Your search found 96936 Results
Antiretroviral treatment adherence among patients in selected health facilities in East London, South Africa: a cross-sectional study.
Online Journal of Health and Allied Sciences. 2018 Apr-Jun; 17(2): p.Studies on antiretroviral therapy (ART) adherence reported variations about the predictors and risk factors, which warrant regional and context-specific research on non-adherence profiles. The purpose of this study was to examine the underlying contributing factors to antiretroviral treatment non-adherence among HIV positive patients in selected health facilities. Methods: This was a descriptive cross-sectional study involving 371 HIV positive patients on antiretroviral treatment in six primary health care facilities in East London, South Africa. A self- designed structured questionnaire was the tool for data collection. Result: The majority (70%) of the participants were non-adherents. About 64% of the participants had been counselled before starting ARV treatment (92.2%) so had a good knowledge of HIV. The majority of the participants experienced no side effects. About 55.0% of the participants had a history of non-adherence, with 26.0% non-adherence rate in the previous month and 19.0% recorded in the previous week. Marital status (married) (p=0.005), having no formal education (p=0.035), being Christian (p=0.007), alcohol consumption (p= 0.021) and viral load suppression had significant associations with non-adherence to ARV treatment. After adjusting for confounders, only non-Christians and unsuppressed viral loads were the independent predictors of non-adherence. Participants who were non-Christians had 3.2 times the likelihood of failing to adhere to ARVs compared to those who were Christians. Furthermore, participants with unsuppressed viral loads were 3 times more likely to be non-adherent to their ARVs compared to participants with suppressed viral loads. The majority of the participants were satisfied with the quality of care they received while accessing the health facility. Concerning viral load distribution, 52% were undetectable, 26% unsuppressed and 22% suppressed. Conclusion: The main contributing factors to ART non-adherence among the participants on ARVs were marital status, level of education, religion and alcohol consumption. Non-Christians and unsuppressed viral loads independently predicted non-adherence among patients in this setting. The majority of the participants, though satisfied with other indicators of quality of care they received, had to wait for more than two hours before receiving service.
Effects of ethinyl estradiol-containing oral contraception and other factors on body composition and muscle strength among young healthy females in Finland-A cross-sectional study.
European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2018 Nov 22; 232:75-81.OBJECTIVE: The aim of this cross-sectional study was to determine the association of hormonal contraception and other life-style factors and habits affecting body composition (BC) and muscle strength. STUDY DESIGN: We measured the body composition of 400 healthy Finnish women (aged 20-40 years) using total body dual energy x-ray absorptiometry (TB-DXA) as well as grip strength (GS [kPa]) with a hand-held dynamometer and knee extension strength (KES [kg]) between 2011 and 2014. Investigated body composition variables were appendicular skeletal mass (ASM [kg]), body mass index (BMI [kg/m(2)]), relative skeletal muscle index (RSMI [ASM/m(2)]), total lean mass (TLM [kg]), skeletal muscle index (SMI [TLM/weight x 100]) and fat-%. Participants filled out a questionnaire concerning life-style factors and habits: hormonal contraception, physical activity, alcohol consumption, age, pregnancies, smoking and self-assessed health that were also adjusting factors in the covariate model. We investigated the effects of hormonal contraception and other life-style factors and habits on body composition and muscle strength using AN(C)OVA in the analyses. RESULTS: Women using hormonal contraception with the combination of ethinyl estradiol + progestogen had significantly lower mean ASM (18.0), RSMI (6.5), TLM (40.8) (p < 0.01) and GS (34.6) (p < 0.001) compared to the women not using hormonal contraception with mean values of ASM (18.8), RSMI (6.7), TLM (42.6) and GS (36.9). After adjustment ASM (18.3), SMI (64.3), GS (35.2) (p < 0.05), RSMI (6.6) and TLM (41.2) (p < 0.01) were significantly lower and fat-% (31.4) higher (p < 0.05) compared to women not using hormonal contraception with mean values of ASM (19.0), SMI (66.1), GS (36.7), RSMI (6.8), TLM (42.7) and fat-% (29.8). CONCLUSION: Use of ethinyl estradiol + progestogen-containing hormonal contraception may have negative association with muscle mass and strength. Copyright (c) 2018 Elsevier B.V. All rights reserved.
Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset.
British Journal of General Practice. 2018 Dec 3;BACKGROUND: Evidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK. AIM: To quantify the association between exposure to DVA and consultations for EC in general practice. DESIGN AND SETTING: Nested case-control study in UK general practice. METHOD: Using the Clinical Practice Research Datalink, the authors identified all women all women aged 15-49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression. RESULTS: Women exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25-39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21). CONCLUSION: A request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence. (c) British Journal of General Practice 2018.
Cervico-vaginal inflammatory cytokine alterations after intrauterine contraceptive device insertion: A pilot study.
PloS One. 2018; 13(12):e0207266.In a prospective study of twenty sexually transmitted infection (STI)-free women, we examined the impact of an intrauterine contraceptive device (IUCD) insertion on cervico-vaginal cytokine levels. Nine women chose the levonorgestrel-containing IUCD and eight chose a copper IUCD. A cervico-vaginal swab was collected for cytokine analysis pre-insertion and four weeks post-insertion. Significant increases were noted in levels of IL-1alpha (median 483.4 versus 316.6 pg/mL, p = 0.046), IL-1beta (median 605.7 versus 147.3 pg/mL, p = 0.018), IL-6 (median 570.1 versus 157.3 pg/mL, p = 0.046), TNFalpha (median 1.19 versus 0.6 pg/mL, p = 0.029) and the chemokine MCP-1 (median 340.2 versus 135.2 pg/mL, p = 0.003). No significant changes were noted in the levels of GM-CSF, IL-8, MIG, MIP-3alpha, RANTES, IL-10, IL-17, IP-10, MIP-1beta. Whether this increase in pro-inflammatory cytokine levels decreases epithelial barrier integrity and enhances susceptibility to STIs, including HIV, merits further study.
Using the Theory of Planned Behavior to determine pharmacy students' intention to participate in hormonal contraception counseling services.
Currents In Pharmacy Teaching and Learning. 2018 Nov; 10(11):1488-1495.INTRODUCTION: Recent policies allow some pharmacists to prescribe hormonal birth control, which may improve access to hormonal contraceptives. This study explored associations between student pharmacists' hormonal contraception knowledge, attitudes, subjective norms, perceived behavioral control to counseling intentions, and preferred learning methods. METHODS: A cross-sectional online survey was developed to assess student pharmacists' hormonal contraception knowledge, perceptions, and counseling intentions. First-year student pharmacists at Auburn University Harrison School of Pharmacy were recruited from a skills course to participate. Constructs from the Theory of Planned Behavior and contraception knowledge were used. True/false questions were used for the knowledge scale and Likert-type items for remaining scales. Low vs. high counseling intention based on contraception knowledge and perceptions and controlling for student pharmacist characteristics was identified by logistic regression. One multiple-choice item explored preferences for learning about hormonal contraception. RESULTS: A response of 110/112 consented student pharmacists was achieved. Mean scores for knowledge, attitudes, subjective norms, perceived behavioral control, and intention were 76.6% (SD = 20.43%), 89.0% (SD = 12.40%), 63.9% (SD = 8.06%), 59.0% (SD = 10.46%), and 81.4% (SD = 12.87%). The contraception attitude variable was statistically significantly associated with counseling intention after controlling for respondent characteristics [Odds Ratio (OR) = 1.10 with 95% Confidence Interval (CI) = 1.05, 1.16] while knowledge, subjective norms, and perceived behavioral control were not statistically significantly associated. Most respondents (56%) preferred to learn by watching examples of counseling, while some (30%) preferred role-play with peers, reading an article (9%), or using a computer simulation (3%). CONCLUSIONS: First-year student pharmacists' attitudes towards hormonal contraception were associated with counseling intentions. Preferred learning methods were observational learning or role-playing. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Fertility and Sterility. 2018 Dec; 110(7):1274.Add to my documents.
Low-Income Texas Women's Experiences Accessing Their Desired Contraceptive Method at the First Postpartum Visit.
Perspectives On Sexual and Reproductive Health. 2018 Dec 3;CONTEXT: Early access to contraception may increase postpartum contraceptive use. However, little is known about women's experiences receiving their desired method at the first postpartum visit or how access is associated with use. METHODS: In a 2014-2016 prospective cohort study of low-income Texas women, data were collected from 685 individuals who desired a reversible contraceptive and discussed contraception with a provider at their first postpartum visit, usually within six weeks of birth. Women's experiences were captured using open- and closed-ended survey questions. Thematic and multivariate logistic regression analyses were employed to examine contraceptive access and barriers, and method use at three months postpartum. RESULTS: Twenty-three percent of women received their desired method at the first postpartum visit; 11% a prescription for their desired pill, patch or ring; 8% a method (or prescription) other than that desired; and 58% no method. Among women who did not receive their desired method, 44% reported clinic-level barriers (e.g., method unavailability or no same-day provision), 26% provider-level barriers (e.g., inaccurate contraceptive counseling) and 23% cost barriers. Women who used private practices were more likely than those who used public clinics to report availability and cost barriers (odds ratios, 6.4 and 2.7, respectively). Forty-one percent of women who did not receive their desired method, compared with 86% of those who did, were using that method at three months postpartum. CONCLUSION: Eliminating the various barriers that postpartum women face may improve their access to contraceptives. Further research is needed to improve the understanding of clinic- and provider-level barriers. Copyright (c) 2018 by the Guttmacher Institute.
Lancet. Oncology. 2018 Dec; 19(12):e659.Add to my documents.
Venous thrombosis and hormonal contraception: what's new with estradiol-based hormonal contraceptives?
Open Access Journal of Contraception. 2018; 9:75-79.Objective: Estradiol (E2)-based hormonal contraceptives impact less than ethinylstradiol (EE) contraceptives on venous thromboembolism (VTE) in comparison to formulations with EE. Study design: In this article, the pharamacologic data of EE and E2 were briefly reviewed, along with the induced biologic effect. These data were then related to a recent large international prospective, controlled, non-interventional cohort active surveillance study, on the cardiovascular risk of users of different types of combined estroprogestin contraceptive (CEPC). Results: The crude HR for E2-valerate (E2V)/dienogest vs other CEPCs with EE was 0.8 (95% CI, 0.4-1.6), but when the data were corrected for age, body mass index, duration of use, and family history of VTE, the corresponding adjusted HR was 0.5 (95% CI, 0.2-1.0). A comparison of the E2V/dienogest and EE/levonorgestrel groups showed that the two contraceptives induced a similar VTE risk with the crude and adjusted VTE HRs of 0.7 (95% CI, 0.3-1.8) and 0.5 (95% CI, 0.2-1.3), respectively. Similar results were obtained when the observation was prolonged to January 2017. Conclusions: The reduced impact of E2 vs EE on coagulation translates into the epidemiologic evidence of a reduced number of events in E2V vs EE users, when progestins other than levonorgestrel are used. However, E2 may continue to negatively impact on the risk of VTE, and this should not be forgotten at the time of prescription. Family history of VTE or thrombophilia, age, and obesity are risk factors for VTE too. If these risk factors are not taken into consideration and excluded, they can overcome or hide the higher safety of E2 vs CEPCs with EE.
Contraceptive use and the risk of sexually transmitted infection: systematic review and current perspectives.
Open Access Journal of Contraception. 2018; 9:91-112.Purpose: Evidence on the association between contraceptive use and risk of sexually transmitted infections (STIs) and bacterial vaginosis (BV) is lacking, with few prospective studies. We systematically reviewed the last 10 years' evidence on the association between contraception and STI/BV, building on the most recent systematic reviews published in 2006 and 2009. Methods: We searched the MEDLINE and POPLINE databases for peer-reviewed articles p ublished between January 1, 2008 and January 31, 2018 reporting prospective studies that assessed the association between contraceptive use and incident STI and/or incident or recurrent BV. Results: We identified 33 articles that evaluated combined oral contraceptives (COC), depot medroxyprogesterone acetate (DMPA), the copper intrauterine device (Cu-IUD), the levonorgestrel intrauterine system (LNG-IUS) and other methods. The strength of the evidence for many specific contraceptive method/STI associations is limited by few prospective studies with comparably defined exposures and outcomes. Available data suggest no association of COCs and Neisseria gonorrhoeae, Trichomonas vaginalis, HSV-2 or syphilis, and mixed evidence on the association with HPV, Chlamydia trachomatis, and BV. For DMPA, none of the studies identified found an association with N. gonorrhoeae or syphilis, and data on C. trachomatis, T. vaginalis, HPV and BV were mixed. Two large studies showed a highly clinically significant increased risk of HSV-2 infection with DMPA use. Data on the effect of Cu-IUD and the LNG-IUS on the acquisition of C. trachomatis, N. gonorrhoeae and T. vaginalis are sparse, and data on HPV and BV are mixed. Conclusion: Few data are available from prospective studies, including randomized trials, to draw strong conclusions about the relationships between contraceptive methods and specific STIs. The overall evidence on the association between contraceptive use and STI/BV risk is limited by the lack of any randomized trials, few published prospective studies designed to analyze these associations, wide variability in exposure definitions and comparator groups, potential for confounding due to inaccurate sexual behavior data, differential confounder adjustment and differences in study populations and sizes. Despite these limitations, new evidence is supportive of a significantly increased risk of HSV-2 infection among DMPA users which warrants additional research to better understand this association.
Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: A systematic review.
Disability and Health Journal. 2018 Nov 9;BACKGROUND: Women spend most of their reproductive years avoiding pregnancy. However, we know little about contraceptive knowledge and use among women with disabilities, or about strategies to improve contraceptive knowledge and decision-making in this population. OBJECTIVE: To systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use. METHODS: We searched MEDLINE, PsychINFO, the Cochrane Library, CINAHL, and ERIC databases from inception through December 2017. Two reviewers independently reviewed studies for eligibility, abstracted study data, and assessed risk of bias following PRISMA guidance. RESULTS: We reviewed 11,659 citations to identify 62 publications of 54 unique studies (total n of women with disabilities=21,246). No standard definition of disability existed across studies. The majority of studies focused on women with intellectual disabilities (ID). Women with ID and those who were deaf or hard-of-hearing had lower knowledge of contraceptive methods than women without disabilities. Estimates of contraceptive use varied widely, with some evidence that women with disabilities may use a narrower range of methods. Five of six studies evaluating educational interventions to increase contraceptive knowledge or use reported post-intervention improvements. CONCLUSIONS: Women with disabilities may use a more narrow mix of contraceptive methods and are often less knowledgeable about contraceptives than women without disabilities. Interventions to improve knowledge show some promise. A lack of data exists on contraceptive preferences among women with disabilities. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Enhancing use of emergency contraceptive pills: A systematic review of women's attitudes, beliefs, knowledge, and experiences in Australia.
Health Care For Women International. 2018 Nov 26; 1-22.Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy.
Associations of hormonal contraceptives and infertility medications on the risk of venous thromboembolism, ischemic stroke, and cardiovascular disease in women.
Journal of Investigative Medicine. 2018 Nov 26;The purpose of this study was to examine the relations of hormonal contraceptives and infertility drugs with the risk of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and cardiovascular disease. The Taiwan National Health Institute Research Database was searched for women who had taken hormonal contraceptives or infertility medications from 2000 to 2010. The two groups were age and index date matched with controls (1:4 ratios). Cox regression analysis was used to examine the risks of VTE, DTE, PE, ischemic stroke, and cardiovascular disease. A total of 32,067 women were included in the hormonal contraceptives group and 4710 in the infertility medications group (matched controls: 127,872 and 18,840, respectively). After adjustment for age, comorbidities, and other confounders, the contraceptives group had a higher risk of VTE (adjusted HR 1.14, 95% CI 1.004 to 1.30) and cardiovascular disease (adjusted HR 1.30, 95% CI 1.26 to 1.34), and lower risk of ischemic stroke (adjusted HR 0.90, 95% CI 0.86 to 0.95). The infertility medications group had a higher risk of VTE (adjusted HR 1.996, 95% CI 1.41 to 2.72) and DVT (adjusted HR 1.86, 95% CI 1.31 to 2.63), and lower risk of ischemic stroke (adjusted HR 0.82, 95% CI 0.68 to 0.99) and cardiovascular disease (adjusted HR 0.83, 95% CI 0.74 to 0.94). Hormonal contraceptives and infertility medications appear to lower the risk of ischemic stroke and increase the risk of VTE; however, their effect on the risk of other types of cardiovascular events varies. (c) American Federation for Medical Research 2018. No commercial re-use. See rights and permissions. Published by BMJ.
Reproductive Biomedicine and Society Online. 2018 Aug; 6:45-54.While the majority of East Asian countries embraced the modern intrauterine device (IUD) during the 1960s, the sale and distribution of the IUD in Japan was not authorized until 1974. In this paper, I address why the Japanese Government took so long to permit the use of the IUD. Firstly, I examine scientific debates in Japan during the early 1950s on the efficacy of the IUD and associated health risks, to illustrate how the Government's conservative attitude was fostered by a co-constitutive relationship between health officials and leading obstetrician-gynaecologists who believed that the IUD was dangerous and likely to induce abortion. I also trace the Japanese Government's rapidly changing attitude through the 1960s, and analyse the influential interaction between national policy making and the enthusiastic response of a small number of Japanese doctors to the transnational movement to curb population growth in developing countries. I argue that the specific ways in which biomedical discourse was shaped by the sociopolitical position of doctors in relation to the Government's health administration explains the Japanese Government's resistance to use of the IUD. However, I also note that the Government's dramatic change in attitude was influenced directly by transnational reproductive politics. This paper will enhance the history of reproductive politics in post-war Japan.
Medicaid Family Planning Expansions: The Effect of State Plan Amendments on Postpartum Contraceptive Use.
Journal of Women's Health. 2018 Nov 28;OBJECTIVE: To determine the effect of state Medicaid family planning (FP) programs transitioning from a Section 1115 waiver to a State Plan Amendment (SPA) on reproductive health outcomes. MATERIALS AND METHODS: Data were from the Pregnancy Risk Assessment Monitoring System on 75,082 women who had a live birth between 2007 and 2013 and were living in one of nine states. We performed a difference-in-differences analysis to quantify the effect of the transition on postpartum contraceptive (PPC) use and unintended births (UBs). RESULTS: Over 80% of the sample reported using PPC; half reported an UB. The odds of PPC use among women who were living in a study state and gave birth after the transition were 1.14 times that of women who were living in a comparison state and/or gave birth before the transition (95% confidence interval: 1.04-1.24). CONCLUSIONS: Findings suggest that women living in states that transitioned from a waiver to SPA experienced an increased likelihood of PPC compared with those living in comparison states.
European Journal of Contraception and Reproductive Health Care. 2018 Nov 30; 1-7.OBJECTIVE: The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC. METHODS: A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour. RESULTS: The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users. CONCLUSION: EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.
Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database.
European Journal of Contraception and Reproductive Health Care. 2018 Nov 30; 1-6.OBJECTIVE: The aim of this study was to evaluate the continuation rates of reimbursed contraceptive methods in French real-world conditions. METHODS: A retrospective cohort study using a representative sample of the national health insurance database, the General Sample of Beneficiaries (Echantillon Generalistes des Beneficiaires [EGB]), was performed between 2006 and 2012. Selected women were >/=15 years of age and had started a reimbursed contraceptive method between 2009 and 2012 without prior reimbursement for an implant or an intrauterine contraceptive method between 2006 and 2008. The outcome of interest was the continuation rates, defined as the probability of women initiating a contraceptive method and continuing to use the same method over time. Continuation rates were assessed for up to 2 years. Only the first contraceptive method used during the study period was considered in the analysis. Non-parametric Kaplan-Meier survival analysis was used to assess continuation rates. RESULTS: A population of 42,365 women representative of the 4,109,405 French women initiating any reimbursed method between 2009 and 2012 was identified in the EGB: 74.5% of women used oral contraceptives, 12.8% the levonorgestrel-releasing intrauterine system (LNG-IUS), 9.2% the copper intrauterine device (Cu-IUD) and 3.5% the subdermal etonogestrel (ENG) implant. The 2 year continuation rates varied from 9.1% for progestin-only oral contraceptives, 27.6% for first to second generation combined oral contraceptives (COCs) and 33.4% for third generation COCs to 83.6% for the ENG implant, 88.1% for the Cu-IUD and 91.1% for the LNG-IUS. CONCLUSION: This study conducted in real-world conditions showed that long-acting reversible contraceptive (LARC) methods remain rarely used in France despite high continuation rates over 2 years. Increasing the use of LARC methods is therefore a public health priority.
BMC Women's Health. 2018 Nov 7; 18(1):179.BACKGROUND: Endogenous ovarian hormones as well as exogenous oestradiol and progesterone play an important role in cognitive processing. Specifically, these hormones play a role in different aspects of memory, both in terms of storage capacity and temporal duration of the mnemonic track. These hormones also have various effects on different types of memory (i.e., verbal, visuo-spatial, prospective). This study investigated the effects of hormones on topographic memory, a type of memory specifically needed to recall a pathway and to acquire spatial information about locations, distances, and directions. METHODS: We compared 25 naturally cycling women (NCW) in two different cycling phases, the early follicular phase (4th - 5th days) and the mid-luteal phase (20th-21st days), with 26 women taking oral contraceptives (OC) tested in the active pill phase (20th to 21st day of OC cycle) and the inactive pill phase (2nd to 4th day of OC cycle). Both groups performed the Walking Corsi Test to assess topographic memory in their respective cycling phases. Women were instructed to learn an eight-step sequence path and recall the path five minutes later. RESULTS: We found that the two groups differed in terms of learning the 8-step sequence path; OC users were always better (4-5 days vs. 20-21 days) than NCW. No differences emerged in the delayed recall of the same path. CONCLUSIONS: As already observed in other memory domains (i.e., verbal memory, emotional memory), OC users showed an advantage in terms of topographic learning. Our results might be explained by hormonal mechanisms and may suggest the future application of OC in women with topographic disorders or visuo-spatial difficulties.
The need for contraception in patients taking prescription drugs: a review of FDA warning labels, duration of effects, and mechanisms of action.
Expert Opinion On Drug Safety. 2018 Nov 3; 1-13.INTRODUCTION: This review provides a guide for the rational use of prescription drugs in patients of reproductive age. Areas covered: A comprehensive retrieval of the labels of FDA-approved drugs was performed to identify drugs where the label recommends contraceptive use during and/or after treatment. The acquired data were analyzed and organized into a table. Contraception was recommended or mandated for 268 single-ingredient drugs. These could be divided into four main categories, with many having effects across several categories: 177 drugs required contraception because they were associated with pregnancy loss or stillbirth, 177 drugs were associated with teratogenesis, 136 were associated with non-teratogenic adverse peri- or postnatal effects on the fetus (e.g. low birth weight), and 44 were associated with decreased efficacy of contraception or a change in ovulatory cycle. We also discuss the period of time contraception is required, as well as the known or hypothesized reasons for the reproductive toxicity of these agents. Expert opinion: We have provided a comprehensive overview of the FDA-approved drugs where the warning labels currently stipulate that contraception should be used. Although other references are available for clinicians, this review provides a useful source of information regarding the single-ingredient prescription drugs that may affect the outcome of pregnancy. This information is particularly relevant for researchers, as it provides an overview of the different drugs with reproductive toxicity, and because it highlights the specific needs for future research. In particular, more work (especially epidemiological studies) is needed to clarify the clinical relevance of these findings, most of which were obtained through animal studies.
Journal of Addiction Medicine. 2018 Nov 2;OBJECTIVES: The aim of the study was to evaluate pregnancy intention, risk perception, and contraceptive utilization among women reporting substance use during pregnancy. METHODS: Data were obtained from the 2009 to 2011 Tennessee Pregnancy Risk Assessment Monitoring System (PRAMS), an annual cross-sectional survey which assesses behaviors before, during and after pregnancy. Substance use during pregnancy and contraceptive use at the time of conception and after delivery were captured by self-report in the postpartum period. Pregnancy intention was categorized as intended (pregnancy desired then or earlier) or unintended (pregnancy desired later or not at all). Weighted descriptive and multivariable analyses were performed. RESULTS: A total of 3042 women completed the PRAMS survey, with 168 (5.4%) reporting substance use during pregnancy. Compared with women who did not report drug use, women who used drugs were more likely to have an unintended pregnancy (65.6% vs 48.4%, P = 0.003), were more ambivalent towards pregnancy planning or prevention (69.7% vs 46.2%, P < 0.001) and were less likely to report contraceptive use before pregnancy (31.3% vs 46.8%, P = 0.022) or in the postpartum period (79.6% vs 88.1%, P = 0.019). Finally, women reporting substance use in pregnancy had 2 times higher odds of reporting that they did not think they could get pregnant at the time of conception after adjusting for age, race, income, education, insurance, and smoking status (adjusted OR 2.18, 95% confidence interval 1.07-4.49, P = 0.033). CONCLUSIONS: Women who report substance use in pregnancy have unique reproductive health needs and would benefit from additional education and counseling concerning their pregnancy intention, contraceptive use, and ability to conceive.
Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey.
Complementary Therapies in Clinical Practice. 2018 Nov; 33:100-106.BACKGROUND AND PURPOSE: This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method. MATERIALS AND METHODS: A secondary analysis of a cross-sectional survey of Australian Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression. RESULTS: Based on the responses from the included women (n=7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception. CONCLUSION: There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations. Copyright (c) 2018. Published by Elsevier Ltd.
Intentions to use emergency contraception: The role of accurate knowledge and information source credibility.
American Journal of Health Education. 2018; 49(4):264-270.Background: Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information. Purpose: The purpose of this study was to determine the sources from which young women learn about EC (including health care providers, friends/interpersonal sources, media sources, or no information sources), and to examine source credibility with the accuracy of EC knowledge and intentions to use EC. Method: Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC. Results: In total, 97% of participants had heard of EC from at least one source and 49% indicated they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC. Discussion: This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC. Translation to Health Education Practice: Future EC promotion efforts should target health education sources instead of media or interpersonal sources to promote EC knowledge and use among young, sexually at-risk populations.
Current Opinion In Obstetrics and Gynecology. 2018 Dec; 30(6):400-406.PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception. RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data. SUMMARY: Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.
Obstetrics and Gynecology. 2018 Nov 5;OBJECTIVE: To study the rate of induced abortion in a population in whom long-acting reversible contraceptive (LARC) methods are offered free of charge as part of primary health care services. METHODS: We conducted a register-based cohort study on females aged 15-44 years in the city of Vantaa, Finland. We assessed the rate of abortion among females entitled to LARC methods free of charge by survival analysis in four cohorts: those visiting public family planning clinics and initiating free-of-charge LARC methods during 2013-2014 (LARC cohort, n=2,035); those visiting public family planning clinics not choosing LARC methods (no LARC cohort, n=7,634); and three age-matched control participants for every LARC and no LARC participant from the general population not using the services (nonservice users, n=5,981 and 22,748). The patients were followed up by means of Finnish national registers until February 28, 2016. RESULTS: During the 78,500 woman-years accumulated, altogether 996 patients in Vantaa underwent an abortion (12.3 abortions/1,000 woman-years, 95% CI 11.6-13.1). Of these, 16 abortions occurred in the LARC cohort (3.9/1,000, 95% CI 2.4-6.0), 243 in the no LARC cohort (15.3/1,000, 95% CI 13.5-17.2), and 737 (12.6/1,000, 95% CI 11.7-13.5) among matched nonservice users. The adjusted abortion rate in the LARC cohort was 80% lower than in the no LARC cohort (risk ratio [RR] 0.20, 95% CI 0.11-0.32) and 74% lower than among their matched control participants (RR 0.26, 95% CI 0.15-0.43). In contrast, there was no difference in the abortion rate between the no LARC cohort and the control participants (adjusted RR 1.01, 95% CI 0.87-1.18). CONCLUSION: When providing a population with free-of-charge LARC methods, the abortion rate was markedly lower among patients initiating free-of-charge LARC compared with patients using the services but not initiating a LARC method. Programs of this kind could be of major importance in populations with high rates of unintended pregnancy.
International Journal of Reproductive Medicine. 2018; 2018:2785839.Emergency contraceptives play a major role in preventing unwanted pregnancy. The use of emergency contraceptives is characterized by myths and lack of knowledge by both health professionals and users. The main objective of this paper is to summarize the clinical pharmacology of hormonal methods of emergency contraception. A literature review was done to describe in detail the mechanism of action, efficacy, pharmacokinetics, safety profile, and drug interactions of hormonal emergency contraceptive pills. This information is useful to healthcare professionals and users to fully understand how hormonal emergency contraceptive methods work.