Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Combined Oral Contraceptive Use and the Risk of Cervical Cancer: Literature Review / Uso de anticoncepcional oral combinado e o risco de câncer cervical: Revisão da literatura

Abstract Cervical cancer (CC) is caused by persistent infection of human papillomavirus of high oncogenic risk (hr-HPV); however, several cofactors are important in its carcinogenesis, such as smoking, multiparity, and prolonged use of oral hormonal contraceptives (COCs). Worldwide, 16% of women use COCs, whereas in Brazil this rate is of ~ 30%. The safety and adverse effects of COCs are widely discussed in the literature, including the increase in carcinogenic risk. Due to the existence of several drugs, combinations, and dosages of COCs, it is hard to have uniform information in epidemiological studies. Our objective was to perform a narrative review on the role of COCs use in the carcinogenesis of cervical cancer. Several populational studies have suggested an increase in the incidence of cervical cancer for those who have used COCs for > 5 years, but other available studies reach controversial and contradictory results regarding the action of COCs in the development of CC.

Resumo O câncer cervical (CC) é causado pela infecção persistente pelo papilomavírus humano de alto risco oncogênico (hr-HPV); entretanto, vários cofatores são importantes na sua carcinogênese, como tabagismo, multiparidade e uso prolongado de contraceptivos hormonais orais (COCs). No mundo, 16% das mulheres usam AOCs, enquanto no Brasil essa taxa é de ~ 30%. A segurança e os efeitos adversos dos COCs são amplamente discutidos na literatura, incluindo o aumento do risco carcinogênico. Devido à existência de várias drogas, combinações e dosagens de COCs, é difícil ter informações uniformes em estudos epidemiológicos. Nosso objetivo foi realizar uma revisão narrativa sobre o papel do uso de COCs na carcinogênese do câncer cervical. Vários estudos populacionais têm sugerido aumento da incidência de câncer de colo uterino para aquelas que usam COCs há mais de 5 anos, mas outros estudos disponíveis chegam a resultados controversos e contraditórios quanto à ação dos COCs no desenvolvimento do CCU.

Uso de anticonceptivos de emergencia y percepción sobre sus perjuicios en estudiantes universitarias colombianas / Use of emergency contraception and knowledge about its harms on Colombian female university students i: en

Introducción: La educación sexual y reproductiva puede prevenir o reducir cualquier daño físico o mental, o ambos, ocasionado por las prácticas sexuales de riesgo y el uso inadecuado de métodos anticonceptivos. Objetivo: Describir el uso de anticonceptivos de emergencia en estudiantes universitarias y la percepción de estas en cuanto a los perjuicios de dichos métodos para la salud. Métodos: Se efectuó un estudio descriptivo y transversal, de abril a octubre de 2021, de 372 féminas mayores de 18 años de edad, matriculadas en universidades ubicadas en Medellín, Colombia, quienes fueron seleccionadas mediante un muestreo no probabilístico. La información se obtuvo a través de una encuesta, en la cual se incluyeron variables relacionadas con el empleo de los anticonceptivos de emergencia y la percepción sobre sus perjuicios. Resultados: En la serie, 67,7 % de las jóvenes había usado anticonceptivos de emergencia, de las cuales 8,7 % refirió consumir hasta 3 píldoras de levonorgestrel al mes y 0,8 %, más de 10 durante un año; en tanto, 97,8 % consideró que este tipo de método afecta la salud. Entre los principales efectos secundarios figuraron los sangrados irregulares (65,8 %), las náuseas (31,7 %), los vómitos (31,7 %), la migraña (3,2 %) y los cambios de ánimo (25,4 %). Conclusiones: Aunque la mayoría de las estudiantes universitarias que usaban anticonceptivos de emergencia se guiaban por las recomendaciones médicas, un pequeño grupo lo hacía de manera inadecuada, lo cual se asoció a una baja percepción sobre los perjuicios de este método para la salud.

Introduction: Sexual and reproductive education can prevent or reduce any physical or mental harm, or both, caused by risky sexual practices and inadequate use of contraceptive methods. Objective: To describe the use of emergency contraception among female university students and their awareness regarding the harms of these methods for their health. Methods: A descriptive and cross-sectional study was conducted, from April to October 2021, of 372 women over 18 years of age, enrolled in universities located in Medellin, Colombia, who were selected through non-probabilistic sampling. The information was obtained through a survey, which included variables related to the use of emergency contraception and the awareness of its harms. Results: In the series, 67.7% of the young women had used emergency contraceptives, of whom 8.7% reported consuming up to 3 levonorgestrel pills per month and 0.8% more than 10 during a year, while 97.8% considered that this type of method affects their health. Among the main adverse effects were irregular periods (65.8%), nausea (31.7%), vomiting (31.7%), migraine (3.2%) and mood changes (25.4%). Conclusions: Although most of female university students who used emergency contraceptives were guided by medical recommendations, a small group did so inappropriately, which was associated with a low perception of the health harms of this method.

Manejo das irregularidades menstruais secundárias ao uso de contraceptivos ­ análise das recomendações atuais / Management of menstrual irregularities secondary to contraceptive use ­ analysis of current recommendations

As irregularidades menstruais representam uma série de desordens na quantida- de, duração, frequência ou regularidade do sangramento uterino. Entre suas cau- sas destaca-se o sangramento secundário ao uso de anticoncepcionais, uma razão frequente de descontinuidade dos contraceptivos, podendo aumentar as taxas de gestações não planejadas. Boa parte dos contraceptivos pode levar a mudanças no padrão de sangramento uterino, e a abordagem inicial do sangramentos irregula- res inclui a avaliação de outras possíveis causas, o reforço do uso correto da medi- cação, a tranquilização da paciente quanto à benignidade do quadro e à tendência a melhora com a continuidade do uso. Os anti-inflamatórios podem ser usados como estratégia inicial, e, não havendo resposta satisfatória, há alternativas espe- cíficas para cada método. Este trabalho visa identificar as recomendações atuais sobre o manejo do sangramento anormal decorrente de contraceptivos, por meio de revisão narrativa de estudos publicados sobre o tema nos últimos vinte anos.

Abnormal uterine bleeding represents a series of disorders in the amount, du- ration, frequency and or regularity of uterine bleeding. Among its causes, uterine bleeding secondary to the use of contraceptives stands out as a frequent reason for contraceptive discontinuity, which could lead to unplanned pregnancies. Most contraceptives can cause changes in the pattern of uterine bleeding, and the ini- tial approach of the abnormal bleeding includes assessing other possible cau- ses, reinforcing the correct use of medication, and reassuring the patient about the benignity of the condition and the tendency to improve with the continuity of the treatment. Anti-inflammatory drugs can be used as an initial strategy, and, if there is no satisfactory answer, there are specific alternatives for each contracep- tive method. This work aims to identify them current recommendations on the management of abnormal bleeding resulting from contraceptives use, through a narrative review of studies published on the subject in the last twenty years.

O impacto do uso de métodos contraceptivos orais na função sexual de mulheres em idade reprodutiva / The impact of the use of oral contraceptive methods on the sexual function of women of reproductive age

Objetivo: Investigar o impacto dos contraceptivos orais hormonais na função sexual de mulheres. Métodos: Estudo transversal realizado por meio do questionário traduzido e validado "Índice da Função Sexual Feminina", capaz de estimar o risco de disfunção sexual feminina. Dados sociodemográficos, ginecológicos, medicamentosos e outros foram avaliados e correlacionados estatisticamente a esse escore, estimando possíveis causas da disfunção sexual, com destaque para o uso de anticoncepcional oral. O estudo foi baseado em uma amostragem por conveniência, incluindo mulheres > 18 anos em idade reprodutiva, de 04/01/2021 a 04/01/2022, obedecendo aos critérios de inclusão e exclusão. Resultados: Participaram deste estudo 105 mulheres com média e desvio-padrão de idade de 23,4 ± 3,8 anos, predominantemente heterossexuais (84,0%) e bissexuais (13,2%). A maioria delas (93,4%) utiliza métodos contraceptivos, sendo esses anticoncepcional oral (45,3%), DIU hormonal (19,8%) e camisinha (17,0%). A composição hormonal mais utilizada foi levonorgestrel (26,4%) e etinilestradiol (25,5%). Oitenta por cento das mulheres são sexualmente ativas, 69,3% delas têm parceria fixa, 42,5% tinham relações quase sempre e 33,0% referiam que as relações sexuais eram sempre satisfatórias. Houve boa adequação da amostra (0,865) e significância estatística (p < 0,0001). Utilizar ou não método contraceptivo apresentou diferença nos domínios desejo, satisfação e dor. Contudo, as questões do histórico sexual foram as que mais apresentaram relevância estatística em relação aos domínios. Conclusão: Apesar de outros estudos serem necessários para provar a hipótese de que os contraceptivos orais têm impacto negativo na função sexual feminina, é clara a importância de os profissionais de saúde já estarem cientes dessa possibilidade e saberem como abordá-la.

Objective: To investigate the impact of hormonal oral contraceptives on women's sexual function. Methods: Cross-sectional study carried out using the translated and validated questionnaire "Index of Female Sexual Function", capable of estimating the risk of female sexual dysfunction. Sociodemographic, gynecological, medication and other data were evaluated and statistically correlated to this score, estimating possible causes of sexual dysfunction, with emphasis on the use of oral contraceptives. The study was based on a convenience sample, including women > 18 years of reproductive age, from 01/04/2021 to 01/04/2022, following inclusion and exclusion criteria. Results: The study included 105 women with a mean and standard deviation of (23.4 ± 3.8) years old, predominantly heterosexual (84.0%) and bisexual (13.2%). Most of them (93.4%) use contraceptive methods, these being (45.3%) oral contraceptives, (19.8%) hormonal IUDs and (17.0%) condoms. The most used hormonal composition was levonorgestrel (26.4%) and ethinylestradiol (25.5%). Eighty percent of the women are sexually active, 69.3% of them have a steady partner, 42.5% almost always had sex and 33.0% said that sex was always satisfactory. There was good sample adequacy (0.865) and statistical significance (p < 0.0001). Using or not using a contraceptive method showed a difference in the desire, satisfaction and pain domains. However, sexual history questions were the ones that showed the most statistical relevance in relation to the domains. Conclusion: Although further studies are needed to prove the hypothesis that oral contraceptives have a negative impact on female sexual function, it is clear that health professionals are already aware of this possibility and know how to approach it.

Patrones de uso de anticonceptivos hormonales en una población de Colombia

Objetivo: El uso de anticonceptivos hormonales ha crecido progresivamente en muchos países del mundo. Determinar los patrones de utilización de anticonceptivos hormonales, frecuencia de comorbilidades y medicaciones concomitantes en mujeres mayores de 15 años afiliadas al Sistema de Salud de Colombia. Materiales y métodos: Estudio de corte, que incluyó datos de mujeres mayores de 15 años con prescripciones y dispensaciones de algún anticonceptivo hormonal durante al menos tres meses continuos (abril a junio-2016). Se creó una base de datos con información sociodemográfica, farmacológica (tipo de anticonceptivos, dosis, comedicaciones y comorbilidades. Se realizaron análisis descriptivos y multivariados buscando identificar factores asociados con comedicaciones de riesgo. Resultados: Se identificaron 34309 mujeres que recibieron anticonceptivos hormonales, con edad media de 27,2±7,0 años (rango:13-60,8 años). Los anticonceptivos más utilizados fueron inyectables de aplicación mensual (63,0 %), inyectables de aplicación trimestral (19,1 %), de administración oral (12,1 %), los implantes subdérmicos (7,4 %) y finalmente los dispositivos intrauterinos hormonales con 0,4 %. El 5,7 % de las pacientes (n=1957), estaban recibiendo alguna comedicación, especialmente con antihipertensivos (2,9 %) y antimigrañosos (1,9 %). Ser mayor de 45 años (OR:2,3; IC95 %:1,7-3,0), utilizar dispositivo intrauterino hormonal (OR:2,4; IC95 %:1,4-4,1) y anticonceptivo inyectable trimestral (OR: 1,7; IC95 %:1,3-2,3) se asociaron con mayor probabilidad de recibir comedicaciones. Conclusiones. Las mujeres colombianas que acceden a anticonceptivos hormonales a través del Sistema de Salud están empleando principalmente presentaciones inyectables, con muy baja frecuencia de las orales, y en general tienen pocas comorbilidades que requieran tratamiento farmacológico, pese a que algunas tienen condiciones cardiovasculares que pueden implicar un potencial riesgo de eventos trombóticos.

Objective: The use of hormonal contraceptives has grown progressively in many countries of the world. The aim was to determine the patterns of use of hormonal contraceptives, frequency of comorbidities and concomitant medications in women over 15 years of age affiliated with the Colombian Health System. Methods: Cross-sectional study, which included data on women over 15 years of age with prescriptions and dispensations of a hormonal contraceptive for at least three continuous months (April-June-2016). A database with sociodemographic, pharmacological information (type of contraceptives, doses, comedications and comorbidities) was created. Descriptive and multivariate analyzes were conducted seeking to identify factors associated with risk comedications. Results: 34309 women who received hormonal contraceptives were identified, with a mean age of 27.2 ± 7.0 years (range: 13-60.8 years). The most commonly used contraceptives were injectable of monthly application (63.0 %), injectable of quarterly application (19.1 %), oral administration (12.1 %), subdermal implants (7.4 %) and finally the hormonal intrauterine devices with 0.4 %. 5.7 % of the patients (n = 1957) were receiving some medication, especially with antihypertensives (2.9 %) and anti-migraines (1.9 %). Be over 45 years old (OR:2.3; 95 %CI: 1.7-3.0), use hormonal intrauterine device (OR: 2.4; 95 % CI:1.4-4.1) and quarterly injectable contraceptive (OR:1.7; 95 %CI:1.3-2.3) were associated with a higher probability of receiving comedications. Conclusions: Colombian women who access hormonal contraceptives through the Health System are mainly using injectable presentations, with very low frequency of oral ones, and in general they have few comorbidities that require pharmacological treatment, although some have cardiovascular conditions that may involve potential risk of thrombotic events.

Características de las mujeres usuarias del método anticonceptivo de esterilización femenina

Introducción: La esterilización femenina es un método anticonceptivo permanente, cuya elección representa una decisión transcendental en la vida de la mujer; influenciada por el contexto y las cualidades personales. Objetivo: Describir las características de las mujeres usuarias del método anticonceptivo de esterilización femenina. Métodos: Estudio de tipo descriptivo basado en la Encuesta Demográfica y de Salud Familiar del 2021. De las bases de datos se seleccionaron a 2 306 mujeres de 20 a 49 años, usuarias de esterilización femenina, en quienes se analizaron las características sociodemográficas, reproductivas y propias del método. Se estimaron recuentos no ponderados y ponderados con intervalos de confianza al 95 %. Resultados: Respecto a las características sociodemográficas, el 51 % tiene de 40 a 49 años, 87,9 % es de zona urbana, 42,8 % tiene nivel de estudios secundarios y 11,4 % es muy pobre. En relación con el perfil reproductivo, 61,7 % tiene de 3 a 4 hijos, 3,7 % recibió la visita de un personal de salud para hablar de planificación familiar y 29,2 % tiene antecedente de aborto. Referente a las características relacionadas al método, el 5,7 % no fueron informadas acerca de que no podrían tener más hijos y 19,9 % tenía de 2 a 3 años de haberlo realizado. Conclusión: Las mujeres, en su mayoría, son adultas, de buen nivel educativo y residen en zonas urbanas. Además, tienen de 3 a más hijos y saben que no pueden tener más después de la esterilización femenina.

Introduction: Female sterilization is a permanent contraceptive method, whose choice represents a transcendental decision in a woman's life, influenced by her context, and her personal qualities. Objective: To describe the characteristics of women users of the female sterilization contraceptive method. Methods: Descriptive study based on the Demographic and Family Health Survey of 2021. From the databases, 2 306 women between 20 and 49 years of age were selected as users of female sterilization, in which the sociodemographic, reproductive and method-specific characteristics were analyzed. Unweighted and weighted counts with 95% confidence intervals. Results: Regarding sociodemographic characteristics, 51% were aged 40 to 49 years, 87.9% were urban, 42.8% had secondary education and 11.4% were very poor. Regarding the reproductive profile, 61.7% have 3 to 4 children, 3.7% have been visited by health personnel to discuss family planning and 29.2% have a history of abortion. Regarding the characteristics related to the method, 5.7% were not informed that they could not have more children and 19.9% had had an abortion 2 to 3 years before. Conclusion: Most of the women are adults, well-educated and live in urban areas. In addition, they have 3 or more children and know that they cannot have more children after female sterilization.

Uso de métodos contraceptivos durante a pandemia da COVID-19 / Use of contraceptive methods during the COVID-19 pandemic

Objetivo: Análise do uso de métodos contraceptivos no período da pandemia. Método: Trata-se de um estudo transversal, descritivo, exploratório, aprovado pelo Comitê de Ética em Pesquisa envolvendo Seres Humanos (número 3.146.657). Foram entrevistadas via chamada telefônicas colaboradoras que retiraram contraceptivos em 01/01/2020 à 30/07/2020, excluídas os menores de 18 anos de idade; cadastro incompleto e residência fora da área de abrangência da Unidade Básica de Saúde Aquiles Stenghel (Londrina ­ Paraná). Resultados: Elaboraram-se tabelas descritivas com as respostas obtidas. Notou-se que quatro colaboradoras não usavam nenhum contraceptivo no momento da entrevista, e oito haviam trocado de métodos contraceptivos. Todas referiram conhecer pelo menos um contraceptivo e tê-lo utilizado em algum momento. Conclusão: O anticoncepcional injetável, apesar dos efeitos indesejáveis mencionados, continuou sendo o mais usado por entre a maioria delas, e observou-se um desuso da camisinha. Ficou evidente a necessidade de ampliar o olhar para as especificidades das mulheres, em especial as que estão em contexto de vulnerabilidades.(AU)

Objective: Analyze the use of contraceptive methods during the pandemic. Method: This is a cross-sectional, descriptive, exploratory study, approved by the Ethics Committee for Research involving Human Beings (number 3,146,657). Women, who collected contraceptives in the period between 01/01/2020 to 07/30/2020, over 18 years old, with complete registration and resident in the coverage area of the Basic Health Unit Aquiles Stenghel (Londrina ­ Paraná) were interviewed by the researchers by telephone. Results: Descriptive tables were created with the interview responses obtained. It was noted that four collaborators were not using any contraceptive at the time of the interview, and eight had changed contraceptive methods. All participants reported being familiar with at least one contraceptive and having used it at some point. Conclusion: Injectable contraceptives, despite the aforementioned undesirable effects, continued to be the most widely used method among the participants, and there was a lack of use of condoms. It is evident that women especially those who are in a vulnerability context need a bit more of pharmacy assistance in order to guarantee correct contraceptives use and its efficiency.(AU)

Objetivo: Análisis del uso de métodos anticonceptivos durante la pandemia. Método: Estudio transversal, descriptivo y exploratorio, aprobado por el Comité de Ética para la Investigación con Seres Humanos (número 3.146.657). Se entrevistó por llamada telefónica a mujeres que tomaron anticonceptivos entre el 01/01/2020 y el 30/07/2020; no se incluyeron menores de 18 años; registro incompleto y residencia fuera de la zona de captación de la Unidad Básica de Salud Aquiles Stenghel (Londrina ­ Paraná). Resultados: Con las respuestas obtenidas se elaboraron tablas descriptivas. Se observó que cuatro colaboradoras no utilizaban ningún anticonceptivo en el momento de la entrevista y ocho habían cambiado de método anticonceptivo. Todas declararon conocer al menos un anticonceptivo y haberlo utilizado en algún momento. Conclusión: El anticonceptivo inyectable, a pesar de los efectos indeseables mencionados, siguió siendo el más utilizado entre la mayoría de las colaboradoras, y se observó desuso del preservativo. Se puso de manifiesto la necesidad de profundizar en las particularidades de las mujeres, especialmente las que se encuentran en contextos vulnerables.(AU)

A STUDY OF USAGE OF CONTRACEPTIVES AMONG WOMEN IN REPRODUCTIVE AGE GROUP

Family planning is very important for population stabilization. It also helps to improve the reproductive health of women. Public health development is affected by utilization of family planning methods. Family planning affects the socio economic condition of the country. The objective of the study is to understand the usage of contraceptive among women staying in urban slums. It was observed that women still have reservations in adopting contraceptive methods. The overall use of different contraceptive is very poor. There is need to create awareness about family planning methods through health education and motivate people regarding contraceptive use

Costo del retiro anticipado de métodos de planificación familiar / Cost of early removal of family planning methods

Resumen OBJETIVO: Determinar el costo del retiro anticipado de los métodos de planificación familiar. MATERIALES Y MÉTODOS: Estudio de costo efectuado con base en los expedientes de usuarias de métodos de planificación familiar en una institución de salud del estado de Querétaro, México (2018 a 2021). La unidad de observación fue el expediente de mujeres que se retiraron anticipadamente los métodos: dispositivo intaruterino T de cobre (DiuTcu), Diu Mirena (DiuM) e implante subdérmico (IMSD). Se definió como retiro anticipado al sucedido antes del tiempo estimado de uso. Se analizaron todos los expedientes en donde estaba registrado el retiro anticipado. Se incluyó a toda la población, de ahí que no fue necesario establecer el tamaño de muestra. El costo del retiro anticipado se identificó a partir del costo unitario del método, tiempo esperado de uso y tiempo de no uso. El análisis estadístico incluyó: promedios, porcentajes, intervalos de confianza y proyecciones, para esto se utilizaron supuestos. RESULTADOS: Se estudiaron 1361 expedientes. El costo unitario del retiro anticipado del DiuTcu fue de 5.59 pesos (IC95%: 5.04 a 6.14), del DiuM de 1210.73 pesos (IC95%: 1029.58 a 1391.87) y del IMSD de 658.41 pesos (IC95%: 557.37 a 759.44). La proyección a la población mexicana del costo del retiro anticipado de los métodos de planificación familiar es 219,272,470 de pesos. CONCLUSIÓN: El costo del retiro anticipado de los métodos de planificación familiar es alto.

Abstract OBJECTIVE: To determine the cost of early removal of family planning methods. MATERIALS AND METHODS: Cost study realized in records of women users of family planning method in a health institution in Querétaro, Mexico from 2018 to 2021. The unit of observation was considered to be the records of women who had early removal of the copper IUD, Mirena IUD and subdermal implant methods. Early removal was defined as the retirement of the method before the estimated time of use. Work was done with the total number of records (1361), with early removal in 148 (83 copper IUDs, 28 Mirena IUDs, 37 subdermal implants). The entire population was included, so no sampling technique was used. The cost of early removal was identified from the unit cost of the method, expected time of use, time of non-use. The statistical analysis plan included averages, percentages, confidence intervals and projections for which assumptions were used. RESULTS: The unit cost of early removal of copper IUD was $5.59 (95% CI; 5.04-6.14), Mirena IUD $1210.73 (95% CI; 1029.58 - 1391.87) Subdermal implant $658.41 (95% CI; 557.37- 759.44). The projection to the Mexican population of the cost of early removal of family planning methods is $359, 384,161. CONCLUSION: The cost of early removal of family planning methods is high.

Cross-sectional Research on Japanese Pharmacists' Awareness of Emergency Contraceptives Using Web Survey / 日本プライマリ・ケア連合学会誌

Introduction: In Japan, online medical care for emergency contraceptives (ECP) was approved in 2019, but only trained pharmacists can fill the prescriptions. Pharmacists are required to confirm necessary information and provide medication counseling and psychological support for women. The government mentions the need for future consideration regarding over-the-counter (OTC) drugs. Therefore, this study aimed to clarify the awareness and efforts of pharmacists regarding ECP through a questionnaire survey.Methods: A web-based questionnaire survey was conducted involving 229 randomly selected pharmacists.Results: The self-assessment of pharmacists' ECP-related knowledge was low, especially their lack of knowledge of the mechanism of action (31.9%). It was also suggested that 60.3% of pharmacists were concerned about women's psychological support. No pharmacist requested an ECP prescription through online medical care, but 46.9% wanted to attend a training session in the future and request a prescription. A total of 44.5% of pharmacists were against OTC conversion of ECP.Conclusion: At this point, many pharmacists are worried about ECP-related knowledge and the psychological support of patients. Common patient-handling procedure manuals and explanatory documents are required to appropriately respond to patients'. Additionally, improving the knowledge and preparation of pharmacists for OTC drugs was considered necessary.

Conocimiento sobre prevención del embarazo en adolescentes mexicanos / Knowledge about pregnancy prevention in Mexican adolescents

Resumen Objetivo: Establecer la relación entre el conocimiento sobre prevención de embarazo, edad de inicio de vida sexual, cantidad de métodos anticonceptivos utilizados alguna vez y características personales del adolescente como sexo, edad y escolaridad. Materiales y métodos: Estudio descriptivo, correlacional de corte transversal, participaron 2509 adolescentes mexicanos de 14 a 19 años de edad. Se emplearon los reactivos que miden el conocimiento en las dimensiones salud sexual, salud reproductiva y uso del condón de la escala psicométrica de conocimientos, actitudes y prácticas en salud sexual y salud reproductiva. Resultados: Se obtuvo una media de conocimiento sobre prevención de embarazo de 17.21 (DE = 4.72) de valores de 0-27. El conocimiento se relaciona significativamente con la edad del adolescente (r = 0.325; p = 0.01), con la cantidad de métodos anticonceptivos que utilizan (r = 0.210; p = 0.01) y una relación incipiente con la edad de IVS (r = 0.074; p = 0.01). El conocimiento es ligeramente mayor en las mujeres (M = 17.42; DE = 4.58) respecto a los hombres (M = 16.92; DE = 4.89), así como en los adolescentes universitarios (M = 18.71; DE = 4.19). Los adolescentes que utilizan 3 o más métodos anticonceptivos, mostraron mayor conocimiento (M = 19.46; DE = 4.11). Conclusiones: El conocimiento sobre prevención de embarazo es mayor conforme aumenta la edad, la edad de inicio de vida sexual y la escolaridad. Los hallazgos resultan de importancia para desarrollar estrategias de información sobre métodos anticonceptivos y salud sexual y reproductiva, de una forma accesible e igualitaria en mujeres y hombres desde edades tempranas y en escolaridad básica, con la intención de que el adolescente sea responsable desde el inicio de su vida sexual y de prevenir y postergar un embarazo a través del conocimiento como herramienta fundamental.

Abstract Objective: Establish the relationship between knowledge of pregnancy prevention, age of sexual debut, number of contraceptive methods ever used and personal characteristics of the adolescent such as sex, age and schooling. Materials and methods: A descriptive, cross-sectional, correlational, cross-sectional study, 2509 Mexican adolescents aged 14 to 19 years participated. The items measuring knowledge in the dimensions of sexual health, reproductive health and condom use of the psychometric scale of knowledge, attitudes and practices in sexual and reproductive health were used. Results: The mean knowledge of pregnancy prevention was 17.21 (SD = 4.72) from 0-27. Knowledge is significantly related to adolescent age (r = 0.325; p = 0.01), to the number of contraceptive methods used (r = 0.210; p = 0.01) and an incipient relationship with age at sexual debut (r = 0.074; p = 0.01). Knowledge is slightly higher in females (M = 17.42; SD = 4.58) relative to males (M = 16.92; SD = 4.89), as well as in college adolescents (M = 18.71; SD = 4.19). Adolescents using 3 or more contraceptive methods showed greater knowledge (M = 19.46; SD = 4.11). Conclusions: Knowledge about pregnancy prevention increases with age, age at sexual debut and schooling. The findings are important to develop information strategies on contraceptive methods and sexual and reproductive health, in an accessible and egalitarian way for women and men from an early age and in basic schooling, with the intention that the adolescent is responsible from the beginning of sexual life to prevent and postpone pregnancy through knowledge as a fundamental tool.

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Abstract Background: The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition. Objective: To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC. Methods: Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 . Results: Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the "moments" of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO2max. Conclusion: The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review / Sistema renina-angiotensina-aldosterona em mulheres usuárias de contraceptivo oral combinado: Revisão sistemática

Abstract Objective To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). Data sourcesThis is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values— also known as plasma renin substrate— angiotensin, and/or aldosterone values. Study selectionA total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. Data collectionData were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. Data synthesisThe collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. Conclusion The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

Resumo Objetivo Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). Fontes dos dadosTrata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio - também conhecido como substrato da renina plasmática -, valores da angiotensina e/ou aldosterona. Seleção dos estudosForam selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. Coleta de dadosOs dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. Síntese dos dadosAs amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. Conclusão Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Comportamiento sexual de pacientes con infección por VIH según grupos de edad / Sexual behavior among patients with HIV according to age groups

Nuestro objetivo fue determinar la prevalencia y conductas de riesgo por grupos de edad entre pacientes con infección por VIH. Se realizó un estudio observacional analítico transversal de pacientes que acuden al servicio de Enfermedades Infecciosas a recibir tratamiento antirretroviral. Resultados: De 117 personas que ingresaron al estudio, se observó que el grupo etario de los jóvenes varones con infección por VIH señalaron una orientación homosexual (HSH) en 64,5% y una mayor tasa de haber sufrido abuso sexual (29%) respecto al resto. En adultos el uso de métodos anticonceptivos es 71,4% y superior al resto de grupos de edad, la concurrencia a lugares de riesgo (visita a trabajadoras sexuales de la calle) se encuentra mayoritariamente en el rango de 45 a 90 años. El rol homosexual activo de los hombres con VIH representa 66,7%. Los hallazgos enfatizan la necesidad de realizar más estudios que profundicen el tema del abuso sexual en adolescentes y adultos jóvenes, debido a la alta prevalencia encontrada en este estudio(AU)

Our objective was to determine the prevalence and risk behaviors by age groups in patients with HIV infection. A cross-sectional analytical observational study of patients attending the Infectious Diseases service to receive antiretroviral treatment was carried out.Results: Out of 117 people who entered the study, it was observed that the age group of young men with HIV infection indicated a homosexual orientation (MSM) 64.5%; and a higher rate of having suffered sexual abuse (29%) in comparison to the others. In adults, the use of contraceptive methods is 71.4%, and higher than the rest of the age groups, attendance at places of risk (visits to street sex workers) is mostly in the range of 45 to 90 years. The active homosexual role of men with HIV represents 66.7%. The findings emphasize the need for more studies that delve into the issue of sexual abuse in adolescents and young adults, due to the high prevalence found in this study(AU)

La automedicación con anticonceptivos orales e inyectables en mujeres en edad fértil: resultados de un plan piloto / Self-medication with oral and injectable contraceptives in women of childbearing age: results of a pilot plan

La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerada como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se utilizó una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento cuantitativo diseñado el cual fue validado por juicio de expertos. Se encuestó a 20 mujeres auto medicadas con anticonceptivo oral e inyectable, seleccionado de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicados a la muestra que representa esta investigación(AU)

La automedicación consiste en la selección y el uso de los medicamentos por parte de las personas, sin la participación del médico ni su prescripción, en este sentido es considerado como un fenómeno constante que se produce como consecuencia de necesidades y problemas de múltiples causas, sobre todo de índole económica. Materiales y métodos: Se realiza una investigación de campo, de corte transversal, tipo descriptiva. Se obtuvo una prueba piloto para establecer la validez, pertinencia y coherencia para determinar el grado de confiabilidad del instrumento diseñado cuantitativamente el cual fue validado por juicio de expertos. Se encontró a 20 mujeres automedicadas con anticonceptivo oral e inyectable, seleccionadas de forma aleatoria. Resultados: en cuanto a la validación del instrumento se obtiene una puntuación de 99.4 de validez, 99.2 de pertinencia y 99.4 de coherencia, en su totalidad de 298 dándonos como resultado final de 99.3 % de confiabilidad. Conclusión: el instrumento ha sido aprobado por su confiabilidad y validez, quedando apto para ser aplicado a la muestra que representa esta investigación(AU)

Socio-economic Correlates of Body Mass Index, Blood Pressure and Contraceptive Use by Reproductive age-group Females

Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions. Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).

Anticoncepción de emergencia, evaluación de conocimiento en adolescentes / Emergency contraception, knowledge assessment in teenagers / Contracepção de emergência, avaliação de conhecimento em adolescentes

El inicio sexual temprano, conlleva numerosos riesgos como embarazos precoces o enfermedades de transmisión sexual, abortos; por ello, la importancia de que los adolescentes conozcan la anticoncepción de emergencia, sobre todo, para la prevención del embarazo no deseado y las secuelas del aborto. Objetivo. Describir la anticoncepción de emergencia y la evaluación de su conocimiento en adolescentes. Materiales y métodos. Revisión sistemática, basado en criterios de inclusión y exclusión, se realizó la búsqueda de documentos entre los años 2020 y 2021, de las bases de datos PubMed, Cochrane, Science Direct, Redalyc, Scielo. Se usaron las palabras clave de los DeCS y MeSH; además, se utilizó los operadores booleanos AND, OR. Se obtuvieron 18 artículos para elaborar esta investigación. Resultados. El uso de anticoncepción de emergencia (AE) varía entre el 10,6% hasta un 60% en dependencia de la población estudiada, además, gran parte de los factores de rechazo radican en una desinformación acerca de su mecanismo de acción y a la estigmatización de la misma, el cual es visto como un método abortivo. El nivel de conocimiento acerca de la AE es baja, destacando factores como el hecho de asistir a un colegio de menor nivel académico y ser inmigrante, los que se asocian con un menor conocimiento de la misma. Conclusiones. Pese a los esfuerzos por garantizar una salud sexual y reproductiva los niveles de conocimiento sobre el AE son bajos, siendo reflejado en la prevalencia de utilización y en los factores que limitan su adquisición y uso.

Early sexual initiation carries numerous risks such as early pregnancy or sexually transmitted diseases, abortions; therefore, it is important for adolescents to know about emergency contraception, especially for the prevention of unwanted pregnancy and the sequelae of abortion. Objective. To describe emergency contraception and the evaluation of its knowledge in adolescents. Materials and methods. Systematic review, based on inclusion and exclusion criteria, we searched for documents between 2020 and 2021, from PubMed, Cochrane, Science Direct, Redalyc, Scielo databases. DeCS and MeSH keywords were used; in addition, the Boolean operators AND, OR were used. Eighteen articles were obtained to prepare this research. Results. The use of emergency contraception (EC) varies from 10.6% to 60% depending on the population studied. In addition, a large part of the rejection factors lie in misinformation about its mechanism of action and its stigmatization, which is seen as an abortive method. The level of knowledge about EC is low, with factors such as the fact of attending a school with a lower academic level and being an immigrant being associated with a lower level of knowledge. Conclusions. Despite the efforts to guarantee sexual and reproductive health, the levels of knowledge about EC are low, being reflected in the prevalence of use and in the factors that limit its acquisition and use.

A iniciação sexual precoce acarreta inúmeros riscos, como gravidez precoce ou doenças sexualmente transmissíveis, abortos; portanto, é importante que as adolescentes estejam cientes da contracepção de emergência, especialmente para a prevenção da gravidez indesejada e das conseqüências do aborto. Objetivo. Para descrever a anticoncepção de emergência e a avaliação de seus conhecimentos em adolescentes. Materiais e métodos. Revisão sistemática, baseada em critérios de inclusão e exclusão, pesquisamos documentos entre 2020 e 2021, nas bases de dados PubMed, Cochrane, Science Direct, Redalyc, Scielo. Foram utilizadas as palavras-chave DeCS e MeSH; além disso, foram utilizados os operadores Booleanos AND, OR. Dezoito artigos foram obtidos para esta pesquisa. Resultados. O uso da anticoncepção de emergência (CE) varia de 10,6% a 60% dependendo da população estudada. Além disso, uma grande parte dos fatores de rejeição reside na desinformação sobre seu mecanismo de ação e sua estigmatização, o que é visto como um método abortivo. O nível de conhecimento sobre CE é baixo, com fatores como o fato de freqüentar uma escola com um nível acadêmico inferior e ser um imigrante sendo associado a um nível de conhecimento inferior. Conclusões. Apesar dos esforços para garantir a saúde sexual e reprodutiva, os níveis de conhecimento sobre CE são baixos, como refletido na prevalência do uso e nos fatores que limitam sua aquisição e uso.

Factores asociados al uso de métodos anticonceptivos en mujeres en edad fértil de 15 a 49 años según encuesta demográfica en Perú / Associated factors within the use of contraceptive methods in women of childbearing age between 15 to 49 years old according to a demographic survey in Peru

Introducción: Los métodos anticonceptivos son importantes herramientas para lograr una planificación familiar deseada. Objetivo: Determinar los factores asociados al uso de métodos anticonceptivos en mujeres en edad fértil de 15 a 49 años según ENDES 2018. Material y métodos: Estudio descriptivo, observacional, analítico y retrospectivo. Se analizó la muestra de la Encuesta Nacional Demográfica de Salud Familiar (ENDES), del año 2018 a mujeres peruanas entre 15 a 49 años que respondieron el módulo de métodos anticonceptivos. Resultados: Mayor prevalencia de usuarias de métodos anticonceptivos en el área urbana (RP=1,046, IC:1,037 ­ 1,054), según estado conyugal se evidencia un mayor uso en casadas o convivientes (RP=1,080 IC:1,071 ­ 1,090), en el nivel educativo se obtiene que mujeres con estudios superiores tiene mayor prevalencia de uso de anticonceptivos (RP= 1,021, IC:1,016 ­ 1,026) y, finalmente, la edad en la 1ª relación sexual menor a los 17 años tiene mayor prevalencia (RP = 1,017 IC:1,016 ­ 1,026). Conclusión: Existe asociación positiva entre residir en área urbana, edad de primera relación sexual menor a 17 años, ser casada o conviviente y tener grado de instrucción superior y el uso de métodos anticonceptivos.

Background: Contraceptive methods are an important tool to achieve the desired family planning.To determine the factors associated Objective:within the use of contraceptive methods in women of childbearing age between 15 to 49 years old according to the ENDES 2018. Material and methods: Descriptive, observational, analytical and retrospective study. The sample, of the National Demographic Survey of Family Health (ENDES) 2018, to Peruvian women between 15 to 49 years old who responded to the contraceptive methods module was analyzed. Results: There is a higher prevalence of women using contraceptive methods in the urban area (PR = 1,046, CI: 1,037 - 1,054), according the marital status there is a high use in married women of contraceptive use (PR = 1,080 CI: 1,071 - 1,090), in the educational level it's obtained that women with higher education have a higher prevalence of contraceptive use (PR = 1,021, CI: 1,016 - 1,026) and, finally, that the age in the first sex relationship before 17 years has a higher prevalence (PR = 1,017 CI: 1,016 - 1,026). Conclusion: There is a positive association between living in an urban area, age of first sexual intercourse less than 17 years, being married and having high educational level in the use of contraceptive methods.