Patterns of contraception utilization among reproductive-aged women with thyroid cancer undergoing radioiodine ablation: A study at Hasan Sadikin Hospital.

The incidence of new cases of thyroid cancer worldwide is around 10.1/100.000 in woman dan 3.1/100.000 in men. Women with thyroid cancer are advised to avoid pregnancy while undergoing radioablation due to teratogenicity. Therefore, it is crucial to utilize contraception to avoid pregnancy during treatment. The purpose of this study was to determine the characteristics of contraceptive use patterns in women with thyroid cancer of reproductive age who underwent radioablation at Hasan Sadikin Hospital Bandung.Cross-sectional study conducted at Hasan Sadikin Hospital Bandung in May 2023. The research sample was all female thyroid cancer of reproductive age who underwent radioablation at the Nuclear Medicine polyclinic of Dr. Hasan Sadikin Bandung in January-December 2022 by purposive sampling. Data obtained from patient medical records and primary data from patients. A total of 450 patients fulfilled inclusion criteria, but only 329 analyzed with complete data. Majority of the patient was in age group 35-49 years (58.1%), parity >1 (55.9%), last education high school (39.2%), married (81.8%), type of papillary thyroid carcinoma (79.9%), sources of information about contraception from doctors (71.7%), and 75.4% use contraception. The most widely used type of contraception was intrauterine device (IUD), accounting for 28.6% patients. Approximately 75.4% patient use contraception. The most widely used type of contraception is the IUD. Contraception counselling is important for increasing contraceptive use rates among women with thyroid cancer. Further research in the form of analytical research is needed to assess the factors that influence contraceptive use in women with thyroid cancer of reproductive age.

L'incidence des nouveaux cas de cancer de la thyroïde dans le monde est d'environ 10,1/100 000 chez la femme et 3,1/100 000 chez l'homme. Il est conseillé aux femmes atteintes d'un cancer de la thyroïde d'éviter une grossesse lorsqu'elles subissent une radioablation en raison de la tératogénicité. Il est donc crucial d'utiliser une contraception pour éviter une grossesse pendant le traitement. Le but de cette étude était de déterminer les caractéristiques des modes d'utilisation des contraceptifs chez les femmes atteintes d'un cancer de la thyroïde en âge de procréer qui ont subi une radioablation à l'hôpital Hasan Sadikin de Bandung. Étude transversale menée à l'hôpital Hasan Sadikin de Bandung en mai 2023. L'échantillon de recherche était entièrement cancer de la thyroïde chez la femme en âge de procréer qui a subi une radioablation à la polyclinique de médecine nucléaire du Dr Hasan Sadikin Bandung en janvier-décembre 2022 par échantillonnage raisonné. Données obtenues à partir des dossiers médicaux des patients et des données primaires des patients. Au total, 450 patients remplissaient les critères d'inclusion, mais seulement 329 ont été analysés avec des données complètes. La majorité des patients appartenaient à la tranche d'âge 35-49 ans (58,1%), parité >1 (55,9%), dernier diplôme d'études secondaires (39,2%), mariés (81,8%), type de carcinome papillaire de la thyroïde (79,9%), sources d'information sur la contraception auprès des médecins (71,7 %) et 75,4 % utilisent la contraception. Le type de contraception le plus utilisé était le dispositif intra-utérin (DIU), représentant 28,6 % des patientes. Environ 75,4 % des patientes utilisent une contraception. Le moyen de contraception le plus utilisé est le DIU. Les conseils en matière de contraception sont importants pour augmenter les taux d'utilisation des contraceptifs chez les femmes atteintes d'un cancer de la thyroïde. Des recherches supplémentaires sous forme de recherches analytiques sont nécessaires pour évaluer les facteurs qui influencent l'utilisation de la contraception chez les femmes atteintes d'un cancer de la thyroïde en âge de procréer.

Prevalence of high-risk HPV and cervical dysplasia in IUD users and controls: a cross sectional study.

OBJECTIVE: To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. METHODS: A cross-sectional register-based study including 16,181 women aged 30-49 years participating in the screening programme for cervical cancer in a Swedish County in 2017-2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. RESULTS: There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04-1.41, and aOR 1.41; 95% CI 1.22-1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02-2.06, and aOR 1.56; 95% CI 1.13-2.16, respectively). No significant differences were found in HPV clearance rates. CONCLUSIONS: Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

Women using copper IUD showed no difference in prevalence of HPV or cervical dysplasia compared to women not using contraception in cross-sectional study.

Catholic Hospital Affiliation and Postpartum Contraceptive Care and Subsequent Deliveries.

Importance: In recent years, the number of Catholic hospitals has grown, raising concerns about access to contraception. The association between living in an area in which the closest hospital is Catholic and the probability of postpartum contraception and subsequent deliveries is unknown. Objective: To assess whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries. Design, Setting, and Participants: This cohort study used data from the Healthcare Cost and Utilization Project's State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states (California, Florida, Georgia, Missouri, Nebraska, Nevada, New York, South Carolina, Tennessee, Vermont, and Wisconsin). Female patients with a delivery from 2016 to 2019 who lived within 20 miles of a nonfederal acute care hospital were included, with patients followed up for 1 to 3 years. Coarsened exact matching was used to match patients based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code-level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Data were analyzed from April 2022 to November 2023. Exposures: Residence in a zip code in which the closest hospital was Catholic. Main Outcomes and Measures: Probabilities of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years. Results: The sample consisted of 4 101 443 deliveries (1 301 792 after matching), with 14.5% of patients living in exposed zip codes (ie, where the closest hospital was Catholic). Living in exposed zip codes was associated with a 21.26-percentage point (pp) increase in the probability of delivery at a Catholic hospital (95% CI, 19.50 to 23.02 pp; 237.3% relative to the mean in unexposed zip codes; P < .001). Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp (95% CI, -1.14 to -0.76 pp; P < .001) and the probability of sterilization in the year after discharge further decreased by 0.21 pp (95% CI, -0.29 to -0.13; P < .001). Subsequent deliveries within 3 years increased 0.47 pp (95% CI, -0.03 to 0.97 pp; 2.3% relative to the mean in unexposed zip codes; P = .07). Conclusions and Relevance: This cohort study finds that living in a zip code in which the closest hospital was Catholic was associated with a modest decrease in the probability of postpartum surgical sterilizations and a modest increase in the probability of subsequent deliveries.

Characterizing Family Planning Utilization in Adult Women and Adolescents in Pohnpei, Federerated States of Micronesia.

INTRODUCTION: Increasing family planning xutilization in low-income countries to improve health outcomes of women and children is a global priority. The Federated States of Micronesia (FSM) has poor maternal child health outcomes; therefore, this study aimed to examine family planning utilization in Pohnpei State, FSM. METHODS: This cross-sectional study sought to characterize family planning utilization in adult women of reproductive age and high school age adolescents in Pohnpei using representative survey data collected in 2019 (N = 570 and N = 1726, respectively). Chi-square tests were used to determine significant factors associated with family planning utilization. RESULTS: Among adult women of reproductive age (18-49 years old) not trying to get pregnant, 31.6% reported using contraception during last intercourse. Contraceptive use was significantly lower among younger women (18-24 years old) (21.7%, p = 0.021), unmarried women (18.6%, p < 0.001), those without health insurance (28.7%, p = 0.030), those who have never had a pap smear (20.5%, p < 0.001), and those who have never been pregnant (14.5%, p < 0.002). Among adolescents who reported being sexually active, 28.5% reported using any contraception at last intercourse and 22.6% reported using a condom at last intercourse. Condom use among sexually active adolescents was lowest among 12th graders (13.5%, p < 0.001) and girls (16.8%, p = 0.004). CONCLUSIONS: Our findings suggest that young, unmarried, never pregnant women face an unmet need for family planning. Additionally, women with lower access to and use of healthcare services have lower use of family planning.

Reproductive healthcare in adolescents with autism and other developmental disabilities.

BACKGROUND: Adults with developmental disabilities often have less access to reproductive health services than adults without these disabilities. However, little is known about how adolescents with developmental disabilities, including autism, access reproductive healthcare. OBJECTIVE: We aimed to characterize the use of reproductive healthcare services among adolescents with autism and those with other developmental disabilities in comparison with adolescents with typical development. STUDY DESIGN: We conducted a cohort study of a sample of adolescents who were continuously enrolled members of Kaiser Permanente Northern California, an integrated healthcare system, from ages 14 to 18 years. The final analytical sample included 700 adolescents with autism, 836 adolescents with other developmental disabilities, and 2187 typically developing adolescents who sought care between 2000 and 2017. Using the electronic health record, we obtained information on menstrual conditions, the use of obstetrical-gynecologic care, and prescriptions of hormonal contraception. We compared healthcare use between the groups using chi-square tests and covariate-adjusted risk ratios estimated using modified Poisson regression. RESULTS: Adolescents with autism and those with other developmental disabilities were significantly more likely to have diagnoses of menstrual disorders, polycystic ovary syndrome, and premenstrual syndrome than typically developing adolescents. These 2 groups also were less likely than typically developing peers to visit the obstetrician-gynecologist or to use any form of hormonal contraception, including oral contraception, hormonal implants, and intrauterine devices. Adolescents in all 3 groups accessed hormonal contraception most frequently through their primary care provider, followed by an obstetrician-gynecologist. CONCLUSION: Adolescents with autism and those with other developmental disabilities are less likely than their typically developing peers to visit the obstetrician-gynecologist and to use hormonal contraception, suggesting possible care disparities that may persist into adulthood. Efforts to improve access to reproductive healthcare in these populations should target care delivered in both the pediatric and obstetrics-gynecology settings.

Descripción de las personas gestantes afiliadas a OSEP que solicitan una interrupción del embarazo / Description of pregnant people affiliated to osep who request a pregnancy interruption

En 2021 entró en vigencia en Argentina la Ley N.º 27.610. El objetivo es describir características de afiliadas a OSEP que solicitaron interrupción del embarazo (SIE).Trabajo observacional descriptivo. Se analizaron las variables del 0800 del Ministerio de Salud de la Nación de todas las personas que SIE con OSEP, entre el 24/01 y 31/12/2021. Los datos fueron analizados con SPSS Statistics. Se utilizaron moda, mediana, porcentaje, tasa y el chi2. Se recibieron 427 SIE, se concretaron 330 (77,3%). Solicitaron ive: media 28,59 años. Modo 19 y 33 años. Concretaron ive: modo 22 años. 84,5% se realizó ambulatorio con misoprostol. De las SIE, 50,4% eran solteras, 43,4% trabajaba, 59,1% tenía secundario completo. Se desconoce 32,8%. De las SIE, 52,7% refirió haber estado utilizando MAC (54,2% preservativo; 37,4% anticonceptivos orales; 2,8% métodos "naturales"; 2,2% DIU). La mayor cantidad fue de zonas urbanas del Gran Mendoza. Sin embargo, se observan tasas elevadas en zonas rurales respecto de algunas zonas urbanas y más pobladas. Se observó progresión de SIE a lo largo del año. Un 11% después de SIE decidió continuar con el embarazo. Aparentemente ninguna de las variables tuvo relación con esa decisión. El MAC utilizado fue mayormente preservativo y anticonceptivos orales. Esto podría indicar falta de educación y poco acceso a métodos de larga duración. La problemática de interrupción es transversal. En base a los resultados de este trabajo, las personas sin pareja conviviente, ante un embarazo no planificado serían las que SIE. Ninguna otra variable parece actuar como determinante. Tampoco del paso de la solicitud a la interrupción efectiva o a la continuación del embarazo. Hay que aumentar la accesibilidad a MAC en zonas rurales (AU)

In 2021, Law No. 27610 entered into force in Argentina. The objective is to describe characteristics of people with OSEP who requested termination of pregnancy (PWRTP). Descriptive observational work. The variables of the 0800 of the Ministry of Health of Argentina of all the PWRTP with OSEP, between 01/24 and 12/31/2021, were analyzed. Data were analyzed with SPSS Statistics. Mode, median, percentage, rate and chi2 were used. PWRTP: 427 requests were received, 330 (77.3%) were completed. PWRTP: mean 28.59 years. Mode 19 and 33 years. People who had an abortion: mode 22 years. 84.5% were performed on an outpatient basis with misoprostol. 50.4% of the PWRTP were single, 43.4% worked, 59.1% had completed high school, 32.8% unknown, 52.7% reported having been using contraceptive methods (CM): 54.2% condoms; 37.4% oral contraceptives; 2.8% "natural" methods; 2.2% IUDs. The largest amount was from urban areas of Mendoza. However, high rates are observed in rural areas. A progression of the amount of PWRTP was observed throughout the year. 11% after requesting an abortion decided to continue with the pregnancy. Apparently none of the variables was related to that decision. The CM used were mostly condoms and oral contraceptives. This may indicate a lack of education and poor access to long-acting CM. The problem of interruption is transversal. People without a cohabiting partner, faced with an unplanned pregnancy, are the ones who RTP. No other variable seems to act as a determinant. Nor from the transition from the request to the effective interruption or continuation of the pregnancy. We must increase the accessibility to CM in rural areas (AU)

Influência da utilização de métodos contraceptivos sobre as taxas de gestação não planejada em mulheres brasileiras / Influence of contraceptive use on unplanned pregnancy rates in Brazilian women

Este estudo teve como objetivo primário analisar a taxa de gestações não planejadas e sua relação com o uso de métodos contraceptivos no Brasil. Secundariamente, procurou-se identificar o impacto da pandemia por SARS-CoV-2 sobre o desejo reprodutivo e a utilização de contraceptivos. Foram entrevistadas mulheres entre 16 e 45 anos que tiveram pelo menos uma gestação, por meio de questionário on-line, em todas as regiões brasileiras. Foram analisados dados de 1.000 mulheres com média etária de 34,7 anos, paridade média de 1,69 filho e número médio de 2,01 gestações. Entre as mulheres, 62% referiram ter tido pelo menos uma gestação não planejada, com maior percentual entre as mulheres que utilizam o sistema público de saúde (65%) em relação ao sistema privado (55%). Entre as mulheres que referiram ao menos uma gestação não planejada, 46% usavam algum método contraceptivo na ocasião. O uso atual de métodos contraceptivos atingiu 81% das mulheres entrevistadas, sendo os contraceptivos orais utilizados por 31%, seguidos dos preservativos (20%), laqueadura tubária (10%) e métodos de longa ação (LARC, 9%). Entre as mulheres, 53% considerariam um LARC como modalidade contraceptiva, especialmente entre as que referiram esquecimento frequente de pílulas. Durante a pandemia, 7% das mulheres entrevistadas referiram suspender o uso de contraceptivos. Para 80%, não houve mudanças no planejamento reprodutivo durante a pandemia, porém observaram-se 10% de gestações não planejadas. Em conclusão, a menor adoção de métodos contraceptivos, aliada ao uso incorreto/ falha do método, associa-se a maiores taxas de gestações não planejadas. Métodos com maior índice de eficácia são considerados por mulheres que já experimentaram gestações não planejadas. Houve pequeno impacto da pandemia sobre o uso de métodos contraceptivos e sobre o planejamento reprodutivo.(AU)

Pediatric oncology clinician communication about sexual health with adolescents and young adults: A report from the children's oncology group.

BACKGROUND: Sexual health (SH) is an important concern for adolescents and young adults (AYAs). This study determined current SH communication practices, barriers, and additional resources needed among pediatric oncology clinicians who treat AYAs. METHODS: A cross-sectional survey was developed by the Children's Oncology Group (COG) AYA Committee and sent to pediatric oncologists (n = 1,987; 85.9%) and advanced practice providers (APPs, n = 326; 14.1%) at 226 COG institutions. Responses were tabulated and compared using tests of proportion and trend. RESULTS: The sample comprised 602 respondents from 168 institutions and was proportionally representative (468 oncologists [77.7%], 76 APPs [12.6%], 58 unidentified [9.6%]; institutional and provider response rates 74.3% and 26.2%, respectively). Almost half of respondents (41.7%) reported no/small role in SH care. Medical topics were discussed most often, including contraception (67.2%), puberty (43.5%), and sexual activity (37.5%). Topics never/rarely discussed included gender identity (64.5%), sexual orientation (53.7%), and sexual function (50.3%). Frequently cited communication barriers included lack of time, low priority, perceived patient discomfort, and the presence of a parent/guardian. Respondents endorsed the need for further education/resources on sexual function (66.1%), gender identity/sexual orientation (59.5%), and body image (46.6%). Preferred education modalities included dissemination of published guidelines (64.7%), skills training modules (62.9%), and webinars (45.3%). By provider type, responses were similar overall but differed for perception of role, barriers identified, and resources desired. CONCLUSIONS: Many pediatric oncology clinicians play minimal roles in SH care of AYAs and most SH topics are rarely discussed. Provider-directed education/training interventions have potential for improving SH care of AYA cancer patients.

Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon.

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

Evaluation of the frequency of coitus interruptus and the effect of contraception counselling on this frequency.

In this prospective study, the aim was to determine the frequency and effectiveness of the coitus interruptus method, to compare the demographic characteristics of women using modern contraception methods and those using the coitus interruptus method and to demonstrate how effective contraceptive counselling is in choosing a contraception method. The researchers collected data from 1000 sexually active women in their reproductive period at the gynaecological clinic of a university hospital in Turkey. The researchers used an introductory information contraceptive counselling form, which they prepared for the data collection tool. The rate of the coitus interruptus method use among the interviewed women was 42.8%. There was a statistically significant difference between the coitus interruptus group and the group using modern contraceptive methods regarding mean age, educational status, smoking, awareness of last menstrual period, number of pads used during the menstrual period, and information sources. Following effective contraception counselling, the rate of switching to a modern and proven contraceptive method was found to be 73.8%.Impact statementWhat is already known on this subject? Although the traditional method of coitus interruptus has been used for many years, its incidence is not clearly known. What we know about the subject is based on ancient research. All the studies on the subject are very old and need to be updated.What do the results of this study add? With the help of the data obtained from this study, it is understood that withdrawal method is still widely used today, it is still not known that it is not a modern contraceptive method and the rate of transition to modern methods with effective contraception counselling is very high.What are the implications of these findings for clinical practice and/or further research? In the outpatient clinic conditions, even a very short period of time for contraception counselling will be very beneficial for women and will contribute to family planning and prevent unwanted pregnancies.

Início da atividade sexual e sexo protegido em adolescentes / Comienzo de la actividad sexual y sexo protegido en adolescentes / Initiation of sexual activity and protected sex in adolescents

Resumo Objetivos Identificar a prevalência do início da atividade sexual em adolescentes e a prática de sexo seguro entre os mesmos. Método Estudo transversal realizado com 499 adolescentes, em Pouso Alegre, Minas Gerais, de fevereiro a abril de 2017, por meio de um questionário autoaplicado e semiestruturado, contemplando iniciação, práticas sexuais, conhecimento sobre contracepção, prevenção de infecções sexualmente transmissíveis e participação em atividades educativas sobre o tema. Os dados foram analisados por estatística descritiva, as diferenças estatísticas avaliadas pelo teste X2 de Pearson. Resultados A prevalência da atividade sexual foi 47,3%, com idade média da sexarca de 14,1 anos, e tendência de iniciação sexual precoce no sexo masculino. Um terço das primeiras relações sexuais foram desprotegidas (33,9%). As participantes do sexo feminino apresentavam maior conhecimento a respeito de contracepção e prevenção de doenças, menor adesão ao uso de preservativos e maior utilização de contraceptivos orais e de emergência. Conclusão e implicações para a prática O estudo mostrou início precoce de vida sexual entre adolescentes, e um terço das relações sexuais sem proteção. Há necessidade de ações de saúde e educação que garantam a aquisição de conhecimento e acesso a métodos contraceptivos.

Resumen Objetivos Identificar la prevalencia de la actividad sexual en adolescentes y la práctica de sexo seguro entre ellos. Método Estudio transversal realizado con 499 adolescentes, de febrero a abril de 2017, por medio de un cuestionario autoadministrado y semiestructurado, que abarca la iniciación sexual y las prácticas, conocimiento sobre métodos anticonceptivos, prevención de infecciones de transmisión sexual y participación en actividades educativas sobre el tema. Los datos se analizaron mediante estadística descriptiva y las diferencias estadísticas se evaluaron mediante la prueba X2 de Pearson. Resultados La prevalencia de la actividad sexual fue del 47,3%, con una edad promedio de la primera relación sexual de 14,1 años y una tendencia a la iniciación sexual temprana entre los participantes masculinos. Un tercio de las primeras relaciones sexuales fueron desprotegidas (33,9%). Las mujeres participantes tenían mayor conocimiento sobre los métodos anticonceptivos y prevención de enfermedades, menos adherencia al uso del condón y mayor uso de anticonceptivos orales y de emergencia. Conclusión e implicaciones para la práctica El estudio mostró un inicio temprano de la vida sexual entre un grupo de adolescentes y un tercio de las relaciones sexuales sin protección. Se advierte la necesidad de llevar a cabo acciones en materia de salud y educación que garanticen la adquisición de conocimiento y el acceso a métodos anticonceptivos.

Abstract Objective Identify the prevalence of sexual activity initiation in adolescents and the practice of safe sex among them. Method A cross-sectional study carried out with 499 adolescents in Porto Alegre, Minas Gerais, from February to April 2017, using a self-administered and semi-structured questionnaire, covering sexual initiation and practices, knowledge about contraceptive methods, prevention of sexually transmitted infections and participation in educational activities on the theme. The data were analyzed using descriptive statistics and the statistical differences were assessed using Pearson's X2 test. Results The prevalence of sexual activity was 47.3%, with a mean age of 14.1 years old at first sexual intercourse, and a tendency for early sexual initiation in the male gender. One third of the first sexual intercourses were unprotected (33.9%). Female participants had greater knowledge about contraceptive methods and disease prevention, lower adherence to condom use and greater use of oral and emergency contraceptives. Conclusion and implications for the practice The study showed an early initiation of sexual life among adolescents, and one third of unprotected sexual intercourses. There is a need for health and education actions that guarantee the acquisition of knowledge and access to contraceptive methods.

Fatores relacionados ao planejamento familiar em região de fronteira / Factores relacionados con la planificación familiar en una región fronteriza / Factors related to family planning in border region

RESUMO Objetivo identificar fatores que potencializam ou interferem no planejamento familiar em região de fronteira. Método pesquisa descritiva, de coorte, transversal e quantitativa, realizada com 280 puérperas, Paraná, Brasil. Para a coleta de dados, aplicou-se um instrumento estruturado com variáveis socioeconômicas, antecedentes obstétricos e planejamento familiar. Para análise, utilizou-se o teste de associação Qui-Quadrado ou o teste G complementado pela análise de resíduos ajustados, com nível de significância de 5% (p<0,05). Resultados idade inferior a 19 anos (66%), baixa renda (65,3%), escolaridade (62,6%), ausência de companheiro (95,6%) e multiparidade (74,4%) foram as características que interferiram no planejamento familiar. Maior escolaridade e acesso a métodos contraceptivos apresentaram-se favoráveis ao planejamento familiar. Mulheres que não planejaram a gravidez aderiram mais aos métodos contraceptivos após seis meses do nascimento do filho. Conclusão e implicações para a prática as baixas condições sociodemográficas interferem na adesão ao planejamento familiar em região de fronteira, o que remete para ajustes no serviço de atenção primária.

RESUMEN Objetivo identificar factores que mejoran o interfieren con la planificación familiar en una región fronteriza. Método investigación descriptiva, de cohorte, transversal y cuantitativa, realizada con 280 puérperas, Paraná, Brasil. Para la recolección de datos se aplicó un instrumento estructurado con variables socioeconómicas, antecedentes obstétricos y planificación familiar. Para el análisis se utilizó la Prueba de Chi-Cuadrado o la Prueba G, complementada con el análisis de residuos ajustados, con un nivel de significancia del 5% (p<0,05). Resultados edad menor de 19 años (66%), bajos ingresos (65,3%), educación (62,6%), ausencia de pareja (95,6%) y multiparidad (74,4%) fueron las características que interfirieron en la planificación familiar. La mayor escolarización y el acceso a métodos anticonceptivos favorecieron la planificación familiar. Las mujeres que no planificaron el embarazo se adhirieron más a los métodos anticonceptivos después de seis meses de parto. Conclusiones e implicaciones prácticas las bajas condiciones sociodemográficas interfieren con la adherencia a la planificación familiar en una región fronteriza, lo que se refiere a ajustes en el servicio de atención primaria.

ABSTRACT Objective to identify factors that enhance or interfere with family planning in border region. Method this descriptive, cohort, cross-sectional, quantitative study was performed with 280 puerperal women in Paraná State, Brazil. For data collection, a structured instrument with socioeconomic variables, obstetric antecedents and family planning was applied. For analysis, the chi-square test or the G test complemented by adjusted residual analysis was used, with a significance level of 5% (p <0.05). Results age below 19 years (66%), low income (65.3%) and education (62.6%), absence of a partner (95.6%) and multiparity (74.4%) were the characteristics that interfered with family planning. Greater education level and access to contraceptive methods were favorable to family planning. Women who did not plan for pregnancy more adhered to contraceptive methods six months after the birth of their child. Conclusion and implications for practice low sociodemographic conditions interfere with adherence to family planning in a border region, which refers to adjustments in the primary care service.

Fertilidade e contracepção em mulheres com câncer em tratamento quimioterápico / Fertilidad y anticoncepción en mujeres con cáncer en tratamiento quimioterápico / Fertility and contraception in women with cancer treatment undergoing chemotherapy

RESUMO Objetivo identificar em mulheres em idade reprodutiva, com câncer e durante o tratamento quimioterápico, as orientações sobre preservação de fertilidade e planejamento reprodutivo e conhecer as informações fornecidas pela equipe de saúde. Métodos estudo descritivo, realizado com mulheres na pré-menopausa, com diagnóstico de câncer e em tratamento quimioterápico. A coleta de dados foi realizada com apoio de um instrumento com informações sociodemográficas, sobre o câncer e seus tratamentos, informações referentes a preservação de fertilidade e uso de métodos contraceptivos antes e após o diagnóstico do câncer. A análise dos dados foi feita por meio de estatística descritiva. Resultados a média de idade das 49 participantes foi de 38,2 anos (DP=6,1) e 79,6% estavam em tratamento devido ao câncer de mama. Quanto as informações recebidas sobre a importância do planejamento reprodutivo, 77,6% das participantes referiram que foram orientadas e 59,2% receberam tais orientações da equipe médica. Entretanto, em relação ao aconselhamento sobre métodos para manter a fertilidade, apenas, 6,1% das participantes foram orientadas. Conclusão e Implicações para a prática Deve-se considerar a relevância do aconselhamento especializado e a da manutenção de tomada de decisões ativas da mulher sobre a preservação de sua fertilidade.

RESUMEN Objetivo identificar en mujeres en edad reproductiva, con cáncer y durante el tratamiento de quimioterapia, las orientaciones sobre preservación de la fertilidad y planificación reproductiva y conocer las informaciones proporcionadas por el equipo de salud. Métodos estudio descriptivo, realizado con mujeres premenopáusicas diagnosticadas con cáncer y sometidas a quimioterapia. La recolección de datos se realizó con apoyo de un instrumento con información sociodemográfica sobre el cáncer y sus tratamientos, información sobre la preservación de la fertilidad y uso de métodos anticonceptivos antes y después del diagnóstico del cáncer. El análisis de los datos se realizó mediante estadística descriptiva. Resultados la media de edad fue de 38,2 años (DE= 6,1), y 79,6% estaban en tratamiento para el cáncer de mama. Cuanto a la información recibida sobre la importancia de la planificación reproductiva, 77,6% de los participantes informaron que estaban orientados y 59,2% recibió orientación del equipo médico. Sin embargo, con respecto al asesoramiento sobre métodos para mantener la fertilidad, solo 6,1% de las participantes recibieron asesoramiento. Conclusión e Implicaciones para la práctica Debe tenerse en cuenta la importancia de la asesoría experta y el mantenimiento de una toma de decisiones activa por parte de las mujeres para preservar su fertilidad.

ABSTRACT Objective to identify in women of reproductive age, with cancer and during chemotherapy treatment, the guidelines on fertility preservation and reproductive planning and to know the information provided by the health team. Methods descriptive study, conducted with premenopausal women diagnosed with cancer and undergoing chemotherapy. Data collection was performed with the support of an instrument with sociodemographic information about cancer and its treatments, information regarding the preservation of fertility and the use of contraceptive methods before and after cancer diagnosis. Data analysis was performed using descriptive statistics. Results the average age of the 49 participants was 38.2 years (SD=6.1) and 79.6% were being treated for breast cancer. Regarding the information received about the importance of reproductive planning, 77.6% of participants reported that they were oriented and 59.2% received such guidance from the medical team. However, regarding counseling on methods to maintain fertility, only 6.1% of participants were counseled. Conclusion and Implications for practice consideration should be given to the importance of expert counseling and the maintenance of active decision making by women about preserving their fertility.

Salud sexual y reproductiva en la ciudad de Buenos Aires: Situación y respuesta 2020 / Sexual and reproductive health in the City of Buenos Aires: Situation and response 2019

Puesta al día sobre la situación de la salud sexual y reproductiva en la Ciudad de Buenos Aires, así como las acciones que han realizado los equipos de salud para garantizar los derechos de la población, aún en el contexto de pandemia que se inició en marzo de 2020 y continúa a la fecha de la elaboración de este documento. Como en las oportunidades anteriores, el eje de la publicación reconoce dos objetivos diferentes y complementarios: valorar el trabajo que se realiza de modo cotidiano en los establecimientos públicos de salud de la ciudad y brindar una herramienta que se confía sea de utilidad para los diferentes actores estatales y de la sociedad civil involucrados e interesados en conocer los logros y desafíos de la política. Se realiza una breve caracterización sobre el impacto de la pandemia en el subsistema público de salud y en la población, y se incluyeron además otros aspectos novedosos que tuvieron lugar en 2020. (AU)

Association of the National Dependent Coverage Expansion With Insurance Use for Sexual and Reproductive Health Services by Female Young Adults.

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.

Human fertility in relation to education, economy, religion, contraception, and family planning programs.

BACKGROUND: The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study. METHODS: We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically. RESULTS: In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita. CONCLUSIONS: These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.

A dismenorreia e suas consequências em estudantes universitárias no Rio de Janeiro / Dysmenorrhea and its consequences in university students in Rio de Janeiro

Objetivo: Avaliar a prevalência da dismenorreia e suas consequências em uma população universitária. Métodos: Trata-se de um estudo descritivo, transversal, com 207 mulheres entre 18 e 46 anos de idade, universitárias. Os sujeitos da pesquisa responderam a um questionário desenvolvido para esse estudo. Resultados: A prevalência global de dismenorreia, entre as universitárias, foi de 84,1%; dessas, 58,6% classificaram a dor em intensidade leve a moderada e 41,4%, em intensa. O absenteísmo escolar e a dificuldade para se concentrar nos estudos durante o período menstrual foram significativamente influenciados pela dismenorreia intensa. Entre as estudantes, 60,9% deixaram de fazer atividades físicas ou de lazer e 41% tinham dificuldade para se concentrar e estudar devido à dismenorreia. Conclusão: A dismenorreia tem uma elevada prevalência na população universitária, contribuindo para um aumento do absenteísmo escolar e para um prejuízo social. A maioria utiliza a automedicação e poucas procuram atendimento médico eletivo com a finalidade de resolver esse problema.(AU)

Objective: Evaluate the prevalence of dysmenorrhea and its consequences in a university population. Methods: A cross-sectional descriptive study with 207 female university students between 18 and 46 years. Data collection was performed through a specific questionnaire developed for this study. Results: The overall prevalence of dysmenorrhea among university was 84.1%, of which 58.6% classified the pain intensity as mild to moderate and 41.4% as severe. School absenteeism and a difficulty to concentrate on studies during the menstrual period were significantly influenced by the presence of severe dysmenorrhea, with 60.9% of students interrupting some physical or leisure activity, and 41% reporting that they had difficulty concentrating and studying due to the dysmenorrhea. Conclusion: Dysmenorrhea has a high prevalence in the university population, contributing to a significant increase in school absenteeism and impairing social life. Most students use self-medication and few seek elective medical care to resolve this problem.(AU)

Effectiveness of clinical decision support to enhance delivery of family planning services in primary care settings.

PURPOSE: There is a need to improve delivery of family planning services, including preconception and contraception services, in primary care. We assessed whether a clinician-facing clinical decision support implemented in a family medicine staffed primary care network improved provision of family planning services for reproductive-aged female patients, and differed in effect for certain patients or clinical settings. METHODS: We conducted a pragmatic study with difference-in-differences design to estimate, at the visit-level, the clinical decision support's effect on documenting the provision of family planning services 52 weeks prior to and after implementation. We also used logistic regression with a sample subset to evaluate intervention effect on the patient-level. RESULTS: 27,817 eligible patients made 91,185 visits during the study period. Overall, unadjusted documentation of family planning services increased by 2.7 percentage points (55.7% pre-intervention to 58.4% intervention). In the adjusted analysis, documentation increased by 3.4 percentage points (95% CI: 2.24, 4.63). The intervention effect varied across sites at the visit-level, ranging from a -1.2 to +6.5 percentage point change. Modification of effect by race, insurance, and site were substantial, but not by age group nor ethnicity. Additionally, patient-level subset analysis showed that those exposed to the intervention had 1.26 times the odds of having family planning services documented after implementation compared to controls (95% CI: 1.17, 1.36). CONCLUSIONS: This clinical decision support modestly improved documentation of family planning services in our primary care network; effect varied across sites. IMPLICATIONS: Integrating a family planning services clinical decision support into the electronic medical record at primary care sites may increase the provision of preconception and/or contraception services for women of reproductive age. Further study should explore intervention effect at sites with lower initial provision of family planning services.

Improvement in contraceptive coverage and gynecological care of adult women with cystic fibrosis following the implementation of an on-site gynecological consultation.

OBJECTIVE: Our study aimed to evaluate the impact of the introduction of a new gynecologic referral service in our adult Cystic Fibrosis (CF) center on contraceptive coverage, gynecological follow-up regularity, and cervical cancer screening coverage. STUDY DESIGN: We implemented an on-site gynecological consultation in our adult CF center in 2015. We compared the results of two surveys conducted successively in 2014 and in 2017 in a cohort of women with CF attending the Lyon CF center. Women completed the same self-report written questionnaire as in 2014. Main outcome measures were the comparisons of contraceptive coverage, gynecological follow-up regularity, and cervical cancer screening coverage between 2014 and 2017. RESULTS: All the 136 women (100%) who attended the clinic in 2017 participated. Contraceptive prevalence rate increased from 69%(CI95%:60.3-78.1) to 86%(CI95%:79.6-92.9) between 2014 and 2017 (p = 0.005). Among transplanted patients, the contraceptive prevalence rate was 92.3%(CI95%:82.0-100) in 2017. Long acting reversible contraceptive use markedly increased from 10% to 21.6% (p = 0.005). The proportion of women that reported an access to gynecological care increased between 2014 and 2017 (74%(CI95%:66.3-82.0) vs 91%(CI95%:86.9-95.4), p < 0.005) and reached 100% among transplanted patients. Cervical cancer screening improved (55%(CI95%:51.2-68.8) vs 85%(CI95%:78.6-90.6) women ever screened) (p < 0.0005) and reached 100% among transplanted patients. CONCLUSIONS: We observed an improvement in contraceptive coverage and gynecological care of adult women with CF following the implementation of a dedicated gynecological consultation in the CF center. IMPLICATIONS: Service linkages and formal links between CF centers and gynecologists can facilitate access to disease-specific contraceptive counseling, adequate gynecological management and cervical cancer screening.

Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers.

BACKGROUND: Reliable contraception enables women and men to plan their family sizes and avoid unintended pregnancies, which can cause distress and anxiety, but also increase maternal mortality. This study explored potential barriers to contraceptive use for women in the Gaza Strip, Palestine from user and provider perspectives. METHODS: A convenient sample was used to recruit women, who were current contraception users, from three healthcare clinics that provide family planning care, two governmental and one non-governmental. A 16-item questionnaire was completed by 204 women, including socio-demographic data, contraceptive use and eight questions exploring user experience. Additionally, 51 women attended focus groups for a deeper insight into their contraceptive use experience and potential barriers. Furthermore, 14 healthcare providers were interviewed about their experience with service provision. Quantitative data are presented as means and frequencies and qualitative data were analysed item by item and are presented in themes jointly with the quantitative data. RESULTS: Women reported usage of only three main modern methods of contraception with 35.2% using intrauterine devices, 25.8% combined oral contraception and 16.4% condoms, while only 3.1% used the hormonal implant. Expectations from family planning services were low with most women attending the clinic having already decided their contraceptive method with decisions being made by husbands (41.2%) or women jointly with their partner (33.3%), only 13.7% took advice from service providers. Healthcare providers experienced high prevalence of beliefs that modern contraceptives cause infertility and cancer. Main barriers to effective family planning services were misconceptions of potential harm, poor availability and limited choice of contraceptive methods. CONCLUSION: Women's contraceptive choices in Gaza are limited by prevalent misconceptions and fears as well as recurring shortages, negatively impacting fertility control. Men are a major factor in choosing a contraceptive method, however, they have limited access to information and therefore, potentially more misconceptions. Therefore, male community members need to be included in the delivery of information on contraceptives to increase women's choice. Furthermore, greater access to long-acting reversible contraceptives, such as the hormonal implant, and improved availability might be key factors in improving contraceptive uptake in Gaza and, thus, reducing unintended pregnancies.