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Expanding contraceptive services in EDs could reduce unintended adolescent pregnancies

Expanding contraceptive services in EDs could reduce unintended adolescent pregnancies



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Key takeaways:

  • Among adolescents surveyed in EDs, 28.9% reported using no contraception.
  • Few adolescents who were eligible for emergency contraception in EDs ultimately received it.

More than one-quarter of sexually active adolescents who accessed care in EDs reported not using contraception, raising their risk for pregnancy, according to a study published in JAMA Network Open.

The results indicate that expanding contraceptive services in pediatric EDs could help reduce the number of unintended adolescent pregnancies, the researchers said. One of them told Healio that for adolescents, the ED is often their “only source of health care access,” making it “vitally important” to identify opportunities to provide preventive care services in the ED for marginalized populations and teenagers in particular.



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“Unintended pregnancy is a significant public health concern in the U.S., especially for adolescents,” Monika K. Goyal, MD, MSCE, co-director of the Center for Translational Research at Children’s National Hospital in Washington, D.C., told Healio. “Identifying pregnancy risk in this group could help inform opportunities to embed pregnancy prevention services in the ED, especially in this current political climate which is making access to sexual and reproductive [services] even more tenuous.”

Goyal and colleagues conducted a planned secondary analysis of a large multicenter pragmatic trial conducted from April 2021 to April 2022, which was designed to implement confidential, computerized sexual health screening through tablets at six pediatric EDs to improve testing, detection and treatment of STIs in adolescents.

“The computerized survey also collected information on pregnancy risk which was assessed for this particular analysis,” Goyal said.

From 5,136 adolescent surveys, the researchers included 1,063 participants (median age, 17.5 years; age range, 15-21 years) assigned female sex at birth who answered questions regarding contraceptive use in their analysis. Of this population, 44.1% identified themselves as non-Hispanic Black, 29.3% as non-Hispanic white, 20.8% as Hispanic and 5.8% as other races or ethnicities.

In this cohort, 71.1% reported contraception use during their last sexual encounter, most often a short-acting hormonal method (29.4%) such as an injectable, patch, pill or vaginal ring; male condoms (24.5%); or a long-acting reversible contraception (15.4%). The remaining 28.9% reported no contraception use.

The researchers calculated the study participants’ annual pregnancy risk to be 7.89%. Although 10.2% of the cohort was eligible for emergency contraception, it was ordered for only 5.6%.

“The results confirmed that adolescents who access care in emergency departments have a high risk for pregnancy,” Goyal said. “There is tremendous need and opportunity to embed sexual health service provision across all venues of health care for adolescents, including emergency departments.”

In an accompanying editorial, Colleen K. Gutman, MD, and Rosemarie Fernandez, MD, both of the University of Florida College of Medicine, and Atsuko Koyama, MD, MPH, of the University of Arizona College of Medicine, noted that adolescents from marginalized backgrounds are increasingly more likely to live in states with limited options for reproductive autonomy.

“With the work of Canter et al, highlighting the continued high and inequitable risk for pregnancy in adolescent ED patients, now is the time to expand what has been learned from the existing, well-designed single-center pilot trials and pursue multicenter hybrid effectiveness-implementation research initiatives,” they wrote. “However, as this work progresses, it is essential that reproductive justice, through adolescent-centered approaches and inclusive recruitment practices, is a central focus.”

Goyal also said studies that develop and test innovative ways to address the sexual health needs of youth are needed.

“Using health information technology — through provision of computerized surveys that integrate with the electronic health record to provide clinical decision support — can be a patient-friendly, efficient and effective tool to identify need for and provide sexual and reproductive health services in the emergency department,” Goyal said.

References:

Canter H, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.18213.

Gutman CK, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.18194.



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