Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Horton LG[original query] |
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Factors associated with provision of depot medroxyprogesterone acetate to adolescents by U.S. health care providers
Ermias Y , Morgan IA , Curtis KM , Whiteman MK , Horton LG , Zapata LB . Contraception 2019 99 (5) 300-305 OBJECTIVE: Identify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents. STUDY DESIGN: We analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year. RESULTS: Although most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30-0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28-0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27-0.91) and family medicine (aOR 0.21, 95% CI 0.09-0.47) versus adolescent medicine, completing training>/=15 versus<5years ago (aOR 0.27, 95% CI 0.09-0.83), and reporting that 0-24% of patients pay with Medicaid or other government healthcare assistance versus>/=50% (aOR 0.23, 95% CI 0.09-0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method. CONCLUSIONS: While most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception. IMPLICATIONS: Although>95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception. |
Research gaps from evidence-based contraception guidance: the U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 and the U.S. Selected Practice Recommendations for Contraceptive Use, 2016
Horton LG , Folger SG , Berry-Bibee E , Jatlaoui TC , Tepper NK , Curtis KM . Contraception 2016 94 (6) 582-589 The US Medical Eligibility Criteria for Contraceptive Use (US MEC) and the US Selected Practice Recommendations for Contraceptive Use (US SPR) were first adapted by the Centers for Disease Control and Prevention (CDC) from their World Health Organization counterparts in 2010 and 2013, respectively [1], [2]. These evidence-based guidance documents provide critically important information for health care providers on the safety of contraceptive methods for women with specific characteristics or medical conditions (US MEC) and on common but sometimes complex clinical issues regarding how to use contraceptive methods in select circumstances (US SPR). Through knowledge and use of the contraception guidance, providers are helping women select and use safe and effective contraceptive methods. Some of these methods may not otherwise have been considered due to patient or provider concerns about potential risks given the patient's particular characteristics or underlying medical condition, or their use may have been delayed due to unnecessary tests prior to initiation. The US MEC and US SPR remove unnecessary medical barriers to access and use of effective contraceptive methods; this is especially important for women with medical conditions associated with heightened risk during pregnancy [1]. | Between August 2014 and August 2015, CDC conducted a formal process to update the 2010 US MEC and the 2013 US SPR. Through this process, CDC identified topics warranting systematic reviews of published evidence to help inform recommendation updates and to serve as a basis for the addition of new topics to the existing guidance. Systematic reviews were then conducted, presented and discussed at a meeting of national family planning experts, and CDC determined the final recommendations. As part of this review process, gaps in the evidence were identified for which research is needed to further inform the recommendations. In this paper, we list these research gaps (Tables 1 and 2) and explore three of the topics in depth. |
U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
Curtis KM , Tepper NK , Jatlaoui TC , Berry-Bibee E , Horton LG , Zapata LB , Simmons KB , Pagano HP , Jamieson DJ , Whiteman MK . MMWR Recomm Rep 2016 65 (3) 1-103 The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2010 U.S. MEC (CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010:59 [No. RR-4]). Notable updates include the addition of recommendations for women with cystic fibrosis, women with multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate; and revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases, and human immunodeficiency virus; and women who are receiving antiretroviral therapy. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options. |
U.S. Selected Practice Recommendations for Contraceptive Use, 2016
Curtis KM , Jatlaoui TC , Tepper NK , Zapata LB , Horton LG , Jamieson DJ , Whiteman MK . MMWR Recomm Rep 2016 65 (4) 1-66 The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. Health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options. |
Combined hormonal contraceptive use among obese women and risk for cardiovascular events: a systematic review
Horton LG , Simmons KB , Curtis KM . Contraception 2016 94 (6) 590-604 CONTEXT: Combined hormonal contraceptive (CHC) use may modify the risk of cardiovascular events in obese [body mass index (BMI) ≥30kg/m2] women. OBJECTIVE: To evaluate from the literature whether CHC use modifies the risk of acute myocardial infarction (AMI), stroke, cerebral venous thrombosis (CVT), and venous thromboembolism (VTE) in obese women, and to evaluate evidence for a dose-response relationship between BMI and VTE. METHODS: We searched PubMed for all articles published between database inception and February 2016 providing direct evidence on BMI, CHCs, and cardiovascular outcomes. We also searched for indirect evidence related to a dose-response relationship between BMI and risk of VTE in the general population, as these data were lacking for CHC users. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force (USPSTF). RESULTS: The direct evidence search yielded three pooled analyses, eleven case-control studies, and one cohort study. There was conflicting evidence about the risk of AMI or stroke among obese combined oral contraceptive (COC) users compared to obese non-users, with one study finding no increased risk for AMI or stroke for COC-users overall or stratified by BMI. A second study found significant increased risk of AMI and stroke for COC-users, with the highest risk estimates for high BMI COC-users. A single study suggested that obese COC-users may be at higher risk for CVT compared with normal weight, non-users. For VTE, obese COC users consistently had a risk that was 5 to 8 times that of obese non-users and approximately 10 times that of non-obese, non-users. Five prospective cohort studies were identified as indirect evidence, and all found increased risk for VTE as BMI increased, suggesting a dose-response relationship between BMI and risk for VTE. No studies on the contraceptive patch or vaginal ring were identified that met the inclusion criteria. CONCLUSION: Limited evidence of Level II-2, fair quality, concerning whether CHC use modifies the risk of AMI and stroke in obese women is inconclusive, while a single study of Level II-2, poor quality found obese COC-users may be at higher risk for CVT compared with normal weight, non-users. Both COC use and higher BMI increase risk for VTE, and the greatest relative risks are for those with both risk factors, based on a body of evidence graded as Level II-2, fair to poor quality. It is not possible to estimate absolute risk of VTE among women with both of these risk factors; however, the absolute risk of VTE in healthy women of reproductive age is small. |
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