Knowledge and Patterns of Use of Emergency Oral Contraception among Portuguese Female Users of Healthcare Services.

INTRODUCTION: The lack of knowledge about the existence, effectiveness, and supply of emergency contraception as well as access to it, its effective duration and the lack of recognition of the need for its use can prevent women from using it. The aim of this study was to ascertain the attitudes, experience, level of knowledge and information sources about emergency contraception of Portuguese female users of healthcare services. MATERIAL AND METHODS: We conducted a multicentre, cross-sectional, observational study among 280 Portuguese women users of health care services through an original and anonymous questionnaire composed of 30 questions. RESULTS: The mean age of the women who replied to the questionnaire was 33.83 ± 8.76 years. Of the observed sample, 27.7% used EC, 50% of whom with no counselling. Despite 92.1% of women claiming knowledge about emergency contraception, only 31.2% of these answered 8 - 10 questions correctly (14 in total). The media were the most frequent source of information (63.4%). Most participants (67.5%) considered that emergency contraception is associated with severe adverse reactions. Furthermore, 76% did not know the time range of effectiveness after unprotected sexual intercourse. Youngest age (p = 0.038), higher education level (p < 0.001), increasing parity (p = 0.051) and previous use of emergency contraception (p = 0.011) were identified as the determinant sociodemographic factors for a higher level of knowledge about emergency contraception. DISCUSSION: The use of emergency contraception after counselling by healthcare professionals was lower than reported in the literature. CONCLUSION: This study showed that female users of healthcare services were aware of the existence of emergency contraception, but they demonstrated a low level of knowledge about it, especially regarding the correct period of use, place of acquisition and safety issues.

Introdução: A falta de conhecimento sobre a existência, eficácia e fornecimento da contraceção de emergência, bem como a sua acessibilidade, prazo efetivo e a falta de reconhecimento da possibilidade da sua utilização podem impedir as mulheres de a utilizarem. O objetivo do estudo foi conhecer a experiência, atitudes, as fontes de informação e nível de conhecimento sobre a contraceção de emergência entre mulheres portuguesas utilizadoras dos cuidados de saúde. Material e Métodos: Foi desenvolvido um estudo observacional, transversal e multicêntrico em 280 mulheres portuguesas utilizadoras dos cuidados de saúde, através da aplicação de um questionário original e anónimo constituido por 30 questões. Resultados: A idade média das mulheres que responderam ao questionário situou-se nos 33,83 ± 8,76 anos. Da amostra em estudo, 27,7% referiram utilização prévia de contraceção de emergência, das quais 50% sem aconselhamento. Apesar de 92,1% afirmar conhecer esta opção, apenas 35,9% respondeu corretamente a entre oito a 10 questões de avaliação de conhecimento (total de 14). Os media constituiram a fonte de informação mais frequente (63,4%). A maioria das participantes (67,5%) considera que a contraceção de emergência está associada a efeitos adversos graves e 76% desconhece o intervalo de tempo de eficácia da contraceção de emergência após relações sexuais desprotegidas. A idade jovem (p = 0,038), maior nível de escolaridade (p < 0,001), o aumento da paridade (p = 0,051) e a utilização prévia de contraceção de emergência (p = 0,031) foram os fatores sociodemográficos associados a maior nível de conhecimento sobre a mesma. Discussão: O uso de contraceção de emergência após aconselhamento por profissionais de saúde foi inferior ao descrito na literatura. Conclusão: O estudo demonstrou que apesar das utilizadoras dos cuidados de saúde de afirmarem ter conhecimento da existência da contraceção de emergência, revelaram baixo nível de conhecimento sobre este tipo de contraceção, particularmente em relação ao período correto de utilização, local de aquisição e questões de segurança.

Misdosing of Non-Vitamin K Antagonist Oral Anticoagulants in Primary Care.

PURPOSE: Prescription patterns of non-vitamin K antagonist oral anticoagulants (NOACs) are unknown among primary care physicians, where most patients with nonvalvular atrial fibrillation (NVAF) are diagnosed and followed up. The goal of this study was to evaluate overdosing and underdosing of NOACs in patients with NVAF followed up in primary care and determine their clinical predictors. METHODS: This multicenter cross-sectional study included all patients with NVAF followed up in 13 primary care units in the center region of Portugal. Patients receiving antithrombotic regimens other than NOACs and patients with missing data were excluded. FINDINGS: The study included 858 patients with NVAF on an NOAC regimen. Overall, 30.3% were prescribed an off-label dosage (25.4% with infratherapeutic dosing [ITD] and 4.9% with supratherapeutic dosing). Chronic kidney disease (odds ratio, 14.0; 95% CI, 5.4-36.5; P < 0.001) and female sex (odds ratio, 2.6; 95% CI, 1.2-5.7; P < 0.001) were independent predictors of supratherapeutic dosing. We also found a significant effect of chronic kidney disease on ITD (odds ratio, 0.22; 95% CI, 0.258-0.678; P < 0.001). IMPLICATIONS: In primary care, NOACs are frequently prescribed with unadjusted dosages, generally infratherapeutic. Attention should be paid to women and patients with chronic kidney disease.

Specific behavioral and cellular adaptations induced by chronic morphine are reduced by dietary omega-3 polyunsaturated fatty acids.

Opiates, one of the oldest known drugs, are the benchmark for treating pain. Regular opioid exposure also induces euphoria making these compounds addictive and often misused, as shown by the current epidemic of opioid abuse and overdose mortalities. In addition to the effect of opioids on their cognate receptors and signaling cascades, these compounds also induce multiple adaptations at cellular and behavioral levels. As omega-3 polyunsaturated fatty acids (n-3 PUFAs) play a ubiquitous role in behavioral and cellular processes, we proposed that supplemental n-3 PUFAs, enriched in docosahexanoic acid (DHA), could offset these adaptations following chronic opioid exposure. We used an 8 week regimen of n-3 PUFA supplementation followed by 8 days of morphine in the presence of this diet. We first assessed the effect of morphine in different behavioral measures and found that morphine increased anxiety and reduced wheel-running behavior. These effects were reduced by dietary n-3 PUFAs without affecting morphine-induced analgesia or hyperlocomotion, known effects of this opiate acting at mu opioid receptors. At the cellular level we found that morphine reduced striatal DHA content and that this was reversed by supplemental n-3 PUFAs. Chronic morphine also increased glutamatergic plasticity and the proportion of Grin2B-NMDARs in striatal projection neurons. This effect was similarly reversed by supplemental n-3 PUFAs. Gene analysis showed that supplemental PUFAs offset the effect of morphine on genes found in neurons of the dopamine receptor 2 (D2)-enriched indirect pathway but not of genes found in dopamine receptor 1(D1)-enriched direct-pathway neurons. Analysis of the D2 striatal connectome by a retrogradely transported pseudorabies virus showed that n-3 PUFA supplementation reversed the effect of chronic morphine on the innervation of D2 neurons by the dorsomedial prefontal and piriform cortices. Together these changes outline specific behavioral and cellular effects of morphine that can be reduced or reversed by dietary n-3 PUFAs.