Availability of mifepristone and misoprostol in Oregon pharmacies: A comparison by rural and urban status.

OBJECTIVES: To evaluate the availability of mifepristone and misoprostol at pharmacies in a state with protective abortion legislation and variation in access by rurality. STUDY DESIGN: Using a secret shopper survey, researchers attempted to contact all community pharmacies in Oregon and evaluate their mifepristone and misoprostol provisions. RESULTS: Among the 444 pharmacies surveyed, mifepristone was planned at 19.2%. Misoprostol was available at 77.5%, but stocking issues and medication ordering impact access, without significant differences by rurality. CONCLUSIONS: Pharmacy engagement and support are key to increasing access to these essential medicines, which may be improved through education and referral programs.

Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin.

BACKGROUND: Some users of the etonogestrel contraceptive implant experience bothersome bleeding, which can reduce contraceptive satisfaction and continuation. Few strategies exist to manage this bleeding. The exact mechanism of progestin-induced bleeding is unknown, but it is likely multifactorial (eg, impaired angiogenesis, "leaky" fragile vasculature, and inflammation). Curcumin, the active ingredient in turmeric, has anti-inflammatory, antiproliferative, and antiangiogenic properties, which may make it a useful agent for implant-associated bothersome bleeding. OBJECTIVE: This study aimed to evaluate whether curcumin decreases frequent or prolonged bleeding or spotting in contraceptive implant users. STUDY DESIGN: The study was a randomized, double-blind, placebo-controlled trial. Here, etonogestrel implant users with frequent or prolonged bleeding or spotting were enrolled and randomized to either 600-mg Theracurmin HP (Immunovites, Las Vegas, NV) or placebo daily for 30 days. The term "frequent" was defined as ≥2 independent bleeding or spotting episodes, and the term "prolonged" was defined as ≥7 consecutive days of bleeding or spotting in a 30-day interval. Implant use was confirmed by clinical examination and negative gonorrhea and chlamydia and pregnancy tests. Enrolled participants initiated study treatment after 3 consecutive days of bleeding or spotting; if no bleeding or spotting occurred within 30 days of enrollment, the participants were withdrawn from the study. Study treatments were encapsulated to maintain a similar appearance. Participants used text messages to record daily bleeding patterns and study drug compliance. Bleeding was defined as a day that required the use of protection with a pad, tampon, or liner, and spotting was defined as a day with minimal blood loss that did not require the use of any protection. Our primary outcome was the total number of days without bleeding or spotting during the 30 days of study drug or placebo exposure. The secondary outcomes included total number of bleeding-free days, bleeding episodes, and satisfaction. A sample size of 22 per group provided 80% power at an alpha level of .05 to demonstrate a 6-day difference between groups. RESULTS: From February 2021 to November 2022, 58 individuals enrolled in the study with 54 participants (93%) completing 30 days of treatment (26 in the curcumin group and 28 in the placebo group). Of note, 1 individual in the curcumin arm did not experience a qualifying bleeding event and, thus, never initiated treatment and, per protocol, was withdrawn from the study. Participant characteristics did not differ between groups, including length of implant use at study enrollment (placebo, 521±305 days; curcumin, 419±264 days). The study groups did not differ concerning any bleeding-related outcome (mean days without bleeding or spotting: curcumin, 16.7±6.9; placebo, 17.5±4.8; P=.62; mean bleeding-free days: curcumin, 23.4±4.9; placebo, 22.4±4.5; P=.44; bleeding episodes: curcumin, 2.0±0.8; placebo, 2.1±0.8; P=.63). In addition, satisfaction with the implant as contraception and acceptability of bleeding over the study period did not differ by study group (P=.54 and P=.30, respectively). CONCLUSION: Daily use of curcumin did not improve bleeding patterns in users of the etonogestrel contraceptive implant experiencing frequent or prolonged bleeding patterns.

Contraceptive services in Oregon's state-funded network during the COVID-19 pandemic.

OBJECTIVES: To understand how changes to in-person health care during the COVID pandemic impacted contraceptive use in Oregon's state-funded network. STUDY DESIGN: A retrospective cohort of 245,600 visits (virtual and in-person) among 70,295 women presenting to publicly funded family planning clinics in Oregon between January 2019 and June 2021. Data were abstracted from clinic records and restricted to visits of patients identifying as female, 12-51 years old, not using sterilization as a method. Contraception was grouped by effectiveness Tier (Tier 1: intrauterine device, implants; Tier 2: progestin injectable, pill/patch/ring). Multivariable logistic regression predicted the use of contraception by stage of the COVID pandemic which corresponded to service availability (prepandemic, acute: nonemergency services halted, subacute: restricted services), patient demographics, including insurance type, and clinic and geospatial characteristics. RESULTS: Overall during the acute stage, people with visits were more likely to leave with a method of contraception odds ratios (OR) 1.39 (95% confidence interval [CI] 1.24-1.57); however, it was significantly less likely to be a Tier 1 method (OR 0.82, 95% CI 0.74-0.91) as compared to prepandemic. This finding was particularly marked in rural areas (OR 0.69 [96% CI 0.58-0.83]) and among the publicly insured (OR 0.87 [95% CI 0.80-0.94]). CONCLUSIONS: Demand for contraception increased during the acute phase of the COVID pandemic, and shifts in method mix from Tier 1 to Tier 2 methods occurred. Disparities in contraceptive access persisted for those in rural locations or with public insurance. IMPLICATIONS: Lessons learned from the COVID-19 pandemic are critical to informing our future emergency response. The need for family planning services increased during the public health emergency.

Association of 12-month contraceptive supply policy and months of oral contraception prescribed by obstetrics and gynecology resident physicians: an exploratory cross-sectional study.

OBJECTIVE: This study sought to determine if there was a difference in the months of oral contraception prescribed by resident physicians living in U.S. states with a 12-month supply policy compared to resident physicians in states without a policy. METHODS: We conducted an exploratory descriptive study using a convenience sample of Obstetrics and Gynecology resident physicians (n = 275) in the United States. Standard bivariate analyses were used to compare the difference between groups. RESULTS: Few resident physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (p < 0.05). CONCLUSIONS: The majority of resident physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12-months of contraception, regardless of whether they lived in a state with a 12-month contraceptive supply policy. Physician education may be needed to effectively implement 12-month contraceptive supply policies.

Examining the association between short interpregnancy interval births and the type and timing of postpartum long acting reversible contraception.

OBJECTIVE: To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births. STUDY DESIGN: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level. RESULTS: Our study sample included 121,422 births to 97,084 individuals who had more than 1 birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by 6 months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5%-25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4%-16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2%-43.0%). CONCLUSION: Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval. IMPLICATIONS: All long acting, reversible contraception, whether placed immediately postpartum or on an interval basis, was associated with a significantly lower probability of a short interpregnancy interval than short acting or no contraceptive method.

Women's perspectives on receiving and expanding access to essential health services in pharmacies in the United States.

BACKGROUND: Expanding reproductive health services in community pharmacies is a promising strategy for reaching underserved communities. Limited information exists on women's attitudes to receive these services and if interest may differ in urban and rural locations. OBJECTIVE: We sought to determine whether there were differences by rural location in women's perspectives and willingness to receive essential preventative and diagnostic reproductive health services in community pharmacies. METHODS: We conducted a cross-sectional national survey of women in November 2020. The survey consisted of demographic data, women's experiences receiving essential preventative health services, and questions regarding perspectives on and interest in receiving these services in community pharmacies. Descriptive statistics assessed differences in survey responses between rural and urban communities. RESULTS: Our sample size consisted of 867 women. We received 544 responses for a response rate of 62.7%. Rural women were as likely as their urban counterparts to delay receiving preventative care owing to concerns about insurance or how they would pay for services (P = 0.45). Rural women were less likely than urban women to have received the human papillomavirus vaccine (P = 0.02) or have had regular cervical cancer screenings (P = 0.04). Overall, both rural and urban women want to receive preventative reproductive health services in community pharmacies. CONCLUSION: Expanded access to reproductive health services in community pharmacies has the potential to improve access and health screening, particularly in underserved rural areas.

Availability of pharmacist prescription of contraception in rural areas of Oregon and New Mexico.

OBJECTIVE: To determine the availability of pharmacist prescribing of hormonal contraception in rural areas of two states. STUDY DESIGN: Cross-sectional survey. RESULTS: Overall, 42% of pharmacies prescribed contraception (Oregon: 46% and New Mexico 19%). A similar proportion of rural pharmacies reported offering pharmacist prescription of 37 contraception as urban locations (39% vs 46%, p = 0.26). Nearly 53% of rural and 45% of urban pharmacies report billing women, rather than insurance, directly for the cost of the pharmacist consultation. Over 80% of pharmacists in both rural and urban locations did not know if Medicaid covered the cost. CONCLUSION: Pharmacists in rural areas are as willing as their urban counterparts to prescribe hormonal contraception. Financial barriers remain a concern.

Direct spectroscopic characterization of a transitory dirhodium donor-acceptor carbene complex.

A multitude of organic transformations catalyzed by dirhodium(II) (Rh2) complexes are thought to proceed via the intermediacy of highly reactive, electrophilic carbenoid intermediates that have eluded direct observation. Herein, we report the generation of a metastable Rh2-carbenoid intermediate supported by a donor-acceptor carbene fragment. This intermediate is stable for a period of ~20 hours in chloroform solution at 0°C, allowing for an exploration of its physical and chemical properties. The Rh=C bond, characterized by vibrational and nuclear magnetic resonance spectroscopy, extended x-ray absorption fine structure analysis, and quantum-chemical calculations, has weak σ and π components. This intermediate performs stoichiometric cyclopropanation and C-H functionalization reactions to give products that are identical to those obtained from analogous Rh2 catalysis.

Influence of surface oxides on the colloidal stability of multi-walled carbon nanotubes: a structure-property relationship.

As with all nanomaterials, a large fraction of the atoms in carbon nanotubes (CNTs) reside at or near the surface. Consequently, surface chemistry will play a crucial role in determining the fate and transport of CNTs in aquatic environments. Frequently, oxygen-containing functional groups (surface oxides) are deliberately grafted into the CNT surface to promote colloidal stability. To study the influence that both the oxygen concentration and the oxygen functional-group distribution have on the colloidal stability of multiwalled carbon nanotubes (MWCNTs), a suite of oxidized MWCNTs (O-MWCNTs) were created using different oxidizing agents and reaction conditions. Stable colloidal suspensions were prepared by low-power sonication of O-MWCNT powders in Milli-Q water. Results from TEM, AFM, DLS, and XPS measurements revealed that, irrespective of the surface chemistry, the colloidal suspensions were composed of individual nanotubes with comparable length distributions. The critical coagulation concentrations (CCC) of O-MWCNTs that exhibited different surface chemistries were measured with time-resolved dynamic light scattering (TR-DLS) using NaCl as the electrolyte. Over a range of environmentally relevant pH values, linear correlations were found to exist between the CCC, total oxygen concentration, and surface charge of O-MWCNTs. In contrast to surface charge, electrophoretic mobility did not prove to be a useful metric of colloidal stability. Information obtained from chemical derivatization studies, carried out in conjunction with XPS, revealed that the distribution of oxygen-containing functional groups also influences the colloidal stability of O-MWCNTs, with carboxylic acid groups playing the most important role. This study highlights the fact that quantitative relationships can be developed to rationalize the influence of surface chemistry on the behavior of nanomaterials in aquatic environments.