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.

Background: Our objective was to describe differences among adolescents and young adults (AYAs) with rheumatic disease using teratogens compared to non-users in receipt of sexual and reproductive health (SRH) counseling, teratogenicity knowledge, perceived importance of SRH topics, and preferences around counseling. Methods: AYAs ages 14–23 years and assigned female at birth were recruited from pediatric rheumatology clinics at a Midwest tertiary care program. Participants completed a one-time online survey assessing SRH. Results: One-hundred eight participants completed the survey, representing a range of rheumatic diseases. 24% reported ever having sex. 36% used a teratogen. Rates of screening and counseling regarding SRH topics were low. Notably, pregnancy prevention and emergency contraception (EC) counseling by rheumatologists were uncommon and not associated with teratogen use or sexual activity. Among AYAs on teratogens, only half reported screening for sexual activity or counseling on teratogenicity or pregnancy prevention. Gaps in pregnancy prevention and EC counseling remained even when accounting for counseling by other providers. Knowledge of medication teratogenicity was also low. AYAs reported SRH topics of high importance, and many reported recent concerns. They preferred to receive information from their rheumatologist, and most agreed it is important to talk to their rheumatologist regarding these topics. Conclusions: AYAs with rheumatic disease report low levels of SRH screening and counseling by their rheumatologist yet report these topics are important and want to discuss them. Gaps in teratogenicity knowledge were identified. This study identifies a need for improved communication with AYAs regarding their SRH. [ABSTRACT FROM AUTHOR]

End-user feedback early in product development is important for optimizing multipurpose prevention technologies for HIV and pregnancy prevention. We evaluated the acceptability of the 90-day dapivirine levonorgestrel ring (DPV-LNG ring) used for 14 days compared to a dapivirine-only ring (DVR-200mg) in MTN-030/IPM 041 (n = 23), and when used for 90 days cyclically or continuously in MTN-044/IPM 053/CCN019 (n = 25). We enrolled healthy, non-pregnant, HIV-negative women aged 18–45 in Pittsburgh, PA and Birmingham, AL (MTN-030 only). Self-reports of vaginal bleeding and adherence (ring removals, expulsions) were collected via daily short message service. Acceptability data were recorded in face-to-face interviews at study exit. We assessed differences in acceptability by product characteristics and adherence; and associations between baseline characteristics/demographics, number of bleeding days, adherence, and overall acceptability. Most (21/23) women in the 14-day MTN-030 study and about half (13/25) in the 90-day MTN-044 study liked their assigned rings. In MTN-030 there were no significant associations between any variables and overall acceptability of either ring. In MTN-044, women who disliked the DPV-LNG ring had a significantly higher incidence of unanticipated vaginal bleeding, and reporting that vaginal bleeding changes were unacceptable than those who liked it. Although we found no overall association between adherence and acceptability, significantly more women who disliked (versus liked) the DPV-LNG ring reported expulsions during toileting. The DPV-LNG ring could meet the needs of women seeking simultaneous protection from HIV and unintended pregnancy. Addressing issues related to vaginal bleeding and expulsions early in product development will likely enhance acceptability of the DPV-LNG ring. Trial registration: Clinical Trial Registration: MTN-030/IPM 041: ClinicalTrials.gov NCT02855346; MTN-044/IPM 053/CCN019: ClinicalTrials.gov NCT03467347. [ABSTRACT FROM AUTHOR]

At rest, the menstrual cycle phase impacts ventilation and chemosensitivity. However, during exercise there is inconclusive evidence that the menstrual cycle phase affects ventilation or chemosensitivity. We sought to examine the influence of menstrual phase and hormonal birth control (BC) on chemosensitivity. We tested 12 males and 20 females (10 BC; 10 normally menstruating, NBC) on three occasions. Day 1 was a maximal exercise test and days 2 (follicular phase) and 3 (luteal phase) consisted of three bouts of chemosensitivity testing during cycle exercise at 30% of peak work rate. Females‐BC and males completed day 3 approximately 2 weeks after day 2, with females‐BC tested during the active phase of their birth control. There were no differences between the two experimental days for any groups for any (hypercapnia, hypoxia, and hyperoxia) chemosensitivity tests, p > 0.05. Females‐BC had a significantly lower average response to transient hypercapnia than both females‐NBC and males (38% and 42% lower, respectively, p < 0.05). Females‐NBC had a significantly smaller change in ventilation to hyperoxia compared to males, −11.7 ± 5.9 versus −17.9 ± 5.4%, respectively (p < 0.05). We conclude that the day‐to‐day variability in chemosensitivity is not different between males, females‐BC and NBC. [ABSTRACT FROM AUTHOR]

Reproductive success in captive non-human primates (NHPs) has increased the demand for safe, effective, and reversible population control methods. This review provides an overview of the current literature on hormonal and non-hormonal contraceptives as reproductive control methods in NHPs. Where available, behavioral and welfare implications, as well as drug efficacy, reversibility, and associated adverse effects, are considered. However, a paucity of data exists for NHPs, particularly in regard to non-hormonal contraceptives, emphasizing the need for institutions to share their experiences with reproductive management techniques in the species under their care. [ABSTRACT FROM AUTHOR]

Purpose: Intrauterine device is one of the most preferred birth control method in the world. Being able to predict that the intrauterine device will not dislocate is very important in terms of preventing unwanted pregnancies. Here, we evaluated the role of uterocervical angle in displacement of intrauterine device and to determine whether it has a discriminative role for displacement. Methods: This cross-sectional case–control study was conducted at an obstetrics and gynecology clinic of a university-affiliated training and research hospital. A total of 108 patients between June 2021 and September 2021 were included. While 36 patients in the case group had intrauterine device displacement, 72 patients in the control group had normal intracavitary intrauterine device detected under transvaginal ultrasound. Demographic characteristics, parameters related to intrauterine device and uterus were recorded. Uterocervical angle was measured in all the patients. Results: There was no statistically significant difference in terms of sociodemographic features, parameters related to uterus size and intrauterine device. The median uterocervical angle was significantly higher in intrauterine device displacement group as compared to controls [159.5 (90–177) vs 146 (118–169) degrees, p < 0.001)]. Uterocervical angle > 156 degree discriminates intrauterine device displacement with 66.67% sensitivity and 80.56% specificity (AUC = 0.763). Conclusion: A larger uterocervical angle may suggest an increased likelihood of intrauterine device displacement. Thus, uterocervical angle seems to have a potential to play a crucial role in the monitoring and management of intrauterine device users even in patients with similar sized uterus. [ABSTRACT FROM AUTHOR]

Background/Objectives: To support women's informed decisions and reproductive self-care, confident reproductive health-related knowledge is needed, supported by adequate health literacy (HL). No corresponding survey has been carried out in Hungary on inequalities to provide information addressing education. Materials and Methods: In the current cross-sectional online survey, 301 women of reproductive age (27.16 ± 0.36 years) were asked with the Hungarian versions of validated and standardised questionnaires about reproductive knowledge on hormones, ovulation, menstrual cycle, pregnancy signs and birth control (Knowledge of Female Body Scale—KFB), and HL (Brief Health Literacy Screening Tool—BRIEF). Spearman correlation and multivariable linear regression analyses were utilised, with a significance level set at p < 0.05. IBM SPSS version 28.0 (IBM SPSS, Armonk, NY, USA: IBM Corp.) and G*Power (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) software. The STROBE checklist was followed. The Clinical Trial Registry Nr. is NCT06146673. Results: The KFB composite score was high (20.01 ± 2.33); 86.374% had "high knowledge". Still, lacking information was identified for the mechanisms of certain contraceptive methods and early physical signs of pregnancy. A significant difference was also found in the KFB scores in the case of higher age (p = 0.019), higher education level (p = 0.018) and previous live birth (p = 0.028). A positive correlation was found between KFB and HL (p < 0.001), education (p = 0.005), and age (p = 0.021). A multiple regression analysis (R2 = 0.087, p < 0.001) indicated that both HL (p < 0.001) and age (p = 0.003) are potential positive predictors of adequate reproductive knowledge, whereas induced abortion (p = 0.013) might serve as an inverse predictor. Conclusions: Inequalities in women's knowledge about their reproductive system and HL were found, and it was significantly the lowest in their highest conception probability age. Therefore, in addition to targeted education, HL also needs improvement. [ABSTRACT FROM AUTHOR]

Background: Valproates are recognized for their significant teratogenic risks, which can lead to physical defects and developmental disorders when used during pregnancy. To mitigate these risks, the Pregnancy Prevention Program (PPP) was developed by European regulators for patients and healthcare professionals (HCPs). Despite the crucial nature of this program, the implementation of the PPP does not appear to be fully effective. This situation highlights the need for a deeper understanding of HCPs' knowledge, attitudes, and behaviors regarding the PPP. Methods: A cross-sectional study using anonymous electronic questionnaires was conducted. The questionnaires were developed by a board of experts from eight different EU countries and were distributed among prescribers (general practitioners (GPs), neurologists, and psychiatrists) and pharmacists. Descriptive statistics were used to analyze the obtained data on participants' knowledge, attitudes, and behaviors regarding the prescribing and dispensing of valproate-containing medicines to women of reproductive age, as well as the impact of PPP materials on their work. Results: The study results indicate that while HCPs in Latvia are generally aware of valproate teratogenic risks, significant gaps remain in the implementation of the PPP. A considerable number of both prescribers and pharmacists expressed the belief that they are not responsible for educating patients about the PPP, attributing this responsibility to other specialists. Furthermore, barriers such as a lack of time and accessible materials were identified. Conclusions: The roles and responsibilities of HCPs should be clearly defined to improve adherence to the PPP. Further research is needed to assess prescription and dispensing strategies, as well as HCPs' attitudes toward the PPP. Additionally, re-evaluating and enhancing the accessibility of PPP materials is essential in effective risk management and better patient care. [ABSTRACT FROM AUTHOR]

Background: To ensure the acceptability and effectiveness of potential Multipurpose Prevention Technologies (MPTs), understanding user needs, and preferences are crucial to inform the design of MPTs. This article aims to explore the perceptions towards potential MPT use and to explore the needs of multiple stakeholders in India within their social and behavioural contexts. Methods: A qualitative multicentric study was conducted in three Indian states—Maharashtra, Karnataka, and Tamil Nadu. The study involved a total of 222 interviews: 77 in-depth interviews with women, including those from the general population, HIV-positive women, and street and brothel-based Female Sex Workers (FSWs); 84 in-depth interviews with men and 61 key informant interviews were conducted. Three focus group discussions were conducted with FSWs. Interviews explored perceptions of the potential MPTs, needs, and factors that may potentially affect their use and adherence. Interviews and FGDs were transcribed and translated verbatim. Thematic analysis approach was used to analyse the data in NVivo version 8. Result: The following themes highlight the need and preferences among women for the potential MPT product: 1) Overall perceptions about new MPT, 2) People at high risk need long acting products, 3) Condom versus new MPT: potential of MPT, 4) Women empowerment through MPTs 5) Secrecy and confidentiality 6) Non-stigmatising MPT product positioning. Conclusion: Several stakeholders in this study expressed their need for new MPTs, but concerns regarding confidentiality, privacy, stigma and, adherence were identified. Besides efficacy, characteristics such as the size, packaging, formulation, and texture of MPTs, should be taken into account when designing the MPT products, also considering the needs of women, specially, female sex workers. [ABSTRACT FROM AUTHOR]

During pregnancy, the maternal cardiovascular (CV) system undergoes major haemodynamic alterations ensuring adequate placental perfusion and a healthy pregnancy course. Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations and preeclampsia, a more severe form, in 3–4%. Women with HDP demonstrated impaired myocardial function, biventricular chamber dysfunction and adverse biventricular remodelling. Shortly after delivery, women who experienced HDP express increased risk of classic CV risk factors such as hypertension, renal disease, abnormal lipid profile, and diabetes. Within the first two decades following a HDP, women experience increased rates of heart failure, chronic hypertension, ischaemic heart and cerebral disease. The mechanism underlying the relationship between HDP in younger women and CV disease later in life could be explained by sharing pre‐pregnancy CV risk factors or due to a direct impact of HDP on the maternal CV system conferring a state of increased susceptibility to future metabolic or haemodynamic insults. Racial disparities in CV risk and social determinants of health also play an important role in their remote CV risk. Although there is general agreement that women who suffered from HDP should undertake early CV screening to allow appropriate prevention and timely treatment, a screening and intervention protocol has not been standardized due to limited available evidence. In this review, we discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction and how cardiac remodelling during or after pregnancy may influence its development. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explores a new way to control fertility in male mice by combining two substances: quinestrol, a synthetic hormone, and ketoconazole, a medication usually used to treat fungal infections. The researchers wanted to see if adding ketoconazole could make quinestrol more effective, so less of the hormone would be needed. They tested different combinations of these two substances on male mice and checked their impact on fertility-related factors like sperm count and reproductive organ size. The most promising results came from a low dose of quinestrol combined with ketoconazole, which significantly reduced sperm count and lowered testosterone levels after 10 days. Even after 30 days, this combination continued to exhibit some suppressive effects on reproductive capacity. The study also found that ketoconazole helped to slow down the body's metabolism of quinestrol, making it work more effectively. This study suggests that using ketoconazole alongside quinestrol could be a safer and more efficient way to control fertility, potentially offering a new approach for managing populations of certain animal species. This study investigates whether ketoconazole, a CYP3A4 inhibitor, can enhance the suppressive effects of quinestrol on reproductive capacity, potentially allowing for a reduced quinestrol dosage while maintaining its efficacy. A total of 104 healthy adult male mice were divided into two groups, assessed at 10 and 30 days. Within each group, six treatment categories were tested: the control (CK), quinestrol alone (Q1, Q5), and quinestrol combined with varying doses of ketoconazole (Q1 + K0.4, Q1 + K2, Q5 + K0.4). The key parameters measured included internal and reproductive organ weights, sperm density, sperm motility, sperm abnormalities, and CYP3A4 enzyme content in intestinal and liver tissues. After 10 days, the combination of a low dose of quinestrol with ketoconazole (Q1 + K0.4) showed the most significant pronounced effects in reducing reproductive potential, with notable reductions in epididymal weight, sperm density, sperm abnormality rate and vitality, serum hormone levels, and CYP3A4 content in the small intestine and liver. Although some reproductive parameters returned to near-baseline levels after 30 days, the Q1 + K0.4 regimen continued to exhibit reduced seminal vesicle weight and testosterone levels. Importantly, the combination did not significantly increase CYP3A4 enzyme content, indicating effective metabolic inhibition. The combination of quinestrol and ketoconazole, especially the Q1 + K0.4 regimen, demonstrated the most noticeable impact on reducing reproductive capacity. This regimen significantly reduced key reproductive parameters and showed strong metabolic inhibition, suggesting that ketoconazole substantially enhances the efficacy of quinestrol in fertility control. [ABSTRACT FROM AUTHOR]

Pest rodents persistently undermine crop yields and food security. Fertility control could be a viable alternative for managing rodent populations. This study investigates the antifertility effects of various concentrations of clarithromycin combined with 1.0 mg/kg quinestrol on male rodents to determine an effective contraceptive dose that minimizes quinestrol usage, addressing key concerns such as potential environmental residue, which may impact ecological balance, and poor palatability, which could reduce ingestion and limit the sterilant's effectiveness. Male mice were divided into five groups and administered different doses of clarithromycin or clarithromycin and quinestrol for three consecutive days, while the control group received sunflower seed oil only. After seven days, organ weights, reproductive organ weights, sperm density, serum hormone levels, and CYP3A4 content in small intestinal and liver tissues were measured to assess persistent effects. Compared with the control group, all treatment groups had significant reductions in epididymal weight, seminal vesicle weight, and serum T and LH levels. Higher concentrations of clarithromycin (2 mg/kg and 10 mg/kg) significantly impacted reproductive metrics, including sperm density, organ weights, and serum LH and testosterone levels, though complete sterilization was not achieved, with more than 60 million cauda epididymal spermatozoa remaining. However, the combination demonstrated potential as an effective strategy for male fertility control. The combination of 2.0 mg/kg clarithromycin and quinestrol can mitigate organ enlargement seen with quinestrol alone. This combination also decreased total enzyme content, thereby diminishing quinestrol's induction of CYP3A4, which may increase the sterilization effectiveness of the treatment. [ABSTRACT FROM AUTHOR]

Background: Fertility is one of the three main components which determines the size, structure, and composition of a population, and fertility preferences are important measures for forecasting fertility levels of a population. Therefore, this study aims to assess the impacts of the inequalities in the utilization of key maternal health services on fertility preference among high parity women in four selected regions (i.e., Afar, Beninshangul-Gumuz, Gambella and Somali) of Ethiopia. Methods: The study used data collected for the 2016 Ethiopian Demographic and Health Surveys (EDHS) survey. It includes a total of 977 high parity women (104 urban and 873 rural) residing in the four regions of the study. Bivariate logistic regression was used to select the potential variables by using a cut off p-value < 0.2 and then the multivariable logistic regression analyses were performed to assess the association between the selected explanatory variables (i.e., control and exposure variables) and the outcome variable (i.e. fertility preference). Further, the study employed a Population Attributable Fractions (PAFs) to examine the population level impacts of the inequalities in maternal and child health service variables on fertility preference. Results: The results showed that religion, household wealth index, place of delivery and contraceptive use were significantly associated with fertility preference. The results of the PAFs analysis indicated that contraceptive use had the biggest impact (80%), meaning that non-use of contraceptive increased fertility preference among women in the four regions. Similarly, out of health facility delivery increased fertility preference by 37%. Conclusion: The study findings underscore the critical factors influencing women's fertility preferences in the studied regions. Low utilization of maternal health services had an impact on fertility preference, accounting for more than half of the observed variations in fertility preferences. To address this issue, targeted interventions are recommended: enhancing access to maternal health services, strengthening fertility control programs, promoting the benefits of using these services, and actively addressing inequalities. [ABSTRACT FROM AUTHOR]

Direct democracy has come to the forefront of the abortion debate. Since Dobbs v. Jackson Women's Health Organization, the seismic Supreme Court decision overruling Roe v. Wade and Casey v. Planned Parenthood, a number of high-profile ballot measures about abortion have drawn both public attention and substantial turnout. The result in every such election since Dobbs has favored the pro-choice side, even in some culturally conservative states. Surveys of public opinion in the wake of Dobbs suggest that there is significant support for abortion rights and opposition to highly restrictive laws in most states. This misalignment between public opinion and abortion law is precisely the circumstance that direct democracy, and especially the initiative, is well situated to mitigate. Yet, paradoxically, precisely where direct democracy seems most needed, it is being most aggressively resisted by legislative opponents of abortion rights. In this Article, I examine this paradox, along with the reconfigured countermajoritarian difficulty that has emerged since Dobbs. It is now state legislatures in many states, and not courts, that are frustrating democratic resolution of abortion policy. All of this suggests the need to recalibrate institutional debates about abortion. [ABSTRACT FROM AUTHOR]

This study compared the mechanical and physiological load placed on Division I female collegiate lacrosse athletes (1) with and without hormone contraceptive (HC) use and (2) with and without menstruation during training and games. Athletes' (20.6 ± 1.5 years, HC users = 9, naturally cycling (NC) athletes = 9) workloads—total distance traveled (TD, m), max speed (km∙h−1), accelerations (repetitions), decelerations (repetitions), and high-intensity distance (HID, m)—were measured through VX Sport wearable microtechnology in training sessions (n = 87/athlete) and games (n = 17/athlete). Analyses showed no statistical group differences based on HC use or not, and no differences during menstruation versus non-menstruation for training or games. However, while not statistically different, athletes taking HCs performed worse during menstruation, with a 5.1% decline in decelerations, 3.4% decline in TD and HID, 1.2% decline in max speed, and 1% decline in accelerations. NC athletes did not show this same decline with menses. Given that withdrawal bleeding exacerbates performance reduction of HC users, it may be beneficial for these athletes to consider skipping their withdrawal bleed if it is likely to coincide with a game. Further research needs to be carried out to see if these trends are consistent across other female athletes in other sports. [ABSTRACT FROM AUTHOR]

Birth control options for men are limited to only condoms and vasectomies. This review focuses on various types of male contraceptives for adequate fertility control and family planning by mutual understanding of couples (healthy family planning). Male contraceptive methods include hormonal and non-hormonal contraceptives, condoms, vasectomies, and using active ingredients from plants. Contraception in men is related to progesterone concentration, sperm count, sperm motility, sperm maturation and sperm viability. Studies are required on no side-effect-safe contraceptives for men that control serum progesterone levels, however do not increase oxidative stress. In conclusion, this article covers hormonal, non-hormonal, and plant-based male contraception in addition to the popular condoms and vasectomy. Furthermore, it includes partial description of the variety and mechanisms of male contraceptive methods available to men.

Abstract Background Contraception knowledge and attitudes are largely formed from conversations within one’s social network. More recently, this network has expanded to include social media. As the fastest growing social media platform, we aimed to assess popular contraception videos on TikTok for content understandability, actionability and accuracy. Methods This is a secondary analysis of the most viewed, contraception-specific TikTok videos that were previously coded as containing educational messaging in a content-analysis study. We assessed videos for understandability (ability to explain a key message) and actionability (identify what they can do to act on that message) using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) instrument and for Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) using a modified instrument within the health information education literature. Results The 174 videos with educational content scored as understandable but not actionable in PEMAT-A/V assessment, with videos created by healthcare providers (HCPs) performing better than those by non-HCPs in six of eleven domains of understandability. Videos overall scored well in relevance and purpose within the CRAAP assessment. Videos created by HCP’s (n = 99) scored higher than those by non-HCPs (n = 75) in relevance (score = 3.9 versus 3.3), authority (score = 4.8 versus 1.7), accuracy (score = 6.0 versus 3.5), and purpose (score = 7.1 versus 5.7) [all p

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]

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]

A quantitative, cross-sectional study, aimed at exploring the associations between the knowledge about contraceptive methods and the outcomes desired by women who attend the SUS. It was conducted with 54 women from 20 to 63 years old in a specialty outpatient clinic and Basic Health Units. Data analysis used descriptive statistics, dispersion and location measures and association tests (Odds Ratio). The Chi-Square test demonstrated that the use of contraceptives allows planning for children when compared to not using them. The Chi-Square associations showed that the use of contraceptives prevented unplanned children much more and had an impact on the number of births, favoring the prevention of pregnancy, and when two or more contraceptive methods were combined, it resulted in fewer unplanned children, up to zero. Adequate use of contraceptive methods has a strong association with the number of births and made planning for children possible. [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]

This study sought to investigate the prominence of U.S. birth control pioneer and eugenicist Margaret Sanger in social media discourse through a critical disinformation studies lens. Using computational and qualitative analysis techniques, 60 months of public Facebook posts and Google search data were analyzed to explore the scope, reach, and engagement with messages that reference Sanger and examine how injustice frames utilizing Sanger's historical ties to eugenics are being used today to misinform and disinform on abortion and other issues. Injustice frames featuring Sanger were deployed to portray abortion as a method for Black genocide; vilify feminism as racist, anti-woman, and anti-motherhood; and depict the Black Lives Matter social justice movement and cancel culture as hypocritical. This analysis also captured a moment in time when Sanger's legacy was being reconsidered by Planned Parenthood, the organization she founded, indicating that a long-sought-after reckoning with the racist roots of the early birth control movement in the United States may be underway—with both predictable and unpredictable rippling effects in disinformative spaces. [ABSTRACT FROM AUTHOR]

Melasma is a benign but emotionally distressing skin condition that reduces patients' quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75%. Troublingly, up to 30% of cases are reported to persist after delivery, even ten years later. And recurrence and aggravation are common in subsequent pregnancies. This review examines the risk factors and mechanisms associated with melasma during pregnancy and summarized corresponding preventive strategies. We emphasize the critical role of photoprotection, including the use of sunscreens from the first trimester, in reducing the incidence of melasma. [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]

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]

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]

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]

BACKGROUND: Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users current experiences, needs, and barriers. While multiple studies have explored patients experiences, needs, and barriers, little is known about clinicians experiences, perspectives, and barriers to delivering contraceptive counseling. OBJECTIVE: This study focused on assessing clinicians experiences, including their perspectives of patients needs and barriers. It also explored clinicians suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. METHODS: Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. RESULTS: Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. CONCLUSIONS: Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients reproductive health contraceptive decision-making.

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: 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]

Personal tax exemption (Penghasilan Tidak Kena Pajak - PTKP) can influence fertility choices by changing the costs or benefits of childbearing and increasing family disposable income. This study aims to investigate the impact of personal tax exemption on the addition of children in Indonesia. This study employs secondary data from Indonesian Family Life Survey (IFLS) data waves 4 and 5. The estimation, using a linear probability model, is an improvement from earlier studies as it employs a non-linear specification to more effectively capture the pattern of children's desired demand. This study found an inverse U-shaped relationship between the addition of children and personal tax exemption. The inverse U-shaped relationship indicates that the marginal effect of personal tax exemption decreases as the value of personal tax exemption increases. In addition, the probability of adding children is also influenced by the mother’s characteristics (age and working status), other adult female family members in the household, and the number of children. This study reveals that the taxation variable, personal tax exemption, can affect fertility. Thus, birth control should be carried out by considering various aspects other than direct birth control (e.g., family planning), including taxation. [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]

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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]

This study examines the factors influencing sexual and reproductive health (SRH) knowledge among in-school adolescents in Nigeria. Data were collected from a sample of 1,133 adolescents through a semi-structured survey questionnaire. Descriptive statistics, and logistic regression analysis were employed to analyze the data. Adolescents' knowledge levels on critical aspects of SRH education reveal varying levels of comprehension across domains. While 35.7% of adolescents demonstrate understanding of the anatomy and physiology of the reproductive system, only 8.0% display comprehension of contraception and birth control methods. Logistic regression coefficients unveil significant predictors of SRH knowledge, with senior secondary students demonstrating higher odds of SRH knowledge compared to junior secondary students (OR = 2.482, 95% CI [1.335, 3.693]). Urban residence is associated with higher odds of SRH knowledge (OR = 1.172, 95% CI [0.084, 1.350]). Healthcare providers significantly influence adolescents' SRH knowledge (OR = 3.519, 95% CI [2.853, 4.271]), while comfortable discussing SRH topics with teachers predicts higher odds of SRH knowledge (OR = 3.101, 95% CI [2.245, 3.355]). These findings underscore the need for tailored and comprehensive SRH education programs to address knowledge gaps and empower adolescents with accurate information and skills necessary for making informed decisions regarding their sexual health. [ABSTRACT FROM AUTHOR]

Background: Little is known about healthcare providers' (HCPs) contraceptive views for adolescents in Haiti, who experience high rates of unintended pregnancy. We sought to describe HCPs' perspectives on barriers and facilitators to contraceptive care delivery in rural Haiti. Methods: We conducted a cross-sectional survey and qualitative interviews with HCPs in two rural communities in Haiti from 08/2021–03/2022. We assessed demographics, clinical practice behaviors and explored contraception perspectives according to Theory of Planned Behavior constructs: attitudes, subjective norms, and perceived behavioral control (e.g., people's perceptions of their ability to perform a given behavior, barriers and facilitators of a behavior).15–17 We used descriptive statistics to report proportions and responses to Likert scale and multiple-choice questions. Guided by content analysis, we analyzed interview transcripts through thematic inductive coding and team debriefing. Results: Among 58 respondents, 90% (n = 52) were female and 53% (n = 31) were nurses. Most reported always (n = 16, 28%) or very often (n = 21, 36%) obtaining a sexual history for adolescents. A majority agreed/strongly agreed that clinicians should discuss pregnancy prevention (n = 45, 78%), high-risk sexual behaviors (n = 40, 69%), and should prescribe contraception (n = 41, 71%) to adolescents. The most frequently cited provider-level barriers (i.e., significant or somewhat of a barrier) included insufficient contraception knowledge (n = 44, 77%) and time (n = 37, 64%). HCPs were concerned about barriers at the patient-level (e.g. adolescents' fear of parental notification [n = 37, 64%], adolescents will give inaccurate information about sexual behaviors [n = 25, 43%]) and system-level (e.g. resistance to providing care from administration [n = 33, 57%]). In interviews (n = 17), HCPs generally supported contraception care for adolescents. Many HCPs echoed our quantitative findings on concerns about privacy and confidentiality. HCPs reported concerns about lack of contraception education leading to misconceptions, and community and parental judgement. HCPs expressed interest in further contraception training and resources and noted the importance of providing youth-friendly contraceptive care. Conclusions: While HCPs support contraceptive care, we identified actionable barriers to improve care for adolescents in rural Haiti. Future efforts should include increasing HCP knowledge and training, community and parent coalition building to increase contraception support and offering youth-friendly contraceptive care to offset risk for related adverse health outcomes in adolescents in rural Haiti. [ABSTRACT FROM AUTHOR]

Simple Summary: Historically, birth control has been geared toward targeting and subsequently reducing female fertility. The cost of unplanned pregnancies is significant, both in human and veterinary medicine. The development of an effective male contraceptive drug could provide an inclusive approach to the responsible use of contraception. The characteristics of an ideal contraceptive drug include reversibility, high efficacy, minimal adverse side effects, and easy administration. Although this seems like an uphill task, there are a few male contraceptive methods that are currently available, along with substantial interest and research being focused on novel targets. This review uses a comparative medicine approach to succinctly identify and discuss the different types of male contraceptives currently available, while also highlighting newer methods and potential targets for the future development of novel male contraceptives. The last few decades have brought contraception to the forefront of research, with great strides made in effectively targeting and optimizing the physiology, pharmacology, and delivery processes that prevent pregnancy. However, these advances still predominantly target female contraceptives for the prevention of contraception, whereas targeting the male sex has lagged far behind. This has led to a marked deficiency in safe and effective male contraceptive agents, resulting in a heavy dependence on female contraceptives to prevent unwanted and unplanned pregnancies. Current research in the veterinary field and in rodents highlights several promising avenues whereby novel, safe, and effective male contraceptive alternatives are being developed—with an emphasis on reduced side effects and reversibility potential. This review aims to discuss current and novel male contraceptives (both human and veterinary formulations) while highlighting their efficacy, advantages, and disadvantages. [ABSTRACT FROM AUTHOR]