BMJ Sexual & Reproductive Health最新文献

{"title":"Self-performed Rh typing: a cross-sectional study.","authors":"Divya Dethier, Mary Tschann, Meliza Roman, John J Chen, Reni Soon, Bliss Kaneshiro","doi":"10.1136/bmjsrh-2024-202349","DOIUrl":"10.1136/bmjsrh-2024-202349","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether patients are capable and willing to self-administer and interpret an EldonCard test to determine their Rh status.</p><p><strong>Methods: </strong>This was a cross-sectional study in Honolulu, HI, USA of pregnancy-capable people aged 14-50 years who did not know their blood type and had never used an EldonCard. Participants independently completed EldonCard testing, determined their Rh type and answered a survey on feasibility and acceptability. Separately, a blinded clinician recorded their interpretation of the participant's EldonCard. When available, we obtained blood type from the electronic health record (EHR). We measured Rh type agreement between participant, clinician and EHR, as well as participant comfort and acceptability of testing.</p><p><strong>Results: </strong>Of the 330 total participants, 288 (87.3%) completed testing. Patients and clinicians had 94.0% agreement in their interpretation of the EldonCard for Rh status. Patient interpretation had 83.5% agreement with EHR while clinician and EHR had 92.3% agreement. Sensitivity of EldonCard interpretation by patient and clinician was 100%. Specificity was 83.2% for patients and 92.2% for clinicians. Two patients (of 117) had Rh-negative blood type in the EHR. The vast majority of participants found the EldonCard testing easy (94.4%) and felt comfortable doing the testing (93.7%). Participants with lower education levels felt less confident (p=0.003) and less comfortable with testing (p=0.038); however, their ability to interpret results was similar to others (p=0.051).</p><p><strong>Conclusions: </strong>Patient-performed Rh typing via the EldonCard is an effective and acceptable option for patients, and could be used as a primary screening test for Rh status.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"36-42"},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foregrounding pain in self-managed early medication abortion: a qualitative study.","authors":"Carrie Purcell, Victoria Louise Newton, Fiona Bloomer, Lesley Hoggart","doi":"10.1136/bmjsrh-2023-202198","DOIUrl":"10.1136/bmjsrh-2023-202198","url":null,"abstract":"<p><strong>Objective: </strong>To explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.</p><p><strong>Methods: </strong>From late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software.</p><p><strong>Results: </strong>Focused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising 'period-like pain'. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to 'period pain' can be misleading and a source of additional uncertainty at a potentially already challenging time.</p><p><strong>Conclusions: </strong>For some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of 'period-like pain' do not clarify expectations and should be avoided.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"3-8"},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140012166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A post-abortion contraception text-and-call service to support patients to access effective contraception after telemedicine abortion.","authors":"John Joseph Reynolds-Wright, Sharon T Cameron","doi":"10.1136/bmjsrh-2024-202391","DOIUrl":"10.1136/bmjsrh-2024-202391","url":null,"abstract":"<p><strong>Background: </strong>Most abortions in Scotland are conducted at home before 12 weeks' gestation using telemedicine. The volume of information given at a pre-abortion consultation may feel overwhelming and contraception may not be prioritised. Telemedicine limits immediate provision of some methods. Pathways to improve access to post-abortion contraception (PAC) are needed.</p><p><strong>Methods: </strong>We piloted a PAC 'text-and-call' service for patients having telemedicine abortion in Edinburgh. Those agreeing to contact were sent a text message 4-6 weeks later. The message offered a follow-up telephone call with a nurse to discuss contraception. An online decision aid was used to support method selection where needed. Rapid access to the chosen method was arranged.</p><p><strong>Results: </strong>During the period February-April 2022, 672 patients accessed abortion care, of whom 427 (64%) agreed to post-abortion text message contact. Most (354/427, 83%) did not respond or declined further contact, and 73/427 (17%) requested a follow-up call.Two participants did not respond to the follow-up call. Most (63/73, 86%) knew what method they wanted prior to the call. Just over half of these patients (34/73, 54%) changed to a higher-effectiveness method than they were currently using and the remainder obtained further supplies of their existing method. Eight participants had not selected a method prior to the call and received structured counselling; five chose long-acting reversible contraception (LARC) but only one subsequently initiated this.</p><p><strong>Conclusions: </strong>This PAC service was taken up by a small proportion of patients but supported a sizeable minority to connect to further contraceptive supplies, half of whom accessed more effective methods.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"51-53"},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of home-based medical abortion among Hong Kong women undergoing an abortion: a cross-sectional study.","authors":"Ingrid D Lui, Sue Seen Tsing Lo, Jianchao Quan","doi":"10.1136/bmjsrh-2024-202360","DOIUrl":"10.1136/bmjsrh-2024-202360","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"80-81"},"PeriodicalIF":3.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between menstrual cycle pattern regularity and changes in menstrual bleeding following COVID-19 vaccination: secondary analysis of an observational study.","authors":"Emily R Boniface, Blair G Darney, Agathe van Lamsweerde, Eleonora Benhar, Leo Han, Kristen Matteson, Victoria Male, Sharon Cameron, Alexandra Alvergne, Alison Edelman","doi":"10.1136/bmjsrh-2024-202564","DOIUrl":"10.1136/bmjsrh-2024-202564","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Making abortion safe': abortion and post-abortion care providers' experiences of stigma in Rwanda, Zimbabwe, Sierra Leone and Nigeria.","authors":"Suzanna Bright, Emma Parnham, Rebecca Blaylock, Louise Bury, Friday Okonofua, Sunhurai Mukwambo, Munyaradzi Nyakanda, Theodomir Sebazungu, Godwin Akaba, Lesley Hoggart","doi":"10.1136/bmjsrh-2024-202495","DOIUrl":"10.1136/bmjsrh-2024-202495","url":null,"abstract":"<p><strong>Background: </strong>Social stigma and the marginalisation of abortion care within medical settings can negatively affect abortion providers. While some research has evaluated stigma interventions in legally restrictive settings, little work has explored the experiences of healthcare professionals (HCPs) providing abortion and post-abortion care (PAC) outside the USA. This study, part of the Royal College of Obstetricians and Gynaecologists' 'Making Abortion Safe' programme, aimed to understand providers' experiences of abortion stigma in four African countries with restrictive legislation.</p><p><strong>Methods: </strong>In-depth interviews with 44 abortion and PAC providers were conducted in Nigeria, Rwanda, Sierra Leone and Zimbabwe.</p><p><strong>Results: </strong>Four themes emerged: personal and professional effects of stigma, multiple manifestations of stigma, driving forces of stigma, and positivity and resilience. Stigma affects providers' professional identity, community belonging and relationships. Restrictive legal frameworks are the main driver of abortion stigma, operating at multiple levels that reinforce each other. The legal status of abortion labels it as 'dirty work', conflicting with healthcare principles. Judgmental attitudes from other HCPs negatively impact providers' well-being and care quality. However, providers showed resilience through professional and personal commitment, and the belief in 'doing the right thing' helped them resist stigma.</p><p><strong>Conclusions: </strong>Legal changes are crucial for increasing access and reducing stigma among the workforce. In these countries, providers face challenges in offering legal healthcare. Organisational interventions are needed to address stigmatising values and create positive workplaces. Ongoing support is essential for HCPs to remain resilient against abortion stigma, helping to normalise abortion care and those who provide it.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the literature.","authors":"","doi":"10.1136/bmjsrh-2024-202598","DOIUrl":"https://doi.org/10.1136/bmjsrh-2024-202598","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the impact of COVID-19 on women's access to and experiences of contraceptive services in England: a qualitative study.","authors":"Lauren McMillan, Erica Gadsby, Rebecca Howell, Michael Ussher, Kate Hunt, Allison Ford","doi":"10.1136/bmjsrh-2023-202206","DOIUrl":"10.1136/bmjsrh-2023-202206","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic response prompted rapid changes to how contraceptive services were delivered in England. Our aim was to examine women's experiences of accessing contraceptive services since March 2020 and to understand any inequalities of access.</p><p><strong>Methods: </strong>We conducted telephone interviews with 31 women aged 17-54 years who had accessed contraceptive services in England since March 2020. The sample was skewed to include participants with lower educational attainment and higher deprivation. Interview transcripts were thematically analysed using inductive and deductive approaches.</p><p><strong>Results: </strong>Few differences were found regarding educational attainment. Participants using contraceptive injections (all living in areas in the most deprived quintile) reported the greatest access challenges. Some switched method or stopped using contraception as a result. More general barriers reported by participants included service closures, unclear booking processes, and lack of appointment availability. Many participants welcomed the flexibility and convenience of remote contraceptive services. However, telephone appointments posed challenges for those at school or living with parents, and some described them as rushed and inconducive to asking questions or raising concerns. Those accessing contraception for the first time or nearing menopause felt they were unable to access sufficient support and guidance during the pandemic. Some participants voiced concerns around the lasting effects of COVID-19 on appointment availability and inadequate service delivery.</p><p><strong>Conclusions: </strong>Women's experiences of accessing contraceptive services in England since March 2020 are diverse. While remote services were suitable for some, COVID-19 restrictions unequally impacted women depending on their method of contraception and life stage.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"242-251"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review.","authors":"Kelly A McNamara, Bridin Murnion, Penelope Fotheringham, Mishka Terplan, Nicholas Lintzeris, Ju Lee Oei, Diana M Bond, Natasha Nassar, Kirsten I Black","doi":"10.1136/bmjsrh-2023-202140","DOIUrl":"10.1136/bmjsrh-2023-202140","url":null,"abstract":"<p><strong>Background: </strong>Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP.</p><p><strong>Objectives: </strong>To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD.</p><p><strong>Search strategy: </strong>The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023.</p><p><strong>Selection criteria: </strong>Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries.</p><p><strong>Data collection and analysis: </strong>Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively.</p><p><strong>Main results: </strong>A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes.</p><p><strong>Conclusion: </strong>There is a paucity of data examining the intersection between AOD use and UIP and further research is needed.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"285-293"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consequences of 'medical exceptions' in restrictive abortion legislation: caesarean scar ectopic pregnancy and beyond.","authors":"Natalie DiCenzo, Adam Elwood, Ruby Lin, Lily Bayat, Todd Rosen","doi":"10.1136/bmjsrh-2024-202301","DOIUrl":"10.1136/bmjsrh-2024-202301","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"294-296"},"PeriodicalIF":3.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}