Daño hepático inducido por uso de anticonceptivos orales en una paciente con ictericia prolongada y transaminasas elevadas: reporte de caso / Drug-induced liver injury secondary to the use of oral contraceptives in a patient with prolonged jaundice and elevated transaminases: Case report

La hepatotoxicidad inducida por medicamentos es un diagnóstico de descarte. Típicamente, se presenta en pacientes que desarrollan cambios clínicos y bioquímicos compatibles con hepatitis, pero relacionados con el inicio reciente de agentes farmacológicos, y que se resuelven tras el retiro de la noxa. Su desarrollo se ha descrito con el uso de algunos antibióticos, antituberculosos, estatinas, herbolarios y antiinflamatorios no esteroideos; sin embargo, hay pocos reportes de casos con el uso de anticonceptivos orales, en los cuales el surgimiento de mecanismos idiosincráticos puede llevar a la presentación de características clínicas como ictericia y anormalidades en los exámenes de laboratorio, como la elevación de las transaminasas. Esto requiere de estudios extensos para descartar otras patologías que pueden presentarse de esta forma, lo que representa un reto clínico. En este artículo se muestra el reporte de un caso de una paciente con antecedente de uso crónico de anticonceptivos implantables y que, tras el ajuste de la terapia con el inicio de anticonceptivos orales, desarrolla un episodio de elevación marcada de transaminasas e ictericia.

Drug-induced liver injury is a rule-out diagnosis. Typically, it occurs in patients who develop clinical and biochemical changes compatible with hepatitis, but related to a history of recent onset of pharmacological agents, and resolves after withdrawal of the noxious substances. Its development has been described with the use of some antibiotics, antituberculosis agents, statins, herbal and nonsteroidal anti inflammatory drugs; however, there are few reports of cases with the use of oral contraceptives, in which the appearance of idiosyncratic mechanisms can lead to the presentation of clinical features such as jaundice and laboratory tests abnormalities, like transaminase elevation, requiring extensive studies to rule out other pathologies that may have this clinical presentation, wich represents a clinical challenge. We present a case report of a patient who had chronic use of implantable contraceptives and who, after adjustment of therapy with the start of oral contraceptives, developed an episode of marked elevation of transaminases and jaundice.

Acesso aos contraceptivos e direito à saúde em Angola: experiências de mulher e de farmacêutica / Access to contraceptives and the right to health in Angola: experiences of a woman and pharmacist

RESUMO Este relato apresenta uma proposta do que a escritora Conceição Evaristo chama de 'escrevivência' - escrita da mulher negra, que se mescla com vivência, relato de memórias e memórias de seu povo, visando incomodar consciências e ecoar nossas histórias. O 'escrever, viver e se ver' da autora é reconhecido como 'escrita da alma', lugar onde cada mulher escreve considerando o mundo que vive, de uma forma integrada. Visa fazer uma breve reflexão sobre o acesso aos medicamentos, tomando o acesso aos métodos contraceptivos em Angola como recorte, tendo em conta a vivência da autora. É um estudo qualitativo e a coleta de dados foi feita por meio de pesquisa documental, estudo de campo e entrevistas. Para o tratamento de dados foi adotada a análise de conteúdo. Identificou-se que o acesso aos métodos contraceptivos em território angolano é incipiente, resultado de políticas públicas e boa governança pouco efetivas, bem como a interferência externa pouco resolutiva. Estes, são reforçados pela herança colonial, que propicia abordagens em desacordo com as necessidades locais. É fundamental que os direitos sexuais e reprodutivos sejam encarados como questão política, de saúde pública e inerente à dignidade humana, para além da perspectiva eugenista de controle de natalidade.

ABSTRACT This report consists of what Conceição Evaristo calls 'writing and living' - the writing of black women, which mixes with experience, their memories, and the memories of their people, aiming to disturb consciences and echo our stories. The author's 'writing, living and self-seeing' is recognized as the 'writing of the soul', from where each woman writes considering the world she lives in. It aims to briefly reflect on access to medicines, focusing on the access to contraceptive methods in Angola, based on the author's experience. It is a qualitative study, and data were collected through documentary research, field study, and interviews. Content analysis was adopted for data processing. Access to contraceptive methods in Angolan territory is incipient, a result of ineffective public policies and good governance, as well as ineffective external interference. These are reinforced by colonial heritage, which provides approaches in disagreement with local needs. Sexual and reproductive rights must be seen as a political and public health issue inherent to human dignity, beyond the eugenic perspective of birth control.

Uma revisão integrativa a respeito de métodos contraceptivos / An integrative review on contraceptive methods / Una revisión integrativa de los métodos anticonceptivos

Os métodos contraceptivos desempenham um papel vital na saúde sexual e reprodutiva, oferecendo opções que permitem o planejamento familiar e a prevenção de gravidezes indesejadas. Este artigo busca descrever os benefícios e desvantagens dos principais anticoncepcionais presentes na atualidade por meio de uma revisão integrativa da literatura, que buscou identificar os achados científicos publicados nos últimos 10 anos (2013 a fevereiro de 2023). A seleção de artigos foi feita nas bases eletrônicas de dados da PubMed, BVS, SciELO e no Google Acadêmico. Para a realização da revisão integrativa foi estabelecida a pergunta norteadora, para possibilitar a busca na base dados: Quais os benefícios e as desvantagens dos anticoncepcionais adesivo combinado, anel vaginal, sistema intrauterino de liberação de Levonorgestrel (SIU-LNG), contracepção de emergência (pílula de emergência), implante hormonal e anticoncepcional oral (ACO). Um dos pontos mais notáveis nesta revisão foi a grande variedade de métodos contraceptivos e suas peculiaridades, que se adequam à necessidade da usuária, sendo, portanto, preciso uma análise cuidadosa do método a ser escolhido. Outro ponto de destaque, foi que apesar dos benefícios dos contraceptivos, também estão presentes os efeitos adversos e possíveis complicações, além das precauções em sua utilização.

Contraceptive methods play a vital role in sexual and reproductive health, offering options that allow for family planning and the prevention of unwanted pregnancies. This article seeks to describe the benefits and disadvantages of the main contraceptives currently available through an integrative literature review, which sought to identify scientific findings published in the last 10 years (2013 to February 2023). The selection of articles was made in the electronic databases of PubMed, VHL, SciELO and Google Scholar. To carry out the integrative review, the guiding question was established, to enable the search in the database: What are the benefits and disadvantages of contraceptives combined patch, vaginal ring, Levonorgestrel-releasing intrauterine system (LNG-IUS), emergency contraception (emergency pill), hormonal implant and oral contraceptive (OC). One of the most notable points in this review was the wide variety of contraceptive methods and their peculiarities, which adapt to the user's needs, therefore requiring a careful analysis of the method to be chosen. Another highlight was that despite the benefits of contraceptives, adverse effects and possible complications are also present, in addition to precautions in their use.

Los métodos anticonceptivos desempeñan un papel vital en la salud sexual y reproductiva, ofreciendo opciones que permiten la planificación familiar y la prevención de embarazos no deseados. Este artículo busca describir los beneficios y desventajas de los principales anticonceptivos actualmente disponibles a través de una revisión integrativa de la literatura, que buscó identificar hallazgos científicos publicados en los últimos 10 años (2013 a febrero de 2023). La selección de artículos se realizó en las bases de datos electrónicas PubMed, BVS, SciELO y Google Scholar. Para realizar la revisión integradora se estableció la pregunta orientadora, para posibilitar la búsqueda en la base de datos: Cuáles son los beneficios y desventajas de los anticonceptivos combinados parche, anillo vaginal, sistema intrauterino liberador de levonorgestrel (SIU-LNG), anticoncepción de emergencia (emergencia píldora), implante hormonal y anticonceptivo oral (AO). Uno de los puntos más destacables de esta revisión fue la gran variedade de métodos anticonceptivos y sus peculiaridades, que se adaptan a las necesidades del usuario, requiriendo por tanto un análisis cuidadoso del método a elegir. Otro destaque fue que a pesar de los beneficios de los anticonceptivos, también están presentes efectos adversos y posibles complicaciones, además de precauciones en su uso.

Garlic Extract Reverses Ischemic Heart Disease in Female Rats Exposed to Combined Oral Contraceptive Pills

Abstract Background Garlic is an herbal medicinal plant with several pharmacological properties used for the management of various ailments. However, its potential in the reversal of ischemic heart disease induced by combined oral contraceptive pills is not well reported. Objective This study investigated the cardioprotective potential of aqueous garlic extract against cardiotoxicity induced by oral contraceptive pills. Methods Forty-six rats were used for this study. Six were used to determine the lethal dose (LD50), and 40 rats were divided randomly into 5 groups of 8 rats each. Group A received feed and distilled water. Group B received 0.6 mg/kg of oral contraceptive pills. Group C received 500 mg/kg of garlic extract. Group D received 0.6 mg/kg of oral contraceptive pills + 500 mg/kg garlic extract. Group E received 0.6 mg/kg of oral contraceptive pills + 700 mg/kg garlic extract. The animals were sacrificed, and blood and tissue samples were collected for biochemical and histological analysis. Statistical analysis was done using SPSS, and p values < 0.05 were considered significant. Results The acute toxicity dose of combined oral contraceptive pills was 1.5 mg/kg for albino rats. Combined oral contraceptive pills induced ischemic necrosis as revealed by the photomicrographs, in addition to elevation of serum cardiac troponin-1, lactate dehydrogenase, creatine kinase, and malondialdehyde levels. Treatment with garlic extract demonstrated significant reduction in cardiac troponin-1 (p = 0.000), lactate dehydrogenase (p = 0.002), creatine kinase (p = 0.001), and malondialdehyde (p = 0.001) levels, as well as restoration of the cardiac cytoarchitecture changes caused by the combined oral contraceptive pills. Conclusion This study has demonstrated that aqueous garlic juice can reverse ischemic heart disease, lessen cytoarchitectural alterations of the heart caused by combined oral contraceptive pills, and thus ameliorate cardiac dysfunction.

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Uso de anticonceptivos de emergencia y percepción sobre sus perjuicios en estudiantes universitarias colombianas / Use of emergency contraception and knowledge about its harms on Colombian female university students i: en

Introducción: La educación sexual y reproductiva puede prevenir o reducir cualquier daño físico o mental, o ambos, ocasionado por las prácticas sexuales de riesgo y el uso inadecuado de métodos anticonceptivos. Objetivo: Describir el uso de anticonceptivos de emergencia en estudiantes universitarias y la percepción de estas en cuanto a los perjuicios de dichos métodos para la salud. Métodos: Se efectuó un estudio descriptivo y transversal, de abril a octubre de 2021, de 372 féminas mayores de 18 años de edad, matriculadas en universidades ubicadas en Medellín, Colombia, quienes fueron seleccionadas mediante un muestreo no probabilístico. La información se obtuvo a través de una encuesta, en la cual se incluyeron variables relacionadas con el empleo de los anticonceptivos de emergencia y la percepción sobre sus perjuicios. Resultados: En la serie, 67,7 % de las jóvenes había usado anticonceptivos de emergencia, de las cuales 8,7 % refirió consumir hasta 3 píldoras de levonorgestrel al mes y 0,8 %, más de 10 durante un año; en tanto, 97,8 % consideró que este tipo de método afecta la salud. Entre los principales efectos secundarios figuraron los sangrados irregulares (65,8 %), las náuseas (31,7 %), los vómitos (31,7 %), la migraña (3,2 %) y los cambios de ánimo (25,4 %). Conclusiones: Aunque la mayoría de las estudiantes universitarias que usaban anticonceptivos de emergencia se guiaban por las recomendaciones médicas, un pequeño grupo lo hacía de manera inadecuada, lo cual se asoció a una baja percepción sobre los perjuicios de este método para la salud.

Introduction: Sexual and reproductive education can prevent or reduce any physical or mental harm, or both, caused by risky sexual practices and inadequate use of contraceptive methods. Objective: To describe the use of emergency contraception among female university students and their awareness regarding the harms of these methods for their health. Methods: A descriptive and cross-sectional study was conducted, from April to October 2021, of 372 women over 18 years of age, enrolled in universities located in Medellin, Colombia, who were selected through non-probabilistic sampling. The information was obtained through a survey, which included variables related to the use of emergency contraception and the awareness of its harms. Results: In the series, 67.7% of the young women had used emergency contraceptives, of whom 8.7% reported consuming up to 3 levonorgestrel pills per month and 0.8% more than 10 during a year, while 97.8% considered that this type of method affects their health. Among the main adverse effects were irregular periods (65.8%), nausea (31.7%), vomiting (31.7%), migraine (3.2%) and mood changes (25.4%). Conclusions: Although most of female university students who used emergency contraceptives were guided by medical recommendations, a small group did so inappropriately, which was associated with a low perception of the health harms of this method.

Manejo das irregularidades menstruais secundárias ao uso de contraceptivos ­ análise das recomendações atuais / Management of menstrual irregularities secondary to contraceptive use ­ analysis of current recommendations

As irregularidades menstruais representam uma série de desordens na quantida- de, duração, frequência ou regularidade do sangramento uterino. Entre suas cau- sas destaca-se o sangramento secundário ao uso de anticoncepcionais, uma razão frequente de descontinuidade dos contraceptivos, podendo aumentar as taxas de gestações não planejadas. Boa parte dos contraceptivos pode levar a mudanças no padrão de sangramento uterino, e a abordagem inicial do sangramentos irregula- res inclui a avaliação de outras possíveis causas, o reforço do uso correto da medi- cação, a tranquilização da paciente quanto à benignidade do quadro e à tendência a melhora com a continuidade do uso. Os anti-inflamatórios podem ser usados como estratégia inicial, e, não havendo resposta satisfatória, há alternativas espe- cíficas para cada método. Este trabalho visa identificar as recomendações atuais sobre o manejo do sangramento anormal decorrente de contraceptivos, por meio de revisão narrativa de estudos publicados sobre o tema nos últimos vinte anos.

Abnormal uterine bleeding represents a series of disorders in the amount, du- ration, frequency and or regularity of uterine bleeding. Among its causes, uterine bleeding secondary to the use of contraceptives stands out as a frequent reason for contraceptive discontinuity, which could lead to unplanned pregnancies. Most contraceptives can cause changes in the pattern of uterine bleeding, and the ini- tial approach of the abnormal bleeding includes assessing other possible cau- ses, reinforcing the correct use of medication, and reassuring the patient about the benignity of the condition and the tendency to improve with the continuity of the treatment. Anti-inflammatory drugs can be used as an initial strategy, and, if there is no satisfactory answer, there are specific alternatives for each contracep- tive method. This work aims to identify them current recommendations on the management of abnormal bleeding resulting from contraceptives use, through a narrative review of studies published on the subject in the last twenty years.

Uso de anticonceptivos y conocimiento del periodo fértil del ciclo menstrual en adolescentes

Introducción: La comprensión de los cambios fisiológicos que se presentan en las mujeres adolescentes son fundamentales para el cuidado de su salud sexual. Esto favorece un comportamiento anticonceptivo orientado a la elección de métodos seguros y eficaces. Objetivo: Establecer la asociación entre el uso de métodos anticonceptivos y el conocimiento del periodo fértil del ciclo menstrual en adolescentes peruanas. Métodos: Estudio transversal basado en el análisis secundario de la Encuesta Demográfica y de Salud Familiar del año 2021. La muestra fue de 717 de mujeres adolescentes con registro completo en las bases de datos. Se calcularon recuentos ponderados, no ponderados y se aplicó la prueba ji cuadrado con un 95 % de nivel de confianza. Resultados: El 19 % de las adolescentes reconocen el periodo fértil del ciclo menstrual y 6,3 % refirió que este periodo sucede durante la menstruación. El 80,8 % de las mujeres que cursan la adolescencia temprana, no conocen el momento del periodo. Respecto al uso de anticonceptivos, el 21,5 % era usuaria de preservativos y 16,3 % de inyectables; no obstante, 47 % señaló que no utilizaban ningún anticonceptivo. El 53,5 % de las adolescentes en etapa tardía indicaron que sí utilizan anticonceptivos. Entre las que son usuarias de estos métodos, 86,3 % no reconocen el periodo fértil. Conclusiones: En las adolescentes, el uso de métodos anticonceptivos no se asocia de manera significativa con el conocimiento que tienen acerca del periodo fértil del ciclo menstrual.

Introduction: The understanding of the physiological changes that occur in adolescent women are essential for the care of their sexual health. Thus, this favors a contraceptive behavior oriented to the choice of safe and effective methods. Objective: To establish the association between the use of contraceptive methods and the knowledge of the fertile period of the menstrual cycle in Peruvian adolescents. Methods: Cross-sectional study based on the secondary analysis of the 2021 Demographic and Family Health Survey. The sample consisted of 717 adolescent women with complete registration in the databases. Weighted and unweighted counts were calculated; and the Chi square test was applied at a 95% confidence level. Results: 19% of adolescents recognize the fertile period of the menstrual cycle and 6.3% reported that this period occurs during menstruation. In addition, 80.8% of women in early adolescence do not know the time of their period. Regarding the use of contraceptives, 21.5% were users of condoms and 16.3% of injectables; however, 47% indicated that they did not use any contraceptive. 53.5% of late-stage adolescents indicated that they do use contraceptives. Among those who are users of these methods, 86.3% do not recognize the fertile period. Conclusions: In adolescents, the use of contraceptive methods is not significantly associated with the knowledge they have about the fertile period of the menstrual cycle.

O uso dos métodos anticoncepcionais por estudantes de Medicina: uma revisão narrativa / Medical students' use of contraceptive methods: a narrative review

Anticoncepção são todas as técnicas e métodos utilizados para evitar a concepção. Os estudantes de Medicina se destacam nesse contexto, por representarem uma população em um período no qual a gravidez e doenças sexualmente transmissíveis são emergenciais. Logo, este estudo analisou a eficácia dos métodos contraceptivos na comunidade acadêmica médica e verificou se há ou não diferença na taxa de eficácia, em comparação com a população em geral. Sendo assim, realizou- -se uma revisão narrativa e encontraram-se 2.182 artigos; desses, 1.513 cumpriram o critério de inclusão, porém somente quatro artigos atendiam a todos os critérios e foram utilizados. A conclusão do estudo foi de que a taxa de Pearl é maior na população estudada devido ao mau uso dos contraceptivos, necessitando da melhora na qualidade da educação sexual nas universidades de Medicina ao redor do mundo, a fim de se evitarem a perpetuação da má utilização de contraceptivos e a desinformação no meio acadêmico médico.

Contraception is all the techniques and methods that are used to prevent conception. Medical students stand out in this context because they represent a population in a period in which pregnancy and sexually transmitted diseases are emergencies. Therefore, this study analyzed the effectiveness of contraceptive methods in the medical academic community and verified whether or not there is difference in the rate of effectiveness compared to the general population. A narrative review was conducted and 2,182 articles were found, of these 1,513 met the inclusion criteria, but only four articles met all the criteria and were used. The conclusion of the study was that Pearl's rate is lower in the studied population due to the misuse of contraceptives, requiring improvement in the quality of sex education in medical universities around the world in order to avoid perpetuation of misuse of contraceptives and misinformation in the medical academic environment.

Conhecimento de estudantes do ensino médio sobre métodos contraceptivos: pesquisa-ação em escolas da rede privada / Knowledge of high school students about contraceptive methods: action research in private schools / Conocimientos de estudiantes de secundaria sobre métodos anticonceptivos: investigación-acción en escuelas privadas

OBJETIVO: Identificar o conhecimento de estudantes sobre os métodos contraceptivos, antes e após a realização de oficinas sobre a temática. MÉTODOS: Pesquisa-ação, realizada com 38 estudantes do ensino médio. Foram realizadas oficinas com discussão da temática (audiogravadas) e aplicação de pré e pós-teste em outubro de 2022. Utilizou-se a análise de conteúdo temática para as narrativas e cálculo da frequência relativa para as questões fechadas do questionário. RESULTADOS: As narrativas se diferenciam entre as escolas. Os estudantes acreditam que o dispositivo intrauterino é abortivo; conhecem pouco sobre dupla proteção; e associam a pílula anticoncepcional aos benefícios à estética. Após as oficinas houve ampliação dos acertos e incorporação de novos conhecimentos mensurados pelo pós-teste nas duas escolas. CONCLUSÃO: É importante realizar oficinas no ambiente escolar a fim de reduzir danos à saúde e o Programa Saúde na Escola pode ser um facilitador para o acesso às temáticas da sexualidade e saúde reprodutiva.

OBJECTIVE: To identify students' knowledge about contraceptive methods, before and after workshops on the topic. METHODS: Action research, carried out with 38 high school students. Workshops were held with discussion of the topic (audiorecorded) and application of pre- and post-tests in October 2022. Thematic content analysis was used for the narratives and calculation of the relative frequency for the closed questions of the questionnaire. RESULTS: The narratives differ between schools. Students believe that the intrauterine device is abortifacient; they know little about double protection; and they associate the contraceptive pill with aesthetic benefits. After the workshops, there was an increase in correct answers and the incorporation of new knowledge measured by the post-test in both schools. CONCLUSION: It is important to hold workshops in the school environment in order to reduce harm to health and the School Health Program can be a facilitator for access to sexuality and reproductive health topics.

OBJETIVO: Identificar los conocimientos de los estudiantes sobre métodos anticonceptivos, antes y después de los talleres sobre el tema. MÉTODOS: Investigación acción, realizada con 38 estudiantes de secundaria. Se realizaron talleres con discusión del tema (audiograbados) y aplicación de pre y post pruebas en octubre de 2022. Para las narrativas se utilizó análisis de contenido temático y cálculo de la frecuencia relativa para las preguntas cerradas del cuestionario. RESULTADOS: Las narrativas difieren entre escuelas. Los estudiantes creen que el dispositivo intrauterino es abortivo; saben poco sobre la doble protección; y asocian la píldora anticonceptiva con beneficios estéticos. Luego de los talleres, hubo un aumento en las respuestas correctas y la incorporación de nuevos conocimientos medidos por el post-test en ambas escuelas. CONCLUSIÓN: Es importante realizar talleres en el ámbito escolar para reducir los daños a la salud y el Programa de Salud Escolar puede ser un facilitador para el acceso a temas de sexualidad y salud reproductiva.

Parches transdérmicos anticonceptivos: evaluación de tecnología sanitaria / Contraceptive transdermal patches: health technology assessment

INTRODUCCIÓN: La anticoncepción es un derecho, y es obligación del Estado garantizar el acceso a métodos anticonceptivos efectivos, seguros y de calidad. Se realizó una evaluación de tecnología sanitaria sobre los parches anticonceptivos transdérmicos. MÉTODOS: Un equipo multidisciplinario e independiente designado por el Comité Provincial de Biotecnologías de Neuquén buscó información epidemiológica, regulatoria y evidencias científicas sobre eficacia, seguridad y adherencia. Se analizó y sistematizó siguiendo metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) y CASPe (Critical Appraisal Skills Programme Español). RESULTADOS: El único parche autorizado en Argentina para su comercialización libera 33,9 µg/día de etinilestradiol y 203 µg/día de norelgestromina. Su prospecto en Argentina, EE.UU. y Europa lo asocia al doble de riesgo de enfermedad tromboembólica venosa si se compara con las píldoras anticonceptivas que provee el Estado. Esto coincide con resultados de estudios de cohortes de alta calidad. Los parches proveen similar eficacia anticonceptiva a corto plazo, pero con altas tasas de abandono en el seguimiento. La Organización Mundial de la Salud no los ha incluido en su listado de medicamentos esenciales. Los parches son más costosos que otros métodos disponibles. DISCUSIÓN: Sobre la base de los principios de beneficencia, no maleficencia, de precaución y de proporcionalidad, no se recomienda la incorporación de parches.(AU)

INTRODUCTION: Contraception is a right, being an obligation of the State to guarantee access to effective, safe and quality contraceptive methods. A health technology assessment was carried out on transdermal contraceptive patches. METHODS: A multidisciplinary and independent team appointed by the Provincial Biotechnology Committee of Neuquén searched for epidemiological and regulatory information and scientific evidence on efficacy, safety and adherence. It was analyzed and systematized following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and CASPe (Critical Appraisal Skills Programme Español) methodology. RESULTS: The only patch authorized for commercialization in Argentina releases 33.9 µg/day of ethinylestradiol and 203 µg/day of norelgestromin. Its package insert in Argentina, the US and Europe highlights that the risk of venous thromboembolic disease is twice as high compared to the contraceptive pills provided by the State. This is consistent with results from high-quality cohort studies. Patches provide similar short-term contraceptive efficacy, but with high dropout rates at follow-up. The World Health Organization has not included them in its list of essential medicines. Patches are more expensive than other available methods. DISCUSSION: Based on the principles of beneficence, non-maleficence, precaution and proportionality, the incorporation of patches is not recommended.(AU)

Intervención educativa dirigida al uso de métodos anticonceptivos en adolescentes / An educational intervention focused on the use of contraceptive methods in adolescents

El inicio de las relaciones sexuales en la adolescencia puede generar problemas de salud biopsi-cosociales, los que pueden ser más complejos sin el adecuado conocimiento acerca del uso opor-tuno de métodos anticonceptivos. La investigación tuvo el objetivo de valorar la efectividad de una intervención educativa dirigida a las conductas sexuales y reproductivas de riesgo en la adolescencia, en dos Consejos Populares del municipio de Quemado de Güines durante el perio-do 2017-2021. Se desarrolló un estudio preexperimental con una población constituida por 1501 adolescentes, de la que se seleccionó una muestra 102 individuos mediante un procedimiento no probabilístico atendiendo a criterios. En el estudio predominó: el sexo femenino (51%), aquellos con edades entre 13 y 15 años (67,7%) y los que no habían comenzado una vida sexual activa (54,9%). La intervención educativa produjo cambios estadísticamente significativos en el contexto de investigación en relación con la información sobre métodos anticonceptivos y la percepción del riesgo sobre su uso inadecuado.

The beginning of sexual relations in adolescence can generate biopsychosocial health problems, which can be more complex without adequate knowledge about the timely use of contraceptive methods. The research aimed to assess the effectiveness of an educational intervention aimed at sexual and reproductive risk behaviors in adolescents in two Popular Councils of the Quemado de Güines Hall during 2017-2021. A pre-experimental study was developed with a population of 1501 adolescents, from which a sample of 102 individuals was selected through a non-probabi-listic procedure according to criteria. The study predominated: the female gender (51%), the ages between 13 and 15 (67.7%), and those ones who had not started an active sexual life (54.9%). The educational intervention produced statistically significant changes in the research context concerning the information on contraceptive methods and the perception of risk regar-ding its inappropriate use

The use of contraceptives and their nutritional impact on medical students

SUMMARY OBJECTIVE: This study aimed to analyze the impact of contraceptives on medical students at the Federal University of Paraná and verify adherence, consequences, and lifestyle effects of the contraceptive method used. METHODS: This is an observational, cross-sectional study in which 214 participants answered an online questionnaire composed of 30 questions. For statistical analysis, the Stata® 16.0 software was used, and the mean and standard deviation were estimated to characterize continuous variables with a normal distribution and percentages for categorical variables. For group-to-group comparisons, a one-way ANOVA was used for normal continuous variables and Fisher's exact test for categorical variables. RESULTS: Almost 10% (9.3%) of women used condoms only, and double protection (condom+oral contraceptives) corresponds to 23.4%. Of the 214 participants, 38 reported making exclusive use of long-acting reversible contraception, and 13.6% of the interviewees used oral contraceptives exclusively. More than 88% of the interviewees believe that the medical course provided adequate education on contraception. Regarding lifestyle habits, 71.5% of the students reported alcohol intake, tobacco use, and/or other drug use. CONCLUSION: There was a great diversity of combinations between contraceptive methods used by the medical student at Federal University of Paraná, the most prevalent being the oral contraceptive associated with male condoms. There was a greater association in the use of long-acting reversible contraception in married students. Although 88.3% of the participants believed that they had a good education about contraception at university, only half of them use condoms in sexual relationships. The rate of adherence to alcohol and tobacco among students is considerable, and such practices can negatively affect a nutritional profile, a healthy lifestyle, and safe sexual practices. Brazilian medical schools are fundamental for the advancement of medical education in contraception and for the creation of public policies on family planning.

Aplicación de un balón de contrapulsación intraaórtico en procedimientos obstétricos. Reporte de caso / Use of an intra-aortic balloon pump in Obstetrics. Case report

Resumen ANTECEDENTES: Las anomalías en la inserción placentaria son cada vez más frecuentes en nuestro medio. En la atención de la paciente embarazada es importante la prevención de la pérdida hemática con balones de contrapulsación intraaórticos, como una opción útil. CASO CLÍNICO: Paciente de 38 años, embarazada, con antecedente de parto eutócico y sin enfermedades de interés, ni intervenciones quirúrgicas previas. El seguimiento prenatal se inició a las 17 semanas, con retraso diagnóstico debido a que continuaba en tratamiento anticonceptivo. La invasión trofoblástica estaba limitada al miometrio, sin evidencia de invasión a los órganos vecinos. Se le expusieron a la paciente las posibles complicaciones a fin de minimizar los riesgos de hemorragia masiva, potencialmente mortal en el momento del parto. Puesto que la paciente expresó no desear volver a embarazarse, se le recomendó la histerectomía poscesárea, dejando la placenta in situ. CONCLUSIONES: La oclusión endovascular con balón de contrapulsación intraaórtico es una opción segura y eficaz para minimizar la pérdida de sangre en casos de anomalías en la inserción placentaria. Además del clásico acceso por vía femoral es posible colocarlo por vía axilar, con igual efectividad. La baja tasa de complicaciones maternas y la seguridad, en términos de irradiación fetal, la convierten en una opción razonable en la atención de pacientes embarazadas en quienes se espera una alta pérdida sanguínea.

Abstract BACKGROUND: Anomalies of placental insertion are becoming increasingly common. Prevention of blood loss with intra-aortic counterpulsation balloons is a useful option in the care of pregnant patients. CLINICAL CASE: 38-year-old pregnant woman with a history of euthyroid delivery and no medical or surgical history. Prenatal follow-up was initiated at 17 weeks, with a delay in diagnosis due to the fact that she was still on contraceptive treatment. Trophoblastic invasion was limited to the myometrium with no evidence of invasion into adjacent organs. The patient was counseled on the potential complications to minimize the risk of massive, potentially fatal hemorrhage at delivery. As the patient did not wish to become pregnant again, a post-cesarean hysterectomy was recommended, leaving the placenta in situ. CONCLUSIONS: Endovascular occlusion with intra-aortic balloon counterpulsation is a safe and effective option to minimize blood loss in cases of placental insertion anomalies. In addition to the classical femoral approach, the axillary route can be used with equal efficacy. The low rate of maternal complications and the safety with respect to fetal irradiation make it a reasonable option in the management of pregnant patients in whom high blood loss is expected.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Escolha da contracepção hormonal por mulheres assistidas na atenção primária: fatores limitantes e medo / Elección del anticonceptivo hormonal por mujeres asistidas en la atención primaria: factores limitantes y miedo / Choice of hormonal contraception by women assisted in primary care: limiting factors and fear

RESUMO Objetivo: Conhecer como ocorre a escolha pela contracepção hormonal por mulheres assistidas na Atenção Primária à Saúde. Método: Estudo qualitativo, descritivo e exploratório realizado em uma Estratégia Saúde da Família na região central do Rio Grande do Sul entre os meses de janeiro a março de 2022. Participaram 20 mulheres entre 18-43 anos. A produção de dados ocorreu mediante entrevista composta por questões abertas, as enunciações foram transcritas e submetidas à análise temática. Resultados: As participantes revelaram a falta de opção fornecida pelo Sistema Único de Saúde na escolha da contracepção hormonal, bem como apresentam fatores limitantes como dúvidas, dificuldades e medo ao utilizar o anticoncepcional hormonal devido à falta de orientação profissional na Atenção Primária à Saúde. Conclusão: A escolha do método contraceptivo precisa levar em consideração a autonomia da mulher e os profissionais de saúde que atuam na Atenção Primária à Saúde devem garantir o direito de escolha, minimizar as dúvidas, medos e tabus que circundam o processo de anticoncepção hormonal. Ademais, as consultas de saúde da mulher devem oportunizar a educação em saúde, o diálogo e a troca de saberes

RESUMEN Objetivo: conocer cómo ocurre la elección del anticonceptivo hormonal por mujeres asistidas en la Atención Primaria de Salud. Método: estudio cualitativo, descriptivo y exploratorio realizado en una Estrategia Salud de la Familia en la región central de Rio Grande do Sul/Brasil entre los meses de enero a marzo de 2022. Participaron 20 mujeres entre 18-43 años. La producción de datos se realizó mediante entrevista compuesta por preguntas abiertas, los relatos fueron transcritos y sometidos al análisis temático. Resultados: las participantes revelaron la falta de opción ofrecida por el Sistema Único de Salud en la elección del anticonceptivo hormonal, así como presentaron factores limitantes como dudas, dificultades y miedo al utilizar el anticonceptivo hormonal debido a la falta de orientación profesional en la Atención Primaria de Salud. Conclusión: la elección del método anticonceptivo necesita tener en cuenta la autonomía de la mujer y los profesionales de salud, que actúan en la Atención Primaria de Salud, deben garantizar el derecho de elección, minimizar las dudas, los miedos y tabúes que rodean el proceso de anticonceptivo hormonal. Además, las consultas de salud de la mujer deben darle la oportunidad a la educación en salud, al diálogo e intercambio de saberes.

ABSTRACT Objective: To know how the choice for hormonal contraception occurs by women assisted in Primary Health Care. Method: Qualitative, descriptive and exploratory study conducted in a Family Health Strategy in the central region of Rio Grande do Sul between the months of January and March 2022. Twenty women aged 18-43 participated. The production of data occurred through interview composed of open questions, the enunciations were transcribed and submitted to thematic analysis. Results: The participants revealed the lack of option provided by the Unified Health System in the choice of hormonal contraception, as well as difficulties and fear when using hormonal contraceptives due to lack of professional guidance in Primary Health Care. Conclusion: The choice of contraceptive method must take into account the autonomy of women and health professionals who work in Primary Health Care must ensure the right to choose, minimize doubts, fears and taboos surrounding the hormonal contraception process. In addition, women's health consultations should provide opportunities for health education, dialogue and knowledge exchange.

m-Health en intervenciones para incrementar el uso de anticonceptivos en adolescentes latinas: revisión de alcance

Objetivo Mapear la forma de uso y el efecto de las tecnologías m-Health en intervenciones a fin de incrementar el uso de anticonceptivos en adolescentes latinas. Métodos Se realizó una revisión de alcance a partir de Peters M en octubre de 2021; se recuperaron artículos del 2015 a 2021 en EBSCO Host, PubMed y BVS, LILACS, SciELO, Web of Science y Scopus, en inglés, español y portugués. Resultados Se identificaron ocho artículos que emplearon las m-Health como potencializadoras. La forma de uso fue ampliamente heterogénea en dosis, intervalo e interacción. El efecto significativo para el uso de anticonceptivos fue reportado en tres diseños experimentales, con una buena aceptabilidad y viabilidad para futuros experimentos. Discusión Las m-Health ofrecen una oportunidad de incrementar el uso de anticonceptivos en adolescentes. Al momento, su efecto es controversial debido a la escasez de intervenciones de este tipo. Por lo tanto, se requieren estudios rigurosos que consideren procesos de adaptación a contextos latinos.

Objective To map the use and effect of m-Health technologies on interventions to increase contraceptive use in Latino adolescents. Methods A low scope review was performed from Peters M in October 2021; articles from 2015 to 2021 were recovered in EBSCO Host, PubMed and BVS, LILACS, SciELO, Web of Science and Scopus, in English, Spanish, and Portuguese. Results We identified eight articles that used m-Health as potentiators. The form of use was widely heterogeneous in dose, interval, and interaction. The significant effect on contraceptive use was reported in three experimental designs with good acceptability and feasibility for future experiments. Discussion m-Health offers an opportunity to increase contraceptive use in adolescents. At the moment its effect is controversial due to the scarcity of interventions of this type. Therefore, rigorous studies that consider processes of adaptation to Latino contexts are required.

Embarazo subsecuente en la adolescencia: causas, consecuencias y posibles soluciones / Subsequent pregnancy in adolescence: Causes, consequences and possible solutions

Introducción: México se encuentra en los primeros lugares de embarazo en la adolescencia entre los países de la Organización para la Cooperación y el Desarrollo Económico. Por lo tanto, el embarazo de primera vez y subsecuente representa un problema sanitario con impacto negativo en el desarrollo de la adolescente y su hijo, por lo que es necesario estudiar el fenómeno a fin de prevenirlo y contribuir al mejoramiento de las condiciones de salud y vida de dos grupos vulnerables (adolescentes e hijos). Desarrollo: las causas del embarazo subsecuente son diversas, implican aspectos relacionados con el entorno familiar y comunitario, el acceso a los servicios de salud y el nivel educativo. Aunque no es exclusivo de un estrato social, se presenta con mayor frecuencia en adolescentes de bajos recursos. Las consecuencias son de índole físico, psicológico, económico y social, y agudizan las condiciones negativas de salud y las mencionadas como causas, con riesgo de que se repita y se perpetue el problema. Conclusiones: las intervenciones basadas en la atención centrada en la persona han mostrado efectos positivos en la conducta anticonceptiva de las adolescentes. Su adopción e implementación en países en desarrollo amerita la suma de esfuerzos interinstitucionales e interdisciplinares de forma vertical y transversal, con sentido bidireccional, a fin de hacer cambios significativos en la prevención de este fenómeno.

Introduction: Mexico ranks in the first places of teenage pregnancy among the countries of the Organisation for Economic Co-operation and Development. For this reason, the first and subsequent pregnancy represents a health problem with a negative impact on the development of the adolescent girl and her child, which is why it is necessary to study the phenomenon, in order to prevent it and to contribute to the improvement of health and living conditions of two vulnerable groups (adolescents and children). Development: The causes of subsequent pregnancy are diverse, involving aspects related to the family and community environment, as well as access to health services, and the educational level. Although it is not exclusive to a social stratum, it occurs more often in low-income adolescents. The consequences are of a physical, psychological, economic and social nature, and they exacerbate the negative health conditions and those mentioned as causes, with the risk of repeating and perpetuating the problem. Conclusions: Person-centered interventions have demonstrated positive effects on the contraceptive behavior of adolescents. Its adoption and implementation in developing countries deserve the sum of inter-agency and interdisciplinary efforts in a vertical and cross-cutting manner with a two-way sense of making significant changes in the prevention of this phenomenon.

Consumo de anticoncepcionais e fatores associados entre estudantes universitários / Contraceptive use and associated factors among university students

Introdução: o uso de anticoncepcionais vem crescendo a cada ano, sendo um dos principais motivos para a redução das taxas de fecundidade total, inclusive na população mais jovem, como a universitária. Objetivo: identificar o consumo de anticoncepcionais hormonais e fatores associados entre estudantes universitárias. Métodos: a população de estudo foi composta por estudantes universitárias matriculadas nos cursos de graduação da Universidade Estadual de Londrina (UEL), em Londrina, estado do Paraná, Brasil, no ano de 2019, integrantes do projeto maior denominado GraduaUEL. As estudantes responderam um instrumento construído em uma plataforma digital on-line. A variável dependente foi o consumo de contraceptivos hormonais, e as variáveis independentes foram aspectos sociodemográficos e hábitos de vida e de saúde. As associações medidas foram verificadas por meio de Regressão de Poisson, com cálculo da Razão de Prevalência (RP) e intervalo de confiança de 95% (IC 95%). Resultados: das 2.221 estudantes avaliadas, identificou-se o consumo de contraceptivos por 13,0%, maior entre mulheres brancas/amarelas, que relataram serem heterossexuais, que apresentavam pais com maior escolaridade, que referiram possuir plano privado de saúde e companheiro, e que praticavam atividade física pelo menos duas vezes na semana. Entretanto, apenas o fato de serem heterossexuais mostrou-se associação significativa após a análise ajustada (RP: 1,865; IC 95%: 1,308-2,659). Conclusões: diante do exposto, fica clara a necessidade de preparar os profissionais de saúde sobre os contraceptivos e seus efeitos adversos; ainda, que questões sociais devem ser consideradas no processo de uso dos contraceptivos, para combater a discriminação e as desigualdades social e econômica quanto ao acesso e uso destes medicamentos.

Introduction: the use of contraceptives has been growing every year, being one of the main reasons for the reduction in total fertility rates, including in the younger population, such as university students. Objective: identify the consumption of hormonal contraceptives and associated factors among university students. Methods: the study population consisted of university students enrolled in undergraduate courses at the Universidade Estadual de Londrina (UEL), in Londrina, Paraná state, Brazil, in 2019, members of the larger project called GraduaUEL. The students answered an instrument built on an on-line digital platform. The dependent variable was the consumption of hormonal contraceptives, and the independent variables were sociodemographic aspects, lifestyle and health. Measured associations were verified using Poisson Regression, with calculation of the Prevalence Ratio (PR) and 95% confidence interval (95% CI). Results: of the 2,221 students evaluated, the consumption of contraceptives was identified by 13.0%, higher among white/yellow women, who reported being heterosexual, who had parents with higher education, who reported having a private health plan and partner, and who practiced physical activity at least twice a week. However, only the fact of being heterosexual showed a significant association after the adjusted analysis (PR: 1.865; 95% CI: 1.308-2.659). Conclusions: in light of the above, the need to prepare health professionals about contraceptives and their adverse effects is clear, as well as what social issues should be considered in the process of using contraceptives, to combat discrimination, social and economic inequality regarding access and the use of these medications.

Factors associated with post-abortion contraceptive discontinuation / Factores associados a la discontinuidade en el uso de métodos anticonceptivos después de sufrir un aborto / Fatores associados à descontinuidade no uso de métodos contraceptivos após a vivência de um abortamento

ABSTRACT Objectives: To assess factors associated with post-abortion contraceptive discontinuation. Method: This cross-sectional study addressed 111 women aged 18-49 attending Primary Health Care Facilities in São Paulo/SP, Aracaju/SE, and Cuiabá/MT, Brazil, who reported an abortion five years before the interview held in 2015-2017. Kaplan-Meier estimates and Cox Regression were used for data analysis. Results: Oral hormonal contraceptives, male condoms, and injectable contraceptives were the methods most frequently used. The contraceptive discontinuation rate was 41.8% in the 12 months after the abortion. The pill was the method most frequently abandoned (58.3%); male condoms were the method that failed the most (72.7%), and injectable contraceptives were the method most frequently switched (50.0%). Being up to 24 years old, having ten or more years of education, having three or more children, and a desire to wait longer before becoming pregnant again were associated with post-abortion contraceptive discontinuation. Conclusion: Short-acting contraceptive methods were predominant among post-abortion women. The type of discontinuation varied according to the type of method used. The factors associated with contraceptive discontinuation were age, education, parity, and reproductive intention.

RESUMEN Objetivos: Analizar los factores asociados a la discontinuidad en el uso de métodos anticonceptivos después de un aborto. Método: Estudio transversal realizado con 111 mujeres de 18 a 49 años, usuarias de Unidades Básicas de Salud de São Paulo/SP, Aracaju/SE y Cuiabá/MT, quienes reportaron aborto en los cinco años previos a la entrevista realizada entre 2015-2017. Se utilizó Kaplan-Meier y la regresión de Cox para el análisis de datos. Resultados: Tras el aborto, los métodos utilizados se centraron en los de corta duración: anticonceptivos hormonales orales, condones masculinos e inyectables. La tasa de discontinuidad en el uso de métodos anticonceptivos fue del 41,8% en los 12 meses posteriores al aborto. La píldora fue el método que se abandonó con más frecuencia (58,3%); el condón masculino en el que ocurrieron más fallas (72,7%); e inyectables intercambiados con mayor frecuencia (50,0%). Tener 24 años o más, 10 o más años de escolaridad, alta paridad (3 o más) y desear esperar para quedar embarazada se asociaron con la discontinuidad en el uso de métodos anticonceptivos después del aborto. Conclusión: Las mujeres después de un aborto utilizaron predominantemente métodos anticonceptivos de corta duración, que con mayor frecuencia se suspenden. El tipo de discontinuidad, abandono, intercambio o falla varió según el tipo de método utilizado. La edad, la educación, la paridad y la intención reproductiva se asociaron con la discontinuidad en el uso de métodos anticonceptivos después del aborto.

RESUMO Objetivos: Analisar os fatores associados à descontinuidade no uso de método contraceptivos após a vivência de um abortamento. Método: Estudo transversal, conduzido com 111 mulheres de 18-49 anos, usuárias de Unidades Básicas de Saúde de São Paulo/SP, Aracaju/SE e Cuiabá/MT, que relataram abortamento nos cinco anos anteriores às entrevistas realizadas entre 2015-2017. Utilizou-se Kaplan-Meier e regressão de Cox para análise dos dados. Resultados: Os métodos mais utilizados foram o contraceptivo hormonal oral, preservativo masculino e injetáveis. A taxa de descontinuidade contraceptiva foi 41,8% nos 12 meses. A pílula foi o método mais abandonado (58,3%); o preservativo masculino aquele que mais falhou (72,7%); e injetáveis os mais trocados (50,0%). Ter até 24 anos de idade, mais de 10 anos de escolaridade, três ou mais filhos e querer esperar mais para engravidar associaram-se a descontinuar o uso dos métodos contraceptivos após o abortamento. Conclusão: Após o abortamento, as mulheres usaram predominantemente métodos contraceptivos de curta duração. O tipo de descontinuidade, abandono, troca ou falha, variou conforme o método usado. Os fatores associados à descontinuidade contraceptiva foram a idade, a escolaridade, a paridade e a intenção reprodutiva.