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2.
Eur J Contracept Reprod Health Care ; 25(3): 190-198, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312130

RESUMO

Objectives: Mifepristone for first-trimester medical termination of pregnancy (MTOP) became available in Quebec in 2018, one year after the rest of Canada. Using the theory of the Diffusion of Innovation (DOI) and the transtheoretical model of change (TTM), we investigated factors influencing the implementation of mifepristone MTOP in Quebec.Material and Methods: Semi-structured interviews were conducted with 37 Quebec physicians in early 2018. Deductive thematic analysis guided by the theory of DOI explored facilitators and barriers to physicians' adoption of mifepristone MTOP. We then classified participants into five stages of mifepristone adoption based on the TTM. Follow-up data collection one year later assessed further adoption.Results: At baseline, three physicians provided mifepristone MTOP (Maintenance) and two were about to start (Action). Thirteen physicians at Preparation and Advanced Contemplation stages intended to start while, within the Slow Contemplation, two intended to start and ten were unsure. Seven had no intention to provide mifepristone MTOP (Pre-Contemplation). Major reported barriers were: complexity of local health care organisations, medical policy restrictions, lack of support, and general uncertainty. One year later, ten physicians provided mifepristone MTOP (including three at baseline) and nine still intended to, while seventeen did not intend to start provision. Seven of sixteen participants (44%) who worked in TOP clinics at baseline were still not providing MTOP with mifepristone one year later.Conclusion: Despite ideological support, mifepristone MTOP uptake in Quebec is slow and laborious, mainly due to restrictive medical policies, vested interests in surgical provision and administrative inertia.

3.
J Obstet Gynaecol Can ; 42(5): 576-582, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31924442

RESUMO

OBJECTIVE: Mifepristone became available in Canada in January 2017, but provincial medical policy delayed its use for medical abortion (MA) in Québec for 1 year. The objective of this study was to identify barriers and facilitators experienced by physicians who could potentially provide this newer abortion practice in Québec. METHODS: This study was part of the Canadian Contraception and Abortion Research Team-Mifepristone Implementation Study, an observational, prospective, mixed-methods study. Interviews were conducted with physicians representing all health regions of Québec. Using thematic analysis guided by diffusion of innovation theory, the study identified key barriers and facilitators to implementation. RESULTS: From January 2017 to March 2018, study investigators interviewed 25 family physicians and 12 obstetrician-gynaecologists. Most were women (81%), over 40 years old (65%), with >20 years in practice since residency (49%). Less than half of the sample provided abortion services (41%), and only 8% provided MA with mifepristone. Key barriers to implementation were: (1) uncertainty or confusion about policies regarding MA, (2) lack of human resources or support from colleagues, (3) uncertainty about product distribution, (4) confusion about professional collaboration, and (5) lack of local infrastructure. Key facilitators were: (1) perception of support and influence from colleagues, (2) previous experience with provision of first trimester MA, (3) requests for first trimester MA by patients or other physicians, and (4) knowledge of research on mifepristone MA. CONCLUSION: Despite Health Canada's approval of mifepristone in Canada and supportive federal policies for provision of MA in primary care, physicians in the province of Québec face onerous barriers to the practice of mifepristone MA.

4.
PLoS One ; 15(1): e0227216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914156

RESUMO

OBJECTIVES: Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. METHODS: This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. RESULTS: Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group's work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. CONCLUSIONS: The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.


Assuntos
Abortivos Esteroides , Aborto Induzido , Mifepristona , Abortivos Esteroides/provisão & distribução , Aborto Induzido/legislação & jurisprudência , Colúmbia Britânica , Aprovação de Drogas/legislação & jurisprudência , Feminino , Política de Saúde , Humanos , Liderança , Mifepristona/provisão & distribução , Gravidez , Saúde Reprodutiva/legislação & jurisprudência
5.
Artigo em Inglês | MEDLINE | ID: mdl-31281015

RESUMO

Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.


Assuntos
Aborto Criminoso , Aborto Induzido , Aborto Legal , Política de Saúde/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudência , Canadá , Feminino , Humanos , Legislação como Assunto , Gravidez , Segundo Trimestre da Gravidez
6.
Pilot Feasibility Stud ; 5: 126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31720004

RESUMO

Background: Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods: In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh's conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin's framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré's validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results: We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. Conclusions: Our team operationalized Greenhalgh's theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.

7.
CMAJ Open ; 7(4): E646-E653, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31690652

RESUMO

BACKGROUND: Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada. METHODS: Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives). RESULTS: Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50). INTERPRETATION: We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.

8.
JMIR Hum Factors ; 6(4): e14558, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31603429

RESUMO

BACKGROUND: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. OBJECTIVE: The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. METHODS: The study design was based on the "development-evaluation-implementation" process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. RESULTS: We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. CONCLUSIONS: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care.

10.
J Med Internet Res ; 21(5): e13387, 2019 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144668

RESUMO

BACKGROUND: Over 30% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. OBJECTIVE: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women's preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. METHODS: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women's abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. RESULTS: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94% (47/50) owned a smartphone, 85% (41/48) used their personal phones to go online, and 85% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. CONCLUSIONS: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion.


Assuntos
Assistência ao Convalescente/métodos , Telefone Celular/estatística & dados numéricos , Adolescente , Adulto , Colúmbia Britânica , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Projetos de Pesquisa , Adulto Jovem
11.
Contraception ; 100(2): 96-100, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31100218

RESUMO

OBJECTIVES: We aim to describe demographic trends associated with postabortion contraceptive choice, characteristics of intrauterine device (IUD) users and relation to subsequent abortion. STUDY DESIGN: Our retrospective chart review study included all patients obtaining an abortion from 2003 to 2010 at the primary service provider in the Interior Health Region of British Columbia, tracking each patient for 5 years to detect subsequent abortion. We used descriptive statistics to analyze demographic trends and logistic regression to examine determinants of choosing an IUD and likelihood of subsequent abortion per contraceptive method. RESULTS: Our study cohort included 5206 patients, 1247 (24.0%) of whom chose an IUD. Patients increased IUD use from 10.14% to 45.74% of the cohort over the study period. Mean age of those choosing an IUD significantly decreased over the study period [30.9±7.3 years in 2003 to 26.2±6.5 years in 2010 (p<.001)]. In multivariable analysis, factors associated with choosing an IUD postabortion were prior delivery [aOR=2.77 (95% CI 2.40-3.20)] and being older than 20 years [20-29 years: AOR=1.87 (1.51-2.32); or 30+ years: AOR=1.96 (1.54-2.50)]. Patients choosing an IUD were less likely to have a subsequent abortion compared to those selecting oral contraceptives [aOR=1.96 (95% CI 1.54-2.52)] or depomedroxyprogesterone acetate [aOR=1.84 (95% CI 1.36-2.49)]. CONCLUSIONS: We found an increasing trend of choosing an IUD after an abortion in our population, especially among youth. Patients who chose an IUD postabortion were less likely to have a subsequent abortion over the next 5 years. IMPLICATIONS: An important strategy for reducing subsequent abortion is to ensure that those seeking abortion have accurate information on the comparative effectiveness of postabortion contraception methods. Educational efforts, alongside removal of cost and other barriers, will contribute to the prevention of subsequent abortion and improve equitable access to IUDs among the population.

12.
BMJ Open ; 9(4): e028443, 2019 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-31005943

RESUMO

INTRODUCTION: In January 2017, mifepristone-induced medical abortion was made available in Canada. In this study, we will seek to (1) understand facilitators and barriers to the implementation of mifepristone across Canada, (2) assess the impact of a 'community of practice' clinical and health service support platform and (3) engage in and assess the impact of integrated knowledge translation (iKT) activities aimed to improve health policy, systems and service delivery issues to enhance patient access to mifepristone. METHODS AND ANALYSIS: This prospective mixed-methods implementation study will involve a national sample of physicians and pharmacists recruited via an online training programme, professional networks and a purpose-built community of practice website. Surveys that explore constructs related to diffusion of innovation and Godin's behaviour change frameworks will be conducted at baseline and at 6 months, and qualitative data will be collected from electronic interactions on the website. Survey participants and a purposeful sample of decision-makers will be invited to participate in in-depth interviews. Descriptive analyses will be conducted for quantitative data. Thematic analysis guided by the theoretical frameworks will guide interpretation of qualitative data. We will conduct and assess iKT activities involving Canada's leading health system and health professional leaders, including evidence briefs, Geographical Information System (GIS)maps, face-to-face meetings and regular electronic exchanges. Findings will contribute to understanding the mechanisms of iKT relationships and activities that have a meaningful effect on uptake of evidence into policy and practice. ETHICS AND DISSEMINATION: Ethical approval was received from the University of British Columbia Children's and Women's Hospital Ethics Review Board (H16-01006). Full publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to research participants through newsletters and media interviews, and to policy-makers through invited evidence briefs and face-to-face presentations.


Assuntos
Abortivos Esteroides/uso terapêutico , Aborto Induzido/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mifepristona/uso terapêutico , Adulto , Canadá , Feminino , Humanos , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
13.
Syst Rev ; 8(1): 74, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30914067

RESUMO

BACKGROUND: For women seeking permanent contraception, there are a variety of options available including surgical techniques such as tubal ligation or bilateral salpingectomy, in-clinic procedures such as hysteroscopic techniques using micro-inserts, or the levonorgestrel-releasing intrauterine contraceptive. Despite the various methods available for women who are seeking permanent contraception, there is not a review or decision-making tool that systematically brings together outcomes related to effectiveness, tolerability, adverse effects, non-contraceptive benefits, recovery, or accessibility: all of which are important for shared decision-making between patients and health care providers. METHODS: We registered our protocol [on Prospero: CRD42016038254] following PRISMA guidelines. A search strategy was created in collaboration with a librarian, and three databases (EMBASE, PubMed, Web of Science) will be searched along with secondary screening of relevant articles. A third reviewer will adjudicate any discrepancies. Data will be extracted independently according to population, intervention, comparison, outcomes (PICOS); length of follow-up; and funding. Articles will be assessed for bias using the Newcastle-Ottawa Scale and the Cochrane Collaboration tool. If appropriate, a network meta-analysis will be conducted to rank and analyze each method according to each objective. If heterogeneity between studies is too high or it is not possible to conduct a network meta-analysis, a narrative analysis of the study results will be provided. DISCUSSION: Clinicians and their patients seeking permanent contraception have several options, yet we were unable to find a systematic review or decision support tool helping to facilitate shared decision-making. This systematic review can inform patients, providers, and health policy decision-makers about which options of permanent contraception will meet different reproductive goals according to various outcomes, which can lead to better health, social, economic, and mental well-being for reproductive age women. This can also aid our understanding of resulting costs to the health care system. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016038254.


Assuntos
Anticoncepção/métodos , Anticoncepção/efeitos adversos , Países Desenvolvidos , Feminino , Humanos , Salpingectomia , Esterilização Tubária
14.
Can J Public Health ; 110(3): 317-322, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30887457

RESUMO

Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow's public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support "innovative population health research that improves health equity for citizens in Canada and around the world." We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.


Assuntos
Pesquisa sobre Serviços de Saúde , Saúde Pública/tendências , Canadá , Humanos
15.
Can Fam Physician ; 65(1): 45-51, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30674515

RESUMO

OBJECTIVE: To examine characteristics at admission and subsequent academic achievements among the graduates of the first 15 years of the clinician scholar program (CSP), Canada's longest-running such program, housed at the University of British Columbia in Vancouver. DESIGN: Cross-sectional study with data gathered from program files, personal correspondence, and public sources. SETTING: Vancouver. PARTICIPANTS: Graduates of the University of British Columbia CSP from 2001 to 2015. MAIN OUTCOME MEASURES: Characteristics at admission (years since medical school graduation, previous graduate degrees) and measures of scholarly success (peer-reviewed publications, subsequent graduate degrees, and academic faculty appointments). RESULTS: We obtained data for all 40 CSP graduates. The median years since medical school graduation at admission to the CSP was 12 years (interquartile range of 8 to 19); 60% of entrants held no previous graduate degree. After CSP completion, 15% of graduates attained an academic faculty appointment and 23% published more than 2 peer-reviewed articles per year. Subsequent success was not diminished with increasing years since medical school graduation, nor was it diminished among those without a previous graduate degree. Clinician scholar program graduates who subsequently completed a graduate degree were significantly more likely (P = .01) to publish frequently. We noted a weak negative relationship between getting a subsequent degree and number of years since medical school graduation (odds ratio of 0.89, 95% CI 0.78 to 0.99, P = .04). CONCLUSION: We found family physicians interested in becoming researchers were usually highly experienced, with physicians entering the CSP a median of 12 years (interquartile range 8 to 19 years) after medical school graduation. Most went on to publish several papers and more than 20% maintained a productivity of more than 2 peer-reviewed papers per year. The mentorship program model during this first 15 years has been effective in training family physicians to begin clinician scholar careers, and has been built upon, with the introduction from 2013 to 2015 of an enhanced curriculum. Future quantitative and qualitative analysis of this program and others is important to better articulate the success of clinician scholars striving to understand and improve primary care and health for Canadians.


Assuntos
Medicina de Família e Comunidade , Publicações/estatística & dados numéricos , Apoio à Pesquisa como Assunto , Apoio ao Desenvolvimento de Recursos Humanos , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
16.
J Obstet Gynaecol Can ; 41(1): 29-37, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30316712

RESUMO

OBJECTIVES: Non-use of contraception is an important contributor to unintended pregnancy. This study assessed non-use of contraception and its determinants among Canadian youth aged 15 to 24. METHODS: Data from the 2009-2010 Canadian Community Health Survey respondents aged 15 to 24 were used to identify non-users of contraception among heterosexual youth who had had intercourse within the previous 12 months, were not pregnant or sterilized, and felt it was important to avoid pregnancy. Sociodemographic, behavioural, and geographic factors were compared for non-users and users of contraception. RESULTS: Among youth at risk for unintended pregnancy, 15.5% were non-users of contraception. There were no differences between sexes. Across regions of Canada, Quebéc had the highest proportion of at-risk youth, but at-risk Quebéc youth were the least likely to be non-users (7.4%; CI 5.7%-9.0%) compared with at-risk youth in the Territories (28.3%; CI 21.6%-35.0%). In the multivariable analysis, aside from residence outside of Quebéc, younger age, lower income, Aboriginal identification (adjusted OR [aOR] 1.67; CI 1.18-2.37), and smoking (aOR 1.55; CI 1.24-1.92) were associated with non-use. Canadian-born youth (aOR 0.61; CI 0.39-0.96) and those enrolled in school (aOR 0.63; CI 0.50-0.81) were less likely to be non-users. CONCLUSION: The 15.5% of Canadian youth at risk for unintended pregnancy who were non-users of contraception represent an estimated 300 000 Canadian youth. Policies and programs to promote and support access to sexual health services and effective contraception with specific attention to supporting the needs of younger teens, Aboriginal youth, newcomers, low-income youth, and youth who are not in school are needed.

17.
Contraception ; 99(1): 10-15, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30125557

RESUMO

OBJECTIVES: To assess whether first-trimester aspiration abortion practices of US providers agree with evidence-based policy guidelines. STUDY DESIGN: We sent surveys by mail or electronically to all abortion facilities in the United States identified via professional networks and websites from June through December 2013. Administrators reported on the volume of procedures performed at their site(s) through 13 weeks 6 days' gestation and on clinic services. Clinicians reported on personal demographic characteristics and abortion practices. We reviewed guidelines from key US professional organizations to determine how well reported practices aligned with available recommendations and the extent to which guidelines have changed since the time of the survey. RESULTS: We identified 703 clinical sites in the United States; 383 (54%) sites responded, 256 of which offer first-trimester aspiration abortions. Most providers identified as obstetrician-gynecologists (74%) and female (64%); 52% were less than 50 years old compared to 36% in 2002. Overall, reported practices follow evidence-based guidelines, including routine administration of periprocedure antibiotics (85%), use of misoprostol for cervical ripening in the late first trimester (94%), pain management practices, and same-day contraception provision (98%) including long-acting devices (76%). Less evidence-based practices include routine preprocedure ultrasound (99%), not providing abortion before 5 weeks' gestation (66%), restrictive fasting policies, and prolonged and postprocedure antibiotic provision. CONCLUSION: Overall, the first-trimester aspiration abortion practices revealed in our survey agree with professional evidence-based policy guidelines, though some related to preprocedure ultrasound use, very early abortion provision, preanesthesia fasting protocols, and antibiotic regimens deserve attention. IMPLICATIONS: In this third cross-sectional survey of US abortion practices (prior surveys 1997 and 2002), first-trimester aspiration abortion providers are younger than before, reflecting an improvement in the "graying" of the abortion provider workforce. Research and education are needed to further improve evidence-based practice in abortion care.


Assuntos
Aborto Induzido/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Abortivos não Esteroides/uso terapêutico , Aborto Induzido/normas , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Misoprostol/uso terapêutico , Gravidez , Primeiro Trimestre da Gravidez , Inquéritos e Questionários , Estados Unidos
18.
CMAJ ; 191(19): E517-E518, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32392474
19.
JAMA Intern Med ; 178(12): 1661-1670, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30383085

RESUMO

Importance: Interpregnancy intervals shorter than 18 months are associated with higher risks of adverse pregnancy outcomes. It is currently unknown whether short intervals are associated with increased risks among older women to the same extent as among younger women. Objective: To evaluate whether the association between short interpregnancy (delivery to conception) interval and adverse pregnancy outcomes is modified by maternal age. Design, Setting, and Participants: A population-based cohort study conducted in British Columbia, Canada, evaluated women with 2 or more singleton pregnancies from 2004 to 2014 with the first (index) pregnancy resulting in a live birth. Data analysis was performed from January 1 to July 20, 2018. Main Outcomes and Measures: Risks of maternal mortality or severe morbidity (eg, mechanical ventilation, blood transfusion >3 U, intensive care unit admission, organ failure, death), small-for-gestational age (<10th birthweight percentile for gestational age and sex), fetal and infant composite outcome (stillbirth, infant death,

Assuntos
Intervalo entre Nascimentos , Idade Materna , Complicações na Gravidez/epidemiologia , Adulto , Canadá , Estudos de Coortes , Feminino , Humanos , Gravidez , Resultado da Gravidez , Adulto Jovem
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