Search

Objectives To describe understanding of the irreversible nature of permanent contraception and knowledge and attitudes about long-acting reversible contraception (LARC) among individuals seeking and not seeking permanent contraception. Methods We performed a cross-sectional survey among patients with Medicaid insurance attending an obstetrics and gynecology clinic in [location]. The survey consisted of 20 true/false and Likert questions assessing knowledge and perceptions about permanent contraception and LARC. Sixty-seven participants were needed to detect a small-to-medium Cohen's effect size f.sup.2 = 0.20, with 95% power and alpha = 0.05. Results Ninety potential participants were contacted and 67 were recruited. Forty-three participants desired permanent contraception and 24 did not. Approximately half of all participants were not aware that permanent contraception is irreversible. Participants who desired permanent contraception had lower LARC knowledge scores (62% correct versus 70%, p = 0.042) and more negative perceptions about LARC (54% versus 38%, p = 0.048). Fewer participants desiring permanent contraception identified LARC efficacy as equal to permanent contraception (32% versus 83%, p < 0.01), and fewer would consider using LARC (intrauterine device: 23% versus 58%, p < 0.01; implant: 16% versus 46%, p < 0.01). These differences persisted in multivariable models adjusting for age, gravidity, and parity. Conclusions for Practice Individuals who desire permanent contraception may not be aware of its permanence, or of equally effective alternatives. They were also found to have more negative perceptions of LARC in our sample. Additional research is needed to understand factors underlying these differences. Counseling practices should be tailored to ensure accurate knowledge about permanent contraception and LARC for all people seeking to avoid pregnancy., Author(s): Andrea Leung [sup.1] , Andrew Loh [sup.1] , Sara Pentlicky [sup.1] , Elizabeth P. Gurney [sup.1] [sup.2] Author Affiliations: (1) grid.239276.b, 0000 0001 2181 6998, Department of Obstetrics & [...]

Plotting two-parameter confidence regions is nontrivial. Numerical methods often rely on a computationally expensive grid-like exploration of the parameter space. A recent advance reduces the two-dimensional problem to many one-dimensional problems employing a trigonometric transformation that assigns an angle ϕ from the maximum likelihood estimator, and an unknown radial distance to its confidence region boundary. This paradigm shift can improve computational runtime by orders of magnitude, but it is not robust. Specifically, parameters differing greatly in magnitude and/or challenging nonconvex confidence region shapes make the plot susceptible to inefficiencies and/or inaccuracies. This article improves the technique by (i) keeping confidence region boundary searches in the parameter space, (ii) selectively targeting confidence region boundary points in lieu of uniformly spaced ϕ angles from the maximum likelihood estimator and (iii) enabling access to regions otherwise unreachable due to multiple roots for select ϕ angles. Two heuristics are given for ϕ selection: an elliptic-inspired angle selection heuristic and an intelligent smoothing search heuristic. Finally, a jump-center heuristic permits plotting otherwise inaccessible multiroot regions. This article develops these heuristics for two-parameter likelihood-ratio-based confidence regions associated with univariate probability distributions, and introduces the R conf package, which automates the process and is publicly available via CRAN. [ABSTRACT FROM AUTHOR]