to lower pain scores at one hour (MD -1.04, 95% CI -1.67 to -0.41) and two hours (MD -0.98, 95% CI -1.64 to -0.32) after insertion. Most women were nulliparous and also had lidocaine paracervical block. AUTHORS' CONCLUSIONS Nearly all trials used modern IUC. Most effectiveness evidence was of moderate quality, having come from single trials. Lidocaine 2% gel, misoprostol, and most NSAIDs did not help reduce pain. Some lidocaine formulations, tramadol, and naproxen had some effect on reducing IUC insertion-related pain in specific groups. The ineffective interventions do not need further research.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alissa Bernholc
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Yanwu Zeng
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Rebecca H Allen
- Women and Infants HospitalDepartment of Obstetrics and Gynecology101 Dudley StreetProvidenceRhode IslandUSA02905
| | - Deborah Bartz
- Brigham and Women's HospitalDepartment of Obstetrics, Gynecology, and Reproductive BiologyBostonMassachusettsUSA
| | - Paul A O'Brien
- Central London Community HealthcareContraception and Sexual HealthRaymede Clinic, Exmoor StLondonUKW10 6DZ
| | - David Hubacher
- FHI 360Contraceptive Technology Innovation Dept359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
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Gomez AM, Hartofelis EC, Finlayson S, Clark JB. Do Knowledge and Attitudes Regarding Intrauterine Devices Predict Interest in Their Use? Womens Health Issues 2015; 25:359-65. [DOI: 10.1016/j.whi.2015.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
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Trent M, Thompson C, Tomaszewski K. Text Messaging Support for Urban Adolescents and Young Adults Using Injectable Contraception: Outcomes of the DepoText Pilot Trial. J Adolesc Health 2015; 57:100-6. [PMID: 26002432 PMCID: PMC4478161 DOI: 10.1016/j.jadohealth.2015.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the feasibility, acceptability, and preliminary effectiveness of DepoText, a text messaging reminder system designed to improve moderately long-acting reversible contraception appointment attendance among young urban adolescent girls and young adult women using Depo-Provera. METHODS Female patients aged 13-21 years willing to be randomized, using Depo-Provera, and owning a cell phone with text messaging were recruited from an urban academic practice in a community with high rates of unplanned pregnancy for this institutional review board-approved randomized controlled pilot trial. Participants completed a baseline Web-based survey and were followed for three injection cycles. Intervention participants received welcome, appointment, and healthy self-management messages using the Compliance for Life short messaging system platform over each injection cycle. Compliance for Life recorded outgoing and incoming communications, and patients were tracked for clinical behaviors. The log-transformed number of days between scheduled appointment and injection was analyzed using linear regression. RESULTS Recruitment data show 95% eligibility and 91% enrollment rates with maximum enrollment completion in 3 months. Most were African-American and resided in low-income, single-parent, and mother-headed households. Most participants had cell phone plans that included unlimited text messaging and Internet access and completed all three Depo-Provera cycles. Intervention participants returned closer to their scheduled appointments than their control peers for the first visit (Β = -.75; 95% confidence interval, -1.4 to .06; p = .03) but not for the second and third visits. CONCLUSIONS The DepoText intervention is acceptable, feasible, and shows short-term preliminary efficacy for improving clinic attendance for moderately long-acting reversible contraception appointments. Additional research exploring the cost and longitudinal prevention effectiveness is warranted.
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Affiliation(s)
- Maria Trent
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Carol Thompson
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland, USA
| | - Kathy Tomaszewski
- Section on Adolescent Medicine, Department of Pediatrics Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Pediatric drug research is gradually becoming more and more accepted as the norm for assessing whether a drug is safe and efficacious for infants and children. The process of informed consent and assent for these trials presents a major challenge. The aim of this review is to map historical, ethical and legal aspects relevant to the challenges of informed consent in the setting of pediatric drug research. The impact of age, level of maturity and life circumstances on the process of obtaining informed consent as well as the relations between consent and assent are discussed. There appears to be a lack of regulatory clarity in the area of pediatric clinical trials; while numerous statements have been made regarding children's rights to autonomy and their ability to care for themselves and for younger ones, the ever changing status of adolescence is still difficult to translate to informed consent. This may delay scientific and clinical advancement for children who are at the very junction of being independent and not needing parental permission. Obtaining consent and assent for pediatric clinical trials is a delicate matter, as both parent and child need to agree to participate. The appropriate transfer of information to guardians and the children, especially concerning potential risks and benefits, is at the heart of informed consent, as it serves to protect both patient and physician. As many adults lack health literacy, one must ensure that guardians receive relevant information at a level and in forms they can understand regarding the trials their children are asked to participate in.
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Francis J, Presser L, Malbon K, Braun-Courville D, Linares LO. An exploratory analysis of contraceptive method choice and symptoms of depression in adolescent females initiating prescription contraception. Contraception 2014; 91:336-43. [PMID: 25553873 DOI: 10.1016/j.contraception.2014.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We examine the association between depressive symptoms and contraceptive method choice among adolescents initiating prescription contraception. STUDY DESIGN This cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15-19 years) presenting for prescription contraceptive initiation at a comprehensive, free-of-cost, adolescent health center in New York City. All participants met with a health care provider who provided standard contraception counseling before initiating contraception. Each participant then selected a short- or long-acting contraceptive: a 3-month supply of the pill, patch, ring or a medroxyprogesterone acetate depot injection (short-acting), or placement/referral for an intrauterine device (IUD; long-acting). We assess the independent association between contraceptive method selection and symptoms of depression [assessed by the Center for Epidemiological Studies - Depression (CES-D) scale]. RESULTS Ten percent (n=21/220) of adolescent females selected an IUD. Bivariate analysis revealed that those with elevated levels of depressive symptoms were more likely to select an IUD as compared to those with minimal symptoms (mean CES-D score 20 vs. 13; t=3.052, p=.003). In multivariate logistic regressions, adolescent females had increased odds of selecting an IUD if they reported moderate to severe depressive symptoms (adjusted odds ratio=4.93; confidence interval, 1.53-15.83; p=.007) after controlling for ethnicity/race, education, number of lifetime partners and gravidity. CONCLUSIONS Inner-city, minority adolescents with elevated symptoms of depression who present for prescription contraceptive initiation may be more likely to select an IUD rather than shorter-acting methods. By recognizing adolescent females with depressive symptoms, providers can strategize their approach to effective contraception counseling.
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Affiliation(s)
- Jenny Francis
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Medical Center, New York, NY 10032, USA.
| | - Liandra Presser
- Department of Pediatrics, Division of Adolescent Medicine, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Katherine Malbon
- Tribeca Pediatrics, Adolescent Medicine Specialist, New York, NY 10007, USA
| | - Debra Braun-Courville
- Department of Pediatrics, Division of Adolescent Medicine. Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lourdes Oriana Linares
- Department of Pediatrics, Division of Adolescent Medicine, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
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170
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Greenberg GM, Ursu A, Hertz MI. Family Planning and Contraception. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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