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BACKGROUND: Mifepristone, used together with misoprostol, is approved by the United States Food and Drug Administration for medication abortion through 10 weeks' gestation. Although in-person ultrasound is frequently used to establish medication abortion eligibility, previous research demonstrates that people seeking abortion early in pregnancy can accurately self-assess gestational duration using the date of their last menstrual period. OBJECTIVE: In this study, we establish the screening performance of a broader set of questions for self-assessment of gestational duration among a sample of people seeking abortion at a wide range of gestations. STUDY DESIGN: We surveyed patients seeking abortion at 7 facilities before ultrasound and compared self-assessments of gestational duration using 11 pregnancy dating questions with measurements on ultrasound. For individual pregnancy dating questions and combined questions, we established screening performance focusing on metrics of diagnostic accuracy, defined as the area under the receiver operating characteristic curve, sensitivity (or the proportion of ineligible participants who correctly screened as ineligible for medication abortion), and proportion of false negatives (ie, the proportion of all participants who erroneously screened as eligible for medication abortion). We tested for differences in sensitivity across individual and combined questions using McNemar's test, and for differences in accuracy using the area under the receiver operating curve and Sidak adjusted P values. RESULTS: One-quarter (25%) of 1089 participants had a gestational duration of >70 days on ultrasound. Using the date of last menstrual period alone demonstrated 83.5% sensitivity (95% confidence interval, 78.4e87.9) in identifying participants with gestational durations of >70 days on ultrasound, with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.79e0.85) and a proportion of false negatives of 4.0%. A composite measure of responses to questions on number of weeks pregnant, date of last menstrual period, and date they got pregnant demonstrated 89.1% sensitivity (95% confidence interval, 84.7e92.6) and an area under the receiver operating curve of 0.86 (95% confidence interval, 0.83e0.88), with 2.7% of false negatives. A simpler question set focused on being >10 weeks or >2 months pregnant or having missed 2 or more periods had comparable sensitivity (90.7%; 95% confidence interval, 86.6e93.9) and proportion of false negatives (2.3%), but with a slightly lower area under the receiver operating curve (0.82; 95% confidence interval, 0.79e0.84). CONCLUSION: In a sample representative of people seeking abortion nationally, broadening the screening questions for assessing gestational duration beyond the date of the last menstrual period resulted in improved accuracy and sensitivity of self-assessment at the 70-day threshold for medication abortion. Ultrasound assessment for medication abortion may not be necessary, especially when requiring ultrasou...

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Pain management for first-trimester uterine aspiration should be individualized for optimal patient satisfaction. Evidence supports multiple approaches to support this individualization. Targeted interventions before, during, and after the procedure should be offered to improve procedure experience and satisfaction.

To develop a drug facts label prototype for a combination mifepristone and misoprostol product and to conduct a label-comprehension study to assess understanding of key label concepts. METHODS:We followed U.S. Food and Drug Administration guidance, engaged a multidisciplinary group of experts, and conducted cognitive interviews to develop a drug facts label prototype for medication abortion. To assess label comprehension, we developed 11 primary and 13 secondary communication objectives related to indications for use, eligibility, dosing regimen, contrain-dications, warning signs, side effects, and recognizing the risk of treatment failure, with corresponding target performance thresholds (80-90% accuracy). We conducted individual structured video interviews with people with a uterus aged 12-49 years, recruited through social media. Participants reviewed the drug facts label and responded to questions to assess their understanding of each communication objective. After transcribing and coding interviews, we estimated the proportion of correct responses and exact binomial 95% CIs by age and literacy group.

Food insecurity is a pressing issue in Hawai‘i as the vast majority of available and accessible foods are imported. To address this issue, a backyard aquaponics program was implemented from 2010 to 2016 to offer additional avenues to food sovereignty in a rural predominantly Native Hawaiian community. Aquaponics provides a contained and sustainable food production system that models Native Hawaiian principles of land and water stewardship. The purpose of this community-engaged study was to identify the outcomes and resources needed to continue sustaining the backyard aquaponics systems. The researchers began building a relationship with the community by helping to build several aquaponics systems. The researchers and community partner co-developed the interview questions and participants were interviewed in-person. The outcomes of the study revealed multiple benefits of having a backyard aquaponics system, including increased access to vegetables and fruit, improved diet, low maintenance cost, and enhanced family and community connectedness. Participants reported a renewed connection to Native Hawaiian values, especially land stewardship. Challenges included leaks and breakages with the system, overproduction of fish, complications in water temperature, and vulnerability to unpredictable weather. These findings suggest that backyard aquaponics systems have the potential to provide multiple benefits including alleviating barriers related to food security.

Restrictive abortion policies did not align with health care professionals' more nuanced views of options for care and patient autonomy.

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