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Barbian J, Kubo CY, Balaguer CS, Klockner J, Costa LMVD, Ries EF, Bayer VML. Emergency contraception in university students: prevalence of use and knowledge gaps. Rev Saude Publica 2021; 55:74. [PMID: 34816977 PMCID: PMC8577535 DOI: 10.11606/s1518-8787.2021055003076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/06/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Investigate prevalence of use and knowledge about emergency contraception (EC) among female university students from two higher education institutions. METHODS Cross-sectional study with 1,740 undergraduates in the city of Santa Maria (RS), from May to October 2017. Information was collected in a semi-structured and self-administered 24-question questionnaire. The investigated variables were grouped into sociodemographic characteristics, sexual behavior, and knowledge of EC. Logistic regression was used for univariate and multivariate analysis, considering variables that presented p < 0.05. The model was adjusted using the Hosmer-Lemeshow test. RESULTS The prevalence of EC use among undergraduates was 52.9%. However, only 11.9% of respondents received guidance on EC, especially on how to use it. Only 0.2% of the participants marked 120 hours as the maximum time of use, and 25.7% considered the EC to be abortive. EC use was associated with the age of first sexual intercourse. CONCLUSION EC use had a high prevalence among female university students, however, several gaps in method knowledge still exists and it demonstrates the importance of discussing this issue earlier and planning actions of an informative nature.
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Affiliation(s)
- Julia Barbian
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Carolina Yumi Kubo
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Caroline Soares Balaguer
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Julia Klockner
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Luiza Maria Venturini da Costa
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Edi Franciele Ries
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
| | - Valéria Maria Limberger Bayer
- Universidade Federal de Santa Maria. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Santa Maria, RS, Brasil
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Smith H, Whyte S, Chan HF, Kyle G, Lau ETL, Nissen LM, Torgler B, Dulleck U. Pharmacist Compliance With Therapeutic Guidelines on Diagnosis and Treatment Provision. JAMA Netw Open 2019; 2:e197168. [PMID: 31314116 PMCID: PMC6647553 DOI: 10.1001/jamanetworkopen.2019.7168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Misuse and overselling of over-the-counter pharmaceuticals poses a major burden on both private and public health expenditures. OBJECTIVE To seek evidence on whether over-the-counter medication dispensing behavior complies or conflicts with the protocols indicated in practice standards and guidelines of a national professional pharmacy organization. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was undertaken in 205 pharmacies in the wider Brisbane, Australia, area. Two standardized patient (SP) scenarios were developed to evaluate noncompliant behavior. Data collection for scenario 1 was conducted between November 23 and December 9, 2016. Data collection for scenario 2 was conducted between September 1 and 28, 2017. A 2-sample test of proportions and a probit regression model were used to evaluate the likelihood of noncompliant treatments and overtreatments in each case scenario. Statistical analysis was performed from January 30 to June 21, 2018, and revised in May 2019. MAIN OUTCOMES AND MEASURES Outcomes were the observed likelihood of noncompliant treatments and overtreatments. Noncompliance is defined as treatments not complying with practice standards and guidelines set by the professional pharmacy society. Noncompliant treatments include undertreatment (patient did not receive necessary treatment) and overtreatments (patient was supplied with more than sufficient treatments) in both scenarios. RESULTS In scenario 1, 9 trained female SPs visited 89 pharmacies to request emergency hormonal contraception from pharmacy staff. In 45 cases, SPs reported having unprotected intercourse within the last 24 hours (case 1A), and in 44 cases, SPs reported having unprotected intercourse more than 72 hours ago (case 1B), which is past the efficacy threshold of over-the-counter emergency hormonal contraception. In scenario 2, 11 SPs (5 male and 6 female) visited 150 pharmacies (154 visits in total) to request treatment for family members or a partner with symptoms indicating bacterial conjunctivitis (case 2A; n = 73) or viral conjunctivitis (case 2B; n = 81). In scenario 1-dispensing emergency hormonal contraception when physician referral is recommended-21 of 44 pharmacists (47.7%) in case 1B violated the recommendation by selling the over-the-counter medication. With the inclusion of both no physician referral and emergency hormonal contraception sold, this rate increased to 79.5% (35 of 44 pharmacists). In scenario 2-1 case each of bacterial and viral conjunctivitis-overtreatment occurred in 55 of 154 cases (35.7%). In both scenarios, 140 of 243 pharmacies (57.6%) followed dispensing behavior compliant with the protocol, while 76 of 243 pharmacies (31.3%) involved some form of overtreatment or overselling of medication. Some evidence of an association between sex of SP and pharmacist was also found. CONCLUSIONS AND RELEVANCE Although the market for dispensing over-the-counter medication in Australia is regulated, relatively high rates of overtreatment and some cases of undertreatment were observed in this study. Given the unintended adverse effects, including overuse of antibiotics and corticosteroids, these observations suggest the advisability of regulatory intervention ensuring compliance with professional protocols.
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Affiliation(s)
- Harriet Smith
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen Whyte
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
| | - Ho Fai Chan
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
| | - Gregory Kyle
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Esther T. L. Lau
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa M. Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
- Center for Research in Economics, Management and the Arts, Zürich, Switzerland
| | - Uwe Dulleck
- School of Economics and Finance, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology, Brisbane, Queensland, Australia
- Crawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia
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Bo M, Casagranda I, Charrier L, Michela Gianino M. Availability of emergency contraception: A survey of hospital emergency department gynaecologists and emergency physicians in Piedmont, Italy. EUR J CONTRACEP REPR 2012; 17:373-82. [DOI: 10.3109/13625187.2012.692410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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David M, Radke AM, Pietzner K. The Prescription of the Morning-After Pill in a Berlin Emergency Department Over a Four-Year Period - User Profiles and Reasons for Use. Geburtshilfe Frauenheilkd 2012; 72:392-396. [PMID: 25298542 DOI: 10.1055/s-0031-1298446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022] Open
Abstract
Questions: There are no current health care studies from Germany regarding the "morning-after pill". This paper will use routine data to analyse details regarding the users' profiles, reasons for using it and the utilisation of hospital outpatient facilities. Patient Collective and Methods: Retrospective analysis of all triage sheets in the emergency department of the Virchow Hospital Campus/Charité University Hospital, Berlin, over a four-year period from 2007 to 2010 that were coded with the ICD diagnosis Z30 (= contraception advice) and statistical processing of the associated administrative data. Results: 860 triage sheets were included in the analysis. The emergency department is used most frequently for the prescription of the "morning-after pill" at the weekend. The average age of the users was 25.1 years. The most common reason cited for needing emergency contraception was unprotected sexual intercourse, with the second-most common being "condom failure". Around half of the women attended the department within 12 hours of having unprotected sex. Less than 2 % (n = 14) of all women decided against a prescription of emergency contraceptive after counselling. Conclusions: The user profile and reasons for using emergency oral contraception correlate largely with the information contained in international literature. Although the "morning-after pill" is probably prescribed mainly in general practices in Germany, and despite the availability of new drugs with a permitted post-exposure interval of up to 120 hours after unprotected sex, there appears to still be a high demand for counselling and prescriptions of the "morning-after pill" in the context of the emergency department.
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Affiliation(s)
- M David
- Department of Gynaecology, Charité - University Medicine Berlin, Virchow Hospital Campus, Berlin
| | - A-M Radke
- Department of Gynaecology, Charité - University Medicine Berlin, Virchow Hospital Campus, Berlin
| | - K Pietzner
- Department of Obstetric Medicine, Charité - University Medicine Berlin, Virchow Hospital Campus, Berlin
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Borges ALV, Fujimori E, Hoga LAK, Contin MV. [Contraceptive practices among university students: the use of emergency contraception]. CAD SAUDE PUBLICA 2010; 26:816-26. [PMID: 20512221 DOI: 10.1590/s0102-311x2010000400023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/11/2010] [Indexed: 11/21/2022] Open
Abstract
This study investigated contraceptive practices and especially the use of emergency contraception by 487 young students at a public university in São Paulo State. A structured questionnaire was sent by e-mail and completed online in December 2007. Contraceptive methods and use of emergency contraception were investigated. Female and male students reported a high proportion of contraceptive use, mainly condoms and the pill. Half of the students had already used emergency contraception, often when already using some other highly effective method. Among female students, multiple regression analysis showed that current age, age at sexual initiation, not having used condoms in sexual relations, condom failure, and knowing someone that has used emergency contraception were associated with use of the latter. The option for emergency contraception proved to be more closely related to inconsistencies in the use of regular methods than to lack of their use, and can thus be considered a marker for discontinuity in regular contraception.
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Affiliation(s)
- Ana Luiza Vilela Borges
- Escola de Enfermagem, Universidade de São Paulo, Rua Dr. Enéias de Carvalho Aguiar 419, São Paulo, Brazil.
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Hernández-Martínez A, García-Serrano I, Simón-Hernández M, Coy-Auñon R, García-Fernández AM, Liante-Peñarrubia E, Floro-Moreno P, Mateos-Ramos A. Efectividad de un programa de educación sexual en adolescentes acerca de la adquisición de conocimientos y cambios de actitud ante el empleo de métodos anticonceptivos. ENFERMERIA CLINICA 2009; 19:121-8. [DOI: 10.1016/j.enfcli.2008.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
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Bastos MR, Borges ALV, Hoga LAK, Fernandes MP, Contin MV. Práticas contraceptivas entre jovens universitárias: o uso da anticoncepção de emergência. TEXTO & CONTEXTO ENFERMAGEM 2008. [DOI: 10.1590/s0104-07072008000300005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Com o objetivo de caracterizar o comportamento contraceptivo, especialmente o uso da anticoncepção de emergência, entre mulheres jovens de alta escolaridade, foi enviado por e-mail um questionário estruturado a todas as graduandas de um curso de enfermagem de uma universidade pública na cidade de São Paulo, no mês de junho de 2006. Do total de 300 alunas que foram convidadas a participar do estudo, 196 responderam ao questionário. Quase metade das entrevistadas com vida sexual já havia utilizado a anticoncepção de emergência (44,9%), basicamente adquirida em farmácias e por iniciativa própria, devido a falhas no método usual ou esquecimento, além da insegurança em relação à eficácia do anticonceptivo utilizado. Por meio de análise de regressão logística múltipla, verificou-se que o uso da anticoncepção de emergência foi associado a ter tido dois ou mais parceiros sexuais, a conhecer alguém que já tinha utilizado-a e a já ter deixado de usar o preservativo masculino em alguma relação sexual.
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Ahonen KA, Buchman D. Emergency contraception: Profiles of women using Plan B in a small Midwestern U.S. community. ACTA ACUST UNITED AC 2008; 20:35-9. [DOI: 10.1111/j.1745-7599.2007.00276.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Merchant RC, Casadei K, Gee EM, Bock BC, Becker BM, Clark MA. Patients' emergency contraception comprehension, usage, and view of the emergency department role for emergency contraception. J Emerg Med 2007; 33:367-75. [PMID: 17976755 DOI: 10.1016/j.jemermed.2007.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 01/18/2006] [Accepted: 01/07/2007] [Indexed: 12/30/2022]
Abstract
Female Emergency Department (ED) patients were surveyed to determine their comprehension of the concept of emergency contraception (EC), to assess how often they had used EC in comparison to other forms of contraception, and to learn which patients want the ED to provide EC services. Most of the 761 respondents were aged < 35 years (62.1%), never married (42.9%), had been pregnant at least once (70.2%), had never had an abortion (76.1%), had never used EC (90.6%), and had sex with a man within the past month (70.7%). Respondents were 2.5 times more likely to have had an abortion than to have used EC; 85.3% could not correctly answer two questions that assessed comprehension of the concept of EC; 43.1% wanted the ED to offer EC, 55.6% to provide information about EC, and 52.6% to refer patients for EC. Younger patients, those who attended religious services infrequently, patients who had ever used EC, and those at risk of pregnancy were more likely to want the ED to provide EC services.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Brown Medical School, Providence, Rhode Island, USA
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Saito MI, Leal MM. Adolescência e contracepção de emergência: Fórum 2005. REVISTA PAULISTA DE PEDIATRIA 2007. [DOI: 10.1590/s0103-05822007000200014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJETIVO: Relatar os resultados do Fórum "Adolescência e Contracepção de Emergência", que teve como proposta trazer maiores esclarecimentos sobre a contracepção de emergência (CE), além de apoio ético e técnico para sua prescrição, a partir da análise de três vertentes principais de discussão: o perfil da clientela adolescente; as questões éticas que envolvem a CE; a eficácia e o risco do método. FONTES DE DADOS: Discussão dos temas propostos a partir da literatura atual sobre o tema do Fórum organizado em 2005, que envolveu a participação de pediatras, ginecologistas, profissionais ligados a Comissões de Bioética, ao Conselho Federal de Medicina e ao Ministério da Saúde, advogados e juízes. SÍNTESEDOS DADOS: A adolescência caracteriza-se por mudanças, transformações e experimentações que vinculam essa fase da vida à vulnerabilidade e risco. Alguns desses riscos estão relacionados ao exercício inadvertido ou impensado da sexualidade, cujas conseqüências são bem conhecidas: gravidez precoce, aborto e doenças sexualmente transmissíveis, entre as quais HPV e AIDS. É fundamental, portanto, que a assistência a essa faixa etária inclua o enfoque de prevenção, na qual a educação sexual seja vista como um processo do qual é parte relevante a orientação anticoncepcional, incluindo-se nesta a contracepção em situações de emergência. CONCLUSÕES: O artigo apresenta as conclusões resultantes das discussões realizadas durante esse evento. Seu principal desdobramento foi a Resolução do Conselho Federal de Medicina: a CE não é abortiva e pode ser usada em qualquer etapa da vida reprodutiva.
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Lewington G, Marshall K. Access to emergency hormonal contraception from community pharmacies and family planning clinics. Br J Clin Pharmacol 2006; 61:605-8. [PMID: 16669854 PMCID: PMC1885065 DOI: 10.1111/j.1365-2125.2006.02623.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To evaluate differences in the time taken to access progestogen-only emergency hormonal contraception (EHC) by young women from family planning (FP) or community pharmacy settings. METHODS An observational study of 203 women requesting EHC from FP clinics and community pharmacies in South-west Kent Primary Care Trust (PCT) from December 2002 to October 2003. RESULTS Access to EHC from community pharmacy was significantly faster than from FP clinics (16 h vs. 41 h, P<0.001). Older teenagers tended to seek EHC more quickly and were more likely to have had a contraceptive failure rather than have used no contraception at all. CONCLUSION The results provide further support for pharmacist involvement in the supply of EHC.
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Affiliation(s)
| | - Kay Marshall
- School of Pharmacy, University of BradfordBradford, UK
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Santamaría Rodríguez T, Crespo del Pozo Á, Cid Prados A, Gontán García-Salamanca M, González Pérez M, Baz Collado C, Sánchez García R. Anticoncepción de emergencia: perfil de las usuarias y características de la demanda. Semergen 2006. [DOI: 10.1016/s1138-3593(06)73282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ranney ML, Gee EM, Merchant RC. Nonprescription Availability of Emergency Contraception in the United States: Current Status, Controversies, and Impact on Emergency Medicine Practice. Ann Emerg Med 2006; 47:461-71. [PMID: 16631987 DOI: 10.1016/j.annemergmed.2005.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 06/21/2005] [Accepted: 07/01/2005] [Indexed: 12/30/2022]
Abstract
In October 2004, the American College of Emergency Physicians Council joined more than 60 other health professional organizations in supporting the nonprescription availability of emergency contraception. This article reviews the history, efficacy, and safety of emergency contraception; the efforts toward making emergency contraception available without a prescription in the United States; the arguments for and against nonprescription availability of emergency contraception; and the potential impact nonprescription availability could have on the practice of emergency medicine in the United States.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Brown Medical School, Providence, RI, USA
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