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Mobile app aids ‘truly informed’ contraception conversations between patients, providers

A new app provides information about contraception with the goal of helping patients make informed decisions with their providers. The app includes a module to address the unique needs of servicewomen around deployment. (Photo by Sgt. Barry St. Clair) A new app provides information about contraception with the goal of helping patients make informed decisions with their providers. The app includes a module to address the unique needs of servicewomen around deployment. (DoD photo)

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A new mobile application designed to help patients make informed decisions about their contraceptive options is now available. The Decide + Be Ready app provides information helpful for men and women, as well as civilian and servicewomen, and an Apple version of the app can now be downloaded free through the App Store, with an Android version available soon at Google Play.

“There are a lot of applications that help women record their cycles, when they’re fertile and not fertile, and this app is different,” said Air Force Col. Catherine Witkop, program director for general preventive medicine residency at the Uniformed Services University of Health Sciences. “This app provides a lot of information about contraception and helps patients figure out which, if any, contraception they’re interested in using. They can bring that information to their providers to have a truly informed conversation.”

Witkop said the app, which is co-owned by the Department of Defense and the University of California at San Francisco, was developed for women, but also includes information for men, said Witkop. The idea of the app came to Witkop when she learned that a team at UCSF had developed a contraception decision aid and found it to be effective. With funding from USU’s Defense Health Horizons Program, Witkop was able to work with the team from the UCSF’s Person-Centered Reproductive Health Program to transform the aid into a mobile app with a module designed for women in uniform.

“It was important to have a module specifically for servicewomen that addresses their unique needs around deployment and duties they have to partake in,” said Witkop. “We also have information on an issue that a lot of military women are interested in, which is controlling their menstrual cycle when they’re deployed. You can use contraceptives to help eliminate periods, which can be helpful during deployments.”

When using the app, patients have the option to learn about the effectiveness of different contraceptive options, side effects, and how they’re used. The app provides information for women who want to know more about planning for pregnancy or considerations for birth control after having a baby, said Witkop. Patients answer a series of questions about their preferences for contraception options and they’re given a summary of the best options for their lifestyle based on the information they provided. Witkop said this information can then be used as a decision aid when talking with providers about contraception.

Navy Cmdr. Shannon Lamb, chief of the Office of Women’s Health for the Navy Bureau of Medicine and Surgery, said she found the app to be useful and user-friendly. The app’s format, ability to compare various options, and information provided specifically for active duty women are unique features, she added.

“As a women’s health provider, I think it is an outstanding tool that can enable shared decision making between the provider and patient,” said Lamb. The app is similar to a paper tool that the Navy’s women’s health clinical community had developed, but the electronic format has some added benefits, including its convenience, ability to rapidly update, and durability, she said. The Navy plans to promote the app in their walk-in contraception clinics as this will help facilitate conversations and streamline information in a busy clinical setting.

The app’s profile option for patients allows them to save their answers to the questions regarding preferences. It also provides ‘pop-up’ information on topics a user may not have considered, such as intrauterine devices and emergency contraception, an option to prevent pregnancy should their primary method of birth control fail, said Lamb.

“The ability to compare contraceptive methods ‘side by side’ is incredibly useful for patients in helping to determine which method may work best for them, and the visuals and graphics on ‘how to take’ the contraception provides an easy go-by for patients to understand,” she said.

Lamb said the app can be a valuable tool in raising awareness among patients about the effectiveness of contraception for other conditions, such as acne and menstrual suppression.

“This may prompt conversations with their health care providers that otherwise may not have occurred as patients may not have been aware of their additional benefits,” said Lamb. “It is invaluable for active duty women, particularly if they have a civilian provider, as it takes into consideration deployment environments that may be less amenable to certain forms of contraception, of which civilian providers may not be aware.”

Witkop said the app follows the same rigorous structure as other tools designed for medical decision making. She noted that the app is not connected to anyone’s medical record or personal identifying information, and it is not being used to collect data.

“The app stores information that you put into it, but it’s only stored there on the phone, so no one else is accessing that information,” she said “Your answers are only accessible to anyone you choose to share the app with.”

TRICARE covers contraception for all servicewomen and beneficiaries who receive care at a military treatment facility, but coverage can vary outside of MTFs, Witkop said.

“This is a tool that will give women access to detailed information about the contraception methods, as well an opportunity to answer questions for themselves about what’s important for their contraception so they can make informed choices,” said Witkop.

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During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Because the majority of women serving in the Armed Forces are of childbearing age, and women’s military career opportunities have expanded into combat roles, contraceptive health care is an increasingly important public health issue. The lack of available, population-based descriptive information on contraceptive use among U.S. service women has generated questions and concerns about ready access to these medical products. This infographic summarizes the annual prevalence of permanent sterilization, as well as use of long – and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraception from 2012 through 2016, among active component service women. FINDINGS •	2012 through 2016, Sterilization decreased from 4.2% to 3.6% LARC use increased from 17.2% to 21.7%; SARC use decreased from 38.5% to 30.4%. •	Emergency contraception use increased from 0.4% to 1.9%. •	Among deployed women, the average annual prevalence of permanent sterilization was 4.2%. •	For deployed women, LARC use was 17.9% SARC use was 28.0%. •	Emergency contraception use among deployed women was 0.4%. •	262,907 (76.2%) women of childbearing potential (WOCBP) used either a LARC or a SARC at some time during the surveillance period. •	The vast majority of service women have utilized at least one form of contraception, and women are selecting LARCs in greater numbers with each passing year. The bar graph displays information on the annual prevalence of contraceptive utilization, by type, service women of child-bearing potential, active component, U.S. Armed Forces, 2012– 2016. Graphic displayed: contraception option. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

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Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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