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PURPOSE: The evolution of new carbapenemase variants is alarming. We aimed to investigate the genetic context and molecular epidemiology of the emerging OXA-484 carbapenemase in the United Arab Emirates, to decipher its resistance mechanisms and evolutionary relationships. METHODS: Antimicrobial susceptibility testing was performed for an E. coli isolate recovered from an intrauterine contraceptive device of a patient returning to the UAE after a trip to Pakistan. Whole genome sequencing was used to characterize the genetic environment of blaOXA-484, resistance and virulence determinants. Sou
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OBJECTIVE: To investigate the association between the duration of levonorgestrel-releasing intrauterine system (LNG-IUS) use and breast cancer risk in Korean women. METHODS: A retrospective cohort study was conducted using the Korean National Health Insurance Claims database from 2013 to 2022. A total of 2,094,029 women aged 30-49 years with initial diagnoses of endometriosis, uterine leiomyomas, or abnormal uterine bleeding between 2014 and 2017 were included in the study. Propensity score matching was applied to create balanced cohorts of LNG-IUS users and nonusers. Cox proportional hazards
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BACKGROUND: Melasma is a common hyperpigmentation disorder that causes significant distress to patients. In the real world, it is closely associated with various medications, making the timely identification and discontinuation of causative drugs an important aspect of clinical management. This study investigates the relationship between melasma and drug exposure based on data from the FDA Adverse Event Reporting System (FAERS) database. METHODS: This study includes reports from the first quarter of 2004 to the second quarter of 2024, focusing on cases related to melasma. We employed four sta
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OBJECTIVE: We compared the contraceptive effectiveness of typical-use LNG implant and depot medroxyprogesterone acetate (DMPA) injectable during efavirenz use. DESIGN: We conducted a prospective cohort study of women with HIV (WHIV) on efavirenz-containing antiretroviral treatment in Lilongwe, Malawi. Eligible participants were 18-40 years of age and initiating LNG implant or DMPA injectable with a desire to prevent pregnancy for 4+ years. Study visits and urine pregnancy testing occurred at enrollment, week 4, and every 24 weeks up to week 192. Malawi's efavirenz-to-dolutegravir transition s
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BACKGROUND: Endometriosis is a common pathology that can lead to a decrease in fertility and is therefore a medical indication for preserving fertility. Traditionally, gonadotropin-releasing hormone (GnRH) antagonist and agonist protocols are used to stimulate the ovaries. However, the recent introduction of the progestin-primed ovarian stimulation (PPOS) protocol, using progestins to prevent LH surges, offers a new alternative. Dienogest, a progestin commonly used to treat endometriosis, could be incorporated into the PPOS protocol for patients with endometriosis, allowing them to maintain th
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The use of modern contraceptives both, short-acting and long-acting in most African countries has been low. This study aimed to determine factors affecting the use of modern contraceptive methods among women of reproductive age in 23 sub-Saharan Africa countries. The most recent 2015-2023 DHS data set of 23 SSA countries was used. A total of 230,387 women who completed the survey were included in the study. In the multivariable analysis variables with p-value less than ≤ 0.05 were considered to be factors associated with the use of both short-acting and long-acting modern contraceptive methods
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PURPOSE: To evaluate the impact of the COVID-19 national emergency declaration on contraceptive dispensing trends among commercially insured Kentucky females. METHODS: Data ranging from 1/7/2019 through 12/27/2020 for female enrollees aged 19-44 with a primary residence in Kentucky were extracted from the Merative Marketscan Commercial Claims and Encounters Database. A segmented regression analysis was used for statistical modeling of an interrupted time series design to describe changes in weekly contraceptive (oral, transdermal, and vaginal) dispensing rates and days' supply following the C
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OBJECTIVES: To describe experiences and systematically compare three U.S. clinics that initiated or expanded access to depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) for self-administration during the COVID-19 pandemic. STUDY DESIGN: We used the Expert Recommendations for Implementing Change (ERIC) framework to systematically compare three case studies of implementation projects that expanded use of self-administered DMPA-SC in the United States during the COVID-19 pandemic. RESULTS: All three settings used multiple implementation strategies and common strategies fell into five mai
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BackgroundThe scale-up of antiretroviral therapy (ART) has enabled more children living with HIV to reach adolescence and become sexually active. We investigated pregnancy incidence and outcomes among adolescents with perinatally acquired HIV enrolled in a multi-country trial of vitamin D and calcium carbonate supplementation (VITALITY; PACTR202009897660297).MethodsBetween February and November 2021, 842 adolescents aged 11-19 years from Zambia and Zimbabwe on ART for at least 6 months were enrolled. Pregnancies occurring during 96 weeks of follow-up (February 2021-October 2023) were identifie
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BACKGROUND: There is mounting evidence that social norms affect attitudes, decision-making, and behaviors related to contraceptive use. Integral to the self-care movement for women to have more control over their reproductive health, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a contraceptive that can be safely administered by women themselves after training. DMPA-SC was introduced in Uganda in 2017 and is slowly gaining traction, especially among women who value a convenient and private method. However, only a small percentage of DMPA-SC users choose to self-inject, perhaps mi
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INTRODUCTION: HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre-exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa. METHODS: The CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in le
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IMPORTANCE: Etiologic heterogeneity in breast carcinogenesis needs to be well characterized for targeted prevention. Associations between menopausal hormonal therapy (MHT) and oral contraceptive (OC) use and breast cancer intrinsic-like subtypes are not well understood. OBJECTIVE: To examine whether exogenous hormone use is differentially associated with breast cancer subtypes and to evaluate heterogeneity by intrinsic-like subtypes. DESIGN, SETTING, AND PARTICIPANTS: This study pooled data from 31 nested and population-based case-control studies involved in the Breast Cancer Association Con
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OBJECTIVE: To evaluate whether dienogest exposure is associated with the risk of breast, endometrial, or tubo-ovarian cancer in women with endometriosis. METHODS: In this nationwide retrospective cohort study (January 2012 to December 2023), we used the Korean National Health Insurance Review & Assessment Service database. Women aged 20-49 years with endometriosis who received dienogest for at least 6 months were compared with an active control group treated with gonadotropin-releasing hormone (GnRH) agonists, with cohorts balanced by inverse probability of treatment weighting. Incident breas
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We emulated a target trial of oral contraceptive pills (OCPs) and thrombosis using administrative claims database. OCP users and non-users were matched 1:1 using exact-matching algorithm. 14,554 women were analyzed, and 30 thrombotic events were observed during follow-up. Women using OCPs with 50 g of ethinyl estradiol (EE) had a 4.3-fold (95% confidence interval: 2.0-6.7) higher thrombotic risk compared to non-users, and women using pills with EE < 50 µg had a 1.0-fold (0.3-1.7) risk, with small differences according to progestin type. Analysis of real-world data can generate novel evidence f
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Pregnant and breastfeeding women (PBW) are at heightened risk of HIV acquisition. We aimed to explore PBW's preferences of various long-acting PrEP modalities. In-depth interviews were conducted with PBW at three sites: Cape Town, East London (South Africa), and Gaborone (Botswana). We conducted thematic analysis, guided by the Health Belief Model, to examine participants' HIV risk perception during pregnancy and breastfeeding, their perceived individual-level facilitators and barriers of each PrEP modality, and the support needed by participants for PrEP uptake and continuation. 40 participan
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OBJECTIVES: This study aimed to validate the real-world performance of the MyIUS mobile application algorithm in predicting bleeding intensity and regularity in levonorgestrel intrauterine device (LNG-IUD) 52 mg, 19.5 mg, and 13.5 mg users following device insertion. STUDY DESIGN: This was an observational real-world performance study conducted in Germany, Denmark, Sweden, Spain, Mexico, and Brazil, including women aged ≥ 18 years who provided electronic written informed consent and had used the MyIUS app for 90 days following LNG-IUD 52 mg, 19.5 mg, or 13.5 mg insertion. At day 90, participa
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Limited prospective data exist for long-term hormonal contraceptive continuation rates among women living with HIV. We conducted a prospective cohort study of women living with HIV in Lilongwe, Malawi from 2017 to 2021 and evaluated their contraceptive method continuation and ART regimens. Participants initiating either depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant were followed every 24 weeks for up to 192 weeks. 1,359 participants enrolled in the study; 689 initiated the DMPA injection, and 670 initiated the LNG implant. At enrollment, DMPA and implant us
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Background Information about contraceptive options is important for informed decision making. We aimed to understand the information needs and preferences of potential users of intrauterine devices and contraceptive implants, methods that are underutilised in Australia. Methods We conducted an online survey of Australian women aged 18-45years. The survey comprised mostly close-ended questions, with a few opportunities for free-text comments. Results In total, 1745 women participated in the survey. Participants had a mean age of 31years; most identified as heterosexual (67%) and said that they
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OBJECTIVES: While the ability of contraceptive initiatives to improve access has been established, less is known about the process of implementing them within health settings. To address this gap, we conducted a process evaluation of Family Planning Elevated (FPE), a statewide contraceptive initiative in Utah. STUDY DESIGN: FPE partnered with 28 clinics to provide no-cost contraceptive care to individuals across Utah. We conducted a mixed methods process evaluation to document how FPE was implemented, how surrounding context affected the implementation, and the mechanisms by which FPE created
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