Evaluation of emergency contraception use among women receiving gynecological treatment in the Brazilian Amazon

Introduction: The use of a postcoital hormonal contraception regimen has been described and is known as emergency contraception (EC) or “the morning-after pill”. The aim of this study was to evaluate the use and level of knowledge about emergency oral contraception (EC) among women attending the gynecology outpatient clinic of the Hospital Fundação Santa Casa de Misericórdia of the State ofPará, the second largest state in the Brazilian Amazon. Methods: a cross-sectional study was conducted with 316 sexually active women, aged 18 to 50 years, who attended the gynecology outpatient clinic. Participants were included based on spontaneous demand between June and July 2012. Patients answered a questionnaire with 29 questions, including: age in years, educational attainment, knowledge about EC, and previous use of the method. The primary outcome was knowledge on EC use. Results: Participants' mean age was 31.84 years (SD ± 8.00). As for their educational level, 46.84% of them had completed high school, and only 8.55% had higher education. Most of the women obtained information about EC through friends (48.61%, n = 152), and only 7.30% from their doctors. Although most participants (83.54%) reported to be aware of the method, only 0.63% reported that EC could be used up to 5 days after unprotected intercourse; 57.59% did not know how to use it; and 76.58% (n = 242) had never used the method. Conclusion: The women in our study seem to have a high level of knowledge and prevalence of use of emergency contraception, although few of them knew about the time limit for its use. They should receive more information about emergency contraception

Clinical and Biomedical Research: Positive prospects for the journal

It is a great pleasure to present the second issue of Clinical and Biomedical Research and some of our work toward setting new standards for the journal. This issue contains two review articles, eight original articles, and four case reports, covering a wide range of topics important to the practice of medical sciences

Abstracts of the XXVII Medical Academic Congress of Unicamp, CoMAU, 2018

Abstracts of the Medical Academic Congress of Unicamp (CoMAU), 2018

P14.01 An example of too much too soon? A review of caesarean sections performed in the first stage of labour in Kenya

Objective: Caesarean Section (CS) has potential short and long-term complications and is associated with excess maternal death. Decisions to perform (CS) are frequently made by inexperienced and unsupported non-specialist doctors, sometimes resulting in inappropriate decision-making and surgery. Our study assesses decision-making for CS in the first stage of labour in Kenya. Method: A panel of one UK and six Kenyan expert obstetricians reviewed clinical data extracted from 87 case-notes, that were randomly selected from a series obtained from seven referral hospitals in five Kenyan counties over six months in 2020. Following a preliminary review of the data and email discussion, an online panel was convened to discuss outstanding cases where consensus was yet to be reached. Agreement was reached by the panel in all but 5 cases. Results: In 41.3% cases, CS was considered appropriate, including 8% where CS was performed too late. The decision to delivery interval exceeded 2 h in 58.6% cases, including 16 cases of non-reassuring fetal status. In 10.3% it was considered that due to delay, further reassessment should have occurred. In 9.1% the CS was done too soon. There was insufficient information available to make a full assessment in 21.8% of cases. In 11.5% the CS was inappropriate. Conclusion: This review demonstrates that unnecessary caesarean sections are being performed, while some with appropriate indications are subject to delays. There is need for improved support for decision-making, coupled with improved record-keeping, improved quality of fetal monitoring during labour and more timely surgery when necessary

P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Objective: Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya. Method: A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach. Results: Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff. Conclusion: Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels

P14.02 An electronic behaviour diary: Monitoring the effects of advanced obstetric surgical skills training

Objective: Training should lead to improvements in the quality of clinical care delivery. It is essential to follow up participants after a training intervention to monitor changes in behaviour associated with adoption of lessons learned into clinical practice. We introduced an electronic diary to facilitate monitoring whilst minimising effort for participants. Method: An electronic diary was created using a freely available on-line platform. Following a training intervention on advanced obstetric surgical skills, obstetric residents from Kenya were invited to pilot completing the diary after their labour ward shifts. Entries were anonymised. Participants were asked to enumerate the times they utilised specific skills, or to state why they had been unable to do so, using tick box options. Reflections on skills used were entered using free comments. Results: All participants reported changed behaviours, for example, improved surgical knot-tying, safer needle handling, separate closure of uterine incision angles and techniques for delivery of the impacted fetal head. 6 reported conducting vaginal breech birth and 6 performed vacuum-assisted birth. All reported improvements in use of the safe surgical checklist, obtaining consent and respectful maternity care. 7 had participated in newborn resuscitation. Reflections suggested participants experienced improved levels of confidence and satisfaction when implementing new skills. Conclusion: This pilot study has demonstrated the feasibility of monitoring clinical behaviour change following training using an electronic platform. Monitoring the effect of training is essential to prove that training results in improvements to clinical practice. We plan to roll out this intervention following future training interventions

Misoprostol: An emerging technology for women\u27s health—Report of a seminar

On May 7–8, 2001, the Population Council and the Center for Reproductive Health Research & Policy of the University of California, San Francisco, convened a technical seminar in New York City on the use of misoprostol for women’s health indications. The seminar was designed to provide a forum for researchers, providers, women’s health advocates, and educators to exchange information with the goal of advancing the potential of misoprostol to improve women’s health. Participants discussed the state of the art in research, examined current clinical use of misoprostol, and created strategies for the future. The first day focused on scientific and clinical aspects of misoprostol use. The second day’s discussion centered on the future of misoprostol for women’s health, including identifying priorities for research and the role of provider groups and women’s health and advocacy organizations in helping to ensure misoprostol’s continued, appropriate use. At the end of each session, the group had an opportunity to share ideas and discuss unanswered questions. This report covers the key issues raised by each speaker and highlights general areas of discussion among participants

Assessing Sexual Minority Women’s Barriers and Facilitators to Seeking and Accessing Mental and Physical Healthcare: A Mixed Methods Study

Sexual minority women (SMW) experience greater mental and physical health concerns when compared to heterosexual women. Three key areas of health SMW report these disparities are: mental health, binge eating/body size, and sexual and reproductive health. SMW also report difficulties accessing healthcare in these three areas. An exploratory sequential mixed methods design was utilized to assess barriers and facilitators to healthcare access for young SMW. Study 1 included 20 semi-structured interviews with SMW, resulting in themes of barriers and facilitators identified by participants. These themes were converted into scale items. In Study 2, an expert panel of mental and physical health professionals, researchers, and SMW provided feedback on the scale. The revised scale, along with measures of healthcare barriers and health outcomes, was completed by 188 SMW via an online survey. Exploratory factor analysis (EFA) was conducted for the barriers scale items, resulting in three barriers scales: Weight Stigma, General/Environmental, and Discrimination. EFA was also conducted for the facilitator items, resulting in a single scale. The Barriers-Weight Stigma and Barriers- General/Environmental scales were both valid and reliable, and the Barriers- Discrimination and the Facilitator scales were reliable. The Barriers-Weight Stigma scale emerged as the primary barrier factor and had the strongest validity and reliability. The Barriers scales were significantly associated with a variety of health outcomes. Future research should continue to assess barriers to healthcare for SMW and how to reduce these barriers

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement 1

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement