Knowledge and attitudes of female university students on menstrual cycle and contraception.

Socioeconomic changes, as well as the development of new contraceptive modalities may influence women's preferences in the selection of a method of contraception. The aim of this study was to evaluate the knowledge, opinions and attitudes of female university students regarding the menstrual cycle, sexual health and contraception. A questionnaire-based survey was conducted among 2572 female university students in Hungary, Romania and Serbia, between November 2009 and January 2011. A higher proportion of students of health sciences than students of other faculties had appropriate knowledge of the fertile period within a menstrual cycle: 86.0%, 71.5% (p = .02) and 61.1% vs. 71.9% (p < .001), 59.8% and 43.2% (p < .001) in Hungary, Romania and Serbia, respectively. Overall, more than 69% of the female university students believed in the need for monthly menstruation in order to be healthy; however, merely 30 to 40% of them wished to have monthly bleeding. In general, the respondents were aware of the importance of menstruation in relation to sexual health; however, they wished to suppress the menstruation-related symptoms. Differences in the knowledge and attitudes of female university students of the three assessed countries may be explained in part by cultural differences, and in part by the nature of their studies.

Contraception for adolescents after abortion.

INTRODUCTION: Preventing repeated unplanned pregnancy among adolescents is still a challenge because many of them fail to use effective contraception after abortion. OBJECTIVE: To review currently recommended options of methods and counselling for effective prevention of repeat pregnancies in adolescents. METHODS: Review of the literature that was identified through the Medline, ScienceDirect, Google and Popline databases and relevant expert opinions. RESULTS: Counselling needs to be adapted to the needs, values and lifestyle of adolescents. The best results are achieved with nondirective or active contraceptive counselling, followed by regular check-ups and cautious and attentive approach in the management of doubts, prejudices and side effects related to the contraceptive chosen. Adolescents should initiate contraception immediately after abortion: the motivation for choosing an efficacious method is highest at that time; resumption of ovulation following induced abortion occurs on average after three weeks; more than half of these girls will resume sexual activity within two weeks after pregnancy termination. Long-acting reversible contraception use during adolescence is safe and most effective. However, achieving a high long-term continuation rate is especially challenging in adolescents; this is due to developmental and environmental characteristics that influence their contraceptive behaviour. CONCLUSION: Adolescents should immediately after abortion initiate a reliable contraceptive method, preferably one whose efficacy is not user-dependent. Providing an appropriate health care would contribute to achieving continuity in the prevention of repeat pregnancy.

Challenges in sexual and reproductive health of Roma people who live in settlements in Serbia.

OBJECTIVE: To investigate the differences in sexual and reproductive health (SRH) between Roma women of reproductive age who live in settlements and the general population of women of the same age in Serbia who do not live in settlements. METHODS: The Multiple Indicator Cluster Survey 4 (MICS4) was administered to Roma and Serbian women and the results were compared between the two groups. In order to get a qualitative perspective, a specifically designed, short open-ended questionnaire about Roma women was given to Roma Health Mediators (RHMs). RESULTS: Roma women have a higher total fertility rate and adolescent birth rate, and early marriage is much more common among them. Differences are less clear regarding antenatal care and assistance during delivery from skilled personnel. Roma women more frequently rely on traditional contraception, and are less likely to use modern contraceptives than the general female population. Problems in the socio-economic sphere, poor school enrolment and maintenance of traditional patterns in Roma people living in settlements contribute to the disparities observed. CONCLUSION: Although data on the SRH of the general population of women in Serbia are far from being satisfactory, those for women who live in Roma settlements are much worse. Political actions aimed at the empowerment of Roma women in the spheres of education, employment and health promotion have been implemented with the hope that they might improve the SRH of this vulnerable population group.

Family planning in Serbia--the perspective of female students from the University of Belgrade.

OBJECTIVES: To assess whether current knowledge and attitudes of future female doctors, pharmacists, politicians, journalists and social workers indicate that positive changes may take place in family planning in Serbia. METHODS: A total of 504 female students from the University of Belgrade completed a questionnaire related to the physiology of reproduction, contraception, childbearing, and extended cycles of combined oral contraceptive (COC) use. RESULTS: Eighty percent of the study population knew the fertile period in the menstrual cycle. The students had positive opinions about COCs in 52% of the cases, and negative opinions in 48%. More than 80% of respondents were aware of the possibility of suppressing uterine bleeding by COC use, but only 22% would utilise COCs in that manner. Seventy-nine percent considered 25-29 years as the optimal age span for starting childbearing. Nearly all expressed the desire to have children later, with 2.56 being the average number of children wanted. CONCLUSION: Our findings indicate that professionals who, in the future, will provide education and counselling in the field of contraception, or will be involved in developing a national family planning framework in Serbia, are not likely to go about much differently from those presently active.

Education and training of health care workers for contraceptive service delivery in 21 countries across Europe.

BACKGROUND: In order to provide women with an informed choice of contraception, responsible health professionals need to be well educated and trained for providing consultation in that area. The objective of the study was to better understand the actual situation regarding education and training of health care providers (HCPs) for contraceptive service delivery. METHODS: A specially designed questionnaire was sent to 74 individuals who were either former or current country representatives in the Board, or members of the Expert groups of the European Society of Contraception and Reproductive Health (ESC). Data were obtained from 27 respondents from 21 countries. RESULTS: Contraceptive services are delivered by different medical professionals and organisational units. Gynaecologists are involved in comprehensive contraceptive care in the majority of countries, general practitioners (GPs) provide hormonal contraception in nine, and midwifes/nurses in six countries. Undergraduate and postgraduate education and training of HCPs pertinent for contraceptive care is at a satisfactory level in less than half of the investigated countries. International educational and training programmes are being underutilized in around half of the countries. CONCLUSION: Different models of contraceptive care exist across Europe. Education of relevant HCPs need to be improved and harmonized in the majority of investigated countries.

The abortion issue in Serbia.

OBJECTIVES: To investigate the causes of the persistently high abortion rate in Serbia. METHODS: We analysed the legal aspect of abortion, related health care regulations and policies, and social environment, as primary factors, and knowledge, attitudes and practice of health care providers and clients, as secondary determinants of the large number of induced abortions. RESULTS: A complex array of factors accounted for the high abortion prevalence. The main ones are easy access to induced abortion coupled with substantial obstacles to efficient use of contraception, insufficient relevant knowledge about and a resistance to modern contraceptives among women and men in need and health care providers, a firm social basis for traditional birth control, and limitations in the family planning programme. CONCLUSIONS: The persistence of a high abortion rate in Serbia appears to be due to many underlying causes, which have changed little over time. The future of this issue will depend on the introduction of a modern concept of family planning at the political, educational and health care level.

Glutathione S-transferase (GST) polymorphism could be an early marker in the development of polycystic ovary syndrome (PCOS) - an insight from non-obese and non-insulin resistant adolescents.

INTRODUCTION: It has been supposed that endocrine disturbances might be responsible for polycystic ovary syndrome (PCOS)-associated oxida-tive stress, with special emphasis on hyperandrogenism. Considering the potential relationship between hyperandrogenism and increased free radical production, parameters of oxidative stress were determined in non-obese normoinsulinemic adolescent girls newly diagnosed with PCOS. MATERIALS AND METHODS: Nitrotyrosine, thiol group concentrations, glutathione peroxidase, and superoxide dismutase activities were determined under fasting conditions and during oral glucose tolerance test (OGTT) in 35 PCOS patients and 17 controls. Insulin resistance was assessed by the homeostasis model (HOMA-IR), HOMA ß, insulinogenic index (IGI), Matsuda insulin sensitivity index (ISI), and AUC for glucose. Glutathione S-transferases (GSTs) polymorphisms were determined by PCR. RESULTS: Under fasting conditions, no significant difference of oxidative stress parameters was found between PCOS and controls. Acute hyperglycaemia during OGTT induced significant alteration in parameters of oxidative protein damage in PCOS patients. Alteration in nitrotyrosine concentrations correlated with testosterone, DHEAS, androstenediones, FAI, and LH, while changes in thiol groups cor-related with DHEAS. Significant inverse association was found between LH and ISI, as well as AUC glucose and thiol groups. PCOS girls, carriers of GSTM1-null genotype, had significantly lower testosterone in comparison to ones with GSTM1-active genotype. CONCLUSIONS: PCOS girls exhibited high free radical production together with unchanged antioxidant enzymatic capacity, independently from obesity and insulin resistance. Based on associations between oxidative stress parameters and testosterone, DHEAS, and androsten-edione, it can be suggested that increased free radical production, probably as a consequence of hyperandrogenaemia, is an early event in the development of PCOS.

Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study.

STUDY OBJECTIVE: To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. DESIGN: A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. SETTING: Mother and Child Health Institute of Serbia 'Dr Vukan Cupic' (Belgrade, Serbia). PARTICIPANTS: Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. INTERVENTIONS AND MAIN OUTCOME MEASURES: Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity (P < .05). RESULTS: No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82-98); and a specificity of 97 (C.I.: 95-99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. CONCLUSION: The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.

[Sexual and reproductive behaviour of young female Internet users in Serbia].

INTRODUCTION: Investigation of sexual and reproductive behaviour of youth in Serbia has not been performed by Internet, although it is their popular information and communication channel. OBJECTIVE: Analysis of the Internet acceptability among adolescent females as a research method for sexual and reproductive behaviour, identification of the common girl from Serbia, which is informed via the Internet, as well as an overview of the most important problems in the field of sexual and reproductive health of our adolescents. METHODS: The possibility of using the Internet is perceived on the basis of the number of girls aged 19-20 years who responded to certain questions asked on the website of the Association of Reproductive Health of Serbia, and reliability of the findings by monitoring the consistency of the obtained responses. Girl's profile is defined according to most commonly selected answer to a particular issue, and the most important problems by selecting answers to some questions chosen by a significant proportion of patients. RESULTS: Internet has proven to be the accepted research tool among young people, according to a large number of adolescent females who responded to the given questionnaire. The common girl lives in the city (78%), with parents (53%), in the functional family (78%) and belongs to a higher economic stratum (47%). She declares having many friends (44%), being a student, and financially completely relying on parents (67%). She had first sexual intercourse at the age of 17 (20%) and sexual experience with one partner (46%). Her main motive for sexual activity is being in love (64%), and is satisfied with her sexual life (64%). She prefers condom as a contraceptive method, has not been pregnant (90%), and has not been diagnosed with STI (85%). At the same time, serious problems, which may affect sexual and reproductive health, have been identified in a significant proportion of respondents. CONCLUSION: Internet has a great potential for defining the model of sexual and reproductive behavior of youth, and offers the possibility of alleviating these problems by a variety of activities, including sending motivational messages via Internet.

Are Serbian gynaecologists in line with modern family planning?

OBJECTIVES: In Serbia, gynaecologists could play an important role in achieving the transition from an abortion-based family planning culture to a modern contraception-based one. Exploring their knowledge, attitudes and practice regarding birth control is of particular importance for ensuring the quality of contraceptive counselling. METHODS: A questionnaire was sent to all the 1,139 members of the Gynaecology and Obstetrics Section of the Serbian Medical Society. The response rate was 27%. RESULTS: Of the respondents, 61.8% reported that either they or their partner had had one or more induced abortions; 37.6% stated that they usually used either coitus interruptus or no contraceptive method at all; 51.0% were unwilling to prescribe combined oral contraceptives (COCs) to girls younger than 18 years, and 76.5% advised women against the use of COCs for more than two years. Irrational concerns about the health risks of contraception were identified. The contraceptive needs of women aged 20 + were particularly hampered by the fact that 75.5% of respondents thought that intrauterine device use was unsafe for women with benign, non infectious cervicitis. CONCLUSIONS: The results indicate that a significant number of Serbian gynaecologists neither use modern methods of contraception themselves nor have adequate knowledge to advise their patients. Thus, education and training of gynaecologists in all methods of available contraception is a priority in Serbia.