Effectiveness of preabortion counseling on postabortion contraceptive use

In a randomized trial, the effect of preabortion counseling was evaluated and contraceptive use postabortion described. The 420 women, who were assigned into either an intervention group (n = 210) or a control group (n = 210), were followed-up 4–6 months later, a total of 148 and 128 women in each respective group. No significant difference was found between the two groups regarding contraceptive use after abortion (86%, 85%), which indicates no immediate intervention effect. The women, in both groups, who had previously undergone abortion were less likely to use contraception. The main contraceptive methods used by intervention and control groups were oral contraceptives (61% and 58%, respectively) and injectables (12% and 11%). Choice of method was mainly based on women's prior perception of effectiveness and convenience of use. A majority of the women in both groups could not specify their contraceptive plans. A postrandomization inequality regarding age, education and parity in the two groups had, however, to be taken into account. Intensive contraceptive counseling before abortion may not be effective, but those who are at higher risk of unplanned pregnancy need special attention.     

高校朋辈心理咨询研究述评

朋辈心理咨询(peer counseling)指经过选拔、培训和督导的非专业心理工作者向年龄相当的求助者提供具有心理咨询功能的人际帮助的过程。朋辈即同辈,通常指年龄相当,有共同的爱好、价值观和文化背景,彼此之间容易理解、沟通的     

Perception of contraceptive counseling and contraceptive use among systemic lupus erythematosus patients

Objectives(1) To evaluate the perception of contraceptive counseling and knowledge regarding the impact of unintended pregnancy and (2) examine the prevalence of, and predictors for contraceptive use among systemic lupus erythematosus (SLE) patients.Study designA cross-sectional survey was conducted at the Rheumatology Clinic of a university hospital. SLE patients who attended the clinic from April 2018 to January 2019 and at risk for unintended pregnancy and were invited to be interviewed. The structured interview guide consisted of three parts: personal and obstetric information, perception of contraceptive counseling and knowledge about the impact of unintended pregnancy, and contraceptive use.ResultsThe mean age of the 137 patients who gave informed consents was 34 ± 8 years, with 47 patients (34%) stating that they had received contraceptive counseling. Seventy-five patients (52%) reported practicing contraception. The intention to not become pregnant (Odds Ratio; 95% CI = 7.28; 1.75–30.27), perception of adequate contraceptive counseling (2.77; 1.06–7.20) and discussion with partners and physicians about contraception (3.95; 1.64–9.50) were predictors for contraceptive use (p < 0.05).ConclusionMost patients reported no contraceptive counseling with approximately half of the patients using contraceptive methods within the past three months. Desire to avoid pregnancy, perception of adequate contraceptive counseling, and the influence of partners and physicians were significant predictors for contraceptive use.ImplicationsContraceptive counseling should be routinely included in discussions about disease processes and treatment plans, including access issues. Best practices for contraceptive counseling and integrated, multi-disciplinary team services should be developed and provided in clinical settings.     

朋辈心理辅导对大学生社会适应能力的干预研究

探讨朋辈心理辅导的3种模式对大学生社会适应能力的干预效果,为开展大学生适应性教育提供参考.方法 于2015年9月至2016年9月从上海市某高校选取180名大一新生,随机平均分配到3个实验组,分别进行为期1年的思想引领模式、心灵慰藉模式、行动支持模式的朋辈心理辅导干预与刺激;同时随机抽取86名大一新生作为对照组,实验期间不给予任何处理.在朋辈心理辅导前后,采用社会适应能力诊断量表对4组进行测评.结果 干预前,实验组和对照组社会适应状况及各因子得分差异均无统计学意义(P值均>0.05);干预后,3个实验组社会适应能力总分[(33.00±3.96) (19.77±6.20) (29.98±5.49)]高于对照组(14.72±3.44)(P值均<0.05).在思想引领模式、行动支持模式下,大学生社会适应能力各因子得分以及男生、女生社会适应性得分均高于对照组(P值均<0.05);在心灵慰籍模式下,身心症状、角色调试维度得分高于对照组(P值均<0.05),女生社会适应性得分高于对照组(P值均<0.05).结论 朋辈心理辅导可以显著提高大学生社会适应能力,3种模式侧重点各有不同.应根据受助需求广泛启动朋辈心理辅导计划.     

The effect of patient gynecologic history on clinician contraceptive counseling

Background

Contraceptive providers have an important influence on women's selection of contraception. Previous studies suggest that clinicians inappropriately limit use of intrauterine contraception (IUC). This study investigated the influence of patients' gynecologic histories on recommendations for IUC and other methods of contraception.

Study Design

Videos of standardized patients varying by history of pelvic inflammatory disease (PID) and parity were shown to clinicians at meetings of national medical societies. Participants indicated their contraceptive recommendations for the patient and whether they would have concerns were the patient to use IUC.

Results

Five hundred twenty-four providers viewed one video of a standardized patient and completed the survey. Gynecologic history was significantly associated with recommendations for the contraceptive ring, contraceptive patch, and copper IUC. Many clinicians indicated that they had concerns about the use of IUC with respect to risks such as PID, infertility and ectopic pregnancy. Concerns about infertility and pain with use of IUC were related to gynecologic history.

Conclusions

Patient gynecologic characteristics affect recommendations for some reversible contraceptive methods. Clinicians continue to have concerns about IUC use despite evidence supporting its safety.     

Follow-up of adolescent oral contraceptive users

Clients in birth control centers (St. Catharines, Niagara Falls, and Welland) in Ontario, Canada were profiled in 1989; factors affecting compliance with the use of oral contraceptives (OCs) were investigated. Compliance was assessed for those 16 years and after 3 months of OC use. A control group and 2 study groups were randomly formed. 1 group was told about a follow up telephone call if the 3-month checkup appointment was not kept and the other not told. Compliance was determined by keeping the follow-up appointment and taking the pill as directed. Self-administered questionnaires were obtained at the 1st appointment and the 2nd study group was interviewed at the 3-month appointment time. Of the 334 intake interviews, 28.4% were adolescents 16 years old. Information on birth control came most frequently from friends (78.7%; then high school classmates, 61.4% grade school classmates, 61.4%; and family, 38.0%). 94.3% had a boyfriend, primarily a steady one. 82.4% were sexually active before the Center visit. 21.3% had had sex when 15 years old. 9.2% of those sexually active had never used birth control. 85.2% of those using contraception had used a condom at least once, and 33.9% used withdrawal. In the preceding month, birth control was used 60% of the time. 46% of mothers and 25% of fathers were considered supportive of birth control. 228 16 years participated in the compliance study. The 2 study groups and the control group were not significantly different in their compliance. The only statistically significant predictor of compliance (from the intake interview) was the previous use of the condom. Those more likely to be compliant were the 10.9% sexually active who had never used a condom. Continuing with the family doctor, not sexually active, advice to stop, side effects concerns, and remembering to take the pill were the most common reasons for noncompliance. The implication for health and sex education is that emphasis needs to the placed on the risks taken by using withdrawal as a birth control method. Birth control education must begin before students become sexually active. Grade 8 is suggested as an appropriate time. A 3-month recheck appointment is unnecessary. For those not complying with the 3-month appointment, follow up is necessary. Compliance issues needs to be researched for the 16 group.     

Non-availability of the IUD and contraceptive choice

The Copper 7 and Lippes Loop IUD are no longer distributed in the United States, and the cost of the Progestasert precludes usage in many family planning clinics. The impact of the loss of this widely used contraceptive method was assessed in a pilot study at the UCLA Family Planning Clinic. The clients who would have selected an IUD at the time of their clinic visit between March and December of 1986 instead chose oral contraceptive pills (55%) or barrier methods (45%) but their level of dissatisfaction with the methods they received was significantly greater than that of all other contraceptors, and this led to their subsequent selection of another method which, in the majority (66%), was of lower efficacy than the IUD. There were two unplanned conceptions amongst twenty women who would have chosen an IUD, both due to non-compliance with oral contraceptive pills; and at the time of survey in March 1987, no clients had opted for sterilization. Women who no longer have their choice of the IUD represent a high risk for contraceptive dissatisfaction and failure, but have not made precipitous decisions to undergo permanent sterilization.     

Knowledge of contraceptive methods among adolescent students

OBJECTIVE: To compare the knowledge of contraceptive methods as well as to identify factors associated with adequate knowledge among public and private school adolescents. METHODS: A cross-sectional study comprising 1,594 adolescents aged between 12 and 19 years old from 13 public and five private schools in the city of S?o Paulo city, Brazil, was carried out from June to December 2003. Schools were randomly selected and students filled out a questionnaire about sociodemographic, reproductive and contraceptive methods. The prevalence ratios were estimated with a 95% confidence interval for each question on their knowledge of contraceptive methods and by school group. Each question correctly answered received a half score, and the cut-off value was 50% of correct answers. Statistical tests utilized were Chi-square and Wilcoxon-Gehan tests and Poisson multiple regression model. RESULTS: Of all respondents, 61% were of females in both school groups. Most students had low socioeconomic condition in public schools while they had mostly high socioeconomic condition in private schools (p<0.001). Nearly 18.6% private and 28.6% public school students were sexually active (p<0.002). In regard to their knowledge, 25.7% of public and 40.8% of private school students had a score equal to or above five. Factors associated with higher knowledge were: being female, at high school of a private school, having high socioeconomic condition, having had sexual intercourse and being older. CONCLUSIONS: Knowledge of contraceptive methods was low in both public and private school students. The study results show that both underprivileged as well as high socioeconomic adolescents need to have adequate information about family planning to improve their knowledge and change their behavior.     

Factors associated with the provision of antenatal contraceptive counseling

BACKGROUND: A chart review was conducted to evaluate patient and provider characteristics associated with having a documented antenatal plan regarding future contraception. STUDY DESIGN: A retrospective chart review of 528 parturients delivering between January and August 2002 was performed. Data obtained from chart review included demographics, antecedent pregnancy outcome, number of prenatal visits, provider type and documentation of an antenatal plan for postpartum contraception. RESULTS: Non-Hispanic white women, as compared to other racial/ethnic groups, were more likely to have documented counseling plans (OR 1.5, 95% CI 0.9-2.3), while non-English-speaking women were significantly less likely to have contraceptive plans recorded (OR 0.5, 95% CI 0.3-0.8). Women with recorded antenatal plans attended more prenatal visits (median 10 vs. 8, p < .001). Nurse practitioners were significantly more likely to document antenatal contraceptive counseling than were residents (OR 3.7, 95% CI 2.4-5.5). In the adjusted analysis, the factors most strongly being positively correlated with antenatal documentation included attending > 10 prenatal visits (adjusted OR 6.2, 95% CI 2.9-13.2), being seen by a nurse practitioner (adjusted OR 4.5, 95% CI 2.9-7.0) and being non-English speaking (adjusted OR 0.6, 95% CI 0.3-1.0). CONCLUSION: The provision of antenatal contraceptive counseling is associated with certain characteristics, including the patient's primary language, the number of prenatal visits and type of provider seen.     

The association between smoking and sexual behavior among teens in US contraceptive clinics.

A study of teenage women in 32 contraceptive clinics in the United States shows a strong negative relationship between age of first intercourse and the level of cigarette smoking; the association is strong enough to reverse the usual correlation of smoking and age during the teenage years. Preventive, timely contraceptive behavior is also negatively associated to smoking. These findings suggest that interventions could well be designed and located in settings which take this association into account.     

Change in trend of contraceptive uptake--effect of educational leaflets and counseling

BACKGROUND: The study was conducted to determine the impact of counseling and educational leaflets on contraceptive practices of couples. STUDY DESIGN: Randomization of 600 women was done in two groups matched for age, parity and socioeconomic status at the Department of Obstetrics and Gynaecology, Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, Pakistan. In Group A, the intervention group was exposed to contraceptive counseling and educational leaflets in the postnatal ward after delivery, whereas in Group B, the nonintervention group was not given any formal contraceptive advice. Later on, both groups were assessed regarding their contraceptive practices. RESULTS: At their follow-up visit (8-12 weeks) postpartum, 19 (6.3%) women in the nonintervention group had started contraceptive use, whereas 153 (50.8%) had decided to start contraception in the next 6 months, and 129 (42.8%) women were still undecided. The main contraceptive user was the male partner (n=117, 38.8%), and the most common method used was coitus interruptus (n=62, 36.3%). In the intervention group, 170 women (56.9%) had started using contraceptives, whereas 129 (43.1%) had decided to start contraceptive use in the next 6 months. The predominant contraceptive user was the females (n=212-70.9%), and the most popular method chosen was oral contraceptive pills (n=111, 37.1%). CONCLUSION: There is a definite increase in contraceptive uptake in women provided with educational leaflets and counseling session with a shift toward use of more reliable contraceptive methods.