Professional counseling in women with serious mental illness: achieving a shift toward a more effective contraceptive method.

OBJECTIVES: Mental disorders in reproductive-aged women have significant implications for the risk of unintended pregnancies. The objective of this study is to assess the professional counseling in clinical practice based on motivational interview in women with serious mental illness (SMI) in order to achieve a change to a more effective contraceptive method. STUDY DESIGN: A prospective observational cohort study (2012-2017) was conducted in a convenience sample of women with severe-moderate psychiatric disorders (n = 91). Information related to psychiatric health, contraceptive use, sexual and reproductive health and socio-demographics was collected. To assess the variation in the contraceptive method, follow-up visits were planned before and after medical counseling. All participants underwent an evidence-based individual motivational interview for contraception counseling. A multivariate logistic model was carried out to identify the factors involved in changing to a more effective contraceptive method. RESULTS: After evidence-based counseling, 51.6% of participants changed their contraceptive method to a more effective one. This change was associated with gender violence (ß coefficient = 1.58, p value = .006). The relation between changing to a more effective contraceptive method and both previous abortions and having children was also positive, although the coefficients did not reach statistical significance. CONCLUSIONS: Evidence-based contraception counseling in clinical practice, based on an adapted protocol to patients with SMI, has shown, in this study, to be adequate to promote the shift to more effective contraceptive methods, avoiding the need of daily compliance in this population. Gender violence has been significantly associated with the shift to very high effectiveness methods as well as previous abortions and having children, not significantly.

Effect of cost on early removal of contraceptive implants: a prospective cohort study.

OBJECTIVES: To evaluate the effect of the cost of subdermal etonogestrel implant (SEI) on the continuation rate one year after insertion, and to assess the reasons given by users to remove the implant before the expiration date. METHODS: Prospective cohort study conducted among 265 women who chose the SEI as a contraceptive method in a sexual and reproductive health center in the eastern region of Spain, between October/2012 and October/2017. The sample was divided into two cohorts depending on the cost of the implant for the user (free-of-charge or requiring partial payment). Kaplan-Meier survival curves were used to compare the cumulative removal rates of free implants with partially paid implants within the first year of insertion. Cox proportional hazards models were used to control for confounders. RESULTS: After adjusting for confounders, no significant associations were found between the cost of the implant and its removal within a year of insertion. No significant associations were found in the reasons given for implant removal and for the duration of implant use. CONCLUSIONS: Cost was not associated with SEI continuation rates within the first year of use. No other significant variables were found to explain implant removal within one year of use.

A rosemary extract rich in carnosic acid selectively modulates caecum microbiota and inhibits ß-glucosidase activity, altering fiber and short chain fatty acids fecal excretion in lean and obese female rats.

BACKGROUND: Carnosic acid (CA) and rosemary extracts (RE) show body-weight, energy metabolism and inflammation regulatory properties in animal models but the mechanisms are not yet understood. Gut microbiota plays an important role in the host metabolism and inflammatory status and is modulated by the diet. The aim of this research was to investigate whether a RE enriched in CA affected caecum microbiota composition and activity in a rat model of genetic obesity. METHODS AND PRINCIPAL FINDINGS: A RE (40% CA) was administered with the diet (0.5% w/w) to lean (fa/+) and obese (fa/fa) female Zucker rats for 64 days. Changes in the microbiota composition and ß-glucosidase activity in the caecum and in the levels of macronutrients and short chain fatty acids (SCFA) in feces were examined. The RE increased the Blautia coccoides and Bacteroides/Prevotella groups and reduced the Lactobacillus/Leuconostoc/Pediococccus group in both types of animals. Clostridium leptum was significantly decreased and Bifidobacterium increased only in the lean rats. ß-Glucosidase activity was significantly reduced and fecal fiber excretion increased in the two genotypes. The RE also increased the main SCFA excreted in the feces of the obese rats but decreased them in the lean rats reflecting important differences in the uptake and metabolism of these molecules between the two genotypes. CONCLUSIONS: Our results indicate that the consumption of a RE enriched in CA modifies microbiota composition and decreases ß-glucosidase activity in the caecum of female Zucker rats while it increases fiber fecal elimination. These results may contribute to explain the body weight gain reducing effects of the RE. The mutated leptin receptor of the obese animals significantly affects the microbiota composition, the SCFA fecal excretion and the host response to the RE intake.