Understanding Risky Sexual Behaviour Among Undergraduates

Background: Exploring sexual activities that may make individuals vulnerable to sexually transmitted infections and unplanned pregnancies is being considered following observation and increased reports of unplanned pregnancies and its attendant consequences among students in tertiary institutions. Objective: Determine the undergraduates’ awareness and attitude towards risky sexual behaviour. Methods: A descriptive Cross-sectional survey was conducted, among year one and year two Medical and Nursing undergraduate students at two tertiary institutions in Rivers State of Nigeria, using a questionnaire adapted from World Health Organisation survey instrument to obtain data on knowledge of and attitude towards risky sexual behaviours. Two hundred and eighty participants were randomly selected. Descriptive analysis was carried out using Statistical Package for Social Sciences version 21.0. Results: About 92.9% of the respondents are aware that unprotected (oral, anal, vaginal) sexual intercourse is a risky sexual behaviour. Assessing respondents’ attitudes to risky sexual behaviour revealed that 9.3% agree that condom should only be used during sexual intercourse with commercial sex workers. Conclusions: Most Undergraduates are aware of sexual activities that constitute risky sexual behaviours but there is need to cascade this awareness to reflect on general sexual habits and reduce public health emergencies among undergraduates.

Impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population

ObjectiveEvaluate the impact of the COVID-19 pandemic on access to contraception and pregnancy intentions.DesignNationwide prospective cohort study.SettingUnited Kingdom.ParticipantsWomen in the UK who were pregnant between 24 May and 31 December 2020.Main outcome measuresAccess to contraception and level of pregnancy intentions, using the London Measure of Unplanned Pregnancy (LMUP) in women whose last menstrual period was before or after 1 April 2020. While the official date of the first UK lockdown was 23 March, we used 1 April to ensure that those in the post-lockdown group would have faced restrictions in the month that they conceived.ResultsA total of 9784 women enrolled in the cohort: 4114 (42.0%) conceived pre-lockdown and 5670 (58.0%) conceived post-lockdown. The proportion of women reporting difficulties accessing contraception was higher in those who conceived after lockdown (n=366, 6.5% vs n=25, 0.6%, p<0.001) and continued to rise from March to September 2020. After adjusting for confounders, women were nine times more likely to report difficulty accessing contraception after lockdown (adjusted odds ratio (aOR) 8.96, 95% CI 5.89 to 13.63, p<0.001). There is a significant difference in the levels of pregnancy planning, with higher proportions of unplanned (n=119, 2.1% vs n=55, 1.3%) and ambivalent pregnancies (n=1163, 20.5% vs n=663, 16.1%) and lower proportions of planned pregnancies (n=4388, 77.4% vs n=3396, 82.5%) in the post-lockdown group (p<0.001). After adjusting for confounders, women who conceived after lockdown were still significantly less likely to have a planned pregnancy (aOR 0.88, 95% CI 0.79 to 0.98, p=0.025).ConclusionsAccess to contraception in the UK has become harder during the COVID-19 pandemic and the proportion of unplanned pregnancies has almost doubled.

Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients

Recent studies estimated an incidence of 4–25% of disease rebound after withdrawal of fingolimod (FTY) for any reason, but specific data on disease reactivation after FTY withdrawal due to pregnancy are limited. The aim of the study was to evaluate the frequency and predictors of disease reactivation in patients who stopped FTY for pregnancy. A multicentre retrospective cohort study was conducted in four Italian MS centres in 2013–2019. Both planned and unplanned pregnancies were included. The annualized relapse rate (ARR) was calculated before FTY treatment, during FTY treatment, during pregnancy and during the year after delivery. In total, 27 patients (mean age 29 years) were included. The ARR 1 year before FTY treatment was 1.3. Patients were exposed to FTY for a median of 2.9 years. The ARR was 0.04 during the last year before conception (p < 0.001 compared with the ARR before FTY treatment). Eleven patients became pregnant after a mean of 88 days following FTY discontinuation, whereas 16 patients stopped FTY after pregnancy confirmation. Relapses were observed in 22% of patients during pregnancy and in 44% in the postpartum period. ARR increased both during pregnancy (0.49; p = 0.027) and in the first year after delivery (0.67; p < 0.001) compared to the last year before pregnancy. Compared with radiological assessment before pregnancy, more patients showed new or enlarging T2 lesions (63% vs 30%; p = 0.02) and gadolinium-enhancing lesions (44% vs 0; p = 0.0001) on brain Magnetic Resonance Imaging. Relapses during pregnancy were the only significant predictor for postpartum relapses (OR 1.9, 95% CI 1.11–3.1). One case of spontaneous abortion and no cases of abnormal foetal development were observed. Despite adequate and prolonged control of disease activity, women who discontinue FTY because of pregnancy are at risk for disease reactivation. In patients who relapsed during pregnancy, the initiation of high-efficacy disease modifying drugs (DMDs) soon after delivery is advisable to prevent postpartum relapses.

Multipurpose Prevention Technologies: Oral, Parenteral, and Vaginal Dosage Forms for Prevention of HIV/STIs and Unplanned Pregnancy

There is a high global prevalence of HIV, sexually transmitted infections (STIs), and unplanned pregnancies. Current preventative daily oral dosing regimens can be ineffective due to low patient adherence. Sustained release delivery systems in conjunction with multipurpose prevention technologies (MPTs) can reduce high rates of HIV/STIs and unplanned pregnancies in an all-in-one efficacious, acceptable, and easily accessible technology to allow for prolonged release of antivirals and contraceptives. The concept and development of MPTs have greatly progressed over the past decade and demonstrate efficacious technologies that are user-accepted with potentially high adherence. This review gives a comprehensive overview of the latest oral, parenteral, and vaginally delivered MPTs in development as well as drug delivery formulations with the potential to advance as an MPT, and implementation studies regarding MPT user acceptability and adherence. Furthermore, there is a focus on MPT intravaginal rings emphasizing injection molding and hot-melt extrusion manufacturing limitations and emerging fabrication advancements. Lastly, formulation development considerations and limitations are discussed, such as nonhormonal contraceptive considerations, challenges with achieving a stable coformulation of multiple drugs, achieving sustained and controlled drug release, limiting drug–drug interactions, and advancing past preclinical development stages. Despite the challenges in the MPT landscape, these technologies demonstrate the potential to bridge gaps in preventative sexual and reproductive health care.

High-intensity focused ultrasound: opportunities and prospects in the treatment of uterine fibroid and deep infiltrative endometriosis

This literature review is devoted to the use of focused ultrasound in gynecological practice as an alternative to the traditional surgical treatment of uterine fibroids and deep infiltrating endometriosis. According to available data, the effectiveness of the treatment of uterine fibroids with focused ultrasound varies widely, ranging from 16.4% to 93.0%. Due to the lack of prospective studies, it is not possible to draw reliable conclusions about the effect of ablation of uterine fibroid with focused ultrasound on fertility. However, unplanned pregnancies after such treatment occurred up to 19.5%, and in 66.3% of cases, pregnancies ended with the childbirth. Research results demonstrate that in 87% of cases, treatment of retrocervical infiltrative endometriosis using focused ultrasound is feasible. Further data accumulation is required to determine the range of patients with uterine fibroids and deep infiltrating endometriosis, to whom the treating technique could be most effective and safe.

Pregnancy, fertility concerns, and fertility preservation procedures in French breast cancer survivors in the FEERIC national study (on behalf of the Seintinelles research network).

Objective To study fertility concerns and oncofertility practices at time of breast cancer (BC) diagnosis. Design The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter study. Setting Web-based collaborative research platform Seintinelles. Patients 517 patients with prior BC diagnosis free from relapse and aged 18 to 43 years at inclusion (from 12th March 2018 to 27th June 2019). Intervention Baseline online self-administered questionnaires. Main Outcome Measure Fertility preservation procedures at BC diagnosis. Results Median age at BC diagnosis was 33.6 years and 424 patients (82.0%) received chemotherapy. Overall, 236 (45.6%) patients were offered specialized oncofertility counseling, 124 (24.0%) underwent one or more FP procedures with material preservation (oocytes n=108, 20.9%; embryos n=31, 6.0%; both oocytes and embryos n=13, 2.5%; ovarian cryopreservation n=6, 1.2%) and 78 patients received gonadotropin-releasing hormone agonists (15.1%). With a median follow-up of 26.7 months after the end of treatments,133 pregnancies (25.7%) had occurred in 85 patients (16.4%), including 20 unplanned pregnancies (15.0%). Most of the pregnancies were spontaneous (n=113, 87.6%), while 16 (12.4%) required medical interventions. Patients who had an unplanned pregnancy were less likely to have received fertility counseling (p=0.02) and contraceptive counseling (p=0.08) at BC diagnosis. Conclusion Most of the patients were not offered proper specialized oncofertility counseling at the time of BC diagnosis. Spontaneous pregnancies after BC were very much more frequent than pregnancies resulting from the use of cryopreserved gametes. Adequate contraceptive counseling seems as important as information about fertility and might prevent unplanned pregnancies.

SARC e LARC: grau de conhecimento e frequência de uso em complexo hospitalar de referência no Paraná / SARC and LARC: degree of knowledge and frequency of use in a reference hospital complex in Paraná

Introdução: Contraceptivos representam um elemento essencial para a vida reprodutiva e para o planejamento familiar. O grau de conhecimento das mulheres sobre esse tema exerce influência sobre suas escolhas por determinados métodos anticoncepcionais. Objetivos: os objetivos deste estudo foram traçar o perfil etário e socioeconômico das pacientes do Ambulatório de Reprodução Humana do CHC-UFPR e avaliar seu conhecimento e uso de contraceptivos de curta e de longa ação (SARC e LARC), de forma a identificar lacunas de informação que pudessem ocasionargestações não planejadas e direcionar futuras estratégias educativas sobre contraceptivos. Métodos: Conduzimos entrevistas por meio de questionários objetivos aplicados a pacientes do sexo feminino entre 18 e 50 anos na ocasião de suas consultas, indagando-as sobre sua ciência da existência de diversos anticoncepcionais, tipo de método utilizado e tempo de uso, presença, frequência e motivos para gestações não planejadas. Resultados: Os principais resultados indicaram um grupo de pacientes jovens e com alta escolaridade, cuja utilização de métodos anticoncepcionais era semelhante entre SARC e LARC. O conhecimento dos anticoncepcionais foi satisfatório, principalmente entre os mais populares como anticoncepcional hormonal oral e DIU de cobre. Gestações não planejadas estiveram presentes na vida reprodutiva de 60% das pacientes, sendo o principal motivo o não uso de contraceptivos. Não houve associação entre uso de SARC ou LARC e maior número de gestações indesejadas. O número de contraceptivos conhecidos por mulheres sem gestações indesejadas foi uma mediana maior do que aquele das mulheres com esses eventos. Conclusão: A abordagem das pacientes do ambulatório da Reprodução Humana do CHC-UFPR deve ser direcionada para pacientes jovens, com alto grau de instrução e amplo conhecimento sobre contraceptivos. É importante que os profissionais de saúde do local busquem orientá-las de forma a reduzir a taxa de gestações não planejadas.Palavras chave: Anticoncepcionais, gravidez não planejada, ConhecimentoABSTRACT Introduction: Contraceptive agents represent an essential element in reproductive life and family planning. The knowledge extension for women about that subject influences choices for certain contraceptive methods. Objective: The aims of this study were to determine the age and socioeconomic profile of the patients of the Human Reproduction Clinic in the Hospital Complex of Federal University of Paraná and to evaluate their knowledge and use of short-acting reversible contraceptives (SARC) and long-acting reversible contraceptives (LARC), in order to idenfity information gaps that could cause unplanned pregnancies and direct future educational strategies on contraceptives. Methodology: We conducted interviews using objective questionnaires applied to female patients aged from 18 to 50 years old before or after their medical appointment, asking about their knowledge of the existence of diverse contraceptive agents, type of contraceptive utilized and duration of use, presence, number and reasons for unplanned pregnancies. Results: The main results indicated that the group was mostly young and highly educated, utilizing SARC and LARC in similar frequencies. The knowledge of the existence of the contraceptive agents was satisfactory and the most popular methods were the contraceptive pill and the Coopper IUD. Unplanned pregnancies were present in the reproductive life of 60% of the patients and the most common reasons for these events was the non use of contraceptives. There was no association between the use of SARC or LARC and a higher number of unplanned pregnancies. The number of contraceptives known by women without previous history of unintended pregnancy was a median higher than those of women with those events. Conclusion: Hereafter, the approach to patients in the Human Reproduction Clinic in the Hospital Complex of Federal University of Paraná should be directed to young and highly educated women, with broad knowledge about contraceptive agents. It is important that health professionals of the clinic guide patients aiming to reduce the local unplanned pregnancy rates.Keywords: Contraceptive agents, Unplanned pregnancy, Knowledge