Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception

Background Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection. Objective The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods. Study Design This is a secondary analysis of the Contraceptive CHOICE Project. We included 2 sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, and 3, 6, and 12 months) (long-acting reversible contraceptive users: N = 2371; other methods: N = 575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: N = 2102; other methods: N = 592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using χ2 tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression. Results Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%; P < .001). There was no difference in change of condom use at 3, 6, and 12 months compared to baseline condom use regardless of method type (P = .65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs 2.0%; P = .03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (odds ratio, 2.0; 95% confidence ratio, 1.07–3.72). Conclusion Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to preinitiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation

Long-acting reversible contraception use among residents in obstetrics/gynecology training programs

Background: The objective of the study was to estimate the personal usage of long-acting reversible contraception (LARC) among obstetrics and gynecology (Ob/Gyn) residents in the United States and compare usage between programs with and without a Ryan Residency Training Program (Ryan Program), an educational program implemented to enhance resident training in family planning. Materials and methods: We performed a web-based, cross-sectional survey to explore contraceptive use among Ob/Gyn residents between November and December 2014. Thirty-two Ob/Gyn programs were invited to participate, and 24 programs (75%) agreed to participate. We divided respondents into two groups based on whether or not their program had a Ryan Program. We excluded male residents without a current female partner as well as residents who were currently pregnant or trying to conceive. We evaluated predictors of LARC use using bivariate analysis and multivariable Poisson regression. Results: Of the 638 residents surveyed, 384 (60.2%) responded to our survey and 351 were eligible for analysis. Of those analyzed, 49.3% (95% confidence interval [CI]: 44.1%, 54.5%) reported current LARC use: 70.0% of residents in Ryan Programs compared to 26.8% in non-Ryan Programs (RRadj 2.14, 95% CI 1.63-2.80). Residents reporting a religious affiliation were less likely to use LARC than those who described themselves as non-religious (RRadj 0.76, 95% CI 0.64-0.92). Of residents reporting LARC use, 91% were using the levonorgestrel intrauterine device. Conclusion: LARC use in this population of women's health specialists is substantially higher than in the general population (49% vs. 12%). Ob/Gyn residents in programs affiliated with the Ryan Program were more likely to use LARC

Information in the Tails of the Distribution of Analysts\u27 Quarterly Earnings Forecasts

Investors generally measure earnings announcement news on the basis of the difference between actual earnings and two salient benchmarks: earnings in the same quarter the previous year and a consensus drawn from a distribution of forecasts by financial analysts. We evaluate the implications of a third salient benchmark: the most optimistic forecast when actual earnings exceed the consensus and the most pessimistic forecast when the consensus exceeds actual earnings. We find that considering the information in these tails of the distribution of analysts\u27 earnings forecasts enhances the profitability of post earnings announcement drift strategies

Iterative Geometry-Aware Cross Guidance Network for Stereo Image Inpainting

Currently, single image inpainting has achieved promising results based on deep convolutional neural networks. However, inpainting on stereo images with missing regions has not been explored thoroughly, which is also a significant but different problem. One crucial requirement for stereo image inpainting is stereo consistency. To achieve it, we propose an Iterative Geometry-Aware Cross Guidance Network (IGGNet). The IGGNet contains two key ingredients, i.e., a Geometry-Aware Attention (GAA) module and an Iterative Cross Guidance (ICG) strategy. The GAA module relies on the epipolar geometry cues and learns the geometry-aware guidance from one view to another, which is beneficial to make the corresponding regions in two views consistent. However, learning guidance from co-existing missing regions is challenging. To address this issue, the ICG strategy is proposed, which can alternately narrow down the missing regions of the two views in an iterative manner. Experimental results demonstrate that our proposed network outperforms the latest stereo image inpainting model and state-of-the-art single image inpainting models.Comment: Accepted by IJCAI 202

Effect of Baseline Menstrual Bleeding Pattern on Copper Intrauterine Device Continuation

Background Heavy menstrual bleeding is a leading cause of copper intrauterine device (IUD) discontinuation. Thus, women with heavy baseline menstrual bleeding may be at increased risk for early copper IUD discontinuation. Our objective was to assess if there was an association between baseline menstrual bleeding pattern prior to IUD insertion and discontinuation rate at 12 months among study participants who chose copper IUD at baseline. Study Design We performed a secondary analysis of the Contraceptive CHOICE Project, a prospective observational cohort study of 9,256 women offered no cost contraception for 2-3 years. Included in our study were participants who chose copper IUD for contraception and for whom method continuation data at 12 months were available. Prior to contraception initiation, participants were asked to qualify their menstrual bleeding over the past year as: light, moderate, moderately heavy or heavy. Light bleeding corresponded to using 10 or fewer pads/tampons per period. Moderate, moderately heavy and heavy bleeding corresponded to 11-20 pads/tampons, 21-30 pads/tampons, and more than 30 pads/tampons per period, respectively. Subjects were then categorized into either a “heavy” baseline group (those reporting moderately heavy or heavy bleeding at baseline), or a “not heavy” group (those reporting light or moderate bleeding). The 12-month continuation rate for each group was then calculated using Kaplan-Meier survival function, and hazard ratio for risk of discontinuation was evaluated using a Cox proportional hazard model to determine if moderately heavy or heavy bleeding at baseline was associated with early discontinuation. Results Of the 918 women meeting the inclusion criteria for this analysis, 165 were in the heavy baseline bleeding group, while 753 were in the not heavy bleeding group. The 12-month continuation rates for groups were similar: 80.2% (heavy) and 85.0% (not heavy; P=0.24). Patients reporting either moderately heavy or heavy baseline bleeding were not at increased risk for early discontinuation of copper IUD (hazard ratio 1.21, 95% CI 0.88, 1.66). Our sample size provided greater than 90% power to detect a clinically important difference of 15% (assuming 20% discontinuation rate in not heavy bleeding group and a 35% discontinuation rate in the heavy bleeding group). Conclusions We did not find that women who reported baseline moderately heavy or heavy menstrual bleeding were at increased risk for early discontinuation. Thus, we do not believe that women with heavy menstrual bleeding should be discouraged from using this safe and highly-effective form of contraception

Anticipated pain as a predictor of discomfort with intrauterine device placement

Background Intrauterine devices have been gaining popularity for the past 2 decades. Current data report that >10% of women who use contraception are using an intrauterine device. With <1% failure rates, the intrauterine device is one of the most effective forms of long-acting reversible contraception, yet evidence shows that fear of pain during intrauterine device placement deters women from choosing an intrauterine device as their contraceptive method. Objectives The objective of this analysis was to estimate the association between anticipated pain with intrauterine device placement and experienced pain. We also assessed other factors associated with increased discomfort during intrauterine device placement. We hypothesized that patients with higher levels of anticipated pain would report a higher level of discomfort during placement. Study Design We performed a secondary analysis of the Contraceptive CHOICE Project. There were 9256 patients enrolled in Contraceptive CHOICE Project from the St. Louis region from 2007–2011; data for 1149 subjects who came for their first placement of either the original 52-mg levonorgestrel intrauterine system or the copper intrauterine device were analyzed in this study. Patients were asked to report their anticipated pain before intrauterine device placement and experienced pain during placement on a 10-point visual analog scale. We assessed the association of anticipated pain, patient demographics, reproductive characteristics, and intrauterine device type with experienced pain with intrauterine device placement. Results The mean age of Contraceptive CHOICE Project participants in this subanalysis was 26 years. Of these 1149 study subjects, 44% were black, and 53% were of low socioeconomic status. The median expected pain score was 5 for both the levonorgestrel intrauterine system and the copper intrauterine device; the median experienced pain score was 5 for the levonorgestrel intrauterine system and 4 for the copper intrauterine device. After we controlled for parity, history of dysmenorrhea, and type of intrauterine device, higher anticipated pain was associated with increased experienced pain (adjusted relative risk for 1 unit increase in anticipated pain, 1.19; 95% confidence interval, 1.14–1.25). Nulliparity, history of dysmenorrhea, and the hormonal intrauterine device (compared with copper) also were associated with increased pain with intrauterine device placement. Conclusion High levels of anticipated pain correlated with high levels of experienced pain during intrauterine device placement. Nulliparity and a history of dysmenorrhea were also associated with greater discomfort during placement. This information may help guide and treat patients as they consider intrauterine device placement. Future research should focus on interventions to reduce preprocedural anxiety and anticipated pain to potentially decrease discomfort with intrauterine device placement

Obesity and Fertility: A Prospective Cohort Study

Background and Hypothesis: Previous studies have linked body mass index (BMI) with time to pregnancy. The objective of this analysis was to determine if obesity (BMI > 30 kg/m2) is associated with reduced fertility in a cohort of women who discontinued contraceptive method to attempt conception. We hypothesized that BMI is associated with time to conception after controlling for potential confounding variables. Methods: We performed a secondary analysis of the FACT (Fertility After Contraceptive Termination) study. We included 432 women, aged 18-35 years old, who discontinued contraception in an effort to conceive, were sexually active with a male partner, had the ability to consent, and had a minimum of 12 months of follow-up data. Participants were excluded who were already pregnant, had a history of infertility or medically induced sterility or, used depot medroxyprogesterone acetate (DMPA) in the past 5 months. We collected participant data on demographic, reproductive, medical characteristics, and sexual history, as well as date of contraceptive termination. We used Cox proportional hazard models to assess associations between BMI and time to conception while controlling for race, socioeconomic status, and prior contraceptive method. Results: A BMI of 30 or greater was associated with reduced fertility compared to participants with a BMI of less than 25 after controlling for race, low SES, and prior contraceptive method (HRadj=0.72; 95% CI 0.53, 0.97; p=0.03). We also noted that obese women with regular menses had reduced fertility compared to normal weight participants with regular cycles (HRadj 0.58; 95% CI 0.39, 0.86, p=0.007). For participants with irregular menstrual cycles, BMI was not associated with time to conception. Conclusion & Potential Impact: Our study supports the association of obesity with reduced fertility and increased time to conception. Future studies of weight loss should be considered as a method to improve conception rates

Socioeconomic Status As a Risk Factor for Unintended Pregnancy in the Contraceptive CHOICE Project

OBJECTIVE: To evaluate the association of low socioeconomic status as an independent risk factor for unintended pregnancy. METHODS: We performed a secondary analysis of data from the Contraceptive CHOICE project. Between 2007 and 2011, 9,256 participants were recruited and followed for up to 3 years. The primary outcome of interest was unintended pregnancy; the primary exposure variable was low socioeconomic status, defined as self-report of either receiving public assistance or having difficulty paying for basic necessities. Four contraceptive groups were evaluated: 1) long-acting reversible contraceptive method (hormonal or copper intrauterine device or subdermal implant); 2) depot medroxyprogesterone acetate injection; 3) oral contraceptive pills, a transdermal patch, or a vaginal ring; or 4) other or no method. Confounders were adjusted for in the multivariable Cox proportional hazard model to estimate the effect of socioeconomic status on risk of unintended pregnancy. RESULTS: Participants with low socioeconomic status experienced 515 unintended pregnancies during 14,001 women-years of follow-up (3.68/100 women-years; 95% CI 3.37-4.01) compared with 200 unintended pregnancies during 10,296 women-years (1.94/100 women-years; 95% CI 1.68-2.23) among participants without low socioeconomic status. Women with low socioeconomic status were more likely to have an unintended pregnancy (unadjusted hazard ratio [HR] 1.8, 95% CI 1.5-2.2). After adjusting for age, education level, insurance status, and history of unintended pregnancy, low socioeconomic status was associated with an increased risk of unintended pregnancy (adjusted HR 1.4, 95% CI 1.1-1.7). CONCLUSION: Despite the removal of cost barriers, low socioeconomic status is associated with a higher incidence of unintended pregnancy

The Tractor and Semitrailer Routing Considering Carbon Dioxide Emissions

The incorporation of the minimization of carbon dioxide (CO2) emissions in the VRP is important to logistics companies. The paper deals with the tractor and semitrailer routing problem with full truckload between any two depots of the network; an integer programming model with the objective of minimizing CO2 emissions per ton-kilometer is proposed. A two-stage approach with the same core steps of the simulated annealing (SA) in both stages is designed. The number of tractors is provided in the first stage and the CO2 emissions per ton-kilometer are then optimized in the second stage. Computational experiments on small-scale randomly generated instances supported the feasibility and validity of the heuristic algorithm. To a practical-scale problem, the SA algorithm can provide advice on the number of tractors, the routes, and the location of the central depot to realize CO2 emissions decrease