Uso de Anticonceptivos Orales y Percepción del Papel del Farmacéutico Comunitario entre Adolescentes: un estudio observacional / Oral Contraceptive Use and Perception of the Role of the Community Pharmacist among Adolescents: an observational study

Introducción: Los embarazos no deseados en adolescentes tienen graves consecuencias tanto para las propias adolescentes y sus bebés como para el uso de los recursos del sistema sanitario. Una de las razones es el escaso uso de píldoras anticonceptivas orales (ACO) entre esta población, debido principalmente a la falta de información o a la no adherencia a los medicamentos. El objetivo de este estudio fue describir la información que reciben las adolescentes sobre los ACO y su uso, así como su percepción del papel del farmacéutico comunitario en este campo. Método: Se realizó un estudio observacional transversal mediante encuesta, aplicada a mujeres entre 12-19 años residentes en España, independientemente de si habían utilizado o no ACO, durante abril de 2021. Para la difusión de esta encuesta se utilizaron diferentes redes sociales. Asimismo, se contactó con diferentes asociaciones españolas dedicadas a la orientación de la planificación familiar y la salud sexual en adolescentes. Resultados: El 81,7% (n=76) de los encuestados no había tomado ACO, aunque el 35,5% (n=33) sí había mantenido relaciones sexuales. El 6% (n=1) que tomaba o había tomado ACO informó que eran adherentes. El 88% (n=82) pensaba que el farmacéutico tiene conocimientos sobre medicamentos; sin embargo, sólo el 19,4% (n=18) les consultaría para resolver dudas sobre ACO. Conclusiones: Para resolver los problemas de falta de información sobre ACO y de adherencia en mujeres adolescentes, el farmacéutico comunitario es un profesional accesible que puede contribuir a ello adoptando una actitud activa y utilizando diferentes formas de material educativo. (AU)

Introduction: Unintended pregnancies in adolescents have serious consequences both for the adolescents themselves and their babies and for the use of health system resources. One of the reasons is the low use of oral contraceptive pills (OCPs) among this population, mainly due to lack of information or non-adherence to the medication. The aim of this study was to describe the information adolescents receive about OCPs and their use, as well as their perception of the role of the community pharmacist in this field. Method: A cross-sectional observational study was carried out by means of a survey applied to women aged 12-19 years living in Spain, regardless of whether or not they had used OCPs, during April 2021. Different social networks were used to disseminate the survey. Different Spanish associations dedicated to family planning and adolescent sexual health counselling were also contacted. Results: 81.7% (n=76) of respondents had not taken OCPs, although 35.5% (n=33) had had sex. The 6% (n=1) who were taking or had taken OCPs reported adherence. 88% (n=82) thought that the pharmacist is knowledgeable about medicines; however, only 19.4% (n=18) would consult them for OCP questions. Conclusions: To solve the problems of lack of information about OCPs and adherence in adolescent women, the community pharmacist is an accessible professional who can contribute to this by taking an active role and using different forms of educational materials. (AU)

Effectiveness of a School-Based Pregnancy Prevention Intervention for Female Teenagers and Their Boyfriends: A Randomized Controlled Trial.

PURPOSE: This study examined the effectiveness of a school-based pregnancy prevention intervention. METHODS: 73 female and male teenagers were recruited from an urban secondary school and randomly assigned to the intervention and control groups. The females were aged 13-15 years, and the boyfriends were aged 13-18 years. The intervention was implemented in six sessions over six weeks. Sessions 1-4 were conducted at the school, and sessions 5-6 were delivered via a smartphone messaging application. The outcomes included sexual health literacy, pregnancy prevention behaviors, and sexual risk behaviors. They were measured three times: at baseline (week 0, T1), immediately post-intervention (week 6, T2), and follow-up (week 10, T3). Two-way mixed repeated measure ANOVA was used to determine the differences of the outcomes. RESULTS: After completion of the intervention, participants in the intervention group had significantly higher sexual health literacy both at T2 and T3 and better pregnancy prevention behavior. They had lower sexual risk behaviors at T3 than the control group. DISCUSSION: The results indicate that the school-based pregnancy prevention intervention is effective. It improved the outcomes in female teenagers and their boyfriends at six weeks and 10 weeks post-intervention.

Sexuality Among Young Danes Treated for Long-Lasting or Severe Physical Disease: Baseline Findings in a Nationwide Cohort Study.

PURPOSE: Sexual ramifications of physical disease are well-documented in adult populations, but are scarcely investigated among adolescents and young adults (AYA). This study compared measures of sexuality and sexual health among 8,696 15-year-old to 24-year-old Danes with and without a history of treatment for long-lasting or severe physical disease. METHODS: Using baseline data from Project SEXUS, a nationally representative cohort study on sexual health in the Danish population, differences in various domains of sexual behaviors and sexual health between AYA who have and AYA who have not been treated for long-lasting or severe physical disease were investigated. Logistic regression analyses yielded demographically weighted age-adjusted odds ratios (ORs) for associations between physical diseases and sexual outcomes. RESULTS: AYA treated for long-lasting or severe physical disease resembled their healthy peers on fundamental aspects of sexual interest, activity and satisfaction. However, significantly increased odds ratios of various sexual difficulties and dysfunctions, early sexual debut, high sex partner numbers, discontentment with body or genital appearance, gender nonconformity, nonheterosexuality, and exposure to sexual assaults were observed, overall or within specific disease categories. DISCUSSION: The overall similarity in sexual profiles between AYA treated for physical disease and healthy peers indicates that clinicians should routinely address questions related to sexuality and relationships when encountering AYA with chronic health conditions. Moreover, the observed excess of certain adversities, including sexual assaults, among physically ill AYA highlights the need for preventive measures and counseling services specifically targeted at AYA afflicted by physical disease.

Measurement of maternal morbidity during postpartum with the WHO-WOICE tools in Morocco.

BACKGROUND: Maternal morbidity refers to any health problems or complications experienced by a woman during pregnancy, childbirth, or the postpartum period. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although, measurement of maternel morbidity remains underdeveloped. We aimed to evaluate the prevalence of non-severe maternal morbidities (including overall health, domestic and sexual violence, functionality, and mental health) in women during postpartum care and further analyze factors associated with compromised mental functioning and clinical health by administration of the WHO's WOICE 2.0 instrument. METHODS: A cross-sectional study was conducted at 10 Health centers in Marrakech, Morocco with WOICE questionnaire included three sections: the first with maternal and obstetric history, sociodemographic data, risk and environment factors, violence and sexual health; the second considers functionality and disability, general symptoms and mental health; and the third includes data on physical and laboratory tests. This paper presents descriptive data on the distribution of functioning status among postpartum women. RESULTS: A total of 253 women averaging 30 years of age participated. For self-reported health status of women, more than 40% reported good health, and just 9.09% of women had a health condition reported by the attending physician. Among postpartum women with clinical diagnoses, 16.34% had direct (obstetric) conditions and 15.56% indirect (medical) problems. When screening for factors in the expanded morbidity definition, about 20.95% reported exposure to violence. Anxiety was identified in 29.24% of cases, and depression in 17.78%. Looking into gestational results, just 14.6% delivered by cesarean section and 15.02% had preterm birth. We found also that 97% reported "good baby health" in the postpartum evaluation, with 92% of exclusive breastfeeding. CONCLUSION: Considering these results, improving the quality of care for women requires a multi-faceted approach, including increased research, better access to care, and improved education and resources for women and healthcare providers.

Sexual and reproductive history of female prisoners in Iran: a health care needs analysis.

PURPOSE: According to estimates, there are approximately 714,000 female prisoners in the world. A considerable proportion are pregnant, of childbearing age at the time of incarceration and may experience numerous reproductive health concerns. The purpose of this study is to examine the demographics and sexual and reproductive history of female prisoners in Iran. DESIGN/METHODOLOGY/APPROACH: Four hundred and thirty-four female prisoners (mean age: 39.0 ± 9.9) serving sentences at Qarchak prison, Iran, completed a questionnaire. The participants were recruited between October 2017 and September 2018 using a convenient sampling method. The questionnaire captured sociodemographic characteristics and sexual and reproductive history. FINDINGS: Most respondents had 7-12 years of formal education, were housewives (69.9%), were either married (41.6%) or divorced (41.8%) and were literate (91.3%). History of drug use among the respondents was 34.7%. Most respondents had regular menstruation (63.5%) and were pre-menopausal (86.1%). Natural birth control was preferred (39.7%) compared to other methods, such as condoms (18%) and oral contraceptive pills (8.4%). Spontaneous and induced abortions were reported by 17.8% and 16.4% of respondents, respectively. There was 5.9% of respondents that reported having a history of sexually transmitted infections (STIs) before incarceration, with HPV the most common (12.7%). RESEARCH LIMITATIONS/IMPLICATIONS: This study has limitations, including the problem of following up with prisoners to shorten the average length of their imprisonment, which can leave many issues in the field of women's health and their follow-up incomplete. Prison health care workers should also follow up on women's health and pregnancy hygiene after their release because there is usually a high prevalence of STIs in prisoners. PRACTICAL IMPLICATIONS: The findings highlight the importance of improving the quality of women's health care and pregnancy-related care in prisons. Additionally, the importance of having a health protocol for incarcerated women in Iran. Other programs should also be implemented for women prisoners to eliminate the discrimination they may face in prison. ORIGINALITY/VALUE: The international community has attempted to develop care guidelines for pregnant prisoners, particularly for prenatal and mental health services. However, currently in Iran no such guidelines have been developed. To date no research has explored the sexual health among female prisoners of this country. The aim of the present study was to examine the demographics and sexual and reproductive history of female prisoners in Iran. A secondary aim was to identify the health care needs of female prisoners in Iran.

Understanding the consequences of Female Genital Mutilation: a phenomenological study in sub-Saharan women living in Spain.

BACKGROUND: Female Genital Mutilation (FGM), which is culturally accepted in some African communities, has serious consequences on the physical, psychological, urogynecological, obstetrical and sexual health of girls and women. It is therefore important to understand women's experiences of the consequences of FGM. OBJECTIVE: to understand the experiences of the consequences of female genital mutilation in sub-Saharan female survivors living in Spain. DESIGN: a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. PARTICIPANTS AND SETTING: 13 sub-Saharan female survivors of female genital mutilation participated. The study was carried out in two south-eastern Spanish provinces where many jobs in the agricultural and service industry are done by African immigrants originating from ethnic groups in which FGM is still prevalent. FINDINGS: In-depth interviews were carried out for data collection. ATLAS.ti was used for inductive analysis, from which two main themes were developed that represent the experiences of the consequences of FGM: (a) The impact of FGM: Hijacked sexual health and (b) The difficult process of genital reconstruction: overcoming the aftereffects and regaining integrity. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The mutilated women experienced serious consequences in their sexual, psychological and obstetrical health. Genital reconstruction was a difficult decision but contributed to regaining their sexual health and identity. The professionals involved play an important role in the care provided for the associated consequences of FGM, in identifying risk groups and in providing advice that allows the women to regain their sexual and reproductive health.

Effect of epidural spinal cord stimulation on female sexual function after spinal cord injury.

Sexual dysfunction is a common consequence for women with spinal cord injury (SCI); however, current treatments are ineffective, especially in the under-prioritized population of women with SCI. This case-series, a secondary analysis of the Epidural Stimulation After Neurologic Damage (E-STAND) clinical trial aimed to investigate the effect of epidural spinal cord stimulation (ESCS) on sexual function and distress in women with SCI. Three females, with chronic, thoracic, sensorimotor complete SCI received daily (24 h/day) tonic ESCS for 13 months. Questionnaires, including the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) were collected monthly. There was a 3.2-point (13.2%) mean increase in total FSFI from baseline (24.5 ± 4.1) to post-intervention (27.8 ± 6.6), with a 4.8-50% improvement in the sub-domains of desire, arousal, orgasm and satisfaction. Sexual distress was reduced by 55%, with a mean decrease of 12 points (55.4%) from baseline (21.7 ± 17.2) to post-intervention (9.7 ± 10.8). There was a clinically meaningful change of 14 points in the International Standards for Neurological Classification of Spinal Cord Injury total sensory score from baseline (102 ± 10.5) to post-intervention (116 ± 17.4), without aggravating dyspareunia. ESCS is a promising treatment for sexual dysfunction and distress in women with severe SCI. Developing therapeutic interventions for sexual function is one of the most meaningful recovery targets for people with SCI. Additional large-scale investigations are needed to understand the long-term safety and feasibility of ESCS as a viable therapy for sexual dysfunction. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03026816, NCT03026816.

Pain, Pattern and Polytrauma - Predictors of Sexual Dysfunction in Pelvic Fractures: A Retrospective Multicenter Analysis.

Objectives: In the local and cultural setting of high trauma rates and a reserved outlook on sexual function, this study examines the incidence and underlying factors of sexual dysfunction (SD) following pelvic fractures. Methods: A Multi-center retrospective cohort analysis performed in two general hospitals and one tertiary orthopedic center with collection between 2017 and 2019. Consecutive patients with pelvic fractures between January 2017 and February 2019 were followed up at 18-24 months to screen for new-onset SD using the International Index of Erectile Function-5 (IIEF-5) and Female-Sexual-Function-Index-6 (FSFI-6). Additional variables include age, sex, Young-Burgess classification, urogenital injury, injury severity score, persisting pain, sacroiliac disruption, intervention and if sexual health was discussed or patient referred for sexual healthcare. Results: One-hundred and sixty-five patients (n = 165) were included, (83%) male, (16%) female with a mean age of 35.1 years (Range 18-55). Fracture patterns included lateral compression (LC) (51.5%), anteroposterior compression (APC) (27.7%), and vertical shear (VS) (20.6%). The urogenital injury occurred in 10.3%. The mean IIEF-5 and FSFI-6 scores were 20.8 and 24.7 in males and females, respectively. A total of 40 males (29%) scored below the 21 cut-off scores for SD, while only one female (3.7%) scored below the corresponding score of 19. Of all participants reporting sexual dysfunction, 56% discussed sexual health with their providers, while 46% of these patients were referred for further management. Significant predictive factors for SD using a multivariate logistic regression model include increasing age (OR-1.093, p = 0.006), APC III (OR 88.887, p = 0.006), VS (OR-15.607, p = 0.020), persisting pain (OR 3.600, p = 0.021) and increasing injury severity score (OR 1.184, p <0.001). Conclusion: SD is common among pelvic fractures, and risk factors include APC or VS type fractures, increasing age, increasing injury severity score, and persisting pain. Providers should ensure patients are screened for SD and referred appropriately as patients may not willingly disclose underlying symptoms.

Breast cancer survivorship and sexual dysfunction: a population-based cohort study.

BACKGROUND: Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. METHODS: We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. RESULTS: Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51-1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5 years after cancer diagnosis (95% CI 1.89-2.22) and 3.05-fold in individuals diagnosed with cancer at < 50 years of age (95% CI 2.65-3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. CONCLUSIONS: Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.

An Intervention to Increase Condom Use Among Users of Sexually Transmitted Infection Self-sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial.

BACKGROUND: Reducing the rates of sexually transmitted infections (STIs) among young people is a public health priority. The best way to avoid STIs from penetrative sex is to use a condom, but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when young people access self-sampling kits for STIs through the internet. The potential of this opportunity is enhanced by the increasing numbers of young people being tested through this route every year in England. Hence, in a cocreation by young people, stakeholders, and researchers, Wrapped was developed--a fully automated, multicomponent, and interactive digital behavior change intervention developed for users of STI self-sampling websites, who are aged 16-24 years. OBJECTIVE: This paper is a protocol for a feasibility randomized controlled trial (fRCT). The fRCT seeks to establish whether it is feasible to run a randomized controlled trial to test the effectiveness and cost-effectiveness of Wrapped. Wrapped aims to reduce the incidence of STIs through increasing correct and consistent use of condoms among users of STI self-sampling websites, who are aged 16-24 years. METHODS: A 2-arm parallel-group randomized fRCT of Wrapped plus usual care, compared to usual care only (basic information on STIs and condom use), with a nested qualitative study. A minimum of 230 participants (aged 16-24 years) are recruited from an existing chlamydia self-sampling website. Participants are randomized into 1 of 2 parallel groups (1:1 allocation). Primary outcomes are the percentage of users recruited to the fRCT and the percentage of randomized participants who return a chlamydia self-sampling kit at month 12. Additionally, besides chlamydia positivity based on biological samples, surveys at baseline, month 3, month 6, and month 12, are used to assess condom use attitude, behavioral capability, self-efficacy, and intention, along with details of any partnered sexual activity and condom use, and health economic data. Nested qualitative interviews with trial participants are used to gain insight into the factors affecting recruitment and attrition. RESULTS: Recruitment to the fRCT began in March 2021 and was completed in October 2021. Data collection was completed in December 2022. CONCLUSIONS: This feasibility study will provide data to inform the design of a future-definitive trial. This work is timely given a rapid rise in the use of internet testing for STIs and the sustained high levels of STIs among young people. TRIAL REGISTRATION: ISRCTN Registry ISRCTN17478654; http://www.isrctn.com/ISRCTN17478654. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43645.

Black Health in Canada: Protocol for a Scoping Review.

BACKGROUND: Black Canadians experience poor health care, poor health outcomes, and a greater burden of health inequalities, much of which is rooted in the unequal distribution of social determinants of health. Despite Canada's emphasis on social inclusion, Canada's Black population faces substantial social inequities that affect their health and well-being. These disparities may specifically be attributed to racial discrimination, immigration status, precarious housing, underemployment, and increased poverty among Black Canadians. OBJECTIVE: This paper describes a protocol for a scoping review that aims to understand the range and nature of research conducted on the health of Black Canadians as well as the gaps in this literature. METHODS: Arksey and O'Malley's methodological framework guided the conduct of the scoping review. We searched electronic databases (CINAHL, Embase, Global Health, MEDLINE, PsycINFO, Scopus, Sociological Abstracts, and Web of Science) and grey literature sources for peer-reviewed articles and grey reports on the health of Black Canadians. Six reviewers independently screened the abstracts and full text of studies to determine eligibility for inclusion. According to the PRISMA-ScR (Preferred Reporting Items for Systematics Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. RESULTS: Title, abstract, and full-text screening concluded in October 2022. Data collection is in progress and is expected to be completed by April 2023. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. CONCLUSIONS: This review will collect important data and evidence related to the health (mental, reproductive, and sexual; social determinants of health) of the Black population in Canada. The findings could help identify existing gaps in the health of Black individuals in Canada and inform future research paradigms. The findings will further inform the development of a knowledge hub on Black Canadians' health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42212.

Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study.

Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones.

Introduction: Transgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth. Methods: As part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH. Results: 21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth. Conclusions: There was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.

Sexual and Physical Victimization and Health Correlates Among Norwegian Adolescents.

Large-scale epidemiological studies have documented that many children and adolescents are exposed to different forms of victimization experiences. However, such population-based studies have rarely examined how specific types of victimization are correlated with health indicators. Thus, we investigated sexual victimization, physical victimization by parents, and physical victimization by peers and their associations with sexual health, mental health, and substance use. We gathered data from a nationally representative sample of Norwegian 18-19-year-old students in their final year of senior high school (N = 2075; 59.1% girls). The analyses showed that 12.1% of the adolescents reported sexual victimization experiences. Physical victimization was more prevalent: 19.5% of the respondents had been exposed to victimization from parents and 18.9% from peers. Multivariate analyses revealed specific associations between sexual victimization and a range of sexual health indicators, such as early sexual intercourse debut, many sexual partners, engaging in sex without contraception while intoxicated, and participating in sexual acts for payment. Neither physical victimization from parents nor from peers were correlated with these variables. However, all three forms of victimization were associated with impaired mental health and potential substance use problems. We conclude that a variety of victimization experiences should be addressed in policies for prevention of adolescent mental health and substance use problems. In addition, a special emphasis is warranted regarding sexual victimization: Sexual health policies should address such potential experiences in addition to more traditional themes such as reproductive health and should also include low-threshold services for young victims of sexual victimization.

Polyphenylene carboxymethylene (PPCM), the active component of the topical contraceptive Yaso-GEL, exhibits potent antimicrobial activity against Neisseria gonorrhoeae in preclinical studies.

INTRODUCTION: Polyphenylene carboxymethylene (PPCM) is a condensation polymer that has both contraceptive and antimicrobial activity against several sexually transmitted viruses including HIV, herpes simplex virus, Ebola virus and SARS-CoV-2 in preclinical studies. PPCM, both as an active pharmaceutical ingredient (API) and in a vaginal gel formulation (Yaso-GEL), has an excellent safety profile. Here, we evaluated the efficacy of PPCM against Neisseria gonorrhoeae in vitro and in a gonorrhoea mouse model. METHODS: The minimal inhibitory concentration (MIC) of PPCM was determined against 11 N. gonorrhoeae strains by agar dilution and a microtitre plate-based method. In vivo efficacy was tested in a murine model of N. gonorrhoeae genital tract infection by applying Yaso-GEL, PPCM incorporated in 2.7% hydroxyethylcellulose (HEC), or the HEC vehicle vaginally prior to challenge with N. gonorrhoeae. Vaginal swabs were quantitatively cultured over 5 days to assess efficacy. RESULTS: PPCM MIC against N. gonorrhoeae ranged between 5-100 µg/mL (agar dilution) and 50-200 µg/mL (microtitre plate method). PPCM/HEC gel applied vaginally prior to bacterial challenge resulted in a concentration-dependent inhibition of infection. Yaso-GEL containing 4% PPCM prevented infection in 100% of mice. Incubation of N. gonorrhoeae with PPCM increased membrane permeability, suggesting PPCM directly compromises N. gonorrhoeae viability, which may be a mechanism by which PPCM inhibits N. gonorrhoeae infection. CONCLUSIONS: Yaso-GEL containing the API PPCM showed significant activity against N. gonorrhoeae in vitro and in vivo in a female mouse model. These data support further development of Yaso-GEL as an inexpensive, non-hormonal and non-systemic product with both contraceptive and antimicrobial activity against gonorrhea and other common sexually transmitted infections (STIs). Such multipurpose prevention technology products are needed by women in all economic, social and cultural circumstances to prevent unintended pregnancy and STIs.

Addressing Gendered Racism Against Black Girls Using a Strengths-Based Empowerment-Intersectional Framework for Sexual Health and Substance Use Prevention Programming.

Although Black girls use substances at lower rates than boys and girls from various other racial groups, they tend to have worse health outcomes associated with substance use that can also impact their sexual health. The association between substance use and sexual risk behaviors is usually attributed to lack of access to quality health care and lack of culturally specific prevention programming and treatment options tailored to this group. Accordingly, the theoretical frameworks for health promotion for Black girls often focus on addressing deficits, ignoring the powerful and intersecting social forces that can impact identity, agency, and behavioral options. Key among these forces is gendered racism. We propose a strengths-based conceptual framework to address and challenge gendered racism as a critical foundation for promoting health and wellbeing for Black girls. Our approach integrates Intersectionality Theory and Empowerment Theory, with psychological and intrapersonal empowerment identified as critical mediators of behavior and health outcomes, supported by protective factors of positive racial identity and gendered racial socialization. This framework has been developed with and for Black girls but can be adapted for health promotion efforts with other minoritized groups.

Validation of a Questionnaire on Sexual and Reproductive Health Among Immigrant Vocational Education Students in Portugal from São Tomé and Príncipe.

Sexual and reproductive health interventions' effectiveness should be evaluated using a valid instrument. This study aimed to validate a questionnaire on sexual and reproductive health in adolescents and young adults from São Tomé and Príncipe who voluntarily enrolled in a vocational school in Portugal to complete their 12th school year and obtain a professional card.A questionnaire consisting of perception and knowledge sections was adapted from previous questionnaires. We followed the steps of psychometric analysis. Firstly, we assessed face validity and content validity. We used factorial analysis to validate the perceptions section (which included Likert-type questions). For the knowledge section (which consisted of multiple-choice questions), we used the key check, discrimination index, and difficulty index. We evaluated internal consistency through Cronbach's alpha for the perceptions section and the Kuder-Richardson score for the knowledge section.Out of 105 invited students, a total of ninety students were enrolled in this study, of whom 88 completed most of the questions. The exploratory analysis showed that most students agreed with the right to refuse intercourse. However, while approximately 23% disagreed that consensual sex among adult women or men is always wrong, around the same proportion agreed. A considerable number of students recognized condoms and pills as effective methods of contraception. However, most students were unfamiliar with other methods. Most knowledge questions showed acceptable difficulty levels, and the discrimination index varied among questions. The knowledge questions demonstrated good consistency levels. This study enabled us to develop an appropriate instrument for evaluating the effectiveness of public health interventions and identifying specific knowledge gaps in migrant populations from low-income countries. This will help prioritise topics to be addressed in sexual health education sessions.

Implementation Fidelity and Theory-Informed Dose Effects of a Teen Pregnancy Prevention Program for Native American Youth.

In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11-19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons.

Surveillance of Mpox Cases Attending Sexual Health Services in England (SOMASS): design, implementation and initial findings from the SOMASS data collection tool, 2022.

OBJECTIVES: We aimed to design and implement a data collection tool to support the 2022 mpox (monkeypox) outbreak, and to describe clinical and epidemiological data from individuals with mpox attending sexual health services (SHSs) in England. METHODS: The UK Health Security Agency and the British Association for Sexual Health and HIV established the Surveillance of Mpox Cases Attending Sexual Health Services in England (SOMASS) system.Descriptive data were collected via a secure web-based data collection tool, completed by SHS clinicians following consultation with individuals with suspected mpox. Data were collected on patient demographics, clinical presentation and severity, exposures and behavioural characteristics. RESULTS: As of 17 November 2022, 276 SOMASS responses were submitted from 31 SHSs in England.Where recorded, most (245 of 261; 94%) individuals identified as gay, bisexual or men who have sex with men (GBMSM), of whom two-thirds were HIV negative (170 of 257; 66%) and taking HIV pre-exposure prophylaxis (87 of 140; 62%), with a median age of 37 years (IQR: 30-43). Where known, thirty-nine per cent (63 of 161) had a concurrent sexually transmitted infection (STI) at the time of their mpox diagnosis.For 46% of individuals (127 of 276), dermatological lesions were the initial symptom. Lesions were mostly asymmetrical and polymorphic, predominately affecting the genital area and perianal areas.Nine per cent (24 of 276) of individuals were hospitalised. We report an association between receptive anal intercourse among GBMSM and proctitis (27 of 115; 24% vs 7 of 130; 5%; p<0.0001), and the presence of perianal lesions as the primary lesion site (46 of 115; 40% vs 25 of 130; 19%; p=0.0003). CONCLUSIONS: We demonstrate multidisciplinary and responsive working to develop a robust data collection tool, which improved surveillance and strengthened the knowledge base. The SOMASS tool will allow data collection if mpox resurges in England. The model for developing the tool can be adapted to facilitate the preparedness and response to future STI outbreaks.