Search

BackgroundPatients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally.ObjectiveA pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill.MethodsA sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, "what should I do if I missed a day of my oral contraception birth control?" alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information.ResultsThe ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text.ConclusionsChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed.

Globally, human–wildlife conflicts continue to increase, owing to human population growth and expansion. Many of these conflicts concern the impacts of invasive non‐native species. In the UK, the invasive, non‐native grey squirrel Sciurus carolinensis negatively affects tree health and has caused the decline of the native red squirrel Sciurus vulgaris. Oral contraceptives are being developed to manage the impacts of the grey squirrel. To be effective, contraceptives will need to be deployed at a landscape scale, and will require a delivery system that is practical and economically viable. Understanding grey squirrel feeding behaviour is important so that delivery methods can be designed so that a sufficient number of target individuals receive an effective contraceptive dose at a time of year that will ensure their infertility throughout peak times of breeding. The main aims of this study were to assess how sex, season, squirrel density and bait point density influenced; (1) the probability of a squirrel visiting a feeder and (2) the amount of bait consumed from feeders. Field trials were conducted on six woodland populations of squirrels in three seasons, with four days of bait deployment via purpose‐designed squirrel‐specific bait hoppers with integrated PIT‐tag readers. It was possible to deliver multiple doses on most days to most male and female grey squirrels, with bait deployment more likely to be effective in spring, immediately before the second annual peak in squirrel breeding, followed by winter, immediately before the first peak in breeding. The results from this study could be used to design methods for delivering oral contraceptive baits to grey squirrels in the future and the methods used could be applied to other small mammal species and other bait delivery systems. © 2024 Crown copyright and The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland. [ABSTRACT FROM AUTHOR]

Background : Perinatal anxiety is common: up to 40% of pregnant women and new mothers experience high levels of anxiety. Given its prevalence, interventions that are low-intensity, highly accessible and cost-efficient, and target modifiable risk factors for anxiety are needed. Repetitive negative thinking (RNT)—such as worrying about ways things will go wrong in the future or ruminating about past negative events—is a risk factor for the development of anxiety. RNT is maintained by the tendency to generate negative interpretations of ambiguous situations. Methods: A parallel two-arm randomised controlled trial will assess the efficacy of adding interpretation training (RELAX) to usual maternity care. Participants (N = 268) will be randomised to (i) 12 sessions of online interpretation training (RELAX) plus usual care, or (ii) usual care alone. We will assess anxiety, depression, RNT, and work and social adjustment at baseline, plus 4, 8 and 36 weeks later. Discussion: Should the intervention result in lower levels of anxiety than usual care, it could be an accessible, cost-effective way to help women who are vulnerable to experiencing anxiety in the perinatal period. Trial registration: ISRCTN 12754931. Registered 25th May 2023, prior to recruitment. [ABSTRACT FROM AUTHOR]

Persistent tuberculosis (TB) in cattle populations in England has been associated with an exchange of infection with badgers (Meles meles). A badger control policy (BCP) commenced in 2013. Its aim was to decrease TB incidence in cattle by reducing the badger population available to provide a wildlife reservoir for bovine TB. Monitoring data from 52 BCP intervention areas 200–1600 km2 in size, starting over several years, were used to estimate the change in TB incidence rate in cattle herds, which was associated with time since the start of the BCP in each area. A difference in differences analysis addressed the non-random selection and starting sequence of the areas. The herd incidence rate of TB reduced by 56% (95% Confidence Interval 41–69%) up to the fourth year of BCP interventions, with the largest drops in the second and third years. There was insufficient evidence to judge whether the incidence rate reduced further beyond 4 years. These estimates are the most precise for the timing of declines in cattle TB associated with interventions primarily targeting badgers. They are within the range of previous estimates from England and Ireland. This analysis indicates the importance of reducing transmission from badgers to reduce the incidence of TB in cattle, noting that vaccination of badgers, fertility control and on farm biosecurity may also achieve this effect. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusion The 2020 Family First Coronavirus Response Act (FFCRA) extended Medicaid coverage for enrollees without rechecking eligibility. Before that, women were eligible for Medicaid coverage up to 60 days postpartum. We examine the FFCRA's effect on Medicaid postpartum coverage, depression symptoms, and birth control use beyond 60 days after delivery.We use data from the 2016–2021 Pregnancy Risk Assessment Monitoring System (PRAMS). The primary sample includes 56,828 women who were income eligible up to 60 days postpartum or beyond in their state.We employ a difference‐in‐differences design comparing outcomes before and after the FFCRA between women who were not income eligible for Medicaid coverage beyond 60 days postpartum in their state and those who were income eligible. We estimate models without and with controlling for state‐specific trends in outcomes over time.N/A.There is an 8.1 percentage‐point increase in the likelihood of having Medicaid coverage without controlling for state‐specific trends, and 5.4 percentage‐points when controlling for state‐specific trends (both p < 0.05). There is a decline in likelihood of being uninsured by 3 percentage‐points (p < 0.05) without state‐specific trends and a smaller and non‐significant decline when including state‐specific trends. Estimated effects on depression symptoms and birth control use are small and statistically non‐significant.Following the FFCRA, there was an increase in Medicaid coverage beyond 60 days postpartum among women who would have been income ineligible for Medicaid after 60 days. However, there is a less pronounced effect on likelihood of being uninsured, which might be partly due to some switching from private to Medicaid coverage. There were no discernable effects on depression symptoms and birth control use. Examining additional health and health care utilization measures over a longer postpartum period is needed to further understand the FCCRA effects on these outcomes. [ABSTRACT FROM AUTHOR]

AbstractBackground/IntroductionMethodsResultsConclusionSHORT CONDENSATIONOn June 24, 2022, the Supreme Court overturned the 1973 verdict in the Roe v. Wade legal suit that had established the constitutional right to medical abortion [1]. With the right to abortion now being left to the states, many restrictions regarding abortion procedures are being established [2]. We aim to evaluate whether this has led to an increase in the number of birth control prescriptions and sterilisation procedures at Cape Fear Valley Medical Centre in rural North Carolina.SlicerDicer program within EPIC medical records database was used to retrieve the records of all women that had an obstetrics and gynaecology appointment with Cape Fear Valley Health System between 11/01/21-12/31/2022 for contraception. The data was sorted into race/ethnicity, age, and types of birth control. Principal outcomes measured the trends in birth control prescription or sterilisation procedure appointments before and after the overturn of Roe v. Wade.Contraceptive pill prescriptions decreased from 51.70% to 32.40%. IUD insertions decreased from 39.40% to 11.30%. Injectable birth control remained consistent, at approximately 16%. Nexplanon implantations dropped from 20.60% to 9.70%. Lastly, sterilisation procedures increased from 6.7% to 10.7%.Majority of birth control prescriptions decreased following the overturn of Roe v. Wade, except for sterilisation, which increased by 4.0%. This may indicate that women are now looking for more permanent birth control options after the overturn of Roe v. Wade. Future research should investigate whether similar trends of increasing prevalence of sterilisation procedures is seen throughout the United States.We aim to assess the impact of the Supreme Court overturn regarding the Roe v. Wade legal suit on contraceptive decisions in rural North Carolina. [ABSTRACT FROM AUTHOR]

The development and regulation of hormonal contraception has been problematic—with concerns and safety of patients often being disregarded. Better birth control prescribing may lie in genetic testing. Direct-to-consumer genetic testing aimed at "personalizing the pill" exists, but regulations and clinical guidelines must adapt to meet the diverse needs of patients. This article analyzes emerging socio-ethical-legal tensions as hormonal contraceptives enter the pharmacogenomic era. Using a narrative lens, the author concludes that further patient-centered research—grounded in the voices of distinct populations—should inform policy so as to better serve birth control users and avoid the historical injustices with respect to hormonal contraception. [ABSTRACT FROM AUTHOR]

At the beginning of the pandemic, SARS-CoV-2 infection represented a great medical burden worldwide, as targeted and effective therapeutic options were lacking. This resulted in the revival of existing molecules and the increasing popularity of over-the-counter nutritional supplements. Among the latter, lactoferrin has been investigated as an adjuvant in COVID-19 therapy with conflicting results, mainly depending on different study designs. Considering that lactoferrin is one of the main components of human breast milk with anti-microbial and anti-inflammatory activity, it is conceivable that such bioactive molecule could be effective in supporting anti-SARS-CoV-2 infection therapy, especially in infants and pregnant women, two subpopulations that have been poorly evaluated in the existing clinical trials. This narrative review is intended to offer insight into the existing literature on lactoferrin's biological functions and protective effects against COVID-19, with a special focus on pregnant women and their infants. [ABSTRACT FROM AUTHOR]

Hormonal contraceptives (HCs) are one of the most highly prescribed classes of drugs in the world used for both contraceptive and noncontraceptive purposes. Despite their prevalent use, the impact of HCs on the brain remains inadequately explored. This review synthesizes recent findings on the neuroscience of HCs, with a focus on human structural neuroimaging as well as translational, nonhuman animal studies investigating the cellular, molecular, and behavioral effects of HCs. Additionally, we consider data linking HCs to mood disorders and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and stress response as a potential mediator. The review also addresses the unique sensitivity of the adolescent brain to HCs, noting significant changes in brain structure and function when HCs are used during this developmental period. Finally, we discuss potential effects of HCs in combination with smoking-derived nicotine on outcomes of ischemic brain damage. Methodological challenges, such as the variability in HC formulations and user-specific factors, are acknowledged, emphasizing the need for precise and individualized research approaches. Overall, this review underscores the necessity for continued interdisciplinary research to elucidate the neurobiological mechanisms of HCs, aiming to optimize their use and improve women’s health. [ABSTRACT FROM AUTHOR]

Introduction: Progress in male contraception development faces the challenge of a lack of regulatory precedent and guidelines on the evidence (trial design and primary endpoint) required for marketing approval. Moreover, the development of a male contraceptive is complicated by the fact that the clinical treatment effect; prevention of pregnancy, is not measured in the patient receiving the intervention. Discussion: Regulatory precedent and guidelines exist for female hormonal contraceptives but their applicability to male contraceptive products likely varies based on the mode of action and the anticipated pharmacodynamic effects of the product. The unique attributes of male contraceptives, including the frequent delay between the intervention (e.g., vasectomy and hormonal methods) and ultimate contraceptive effect, sperm suppression near azoospermia, and pregnancy prevention need to be addressed. Conclusion: This article describes the regulatory challenges faced by developers of male contraceptive products and offers proposals, paving the way for the development of both hormonal methods and non‐hormonal approaches. Our article intends to suggest the directions but cannot substitute for the advice of regulatory agencies. [ABSTRACT FROM AUTHOR]

Despite the projected impact of new male contraceptives, resources and investments directed at their development remain limited in part due to concerns that men would not actually use them. Now, more than 30 studies have been conducted over the last 30 years—regionally and internationally, within clinical trials, and across populations—examining men and women's attitudes towards new male contraceptive methods, all consistently demonstrating interest in and willingness to use new methods. Yet even these studies, inclusive of competitive contraceptive market projections, seem not to be convincing enough. Rather than study whether men would be willing to use male contraceptives, more resources should be devoted to developing the infrastructure and supporting the cultural changes needed to ensure that when new male contraceptives inevitably emerge, that they will be disseminated quickly and made readily accessible. Men's views on what their roles are in society, families, relationships, and pregnancy prevention are changing in ways that may impact what they consider to be acceptable contraceptive risks. As society moves toward more gender equitable beliefs, men's positive involvement in contraception might organically develop into an expected behavior. Interventions aimed at sensitizing men toward gender equitable beliefs may pay dividends in improving male contraceptive acceptability. The current lack of a reversible male contraceptive method prevents us from collecting data that might disprove presumptions that men would be unwilling to take on responsibility for pregnancy prevention. However, studies of men's involvement in (1) over‐the‐counter emergency contraception, (2) vasectomy, and (3) abortion offer case studies for men's increasing consciousness of opportunities for shared contraceptive responsibility, the structural and sociopolitical barriers that men face when trying to participate in family planning, and how these might translate into new male contraceptive interest and development. [ABSTRACT FROM AUTHOR]

Many female military service members choose to use hormonal contraception to prevent pregnancy and/or to control or suppress menses. Hormonal contraception, which comes in many different forms based on dose, estrogen/progestin type, and route of administration (oral, vaginal, transdermal, implant, intrauterine device, injectable), may cause side effects, some of which can influence military medical readiness, or the health status necessary to perform assigned missions. This expert review summarizes the evidence around common military-relevant side effects of hormonal contraception that could impact readiness, including effects on weight and body composition, bone health, psychological health, and physical performance, and serves as a tool for uniformed and civilian clinicians counseling female service members about hormonal contraception. Current evidence suggests some hormonal contraception can lead to weight and fat gain, may modulate susceptibility to mood or mental health disorders, and could impact bone mineral density and stress fracture risk; more research is needed on physical performance effects. Clinicians must be familiar with readiness considerations of each type of hormonal contraception to provide comprehensive patient education and allow for optimal shared decision-making about hormonal contraception use among female Service members. Considering the relative lack of data on the effects of nonoral hormonal contraception routes on readiness outcomes and the growing interest in long-acting reversible contraceptives among female service members, future research should continue to investigate effects of all hormonal contraception methods available to service members. [ABSTRACT FROM AUTHOR]

ABSTRACT In recent decades, the integration of horses (Equus ferus) in European rewilding initiatives has gained widespread popularity due to their potential for regulating vegetation and restoring natural ecosystems. However, employing horses in conservation efforts presents important challenges, which we here explore and discuss. These challenges encompass the lack of consensus on key terms inherent to conservation and rewilding, the entrenched culture and strong emotions associated with horses, low genetic diversity and high susceptibility to hereditary diseases in animals under human selection, as well as insufficient consideration for the social behaviour of horses in wild‐living populations. In addition, management of wild‐living horses involves intricate welfare, ethics and legislative dimensions. Anthropocentric population‐control initiatives may be detrimental to horse group structures since they tend to prioritise individual welfare over the health of populations and ecosystems. To overcome these challenges, we provide comprehensive recommendations. These involve a systematic acquisition of genetic information, a focus on genetic diversity rather than breed purity and minimal veterinary intervention in wild‐living populations. Further, we advise allowing for natural top‐down and bottom‐up control – or, if impossible, simulating this by culling or non‐lethal removal of horses – instead of using fertility control for population management. We advocate for intensified collaboration between conservation biologists and practitioners and enhanced communication with the general public. Decision‐making should be informed by a thorough understanding of the genetic makeup, common health issues and dynamics, and social behaviour in wild‐living horse populations. Such a holistic approach is essential to reconcile human emotions associated with horses with the implementation of conservation practices that are not only effective but also sustainable for the long‐term viability of functional, biodiverse ecosystems, while rehabilitating the horse as a widespread wild‐living species in Europe. [ABSTRACT FROM AUTHOR]

Introduction: Structural racism plays a major role in reproductive health inequities. Colorism, discrimination based on skin color, may profoundly impact reproductive health access and service delivery. However, quantitative research in this area is limited. Methods: We administered an online survey of women (n = 1,299) aged 18–44 from Harris County, Texas to assess the relationship between skin color discrimination and reproductive health service avoidance. The survey included questions on demographics, self-reported skin tone, and dichotomous measures of previous discrimination experiences and avoidance of care because of perceived discrimination. Binary logistic regression was used to examine whether race/ethnicity, skin tone, and previous discrimination experiences were related to avoidance of contraceptive care because of perceived discrimination. Results: Approximately one-third (31.5%) of the sample classified themselves as non-Hispanic Whites (31.5%), 22.4% as Black, 27.4% as Hispanic and born within the US, and 7.6% as Hispanic born outside of the US. Approximately one-third of women classified themselves in the lightest skin tones, whereas almost one in five women classified themselves in the darkest skin tone palates. Darker skin tones had increasingly greater odds of reporting that they avoided seeking birth control out of a concern for discrimination compared to the lightest skin tone. After adjusting for race/ethnicity and sociodemographic variables (model 3), darker skin tones remained significantly associated with avoiding birth control. Discussion: This study demonstrates the role that skin color discrimination plays in negative reproductive health experiences. While this is not surprising given that those with racist ideologies developed the concept of these racial and ethnic categories, the apparent association with darker skin colors and avoidance of seeking birth control provides evidence that structural and individual racism continues to have far-reaching and insidious consequences. Conclusion: Contraception is recognized for reducing maternal mortality, improving child health, increasing female empowerment, and decreasing poverty. However, not all women equally enjoy the benefits of access to contraception. Addressing colorism within reproductive healthcare has become critically important as the nation becomes increasingly diverse. Focusing on skin tone-based discrimination and its roots in anti-blackness expands our understanding beyond a Black–White binary traditionally applied when addressing racism in healthcare delivery. [ABSTRACT FROM AUTHOR]

Fertility control has traditionally been applied in zoos to control captive populations, and reversible contraception is important. However, contraceptive methods for male bears have not been reported. We aimed to establish a reversible contraceptive for male brown bears by investigating the effects of a gonadotropin‐releasing hormone (GnRH) vaccine (Improvac®) that was developed for the immune castration of pigs. We vaccinated six bears with two sequential doses of 400 (n = 2) or 600 μg Improvac® (n = 4) with a 1‐month interval during the pre‐breeding season (February to April). We compared the reproductive parameters (testosterone levels and semen parameters) of the six vaccinated and four non‐vaccinated (control) bears once during the breeding season (May or June). To investigate whether the reproductive performance could be restored in the following year of contraception, we also compared the reproductive parameters once during the breeding season in two bears between the year with GnRH vaccination and the following year without vaccination. Vaccination treatments suppressed reproductive parameters in 5 bears, although vaccination with 400 μg of Improvac® was not effective in one bear. Testosterone levels and the rate of progressive sperm motility were significantly lower, and total sperm count and testis size tended to be lower in vaccinated bears, compared with the controls. Blood biochemical findings and direct observations after Improvac® vaccination did not reveal side effects. Moreover, testosterone levels and spermatogenic scores of two bears were restored in the following year. We confirmed that the Improvac® vaccine elicited a reversible contraceptive effect in male brown bears. [ABSTRACT FROM AUTHOR]

Abstract Introduction Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized. Methods This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019–2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants’ experiences with AEs also were collected for the COVID-19 vaccine recipients. Results Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs. Conclusions Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women.

Background Methods Results Conclusion Adolescent contraceptive decision‐making is influenced by a number of patient and clinician‐driven factors. Although the AAP continues to endorse an efficacy‐based model of contraceptive counseling, many professional organizations are shifting to a shared decision‐making model as the optimal approach for providing unbiased and patient‐driven contraceptive counseling. While SDM is intended to reduce the influence of clinician bias, it can exacerbate inequity if a clinician tailors a conversation based on their assumptions of a patient's goals or preferences. In this qualitative study, we explored self‐reported contraceptive counseling practices among US‐based clinicians who see adolescent patients to assess how these practices create barriers or facilitators to SDM and person‐centered contraceptive care.We interviewed 16 clinicians at the 2022 AAP Annual Meeting who counsel adolescent patients about contraception. We used thematic content analysis to analyze interview transcripts using Dedoose.We identified six aspects of contraceptive counseling that clinicians commonly employed with adolescent patients. These were: (1) sociodemographic characteristics driving counseling, (2) reliance on tiered effectiveness counseling, (3) initiating counseling conversations using “ask then explain” or “explain then ask” approaches, (4) emphasis on teen pregnancy prevention, (5) the influence of method accessibility on counseling, and (6) parental involvement in decision‐making and patient confidentiality. We describe how these themes align with or diverge from each component of the SDM framework.Clinicians in this study frequently engaged in non‐patient‐centered techniques during contraceptive counseling with adolescents. These findings can inform practice recommendations to support clinicians in providing high‐quality contraceptive counseling using shared decision‐making. [ABSTRACT FROM AUTHOR]

Background: HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa. Methods: Between March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16–40 stratified by ages (16–17, 18–24, 25–40), half of whom were COC users. We explored adolescent girls and women's opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis. Results: The majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient "two-in-one" solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers. Conclusions/significance: The DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence. [ABSTRACT FROM AUTHOR]

Objective: To assess adolescent and young adult males' perceptions regarding gender equity in La Romana, Dominican Republic. Methods: We used the Gender Equitable Men (GEM) scale among males aged 15–24, who reported level of agreement with gender equity attitudes, establishing 0.01–0.5 = "low gender equitable", 0.51–0.79 = "medium gender equitable" and 0.8–1 = "high gender equitable". We established p < 0.05 for statistical significance, using Chi square for bivariate analysis and binary logistic regression to analyze predictors. Results: A total of 358 males participated; one-fourth (n = 95, 26.5%) reported high GEM scores. The reproductive health and violence subscales presented higher distribution of high GEM scores (69.3% and 66.2%). Predictors for high GEM scores included high school or higher education for self (OR: 6.1 CI 2.9–12.7, p < 0.01) or mother (OR 14 CI 1.8–11.8 p = 0.01), being married/cohabitating predicted lower gender equitable scores (OR: 0.1 CI 0.1–0.7 p = 0.01). Conclusion: Male Dominican adolescent and young adults present mixed attitudes about gender equity, reporting gender equitable mindset for violence and reproductive health. Further research should explore how perceptions of gender roles impact family planning decisions, pregnancy prevention, STIs, and gender-based violence. [ABSTRACT FROM AUTHOR]

Background: Health apps developed to improve the well-being of pregnant women have been varied. This screening and education app tool was developed based on a literature review and qualitative research results. Methods: The design adopted for this study will be an exploratory sequential mixed method design; thematic analysis will be carried out after data collection; and quantitative analysis with an independent t-test will also be carried out. The study will involve 124 second- and third-trimester pregnant women with anemia, who are divided into two groups: intervention and control groups without randomization. The primary outcomes to be sought are prevention of anemia complications and hemoglobin levels. Secondary outcomes include the experiences of postpartum women who have experienced anemia complications and the M-Health App Usability Questionnaire (MAUQ) and demographic information. The completion of the anemia complication prevention behavior questionnaire and measurement of hemoglobin levels will be carried out after 6 weeks of participants using the screening and educational application tools. Evaluation of the control group will be conducted 6 weeks after recruitment. Result: The trial recruitment will be carried out in September 2023. Data collection will be carried out at a later date. Conclusion: This study is to develop and test the effectiveness of a web-based application applied to pregnant women to prevent complications of anemia. This application will be developed based on the concept of anemia and the experience of postpartum women with anemia complications. [ABSTRACT FROM AUTHOR]

Introduction : The National Family Planning and Welfare Program has been in place for more than 50 years, yet the high rate of unmet family planning need remains a significant obstacle for the program. The goal is to reach all women whose reproductive behavior necessitates the use of contraception but who, for a variety of reasons, do not use it. Objectives : This study aimed to determine the prevalence of different types of contraceptive methods adopted by eligible couples (aged 15-49 years) as a method of family planning. Methods : The present descriptive, cross sectional study was carried out amongst 200 women of reproductive age group in the Sonarpur rural area of West Bengal. Participants were interviewed by the trained staff using the pre-tested questionnaire. The information about various family planning methods adopted by couple was taken. Study was carried out from August 2023 to December 2023. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results : A total of 200 eligible couples were interviewed. Maximum couples were in the age group of 30-34 years i.e. 44 (40%). Total 110 (55%) couples were using one or the other method of family planning. Condoms were most commonly used method by 52 (47%) couples followed by oral contraceptive pills 32 (29%). Among permanent methods of family planning, tubectomy was adopted by 8 (7%) and vasectomy only by 6 (6%) couples. No one was practising any miscellaneous method of contraception. The percentage of family planning methods used by Hindus was maximum 84 (76.4%). The highest percentage of using family planning methods was used by upper middle class (41.8%) followed by middle class (34.5%) and least by lower middle class (5.5%). Conclusions : Almost 50% of couples who qualified did not use any form of birth control. The adoption of permanent methods of contraception, particularly vasectomy, ought to be encouraged among suitable couples. [ABSTRACT FROM AUTHOR]

Background/Obectives: Oral retinoids are teratogenic, and pregnancy avoidance is an important part of retinoid prescribing. Australia does not have a standardised pregnancy prevention programme for women using oral retinoids, and the contraception strategies for women who use oral retinoids are not well understood. The objectives were to determine trends in the use of prescription retinoids among Australian reproductive‐aged women and whether women dispensed oral retinoids used contraception concomitantly. Methods: This was a population‐based study using Australian Pharmaceutical Benefits (PBS) dispensing claims for a random 10% sample of 15‐44‐year‐old Australian women, 2013 ‐ 2021. We described rates and annual trends in dispensing claims for PBS‐listed retinoids and contraceptives. We also estimated concomitant oral retinoid and contraceptive use on the day of each retinoid dispensing and determined if there was a period of contraceptive treatment that overlapped. Estimates were then extrapolated to the national level. Results: There were 1,545,800 retinoid dispensings to reproductive‐aged women; 57.1% were oral retinoids. The rate of retinoid dispensing to reproductive‐aged women increased annually, from 28 dispensings per 1000 population in 2013 to 41 per 1000 in 2021. The rate of oral retinoid dispensing doubled over the study period, from 14 dispensings per 1000 population in 2013 to 28 per 1000 in 2021, while topical retinoid dispensing did not change. Only 25% of oral retinoid dispensings had evidence of concomitant contraceptive use in 2021. Conclusions: Rates of oral retinoid dispensing have doubled among reproductive‐aged women over the past decade. A large percentage of oral retinoid use does not appear to have concomitant contraception use, posing a risk of teratogenic effects in pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To conduct research in order to determine the effect that antenatal counseling has on the use of contraception during the immediate postpartum period in the conservative society that exists in the rural areas surrounding Lahore, Pakistan. Study Design: Randomized Clinical Trial. Setting: Central Park Teaching Hospital in Lahore, Pakistan. Period: Jan, 2022 to April, 2022. Methods: A random selection was used to divide 400 antenatal patients who were at least 28 weeks along in their pregnancies into two groups. Patients who did not receive antenatal counseling regarding birth control options were included in Group X while patients who received antenatal counseling regarding the use of birth control were included in Group Y. A pre-designed proforma was completed following a written informed consent. Data was analyzed using SPSS 26. Results: Data was collected from 400 females (200 in each group) who visited CPTH. The mean age of the female participants was 27.26 + 4.78 years. Most of the participants lived in extended family systems. Nearly one third of the females was illiterate or has primary level of education. Approximately one-fourth of the females were graduated or above. After first pregnancy, 68% in group I and 86% in group II mentioned that they used contraceptive method, (p = 0.005, statistically significant). After second and fifth pregnancy, effect of counseling was affective and difference was statistically significant. The most common contraceptive method was barrier method followed by injection after first and second pregnancy. Conclusion: Antenatal contraceptive counseling proves to be a highly effective intervention in enhancing the acceptance and utilization of contraceptives within the conservative societies of Pakistan. Health care providers ought to undergo comprehensive training and exhibit unwavering motivation in order to effectively engage in antenatal contraceptive counseling. [ABSTRACT FROM AUTHOR]

Following the Dobbs v. Jackson Women's Health Organization decision, Republican-controlled legislatures across the U.S. initiated draconian abortion restrictions. In order to appeal to anti-abortion policymakers, advocates across the country have strategically separated "maternal and child health" (MCH) issues, such as increased insurance coverage for midwifery and doula care, from issues often labeled as "reproductive rights," such as access to sex education, birth control, and abortion. Advocates point out this strategic separation has likely contributed overall to the downfall of abortion rights. In this paper, we analyze legislative discourse to understand the legislative challenges advocates face, the strategic separations and allyships they employ, and the implications for other states and reproductive health more broadly. We find that legislators legitimate the same scientific evidence in some contexts while not in others in order to hold onto rhetorical purity within the abortion debate. In their attempts to parse the ideal abortion seeker, conservative legislators create legal ambiguities with serious consequences for healthcare. [ABSTRACT FROM AUTHOR]

Introduction: The Dual Prevention Pill (DPP) combines oral pre‐exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self‐care and technology‐based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP. Methods: Between March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage. Results: Wide geographic reach, ongoing pharmacy‐administered PrEP pilots in Kenya and South Africa, and over‐the‐counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology‐based channels such as e‐pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness‐to‐pay for all channels. Conclusions: The private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non‐traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness‐to‐pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies. [ABSTRACT FROM AUTHOR]

The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. Repeated cross-sectional study. Women aged 16–49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. A total of 38,288 women were included with a median age of 25 (interquartile range: 22–29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%–56.1%; P trend <0.001) and oral contraception (27.2%–20.5%; P trend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%–6.0%; P trend = 0.002) and intrauterine device (2.8%–11.8%; P trend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (P trend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56–0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48–0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07–1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22–1.87) had higher odds of using moderate-high-efficacy contraception. Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes. [ABSTRACT FROM AUTHOR]

Additional risk minimization strategies may be required to assure a positive benefit–risk balance for some therapeutic products associated with serious adverse drug reactions/risks of use, without which these products may be otherwise unavailable to patients. The goals of risk minimization strategies are often fundamentally to influence the behavior of healthcare professionals (HCPs) and/or patients and can include appropriate patient selection, provision of education and counselling, appropriate medication use, adverse drug reaction monitoring, and adoption of other elements to assure safe use, such as pregnancy prevention. Current approaches to additional risk minimization strategy development rely heavily on information provision, without full consideration of the contextual factors and multi-level influences on patient and HCP behaviors that impact adoption and long-term adherence to these interventions. Application of evidence-based behavioral science methods are urgently needed to improve the quality and effectiveness of these strategies. Evidence from the fields of adherence, health promotion, and drug utilization research underscores the value and necessity for using established behavioral science frameworks and methods if we are to achieve clinical safety goals for patients. The current paper aims to enhance additional risk minimization strategy development and effectiveness by considering how a behavioral science approach can be applied, drawing from evidence in understanding of engagement with pharmaceutical medicines as well as wider public health interventions for patients and HCPs. [ABSTRACT FROM AUTHOR]

Valproate is the most effective medication for generalised epilepsies, and several specific epilepsy syndromes. For some people, it will be the only medication to establish seizure remission, and withdrawing it carries risks of seizure recurrence and Sudden Unexpected Death in Epilepsy (SUDEP). It is also of proven efficacy for bipolar disorder and migraine prevention. Guidelines based on observational and epidemiological studies stress that maternal valproate related teratogenicity and neurodevelopmental effects are significantly higher than for other antiseizure medications (ASMs). It should, therefore, only be used if other medications are ineffective and after balancing the teratogenicity risk. Regulatory restrictions have changed prescribing practices and reduced valproate use. The number of other medications that must be trialled in the different conditions for which valproate has effectiveness and the consequences of the lack of efficacy of those drugs leading to significant harm including death remains unexplored. Risk minimisation measures (RMMs) for valproate, chiefly Pregnancy Prevention practices (PPP), consider foetal risk and not risk to people living with epilepsy. In the United Kingdom (UK), limitations relating to valproate use in all people < 55 years commenced in January 2024. While the evidence in child-bearing women is not disputed, the data in males are based on animal models, case reports, and one commissioned, unpublished, non-peer reviewed report unavailable to the UK public, stakeholder charities or professionals. Evidence suggests that 30–40% of people switching from valproate have breakthrough seizures. Thus, an estimated 21,000–28000 people in the UK will imminently be exposed to the potential hazards of breakthrough seizures, including death. There is little government investment in monitoring the effects of these changes to valproate prescribing on patient health and quality of life. This review summarises the history of valproate regulation, evidence underpinning it and argues how the latest regulations in the UK do not align with the country's medical regulatory bodies ethical principles nor with the Montgomery principles of informed patient choice and autonomy. It dissects how such regulations infringe Common Law principles, nor give due regard for patient outcomes beyond reproduction. The paper looks to provide recommendations to redress these concerns while appreciating the core need for such governance to emerge in the first place. [ABSTRACT FROM AUTHOR]

The article explores abortion at college and university campuses during the sexual liberation and reproductive control at southern colleges and universities before 1973. Topics discussed include the arrest and indictment of Ron Sachs, editor of the University of Florida's student newspaper, the "Florida Alligator" on October 6, 1971, for violating the state's 1868 law prohibiting abortion and the widespread familiarty of women on abortion despite the silence surrounding it.

Background: The WHO 2016 antenatal care (ANC) policy recommends at least eight antenatal contacts during pregnancy. This study assessed ANC8 uptake following policy implementation and explored the relationship between ANC attendance and intermittent preventive treatment in pregnancy (IPTp) coverage in sub-Saharan Africa following the rollout of the World Health Organization (WHO) 2016 ANC policy, specifically, to assess differences in IPTp uptake between women attending eight versus four ANC contacts. Methods: A secondary analysis of data from 20 sub-Saharan African countries with available Demographic Health and Malaria Indicator surveys from 2018 to 2023 was performed. The key variables were the number of ANC contacts and IPTp doses received during a participant's last completed pregnancy in the past two years. Pooled crude and multivariable logistic regression models were used to explore factors associated with attendance of at least four or eight ANC contacts as well as receipt of at least three doses of IPTp during pregnancy. Results: Overall, only a small proportion of women (median = 3.9%) completed eight or more ANC contacts (ANC8 +). Factors significantly associated with increased odds of ANC8 + included early ANC attendance (AOR: 4.61: 95% CI 4.30—4.95), literacy (AOR: 1.20; 95% CI 1.11—1.29), and higher wealth quintile (AOR: 3.03; 95% CI 2.67—3.44). The pooled estimate across all countries showed a very slight increase in the odds of IPTp3 + among women with eight (AOR: 1.06; 95% CI 1.00—1.12) compared to those with four contacts. In all but two countries, having eight instead of four ANC contacts did not confer significantly greater odds of receiving three or more doses of IPTp (IPTp3 +), except in Ghana (AOR: 1.67; 95% CI 1.38—2.04) and Liberia (AOR: 1.43; 95% CI 1.18—1.72). Conclusion: Eight years after the WHO ANC policy recommendation, all countries still had sub-optimal ANC8 + coverage rates. This paper is a call to action to actualize the vision of the WHO and the global malaria community of a malaria free world. Policies to improve ANC and IPTp coverage should be operationalized with clear actionable guidance and local ownership. Study findings can be used to inform multi-level policy, programmatic, and research recommendations to optimize ANC attendance and malaria in pregnancy prevention, thus improving maternal and child health outcomes, including the reduction of malaria in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Multipurpose prevention technologies (MPTs) are products capable of simultaneously addressing multiple sexual and reproductive health needs such as unwanted pregnancy, STIs including HIV-1, and other reproductive tract infections. MPTs are urgently needed to address the double burden of unplanned pregnancy and HIV. While condoms are currently the only accessible MPTs, they are not solely under a woman's control, and female condoms face limitations due to poor acceptability and high cost. Methods: We conducted a sub-analysis of qualitative data from 39 couples participating in the MTN 045 study to examine the perception of couples on choice and acceptability of a "2 in 1" MPT that combines HIV and pregnancy prevention. Results: Couples recognized the benefits of MPTs for HIV and pregnancy prevention but perceptions tied to each indication and a novel prevention technology tool raised important concerns relevant to use of future MPTs. In the study, participants' perceptions of MPT use were influenced by pregnancy planning. When the timing was less critical, they prioritized HIV prevention. Misinformation about family planning methods, including MPTs, affected decision-making with potential to hinder uptake of future MPTs. Concerns about side effects, such as weight gain and hormonal imbalances, influenced willingness to use MPTs. Conclusion: Addressing the myths and misconceptions surrounding the use of contraceptives is crucial in promoting their acceptance and ultimate use. Strategies for addressing the drawbacks women might experience while using a particular product should be in place as new MPTs progress through the development pipeline and approach roll-out. [ABSTRACT FROM AUTHOR]

Background: The association between combined oral contraceptive pills and increased risk of venous thromboembolism has been extensively researched but little has been reported on its effects on all haematological parameters and coagulation factors. This study aimed to evaluate the effects of different forms of oral contraceptives on the coagulation profile of female subjects in Enugu metropolis. This case-control study was conducted among women attending the Family planning unit of University of Nigera Teaching Hospital, Ituku Ozalla, Enugu State. Methods: The subjects were 36 women undergoing oral contraceptive medication and the control were 36 healthy women not taking this medication. ABO blood grouping and Full blood count (FBC) were carried out while prothrombin time (PT) and activated partial thromboplastin time (APTT) of test subjects were determined using test kits from Technoclone Austria. Most of the test subjects were found to be of the O+ blood group. The haematological profile of test subjects showed a statistically significant increase in Red blood cell (RBC), packed cell volume (PCV), neutrophil, eosinophil, mean platelet volume (MPV) and plateletcrit while showing statistically significant reductions in mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell haemoglobin concentration (MCHC), lymphocyte, basophil, platelet volume distribution width (PDW) and red cell distribution widths in comparison to the control group. There was a significant decrease in the PT of test subjects (16.06±1.35 secs) in comparison to the control group (19.63±1.28 secs) while the slight increase in their APTT values was not significant. Conclusion: Thrombotic markers such as increased Red cell markers; RBC, haematocrit and platelet indices; MPV, PCT were increased along with decreased PT levels and prolonged APTT values though not significant can link oral contraceptives medication use to a hypercoagulable state in subjects thereby increasing their risk to venous thromboembolism. [ABSTRACT FROM AUTHOR]

Managing menstruation is a global public health issue. Cultural issues such as period poverty, negative stigmas, and technological advancements are often discussed in the menstrual care space. Technologies, such as mobile apps (e.g., Flo, Glow, iPhone Health) and devices (e.g., menstrual cups, intrauterine devices), have changed how menstruators monitor and manage their menses. Little research exists on how these tools could affect university student menstruators. Virtual focus group discussions (n = 32 across five focus groups) were conducted in February 2021. Eligible participants were student-menstruators attending a large Midwestern University. Thematic analysis techniques were used for data analysis, allowing for a constant comparative approach to contextualization and theme identification. Results demonstrated that participants employed various technologies, including mobile apps, birth control methods, and reusable products, to track, predict, and manage their menstrual experiences effectively. These technologies proved instrumental in tracking symptoms, manipulating the timing of menstruation, facilitating communication with healthcare providers, and alleviating menstrual discomfort. Furthermore, participants emphasized the factors influencing their technology choices, such as menstrual cups' economic and environmental advantages. These findings have implications for menstrual health programs, public health initiatives, and period policies, emphasizing the importance of integrating technology-driven solutions for menstrual health management. The study showcases the value of incorporating technology into education and awareness campaigns to empower individuals in managing their menstrual health and facilitating informed decisions about contraception and fertility. Furthermore, the research highlights the need for policymakers to support reusable menstrual technologies and destigmatize menstruation, ultimately contributing to gender equality and overall well-being. [ABSTRACT FROM AUTHOR]

Background Nearly 40% of unplanned pregnancies in the USA are the result of inconsistent or incorrect contraceptive use. Finding ways to increase women's comfort and satisfaction with contraceptive use is therefore critical to public health. One promising pathway for improving patient outcomes is through the use of digital decision aids that assist women and their physicians in choosing a contraceptive option that women are comfortable with. Testing the ability of these aids to improve patient outcomes is therefore a necessary first step toward incorporating this technology into traditional physician appointments. Purpose To evaluate the effectiveness of a novel contraceptive decision aid at minimizing decisional conflict and increasing comfort with contraception among adult women. Methods In total, 310 adult women were assigned to use either the Tuune contraceptive decision aid or a control aid modeled after a leading online contraceptive prescriber's patient intake form. Participants then completed self-report measures of decisional conflict, contraceptive expectations, satisfaction, and contraceptive use intentions. Individual between-subjects analysis of variance (ANOVA) models were used to examine these outcomes. Results Women using the Tuune decision aid (vs. those using the control aid) reported lower decisional conflict, more positive contraceptive expectations, greater satisfaction with the decision aid and recommendation, and more positive contraceptive use intentions. Conclusions Use of Tuune improved each of the predicted patient outcomes relative to a control decision aid. Online decision aids, particularly when used alongside physician consultations, may be an effective tool for increasing comfort with contraceptive use. Clinical Trials Registration # NCT05177783 , ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT05177783 [ABSTRACT FROM AUTHOR]

• Most synthetic contraceptives have several negative sides effects. • Plant-based contraceptives can offer alternative to synthetic contraceptives. • We assessed a herbal mixture for contraceptive use in folk medicine. • The herbal mixture contain compounds that might be responsible for antifertility activity. Herbal contraceptives are often considered as an affordable and accessible option for birth control practice. This study evaluated the antifertility activity of a South African herbal mixture made from three plants (Helichrysum caespititium (DC.) Sond. ex Harv , Bulbine frutescens (L.) Willd and Teucrium trifidum Retz; ratio 1:1:1) in female Sprague-Dawley rats. Phytochemical profile of the herbal extract was analysed using ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS). To determine the effects of the herbal mixture on the oestrus cycle, 20 female Sprague‑Dawley rats were divided into four groups (A, B, C, and D) of 5 rats per group. Group A served as the control and received distilled water for 21 days. Group B, C and D received the herbal mixture extract at a dosage of 100, 300, and 500 mg/kg, respectively, for 21 days, and vaginal smears were monitored daily. To evaluate the effects of the extract on the reproductive outcome, 21 female rats were divided into 3 groups (Groups E, F, and G), consisting of 7 rats per group. Group E served as the control and received distilled water. Group F received 300 mg/kg of the extract pre-coital for 5 days, while Group G received 300 mg/kg of the extract prior to mating with continuous administration for 14 days. The phytochemical analysis of the herbal extract revealed the presence of 19 compounds, notably verbascoside, which is known to exert either oestrogenic or anti-estrogenic activities. The results showed that 300 and 500 mg/kg dose extended (p < 0.05) the duration of the metestrus phase when compared to the control, confirming the disruption of the oestrous cycle. The prolonged metestrus phase of the oestrus cycle by the herbal extract could be indicative of low reproductive hormones, decreasing the probability of conception. However, the herbal extract at 300 mg/kg had no antifertility activity in female Sprague-Dawley rats based on the number of litters in the treatment group relative to the control. It will be pertinent to assess other parameters such as anti-implantation activity, estrogenic/anti-estrogenic activity and hormonal analysis in future studies. [ABSTRACT FROM AUTHOR]

Microarray patches (MAPs) offer a noninvasive and patient-friendly drug delivery method, suitable for self-administration, which is especially promising for low- and middle-income country settings. This study focuses on the development of dissolving bilayer MAPs loaded with norelgestromin (NGMN) as a first step towards developing a future potential drug delivery system for sustained hormonal contraception. The fabricated MAPs were designed with the appropriate needle lengths to penetrate the stratum corneum, while remaining minimally stimulating to dermal nociceptors. Ex vivo assessments showed that the MAPs delivered an average of 176 ± 60.9 μg of NGMN per MAP into excised neonatal porcine skin, representing 15.3 ± 5.3% of the loaded drug. In vivo pharmacokinetic analysis in Sprague Dawley rats demonstrated a Tmax of 4 h and a Cmax of 67.4 ± 20.1 ng/mL for the MAP-treated group, compared to a Tmax of 1 h and a Cmax of 700 ± 138 ng/mL for the intramuscular (IM) injection group, with a relative bioavailability of approximately 10% for the MAPs. The MAP-treated rats maintained plasma levels sufficient for therapeutic effects for up to 7 days after a single application. These results indicate the potential of NGMN-loaded dissolving bilayer MAPs, with further development focused on extending the release duration and improving bioavailability for prolonged contraceptive effects. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Present an approach to the safe and efficient provision of anesthesia and birth control measures to a large group of primates. ANIMALS: 98 hamadryas baboons (Papio hamadryas) held in a German zoological institution. METHODS: A group of 12 veterinarians, 2 zookeepers, and 6 volunteers anesthetized all animals within 2 days. The baboons were orally premedicated with midazolam (0.1 to 0.5 mg/kg) and anesthetized with medetomidine (40 to 60 μg/kg, IM) and ketamine (2 to 4 mg/kg, IM); isoflurane at rates of 1.5% to 2% was used for maintaining anesthesia if necessary. All animals received a physical examination, prophylactic medication, and tuberculin testing. For population management, the animals received a contraceptive implant (adult females), orchiectomy (young males), or vasectomy (breeding males). Young males received intratesticular blocks with lidocaine. All animals received atipamezole (125 to 150 μg/kg) before recovery. RESULTS: Premedication resulted in anxiolysis, which facilitated separating and darting. Median time from darting to access to the animal was 10 minutes. Mean anesthetic times were 25 minutes for females and 55 minutes for males. The depth of anesthesia was appropriate for the procedures. No fatalities were recorded. One animal was injured by other baboons but recovered after treatment. CLINICAL RELEVANCE: Health management and birth control measures are necessary in baboon troops under human care. Anesthesia and/or contraception of individual animals often leads to intraspecific aggression. This case series describes how to provide anesthesia and contraception to an entire troop as an alternative approach that can be adopted to future similar interventions. [ABSTRACT FROM AUTHOR]

Building on recent research, this paper recounts the emergence of Catholic women's activism in favor of the right to abortion in late twentieth-century Mexico. The article argues that contests over legitimacy—specifically, disputes among Catholics about which beliefs are legitimately Catholic—are central to this history. In this case, the article follows Catholic women's attempts to legitimize their position in favor of the right to abortion and Catholic authorities' attempts to delegitimize the same idea. The paper concludes with a 1992 episode in Guanajuato that has not received much scholarly attention, when secular and Catholic feminists collaborated. Because these Catholic activists faced opposition from angry protestors, they set up a press conference to dispel any misconceptions and legitimize their own Catholic position in favor of the right to abortion to the Mexican public. The resistance Elvia Neri, a retired Catholic woman and mayordoma for her church, faced led her to share her testimonio, a rare archival source that publicly reconciled a commitment to both the Catholic faith and reproductive rights. Scholarship on feminist mobilization has at least included the work of Catholic activists who advocated the right to abortion. However, these contests over legitimacy have led scholarship on Catholic women's activism to neglect Catholic perspectives that favor the right to abortion. [ABSTRACT FROM AUTHOR]

Baiting is widely used in wildlife management for various purposes, including lethal control, fertility control, disease and parasite control, and conditioned aversion programs for many invasive vertebrate species. The efficacy of baiting programs relies on the likelihood that target animals will encounter the bait, consume it and receive an appropriate dose of the active ingredient. However, there has been little focus on encounter rate of toxic baits combined with behavioural aversion, which are likely to be significant factors affecting efficacy.Following optimal foraging theory, the likelihood of an animal encountering and consuming a toxic grain bait should increase in proportion to its availability relative to background food quantity if it is neither more or less detectable or palatable. Furthermore, the probability of consuming toxic baits might also be influenced by bait aversion following ingestion of a non‐lethal dose of toxin.Using a model system of wild house mice (Mus musculus L.) in mouse‐proof enclosures in Australia, we manipulated background food, applied zinc phosphide (Zn3P2) baits and measured mouse mortality. When background food was scarce, mouse mortality was high, whereas an increasing abundance of background food led to reduced mortality. A scenario modelling random encounters and including bait aversion explained 78% of the variation in observed mortality outcomes and achieved a closer fit to the data than modelling random encounters alone. Mortality rates were predicted to be higher with a higher strength bait, which would overcome behavioural aversion.Ensuring that animals locate and consume a lethal dose of toxic bait is a critical factor for successful bait delivery and efficacy. This is particularly significant in toxic baiting programs, where sublethal doses can make animals feel sick, leading to a negative association with the bait, and the development of aversion.Synthesis and applications: Our findings explain why some toxic baiting programs might fail. To achieve successful control, efforts should be directed at reducing the availability of background food to increase the probability of encounter and uptake of toxic baits. It is important to measure and understand the role of background food on toxic baiting programs to explain variable outcomes and inform strategies for successful bait delivery. [ABSTRACT FROM AUTHOR]

Introduction: Active and passive surveillance studies have found that a greater proportion of females report adverse events (AE) following receipt of either the COVID-19 or seasonal influenza vaccine compared to males. In a predominately young adult female population of healthcare workers, we sought to determine the intersection of biological sex and sociocultural gender differences in prospective active reporting of vaccine outcomes, which remains poorly characterized. Methods: This cohort study enrolled Johns Hopkins Health System healthcare workers (HCWs) who were recruited from the mandatory annual fall 2019–2022 influenza vaccine and the fall 2022 COVID-19 bivalent vaccine campaigns. Vaccine recipients were enrolled the day of vaccination and AE surveys were administered two days post-vaccination for bivalent COVID-19 and influenza vaccine recipients. Data were collected regarding the presence of a series of solicited local and systemic AEs. Open-ended answers about participants' experiences with AEs also were collected for the COVID-19 vaccine recipients. Results: Females were more likely to report local AEs after either influenza (OR = 2.28, p = 0.001) or COVID-19 (OR = 2.57, p = 0.008) vaccination compared to males, regardless of age or race. Males and females had comparable probabilities of reporting systemic AEs after either influenza (OR = 1.18, p = 0.552) or COVID-19 (OR = 0.96, p = 0.907) vaccination. Hormonal birth control use did not impact the rates of reported AEs following influenza vaccination among reproductive-aged female HCWs. Women reported more interruptions in their daily routine following COVID-19 vaccination than men and were more likely to seek out self-treatment. More women than men scheduled their COVID-19 vaccination before their days off in anticipation of AEs. Conclusions: Our findings highlight the need for sex- and gender-inclusive policies to inform more effective mandatory occupational health vaccination strategies. Further research is needed to evaluate the potential disruption of AEs on occupational responsibilities following mandated vaccination for healthcare workers, a predominately female population, and to more fully characterize the post-vaccination behavioral differences between men and women. Plain English summary: Research that addresses both the sex and gender differences of vaccine outcomes and behaviors is lacking. In this survey study of healthcare workers, comprised of mostly reproductive-aged females/women, we investigated biological sex (male/female) and gender (man/woman) differences in vaccine adverse events and outcomes following either influenza or bivalent COVID-19 vaccination. Regardless of age or race, females were more likely to report local (at injection site), but not systemic (whole body), adverse events than males, consistent across influenza and bivalent COVID-19 vaccine cohorts. Sex hormones are hypothesized to play a role in the differences in immune response following vaccination between males and females. We investigated if hormonal birth control use among females may be associated with differences in vaccine adverse events among the influenza vaccine cohort. However, there was no difference in the likelihood of reporting adverse events between birth control users and non-users. Based on open-ended responses to survey questions, women were found to report more interruptions to their daily routine than men following COVID-19 vaccination. Women were also more likely to seek out self-treatment with over-the-counter medication and intentionally schedule their vaccination around days off in anticipation of adverse events. With nearly 80% of healthcare jobs held by women, even higher for direct patient care positions like nursing, females/women may be disproportionately impacted by mandated annual vaccinations. Vaccinations are necessary for the prevention of disease transmission; however, our findings highlight a need for more equitable occupational vaccine strategies that consider both sex and gender differences. Highlights: • Research that addresses both the sex and gender disparities of vaccine outcomes and behaviors is lacking. • This active reporting study implements both logistic regression and thematic analyses to examine sex and gender differences in AEs following influenza or bivalent COVID-19 vaccination among a cohort of predominately female, reproductive-aged healthcare workers. • Females report more local adverse events than males following either influenza or bivalent COVID-19 vaccination, regardless of age or race. • Women report more disruptions to their daily routines than men. Women also are more likely to seek out self-treatment and schedule their vaccinations around days off in anticipation of adverse events. • Sex and gender differences in vaccine AEs and outcomes should drive the development of more equitable vaccine strategies and policies in occupational health settings, particularly for mandated vaccinations. [ABSTRACT FROM AUTHOR]

Background: The etonogestrel contraceptive implant is currently approved by the United States Food and Drug Administration (FDA) for the prevention of pregnancy up to 3 years. However, studies that suggest efficacy up to 5 years. There is little information on the prevalence of extended use and the factors that influence clinicians in offering extended use. We investigated clinician perspectives on the barriers and facilitators to offering extended use of the contraceptive implant. Methods: Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured qualitative interviews. Participants were recruited from a nationwide survey study of reproductive health clinicians on their knowledge and perspective of extended use of the contraceptive implant. To optimize the diversity of perspectives, we purposefully sampled participants from this study. We used content analysis and consensual qualitative research methods to inform our coding and data analysis. Themes arose deductively and inductively. Results: We interviewed 20 clinicians including advance practice clinicians, family medicine physicians, obstetrician/gynecologist and complex family planning sub-specialists. Themes regarding barriers and facilitators to extended use of the contraceptive implant emerged. Barriers included the FDA approval for 3 years and clinician concern about liability in the context of off-label use of the contraceptive implant. Educational materials and a champion of extended use were facilitators. Conclusions: There is opportunity to expand access to extended use of the contraceptive implant by developing educational materials for clinicians and patients, identifying a champion of extended use, and providing information on extended use prior to replacement appointments at 3 years. [ABSTRACT FROM AUTHOR]

Simple Summary: Bait-based fertility control could contribute to rodent pest management. Bait containing 4-vinylcyclohexene diepoxide (VCD) and triptolide (TP), registered as ContraPest®, was delivered to male common voles to assess the effects on reproductive structures and residues in the liver and testes. There were no effects or inconclusive effects for most reproductive parameters considered. However, there was an increase in sperm defects in voles treated for 14/28 days and fewer normal sperm cells in voles treated for 28 days. There were no TP residues in the testes, few and low TP residues and no VCD residues in the liver tissue. Treatments with VCD + TP seemed to have minor effects on male reproductive organs. Some rodent species cause significant damage to agriculture and forestry, and some can transmit pathogens to humans and livestock. The common vole (Microtus arvalis) is widespread in Europe, and its population outbreaks have resulted in massive crop loss. Bait-based fertility control could contribute to rodent pest management. Bait containing 4-vinylcyclohexene diepoxide (VCD) and triptolide (TP), registered as ContraPest®, was delivered to male common voles for 14 or 28 consecutive days. The effects on reproductive structures and residues in the liver and testes were assessed. There was no effect on testis weight, sperm viability, sperm motility and oxidative stress in sperm cells. Results regarding the mitochondrial membrane potential of sperm, DNA fragmentation and progressively motile sperm cells were inconclusive. However, there was an increase in morphological sperm defects in voles treated for 14/28 days and fewer normal sperm cells in voles treated for 28 days. There were no TP residues in the testes, few and low TP residues and no VCD residues in liver tissues, making considerable secondary exposure to non-target species unlikely. Treatments with VCD + TP seemed to have minor effects on the reproductive organs of males. Further studies should evaluate the effect of VCD + TP on females and on the reproductive success of common voles and other pest rodent species. [ABSTRACT FROM AUTHOR]

The goal of the current study was to examine associations between hormonal contraceptive use and indicators of well-being including body image, eating behavior, sleep and energy level. Drawing on a health protection framework, we expected that individuals who use hormonal contraceptives would be more attuned to health and report more positive health attitudes and behaviors on these dimensions. Undergraduate college women (N = 270; M = 19.39 years, SD = 2.43, range 18–39 years) from diverse racial/ethnic and sexual orientation groups completed a survey online. Measures included hormonal contraception use, body image, weight control behavior, breakfast consumption, sleep behavior, and daytime energy level. Nearly 1/3 (30.9%) of the sample reported current hormonal contraceptive use, with most users reporting use of birth control pills (74.7%). Women who used hormonal contraceptives reported significantly higher appearance orientation and body surveillance, lower average energy, more frequent night awakenings, and more naps. Longer duration of hormonal contraceptive use was significantly related to higher body surveillance, and engaging in more unhealthy weight control behavior. Hormonal contraceptive use is not related to indicators of greater well-being. Rather, hormonal contraceptive use is related to greater attention to appearance, lower daytime energy, and some indicators of poorer sleep quality. Clinicians who prescribe hormonal contraceptives should attend to body image, sleep and energy concerns among users. [ABSTRACT FROM AUTHOR]

Seventeen magazine's minimal coverage of contraception and abortion provides teen girl readers with inadequate and limited information regarding reproductive and sexual health. This pre-Dobbs historical analysis of the content of the main editorial sections of the magazine from 2010 to 2018 demonstrates a lack of discourse regarding contraceptive methods for readers. Examining how contraception and abortion are discussed in the print versions of Seventeen magazine through a postfeminist lens can assist in identifying and responding to gaps in education and misperceptions of these topics in order to better serve teen girl readers. [ABSTRACT FROM AUTHOR]