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Liang AC, Sanders NS, Anderson ES, Heeney ME, Hirschman CM, Kane AR, Wills CP. "ContraceptED": A Multidisciplinary Framework for Emergency Department-Initiated Contraception. Ann Emerg Med 2023; 81:630-636. [PMID: 36925395 DOI: 10.1016/j.annemergmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 03/15/2023]
Abstract
Emergency departments (EDs) are common access points for patients who are at high risk for unintended pregnancy. Low-barrier access to effective contraception represents a crucial and low-cost intervention to address this public health need. Same-day initiation of contraception during an ED visit is a unique opportunity to provide reproductive health care for high-risk patients with otherwise limited health care access. We collaborated with our obstetrics and gynecology (OB/GYN) department, pharmacists, and a team of community health advocates to support emergency clinicians (namely, emergency physicians and advanced practice providers) in assessing pregnancy and contraceptive readiness, increasing proficiency in contraception counseling, prescribing hormonal contraception, counseling on barrier and emergency contraception, and inserting (and removing) the Nexplanon implant, a form of long-acting reversible contraception. With this novel approach, we found that emergency clinicians voluntarily participated in trainings on contraception, including low-threshold long-acting reversible contraception initiation; and, after completing these trainings, clinicians integrated these skills into their workflow in the ED. We report our results after screening 38 patients during our current Pilot Phase of implementing this program.
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Affiliation(s)
- Amy C Liang
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA.
| | - Noah S Sanders
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA
| | - Erik S Anderson
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA; Department of Medicine-Substance Use Disorder Program, Highland Hospital, Alameda Health System, Oakland, CA
| | - Megan E Heeney
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA
| | - Claire M Hirschman
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA
| | - Amy R Kane
- Department of Obstetrics and Gynecology, Alta Bates Summit Medical Center, Berkeley, CA
| | - Charlotte P Wills
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA
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Long-acting reversible contraception in the pediatric emergency department: clinical implications and common challenges. Pediatr Emerg Care 2015; 31:286-92; quiz 293-5. [PMID: 25831033 DOI: 10.1097/pec.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-acting reversible contraception (LARC) is recommended as first-line contraception for adolescents and young adults. As the use of LARC increases, pediatric emergency medicine clinicians should be able to recognize different types of LARC and address their common adverse effects, adverse reactions, and complications. This continuing medical education activity provides an overview of LARC and will assist clinicians in the evaluation and management of patients with LARC-associated complaints.
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Dassah ET, Odoi AT, Owusu-Asubonteng G. Prevalence and factors predictive of long-acting reversible contraceptive use in a tertiary hospital in urban Ghana. EUR J CONTRACEP REPR 2013; 18:293-9. [PMID: 23650905 DOI: 10.3109/13625187.2013.790951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence, socio-demographic and reproductive factors associated with long-acting reversible contraceptive (LARC) use among clients resorting to reversible birth control methods in a tertiary hospital in Ghana. METHODS Retrospective review of records of clients who opted for reversible family planning (FP) methods at Komfo Anokye Teaching Hospital, Kumasi, Ghana, from 1 July 2003 to 30 June 2008. We recorded data on their contraceptive history, and socio-demographic- and reproductive characteristics. Categorical variables were compared using the χ(2) test and factors associated with LARC uptake examined by binomial regression with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Of 5946 clients who opted for reversible contraception, 71% chose LARCs, and the remaining 29% chose shorter-acting contraceptives. LARCs were employed mainly by women with more living children (p trend < 0.001) who had previously used LARCs (adjusted RR: 1.49; 95% CI: 1.39-1.60). Over half of non-contraceptive users started with LARCs while 27% of women switched from shorter-acting contraceptives to LARCs. CONCLUSION The prevalence of LARC uptake was much higher than the national average. Significant factors associated with current LARC use were the number of surviving children and previous LARC use.
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Affiliation(s)
- Edward T Dassah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Bryant AG, Stuart GS, Narasimhan S. Long-acting reversible contraceptive methods for adolescents with chronic medical problems. J Pediatr Adolesc Gynecol 2012; 25:347-51. [PMID: 22929761 DOI: 10.1016/j.jpag.2012.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 05/23/2012] [Accepted: 05/29/2012] [Indexed: 10/27/2022]
Abstract
Adolescents with chronic medical problems are just as at-risk for unintended pregnancy as their healthy counterparts, but pregnancy in these adolescents can carry greater health risks. The objective of this article is to provide an overview of the United States Medical Eligibility Criteria for Contraceptive Use, the concept of contraceptive effectiveness, and a risk-benefit algorithm. Together these tools provide an evidence-based and clinically sound method of providing contraception to adolescents with chronic medical problems. Three cases of adolescents with chronic medical problems are used to illustrate this approach. To best avoid the complicated problem of a teenager with a chronic medical problem becoming pregnant, LARC should be considered as first-line contraception. In most cases, LARC methods are safe to prescribe, and preferable to less effective methods.
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Affiliation(s)
- Amy G Bryant
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Abstract
Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.
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MESH Headings
- Adolescent
- Adult
- Bone Density/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/therapeutic use
- Female
- Fractures, Bone/chemically induced
- Fractures, Bone/epidemiology
- Humans
- Lactation
- Perimenopause
- Practice Guidelines as Topic
- Risk Factors
- Young Adult
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Affiliation(s)
- Michelle M Isley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA.
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Deokar AM, Jackson W, Omar HA. Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant. Int J Adolesc Med Health 2011; 23:75-77. [PMID: 21721368 DOI: 10.1515/ijamh.2011.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were removed because of menstrual bleeding problems. METHOD We conducted a chart review of the adolescent patients who received the ENG implant in our adolescent clinic. An analysis was done based on symptoms experienced by patients who were on the ENG implant and their management, which in some cases resulted in its removal. SETTING The data is presented on adolescent and young adult patients who receive their reproductive care in the Adolescent Medicine Clinic at the University of Kentucky, Lexington, KY, USA. CONCLUSIONS ENG implant when used correctly and as indicated is extremely effective in providing contraception for up to 3 years. However, menstrual irregularities can be very troublesome and often a reason for its removal. In our experience, 22.4% (13 out of the 58 subjects) had menstrual problems post-insertion that led to its removal. It is crucial for a clinician to inform and be informed about such side effects.
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Affiliation(s)
- Amit M Deokar
- Department of Pediatrics, Division of Adolescent Medicine, Kentucky Women's Health, University of Kentucky, Lexington, KY 40536, USA
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Tickle JJ, Beach ML, Dalton MA. Tobacco, alcohol, and other risk behaviors in film: how well do MPAA ratings distinguish content? JOURNAL OF HEALTH COMMUNICATION 2009; 14:756-767. [PMID: 20029709 PMCID: PMC2802064 DOI: 10.1080/10810730903295567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To evaluate the usefulness of Motion Picture Association of America (MPAA) ratings for parental selection of appropriate films for children, the 100 top grossing movies each year from 1996 through 2004 (N = 900) were content analyzed to measure risk behaviors in each film. More restrictive MPAA ratings (R and PG-13) were associated with increased mean seconds of portrayals of tobacco use, alcohol use, and sexual content; increased frequency of violent content; and increased salience of drug use. MPAA ratings, however, did not clearly distinguish films based on tobacco or alcohol use. Fifty percent of R-rated movies contained 124 seconds or more of tobacco use, comparable with 26% of PG-13 and 17% of PG movies. Fifty percent of R-rated movies contained 162 seconds or more of alcohol use, comparable with 49% of PG-13 and 25% of PG movies. Because of the high degree of overlap in alcohol and tobacco content between rating categories, the MPAA rating system, as currently defined, is not adequate for parents who wish to limit their children's exposure to tobacco or alcohol content in movies.
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Affiliation(s)
- Jennifer J Tickle
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, Maryland 20686, USA.
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Hubacher D, Mavranezouli I, McGinn E. Unintended pregnancy in sub-Saharan Africa: magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception 2008; 78:73-8. [PMID: 18555821 DOI: 10.1016/j.contraception.2008.03.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/08/2008] [Accepted: 03/16/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unintended pregnancies continue to burden many countries in sub-Saharan Africa. Our aim was to estimate the number of unintended pregnancies in the region and model the impact of expanding use of contraceptive implants at the expense of short-term hormonal birth control methods. STUDY DESIGN For the 42 countries in mainland sub-Saharan Africa, we estimated current levels of unintended pregnancy, prevalence of hormonal contraceptive use and number of unintended pregnancies stemming from early discontinuation and typical method failure rates. Using a decision-analytic model, we estimated the potential impact of more widespread use of the contraceptive implant. RESULTS Every year in sub-Saharan Africa, approximately 14 million unintended pregnancies occur and a sizeable proportion is due to poor use of short-term hormonal methods. If 20% of the 17.6 million women using oral contraceptives or injectables wanted long-term protection and switched to the contraceptive implant, over 1.8 million unintended pregnancies could be averted over a 5-year period. CONCLUSION Poor patterns of short-term hormonal contraceptive use (high discontinuation rates and incorrect use) contribute significantly to the problem of unintended pregnancy in sub-Saharan Africa. More availability and widespread use of highly effective methods, such as the contraceptive implant, will improve reproductive health in the region.
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Affiliation(s)
- David Hubacher
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA.
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Abstract
PURPOSE OF REVIEW To help clinicians guide adolescent patients to sound choices regarding long-acting contraceptives. The safety, side effects and non-contraceptive benefits of injectable, implantable and intrauterine contraception are detailed. RECENT FINDINGS The use of depot medroxyprogesterone acetate contraceptive injections has been associated with declines in teenage pregnancies in the United States. Although the US Food and Drug Administration has placed a black box warning concerning skeletal health and depot medroxyprogesterone acetate, data in adolescents confirm that declines in bone mineral density with depot medroxyprogesterone acetate are fully reversible. Concerns regarding skeletal health should not restrict the initiation or continuation of depot medroxyprogesterone acetate in adolescents. A highly effective, convenient, and easy to insert/remove single rod progestin-only contraceptive implant (Implanon) is now available in the United States. Although not widely used in adolescents, intrauterine devices offer selected adolescents convenient, highly effective, safe birth control. Use of the progestin-releasing intrauterine device (Mirena) is also associated with important non-contraceptive benefits. SUMMARY The efficacy and convenience associated with long-acting contraceptives make them indispensable for adolescent patients. This review will help clinicians guide teenage patients towards sound contraceptive choices and the successful long-term use of injectable, implantable and intrauterine methods of birth control.
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Affiliation(s)
- Lama L Tolaymat
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida 32207, USA.
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Affiliation(s)
- Erica Monasterio
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California, USA
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Fonseca H, Greydanus DE. Sexuality in the Child, Teen, and Young Adult: Concepts for the Clinician. Prim Care 2007; 34:275-92; abstract vii. [PMID: 17666227 DOI: 10.1016/j.pop.2007.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article discusses basic concepts of sexuality in children, adolescents, and young adults based on development stages. Sexual behavior of adolescents is a common phenomenon, leading to sexually transmitted diseases (STDs) and unwanted pregnancy. Clinicians should provide anticipatory guidance to help with healthy sexuality development while reducing negative aspects of human sexuality. Comprehensive sexuality education should be provided, with emphasis on avoiding unwanted sexual advances (including Internet dangers), bullying, pregnancy, and STDs. Clinicians can teach sexually active patients to use effective contraception and condoms for STD protection. Ensuring full immunization with the hepatitis B vaccine and the human papillomavirus vaccine also is important.
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Affiliation(s)
- Helena Fonseca
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Glasier A, Yan Y, Wellings K. How do health care professionals respond to advice on adverse side effects of contraceptive methods? The case of Depo Provera. Contraception 2007; 76:18-22. [PMID: 17586131 DOI: 10.1016/j.contraception.2007.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 03/29/2007] [Accepted: 03/29/2007] [Indexed: 11/16/2022]
Abstract
CONTEXT Depomedroxyprogesterone acetate (DMPA) (Depo Provera) is a long-acting contraceptive popular in the United Kingdom, particularly among young women. In the United States, use of DMPA has been instrumental in reducing teenage pregnancy rates. Evidence for a detrimental effect of DMPA on bone mineral density led to advice from drug regulatory authorities in the United Kingdom and the United States, recommending caution in prescribing DMPA, particularly for young people. OBJECTIVE The study was conducted to explore changes in practice in response to prescribing advice about DMPA among primary care doctors and nurses working in the UK. METHODS A self-completed questionnaire sent to 420 primary care health professionals. RESULTS In response to the advice, 16% of practitioners would deter all women, and one third would deter young women, from using DMPA. One in five practitioners would limit use of DMPA to 2 years. Fewer than one in 10 would suggest contraceptive implants as an alternative contraceptive. CONCLUSIONS The response of primary care professionals in their prescribing advice about DMPA risks increasing rates of unintended pregnancy in the UK, particularly among teenagers. The findings demonstrate an urgent need for a clear, balanced approach to advising health professionals on how to respond to new findings about adverse effects of contraceptives.
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Affiliation(s)
- Anna Glasier
- London School of Hygiene and Tropical Medicine, University of Edinburgh, Edinburgh, E816 4SB Scotland, UK.
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