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  • 1
    In: Obstetrics & Gynecology, 2017, Vol.130(2), pp.387-392
    Description: OBJECTIVE:: To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion. METHODS:: In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. RESULTS:: From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0). CONCLUSION:: Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02454296.
    Keywords: Abortion, Induced–Methods ; Adult–Methods ; Anesthesia, Obstetrical–Administration & Dosage ; Double-Blind Method–Administration & Dosage ; Female–Administration & Dosage ; Gestational Age–Administration & Dosage ; Hawaii–Administration & Dosage ; Humans–Administration & Dosage ; Laminaria–Administration & Dosage ; Lidocaine–Administration & Dosage ; Pain Measurement–Administration & Dosage ; Patient Satisfaction–Administration & Dosage ; Pregnancy–Administration & Dosage ; Pregnancy Trimester, Second–Administration & Dosage ; Sodium Bicarbonate–Administration & Dosage ; Abridged ; Sodium Bicarbonate ; Lidocaine;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 2
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, July 2017, Vol.76(7), pp.178-182
    Description: Emergency contraceptive pills (ECPs) are medications used after unprotected intercourse, underprotected intercourse, or sexual assault to decrease the risk of pregnancy. Availability of ECPs in Hawai'i's retail pharmacies was last assessed in 2007, following over-the-counter access to levonorgestrel ECPs (LNG-ECP) for women age 18 years or older and prior to U.S. Food and Drug Administration (FDA) approval of prescription-only ulipristal acetate (UPA). We conducted a county-by-county subanalysis from a larger observational population-based study on statewide availability of ECPs in Hawai'i's pharmacies. In the original study, researchers called all 198 unique retail pharmacies in Hawai'i between December 2013 and June 2014. Only 3% of pharmacies had UPA immediately available on-site in the state, with UPA available on Kaua'i and O'ahu only. At least one form of LNG-ECPs was available in 82% of pharmacies in 2013-2014, roughly the same as 2007 (81%) (P=0.9) when Lana'i and Moloka'i lacked access. Currently, only Moloka'i lacks retail pharmacy access to ECPs. When controlling for general inflation, the 2013-2014 mean price for name brand LNG-ECP fell within the reported range of 2007 prices. Generic LNG-ECPs were substantially lower in price than name brand LNG-ECPs in 2007 and 2013-2014. Availability of UPA is limited and significantly lower compared to LNG-ECPs. Availability of LNG-ECPs statewide has remained stable and the arrival of generics has decreased prices.
    Keywords: Availability ; Emergency Contraception ; Hawai‘i ; Pharmacies ; Ulipristal Acetate ; United States ; Contraceptives, Postcoital -- Therapeutic Use ; Health Services Accessibility -- Standards ; Pharmacy -- Statistics & Numerical Data
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 3
    Language: English
    In: Journal of Pediatric and Adolescent Gynecology, February 2017, Vol.30(1), pp.29-34
    Description: To assess the values and beliefs regarding sexual behavior, sexual decision-making, and reproductive health learning preferences among teens in Hawaii. Survey regarding teens' knowledge, attitudes, and beliefs about sexual behaviors and preferences for learning about reproductive health. University of Hawaii Department of Obstetrics and Gynecology clinics in Honolulu, Hawaii. Female patients and their male or female companions ages 14-19 years. A 30-question anonymous survey. The main outcome was to describe the norms, attitudes, beliefs, and preferences of teens in this setting with regard to sexual health and sexual health education. For this, we provide a description of response frequencies and a comparison of mean scores across demographic characteristics. We analyzed a total of 100 surveys. Teens endorsed more values and norms protective against sexually transmitted infection than those protective against pregnancy. Younger teens expressed more protective values as a result of the influence of perceived parental values, whereas older teens expressed less protective values on the basis of the influence of peers. Respondents expressed comfort talking with their clinician about sexual health, and also expressed a slight preference that their clinicians initiate these conversations. The influence of parental values and peer norms on sexual behavior must be taken into consideration when designing interventions to address adolescent sexual health. Additionally, teens' greater concern about the consequences of sexually transmitted infection could be leveraged by clinicians to initiate broader conversations about sexual health, and a variety of modalities, including online resources and in-person conversations, should be used to meet the diversity of preferences expressed by teens across demographic groups.
    Keywords: Adolescents ; Pregnancy ; Sexually Transmitted Infections ; Surveys ; Norms ; Attitudes ; Behaviors ; Prevention ; Medicine
    ISSN: 1083-3188
    E-ISSN: 1873-4332
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  • 4
    Language: English
    In: Contraception, May 2016, Vol.93(5), pp.452-454
    Description: To determine pharmacy availability of ulipristal acetate (UPA) and compare to availability of levonorgestrel-containing emergency contraceptive pills (LNG-ECPs). We conducted an observational population-based study utilizing a telephone-based secret shopper methodology. Researchers called all 198 unique retail pharmacies in Hawaii on December 2013–June 2014, representing themselves as patients and physicians. Only 2.6% of pharmacies had UPA immediately available, though 22.8% reported ability to order UPA. In contrast, 82.4% reported immediate availability of LNG-ECPs. No significant difference in availability was reported to patients and physicians. Availability of UPA is limited and significantly lower compared to LNG-ECPs. The study period did overlap with a change in distributor for UPA, likely capturing some disruption of the supply chain. Systems-based interventions are needed to address barriers to obtaining UPA.
    Keywords: Ulipristal Acetate ; Emergency Contraception ; Pharmacies ; Availability ; United States ; Hawaii ; Medicine
    ISSN: 0010-7824
    E-ISSN: 1879-0518
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  • 5
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, January 2018, Vol.77(1), pp.7-13
    Description: The literature suggests that women of different races are more or less likely to use certain contraceptive methods and patient race can influence which contraceptive recommendations a provider makes. To explore whether health care providers treat individuals of different races differently, we conducted a preliminary investigation on whether medical students recommended different contraceptive methods for hypothetical patients presenting with the same clinical features who only varied by race. Third- and fourth-year medical students (n=103) at the University of Hawai'i completed an online survey. Students read case studies about a 23-year-old and 36-year-old patient and then made contraceptive recommendations. All students reviewed the same scenarios, with the exception of the patient's name which was randomly assigned to represent one of five racial/ethnic groups (White, Chinese, Filipina, Native Hawaiian, and Micronesian). Recommendations were analyzed using χ tests and bivariate logistic regressions. For the younger patient, students were most likely to recommend intrauterine devices (IUDs), followed by the contraceptive pill and Etonogestrel implant; recommendations did not differ by race/ethnicity (P = .91). For the older patient, students were most likely to recommend IUDs or sterilization, and Micronesian women were more likely to receive sterilization recommendations compared to White women (60% versus 27%, P = .04). In summary, contraceptive recommendations, specifically the frequency of recommending sterilization varied by race. Our findings add to the literature exploring the role of a patient's race/ethnicity on recommendations for contraception and highlights the need for more studies exploring the etiology of health care disparities.
    Keywords: Contraception ; Disparities ; Medical Students ; Race/Ethnicity ; Sterilization ; Age Factors ; Continental Population Groups -- Statistics & Numerical Data ; Contraception Behavior -- Ethnology ; Racism -- Psychology ; Students, Medical -- Psychology
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    In: Perspectives on Sexual and Reproductive Health, December 2015, Vol.47(4), pp.163-170
    Description: CONTEXT: Native Hawaiians experience the highest reported rate of unintended pregnancy of any ethnic group in Hawaii. Understanding the context in which they make decisions that influence pregnancy and pregnancy planning is essential to reducing this rate.METHODS: A qualitative study was carried out in partnership with a community health center serving a large Native Hawaiian population to explore how Native Hawaiians conceptualize pregnancy and pregnancy planning. Between August and October 2013, semistructured interviews were conducted with 10 diverse key informants from the Hawaiian community. Content analysis was used to identify themes and patterns that emerged from the interviews.RESULTS: Core Hawaiian values of children and family strongly affect how Native Hawaiians view pregnancy, pregnancy planning and unintended pregnancies. 'Ohana (families) are large and characterized by tremendous support, which is perceived to lessen the burden of an unintended pregnancy. Pregnancies, whether planned or not, are seen as blessings because children are highly valued. Because of these concepts, there is an expectation for women to continue unplanned pregnancies. Although Hawaiians ascribe value to planning pregnancies and hope that children are born under what they identify as ideal circumstances, they acknowledge that these circumstances are not necessary and often do not occur.CONCLUSION: The concepts of family and children serve as core values to Native Hawaiians and are linked to the ways in which they view pregnancy and pregnancy planning.
    Keywords: Medicine ; Sociology & Social History;
    ISSN: 1538-6341
    E-ISSN: 1931-2393
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  • 7
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, November 2015, Vol.74(11), pp.369-74
    Description: The levonorgestrel intrauterine device (LNG-IUD) is a safe, effective, long-acting, reversible contraceptive that reduces unintended pregnancy and decreases heavy menstrual bleeding. Many procedures such as IUD insertion are more challenging in overweight and obese women. The objective of this study was to describe LNG-IUD insertion, continuation, and complications in overweight and obese women in an ethnically diverse population in Hawai'i. A retrospective cohort study of women who had a LNG-IUD inserted at the University of Hawai'i, Department of Obstetrics and Gynecology Resident and Faculty practice sites between January 2009 and December 2010 was performed. A total of 149 women were followed. The most commonly reported races were Asian (32%), Native Hawaiian (26%), and non-Hawaiian Pacific Islander (20%). The mean BMI of the study population was 28.4 (standard deviation 7.2) with 37% classified as normal weight, 30% as overweight, and 33% as obese. Overall, 76% of women continued the LNG-IUD 12 months after insertion. No statistically significant difference emerged in 12-month IUD continuation between the BMI groups. Difficult (5%) and failed (3%) IUD insertions were rare for all BMI groups. IUD complications occurred in 9% of women and included expulsion and self-removal. In this diverse population, the majority of women continued to use the LNG-IUD one year after insertion with low rates of difficult insertions and complications.
    Keywords: Contraception -- Statistics & Numerical Data ; Contraceptive Agents, Female -- Therapeutic Use ; Intrauterine Devices, Medicated -- Statistics & Numerical Data ; Levonorgestrel -- Therapeutic Use ; Overweight -- Ethnology
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 8
    Language: English
    In: Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, November 2017, Vol.76(11), pp.305-309
    Description: The birth plan was developed as a way for pregnant women to communicate their desires and expectations for labor and delivery. Standardized birth plans have been used by some birth facilities as a communication tool. In this quality improvement project, we sought to describe communication, trust, and satisfaction scores after delivery in a group of patients who used a standardized birth plan. All pregnant women at 24 or more weeks of gestation were asked to complete a short, standardized birth plan. Communication, trust, and satisfaction were assessed before and after delivery. Descriptive analyses showed that communication, trust, and satisfaction scores were high following delivery. Scores for all three factors increased significantly following delivery though increases were modest. Most patients (84%) indicated they would use a birth plan with a subsequent delivery.
    Keywords: Birth Plan ; Communication ; Delivery ; Labor ; Satisfaction ; Trust ; Communication ; Delivery, Obstetric ; Trust ; Patient Satisfaction -- Statistics & Numerical Data
    E-ISSN: 2165-8242
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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