Contraceptive strategies for reducing the risk of reproductive cancers.

Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.

FIGO position statement on comprehensive sexuality education.

Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.

The Role of Preprocedure Genetic Counseling in Pregnancies Interrupted for Fetal Abnormalities.

OBJECTIVE: Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. STUDY DESIGN: This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. RESULTS: Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41-4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. CONCLUSION: Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. KEY POINTS: · Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies.. · Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time.. · Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate..

Real Time, Remote, and Recorded: Medical Student Experiences with Smart Glasses in Obstetrical Simulation.

OBJECTIVES: The coronavirus disease 2019 pandemic generated the need for a teaching tool for enhancing remote education and evaluation of medical trainees. Smart glasses are being explored as a hands-free teaching tool for teleconferencing with hands-on demonstrations in addition to livestreaming capability. We wanted to understand the efficacy of such virtual teaching techniques in teaching procedural and surgical skills. METHODS: Medical students in their Obstetrics and Gynecology clerkship at our medical school were recruited to participate in a virtual demonstration of normal vaginal delivery. A birthing simulator and smart glasses were used to livestream the simulated delivery, and a previously published checklist was used to show the steps for conducting routine vaginal delivery. A follow-up electronic survey assessed the clarity of the video and audio feed, level of satisfaction, positive and constructive feedback, and an error-identification exercise with a smart glass-recorded video. RESULTS: A total of 62 students participated; 98% of them reported that the audio and video feeds were clear and 95% of the students reported being extremely satisfied or satisfied with the teaching tool. Students could identify on average three out of four errors. Students believed the streaming to be "interactive" and a "most effective remote learning" tool, but expressed that it did not "take the place of clinical skills learning." CONCLUSIONS: The combination of smart glass technology and simulation can be a useful new tool for clinical faculty who simultaneously deliver care to patients and teach. Continued research is needed to explore the use of smart glass technology into livestreaming or surgeries and examinations, with consideration for patient privacy concerns and remote assessment of students.

Patient Experiences at California Crisis Pregnancy Centers: A Mixed-Methods Analysis of Online Crowd-Sourced Reviews, 2010-2019.

OBJECTIVES: Crisis pregnancy centers (CPCs) are nonprofit antiabortion organizations that claim provision of pregnancy resources. With the Reproduction Freedom, Accountability, Comprehensive Care, and Transparency Act repealed, CPCs are no longer mandated to share information on state-funded family planning and abortion services. As patients increasingly seek healthcare guidance online, we evaluated crowd-sourced reviews of CPCs using the social networking site Yelp. METHODS: CPCs were identified with the CPC Map, a geo-based location resource. Of California's 145 CPCs, 84% had Yelp pages, and 619 reviews (2010-2019) were extracted. Thematic codes were individually applied to 220 excerpts and then analyzed in detail using thematic analysis to capture emergent themes related to motivations for and experiences of CPCs. To ensure thematic saturation, we applied a natural language-processing technique called the meaning extraction method to computationally derive themes of discussion from all of the extracted posts. RESULTS: Motivations to seek care from CPCs included pregnancy confirmation, gaps in healthcare coverage, parenting and emotional support, and abortion care. A review of experiences reveal that CPC faith-based practice garnered both positive- and negative-based experiences. Reviewers also articulated inaccurate medical information, lack of transparency, and reduced options at CPCs. CONCLUSIONS: This is the first study to analyze California CPCs using a social media platform. Pregnant patients turn to social media to share experiences about pregnancy resources, to find healthcare providers, and to increase transparency of services. This content provides valuable insight into the concerns of pregnant patients and offers an intimate view of California CPCs at a time when no federal regulations are in place.

Traditional or technological? A cross sectional survey of oral contraceptive reminders in young adults.

OBJECTIVES: For patients relying only on oral contraceptive pills (OCPs) for pregnancy prevention, timely and correct usage of OCPs is essential. This study describes the prevalence of reminder systems used among our patients, the patient population that uses those reminder systems, and whether the reminder system was effective for the user in terms of not missing pills per pack. METHODS: We conducted a cross-sectional survey among 102 OCP users at 3 individual clinics in the UCLA Health System. To quantify OCP adherence, we used the unit pill pack to indicate one month's supply of OCPs. RESULTS: Majority of patients were young educated individuals who used OCPs for 1 year or longer. 44% of participants used strictly technology-based reminders including alarms, phone applications, and text-based systems. 25% of participants used only traditional reminders, including co-administration with other medications, location placement, and as part of a morning/evening routine. 6% of participants used a combination of technology-based and traditional reminders. 21% of participants did not rely on any reminder system for OCP self-administration. 4% of participants used "Other or Unknown" reminder systems. The majority of participants missed less than 2 pills in their pill pack. Those who relied on technological reminders missed pills more frequently than those who depended on traditional reminders. CONCLUSION: Our results indicate that despite growing prevalence of technology-based reminder systems, traditional reminders are as prevalent as the technology-based ones. There was no difference in the number of missed pills between the two groups. The study is limited by the use of convenience sampling. Our study sheds light on strategies that a majority young and educated patient population might use to increase OCP adherence.

Impact of perceived contraceptive policy changes on long acting reversible contraception dispensing trends.

OBJECTIVE: We observed the long-term trend of Long Acting Reversible Contraception (LARC) usage before and after the 2016 presidential election. METHODS: We observed the rate of LARC dispensed at a university student health centre in the 18 months preceding and 27 months following the 2016 U.S. presidential election which posed threat to contraception access. We applied a segmented regression model using two linear regression line segments to evaluate whether there is a time point where the trend of LARC dispensing changed. We fit the regression models with a breakpoint at month 0 (election month) and 3 months with a Locally Estimated Scatterplot Smoothing (LOESS) estimate with parameters obtained by estimating simple linear regression models separately below and above the breakpoint '0'. RESULTS: There were a total of 2067 LARC methods dispensed from May 2015 to February 2019. The average number of LARC methods dispensed before November 2016 was 38/month and increased to 51/month post-presidential election. The LARC dispense rate significantly increased each month (0.38, 1.74; 95% confidence level, p < 0.05) until a breakpoint at 6 months (standard error 4.11) post-election followed by slower decrease (-0.59/month, 95% confidence level: -1.37, 0.20; p=not significant). CONCLUSION: Our study is the first to report long-term trends (27 months post-election) in LARC uptake amidst the public discourse that suggested the end of a policy that provided LARC insurance coverage. Although this observational study cannot suggest causality, the findings could reflect actions taken to prevent unintended pregnancy in response to the event of uncertain national policy.

Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study.

OBJECTIVES: Most women experience moderate to severe pain during first-trimester surgical termination of pregnancy despite the application of various analgesic techniques. Studies have shown that virtual reality (VR) is effective in reducing anxiety among a range of women in differing circumstances. Our study objectives were to assess the feasibility of using VR during first-trimester dilation and curettage under local anaesthesia and understand the effect of VR on procedure-related anxiety during first-trimester dilation and curettage. METHODS: A pilot feasibility study was conducted in a convenience sample of 30 women (15 in the intervention group and 15 in the control group). Anxiety scores were recorded before, during and after the procedure. In-depth interviews were conducted after the procedure. RESULTS: Participants reported that VR was either very effective (53%) or somewhat effective (40%) in relieving anxiety during and after the procedure. Eleven participants used the VR device for the entire procedure and four participants removed it during the procedure. The anxiety scores before the procedure were not significantly different between the groups. The intervention group had a median five point post-procedure decrease in anxiety score rated on a visual analogue scale, which was significantly different from that of the control group. Overall, participants had a positive experience but there were some technological frustrations. CONCLUSION: Women undergoing dilation and curettage in the first trimester were able to use a VR device during the procedure. VR-induced distraction and relaxation helped to reduce anxiety in some participants both during and after the procedure.

Novel Corona Virus Pandemic and Neonatal Care: It's Too Early to Speculate on Impact!

The entire world is reeling under the effects of the novel corona virus pandemic. As it is a new infection, our knowledge is evolving constantly. There is limited information about impact of corona virus on neonatal care in relation to newborns with confirmed or suspected COVID-19. In this article, we summarize the current approach to this infection in relation to newborn babies. We discuss the basic aspects of the infection, the approach of care to novel corona virus disease 2019 (COVID-19) in positive pregnant women, the likely presentation in newborns (as per current knowledge), and the approach to the management of neonates with infection or at risk of the infection. Children are less susceptible to COVID-19 infection and generally have a mild course. There is a lower risk of severe disease among pregnant women and neonates. It was recommended to follow the current protocols for management of symptomatic newborn with isolation precautions, antibiotics, and respiratory support.

Outcomes assessment pitfalls: challenges to quantifying knowledge gain in a sex education game.

Background: We describe challenges associated with incorporating knowledge assessment into an educational game on a sensitive topic and discuss possible motivations for, and solutions to, these challenges. Methods: The My Future Family Game (MFF) is a tool for collecting data about family planning intentions. The game was expanded to include information about human anatomy and sexual reproduction. To assess the efficacy of the game as a tool for teaching sexual education, we designed a pre-post study with assessments before and after the game which was deployed in three schools in and around Chennai, India in summer of 2018. Results: The pre-post process did not effectively assess knowledge gain and made the game less enjoyable. Although all participants completed the pre-test because it was required to access the main game, many did not complete the post test. As a result, the post-test scores are of limited use in assessing the efficacy of the intervention as an educational tool. This deployment demonstrated that pre-post testing has to be integrated in a way that motivates players to improve their scores in the post-test. The pre-test results did provide useful information about players' knowledge of human anatomy and mechanisms of human reproduction prior to gameplay and validated the tool as a means of data collection. Conclusion: Adding outcomes assessment required asking players questions about sexual anatomy and function with little or no introduction. This process undermined elements of the initial game design and made the process less enjoyable for participants. Understanding these failures has been a vital step in the process of iterative game design. Modifications were made to the pre-post test process for future deployments so that the process of assessment does not diminish enthusiasm for game play or enjoyment and motivates completion of the post-test as part of gameplay.

Effect of theory-based contraception comics on subjective contraceptive knowledge: a pilot study.

OBJECTIVES: We assessed the effect on subjective knowledge of a pilot educational comic decision aid about contraceptive methods. STUDY DESIGN: We designed four comics (www.birthcontroltales.com), each about a different contraceptive method choice. The comics employ a theoretical framework, and the methods addressed were injection, intrauterine device, implant and combined hormonal contraceptives (including pill, patch and ring). The study population included young women presenting to a college student health clinic whose preferred language is English. Participants had not used the contraceptive method described in the comic and viewed the comics in color printed copy. We assessed contraception subjective knowledge using a pretest/posttest six-question survey with Likert scale responses before and after exposure to the comics. Surveys conducted during the participants' visit also measured participant satisfaction with the comic and participant sexual history. RESULTS: A total of 120 individual participants divided into groups of 30 each viewed one of four separate comics. Across the four groups, the difference in the pretest/posttest scores of the six-question subjective knowledge survey indicated a 72% average increase (p value<.001). CONCLUSION: Comics about contraceptive methods can be a communications tool that increases subjective knowledge of contraceptive methods. Comics that model contraceptive choice decision processes can increase individual subjective knowledge of the contraceptive method mechanism, effect, usage, side effects, feasibility and benefits. Possessing subjective knowledge of contraceptive methods can influence contraceptive initiation and use and therefore has potential implications for changing contraceptive attitudes and behavior. IMPLICATIONS: Contraceptive method comics should be further examined in other clinic settings with broader demographic populations to glean the effect on patient decision and contraceptive behavior. Integration of the comics into a contraceptive counseling practice can be assessed in an observational trial. Additionally, studies should also consider testing long-term patient behavior, and both patient and provider satisfaction.

Evaluation of a Mobile Application for Pelvic Floor Exercises.

BACKGROUND: Pelvic floor exercises are effective in improving muscle strength and urinary incontinence symptoms. Increasingly popular mobile applications can be effective in teaching patients these exercises. INTRODUCTION: A mobile application, Bwom©, aims to educate women about pelvic floor exercises with individually tailored plans relevant to the user's risk factors. The objective of this study is to assess the understandability and actionability of Bwom. MATERIALS AND METHODS: This is a cross-sectional survey of patients and providers at an academic medical center. The survey utilized the Patient Education Material Assessment Tool (PEMAT) validated by the U.S. Department of Health Services, which provides scores on understandability and actionability. Participants completed an initial demographic survey, used Bwom for 2 weeks, and then completed the PEMAT tool. RESULTS: Twenty five patients and 22 providers participated in the study, for a total of 47 participants. Providers included gynecology residents and faculty (91%), pelvic floor physical therapists (5%), and other healthcare professionals (5%). The majority of patients were age 31-40 (70%) and Caucasian (55%). Thirty nine percent had not yet tried pelvic floor exercises on their own before the study. The mean understandability score was 93.8% (±11.7) and the mean actionability score was 91.7% (±16.3). DISCUSSION: This study paves the way for future investigations into the effectiveness of this app in decreasing symptoms of pelvic floor weakness and incontinence. CONCLUSIONS: This study demonstrates that Bwom shows promise as a mobile application to educate women about pelvic floor exercises by providing user-friendly actions in an understandable way.

Perceptions of Pregnancy and Contraceptive Use: An In-Depth Study of Women in Los Angeles Methadone Clinics.

INTRODUCTION: In 2016, 2.1 million people in the United States were estimated to have an opioid use disorder. Although the disorder can be safely and effectively treated with prescription methadone, treatment is potentially long term and may span women's peak childbearing ages. Little is known about women's reproductive health needs while on methadone. METHODS: We interviewed 22 sexually active, nonpregnant women ages 21-39 years at two Los Angeles methadone clinics in 2016. The interviews were transcribed and coded by four researchers using thematic and open coding techniques. RESULTS: One-half of the women were nulliparous and 17 were in stable, monogamous relationships with men. Women reported a range of feelings and perceptions about pregnancy, but nearly all wanted to delay pregnancy until discontinuing methadone. However, many women indicated limited interest in preventing pregnancy because of the relative stability of their relationships, fear of infertility, and low perceived risk of pregnancy. These factors influenced contraceptive use. DISCUSSION: Women described mixed feelings about pregnancy and many ultimately felt that an unplanned pregnancy would be acceptable in the context of their relationships and uncertain fertility. These findings provide context for previous quantitative findings that women in methadone treatment have higher rates of unintended pregnancy and lower rates of contraceptive use than the general population. CONCLUSIONS: Accurate information about pregnancy in the context of methadone treatment may help women to make proactive family planning decisions. Health care providers should discuss the guidelines for pregnancy on methadone and offer a range of options to help women achieve their reproductive goals.

An Evaluation of the Implementation of Pharmacist-Prescribed Hormonal Contraceptives in California.

OBJECTIVE: To evaluate the implementation of pharmacist-prescribed hormonal contraceptives in California after a recent expansion of pharmacists' scope of practice. METHODS: A probability sample of 480 licensed California retail pharmacies (stratified by nonrural or rural location and independent or chain status) was included in a cross-sectional "secret shopper" telephone survey assessing the availability of pharmacist-prescribed hormonal contraceptives and service details. Survey data were analyzed using weighted descriptive statistics, CIs, and Wald tests. RESULTS: Findings included data from 457 pharmacies (response rate 95.2%). Only 5.1% of pharmacies reported providing pharmacist-prescribed hormonal contraceptives (95% CI 2.9-7.2%). This proportion did not differ significantly between rural and nonrural pharmacies (P=.83) nor between independent and chain pharmacies (P=.40). Five of the 22 pharmacies that were providing pharmacist-prescribed hormonal contraceptives informed secret shoppers that all allowed hormonal methods were available; most of these pharmacies (77.3%) did proactively describe that a health history was required before receiving medications. Only half of pharmacies providing pharmacist-prescribed hormonal contraceptives would do so for minors although this was allowed by law. CONCLUSION: In the first year after statewide protocol implementation, only a small proportion of retail pharmacies across California has begun offering hormonal contraception services. In the absence of additional supportive legislation regarding reimbursement for pharmacist services, increases in scope of practice regulations to build a larger network of contraceptive providers may not be effective in increasing access to birth control.