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Canela MRM, Brito LGO, Silva-Filho AL, Bahamondes L, Juliato CRT. Provision of contraceptives by Brazilian general gynaecologists: a nationwide online survey. EUR J CONTRACEP REPR 2023; 28:251-257. [PMID: 37505798 DOI: 10.1080/13625187.2023.2233649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To assess the provision of contraceptives by Brazilian obstetricians and gynaecologists (Obst/Gyns) during medical consultation and associated factors. METHODS An anonymous online survey was conducted with Obst/Gyns regarding age, gender, training, method counselling about and provision of long-acting reversible contraception (LARC). RESULTS Of 16,000 Obst/Gyns, 610 (3.8%) answered the survey. After multiple regression analysis, female Obst/Gyns (reference) (OR male was 0.53 [95%CI 0.28-0.98], p = 0.044) and Obst/Gyns aged between 20 and 39 were more likely to provide an IUD. For hormonal-IUDs, Obst/Gyns who had had theoretical training in hormonal-IUD insertion (reference no training) (OR = 2.13 [95%CI 1.14-3.99], p = 0.018), those who work in a private facility or public hospital, and those that allowed more time during consultations (reference) (OR short time = 0.33 [95%CI 0.17-0.63], p < 0.001) were more likely to provide them. Obst/Gyns who were hands-on trained were more likely to provide subdermal implant (OR = 2.04 [95%CI 1.45-2.87], p < 0.001). CONCLUSIONS There is a gap between theoretical and practical training received by this cohort of Obst/Gyns regarding LARCs, mainly contraceptive implants and hormonal-IUDs. The identification of barriers to offering contraceptives is essential to providing client-centred contraceptive care.
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Affiliation(s)
- Mariana R M Canela
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Agnaldo Lopes Silva-Filho
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, (UFMG), Belo Horizonte, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Faculty of Medical Sciences, Campinas, Brazil
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Bittner B, Sánchez-Félix M, Lee D, Koynov A, Horvath J, Schumacher F, Matoori S. Drug delivery breakthrough technologies - A perspective on clinical and societal impact. J Control Release 2023; 360:335-343. [PMID: 37364797 DOI: 10.1016/j.jconrel.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
The way a drug molecule is administered has always had a profound impact on people requiring medical interventions - from vaccine development to cancer therapeutics. In the Controlled Release Society Fall Symposium 2022, a trans-institutional group of scientists from industry, academia, and non-governmental organizations discussed what a breakthrough in the field of drug delivery constitutes. On the basis of these discussions, we classified drug delivery breakthrough technologies into three categories. In category 1, drug delivery systems enable treatment for new molecular entities per se, for instance by overcoming biological barriers. In category 2, drug delivery systems optimize efficacy and/or safety of an existing drug, for instance by directing distribution to their target tissue, by replacing toxic excipients, or by changing the dosing reqimen. In category 3, drug delivery systems improve global access by fostering use in low-resource settings, for instance by facilitating drug administration outside of a controlled health care institutional setting. We recognize that certain breakthroughs can be classified in more than one category. It was concluded that in order to create a true breakthrough technology, multidisciplinary collaboration is mandated to move from pure technical inventions to true innovations addressing key current and emerging unmet health care needs.
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Affiliation(s)
- Beate Bittner
- Global Product Strategy, Product Optimization, Grenzacher Strasse 124, 4070 Basel, Switzerland.
| | - Manuel Sánchez-Félix
- Novartis Institutes for BioMedical Research, 700 Main Street, Cambridge, MA 02139, USA
| | - Dennis Lee
- Bill & Melinda Gates Foundation, Seattle, WA 98119, United States
| | - Athanas Koynov
- Pharmaceutical Sciences, Merck & Co., Inc., Rahway, NJ 07033, United States
| | - Joshua Horvath
- Device and Packaging Development, Genentech, Inc., South San Francisco, CA, United States
| | - Felix Schumacher
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, 4070 Basel, Switzerland
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montréal, QC H3T 1J4, Canada.
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Motlhokodi MD, Ramavhoya TI, Peu MD. Experiences of women of childbearing age regarding Implanon provision in South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37403683 PMCID: PMC10476454 DOI: 10.4102/phcfm.v15i1.3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The World Health Organization has stated that millions of women of childbearing age in developing countries who are not planning to be pregnant are not utilising modern contraceptives such as long-term contraceptives, including Implanon. South Africa had a high rate of women of childbearing age who used Implanon as one of long-term contraception methods from its introduction in 2014. Familiar reasons for women to not use modern contraceptives involved a lack of healthcare facilities, supplies and trained healthcare workers in their area to provide effective contraceptive services in South Africa. AIM This study aimed to explore and describe the experiences of women of childbearing age regarding Implanon provision. SETTING The study was conducted in primary health care facilities of Ramotshere Moiloa subdistrict, South Africa. METHODS Qualitative, descriptive phenomenological approach was used in this study. Twelve women of childbearing age were purposively sampled. Childbearing age refers to woman in their reproductive ages who will not be regarded as high risk for pregnancy. Semi-structured interviews were utilised to collect data and five Colaizzi's steps of data analysis were used. Data were collected from 12 of 15 selected women of childbearing age who had experience in utilising Implanon contraceptive device. Data saturation was reached after interviewing 12 participants as the information was coming out, repeatedly. RESULTS Three themes with subthemes emerged from the study, namely period of Implanon use, experiences of obtaining information regarding Implanon and healthcare experiences related to Implanon. CONCLUSION It was evident that a lack of effective pre- and post-counselling, eligibility screening and poor management of severe side effects are contributory factors that led to early removal and decline in uptake of the said method. There is also a lack of effective comprehensive Implanon training to some of reproductive service providers.Contribution: It may increase the number of women who still want to use Implanon as a reliable method.
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Affiliation(s)
- Modiegi D Motlhokodi
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and Department of Health, Bojanala District, Rustenburg, North-West Province.
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Martínez-Zamora M. El tratamiento hormonal es imperativo para todas las pacientes: lo antes posible y siempre. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Chapman HL, Chase D, Bhattarai B, Sutton M, Meyer I, Schofield C. Association of quality of prenatal care with contraceptive planning in a United States population: a retrospective cohort study. BMC Womens Health 2023; 23:214. [PMID: 37131190 PMCID: PMC10155310 DOI: 10.1186/s12905-023-02368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Understanding how prenatal care influences planned postpartum contraception can help guide shared decision-making. This study looks to examine the association of the quality of prenatal care with planned postpartum contraception. METHODS This is a retrospective cohort study conducted in a single tertiary, academic urban institution in the southwest United States. The institutional review board (IRB) for human research at Valleywise Health Medical Center approved this study. Using a validated measure of prenatal care, the Kessner index, prenatal care was classified as adequate, intermediate, or inadequate. The World Health Organization (WHO) protocol for contraceptive effectiveness was used to classify contraceptives as very effective, effective, and less effective. The planned contraceptive choice was determined at the time of hospital discharge after delivery by discharge summary. Chi-squared testing and logistic regression were used to measure associations between the adequacy of prenatal care and contraceptive planning. RESULTS This study included 450 deliveries, 404 (90%) patients with adequate prenatal care, and 46 (10%) patients without adequate (intermediate or inadequate) prenatal care. There was not a statistically significant difference in planning for very effective or effective methods of contraception at hospital discharge between adequate (74%) and non-adequate (61%) prenatal care groups (p = 0.06). There was no association between the adequacy of prenatal care and the effectiveness of contraceptive planning after controlling for age and parity (aOR = 1.7, 95% CI 0.89-3.22). CONCLUSIONS Many women chose very effective and effective methods of postpartum contraception; however, there was no statistically significant association between the quality of prenatal care and planned contraception at hospital discharge.
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Affiliation(s)
- Hannah L Chapman
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Dana Chase
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Bikash Bhattarai
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Maureen Sutton
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA.
| | - Isuzu Meyer
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Birmingham, USA.
| | - Caleb Schofield
- Department of Obstetrics, Gynecology & Women's Health, District Medical Group, Valleywise Health System, 2601 E Roosevelt St Phoenix, Phoenix, AZ, 85008, USA
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Belachew TB, Negash WD, Bitew DA, Asmamaw DB. Modern contraceptive utilisation and its associated factors among reproductive age women in high fertility regions of Ethiopia: a multilevel analysis of Ethiopia Demographic and Health Survey. BMJ Open 2023; 13:e066432. [PMID: 36787981 PMCID: PMC9930559 DOI: 10.1136/bmjopen-2022-066432] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE This study is aimed to assess the magnitude of modern contraceptives utilisation and associated factors among reproductive age women in high fertility regions of Ethiopia. DESIGN Cross-sectional study. SETTING High fertility regions of Ethiopian. PARTICIPANTS A total weighted sample of 3822 married reproductive age women. METHODS In this study, data were obtained from the recent Ethiopian Demographic and Health Surveys. A total weighted sample of 3822 women of reproductive age was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of modern contraceptive utilisation. Statistical significance was determined using adjusted OR (AOR) with 95% CI. RESULTS The overall modern contraceptive utilisation was 29.75% (95% CI 28.2% to 31.2%). Among the factors associated with utilisation were women's age 25-34 years (AOR 1.3; 95% CI 1.01 to 1.66) and ≥35 (AOR 1.71; 95% CI 1.37 to 2.70), husband's occupation (AOR 1.49; 95% CI 1.03 to 1.99), number of alive children: 1-4 (AOR 2.20; 95% CI 1.47 to 3.30), 5-8 (AOR 1.74; 95% CI 1.09 to 2.77), husband's desired number of children (AOR 0.77; 95% CI 0.61 to 0 .96), residency (AOR 2.37; 95% CI 1.20 to 4.67), community media exposure (AOR 1.77; 95% CI 1.01 to 3.08), region (AOR 0.13; 95% CI 0.03 to 0.52) and religion (AOR 0.49; 95% CI 0.36 to 0.66) were significantly associated with modern contraceptive utilisation. CONCLUSION Modern contraceptives utilisation in high fertility regions of Ethiopia was low. Women age, husband occupation, number of living children, husband's desired number of children, residency, community media exposure, region and religion were significantly associated with modern contraceptive utilisation. Therefore, to improve the utilisation of modern contraceptives, public health policy makers should consider creating awareness through mass media, male involvement in family planning, as well as family planning programmes, should be encouraged in rural areas.
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Affiliation(s)
| | | | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Martínez Pérez A, Terrón Barroso J, Alayón Hernández N, Ariza Chana N. Métodos anticonceptivos de larga duración (LARC): características de las usuarias, tasa de continuidad y efectividad. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Asdell SM, Bennett RD, Cordon SA, Zhao Q, Peipert JF. Knowledge and intention to use long-acting reversible contraception among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-4. [PMID: 35737977 PMCID: PMC9780399 DOI: 10.1080/07448481.2022.2089043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/16/2021] [Accepted: 03/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the relationship between knowledge of long-acting reversible contraception (LARC) and intention to use LARC among female students. PARTICIPANTS Participants consisted of a convenience sample of 292 female undergraduate and graduate students at a large midwestern university. METHODS We conducted a cross-sectional in-person survey and multivariate analysis of LARC knowledge and intention to use LARC. RESULTS Total response rate was 84.9%. Among contraceptive users, 13.3% were using a LARC method. On average, respondents scored 4.8/10 (SD 2.5) on a 10-item LARC knowledge assessment. Higher levels of LARC knowledge were associated with the intent to use LARC in the future in our multivariate analysis (RR 1.7, 95% CI 1.14-2.54: p = .01). Common reasons for LARC hesitancy were a need for more information, safety concerns, and risk of undesirable side effects. CONCLUSIONS Low LARC knowledge and students' self-identified need for further LARC information represent an opportunity for campus contraceptive interventions which empower students to make informed reproductive decisions.
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Affiliation(s)
| | | | - Sabrina A. Cordon
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
| | - Qiuhong Zhao
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
| | - Jeffrey F. Peipert
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
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Bácskay I, Ujhelyi Z, Fehér P, Arany P. The Evolution of the 3D-Printed Drug Delivery Systems: A Review. Pharmaceutics 2022; 14:pharmaceutics14071312. [PMID: 35890208 PMCID: PMC9318419 DOI: 10.3390/pharmaceutics14071312] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Since the appearance of the 3D printing in the 1980s it has revolutionized many research fields including the pharmaceutical industry. The main goal is to manufacture complex, personalized products in a low-cost manufacturing process on-demand. In the last few decades, 3D printing has attracted the attention of numerous research groups for the manufacturing of different drug delivery systems. Since the 2015 approval of the first 3D-printed drug product, the number of publications has multiplied. In our review, we focused on summarizing the evolution of the produced drug delivery systems in the last 20 years and especially in the last 5 years. The drug delivery systems are sub-grouped into tablets, capsules, orodispersible films, implants, transdermal delivery systems, microneedles, vaginal drug delivery systems, and micro- and nanoscale dosage forms. Our classification may provide guidance for researchers to more easily examine the publications and to find further research directions.
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Affiliation(s)
- Ildikó Bácskay
- Healthcare Industry Institute, University of Debrecen, Nagyerdei körút 98, H-4032 Debrecen, Hungary
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, H-4032 Debrecen, Hungary
| | - Zoltán Ujhelyi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, H-4032 Debrecen, Hungary
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei körút 98, H-4032 Debrecen, Hungary
| | - Petra Arany
- Healthcare Industry Institute, University of Debrecen, Nagyerdei körút 98, H-4032 Debrecen, Hungary
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Al-Husban N, Kaadan D, Foudeh J, Ghazi T, Sijari Y, Maaita M. Factors affecting the use of long term and permanent contraceptive methods: a Facebook-focused cross-sectional study. BMC Womens Health 2022; 22:204. [PMID: 35655199 PMCID: PMC9160863 DOI: 10.1186/s12905-022-01784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction In the Muslim world, the use and acceptance of long-term and permanent contraceptives were limited. Our aim was to investigate those limiting factors so we can help making these methods widely available and acceptable to the society.
Methods and data analysis There were 1365 women from Facebook groups in the period 08/10/2020–8/11/2020. Participants were married women, living in Jordan. This was a cross-sectional study. Statistical Package for Social Sciences (SPSS), version 16, software was used for statistical analysis (Chicago, Illinois, USA). Results Among participants, 22.3% had never used any contraceptives. Non-hormonal IUCD was the most commonly used method. There was a statistically significant association between the use of hormonal IUCD and women's age, marriage duration, education and number of children (p < 0.0001). Tubal ligation was adopted by only 44 (3.22%) participants. 19.68% of participants declined tubal ligation merely due to religious issues. Women who completed only high school level of education underwent tubal ligation significantly more than those with university (Bachelor) and post-university (Master or PhD) degrees (p < 0.0001 and 0.026, respectively). Only 1.83% of women's partners underwent vasectomy, the majority of these vasectomies (72.0%) were done because of the need for lifelong contraception. Around 17% of women's partners had poor knowledge about vasectomy. Further, women's employment status (housewives or full-time employees) was found to be the only variable that affected acceptance of vasectomy (p = 0.0047). Conclusions Women endured a heavy burden of contraception. Cultural and religious taboos influenced tubal ligation. Vasectomy was still very rarely adopted by men due to the lack of knowledge about the procedure. Our results raised the need for further dissemination of contraception knowledge and counselling through the primary care and maternity centers, mosques and media in official, comprehensive and integrated programs. Future research is needed in the field of permanent contraceptive methods.
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Affiliation(s)
- Naser Al-Husban
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan.
| | - Dalia Kaadan
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan
| | - Jude Foudeh
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan
| | - Tara Ghazi
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan
| | - Yumen Sijari
- School of Medicine, The University of Jordan, P O Box 2194, Amman, 11941, Jordan
| | - Maher Maaita
- Obstetrics and Gynecology Department, The Royal Medical Services, Amman, Jordan
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Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months. J Pediatr Adolesc Gynecol 2022; 35:336-340. [PMID: 34737030 DOI: 10.1016/j.jpag.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. RESULTS Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. CONCLUSION PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.
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Gupta D, Prabhakar B, Wairkar S. Non-oral routes, novel formulations and devices of contraceptives: An update. J Control Release 2022; 345:798-810. [PMID: 35378212 DOI: 10.1016/j.jconrel.2022.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
Family planning enables society to prevent unintended pregnancies and helps in attaining desired spacing between the pregnancies. It is done with the use of contraceptive methods and infertility treatments. The use of contraceptives serves to ease maternal ill-health and reduce pregnancy-related deaths and helps to decrease the number of unsafe abortions and HIV transmission from mothers to newborns. The most popular contraception method is a daily dose of combined oral contraceptives pills. However, poor compliance and various adverse effects are common problems of oral contraceptives that considerably reduce their long-term use. Thus, several non-oral contraceptive options have been developed for better compliance, reduced side effects and improved therapeutic efficacy. This review presented the non-oral contraceptive formulations given by different routes such as transdermal, nasal, subcutaneous, intramuscular, intrauterine and vaginal routes. These formulations delivering contraceptives, mainly through devices, include transdermal patches and microneedles, nasal sprays, intrauterine devices and intrauterine systems, vaginal rings, contraceptive implants and contraceptive injections, which are unique in their specific advantages and drawbacks.
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Affiliation(s)
- Deepak Gupta
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India
| | - Sarika Wairkar
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKMs NMIMS, V.L.Mehta Road, Vile Parle (W), Mumbai, Maharashtra 400056, India.
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Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
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Ngacha JK, Ayah R. Assessing the cost-effectiveness of contraceptive methods from a health provider perspective: case study of Kiambu County Hospital, Kenya. Reprod Health 2022; 19:11. [PMID: 35039047 PMCID: PMC8762951 DOI: 10.1186/s12978-021-01308-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kenya's contraceptive prevalence rate at 53% is low, with wide disparity among the 47 counties that make up the country (2-76%). Significant financial investment is required to maintain this level of contraceptive use and increase it to levels seen in more developed countries. This is in the context of a growing population, declining donor funding, limited fiscal space and competing health challenges. Studies have shown that long-term contraceptive methods are more cost-effective than short-term methods. However, it is unclear if this applies in Sub-Saharan Africa; with limited financial resources, lower social economic status among users, and publicly managed commodity supply chains, in vertical programs largely dependent on donor funding. This study assessed the cost-effectiveness of contraceptive methods used in Kenya. METHODS A cross-sectional study was undertaken in a county referral hospital in mid-2018. Purposive sampling of 5 family planning clinic providers and systematic sampling of 15 service delivery sessions per method was done. Questionnaire aided interviews were done to determine inputs required to provide services and direct observation to measure time taken to provide each method. Cost per method was determined using activity based costing, effectiveness via couple year protection conversion factors, and cost-effectiveness was expressed as cost per couple year protection. RESULTS The intra-uterine copper device was most cost-effective at 4.87 US dollars per couple year protection followed by the 2-Rod Implant at 6.36, the 1-Rod Implant at 9.50, DMPA at 23.68, while the combined oral contraceptive pills were least cost-effective at 38.60 US dollars per couple year protection. Long-term methods attracted a higher initial cost of service delivery when compared to short-term methods. CONCLUSION Long-term contraceptive methods are more cost-effective. As such, investing in long-term contraceptives would save costs despite higher initial cost of service delivery. It is recommended, therefore, that Sub-Saharan Africa countries allocate more domestic financial resources towards availability of contraceptive services, preferably with multi-year planning and budget commitment. The resources should be invested in a wide range of interventions shown to increase uptake of long-term methods, including reduction of cost barriers for the younger population, thereby increasing contraceptive prevalence rates.
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Affiliation(s)
- James Kiragu Ngacha
- Department of Public & Global Health, University of Nairobi, Nairobi, Kenya.
| | - Richard Ayah
- Department of Public & Global Health, University of Nairobi, Nairobi, Kenya
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15
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Wang J, Wang D. Wearable Devices and Intelligent Application in Women's Postpartum Repair for Smart Healthcare. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4454926. [PMID: 35035836 PMCID: PMC8759894 DOI: 10.1155/2022/4454926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/27/2021] [Indexed: 11/18/2022]
Abstract
Wearable devices are more and more widely used in the field of smart healthcare. The purpose of this study was to explore the effect of contraceptive counseling and education on contraceptive behavior of women after induced abortion. The investigators will explain the situation of this topic to the respondents and select the respondents in strict accordance with the framework requirements of sampling design. All the data are from the induced abortion women in the first-, second-, and third-level hospitals, which reduces the selection bias of the respondents. It is found that the proportion of induced abortion among college students is the highest, reaching 66.03%. This study is helpful to reduce the incidence of unwanted pregnancy, induced abortion, and repeated abortion and improve the reproductive health of women.
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Affiliation(s)
- Jing Wang
- Operation Room of Gynaecology OutPatient, the First People's Hospital of Wenling, Taizhou 317500, China
| | - Danfeng Wang
- Recovery Room of Anesthesiology Department, the First People's Hospital of Wenling, Taizhou 317500, China
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16
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Coaxial electrospray of uniform polylactide core-shell microparticles for long-acting contraceptive. J Control Release 2021; 341:634-645. [PMID: 34921972 DOI: 10.1016/j.jconrel.2021.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
Despite its high efficacy and good patient compliance, the only long-acting injectable (LAI) contraceptive currently available in the US, depot medroxyprogesterone acetate (DMPA), is limited by significant side effects and a delayed return to fertility for up to 10 months after its intended duration of action. To overcome these limitations, we sought to develop an injectable poly(D,l-lactide) (PLA) microparticle for sustained release of contraceptive hormone, etonogestrel (ENG). A one-step technique, coaxial electrospray method was applied to prepare uniform ENG loaded core-shell structured and slow-degrading PLA microparticles (ENG-cs-MPs) to provide release control while minimizing polymer content. By adjusting voltage, polymer concentration and flow rate of the coaxial jetting solution, the prepared ENG-cs-MPs exhibited uniformly small particle size with volume mean diameter of 14.7 ± 0.5 μm and a shell thickness of 2.5 ± 0.1 μm, high drug loading of ~54%, high encapsulation efficiency of ~99%, and initial 1-day burst release of just ~10%. Long-term in vitro release of ENG was continuous for more than 3 months without change of the shell structure in 6 months. In PK studies, ENG-cs-MPs achieved a steady and continuous drug release for approximately 3 months and then quickly tapered off within 3 weeks. Hence, ENG-cs-MPs prepared by the coaxial electrospray method may be useful as a LAI contraceptive with an improved PK profile relative to DMPA.
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Parhi R, Jena GK. An updated review on application of 3D printing in fabricating pharmaceutical dosage forms. Drug Deliv Transl Res 2021; 12:2428-2462. [PMID: 34613595 DOI: 10.1007/s13346-021-01074-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/22/2023]
Abstract
The concept of "one size fits all" followed by the conventional healthcare system has drawbacks in providing precise pharmacotherapy due to variation in the pharmacokinetics of different patients leading to serious consequences such as side effects. In this regard, digital-based three-dimensional printing (3DP), which refers to fabricating 3D printed pharmaceutical dosage forms with variable geometry in a layer-by-layer fashion, has become one of the most powerful and innovative tools in fabricating "personalized medicine" to cater to the need of therapeutic benefits for patients to the maximum extent. This is achieved due to the tremendous potential of 3DP in tailoring various drug delivery systems (DDS) in terms of size, shape, drug loading, and drug release. In addition, 3DP has a huge impact on special populations including pediatrics, geriatrics, and pregnant women with unique or frequently changing medical needs. The areas covered in the present article are as follows: (i) the difference between traditional and 3DP manufacturing tool, (ii) the basic processing steps involved in 3DP, (iii) common 3DP methods with their pros and cons, (iv) various DDS fabricated by 3DP till date with discussing few research studies in each class of DDS, (v) the drug loading principles into 3D printed dosage forms, and (vi) regulatory compliance.
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Affiliation(s)
- Rabinarayan Parhi
- Department of Pharmaceutical Sciences, Susruta School of Medical and Paramedical Sciences, Assam University (A Central University), Silchar-788011, Assam, India.
| | - Goutam Kumar Jena
- Roland Institute of Pharmaceutical Sciences, Berhampur-7600010, Odisha, India
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18
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Farah D, Andrade TRDM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis. EUR J CONTRACEP REPR 2021; 27:127-135. [PMID: 34431421 DOI: 10.1080/13625187.2021.1964467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.
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Affiliation(s)
- Daniela Farah
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Manoel João Batista Castello Girão
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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19
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Farah D, Andrade TRM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis. EUR J CONTRACEP REPR 2021; 25:492-501. [PMID: 33140990 DOI: 10.1080/13625187.2020.1833187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER CRD42017055452.
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Affiliation(s)
- Daniela Farah
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa Raquel Moraes Andrade
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Manoel João Batista Castello Girão
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
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20
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Yang L, Yang Y, Chen H, Mei L, Zeng X. Polymeric microneedle‐mediated sustained release systems: Design strategies and promising applications for drug delivery. Asian J Pharm Sci 2021; 17:70-86. [PMID: 35261645 PMCID: PMC8888142 DOI: 10.1016/j.ajps.2021.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/24/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022] Open
Abstract
Parenteral sustained release drug formulations, acting as preferable platforms for long-term exposure therapy, have been wildly used in clinical practice. However, most of these delivery systems must be given by hypodermic injection. Therefore, issues including needle-phobic, needle-stick injuries and inappropriate reuse of needles would hamper the further applications of these delivery platforms. Microneedles (MNs) as a potential alternative system for hypodermic needles can benefit from minimally invasive and self-administration. Recently, polymeric microneedle-mediated sustained release systems (MN@SRS) have opened up a new way for treatment of many diseases. Here, we reviewed the recent researches in MN@SRS for transdermal delivery, and summed up its typical design strategies and applications in various diseases therapy, particularly focusing on the applications in contraception, infection, cancer, diabetes, and subcutaneous disease. An overview of the present clinical translation difficulties and future outlook of MN@SRS was also provided.
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21
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Ivone R, Yang Y, Shen J. Recent Advances in 3D Printing for Parenteral Applications. AAPS J 2021; 23:87. [PMID: 34145513 PMCID: PMC8212901 DOI: 10.1208/s12248-021-00610-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
3D printing has emerged as an advanced manufacturing technology in the field of pharmaceutical sciences. Despite much focus on enteral applications, there has been a lack of research focused on potential benefits of 3D printing for parenteral applications such as wound dressings, biomedical devices, and regenerative medicines. 3D printing technologies, including fused deposition modeling, vat polymerization, and powder bed printing, allow for rapid prototyping of personalized medications, capable of producing dosage forms with flexible dimensions based on patient anatomy as well as dosage form properties such as porosity. Considerations such as printing properties and material selection play a key role in determining overall printability of the constructs. These parameters also impact drug release kinetics, and mechanical properties of final printed constructs, which play a role in modulating immune response upon insertion in the body. Despite challenges in sterilization of printed constructs, additional post-printing processing procedures, and lack of regulatory guidance, 3D printing will continue to evolve to meet the needs of developing effective, personalized medicines for parenteral applications.
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Affiliation(s)
- Ryan Ivone
- grid.20431.340000 0004 0416 2242Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island 02881 USA
| | - Yan Yang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Jie Shen
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA. .,Department of Chemical Engineering, University of Rhode Island, 7 Greenhouse Road, Kingston, Rhode Island, 02881, USA.
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22
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Florio KL, Kao M, Johnson T, Tuttle HA, White D, Nelson L, Patel N, Ramaeker D, Kendig S, Schmidt L, Grodzinsky A, Economy K. Contraception for the Cardiac Patient: a Cardiologist’s Primer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Purpose of review
Cardiovascular disease (CVD) is the number one cause of maternal mortality in the USA. There are many cardiac conditions which pose significant risk to maternal health, and these women should be offered options to avoid unwanted pregnancies. Individualized contraceptive counseling focusing on woman’s desire for future pregnancy, comorbid conditions, and desire for hormone or non-hormonal (contraceptive) options is paramount to avoid adverse or unwanted side effects. The purpose of this review is to give general guidance on prescribing both hormonal and non-hormonal contraceptives for providers caring for women with heart disease.
Recent findings
Specific recommendation for the use of either non-hormonal or hormonal contraception requires knowledge of the types of contraceptive options available, cost, failure rates, and contraindications to use. Newer progestin-only options have become available and should be considered first-line therapy for women with cardiovascular disease.
Summary
The physiologic burden of pregnancy on the cardiovascular system can cause significant maternal morbidity and mortality for women with underlying CVD. These women should be offered safe and effective options for birth control, and both cardiology and obstetrical providers alike should possess fundamental knowledge of appropriate options.
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23
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Salinas A, Merino PM, Giraudo F, Codner E. Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes. Pediatr Diabetes 2020; 21:1074-1082. [PMID: 32562346 DOI: 10.1111/pedi.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/28/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Adolescent pregnancy is a major public health problem worldwide. Adolescents living with diabetes are not aware of the risks of unplanned pregnancy and the high rate of fetal and maternal complications when gestation occurs in women with significant hyperglycemia. These data highlight the significance of pregnancy prevention in young women with diabetes. Long-acting reversible contraceptives (LARCs), which include subdermal progestin implants and hormonal and nonhormonal intrauterine devices (IUDs), have been recommended by the American College of Obstetricians Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents and young women. This article reviews LARC options for adolescents and young women with type 1 (T1D) and type 2 (T2D) diabetes as well as the possible complications and side effects.
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Affiliation(s)
- Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Chilean Institute of Reproductive Medicine ICMER, Santiago, Chile
| | - Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Franco Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile FDJ, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Xiong BJ, Tao GJ, Jiang D. Bladder-embedded ectopic intrauterine device with calculus. Open Med (Wars) 2020; 15:501-507. [PMID: 33336004 PMCID: PMC7712230 DOI: 10.1515/med-2020-0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to analyze the data of embedded intrauterine device (IUD) in the bladder wall with the additional presence of calculus. This case series study included 11 female patients with partially or completely embedded IUD in the bladder wall. Their median age was 34 (range, 32-39) years. The median duration of IUD placement was 36 (range, 24-60) months. The median duration of symptoms was 9 (range, 3-12) months. Six patients underwent laparoscopy: the operation duration was 129 (range, 114-162) min, blood loss was 15 (range, 10-25) mL, the hospital stay was 4 (range, 4-4.5) days, the visual analog scale (VAS) for pain at 6 h after surgery was 3 (range, 2-6), and the time to removal of the urethral catheter was 7 (range, 7-8) days. Five patients underwent open surgery: the operation duration was 126 (range, 96-192) min, blood loss was 30 (range, 20-50) mL, the hospital stay was 7 (range, 7-15) days, the VAS was 6 (range, 4-9) at 6 h after surgery, and the time to removal of the urethral catheter was 9 (range, 8-17) days. The IUD and bladder stones were successfully removed in all 11 (100%) patients.
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Affiliation(s)
- Bing-Jian Xiong
- Department of Urology, Ankang City Central Hospital, Ankang, Shaanxi, 725000, China
| | - Guang-Jing Tao
- Department of Urology, Ankang City Central Hospital, Ankang, Shaanxi, 725000, China
| | - Duo Jiang
- Department of Urology, Ankang City Central Hospital, Ankang, Shaanxi, 725000, China
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Khatri B, Khadka A, Amatya A, Shrestha SM, Paudel R. Perception And Use Of Intrauterine Contraceptive Devices (IUCD) Among Married Women Of Reproductive Age In Bhaktapur, Nepal. Open Access J Contracept 2019; 10:69-77. [PMID: 31819678 PMCID: PMC6886550 DOI: 10.2147/oajc.s219188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The copper-T (TCu-380A), an intrauterine contraceptive device (IUCD), is widely available and is highly effective in terms of safety and effectiveness. Despite this fact, there is low utilization of IUCD in Nepal. This paper describes the perception and use of IUCD among married women of reproductive age attending an institutional clinic in Bhaktapur, Nepal. Methods An institution-based cross-sectional study was conducted among 273 married women attending the institutional clinic of Bhaktapur hospital who were interviewed by trained staff nurses using semi-structured questionnaires. Systematic random sampling method was applied to select the participants. Logistic regression analysis was used to determine the relationship between factors associated with utilization of IUCD. Results Just below half (48.7%) of the participants had heard about IUCD. Only 7.0% of the potential users were currently using IUCD, and all of them had discussed using it with their husbands. Among women aware of IUCD, nearly a quarter of them (23.8%) did not want to use it because of their husband's disapproval and their assumed fear of decreased sexual pleasure. There was a significant association between previous abortion and use of IUCD, where the women who had a history of abortion had increased odds of using the IUCD by 5.45-times compared to those who had not (p=0.01). The women who were counseled about IUCD by health workers were 2.83-times more likely to use an IUCD than those who were not. The women who had a good knowledge level about IUCD as a method of modern contraception had 2.85-times increased odds of using the IUCD compared to those who had poor or no knowledge about it. Conclusion The use of IUCD depends on the support of husbands, knowledge about its safety, efficacy, and counseling.
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Affiliation(s)
- Bijay Khatri
- Academic and Research Department, B.P. Eye Foundation, Kathmandu, Nepal
| | - Anjana Khadka
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Archana Amatya
- Save the Children International, Nepal Country Office, Kathmandu, Nepal
| | - Sushan Man Shrestha
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rajan Paudel
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Li W, Tang J, Terry RN, Li S, Brunie A, Callahan RL, Noel RK, Rodríguez CA, Schwendeman SP, Prausnitz MR. Long-acting reversible contraception by effervescent microneedle patch. SCIENCE ADVANCES 2019; 5:eaaw8145. [PMID: 31723599 PMCID: PMC6834388 DOI: 10.1126/sciadv.aaw8145] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 09/17/2019] [Indexed: 05/10/2023]
Abstract
To increase access to long-acting contraception, we developed a reversible contraceptive microneedle patch that is simple-to-administer, slowly releases contraceptive hormone (levonorgestrel) for >1 month, and generates no biohazardous sharps waste. After manually pressing the patch to skin for 1 min, microneedles rapidly separate from the patch within the skin due to effervescence triggered by contact with skin's interstitial fluid, as demonstrated in rats and human participants. Long-acting contraception is achieved by formulating microneedles with a biodegradable polymer [poly(lactic-co-glycolic) acid] that slowly releases levonorgestrel for ~1 month in vitro. In rats, the patch maintained levonorgestrel concentration above the human contraceptive threshold level for >1 month, and a placebo microneedle patch was well-tolerated in human participants. Women of reproductive age in three continents demonstrated interest in and preference for long-acting contraception by microneedle patch. These studies indicate that an effervescent microneedle patch could facilitate greater access to long-acting contraception.
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Affiliation(s)
- Wei Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
| | - Jie Tang
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Richard N. Terry
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
| | - Song Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
| | - Aurelie Brunie
- Health Services Research, FHI 360, 1825 Connecticut Ave NW, Washington, DC 20009, USA
| | - Rebecca L. Callahan
- Product Development and Introduction, FHI 360, 359 Blackwell Street #200, Durham, NC 27701, USA
| | - Richard K. Noel
- Physiological Research Laboratory, Georgia Institute of Technology, 950 Atlantic Drive, Atlanta, GA 30332, USA
| | - Carlos A. Rodríguez
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Steven P. Schwendeman
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Mark R. Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, GA 30332, USA
- Corresponding author.
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Kiemtoré S, Zoungrana Z, Zamané H, Kaboré CW, Ouédraogo A, Bonané B. Interventions to improve the use of long‐acting reversible contraceptive methods at primary health centers in Burkina Faso. Int J Gynaecol Obstet 2019; 147:350-355. [DOI: 10.1002/ijgo.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/25/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Sibraogo Kiemtoré
- Département de Gynécologie ObstétriqueUnité de Formation et de Recherche en Sciences de la SantéUniversité Joseph Ki‐Zerbo Ouagadougou Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouédraogo Ouagadougou Burkina Faso
| | - Zakaria Zoungrana
- Centre Hospitalier Universitaire Yalgado Ouédraogo Ouagadougou Burkina Faso
| | - Hyacinthe Zamané
- Département de Gynécologie ObstétriqueUnité de Formation et de Recherche en Sciences de la SantéUniversité Joseph Ki‐Zerbo Ouagadougou Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouédraogo Ouagadougou Burkina Faso
| | | | - Ali Ouédraogo
- Département de Gynécologie ObstétriqueUnité de Formation et de Recherche en Sciences de la SantéUniversité Joseph Ki‐Zerbo Ouagadougou Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouédraogo Ouagadougou Burkina Faso
| | - Blandine Bonané
- Département de Gynécologie ObstétriqueUnité de Formation et de Recherche en Sciences de la SantéUniversité Joseph Ki‐Zerbo Ouagadougou Burkina Faso
- Centre Hospitalier Universitaire Yalgado Ouédraogo Ouagadougou Burkina Faso
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Brown A, Harries J, Cooper D, Morroni C. Perspectives on contraceptive implant use in women living with HIV in Cape Town, South Africa: a qualitative study among primary healthcare providers and stakeholders. BMC Public Health 2019; 19:1003. [PMID: 31349786 PMCID: PMC6660962 DOI: 10.1186/s12889-019-7312-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored primary healthcare provider and HIV/contraception expert stakeholder perspectives on South Africa's public sector provision of contraceptive implants to women living with HIV. We investigated the contraceptive service-impact of official advice against provision of implants to women using the HIV antiretroviral drug, efavirenz, issued by the South African National Department of Health (NDoH) in 2014. METHODS Qualitative data was collected in Cape Town in 2017 from primary healthcare contraceptive providers in four clinics that provide implants, as well as from other expert stakeholders selected for expertise in HIV and/or contraception. In-depth interviews and a group discussion explored South Africa's implant introduction and implant provision to women living with HIV. Data was analysed using an inductive thematic analysis approach. RESULTS Interviews were conducted with 10 providers and 10 stakeholders. None of the four clinics where the providers worked currently offered the implant to women living with HIV. Stakeholders confirmed that this was consistent with patterns of implant provision at primary healthcare facilities across Cape Town. Factors contributing to providers' decisions to suspend provision of the implant to women living with HIV included: inadequate initial and ongoing provider training; interpretation of NDoH communications about implant use with efavirenz; provider unwillingness to risk harming clients and concerns about professional liability; and other pressures related to provider capacity. CONCLUSIONS All South African women, including those living with HIV, should have access to the full range of contraceptive options for which they are medically eligible. Changing guidance should be initiated and communicated in consultation with primary-level providers and service beneficiaries. Guidance issued to providers needs to be clear and fully evidence-informed, and its correct interpretation and implementation facilitated and monitored. Guidance should be accompanied by provider training, as well as counselling messages and tools to support providers. Generalized retraining of providers in rights-based, client-centred family planning, and in particular implant provision for women with HIV, is needed. These recommendations accord with the right of women living with HIV to access the highest possible standard of sexual and reproductive healthcare, including informed contraceptive choice and access to the contraceptive implant.
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Affiliation(s)
- Anna Brown
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Diane Cooper
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Chelsea Morroni
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,Botswana UPenn Partnership, Gaborone, Botswana.,Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Lang B, Josephy T, Micks E, McCoy E, Prager S. Use of the Levonorgestrel Intrauterine Device in Women With Type 2 Diabetes. Clin Diabetes 2018; 36:251-256. [PMID: 30078945 PMCID: PMC6053853 DOI: 10.2337/cd17-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IN BRIEF Women with type 2 diabetes are less likely to receive prescriptions for contraceptives despite the fact that diabetes is associated with an increased risk of maternal and fetal complications. In the largest case series to date examining use of the levonorgestrel-releasing intrauterine device (LNG-IUD) in women with type 2 diabetes, we demonstrate that the LNG-IUD is safe and effective and does not affect glycemic control in women with type 2 diabetes. In this study of 115 women under the age of 55 years with type 2 diabetes who had an LNG-IUD placed between 2007 and 2012, we found low rates of pregnancies, expulsions, and other complications in every age category and disease stratification. Thirty-nine patients had A1C data before and up to 2 years after placement, and there was no significant change in A1C (mean A1C decrease of 0.17, 95% CI -0.76 to 0.43). This study will enable evidence-based contraceptive counseling for women with type 2 diabetes.
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Affiliation(s)
- Benjamin Lang
- University of Washington School of Medicine, Seattle, WA
| | - Tatiana Josephy
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Erin McCoy
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Sarah Prager
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
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Lim SH, Kathuria H, Tan JJY, Kang L. 3D printed drug delivery and testing systems - a passing fad or the future? Adv Drug Deliv Rev 2018; 132:139-168. [PMID: 29778901 DOI: 10.1016/j.addr.2018.05.006] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/12/2018] [Accepted: 05/12/2018] [Indexed: 12/23/2022]
Abstract
The US Food and Drug Administration approval of the first 3D printed tablet in 2015 has ignited growing interest in 3D printing, or additive manufacturing (AM), for drug delivery and testing systems. Beyond just a novel method for rapid prototyping, AM provides key advantages over traditional manufacturing of drug delivery and testing systems. These includes the ability to fabricate complex geometries to achieve variable drug release kinetics; ease of personalising pharmacotherapy for patient and lowering the cost for fabricating personalised dosages. Furthermore, AM allows fabrication of complex and micron-sized tissue scaffolds and models for drug testing systems that closely resemble in vivo conditions. However, there are several limitations such as regulatory concerns that may impede the progression to market. Here, we provide an overview of the advantages of AM drug delivery and testing, as compared to traditional manufacturing techniques. Also, we discuss the key challenges and future directions for AM enabled pharmaceutical applications.
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Affiliation(s)
- Seng Han Lim
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, 117543, Singapore
| | - Himanshu Kathuria
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, 117543, Singapore
| | - Justin Jia Yao Tan
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Block S4A, Level 3, 117543, Singapore
| | - Lifeng Kang
- School of Pharmacy, University of Sydney, Pharmacy and Bank Building A15, NSW 2006, Australia.
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Walsh-Buhi ER, Helmy HL. Trends in long-acting reversible contraceptive (LARC) use, LARC use predictors, and dual-method use among a national sample of college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:225-236. [PMID: 29111911 DOI: 10.1080/07448481.2017.1399397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use. PARTICIPANTS Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18-24 years, who reported having vaginal sex (N = 37,899). METHODS Secondary analyses of Fall 2011-2014 ACHA-NCHA II data. RESULTS Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users. CONCLUSION This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.
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Affiliation(s)
- Eric R Walsh-Buhi
- a Division of Health Promotion and Behavioral Science , Graduate School of Public Health, San Diego State University , San Diego , California , USA
| | - Hannah L Helmy
- b Department of Public Health , Montclair State University , Montclair , New Jersey , USA
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López Del Cerro E, Serrano Diana C, Castillo Cañadas AM, González Mirasol E, García Santos F, Gómez García MT, González de Merlo G. Influence of age on tolerability, safety and effectiveness of subdermal contraceptive implants. J OBSTET GYNAECOL 2018; 38:979-984. [PMID: 29553853 DOI: 10.1080/01443615.2018.1430753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The use of long-acting contraceptive methods is on the rise. The aim of this study was to describe the main variables (effectiveness, tolerability, menstrual bleeding) associated with the use of subdermal contraceptive implants and to investigate the influence of age on these variables. This was a descriptive, retrospective, observational study of 221 cases of contraceptive implants inserted at a Spanish hospital between 2006 and 2015. The mean age of implant users was 31.2 ± 7.5 years. Effectiveness was 100% and good tolerability was recorded for 86.5%. Infrequent bleeding was the most common bleeding pattern, followed by amenorrhoea. Of the 221 implants inserted, 47.5% were removed. The main reasons were expiration (54.3%) and discomfort due to bleeding alterations and other adverse effects (25.7%). Nulliparity and weight gain were significantly associated with an increased probability of implant removal. This study shows that implants were highly effective, safe and well-tolerated in our population. The age of users had no influence on any of the study variables analysed. Impact Statement What is already known on this subject? Subdermal contraceptive implants are long-acting reversible contraceptives which are both safe and effective. What do the results of this study add? The age of users had no influence on any of the study variables analysed. Nulliparity and weight gain were significantly associated with an increased probability of implant removal. What are the implications of these findings for clinical practice and/or further research? Subdermal contraceptive implants were a safe and effective long-acting progestin contraceptive method for women from all age groups in our series because no significant age-related differences were observed for the tolerability, vaginal bleeding patterns, the effectiveness, the adverse effects or any other variables.
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Affiliation(s)
- Esther López Del Cerro
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
| | - Carolina Serrano Diana
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
| | - Ana María Castillo Cañadas
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
| | - Esteban González Mirasol
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
| | - Francisco García Santos
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
| | - María Teresa Gómez García
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain.,b Departamento de Ciencias Médicas , Facultad de Medicina de la Universidad de Castilla La Mancha , Albacete , Spain
| | - Gaspar González de Merlo
- a Department of Obstetrics and Gynecology , Hospital General Universitario de Albacete , Albacete , Spain
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Bahamondes L, Villarroel C, Frías Guzmán N, Oizerovich S, Velázquez-Ramírez N, Monteiro I. The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations. Hum Reprod Open 2018; 2018:hox030. [PMID: 30895242 PMCID: PMC6276683 DOI: 10.1093/hropen/hox030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/18/2017] [Accepted: 12/25/2017] [Indexed: 12/19/2022] Open
Abstract
STUDY QUESTION Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971, Campinas, SP, Brazil
| | - Claudio Villarroel
- Institute for Mother and Child Research (IDIMI), University of Chile, Av. Santa Rosa 1234, Santiago, Chile
| | - Natalia Frías Guzmán
- Cervical Cancer Education and Early Detection Programme, Arabia #1, Arroyo Hondo, Santo Domingo, Dominican Republic
| | - Silvia Oizerovich
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Buenos Aires, Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Norma Velázquez-Ramírez
- Department of Sexual and Reproductive Health Care (Reproductive Biology), Instituto Nacional de Perinatología (INPER), Montes Urales 800, Lomas 11000, CDMX, Mexico
| | - Ilza Monteiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP) Medical School, Caixa Postal 6181, 13084-971, Campinas, SP, Brazil
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Tappa K, Jammalamadaka U, Ballard DH, Bruno T, Israel MR, Vemula H, Meacham JM, Mills DK, Woodard PK, Weisman JA. Medication eluting devices for the field of OBGYN (MEDOBGYN): 3D printed biodegradable hormone eluting constructs, a proof of concept study. PLoS One 2017; 12:e0182929. [PMID: 28797120 PMCID: PMC5552136 DOI: 10.1371/journal.pone.0182929] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/18/2017] [Indexed: 01/17/2023] Open
Abstract
3D printing has the potential to deliver personalized implants and devices for obstetric and gynecologic applications. The aim of this study is to engineer customizable and biodegradable 3D printed implant materials that can elute estrogen and/or progesterone. All 3D constructs were printed using polycaprolactone (PCL) biodegradable polymer laden with estrogen or progesterone and were subjected to hormone-release profile studies using ELISA kits. Material thermal properties were tested using thermogravimetric analysis and differential scanning calorimetry. The 3D printed constructs showed extended hormonal release over a one week period. Cytocompatibility and bioactivity were assessed using a luciferase assay. The hormone-laden 3D printed constructs demonstrated an increase in luciferase activity and without any deleterious effects. Thermal properties of the PCL and hormones showed degradation temperatures above that of the temperature used in the additive manufacturing process–suggesting that 3D printing can be achieved below the degradation temperatures of the hormones. Sample constructs in the shape of surgical meshes, subdermal rods, intrauterine devices and pessaries were designed and printed. 3D printing of estrogen and progesterone-eluting constructs was feasible in this proof of concept study. These custom designs have the potential to act as a form of personalized medicine for drug delivery and optimized fit based on patient-specific anatomy.
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Affiliation(s)
- Karthik Tappa
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Udayabhanu Jammalamadaka
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Todd Bruno
- Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, Shreveport, Louisiana, United States of America
| | - Marissa R. Israel
- Department of Pharmacy, St. Louis University Hospital, St. Louis, Missouri, United States of America
| | - Harika Vemula
- Pharmaceutical Sciences and Chemistry, University of Missouri- Kansas City, Kansas City, Missouri, United States of America
| | - J. Mark Meacham
- Department of Mechanical Engineering & Materials Science, Washington University, St Louis, Missouri, United States of America
| | - David K. Mills
- Department of Biomedical Engineering, Louisiana Tech University, Ruston, Louisiana, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jeffery A. Weisman
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, United States of America
- * E-mail:
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Abstract
Contraception services should be part of routine health care maintenance in reproductive-aged women, especially in light of the fact that approximately 50% of pregnancies in the United States remain unplanned. Barrier methods, especially condoms, may play a role in sexually transmitted disease prevention but are less efficacious for pregnancy avoidance. There are several available hormonal contraceptive options, including the combination hormonal pill, progestin-only pill, combination hormonal patches and rings, injectable progestins, implantable progestins, intrauterine devices (copper or progestin), and permanent sterilization. These methods have varying efficacy, often related to patient compliance or tolerance of side effects.
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Affiliation(s)
- Erin E Tracy
- Vincent Obstetrics and Gynecology, Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Founders 406, 55 Fruit Street, Boston, MA 02114, USA.
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Godiwala P, Appelhans BM, Moore Simas TA, Xiao RS, Liziewski KE, Pagoto SL, Waring ME. Pregnancy intentionality in relation to non-planning impulsivity. J Psychosom Obstet Gynaecol 2016; 37:130-136. [PMID: 27319571 PMCID: PMC5045788 DOI: 10.1080/0167482x.2016.1194390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Half of US pregnancies are unintended. Understanding risk factors is important for reducing unintended pregnancy rates. AIM We examined a novel risk factor for unintended pregnancies, impulsivity. We hypothesized that non-planning impulsivity, but not motor or attentional impulsivity, would be related to pregnancy intention. METHODS Pregnant women (N = 116) completed self-report measures during their second or third trimester. Impulsivity was measured using the Barratt Impulsiveness Scale (BIS-15); subscales measured motor, attentional and non-planning impulsivity (subscale range: 5-20). On each subscale, high impulsivity was indicated by a score of ≥11. Pregnancy intention was assessed by asking women whether they were trying to become pregnant at the time of conception (yes or no). Crude and multivariable-adjusted logistic regression models estimated the cross-sectional association between impulsivity and unplanned pregnancy. RESULTS Thirty-four percent of women reported that their current pregnancy was unplanned, and 32% had high non-planning impulsivity. Fifty-one percent of women with high non-planning impulsivity reported an unplanned pregnancy versus 25% of women with low impulsivity. Women with high non-planning impulsivity had 3.53 times the odds of unplanned pregnancy compared to women with low non-planning impulsivity (adjusted OR =3.53, 95% CI: 1.23-10.14). Neither motor (adjusted OR =0.55, 95% CI: 0.10-2.90) nor attentional (adjusted OR =0.84, 95% CI: 0.25-2.84) impulsivity were related to pregnancy intentionality. CONCLUSIONS High non-planning impulsivity may be a risk factor for unplanned pregnancy. Further research should explore whether increasing the use of long-acting reversible contraceptives or integrating if-then planning into contraceptive counseling among women with higher non-planning impulsivity can lower unplanned pregnancy rates.
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Affiliation(s)
- Prachi Godiwala
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Department of Obstetrics & Gynecology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | | | - Tiffany A. Moore Simas
- Division of Research, Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Rui S. Xiao
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Kathryn E. Liziewski
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Worcester Polytechnic Institute, Worcester, MA
| | - Sherry L. Pagoto
- Division of Behavioral and Preventive Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA,Division of Research, Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Worcester, MA
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Scarsi KK, Darin KM, Chappell CA, Nitz SM, Lamorde M. Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV. Drug Saf 2016; 39:1053-1072. [PMID: 27562873 PMCID: PMC5048570 DOI: 10.1007/s40264-016-0452-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Family planning options, including hormonal contraceptives, are essential for improving reproductive health among the more than 17 million women living with HIV worldwide. For these women, prevention of unintended pregnancy decreases maternal and child mortality, as well as reduces the risk of perinatal HIV transmission. Similarly, treatment of HIV with antiretroviral therapy (ART) is essential for reducing morbidity and mortality among HIV-positive individuals, as well as preventing HIV transmission between sexual partners or from mother to child. Importantly, despite the benefits of hormonal contraceptives, barriers to effective family planning methods exist for HIV-positive women. Specifically, drug-drug interactions can occur between some antiretroviral medications and some hormonal contraceptives, which may influence both contraceptive efficacy and tolerability. In addition, safety concerns have been raised about the impact of hormonal contraceptives on HIV disease progression, tolerability, and the risk of female-to-male HIV transmission. This review article summarizes the potential for drug-drug interactions, tolerability, and contraceptive effectiveness when hormonal contraceptives are combined with ART. In addition, the evidence surrounding the influence of hormonal contraceptives on HIV transmission and HIV disease progression in women living with HIV are summarized.
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Affiliation(s)
- Kimberly K Scarsi
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA.
| | - Kristin M Darin
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephanie M Nitz
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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Abstract
PURPOSE OF REVIEW The last several years have seen a number of important clinical and academic advances in long-acting reversible contraceptive (LARC) methods, such that many professional medical organizations now recommend these methods as first-line contraception for all women. RECENT FINDINGS Recent data support the use of LARC in a variety of special circumstances including adolescents, nulliparous women and immediately postpartum and postabortion. Evidence also shows that traditional methods of pain control with intrauterine device (IUD) insertion and cervical preparation prior to insertion may not be warranted. Further, the extended use of IUDs is safer and more effective than previously realized. SUMMARY The rising uptake of LARC methods in the United States has the potential to dramatically decrease undesired pregnancies and abortion rates, and should be considered an effective option in the majority of women.
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Intrauterine Contraception Among Women Living With Human Immunodeficiency Virus: A Randomized Controlled Trial. Obstet Gynecol 2016; 126:928-934. [PMID: 26444127 DOI: 10.1097/aog.0000000000001087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare discontinuation rates of the levonorgestrel and copper intrauterine devices (IUDs) among women with human immunodeficiency virus. METHODS A double-masked randomized trial was conducted at Mulago Hospital, Uganda. Women received either a copper or levonorgestrel IUD. The primary outcome was discontinuation of intrauterine contraception within 1 year of placement. The secondary outcomes were incidence of side effects and severe adverse events. To discern a difference of 10% from a copper IUD discontinuation rate of 18%, power of 80%, and 95% confidence interval (CI), a sample size of 351 per arm was estimated. Analysis of the primary outcome was by intension-to-treat principle. RESULTS From September 2013 to December 2014, 979 were screened and 703 randomized as follows: 349 to the copper group and 354 to the levonorgestrel group. In total, 8.6% (29/338) women in the copper group compared with 8.1% (27/334) in the levonorgestrel group discontinued intrauterine conception within 1 year of placement (incidence rate ratio 1.1 [95% CI 0.64-1.96]). Overall, the incidence of heavy bleeding was higher in the copper group (37% [125/338]) than in the levonorgestrel group (19.5% [65/334]). However, the incidence of amenorrhea, which occurred in 3.3% (11/338) of women, was lower in the copper group than the 19.8% (66/334) of women who reported amenorrhea in the levonorgestrel group. CONCLUSION There was no difference in discontinuation rates between the copper and levonorgestrel devices. Women in the levonorgestrel group had reduced incidence of heavy bleeding and a higher incidence of amenorrhea compared with those in the copper group. CLINICAL TRIAL REGISTRATION Pan African Clinical Trial Registry, www.pactr.org, PACTR 201308000561212. LEVEL OF EVIDENCE I.
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Mayondi GK, Wirth K, Morroni C, Moyo S, Ajibola G, Diseko M, Sakoi M, Magetse JD, Moabi K, Leidner J, Makhema J, Kammerer B, Lockman S. Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study. BMC Public Health 2016; 16:44. [PMID: 26774918 PMCID: PMC4715872 DOI: 10.1186/s12889-015-2498-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. Methods We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. Results The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). Conclusions The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.
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Affiliation(s)
- Gloria K Mayondi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | | | - Chelsea Morroni
- EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. .,University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. .,Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana.
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Gbolahan Ajibola
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Maureen Sakoi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jane Dipuo Magetse
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Kebaiphe Moabi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jean Leidner
- Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA.
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA.
| | - Betsy Kammerer
- Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA. .,Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA.
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Biskamp C, Kauffman RP. Arm flexion during ultrasound assists localization of an intramuscular etonogestrel contraceptive implant. Contraception 2015; 93:273-5. [PMID: 26549857 DOI: 10.1016/j.contraception.2015.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/24/2015] [Accepted: 11/01/2015] [Indexed: 11/19/2022]
Abstract
A nonpalpable etonogestrel implant was identified by high-frequency ultrasound in the biceps muscle 4-6mm below the skin. Active elbow flexion resulted in proximal movement of the implant relative to the ultrasound probe, suggesting localization in the muscle. This maneuver may assist in verifying intramuscular placement prior to surgical excision.
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Affiliation(s)
- Connor Biskamp
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine at Amarillo, 1400 South Coulter, Amarillo, TX 79106, USA
| | - Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine at Amarillo, 1400 South Coulter, Amarillo, TX 79106, USA.
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Development and Implementation of CHOICES Group to Reduce Drinking, Improve Contraception, and Prevent Alcohol-Exposed Pregnancies in American Indian Women. J Subst Abuse Treat 2015; 59:45-51. [PMID: 26265591 DOI: 10.1016/j.jsat.2015.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 11/24/2022]
Abstract
Public health officials assert that prevention of alcohol-exposed pregnancies (AEP) should begin before conception, by reducing alcohol consumption in women at-risk for or planning pregnancy, and/or preventing pregnancy in women who are drinking at risky levels. One such effort is the Oglala Sioux Tribe (OST) CHOICES Program. While the OST CHOICES Program has been successfully implemented, a community-based needs assessment determined that the OST CHOICES intervention should expand and be delivered in a group setting using group motivational interviewing (MI) techniques. After extensive group MI and CHOICES group trainings, recruitment for CHOICES Group began and within a ten month period, a total of twelve groups with non-pregnant American Indian women were held for this pilot intervention. Evaluations completed by participants indicated that CHOICES Group sessions positively engaged members, had low levels of anger or tension, and had average levels of avoidance of personal responsibility. An evaluation of the CHOICES Group leaders indicated strengths in certain MI skills, although improvement is needed in some core MI and group leadership skills. This is an important expansion of a successful AEP prevention program (CHOICES), as well as a novel application of MI, and recommendations and future plans for this intervention are outlined.
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Allen C, Kolehmainen C. Intrauterine devices and other forms of contraception: thinking outside the pack. Med Clin North Am 2015; 99:505-20. [PMID: 25841597 DOI: 10.1016/j.mcna.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A variety of contraception options are available in addition to traditional combined oral contraceptive pills. Newer long-acting reversible contraceptive (LARC) methods such as intrauterine devices and subcutaneous implants are preferred because they do not depend on patient compliance. They are highly effective and appropriate for most women. Female and male sterilization are other effective but they are irreversible and require counseling to minimize regret. The contraceptive injection, patch, and ring do not require daily administration, but their typical efficacy rates are lower than LARC methods and similar to those for combined oral contraceptive pills.
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Affiliation(s)
- Caitlin Allen
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 5120 MFCB, 1685 Highland Avenue, Madison, WI 53705, USA.
| | - Christine Kolehmainen
- William S. Middleton Memorial Veteran's Hospital, University of Wisconsin School of Medicine and Public Health, 11G, 2500 Overlook Terrace, Madison, WI 53703, USA
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Roos-Hesselink JW, Cornette J, Sliwa K, Pieper PG, Veldtman GR, Johnson MR. Contraception and cardiovascular disease. Eur Heart J 2015; 36:1728-34, 1734a-1734b. [DOI: 10.1093/eurheartj/ehv141] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
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George TP, DeCristofaro C, Dumas BP, Murphy PF. Shared Decision Aids: Increasing Patient Acceptance of Long-Acting Reversible Contraception. Healthcare (Basel) 2015; 3:205-18. [PMID: 27417757 PMCID: PMC4939531 DOI: 10.3390/healthcare3020205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022] Open
Abstract
Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception.
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Affiliation(s)
- Tracy P George
- Department of Nursing, Francis Marion University, Florence, SC 29502, USA.
- South Carolina Department of Health and Environmental Control, Dillon, SC 29536, USA.
| | - Claire DeCristofaro
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
- Department of Behavioral Sciences, College of Health, Human Services, and Science, Ashford University, San Diego, CA 92123, USA.
| | - Bonnie P Dumas
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Pamela F Murphy
- Department of Behavioral Sciences, College of Health, Human Services, and Science, Ashford University, San Diego, CA 92123, USA.
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Robinson N, Moshabela M, Owusu-Ansah L, Kapungu C, Geller S. Barriers to Intrauterine Device Uptake in a Rural Setting in Ghana. Health Care Women Int 2014; 37:197-215. [PMID: 25153448 DOI: 10.1080/07399332.2014.946511] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Long-acting reversible contraception is an underutilized method in low-resource areas. Our study aims to: (a) assess knowledge and attitudes around contraception; (b) identify barriers to intrauterine device (IUD) uptake; and (c) develop interventions to address this gap in contraceptive care. We conducted focus group discussions with pregnant, postpartum, and reproductive-aged women, males, and health care workers in rural Ghana. Lack of IUD-specific knowledge, provider discomfort with insertion, and incomplete contraceptive counseling contribute to lack of IUD use. Participant- and provider-related barriers contribute to poor uptake of IUDs within the community. Targeted interventions are necessary to improve IUD use.
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Affiliation(s)
- Nuriya Robinson
- a Department of Obstetrics and Gynecology, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Mosa Moshabela
- b Department of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal , Durban , South Africa
| | | | - Chisina Kapungu
- a Department of Obstetrics and Gynecology, University of Illinois at Chicago , Chicago , Illinois , USA
| | - Stacie Geller
- a Department of Obstetrics and Gynecology, University of Illinois at Chicago , Chicago , Illinois , USA
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McCoy SI, Buzdugan R, Ralph LJ, Mushavi A, Mahomva A, Hakobyan A, Watadzaushe C, Dirawo J, Cowan FM, Padian NS. Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe. PLoS One 2014; 9:e105320. [PMID: 25144229 PMCID: PMC4140753 DOI: 10.1371/journal.pone.0105320] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. METHODS We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. RESULTS Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. CONCLUSIONS Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.
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Affiliation(s)
- Sandra I. McCoy
- University of California, Berkeley, California, United States of America
- * E-mail:
| | - Raluca Buzdugan
- University of California, Berkeley, California, United States of America
| | - Lauren J. Ralph
- University of California, Berkeley, California, United States of America
| | | | - Agnes Mahomva
- Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe
| | - Anna Hakobyan
- Children’s Investment Fund Foundation, London, United Kingdom
| | | | - Jeffrey Dirawo
- Centre for Sexual Health and HIV Research, Harare, Zimbabwe
| | - Frances M. Cowan
- Centre for Sexual Health and HIV Research, Harare, Zimbabwe
- University College London, London, United Kingdom
| | - Nancy S. Padian
- University of California, Berkeley, California, United States of America
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Wildemeersch D, Jandi S, Pett A, Nolte K, Hasskamp T, Vrijens M. Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study. Int J Womens Health 2014; 6:727-34. [PMID: 25125987 PMCID: PMC4130709 DOI: 10.2147/ijwh.s65462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to provide additional data on the experience with frameless copper and levonorgestrel (LNG) intrauterine devices (IUDs) in nulliparous and adolescent women. METHODS Nulliparous and adolescent women, 25 years of age or younger, using the frameless copper IUD or the frameless LNG-releasing intrauterine system (IUS), were selected from previous studies and a current multicenter post-marketing study with the frameless copper IUD. The small copper-releasing GyneFix(®) 200 IUD consists of four copper cylinders, each 5 mm long and only 2.2 mm wide. The frameless FibroPlant(®) LNG-IUS consists of a fibrous delivery system releasing the hormone levonorgestrel (LNG-IUS). The main features of these intrauterine contraceptives are that they are frameless, flexible, and anchored to the fundus of the uterus. RESULTS One hundred and fifty-four nulliparous and adolescent women participated in the combined study. One pregnancy occurred with the GyneFix 200 IUD after unnoticed early expulsion of the device (cumulative pregnancy rate 1.1 at one year). Two further expulsions were reported, one with the GyneFix 200 IUD and the other with the FibroPlant LNG-IUS. The cumulative expulsion rate at one year was 1.1 with the copper IUD and 2.2 with the LNG-IUS. The total discontinuation rate at one year was low (3.3 and 4.3 with the copper IUD and LNG-IUS, respectively) and resulted in a high rate of continuation of use at one year (96.7 with the copper IUD and 95.7 with the LNG-IUS, respectively). Continuation rates for both frameless copper IUD and frameless LNG-IUS remained high at 3 years (>90%). There were no cases of perforations or pelvic inflammatory disease reported during or following insertion. CONCLUSION This report confirms earlier studies with frameless devices and suggests that the high user continuation rate is attributable to the optimal relationship between the IUD and the uterine cavity. IUD studies have shown that an IUD that does not fit well will often lead to side effects (ie, pain, bleeding, embedment, expulsion) and subsequent removal of the IUD. Early discontinuation is not the aim of long-acting reversible contraception.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Sohela Jandi
- Gynecological Outpatient Clinic, Berlin, Belgium
| | - Ansgar Pett
- Gynecological Outpatient Clinic, Berlin, Belgium
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Bahamondes L, Bottura BF, Bahamondes MV, Gonçalves MP, Correia VM, Espejo-Arce X, Sousa MH, Monteiro I, Fernandes A. Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic. Hum Reprod 2014; 29:2163-70. [PMID: 25085802 DOI: 10.1093/humrep/deu191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. SUMMARY ANSWER Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. WHAT IS KNOWN ALREADY LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. STUDY DESIGN, SIZE AND DURATION We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. MAIN RESULTS AND THE ROLE OF CHANCE We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. LIMITATIONS, REASONS FOR CAUTION The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. WIDER IMPLICATIONS OF THE FINDINGS LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. STUDY FUNDING/COMPETING INTERESTS This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study.
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Affiliation(s)
- Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bruna F Bottura
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - M Valeria Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Mayara P Gonçalves
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Vinicius M Correia
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ximena Espejo-Arce
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria H Sousa
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ilza Monteiro
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Arlete Fernandes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, SP, Brazil
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