Do Swiss community pharmacists address the risk of sexually transmitted infections during a consultation on emergency contraception? A simulated patient study.

Objectives: Since 2002, Swiss community pharmacists have dispensed emergency contraception (EC) as pharmacist-only medicine ideally using the official Swiss protocol. Our study aimed to determine pharmacists' resolution of an imaginary EC case, compliance with the protocol, and provision of information on the risk of sexually transmitted infections (STIs). Methods: We conducted a simulated patient study with 69 students who each visited a community pharmacy. The scenario started with the student requesting the 'morning after pill'. Current practice was assessed using an online evaluation form adapted from the Medication-Related Consultation Framework. Descriptive and statistical analyses were carried out. Results: All pharmacists correctly identified that the person needed EC. All pharmacists used an EC protocol and asked on average 10.9 (standard deviation 0.68) of 11 compulsory EC assessment questions. In total, 93% of pharmacists addressed EC counselling items and 56% addressed the risk of STIs, mainly by mentioning that condoms offered the best protection (76%). Conclusions: Community pharmacists correctly issued the EC, complied with the dispensing protocol and used their professional judgement to ensure optimal EC use. There is nevertheless room for improvement regarding pharmacists' STI counselling. Finally, the protocol's STI section could be enriched with specific information to guide counselling.

Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF).

The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.

Controversias sobre el mecanismo del levonorgestrel postcoital: pruebas a partir de la disminución de embarazos / Controversies about the mechanism of postcoital levonorgestrel: evidences according to the decrease of pregnancies

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[New recommendations from the World Health Organization (WHO) for the use of contraceptive methods]. / Nuevas recomendaciones de la Organización Mundial de la Salud (OMS) para el uso de los métodos anticonceptivos.

The Medical Eligibility Criteria for Contraceptive Use of the World Health Organization have been updated recently. These criteria constitute a guideline for the selection of family planning methods appropriated for women and men with known medical conditions or personal characteristics of medical relevance. The guidelines last updating incorporates recommendations for the use of a new emergency contraceptive pill and three long-acting hormonal methods, and revises some previously established recommendations. This article provides information on the last edition of such document and aims to contribute to its dissemination.

A vueltas con la objeción de conciencia de los farmacéuticos comunitarios / Struggling with the conscientious objections of community pharmacists

La sentencia del Pleno del Tribunal Constitucional del 25 de junio de 2015 ha provocado que se coloque de nuevo en el debate público la cuestión de la objeción de conciencia en las profesiones sanitarias. En 2010, año de la aprobación de la Ley 2/2010, de salud sexual y reproductiva, éste había sido ya un tema de amplia discusión. En este comentario nos proponemos exponer los problemas éticos y jurídicos fundamentales que plantea el recurso de amparo, los argumentos principales que refleja la sentencia y que, a nuestro juicio, son relevantes para la bioética y tratar de fijar cuáles son los avances o retrocesos que en la cuestión bioética de la objeción de conciencia de los profesionales sanitarios aporta esta resolución judicial (AU)

The ruling of the plenary session of the constitutional tribunal of June 25, 2015 once again brought the question of conscientious objection in the healthcare profession into public debate. This was a subject of considerable discussion in 2010, when Law 2/2010 regarding sexual and reproductive health was approved. In this article we attempt to illustrate the fundamental ethical and legal problems presented by this appeal on the grounds of unconstitutionality and the main arguments in the judgment that are, in our opinion, relevant to bioethics. We also attempt to identify the advances or setbacks of this legal ruling with regard to bioethics of the conscientious objection of the healthcare professionals (AU)

Emergency Contraception for Adolescents: A Political Battle.

The political debate for adolescents to have access to emergency contraception that is available over the counter has been going on for years. Since 1999, Levonorgestrel, Plan B One Step®, has been used in the United States as an emergency contraception but with a prescription at the time. The FDA has done years of research and testing with Barr Laboratories, the manufacture of Plan B One Step®, to make it safe for females of all ages. In 2003, the FDA recommended the over the counter use of Plan B One Step® for all ages, yet this did not occur. In pharmacies across our nation young women find it impossible to purchase this product whether they be of age or not. Politics is making the choices for our young females, not medical evidence. How long are we going to let this continue?

Practice Bulletin Summary No. 152: Emergency Contraception.

Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception (1-3). Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen-progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises (4-6). The purpose of this Practice Bulletin is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase awareness of these methods among obstetrician-gynecologists and other gynecologic providers.

ISGE statement on oral emergency contraception.

Unintended pregnancy is an important public health problem worldwide. Unwanted pregnancies may end in induced abortion (legal or illegal, safe or unsafe) or in childbirth. In many parts of the world both can be life threatening. Even where both are safe, abortion is distressing for all concerned while unwanted births often lead to poor health and social outcomes for both the mother and her child.

Thinking outside the box: meeting the sexual health needs of women presenting for emergency contraception.

This was a retrospective audit of sexual health screening and advice for long-term contraception in 174 and 993 women attending genitourinary (GU) medicine and contraceptive services (CS), respectively, for emergency hormonal contraception (EHC) over a 21-month period (April 2007-September 2008). Assessment and screening for sexually transmitted infection (including HIV) were more comprehensive at GU medicine (78% offered screening at GU medicine versus 17% at CS) while contraceptive management was more complete at CS (ongoing contraception discussed in 99% at CS versus 78% at GU medicine). Follow-up was seldom recommended or attended. Local HIV prevalence necessitates a more pro-active approach to HIV testing. Women requesting EHC present to a variety of clinical settings, each with their own areas of expertise. In an age of integrated sexual and reproductive health, these women deserve a holistic approach to care.

Emergency contraception: can we benefit from lessons learned?

The aim of the paper was to evaluate current emergency contraception (EC) methods and policies in order to implement lessons learned and maximize potential population impact while introducing dedicated EC pills in Croatia. Literature search for potential reasons for EC failing to show positive population impact and detecting actionable points to be implemented in national guidelines. Six potential reasons for ECs failure to show population impact were evaluated and four actionable points were detected: low use of EC compared to the numbers of risk events, low awareness on EC in general population, differences in efficacy of EC methods and EC vailability. In order to ensure EC's population impact in Croatia it is of a critical relevance to establish continuous education programs for population of women at risk. When recommending an EC method, superior efficacy must be a key decision-making criteria therefore cooper IUD and ulipristal acetate should be our primary options. Counseling is a critical step to ensure maximal efficacy of the EC method, but also to encourage future use of regular contraceptives. Finally, national ECP dispension protocol is needed to close the loop from effective women screening, prompt yet appropriate ECP administration/dispensing towards structured follow up after EC pills intake.

Emergency contraception: knowledge and attitudes of Nova Scotian family physicians.

OBJECTIVE: To determine the extent to which Nova Scotian FPs prescribe and provide emergency contraceptive pills (ECPs) and to explore their knowledge of and attitudes toward ECPs. DESIGN: Survey of Nova Scotian FPs using a modified Dillman method. SETTING: All regions of Nova Scotia. PARTICIPANTS: Family physicians registered with Dalhousie University's Division of Continuing Medical Education. MAIN OUTCOME MEASURES: Sex differences in the provision of ECPs and knowledge and attitudes about the ECP Plan B. RESULTS: Of 913 eligible FPs, 155 (17.0%) participated in the survey. Respondents resembled the sampling frame closely. Most physicians (64.0%) had prescribed ECPs in the previous year (mean number of prescriptions, 4.92); only 12.9% provided ECPs in advance of need. Knowledge about Plan B was quite good, except for knowledge of the time frame for potential effectiveness; only 29.2% of respondents answered that question correctly. Respondents generally supported nonprescription availability of ECPs, but 25.0% of FPs were concerned that this could lead to less use of more effective methods of contraception, and 39.2% believed that it would encourage repeat use. Younger FPs provided ECPs more often than their older colleagues, while female respondents had better knowledge about Plan B. In multivariate analysis being younger than 40 years was marginally associated with prescribing Plan B and with prescribing any form of ECP. CONCLUSION: Most Nova Scotian FPs provided ECPs and had generally good knowledge about and attitudes toward providing such contraception without prescription. However, FPs were poorly informed about the length of time that Plan B can be effective, which could potentially affect use when patients consult several days after unprotected sex. There were some concerns about nonprescription availability of ECPs, which could have implications for recommending it to patients. Rarely were ECPs prescribed for advance use, which might represent a lost prevention opportunity, especially for adolescents who often do not use effective contraception.

Knowledge and practices of emergency contraception among Ghanaian women.

The use of emergency contraceptives (EC) to prevent unwanted pregnancies when effective contraception has not been used is universally acknowledged. A study looked at the knowledge and practices of emergency contraception in 476 women in the reproductive age in Ghana. Knowledge and usage of EC applied to 57% and 41% of participants, respectively. Knowledge was independent of age (p = 0.26), marital status (p = 0.14) and level of education (p = 0.21). Drugs (85.6%), herbal preparations (14.4%) and douching (43%) were used for emergency contraception. Drugs used included the combined Pill-24.0%, Postinor-28.5% and Norethisterone-43%. Only 44% correctly used drugs as EC. There is a high level of knowledge about EC as well as usage in the country. There is general misuse ofnorethisterone as EC. There is no knowledge in this study population that intrauterine device can be used as EC.

Update on emergency contraception.

Emergency contraception is a woman's last chance to prevent unintended pregnancy. Ulipristal acetate, a selective progesterone receptor modulator, when taken as a single 30 mg dose, is a new, safe and effective emergency contraceptive that can be used from the first day and up to 5 days following unprotected intercourse. The older progesterone-only emergency contraceptive, levonorgestrel, is taken as two 0.75 mg pills 12 hours apart (Next Choice(®); Watson Pharmaceuticals Inc., Morristown, NJ, USA) or a single 1.5 mg pill (Plan B One-Step™; Watson Pharmaceuticals Inc.), and is approved for only 72 hours after unprotected intercourse. During clinical development, ulipristal acetate has been shown to be more effective than levonorgestrel in delaying or inhibiting ovulation. A recent meta-analysis of two randomized clinical trials showed ulipristal acetate to have a pregnancy risk 42% lower than levonorgestrel up to 72 hours and 65% lower in the first 24 hours following unprotected intercourse. Moreover, when taken beyond 72 hours, significantly more pregnancies were prevented with ulipristal acetate than with levonorgestrel. Side effects are mild and similar to those seen with levonorgestrel. Ulipristal acetate was approved for emergency contraception by the US Food and Drug Administration in August 2010, and has been launched in the USA as ella(®) (Watson Pharmaceuticals Inc.) since December 1, 2010. Ella is prescription only and is priced comparable to Plan B One-Step.

Emergency contraception in Argentina: grey areas of common sense and public policy.

Abstract This paper discusses specific obstacles to emergency contraception (EC) in Argentina, the 'grey areas' between contraception and abortion: potential users as well as health providers do not distinguish clearly between ordinary contraception, EC and abortion. Based on quantitative and qualitative findings, the study shows the need to intervene in providing the population and the health sector with information on EC, its mechanisms and accessibility, and the 'grey areas' that hinder an adequate distinction between regular contraception, EC and abortion.

Cambio en la accesibilidad a la píldora poscoital y análisis de la influencia sobre la incidencia en las infecciones de transmisión sexual / Change in the accesibility of the emergency contraceptive pills and analysis concerning the influence on the incidence of sexually transmitted disease

Introducción: En España se ha puesto en marcha la dispensación gratuita de la píldora poscoital en los servicios de urgencias de atención primaria, lo que permite el acceso rápido y gratuito a las usuarias. Objetivos: Evaluar la influencia que ha tenido la administración gratuita de la píldora poscoital en atención primaria sobre su consumo, y comparar su evolución con las tendencias evolutivas de la incidencia de infecciones de transmisión sexual(ITS). Material y método: Estudio observacional y descriptivo. Se incluyeron datos de consumo de la píldora poscoital en farmacias y centros de salud e ITS de declaración obligatoria durante un periodo de 6 años (2002-2007). Variables de medida: tasa de consumo anual (consumo en número de envases de píldora poscoital por 1.000 habitantes y año), incidencia (número de nuevos casos acontecidos en un año) y tasa de incidencia (por 100.000 habitantes) para la sífilis e infecciones gonocócicas. Resultados: Tasa de consumo de la píldora poscoital al inicio del estudio (dispensación en oficinas de farmacia) de 3,02 frente a 12,44 en el año 2007. La tendencia al aumento de la tasa de consumo total de la píldora poscoital se relacionó de manera significativa (p= 0,024) y de tipo lineal con la tendencia al aumento de la incidencia de sífilis. Conclusiones: Se detecta un elevado incremento del consume de la píldora poscoital y una probable asociación con el aumento de la incidencia de sífilis (AU)

Introduction: In Spain they have implemented, the free dispensing of the emergency contraceptive pills in the primary care emergency departments, which allows the rapid and free access for the users. Objective: To evaluate the influence that free administration of emergency contraception in Primary Care has had on its consumption and compare the evolution of consumption of the above mentioned over time with incidence of sexually transmitted diseases (STDs). Materials and Method: Descriptive observational study Data on the consumption of the emergency contraceptive pill from drugstores and health centres of Obligatorily Declared sexually transmitted diseases were collected over 6 years (2002-2007). Main outcome measures: Annual level of consumption (consumption in number of emergency contraceptive pill boxes per 1,000 inhabitants per year, incidence (number of new cases detected in a year), and incidence rate (incidence per 100,000 inhabitants) for syphilis and gonococcal infections. Results: The consumption rate of the emergency contraceptive pill at the beginning of the study (distributed in drugstores) was3.02 versus to 12.44 in the year 2007. The tendency of the consumption rate of the emergency contraceptive pill to increase was found to be significant (p=0.024) and lineally related with the tendency of the syphilis rate to increase. Conclusions: An increased consumption of the emergency contraceptive pill and a probable association with the increase in the occurrence of syphilis was detected (AU)