Population attitudes toward contraceptive methods over time on a social media platform.

BACKGROUND: Contraceptive method choice is often strongly influenced by the experiences and opinions of one's social network. Although social media, including Twitter, increasingly influences reproductive-age individuals, discussion of contraception in this setting has yet to be characterized. Natural language processing, a type of machine learning in which computers analyze natural language data, enables this analysis. OBJECTIVE: This study aimed to illuminate temporal trends in attitudes toward long- and short-acting reversible contraceptive methods in tweets between 2006 and 2019 and establish social media platforms as alternate data sources for large-scale sentiment analysis on contraception. STUDY DESIGN: We studied English-language tweets mentioning reversible prescription contraceptive methods between March 2006 (founding of Twitter) and December 2019. Tweets mentioning contraception were extracted using search terms, including generic or brand names, colloquial names, and abbreviations. We characterized and performed sentiment analysis on tweets. We used Mann-Kendall nonparametric tests to assess temporal trends in the overall number and the number of positive, negative, and neutral tweets referring to each method. The code to reproduce this analysis is available at https://github.com/hms-dbmi/contraceptionOnTwitter. RESULTS: We extracted 838,739 tweets mentioning at least 1 contraceptive method. The annual number of contraception-related tweets increased considerably over the study period. The intrauterine device was the most commonly referenced method (45.9%). Long-acting methods were mentioned more often than short-acting ones (58% vs 42%), and the annual proportion of long-acting reversible contraception-related tweets increased over time. In sentiment analysis of tweets mentioning a single contraceptive method (n=665,064), the greatest proportion of all tweets was negative (65,339 of 160,713 tweets with at least 95% confident sentiment, or 40.66%). Tweets mentioning long-acting methods were nearly twice as likely to be positive compared with tweets mentioning short-acting methods (19.65% vs 10.21%; P<.002). CONCLUSION: Recognizing the influence of social networks on contraceptive decision making, social media platforms may be useful in the collection and dissemination of information about contraception.

Young children communicate their ignorance and ask questions.

Children acquire information, especially about the culture in which they are being raised, by listening to other people. Recent evidence has shown that young children are selective learners who preferentially accept information, especially from informants who are likely to be representative of the surrounding culture. However, the extent to which children understand this process of information transmission and actively exploit it to fill gaps in their knowledge has not been systematically investigated. We review evidence that toddlers exhibit various expressive behaviors when faced with knowledge gaps. They look toward an available adult, convey ignorance via nonverbal gestures (flips/shrugs), and increasingly produce verbal acknowledgments of ignorance ("I don't know"). They also produce comments and questions about what their interlocutors might know and adopt an interrogative stance toward them. Thus, in the second and third years, children actively seek information from interlocutors via nonverbal gestures or verbal questions and display a heightened tendency to encode and retain such sought-after information.

The influence of noninvasive prenatal testing on gestational age at time of abortion for aneuploidy.

OBJECTIVE: The objective of this study is to compare the gestational age at termination for trisomy 13, 18, or 21 (aneuploidy) before and after the introduction of noninvasive prenatal testing (NIPT). METHODS: A retrospective cohort of women undergoing termination for aneuploidy at two academic institutions and one private clinic. We compared two time periods: before and after the introduction of NIPT (2006-2011 and 2012-2014, respectively). Maternal demographics and clinical characteristics were abstracted from the medical record. Nonparametric statistical methods were used to compare the two cohorts. RESULTS: Our cohort included 93 women: 41 prior to NIPT and 52 post-NIPT. Maternal age (38 post-NIPT vs 37 pre-NIPT; p = 0.17) did not differ between the time periods. Women in the post-NIPT were less likely to undergo diagnostic testing (82.7% vs 97.6%; p < 0.01) before proceeding to abortion after a positive screening result. In the post-NIPT period, there was a significant decrease in the gestational age at time of invasive testing (13.0 vs 15.7 weeks; p < 0.01) and women were more likely to undergo chorionic villous sampling (CVS) (59.6% vs 41.5%; p < 0.01). There was a significant decrease in the gestational age at termination (14.2 vs 17.2; p < 0.01). Women in the post-NIPT group were less likely to have terminations after 16 weeks (25.0% vs 61.0%; p < 0.01), 18 weeks (7.7% vs 39.0%; p < 0.01), or 20 weeks (3.9% vs 12.2%; p = 0.23). CONCLUSION: With the introduction of NIPT, the median gestational age at diagnosis and termination for women with Trisomy 13, 18, or 21 was 3 weeks earlier. Women were four times less likely to have a termination after 18 weeks and three times less likely to have a termination after 20 weeks. © 2017 John Wiley & Sons, Ltd.

Interventions for pain with intrauterine device insertion.

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.

Gynecologic simulation training increases medical student confidence and interest in women's health.

BACKGROUND: Exposure to commonly performed gynecologic procedures via simulation has potential to improve medical student knowledge and foster confidence with procedures. PURPOSES: To implement and evaluate a gynecologic simulation curriculum for 3rd-year medical students during their obstetrics and gynecology core clerkship. METHODS: A gynecologic simulation curriculum was implemented for medical students during their obstetrics and gynecology clerkship. Participants completed pre-and postsurveys to assess learner confidence; effect on interest in a surgical field, women's health, and obstetrics and gynecology as a career; and whether the session met their learning needs. RESULTS: Fifty-nine students participated. Improved confidence in performing the procedures was noted when comparing mean survey scores before and after the simulation for IUD insertion and removal (1.9 pre, 4.3 post, p < .0001), for dilatation and curettage (1.7 pre, 3.8 post, p < .0001), and basic laparoscopy skills (2.1 pre, 4.3 post, p < .0001). An increase in pursuing a surgical field (3.3 pre, 3.6 post, p < .003) and interest in women's health (3.7 pre, 4.9 post, p < .004) was noted among students after the simulation session. The curriculum strongly met the students learning needs with a mean score of 4.54 on the 5-point scale. CONCLUSIONS: Gynecologic simulation training for medical students can increase confidence in procedures, interest in pursuing a surgical field and women's health, and was highly effective in meeting student learning needs.

Opill: The Over-the-Counter Contraceptive Pill.

The U.S. Food and Drug Administration has approved the first oral contraceptive pill (OCP) for over-the-counter status. This progestin-only pill contains norgestrel 0.075 mg taken daily, with a Pearl Index estimated at 4.4 (95% CI, 1.9-8.8). This formulation has an excellent safety profile, with current breast cancer as the only absolute contraindication and few relative contraindications. Ultimately, this approval has great potential to improve the accessibility of effective contraception for many pregnancy-capable Americans, especially those who have poor access to the health care system for prescription-required contraception, most notably people who hold marginalized identities. The pill's overall success in reducing rates of unintended pregnancy will rely on its availability, particularly in rural communities that may rely on one pharmacy, and affordability, especially for uninsured or underinsured individuals. However, given the need for improved contraceptive provision, particularly in abortion-restrictive settings, the over-the-counter approval of this daily OCP is a major advancement in the nation's contraceptive ecosystem.

National Postpartum Permanent Contraception Practices and Perceived Barriers.

Single institution-level studies have demonstrated low postpartum permanent contraception fulfillment rates after vaginal birth. To explore the national scope of the problem, we collected cross-sectional survey data from faculty at 109 U.S. academic medical centers to elicit perceptions about postpartum permanent contraception practices after vaginal birth, including barriers to and changes in practice after the Dobbs v Jackson Women's Health Organization decision, a decision that eliminated the U.S. federal protection of the right to abortion. Of 68 respondent institutions, 65 (95.6%) offered postpartum permanent contraception. A large majority (87.3%) perceived there to be a problem with postpartum permanent contraception fulfillment at their institution. Respondents at institutions with postpartum permanent contraception fulfillment rates in the bottom quartile used main operating rooms (66.7% vs 25.0% respectively, P =.032) and reported institutional culture barriers (86.7% vs 50.0%, respectively, P =.054) more frequently than respondents in the top quartile. Our national data indicate that health care culture changes and the use of labor and delivery operating rooms could increase postpartum permanent contraception fulfillment.

Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation.

OBJECTIVES: This study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting. STUDY DESIGN: In this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group. RESULTS: We enrolled 149 patients in the local anesthesia group and 155 in the moderate IV sedation group. The mean procedure pain scores were 6.9 (±2.1) out of 10 in the local group and 4.0 (±2.7) in the IV group (p < 0.0001). More women in the IV group (92%) were satisfied or very satisfied with the amount of pain relief they experienced compared to the local group (66%; p < 0.0001). In the univariable model, only being afraid of a minor medical procedure was predictive of less satisfaction with local anesthesia for pain control (relative risk 0.8 [95% CI, 0.6-0.9]). Age, gestational age, anticipated pain, self-reported pain tolerance, self-reported anxiety, discomfort with the abortion decision, and history of prior vaginal or cesarean delivery or induced abortion did not predict satisfaction levels. CONCLUSIONS: Fear of minor medical procedures was the only variable that predicted decreased satisfaction with local anesthesia alone for procedural abortion under 12 weeks. IMPLICATIONS: Reliable predictors for satisfaction with local anesthesia alone for procedural abortion in the outpatient setting remain elusive. Fear of minor medical procedures may serve as an indicator of decreased satisfaction and could be incorporated into patient counseling. Moderate IV sedation is associated with high satisfaction levels.

Trauma-Informed Care Training in U.S. and Canadian Ob/Gyn Residencies.

This is a cross-sectional study investigating the prevalence and nature of trauma-informed care (TIC) training in obstetrics and gynecology residency programs. In our sample, 20% of programs had annual TIC training, 53% had less than annual training, and 27% had no training at all. Only 25.3% of respondents were satisfied with their current training in interpersonal trauma and TIC. A lack of facilitators to conduct such training was the primary barrier to implementing TIC. Significant opportunity exists to improve TIC education for Ob/Gyn trainees.

Popular contraception videos on TikTok: An assessment of content topics.

OBJECTIVES: This study aimed to explore the contraception content topics on the highly popular social media platform TikTok to understand this influential information source patients may bring into birth control counseling visits. STUDY DESIGN: Utilizing a snapshot method, we collected the 100 most popular TikTok English-language videos for each of the eight contraception-specific search terms. We abstracted video content topics addressed and creator attributes. Two independent abstractors coded each video with high agreement, with a third coder adjudicating discrepancies. RESULTS: The final data set included 700 unique videos, with a total of 1.18 billion views, 131 million likes, 1.5 million comments, and 4.1 million shares. In these videos, the most common topics addressed were patient experience (n = 365, 52.1%) and logistics of use (n = 351, 50.1%). Health care professionals created only 19.3% of videos (n = 135), but these videos accounted for a larger portion of the total video views (41.3%). Health care professionals largely made educational videos (92.6%) compared to 22.5% of videos coded as educational videos when made by perceived non-health care professionals. A small number of prolific video creators developed the majority of videos made by health care professionals, with 91 (67.4%) made by six TikTok creators. CONCLUSIONS: TikTok contains highly accessible contraception content, which garners high viewership, especially when created by health care providers. Clinicians should be aware of TikTok's potential to influence patients prior to contraceptive counseling visits and recognize this platform as a public health instrument to disseminate contraceptive information to a key demographic. IMPLICATIONS: Few previous studies have examined the presence and popularity of contraception content topics on TikTok; little is known about the health content on this highly popular platform. Providers should be aware of the contraceptive topics on TikTok for understanding both patient perceptions and the potential for health education through this media.

Contraceptive content shared on social media: an analysis of Twitter.

BACKGROUND: Information on social media may affect peoples' contraceptive decision making. We performed an exploratory analysis of contraceptive content on Twitter (recently renamed X), a popular social media platform. METHODS: We selected a random subset of 1% of publicly available, English-language tweets related to reversible, prescription contraceptive methods posted between January 2014 and December 2019. We oversampled tweets for the contraceptive patch to ensure at least 200 tweets per method. To create the codebook, we identified common themes specific to tweet content topics, tweet sources, and tweets soliciting information or providing advice. All posts were coded by two team members, and differences were adjudicated by a third reviewer. Descriptive analyses were reported with accompanying qualitative findings. RESULTS: During the study period, 457,369 tweets about reversible contraceptive methods were published, with a random sample of 4,434 tweets used for final analysis. Tweets most frequently discussed contraceptive method decision-making (26.7%) and side effects (20.5%), particularly for long-acting reversible contraceptive methods and the depot medroxyprogesterone acetate shot. Tweets about logistics of use or adherence were common for short-acting reversible contraceptives. Tweets were frequently posted by contraceptive consumers (50.6%). A small proportion of tweets explicitly requested information (6.2%) or provided advice (4.2%). CONCLUSIONS: Clinicians should be aware that individuals are exposed to information through Twitter that may affect contraceptive perceptions and decision making, particularly regarding long-acting reversible contraceptives. Social media is a valuable source for studying contraceptive beliefs missing in traditional health research and may be used by professionals to disseminate accurate contraceptive information.

Intrauterine device knowledge and practices: a national survey of obstetrics and gynecology residents.

OBJECTIVES: The primary objective of this study was to assess the current intrauterine device (IUD) knowledge and counseling practices of US obstetrics and gynecology chief residents. The secondary objective was to evaluate the current IUD experience of obstetrics and gynecology residents. METHODS: A Web-based survey about IUD knowledge and practices was sent to US obstetrics and gynecology residents in January 2010. An analysis of responses by postgraduate year was completed using descriptive statistics. RESULTS: We received 699 surveys (36%) from a pool of 1922 residents in 96 different residency programs. A total of 654 respondents (94%) had placed an IUD during residency and 88% had received formal teaching about IUDs during residency. Only 53% of respondents knew that the copper IUD could be used for emergency contraception. Less than 65% of respondents would routinely recommend the IUD to adolescents or immediately after first trimester abortion. CONCLUSIONS: Many US obstetrics and gynecology residents lack knowledge about IUD benefits and do not counsel all eligible women to use IUDs. We should continue to evaluate our training and educational programs to ensure that women's health providers do not act as a barrier to IUD use.

Society of Family Planning Clinical Recommendation: Emergency contraception.

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

We Must Address the Antiobesity Biases We Espouse in Our Operating Rooms.

OBJECTIVE: To describe anti-obesity bias in medical education including impact on patients, growth of biases over time, and education-based initiatives aimed at reducing bias. DESIGN: We reviewed available literature on anti-obesity bias in medical education and initiatives to address this bias. SETTING: Information from a wide variety of medical educational settings was included. PARTICIPANTS: N/A RESULTS: Anti-obesity bias in healthcare is an independent risk factor for poor health outcomes and is pervasive throughout the culture of medicine. Medical students identify operating rooms as the number one location for anti-obesity comments, and students' biases increase throughout medical school. We propose several interventions (the 6 I's) as the next step in addressing this bias.

Consent Policies for Pelvic Exams Under Anesthesia Performed by Medical Students: A National Assessment.

Background: Medical students report low confidence in their ability to perform pelvic exams. Pelvic exams under anesthesia (EUA) are one way for students to practice the exam, but this needs to be balanced with patients' bodily autonomy through explicit disclosure and consent. This study seeks to characterize U.S. medical schools' policies regarding the consent process for students to perform pelvic EUA. Materials and Methods: Obstetrics and gynecology clerkship directors were anonymously surveyed about their medical school affiliated hospitals' (MSAH) consent policies for pelvic EUA in general and explicitly for medical students. Chi-square and Fisher's exact test were used to test for differences between categorical variables and thematic analysis was used to review qualitative responses. Results: A total of 87 clerkship directors completed the survey (44.4% response rate). Most MSAH explicitly consent patients for pelvic EUA (80.2%), and specifically for performance by medical students (79.1%). Sixty-nine respondents (79.3%) stated that performing pelvic EUA is important for medical student education. Five themes were identified from review of qualitative responses, including consent policy details, the importance of pelvic EUA, other opportunities for pelvic exam teaching, barriers to standardization, and outside guidance. Conclusions: The pelvic EUA is a necessary part of both surgical care and medical education but patient dignity must be protected too. Most MSAH have consent policies for students to perform pelvic EUA. Still, these policies need to be further strengthened and standardized across institutions to protect patients' rights while continuing to teach students the pelvic exam.

Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks.

OBJECTIVE: Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E). STUDY DESIGN: This retrospective, noninferiority, cohort study compared complication rates for same-day versus overnight cervical preparation with D&E between 14 and 16 weeks gestation. Cervical preparation was achieved with misoprostol, osmotic dilators, or both. Our primary outcome was the acute complication rate, defined as: hemorrhage (≥500 mL); hospitalization or hospital transfer; transfusion; or unplanned procedure occurring within 24 hours of the index procedure. Secondarily we evaluated nonmajor (re-aspiration, suture repair of cervical laceration, uterine tamponade, or emergency department only transfer) and major (transfusion, uterine artery embolization, abdominal surgery, or hospital admission) complications separately. Inverse probability of treatment weighting using the propensity score was used to perform an adjusted analysis, taking into account age, ethnicity, clinic location, insurance, gestational age, gravidity, and prior pregnancy outcomes. RESULTS: We analyzed 1,319 subjects (n = 864 same-day, n = 455 overnight). Same-day cervical preparation patients were more likely to have Medicaid and a prior vaginal delivery. In both unadjusted and adjusted analyses, acute complication rates for same-day were noninferior to overnight preparation (unadjusted 0.93% vs 1.98%, difference of -1.05%, CI: -2.48% to 0.38%; adjusted difference -0.50%, CI: -1.45 to 0.44%). Only one major complication in the same-day group, a cervical laceration resulting in hemorrhage requiring transfusion, occurred in the entire sample. CONCLUSIONS: In this retrospective review, same-day cervical preparation was noninferior to overnight preparation for D&E between 14 and 16 weeks gestation, both with low complication rates. IMPLICATIONS: For early second trimester dilation and evacuation, same-day cervical preparation should be considered a safe alternative to overnight cervical preparation.