Conocimiento de los enfermeros sobre el dispositivo intrauterino en el contexto de las unidades básicas de salud

Objetivo: Verificar el conocimiento de los enfermeros sobre el dispositivo intrauterino en el contexto de las Unidades Básicas de Salud. Método: Estudio observacional realizado con enfermeros de atención primaria. El instrumento de recolección fue elaborado a través de una revisión bibliográfica y validado por especialistas en el área de la salud de la mujer. Los datos se recopilaron de forma remota entre octubre de 2021 y enero de 2022. Se respetaron las consideraciones éticas para la investigación con seres humanos. Resultados: Participaron 66 enfermeros. La mayoría de los enfermeros tuvieron sus conocimientos clasificados como satisfactorios (75.8%). Se observó que la mayoría respondió correctamente sobre la clasificación del DIU con cobre (69.7%), sus efectos secundarios (89.4%), que no interfiere con la lactancia (97%), no protege contra las ITS (92.4%), no desarrolla cáncer de cuello uterino (92.4%). Sabían que las mujeres nulíparas (69.7%), diabéticas (97%) e hipertensas (97%) pueden usar DIU de cobre. Sin embargo, desconocían el uso del DIU como anticoncepcional de emergencia (87.8 %) y por parte de las mujeres con SIDA (66.7 %);consideraban la necesidad de exámenes previos como criterio de elegibilidad (86.4 %) y que la perforación uterina es el más frecuente riesgo de inserción (63.6%).Conclusión: El desconocimiento de los enfermeros, en el contexto de la atención primaria de salud, sobre el dispositivo intrauterino, se convierte en una barrera que limita el acceso al método anticonceptivo. Por lo tanto, las habilidades de los enfermeros deben ser fortalecidas a través de la educación continua para la calificación de la atención primaria de salud.Alternate :Objetivo: Verificar o conhecimento de enfermeiros sobre o dispositivo intrauterino no contexto das Unidades Básicas de Saúde. Método: Estudo observacional realizado com enfermeiros da atençâo básica. O instrumento de coleta foi elaborado por revisâo de literatura e validado por especialistas da área da saúde da mulher. Os dados foram coletados de forma remota entre outubro de 2021 e janeiro de 2022. Respeitaram-se as consideraçöes éticas para pesquisas com seres humanos. Resultados: Participaram 66 enfermeiros. A maioria dos enfermeiros teve seu conhecimento classificado como satisfatório (75,8%). Observou-se que a maioria respondeu corretamente acerca da classificaçâo do DIU com cobre (69,7%), seus efeitos colaterais (89,4%), que o mesmo nao interfere na amamentaçâo (97%), nao protege contra IST's (92,4%), nao desenvolve cáncer de colo uterino (92,4%). Sabiam que nulíparas (69,7%), diabéticas (97%) e hipertensas (97%) podem fazer o uso do DIU com cobre. No entanto, desconheciam o uso do DIU como contracepçâo de emergencia (87,8%) e por mulheres com AIDS (66,7%), consideraram a necessidade de exames prévios como critério de elegibilidade (86,4%) e que a perfuraçâo uterina é o risco mais frequente da inserçâo (63,6%). Conclusäo: A falta de conhecimento dos enfermeiros, no ámbito da atençâo primária de saúde, sobre o dispositivo intrauterino, torna-se uma barreira que limita o acesso ao método contraceptivo. Deve-se, portanto, fortalecer as habilidades dos enfermeiros por meio da educaçâo continuada para a qualificaçâo da atençâo primária â saúde.Alternate :Objective: To verify nurses' knowledge about the intrauterine device in the context of Basic Health Units. Method: Observational study conducted with primary care nurses. The collection instrument was developed by literature review and validated by specialists in the field of women's health. Data were collected remotely between October 2021 and January 2022. Ethical considerations for research with human beings were respected. Results: Sixty-six (66) nurses participated. Most nurses had their knowledge classified as satisfactory (75.8%). It was observed that the majority answered correctly about IUD classification with copper (69.7%), its side effects (89.4%), that it does not interfere with breastfeeding (97% , does not protect against STI (92.4%), does not develop cervical cancer (92.4%). They knew that nulliparous (69.7%), diabetic (97%) and hypertensive (97%) women can use the IUD with copper. However, they were unaware of the use of IUDs as emergency contraception (87.8%) and by women with AIDS (66.7%), considered the need for previous examinations as an eligibility criterion (86.4%) and that uterine perforation is the most frequent risk of insertion (63.6%). Conclusion: The lack of knowledge of nurses, in the context of primary health care, about the intrauterine device, becomes a barrier that limits access to the contraceptive method. Therefore, the skills of nurses should be strengthened through continuing education for the qualification of primary health care.

How did regional lockdowns during the COVID-19 pandemic affect recruitment into a large multinational cohort study of intrauterine device users?

OBJECTIVES: To investigate the impact of lockdown policies on the recruitment of an ongoing cohort study. STUDY DESIGN: We performed descriptive analyses of recruitment, dropout, and baseline characteristics over time. Oxford Stringency Index was used to assess the impact of regional constraints on recruitment. RESULTS: Drop in recruitment clearly reflected the Stringency Index within the first months of the pandemic. Unexpectedly, drop-out rates declined in 2020/2021. Baseline characteristics were comparable, yet younger women were recruited more frequently during the pandemic. CONCLUSIONS: There was no strong evidence of recruitment bias due to the pandemic. IMPLICATIONS: The COVID-19 pandemic is a potential source of bias for ongoing studies and its influence on the study conduct (e.g., recruitment, drop-out) should be thoroughly evaluated to ensure that study results are not biased in this regard. The Oxford's Government Stringency Index can be used to identify pandemic-affected time periods.

Acceptance rate of post-placental plac ement of intrauterine devices during the SARS-CoV-2 (COVID-19) pandemic.

OBJECTIVE: To evaluate the acceptance rate of post-placental intrauterine device (PPIUD) placement during the SARS-CoV-2 (COVID-19) pandemic and to to assess factors associated with PPIUD acceptance. METHODS: A cross-sectional study was conducted between August 2020 and August 2021. PPIUDs were offered to women scheduled for caesarean delivery or admitted in labour at the Women's Hospital of the University of Campinas. The study compared women according to whether they accepted or did not accept the IUD placement. The factors associated with PPIUD acceptance were analysed through bivariate and multiple logistic regression analyses. RESULTS: We enrolled 299 women (15.9% of the deliveries that occurred during study period), aged 26.8 ± 6.5 years; 41.8% were White, almost one third were primiparous, and 155/299 (51.8%) had a vaginal delivery. The PPIUD acceptance rate was 65.6%. The principal reason for refusal was the desire for another contraceptive (41.8%). Women with the highest likelihood of accepting a PPIUD were younger (<30 years old has 1.7 more likely or 74% greater), those without a partner (3.4 times more likely) and those after vaginal delivery (1.7 times more likely or 69% greater). CONCLUSION: The COVID-19 does not affected the PPIUD placement. PPIUD is a viable alternative during crisis in which women has difficult to access health services. Younger women, those without a partner and after vaginal delivery were more likely to accept a PPIUD during the COVID-19 pandemic.

Post-placental IUDs are an alternative during periods of crisis like the COVID-19 pandemic. Younger women, those without a partner and after vaginal delivery were more likely to accept a PPIUD during the COVID-19 pandemic.

Trends of intrauterine device insertion and 'Googling' about intrauterine devices before and during the COVID-19 pandemic in Australia.

Objective: The COVID-19 pandemic significantly disrupted access to primary care in Australia. This could have negatively impacted reproductive health services rates such as intrauterine device insertion rates, and interest in seeking information about intrauterine devices by searching on Google. We aimed to assess the trends of, and the association between, the actual Medicare service utilization rates for intrauterine device insertion and searching about intrauterine devices on Google, before and during the COVID-19 pandemic. Methods: We conducted systematic analyses of secondary data from June 2017 to May 2022, using Medicare and Google Trends data sources. We visualized the rates of intrauterine device insertion, plus Google's search volumes about 'Intrauterine device' and 'Progestin IUDs' as topics. Then, we assessed the correlation between intrauterine device insertion rates and Google search, using Spearman correlation. Results: The average yearly rates of intrauterine device insertion increased noticeably from 25.1-26.3 in 2018-2019 to 29.3-31.2 per 100,000 population in 2020-2021 (12-18% increase). The highest monthly intrauterine device insertion rate nationally (37 per 100,000 population) was seen in March 2021. By June 2020, search term use for the two intrauterine device-related topics returned to much higher levels (50% increase for 'Progestin IUDs', and 54% for 'Intrauterine device', respectively). A moderately strong correlation was seen between actual intrauterine device insertion rates and search on Google about intrauterine devices (Spearman rho = 0.61, p < 0.000). Conclusion: We demonstrated a moderately strong correlation between trends of intrauterine device insertion rates and search on Google about intrauterine devices, before and during the COVID-19 pandemic in Australia. Googling about intrauterine devices could, therefore, be a useful indicator to gauge future interest in actual intrauterine device insertion for months thereafter.

Contraception Recommendations: Updates for the Busy Clinician

Primary care clinicians are an important source of reproductive health care for their patients. Knowledge of contraception methods is essential to informed patient-centered decision-making about contraceptive options

Recap of the sixth international symposium on intrauterine devices and systems for women's health.

Due to the COVID-19 pandemic, the Sixth International Symposium on Intrauterine Devices and Systems for Women's Health was held as a series of seven 2-hour webinars between May 28, 2020, and June 22, 2021. This Symposium featured 48 different presenters and moderators covering a wide range of topics to highlight new IUD issues and update general IUD knowledge, just as it was done in previous symposia dating back to 1962 [1-5]. A total of 1346 people attended remotely to observe the events live. In this article, we share summaries of the presentations from the sixth symposium. These summaries, provided by the presenters, are meant to archive the symposium. This article gives the reader an overview of the topics and identifies the sessions' moderators and speakers charged with providing the content. Those interested in further detail, references, and information about the speakers can find more information on the conference website: www.iud2020.com. After the summaries, we share ideas for future IUD research and programmatic needs, as provided by Symposium's presenters and organizers. The authors' summaries are personal opinions and do not necessarily reflect the perspectives of the Symposium's organizers or the medical community at large. The Symposium was recorded and the sessions are available for viewing free of charge at the website, www.iud2020.comor on YouTube. As of July 2022, approximately 1700 visitors have viewed the recordings.

IUD insertion timing, breastfeeding associated with device expulsion risk

The article discusses research which examined the association of intrauterine device (IUD) insertion timing and breastfeeding to IUD expulsion, conducted by Mary Anne Armstrong and published in an issue of "JAMA Network Open" journal. Topics explored include the risk of uterine perforation in postpartum IUD insertion in breastfeeding women, the incidence rates recorded among breastfeeding and nonbreastfeeding women, and the acknowledgment of IUD expulsion risk in pre-insertion counseling.

Perspectives of obstetricians and midwives on the provision of immediate postpartum intrauterine devices: a qualitative service evaluation.

BACKGROUND: Immediate postpartum intrauterine device (PPIUD) insertion is safe and effective but largely unavailable in Europe. Data on maternity staff views on the provision and implementation of PPIUD services are limited. The objective of this qualitative evaluation was to explore the views and experiences of obstetricians and midwives providing PPIUD within a UK maternity setting, in order to identify areas for improvement and inform service provision in other areas. METHODS: Qualitative health services research within two public maternity hospitals in Lothian (Edinburgh and surrounding region), UK. Interviews with 30 maternity staff (obstetricians n=8; midwives n=22) involved in PPIUD provision. Data were analysed thematically. RESULTS: Maternity staff were positive about the benefits of PPIUD for women. Midwives reported initial concerns about PPIUD safety, and the impact on workload; these views shifted following training, and as PPIUD was embedded into practice. Having a large pool of PPIUD-trained staff was identified as an important factor in successful service implementation. Having PPIUD 'champions' was important to address staff concerns, encourage training uptake, and advocate for the service to ensure continued resourcing. CONCLUSIONS: PPIUD in maternity services can help address unmet need for effective contraception in the immediate postpartum period. We emphasise the importance of widespread engagement around PPIUD among all healthcare professionals involved in the care of women, to ensure staff are informed and supported. Clinical champions and leaders play a key role in amplifying the benefits of PPIUD, and advancing organisational learning.

More than just contraception: the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years.

Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.