The association of pregnancy control, emotions, and beliefs with pregnancy desires: A new perspective on pregnancy intentions.

CONTEXT: Standard pregnancy intentions measures do not always align with how people approach pregnancy. Studies that have investigated beyond a binary framework found that those with "ambivalent" feelings towards pregnancy are less likely to use contraception consistently, but the reasons for this are unclear. We sought to gain a nuanced understanding of pregnancy desires, and how perceptions about pregnancy are associated with contraceptive use. METHODS: We used non-probability quota sampling based on sex, age, and geographic region for a web-based survey of heterosexual men and women, aged 21-44 years, who could become pregnant/impregnate and were not currently pregnant (n = 1,477; 51% female). The survey was created using unique items informed by recent literature. Bivariate and multivariable analyses explored relationships between various perceptions about pregnancy with pregnancy desires categorized as: wanting a pregnancy, not wanting a pregnancy, and not trying but would be okay with a pregnancy. We conducted a sub-group analysis of those who were not trying but would be okay with a pregnancy (n = 460), using descriptive statistics to examine how consistent contraceptive use was associated with emotions and beliefs about avoiding pregnancy. RESULTS: After adjustment, those who felt that pregnancy may not always be avoidable, but instead determined by fate/higher power, or a natural process that happens when it is meant to, were significantly more likely (aOR: 1.83, 95% CI: 1.05-3.36; aOR: 2.21, 95% CI: 1.29-3.76, respectively) to report not trying but being okay with pregnancy, whereas those with negative feelings about a pregnancy were less likely to feel okay about a pregnancy (aOR: 0.11, 95% CI: 0.08-0.15), versus not wanting a pregnancy. In the sub-group analysis, those who felt pregnancy was determined by fate/higher power or a natural process were more likely to report not using contraception consistently (70%, 68%, respectively). CONCLUSIONS: Those who state they are not trying but would be okay with pregnancy may not use contraception consistently because of beliefs that pregnancy is predetermined. Our findings support less categorical and more multidimensional approaches to measuring fertility intentions, with important implications for reproductive health service provision.

Revisiting the Association between Race, Ethnicity, and Beliefs about Pregnancy.

Objective: Black and Latinx individuals are often the focus of health educational efforts to 'correct' perceived flawed beliefs about pregnancy, in order to increase contraceptive use and reduce unintended pregnancies. We sought to revisit the association between race, ethnicity, and beliefs about pregnancy. Methods: We administered a web-based survey to 2,099 heterosexual men and women aged 21-44 years, using non-probability quota sampling. We analyzed a subset who were not currently pregnant (n=1,884) and conducted chi-square tests to examine the association between race/ethnicity and beliefs about avoiding pregnancy (can be avoided, determined by fate/God, 'just happens,' and is a natural process). We then performed a two-stage multinomial logistic regression, modeling the belief that pregnancy can be avoided. The first model included sociodemographic characteristics and the second model added feelings about pregnancy. Results: Bivariate analyses revealed that, compared with Whites, those who identified as Black/African American or Latinx were significantly more likely to believe that pregnancy was determined by fate/God (15%,13% vs 9%, respectively) or a natural process (13%,13% vs 9%, respectively) and less likely to report that it can be avoided (57%,56% vs 67%, respectively; P=.001). In the first regression model, these differences persisted. However, in the second model, being Black/African American or Latinx was not significantly associated with beliefs about avoiding pregnancy. Conclusions: Our findings suggest that once more nuanced beliefs about pregnancy prevention are considered, Black and Latinx individuals do not hold strongly different beliefs than Whites. Efforts that exclusively focus on people of color to change beliefs about pregnancy appear unwarranted.

Women's Perspectives on Reproductive Health Services in Primary Care.

BACKGROUND AND OBJECTIVES: Primary care providers (PCPs) are increasingly offering reproductive health (RH) services to help address patients' unmet contraceptive needs and improve pregnancy outcomes. We sought to understand patient perspectives on receipt of RH services in primary care settings. METHODS: We used a purposeful stratified sampling approach to recruit women aged 21 to 40 years into focus groups (FGs) and in-depth interviews (IDIs). We held all four FGs in two New York City neighborhoods and all 18 IDIs in two upstate NY suburban/rural neighborhoods (each with half of the neighborhoods above and below the median county income in each setting type). We explored participants' preferences for RH services from PCPs, including their feelings about being asked about pregnancy intentions. We also asked their opinions on three distinct pregnancy intention screening and reproductive health needs assessment questions. Data analysis involved an iterative process of excerpt coding and interpretive analysis to identify key themes. RESULTS: We conducted four FGs and 18 IDIs with a total of 39 women. Participants were receptive to the availability of RH services in primary care and the benefits to streamlining this care, provided clinicians approach these services in a manner that respects patient autonomy and reproductive desires. They discussed a lack of preconception care counseling and concerns about primary care providers' training and/or comfort with RH, as well as time spent with patients. Participants had the most positive response to the proposed question "Can I help you with any reproductive health services today, such as birth control or planning for a healthy pregnancy?" based on its open-endedness, inclusiveness, and promotion of reproductive autonomy. CONCLUSIONS: The findings of this study support the continued expansion of RH services in primary care settings. Future research should test the preferred RH service needs question to understand how it may affect service delivery, patient satisfaction, reproductive autonomy, as well as unmet contraceptive need and indicators of maternal and child health.

Physician perspectives on routine pregnancy intention screening and counseling in primary care.

OBJECTIVES: To assess factors associated with routine pregnancy intention screening by primary care physicians and their support for such an initiative. STUDY DESIGN: We conducted a cross-sectional survey study of 443 primary care physicians in New York State. We performed multivariable logistic regression analyses of physician support for routine pregnancy intention screening and implementation of screening in the last year. Predictors included in the models were physician age, sex, specialty, clinic setting, and, for the outcome of support for screening, experience with screening in the last year. RESULTS: In this convenience sample, the vast majority of respondents from all specialties (88%) felt pregnancy intention screening should be routinely included in primary care, with 48% reporting that they routinely perform such screening. The preferred wording for this question was one which assessed reproductive health service needs. In multivariable analyses, internal medicine physicians were less likely than family medicine physicians to have provided routine pregnancy intention screening (aOR = 0.15, 95% CI 0.09, 0.25). Only 8% of the sample reported they required more training to implement pregnancy intention screening, but more reported needing training prior to contraceptive provision (17%), contraceptive counseling (16%), and preconception care (15%). More internal medicine and other types of doctors cited a need for this additional training than family medicine physicians. CONCLUSIONS: Most responding primary care physicians supported routine integration of pregnancy intention screening. Incorporating additional training, especially for internal medicine physicians, in contraception and preconception care counseling is key to ensuring success. IMPLICATIONS STATEMENT: Responding primary care physicians supported routine inclusion of reproductive health needs assessment in primary care. Primary care may become increasingly important for ensuring access to a full range of reproductive health services. Providing necessary training, especially for internal medicine physicians, is needed prior to routine inclusion.

[Electrophysiologic study and ablation therapy in idiopathic paroxystic atrial fibrillation]. / Estudio electrofisiológico y ablación de actividad eléctrica anormal en venas pulmonares de pacientes con fibrilación auricular paroxística idiopática.

OBJECTIVE: To analyze the results of radiofrequency catheter ablation (RFCA) of the pulmonary veins (PV) in patients with paroxysmal atrial fibrillation (PAF). MATERIAL AND METHODS: We describe 4 patients (38 +/- 12 years, interval 8-52; 11 men) with symptomatic PAF, refractory to antiarrhythmic drugs. Special mapping catheters were used and ablation was performed at the ostium/antrum of those veins with abnormal electrical activity (AEA). RESULTS: AEA in one or more PV was identified in 13 patients (86%); in one patient AEA was also found in the superior vena cava (6.6%). One procedure was complicated by unstable ventricular tachycardia and was notfinished. Success was accomplished in 10, in 5 after the first ablation, in 4 after the second, and in one after a third procedure. One patient had pericarditis with a small pericardial effusion that did not require intervention. CONCLUSIONS: RFCA is a useful and relatively safe procedure for the treatment of PAF and the only one with curative potential. The long-term rate of success (with or without antiarrhythmics) in this series was 71%. These results justify catheter ablation in selected patients with symptomatic PAF unresponsive to medical treatment.

Estudio electrofisiológico y ablación de actividad eléctrica anormal en venas pulmonares de pacientes con fibrilación auricular paroxística idiopática / Electrophysiologic study and ablation therapy in idiopathic paroxystic atrial fibrillation

Objetivo: Informar la ablación en las venas pulmonares (VPs) en pacientes con fibrilación auricular paroxística (FAP). Material y métodos: Catorce pacientes (38±12 años [intervalo 8-52, 11 hombres, 3 mujeres) con FAP idiopática, sintomática y refractarios a antiarrítmicos y con estudio electrofisiológico. En 13 se encontró actividad eléctrica anormal (AEA) en VPs mediante catéteres especiales de cartografía y se realizó ablación. Resultados: Se identificó AEA en VP’s (13 pacientes, 86%) y en vena cava superior (un paciente, 6.6%). Un procedimiento fue suspendido por taquicardia ventricular. La ablación fue exitosa en 7 de los 12 pacientes restantes. Los cinco pacientes con ablación inicial fallida fueron llevados a un segundo procedimiento que fue exitoso en dos. En un paciente fue necesario un tercer procedimiento que resultó exitoso. Una paciente tuvo pericarditis con derrame ligero que no requirió drenaje. Conclusión: La ablación de FAP es un procedimiento seguro con una tasa de éxito combinada (con y sin antiarrítmicos) en esta población y a largo plazo, del 71%.

OBJECTIVE: To analyze the results of radiofrequency catheter ablation (RFCA) of the pulmonary veins (PV) in patients with paroxysmal atrial fibrillation (PAF). MATERIAL AND METHODS: We describe 4 patients (38 +/- 12 years, interval 8-52; 11 men) with symptomatic PAF, refractory to antiarrhythmic drugs. Special mapping catheters were used and ablation was performed at the ostium/antrum of those veins with abnormal electrical activity (AEA). RESULTS: AEA in one or more PV was identified in 13 patients (86%); in one patient AEA was also found in the superior vena cava (6.6%). One procedure was complicated by unstable ventricular tachycardia and was notfinished. Success was accomplished in 10, in 5 after the first ablation, in 4 after the second, and in one after a third procedure. One patient had pericarditis with a small pericardial effusion that did not require intervention. CONCLUSIONS: RFCA is a useful and relatively safe procedure for the treatment of PAF and the only one with curative potential. The long-term rate of success (with or without antiarrhythmics) in this series was 71%. These results justify catheter ablation in selected patients with symptomatic PAF unresponsive to medical treatment.