Accuracy of self-screening tools for contraindicated use of oral contraceptives: A systematic review
Bibliographic record
Abstract
Introduction: Progesterone-only pills have been approved for over-the-counter sale in the United States. The American College of Obstetrics and Gynecology has long supported access to and advises the use of a self-screening tool to identify contraindications if combined oral contraceptives are to be sold without prescription. Objective: To evaluate whether self-screening tools used by women seeking oral contraceptives are sufficiently accurate to replace in-person screening performed by healthcare professionals to detect relevant contraindications. Methods: A systematic literature search was conducted using PubMed, Embase, Web of Science, and Scopus on April 16, 2024. Eligible studies were original studies that compared a self-screening tool with in-person screening performed by a healthcare professional. The target condition was defined as the presence of one or more category 3 or 4 contraindications to combined oral contraceptive use according to the World Health Organization's Medical Eligibility Criteria for contraceptive use. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies. Due to the heterogeneity in the study populations and tool format, a narrative synthesis was conducted. Results: Of the 1353 unique records screened, five cross-sectional studies were included, comprising a total of 4,043 participants. The highest sensitivity of a self-screening tool was 83.2% (95% CI, 79.5-85.3) and lowest was 58.8% (95% CI, 51.0-66.3). Two studies presented agreement percentages between self-screening and healthcare professionals for individual contraindications, with all items above 83.6%. A meta-analysis could not be conducted because of the heterogeneity. The overall quality of the included studies was moderate. Conclusion: Limited but consistent evidence suggests that self-screening tools indicate contraindications to combined oral contraceptive use with moderate to high sensitivity and negative predictive value. These tools may be suitable for triage in situ considering over-the-counter access to combined oral contraceptives, and further validation is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.150 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.009 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".