Population Of Reproductive Age Research Articles

Evaluating the impact and cost-effectiveness of chlamydia management strategies in Hong Kong: A modeling study.

ObjectivesTo illustrate the epidemiologic and cost-effectiveness impact of shifting the focus from population-based screening toward a targeted management approach for genital chlamydia infection.DesignModeling study, implementing an individual-based, stochastic, dynamic network model.SettingHong Kong.PopulationA hypothetical sample network of 10,000 people with a partnership distribution based on Hong Kong's sexually active population of reproductive age (age 18–49 years).InterventionsIn this study, we present several scenarios with different implementations of universal vs. targeted screening (based on partner numbers). We also explored the impact of (1) screening only, (2) screening plus expedited partner therapy, and (3) screening plus partner testing.Primary outcome measuresChange of chlamydia prevalence before and after implementing the different strategies. The cost-effectiveness analysis reports total direct cost from a health provider perspective, the QALYs gained, and incremental cost-effectiveness ratios (ICER).ResultsIn comparing the effects of universal screening only and targeted screening of the high-risk population, the mean prevalence during the 10th year of intervention was 2.75 ± 0.30% and 2.35 ± 0.21%, respectively (compared with 3.24 ± 0.30% and 3.35 ± 0.21% before the interventions, respectively). The addition of contact tracing to the latter targeted screening scenario reduces the mean prevalence during the 10th year of intervention to 1.48 ± 0.13% (compared with 3.31 ± 0.33% at baseline) in the best-case of testing before treatment and maximal contact-tracing effectiveness (40%). Overall, the most effective scenarios were those for which interventions focused on the high-risk population defined by the number of partners, with contact tracing included. The ICER for targeted screening with contact tracing at 20% and 40% efficiency was $4,634 and $7,219 per QALY gained, respectively (10-year time horizon). Expedited partner therapy did not significantly impact overall chlamydia prevalence and caused overtreatment.ConclusionsOur study suggests that targeted screening with strengthened contact tracing efforts is the most cost-effective strategy to reduce the prevalence of chlamydia in Hong Kong.

Impact of satellite clinics on geographic access to assisted reproductive technology services in the United States

BackgroundMany assisted reproductive technology (ART) centers utilize satellite clinics to expand reach and access to clinical services, but their contribution to lowering geographic barriers in access to care has not been examined. This study’s purpose is to determine the extent to which satellite clinics impact geographic access to ART and estimate the percentage of reproductive-age women who have geographic access to ART services.MethodsA systematic web-search collected the locations of all main and satellite ART clinics in the United States (US). Driving times were calculated between satellite clinics and main clinics. The percentage of women with geographic access to care was characterized by clinic type using US Census Core Based Statistical Areas (CBSAs). Logistic regression was used to statistically model the presence of main and satellite clinics as a function of CBSA median income and female reproductive-age population.ResultsFour hundred sixty-nine main clinics with embryology labs and 583 satellite clinics were found in the US. Practices with satellite clinics tend to perform more ART cycles. Satellite clinics are located on average 66 minutes from their practice’s main clinic and 31 minutes from any main clinic. 22% of satellite clinics were in CBSAs without a main clinic. 46 M (72%) US reproductive-age women live in a CBSA with a main clinic, 5.1 M (8%) women live in a CBSA without a main clinic but at least one satellite clinic, and 13 M (20%) women live in an area with no ART clinic of either type. Female reproductive-age population was found to be a more important predictor of clinic presence than median income.ConclusionsThe majority of satellite clinics in the US are positioned in relative proximity to a main clinic. 85% of satellite clinics are located closer to the main clinic of other practices than to their own main clinic. Less than a quarter of ART satellite clinics expand geographic access to ART services by being located in areas without a main clinic, and the vast majority of practices with satellite clinics position their satellite clinics close to another practice’s main clinic.Trial registrationNot applicable.

Understanding of a Veiled Illness: Evaluation of Polycystic Ovarian Syndrome awareness (PCOS) in Young Female Students of Karachi.

Introduction: PCOS is a major endocrinological syndrome that affects females and impairs hormonal stability thus having an impact on the normal functioning of some body systems. This has affected 6-20% of the female population of reproductive age and hence its diagnosis is important. Methods: This is a retrospective cross-sectional observational study. A total of 151 females were enrolled; after signing an informed consent form, females were asked a few questions about their general health, comorbidities, and generalized menstruation history. The last part of the questionnaire contains common signs and symptoms of polycystic ovarian disease to assess awareness. The data was analyzed in the statistical package of social sciences (SPSS) version 2021.Result: The participants were asked about 7 signs of PCOS. 9.3% (n=14) were facing irregular periods, heavy bleeding was experienced by 16.6% (n=25) participants. Facial hair growth has occurred in 13.2% (n=20) of participants. 15.2% (n=23) had oily scalp and dandruff. Participants were also asked if they were aware of some major risk factors of PCOS. 15.9% (n=24) knew that PCOS can cause infertility, and 7.3% (n=11) said PCOS causes Anovulatory cycles. 41.7% knew that lifestyle modification can help reduce adverse effects of the syndrome. Conclusion: the majority of study participants indicated decreased awareness of PCOS and its major risk factors, Hence there is a dire need for awareness as it is rather ignored.

P-376 Estimating the costs associated with the implementation of a best practice model of care for recurrent miscarriage clinics in Ireland: a cost analysis

Abstract Study question What are the potential costs to the Irish healthcare system of implementing a ‘best practice’ model of care for recurrent miscarriage clinics? Summary answer Total cost for RM patients ranges from €1,634.19 to €4,817.87 for a pregnancy outcome and from €1,245.77 to €4,317.87 for women who do not conceive. What is known already Recurrent miscarriage (RM) affects 1% -5% of the reproductive age population. It is recognised that the best care for RM is offered in a dedicated recurrent miscarriage clinic (RMC). While RM represents a significant burden to couples, the setup of RMCs involves substantial resource costs. This study reports on the cost impact to the Irish healthcare system of implementing a ‘best practice’ model of care for RMCs. Evidence from cost analysis plays an important role in informing the cost-effectiveness of interventions ensuring that those available resources are used efficiently, as health policymakers plan for future healthcare services. Study design, size, duration A micro-costing approach was employed using a range of data sources to identify, measure, and value the resources required to implement the proposed model of care. Data was collected from March – September 2021. The cost analysis was calculated using the following components: 1. The initial set up costs of a best practice RMC, 2. The ongoing implementation costs of delivering a best practice RMC, and 3. The subsequent and related care pathway costs. Participants/materials, setting, methods Per patient costs were estimated within a best practice RMC using two scenarios (a typical versus a complex RM case). The cost estimates were extrapolated to estimate the cost impact to the Irish healthcare care system over a 1-year period using population data and published prevalence rates for RM. A sensitivity analysis was performed to control for the uncertainty in each of the parameters. Main results and the role of chance The total cost to set up a best practice RMC is €37,321. The yearly on-going delivery cost is €6,212.25. The total cost for a RM patient who has another pregnancy after receiving investigations, treatment and reassurance scans ranges between €1,634.19 (typical) and €4,817.87 (complex). For a RM patient who does not conceive again, costs range from €1,245.77 (typical) to €4,317.87 (complex). Using population estimates, the total budget impact to the health service for women who experience ≥2 losses costs €61,927,630 (typical) /€20,336,229 (complex) for a pregnancy outcome and €22,480,630 (typical)/€7,78,437 (complex) for women who do not conceive. Sensitivity analysis identified RM investigations and treatments costs as the main cost drivers for per-patient costs. Limitations, reasons for caution With only six RMCs operating in Ireland, calculating costs savings was not possible. A fixed number of investigations and treatments for patient scenarios were applied. In a real-world setting, investigations and treatments will vary significantly by patient need, risk factors and previous history of loss, directly impacting the costs reported. Wider implications of the findings This study proposes a model of care for RMCs in Ireland, providing cost estimates at the patient and healthcare system level. While future studies should consider the cost-effectiveness of this model of care, this analysis provides a valuable first step in providing a breakdown of the resources and costs. Trial registration number Not applicable

Social determinants of vulnerability in the population of reproductive age: a systematic review

BackgroundThe health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age.MethodsThe databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021.Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner.ResultsWe identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience.ConclusionsThis review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life.

Associations between COVID-19 lockdown and post-lockdown on the mental health of pregnant women, postpartum women and their partners from the Queensland family cohort prospective study

BackgroundThere are very few developed countries where physical isolation and low community transmission has been reported for COVID-19 but this has been the experience of Australia. The impact of physical isolation combined with low disease transmission on the mental health of pregnant women is currently unknown and there have been no studies examining the psychological experience for partners of pregnant women during lockdown. The aim of the current study was to examine the impact of the first COVID-19 lockdown in March 2020 and post lockdown from August 2020 on the mental health of pregnant women or postpartum women and their partners.MethodsPregnant women and their partners were prospectively recruited to the study before 24 weeks gestation and completed various questionnaires related to mental health and general wellbeing at 24 weeks gestation and then again at 6 weeks postpartum. The Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) were used as outcome measures for the assessment of mental health in women and DASS-21 was administered to their partners. This analysis encompasses 3 time points where families were recruited; before the pandemic (Aug 2018-Feb 2020), during lockdown (Mar-Aug 2020) and after the first lockdown was over (Sept-Dec 2020).ResultsThere was no significant effect of COVID-19 lockdown and post lockdown on depression or postnatal depression in women when compared to a pre-COVID-19 subgroup. The odds of pregnant women or postpartum women experiencing severe anxiety was more than halved in women during lockdown relative to women in the pre-COVID-19 period (OR = 0.47; 95%CI: 0.27–0.81; P = 0.006). Following lockdown severe anxiety was comparable to the pre-COVID-19 women. Lockdown did not have any substantial effects on stress scores for pregnant and postpartum women. However, a substantial decrease of over 70% in the odds of severe stress was observed post-lockdown relative to pre-COVID-19 levels. Partner’s depression, anxiety and stress did not change significantly with lockdown or post lockdown.ConclusionA reproductive age population appear to be able to manage the impact of lockdown and the pandemic with some benefits related to reduced anxiety.

Abdominal wall endometrioma: Case report

Background: Endometriosis is a disease that presents primarily with pelvic pain and infertility. Endometrioma is a cyst consisting of endometrial glands and stoma and is typically an advanced presentation of endometriosis. Endometriomas usually grow benignly. There are few reports of patients with endometrioma with malignant features reported in the literature. A case of infrequent occurrence and low diagnostic rate will be reported but having as its origin a relatively common disease with great impact on the female population in reproductive age. Case Summary: A 54-year-old female patient came in with abdominal wall bulging referring to gradual growth and emergence over the last 4 years. Personal history includes previous cesarean section 2 decades ago. The patient also had hypertension, diabetes, a history of total thyroidectomy for thyroid neoplasia 18 years ago, bile duct lithiasis, uterine myomatosis, obesity and epilepsy that started a few years ago with no defined etiology. We report a case of endometrioid pattern adenocarcinoma of the abdominal wall. The patient was submitted to exploratory laparotomy with resection of the tumor in the abdominal wall besides extended hysterectomy, umbilical herniorrhaphy and cholecystectomy. The procedure was performed under general anesthesia and spinal anesthesia, laparoscopically with a report of cystography and bilateral pelvic lymphadenectomy. The patient was followed up as an outpatient, with adjuvant chemotherapy using the carboplatin and paclitaxel protocol. Conclusion: This report highlights a case of endometriosis with abdominal wall metaplastic invasion, an uncommon finding in everyday medical practice. Core Tip: The study consists of a case report of a patient presenting with endometriosis with abdominal wall invasion with elements of conversion to malignant disease and is considered an atypical case rarely reported in the literature. As a result, it may highlight a condition that in its early stages can be treated relatively easily but often goes unnoticed until advanced stages where it is no longer possible to treat it effectively.

Effect of Ethanol Leave Extract of Gongronema latifolium on Female Reproductive System in Albino Wistar Rats

Reproductive system has infertility as a disease that affect both sex at equal frequency. A ten percent population of human reproductive age are affected with the phenomenon globally. This study investigated how ethanol crude leaves of Gongronema latifolium affect the reproductive system of female Albino Wistar rats. Phytochemical screening was conducted using standard methods. The extract effect on reproductive hormones and estrous cycle were ascertained on experimental rats weighing 140-160g. Matured females; twenty-five in numbers were equally shared into five groups: The normal and positive controls were groups 1 and 2 which were administered distilled water and standard drug; On the other hand crude ethanol leaves of Gongronema latifolium were given to the last three groups in a 200, 300 and 400 in mg/body weight i.e mg/kg. Phytochemical profile revealed saponins, alkaloids, tannins, flavonoids including cardiac glycosides. Hormonal results indicated that the low dose and middle dose were decreased significantly (P = .05) in both FSH and Progesterone levels, but increased significantly (P = .05) in LH and Estradiol levels. The high dose had a significantly decreased (P = .05) FSH and LH but a significantly increased (P = .05) Progesterone and Estradiol. The study further demonstrated irregularities of estrous cycle as an effect of the ethanol crude Gongronema latifolium leaves. Also, the crude leaves might distort the process of reproduction of female Wistar rats. The secondary metabolites in Gongronema latifolium leaves could have caused these effects.

Ovarian stimulation for fertility treatments and risk of breast cancer: a matched cohort study.

Is there a difference in the breast cancer risk among women who underwent ART treatments compared to those who underwent medically assisted reproduction (MAR) infertility treatments or women of reproductive age in the general population? The risk of breast cancer among women treated by ART was similar to the risk among women treated by MAR and women who did not undergo fertility treatments. Studies investigating breast cancer risk in women who have undergone fertility treatments have provided conflicting results. A retrospective, population-based cohort study included women who underwent ART or MAR treatments and women who did not undergo fertility treatments from 1994 to 2019. Women who underwent ART were matched one to one with women who underwent MAR treatments and one to one with woman from the general population of reproductive age, by year of birth and year of first delivery or nulliparity status. MAR women were also matched to ART women by treatment initiation calendar year. All included women were members of Maccabi Healthcare Services. Data regarding demographics, fertility treatments, BRCA mutation and possible confounders were obtained from the computerized database of electronic health records. The incidence of breast cancer after fertility treatments was compared to the matched controls. Of 825721 women of reproductive age, 32366 women who underwent ART were matched with patients treated by MAR (n = 32366) and 32366 women of reproductive age. A total of 984 women (1.0%) were diagnosed with breast cancer (mean follow-up period, 9.1 ± 6.3 years; interquartile range [IQR], 3.8-13.7 years). The incidence rates of breast cancer per 10000 person-years were 11.9 (95% CI, 10.7-13.3), 10.7 (95% CI, 9.6-11.9) and 10.7 (95% CI, 9.6-12.0) in the ART group, MAR group and general population, respectively. The crude risk for breast cancer was similar in the ART group compared with the general population (hazard ratio (HR) = 1.10, 95% CI, 0.94-1.28) and in the ART group compared with the MAR group (HR = 1.00, 95% CI, 0.86-1.16). Further adjustment for age, BMI, smoking, socioeconomic status and parity did not substantially impact the hazard rates for breast cancer (ART vs general population: HR = 1.10, 95% CI, 0.94-1.28; ART vs MAR: HR = 0.99, 95% CI, 0.85-1.16). Among women diagnosed with breast cancer, the prevalence of BRCA1/2 mutations and tumour staging did not differ between the ART, MAR and general population groups. Among women who underwent ART, no correlation was found between breast cancer and the number of ART cycles or the use of recombinant medications or urine-derived medications. The mean age of women at the end of follow-up was only 42 years thus the study was not powered to detect potential differences in the risk of postmenopausal breast cancer. In addition, we did not sub-classify the exposed patients by the reason for infertility. Breast cancer incidence following ART was comparable to that in the general population or following MAR. Women undergoing fertility treatments and their clinicians may be reassured about the safety of assisted reproduction technologies in terms of premenopausal breast cancer risk. No specific funding was used and there are no competing interests. N/A.

Comparison of Organoids from Menstrual Fluid and Hormone-Treated Endometrium: Novel Tools for Gynecological Research.

Endometrial organoids (EMO) are an important tool for gynecological research but have been limited by generation from (1) invasively acquired tissues and thus advanced disease states and (2) from women who are not taking hormones, thus excluding 50% of the female reproductive-aged population. We sought to overcome these limitations by generating organoids from (1) menstrual fluid (MF; MFO) using a method that enables the concurrent isolation of menstrual fluid supernatant, stromal cells, and leukocytes and (2) from biopsies and hysterectomy samples from women taking hormonal medication (EMO-H). MF was collected in a menstrual cup for 4–6 h on day 2 of menstruation. Biopsies and hysterectomies were obtained during laparoscopic surgery. Organoids were generated from all sample types, with MFO and EMO-H showing similar cell proliferation rates, proportion and localization of the endometrial basalis epithelial marker, Stage Specific Embryonic Antigen-1 (SSEA-1), and gene expression profiles. Organoids from different disease states showed the moderate clustering of epithelial secretory and androgen receptor signaling genes. Thus, MFO and EMO-H are novel organoids that share similar features to EMO but with the advantage of (1) MFO being obtained non-invasively and (2) EMO-H being obtained from 50% of the women who are not currently being studied through standard methods. Thus, MFO and EMO-H are likely to prove to be invaluable tools for gynecological research, enabling the population-wide assessment of endometrial health and personalized medicine.

Development of a health literacy scale for preconception care: a study of the reproductive age population in Japan

BackgroundPreconception care aims to improve both maternal and child health in the short as well as long term, along with providing health benefits to adolescents, women, and men, whether or not they plan to become parents. However, there is limited evidence regarding the effectiveness of interventions for improving preconception health in population-based settings. To accumulate evidence in this field, this study focused on the concept of health literacy, and aimed to develop a self-report health literacy scale in Japanese, focusing on preconception care.MethodsWe conducted a cross-sectional online survey. Participants were recruited from December 2019 to February 2020 from the registered members of a web-based research company. Participants were Japanese men and women aged 16–49 (n = 2000). A factor analysis was conducted to select both factors and items for health-related behavior and skills (33 initial items were generated), along with an item response theory analysis to examine how the 16 items were related to people’s knowledge of preconception care.ResultsWe developed a 6-factor (including “appropriate medical examinations,” “appropriate diet,” “stress coping,” “healthy weight,” “safe living environment,” and “vaccinations”), 25-item behavior and skills scale, as well as a 13-item knowledge scale, to evaluate participants’ health literacy around preconception care. A shortened version, consisting of 17 items, was also prepared from the 25 items. The reliability coefficients of total scores and each factor of the behavior and skills scale were comparatively high, with weak-to-moderate correlation between behavior and skills and knowledge.ConclusionsThe new scale will, ideally, provide information on the current state of preconception care health literacy of the general population. In addition, this scale, which consists of both behavioral/skills and knowledge dimensions, should help support the effective implementation of risk assessment programs and interventions aimed at promoting behavioral changes using a population-based approach. Future studies using different question/administration formats for diverse populations, and considering respondents’ opinions on health literacy scales should be effective in improving this scale.

Total Blood Mercury Predicts Methylmercury Exposure in Fish and Shellfish Consumers

Many studies evaluating methylmercury (MeHg) toxicity rely on whole blood total mercury (THg) measurements to estimate MeHg exposure. However, whole blood THg includes other forms of mercury (Hg), such as inorganic Hg, which have different exposure sources and toxicological effects than MeHg. Therefore, estimating the whole blood MeHg/THg ratio is critical to predicting MeHg exposure and, subsequently, efforts to establish an exposure–response relationship for use in risk assessment. A large, representative dataset (National Health and Nutrition Examination Survey (NHANES) 2011–2016) was used to determine the whole blood MeHg/THg ratio among (a) self-reported fish and shellfish consumers, ≥ 15 years of age (the “full adult” population (N = 5268 training dataset; N = 2336 test dataset)) and (b) female fish and shellfish consumers, 15–44 years of age (the “women of reproductive age” population (N = 1285 training dataset; N = 560 test dataset)). Unadjusted and adjusted linear and spline models with direct measurements for both THg and MeHg were evaluated. The mean whole blood MeHg/THg ratio was 0.75 (95% confidence interval (CI): 0.74, 0.75). This ratio was significantly higher among those with higher THg concentrations. All models exhibited excellent fit (adjusted R2 from 0.957 to 0.982). Performance was slightly improved in spline versus linear models. For the full adult population and women of reproductive age, the unadjusted spline model predicted whole blood MeHg concentrations of 5.65 µg/L and 5.55 µg/L, respectively, when the THg concentration was 5.80 µg/L. These results suggest that whole blood THg is a good predictor of whole blood MeHg among fish and shellfish consumers.

Re-emergence of syphilis in women of reproductive age and its association with the increase in congenital syphilis in Mexico during 2010\u20132019: an ecological study

BackgroundSyphilis is a sexually transmitted infection that is re-emerging in different parts of the world. This infection can be transmitted during pregnancy, causing neonatal syphilis. The objective of this study was to examine trend in syphilis, congenital syphilis, and neonatal deaths among the Mexican population during 2010–2019.MethodsAn ecological study was carried out to collect information about the incidence of syphilis, the incidence of congenital syphilis, and the incidence of neonatal death from congenital syphilis. The variables were described considering age, sex, Mexican state, and year. Trends across time (calendar year) were analyzed using linear regression, increases were estimated with 95% confidence intervals, and p < 0.05 was considered statistically significant.ResultsThe incidence of syphilis increased by an average of 0.336 cases/100,000 per year and was higher among women aged 15–19 years (0.693 cases). Cases of congenital syphilis increased from 62 cases in 2010 to 372 cases in 2019; furthermore, the increase in syphilis cases among women aged 20 to 24 years was associated with an increase in cases of congenital syphilis. In 2010, 50% of Mexican states did not report cases of congenital syphilis, but in 2018, only 10% did not report cases of congenital syphilis. Between 2010 and 2018, 83 neonatal deaths were reported, with the highest incidence in 2018 (0.88 deaths/100,000 newborns).ConclusionThe incidence of congenital syphilis is increasing in Mexico. As a consequence of the reemergence of syphilis among the population of reproductive age, it is necessary to address and treat syphilis in various population groups.

Utilization of Intravenous Ribavirin Among Reproductive Age Adults in 2010-2017: A Population-Based Study in the Yinzhou District, Ningbo City of China.

Background: Intravenous (IV) ribavirin is not approved in US and European Union, but it is authorized in China. Significant teratogenic and embryocidal effects of ribavirin have been found in almost all animal studies, it is critical to investigate the prevalence and trends of the utilization of IV ribavirin among reproductive age population.Objective: To evaluate the prevalence and trends of IV ribavirin use among reproductive-age population in 2010–2017.Methods: The study design of our study is retrospective cross-sectional study based on healthcare database. We identified and extracted the data of residents aged 18–44 years by using Yinzhou healthcare information database at 21 January, 2018. A cohort of IV ribavirin users were identified through outpatient prescription records in 3 general hospitals and 24 community health centers from 2010 to 2017. We reported the number, proportion, and prevalence of the exposure to IV ribavirin stratified by sex, age, marital status, education level, occupation, hospital level, calendar year, diagnosis, and dosage. The overall trends of IV ribavirin use, and the trends in different levels of hospital and common diagnoses were further analyzed and described.Result: During the study period, the prevalence of IV ribavirin use among reproductive-age adults was 6.02% (48,287/801,667). Relatively higher prevalence were found in adults aged 40–44 (8.04%, 95% CI: 7.90–8.17), unmarried patients (8.91%, 95% CI: 8.74–9.08), and who had more than 9 years of education (6.82%, 95% CI: 6.74–6.90). Compared to secondary and tertiary hospitals, IV ribavirin was more likely to be dispensed in primary hospitals (19.44%, 95% CI: 19.28–19.61). The most common diagnoses were acute upper respiratory infections (AURIs), accounting for 80% of the patients exposed to IV ribavirin. For patients with AURIs, the prevalence of IV ribavirin was nearly 30%. Overall, the prevalence of IV ribavirin use decreased from 1.72% in 2010 to 0.24% in 2017.Conclusion: We found IV ribavirin was mainly used for AURIs which suggested that a large amount of IV ribavirin use was probably inappropriate. The prevalence was decreasing by 87% over the past 8 years, and we encourage clinicians and pharmacists to continually avoid inappropriate use of IV ribavirin.

SERUM TRIGLYCERIDES AND TOTAL CHOLESTEROL ARE ASSOCIATED WITH ANTIMULLERIAN HORMONE LEVELS

To determine if serum lipid levels (high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides (TG), or total cholesterol (TC)) are associated with antimullerian (AMH) levels in a reproductive aged population of women from the Midwest in order to identify potential modifiable targets to improve ovarian reserve. A cohort of 199 women between the ages of 18 and 44 were enrolled into a cross-sectional cohort study. Women with regular menstrual cycles were included, women who were currently pregnant or had a history of major chronic illness or ovarian surgery were excluded. Fasting blood was drawn and stored at -80 degrees celsius for batched analysis. AMH values were measured using the Roche cobas e411 analyzer. The lipid values were measured using Roche cobas 6000 automated platform with a c501 analyzer using FDA-approved kits from Roche Diagnostics, with the exception of LDL cholesterol, which was calculated by the Friedewald equation. Bivariate statistics were used to assess associations between lipid and AMH levels. SPSS v26 was used for analysis. This study was approved by the Washington University IRB. On average, participants were 30.9 ± 6.7 years and had a body mass index of 28.3±7.1 kg/m2. Most of the study participants were white (n=136, 68%) and approximately one third were black (n=60, 30%). AMH values were not normally distributed and were negatively skewed. The median AMH level was 2.5ng/mL (IQR 1.44-4.01). The median TC and TG were significantly higher in those with AMH levels <1ng/mL compared to those with AMH levels ≥1ng/mL (p = 0.023 and p = 0.002, respectively). When stratified by BMI greater than or less than 25, TG levels were higher in the AMH <1ng/mL group compared to the AMH ≥ 1ng/mL group (p=0.007). LDL and TC levels were also higher in the BMI < 25 group with a trend towards significance (p=0.055, p=0.070). In the BMI ≥ 25 group, TG levels were higher in the AMH <1 group compared to the AMH > 1 group with a trend towards significance (p=0.057). Our data suggest that for healthy, reproductive aged women from the Midwest, total cholesterol and triglycerides could be potential targets to modify with lifestyle changes and/or medication that could potentially improve AMH. With a healthy BMI, lower AMH values were associated with higher LDL, TG, and TC levels. Perhaps women with a lower BMI who have a diet that is high in fats have impacted their ovarian reserve. Future interventional studies are needed.

ВОЗРОЖДЕНИЕ ВНУТРИМАТОЧНОЙ КОНТРАЦЕПЦИИ

The topic of intrauterine contraception remains relevant for a very long time. The active search for optimal and safe means of intrauterine contraception began in the last century and is gaining more and more momentum in the modern world. The importance of this issue is due to the continuing need of the population of reproductive age to control childbearing, the popularization of data on various methods of birth control and the desire to use safe, effective, environmentally friendly methods of contraception. The presented topic touches on the aspects of family planning and pre-gravidar training, so it is not only a significant medical, but also a social problem. This leads to the constant need to study new mechanisms of systemic and local effects of intrauterine contraceptives on the female body. This article discusses the use of intrauterine contraceptives, the features of their impact on the endometrium, the reproductive potential of women, as well as the positive and negative aspects of their use. There are also groups of women for whom intrauterine contraception is the method of choice for birth control. The indications for the extraction of an intrauterine contraceptive are described. Among them, there are menstrual disorders of the type of hypermenorrhea lasting more than 6 months in the absence of the effect of the use of non-steroidal anti-inflammatory drugs, the end of the period of use of an intrauterine contraceptive, the desire and need of a woman, the desired pregnancy, expulsions, the postmenopausal period. Knowledge of all aspects of intrauterine contraception allows the obstetrician-gynecologist to correctly select a certain type of IUD, to explain to the woman all the risks of its use, to diagnose and correct complications in a timely manner.

PREVALENCE OF NEISSERIA GONORRHOEAE AND MYCOPLASMA GENITALIUM IN BULGARIAN POPULATION FROM SOFIA MUNICIPALITY OF REPRODUCTIVE AGE, 2018-2019

Background: N. gonorrhoeae and M. genitalium infections remain public health concern due to emerging antimicrobial resistance which compromise effective treatment and infection prevention and control. Objective: To estimate the prevalence for N. gonorrhoeae and M. genitalium infections and identify demographic and sexual behavioral risk factors in Bulgarian population of reproductive age from Sofia municipality. Material and methods: Participants were sexually active 443 men and 198 women aged 18-49 years. They answered questionnaires on sexual behavior and provided samples for N. gonorrhoeae and M. genitalium testing. Results: The prevalence of N. gonorrhoeae infection was 3.28% (21/641) and with M. genitalium infection it was 2.49% (16/641). For both infections the presence of urogenital symptoms was associated with greater risk of being infected. Among gonococcal infections an increased number of lifetime partners and partners during the last 6 months, previously diagnosed STIs and use of contraception other than condoms were associated risk factors. Conclusions: The prevalence of N. gonorrhoeae and M. genitalium infections in Bulgarian population of reproductive age from Sofia municipality was relatively low but due to significant disease burden data on prevalence and identified risk factors should help the development of future control strategies.

Who is providing contraception care in the United States? An observational study of the contraception workforce

Contraception care is essential to providing comprehensive healthcare; however, little is known nationally about the contraception workforce. Previous research has examined the supply, distribution, and adequacy of the health workforce providing contraception services, but this research has faced a series of data limitations, relying on surveys or focusing on a subset of practitioners and resulting in an incomplete picture of contraception practitioners in the United States. This study aimed to construct a comprehensive database of the contraceptive workforce in the United States that provides the following 6 types of highly effective contraception: intrauterine device, implant, shot (depot medroxyprogesterone acetate), oral contraception, hormonal patch, and vaginal ring. In addition, we aimed to examine the difference in supply, distribution, the types of contraception services offered, and Medicaid participation. We constructed a national database of contraceptive service providers using multiple data sets: IQVIA prescription claims, preadjudicated medical claims, and the OneKey healthcare provider data set; the National Plan and Provider Enumeration System data set; and the Census Bureau's American Community Survey data on population demographics. All statistical analyses were descriptive, including chi-squared tests for groupwise differences and pairwise post hoc tests with Bonferroni corrections for multiple comparisons. Although 73.1% of obstetrician-gynecologists and 72.6% of nurse-midwives prescribed the pill, patch, or ring, only 51.4% of family medicine physicians, 32.4% of pediatricians, and 19.8% of internal medicine physicians do so. The ratio of all primary care providers prescribing contraception to the female population of reproductive age (ages, 15-44 years) varied substantially across states, with a range of 27.9 providers per 10,000 population in New Jersey to 74.2 providers per 10,000 population in Maine. In addition, there are substantial differences across states for Medicaid acceptance. Of the obstetrician-gynecologists providing contraception, the percentage of providers who prescribe contraception to Medicaid patients ranged from 83.9% (District of Columbia) to 100% (North Dakota); for family medicine physicians, it ranged from 49.7% (Florida) to 91.1% (Massachusetts); and for internal medicine physicians, it ranged from 25.0% (Texas) to 75.9% (Delaware). For in-person contraception, there were large differences in the proportion of providers offering the 3 different contraceptive method types (intrauterine device, implant, and shot) by provider specialty. This study found a significant difference in the distribution, types of contraception, and Medicaid participation of the contraception workforce. In addition to obstetrician-gynecologists and nurse-midwives, family medicine physicians, internal medicine physicians, pediatricians, advanced practice nurses, and physician assistants are important contraception providers. However, large gaps remain in the provision of highly effective services such as intrauterine devices and implants. Future research should examine provider characteristics, programs, and policies associated with the provision of different contraception services.

P–492 Knowledge about reproductive health among cohort of oocyte donors in Spain

Abstract Study question What degree of reproductive health knowledge have oocyte donors? Summary answer The results of this study reveal that although oocyte donors are aware of the risks of possible fertility disorders, reproductive health knowledge is insufficient What is known already Sterility affects approximately 15% of the population of reproductive age, that is, young people. However, the information that young people have about fertility is scarce. Gamete donors are a group especially involved in reproductive issues since they help many people to solve their fertility problems and must undergo numerous tests before being accepted as such. However, there are no studies in Spain that deal with the knowledge that young people and, more specifically, donors, have about reproductive health and fertility Study design, size, duration A prospective, cross-sectional multicenter study including oocyte donors at ten fertility clinics performing gamete donation treatment in Spain. During a 2-month period (September-October 2020), 63 donors aged between 19 and 35 years old were recruited consecutively and a total of 63 oocyte donors were included as sample population. Most of them (78%) had not donated before Participants/materials, setting, methods 54% oocyte donors had secondary education and 43% have achieved university studies. Participants anonymously completed a questionnaire containing 41 questions divided into three sections: sociodemographic characteristics (11 items), knowledge on fertility and reproduction (22 items) and with a Likert scale, response to determine general reproductive health information as well as known risks for fertility disorders (8 items). Besides descriptive statistics, statistical analysis was performed with Chi square test. p &amp;lt; 0.05 was considered significant Main results and the role of chance In the survey 96.8% of the participants reported that they had already known the tests for fertility disorders. The increasing age of the women was correctly assessed by the participants of the study as a decisive risk factor for fertility, but it was found that exact knowledge was lacking: the decrease of a woman’s fertility by 39.7% was stated to occur on average at the age of 35–40 and by 30% at 40–45. Nevertheless, 66% of donors considered that fertility preservation should be carried out before the age of 35. 61.1% of the non-university donors reported that fertility can drop as a woman ages due to the decreasing number and quality of the remaining eggs. Among university donors, this percentage increases to 92,6% (p:0,034). Merely 47% of the participants informed what they understood that ovarian reserve is and 47.6% of donors believed that women create new eggs every month. Regarding the known risk factors for fertility, lifestyle was mentioned most frequently by all participants (91,2%), followed by chemo/radiotherapy (83,8%) and smoking, alcohol, and drugs (82,4%). Concerning the influence of the body mass index on fertility, differences were found between non-university (61%) and university donors (88,9%) (p:0,012). Limitations, reasons for caution Financial compensation has been found to be a motivating factor for oocyte donors and therefore one could question the representativeness of the participating oocyte donors. It would be of great interest to explore the significance of the financial compensation further. Wider implications of the findings: The present study reveals an existing requirement for information among oocyte donors, which is not only important for the success of prevention plans but also provides a foundation for possible strategies for the prevention of fertility disorder. Trial registration number Not applicable

Increased cervical Chlamydia trachomatis and syphilis infections in Japanese females of reproductive age in the late 2010s: Possible cause

From 2000 to 2019, Japan's reproductive-age population gradually declined by 24%. In comparison, the Chlamydia trachomatis infection rate increased from 2016, with the syphilis infection rate increasing more sharply from 2014. Since 2013, the numbers of foreign tourists to Japan have also increased. From 2011 to 2018, the rate of increase in tourists was 5.02 times, while the rate of increase in syphilis patients was higher at 22.4 times. The lack of a one-to-one relationship between foreign tourists and syphilis cases suggests that cases of syphilis were transmitted to others. Although the prevalence of syphilis in the tourists' home countries (Korea in 2014 and China in 2013) was 20–30 times higher than that in Japan, the Japanese sex industry did not discriminate against foreign tourists, leading to increased STI infections in Japanese female sex workers. Indeed, from 2017 to 2018, a history of working in the sex industry for six months was identified as a risk factor for syphilis. The rise in Chlamydia trachomatis infections has lagged behind that of syphilis by two years, with the rate of increase lower. We suspect the difference in increasing rates of syphilis and chlamydial infections is due to the different methods of infection: syphilis can be transmitted by light physical contact, such as a kiss, whereas chlamydia requires close sexual contact, such as oral sex or sexual intercourse. Regardless, examinations and infection control are necessary to prevent the spread of STIs in Japan due to inbound tourists.