Pill Use Research Articles

A profile of abortion in a tertiary care centre: An observational study

The recent years have seen rise in unintended pregnancy which includes unwanted and mistimed pregnancy. Despite the conducive environment of legal abortion in India through MTP Act, many women resort to unsafe methods of abortion. In India, estimated abortions in 2015 were 15.6 million. The overall rate of abortion was estimated to be 4.8%, among which 67.1% of abortions were classified to be unsafe. Thus, the aim of the study is to analyze the demographic profile of patients, reason for seeking abortion and evaluation of significant adverse outcome and management. This was a hospital-based observation study carried out in the department of OBG in MMC&RI, Mysuru during the period January 2019 to December 2020. 100 women seeking MTP and 100 women presenting to hospital for help following the consumption of over the counter pills were included in the study. : 100 women with self-consumption of pills presented to hospital with complaints of heavy bleeding (35%), spotting PV (22%) and pain abdomen (15%). Most were married, belonging to lower socioeconomic status with age of 21-25 years (42%), followed by 26 – 30 years (22%). In 100 women seeking MTP, congenital fetal anomalies (51%) was the main indication, followed by contraception failure (36%). In comparison to the women seeking abortion services under medical supervision, the complication rates were higher in unsupervised group. This included retained products of conception (25%), moderate anemia (12%), severe anemia (7%), shock (3%), sepsis (4%) requiring surgical evacuation (51%), medical management (46%), anemia correction (17%), ICU admission (7%) and emergency laparotomy (3%). The cornerstone is motivation and encouragement of women to adapt family planning services to reduce unintended pregnancy. For women needing these services, accessibility and comprehensive education regarding unsafe abortion is needed. Legislation and strict policy is required for the use of MTP pills, so as to reduce the sales without prescription.

Identification of prescription opioid misuse and abuse behaviors and risk factors in chronic pain patients using the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ)

Objectives To identify patient risk factors associated with prescription opioid misuse and abuse as well as groupings of misuse and abuse behaviors as measured by the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ). Methods Adults with chronic pain requiring long-term treatment with opioids completed the POMAQ and other study questionnaires. Latent class analysis (LCA) was used to examine underlying subgroups exhibiting particular risk profiles. Patient demographic and clinical characteristics were examined as covariates and the concordance between the identified latent classes at-risk classifications and the POMAQ clinical scoring algorithm was assessed. Results Analysis of data from 809 patients revealed four classes: “chronic pain, low risk” (n = 473, low to no prevalence of POMAQ behaviors), “chronic pain, comorbid condition” (n = 152, high prevalence of anti-anxiety, sleeping pill, and antihistamine use), “at risk” (n = 154, taking more opioids than prescribed and drinking alcohol with opioids more frequently than other groups), and “high risk” (n = 30, highest prevalence of each behavior). The “high risk” group was associated with being younger, less educated, and unemployed compared to other groups. When examining the LCA classes by groups defined by the original POMAQ clinical scoring algorithm, the “high risk” class had the highest proportion of participants identified with abuse behaviors (46.7%), compared to just 4.7% in the “chronic pain, low risk” group. Conclusions Findings suggest there are four distinct subgroups of patients defined by chronic opioid misuse and abuse behaviors and support the use of the POMAQ to identify risk factors associated with prescription opioid misuse and abuse.

Maternal age at birth of last child and cardiovascular disease mortality later in life among a national cohort of postmenopausal women from the United States.

Abstract Maternal age at last birth of child is increasing in the United States, and it has been reported to influence future chronic diseases. In this study of nationally-representative sample of postmenopausal women, there was no conclusive association between maternal age at last birth of child and cardiovascular disease mortality later in life. Objective Maternal age at last birth (ALB) of child is increasing in the United States, and it has been reported to influence future chronic diseases. However, the relationship of ALB and cardiovascular disease (CVD) events later in life has not been widely studied. We evaluated the association of ALB with CVD mortality. Methods Data were from 7,971 parous postmenopausal women older than 45 years who participated in the US National Health and Nutritional Examination Survey from 1999 to 2018 and had mortality follow-up data through to December 31, 2019. ALB was self-reported, whereas CVD mortality was assessed using International Classification of Diseases codes. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results The mean age of participants was 63 ± 9.8 years, with 9.5% being non-Hispanic Black, 9.7% being Hispanic women, and 21% reporting ALB ≥35 years. During a median follow-up of 8.1 years, 443 participants died from CVD. In age-adjusted models, CVD mortality was elevated for women with ALB of <25 years (HR, 1.68; 95% CI, 1.23-2.29) and ALB of ≥35 years (HR, 1.37; 95% CI, 1.00-1.88). However, after additional adjustment for race and ethnicity, foreign born, education, marital status, poverty income ratio, parity, smoking status, age at menarche, oral contraceptive pills use and family history of myocardial infarction, these estimates were attenuated resulting in no association between ALB and CVD mortality. Conclusions In this study of nationally representative sample of postmenopausal women, there was no conclusive association between maternal ALB and CVD mortality later in life.

Cerebral Venous Sinus Thrombosis Following an mRNA COVID-19 Vaccination and Recent Oral Contraceptive Use

Rising concerns of cerebral venous sinus thrombosis (CVST) and other forms of venous thromboembolism have been associated with the SARS-CoV-2 vaccinations. Adverse effects with vector-based vaccines are well documented in the literature, while less is known about the mRNA vaccines. This report documents a case of CVST in a 32-year-old female patient who received her second Pfizer mRNA COVID-19 vaccination 16 days prior to hospital admission and had started oral combined contraceptives approximately 4 months beforehand. Clinicians should be cognizant of the possibility that mRNA vaccines, when combined with other risk factors like oral contraceptive pill use, may enhance one's hypercoagulable status.

Cultural Variations in the Care and Support of Breastfeeding

Breastfeeding MedicineVol. 18, No. 2 EditorialFree AccessCultural Variations in the Care and Support of BreastfeedingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding MedicineSearch for more papers by this authorPublished Online:15 Feb 2023https://doi.org/10.1089/bfm.2023.29234.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine highlights two disparate articles that on first reading seemingly have absolutely nothing to do with each other. In one, in a comment in the Perspective Section, Segev and colleagues discuss the “unique” problem of which oral contraceptives should be recommend to Orthodox Jewish breastfeeding mothers. In the Clinical Research section Cordova Ramos and colleagues report on their study of the association of the mother's primary language and subsequent breastfeeding rates.As Segev notes, traditionally, estrogen-only medications have been the recommended oral contraceptive for breastfeeding mothers because of a concern that combined therapy (estrogen/progesterone) contraceptives run the risk of reducing the mother's milk production. For the general population the increased risk of breakthrough bleeding from the use of estrogen-only pills posed a relatively “minor adverse outcome,” surely offset by the confidence that the mothers are producing their maximum capacity of milk.However, as Segev details, the concern of breakthrough bleeding is not a minor inconvenience in a population that conducts its life under strict religious (halachic) law. Per this religious code, a single menstrual-like breakthrough bleeding results in a prohibition of any sexual contact for periods of days and repeated bleeds may result in months of deferred marital relationships with all the inevitable negative consequences for the couple. Thus, not surprising for this population the risk–benefit ratio based on its particular social cultural priorities would support the use of combine hormonal contraceptive preparations.Cordova-Ramos study of the association of the mothers' primary language and breastfeeding rates and patterns is no less intriguing and enlightening. This study was performed in the context of what has already been reported about the realities of the inequalities in medical care and the need for more detailed and nuanced cultural sensitivity in developing medical services. Given the reports of the racial and ethnic disparities in human milk intake in neonatal intensive care units,1–3 such a study was clearly of high priority.What Cordova-Ramos proceed to do is expand how we categorize the mothers beyond the standard labels of race and ethnicity by adding the variable of primary language into their analysis of the results. The authors justified this expanded analysis on the assumption that the mothers' primary language would serve as a marker of cultural identity (let alone immigrant or native born status). What was found, surprisingly, was that there was different and opposite association of the mothers' primary language with mother's milk provision among different groups.For example among Hispanic mothers, non-English- versus English-speaking mothers had lower rates of milk provision, whereas among Black mothers, non-English- versus English-speaking mothers had higher rates of milk provision. These differences likely reflected a much more complex interplay of social and cultural factors that influence continuation of mother's milk provision in minority mothers and highlights the heterogeneity that exists within conventionally labeled racial/ethnic minority groups. Surely it is difficult to justify combining under the label of Hispanic data regarding third-generation Puerto Rico mothers living in New York with data regarding Mexican or other Central American immigrants living in Texas or California.4What is the common thread in these two seemingly unrelated articles and what we should learn from the data presented? The clear message that we should neither analyze the clinical manifestation of any given medical situation only utilizing the broad and somewhat at times simplistic construct of race and ethnicity. No less so, we should be careful in promoting global recommendations or standard management protocols that are not adjusted for specific groups and subgroups. Clearly there is need for greater sophistication and sensitivity to the various subsets of the standard racial and ethnic categories,Homogenizing the differences between mothers based on the standard labels without factoring the specific social, cultural, beliefs, and practices in subgroups preclude appropriate individualized care and therapy. Simply put, we need not only to be attuned to the language (and cultural context) that specific mothers are talking, but also we need to adjust, in turn, our language to be appropriately attuned to these mothers.

DOP25 Contraceptive method use according to Inflammatory Bowel Disease status among young women in the United States

Abstract Background Inflammatory bowel disease (IBD) and estrogen-based contraceptives both increase thromboembolism risk, leading gastroenterologists to recommend long-acting reversible contraceptives (LARCs) over estrogen-based methods for women with IBD. No study has evaluated whether young women with IBD follow this guidance, especially as many patients lack awareness of estrogen-related risks, and young women generally prefer estrogen-based methods. We evaluated contraceptive use patterns for young women with versus without IBD, including odds of estrogen-based contraceptive use. Methods Using the IQVIA Pharmetrics Plus Database, a United States (US) health insurance claims database, we identified US women ages 15-25 with ≥1 prescription contraceptive and ≥6 months continuous enrollment from enrollment start to first contraceptive code (intake period). We excluded patients with ≥1 hysterectomy/sterilization claim during intake. The independent variable was IBD diagnosis, defined as ≥3 codes for Crohn’s disease (CD) or ulcerative colitis (UC), 2 CD and/or UC codes and 1 IBD medication code, or 1 CD or UC code and 2 IBD medication codes during intake. The dependent variable was estrogen-based contraceptive use (estrogen-based contraceptive pill, patch, and ring) versus non-estrogen-based (progestin-only pill, injectable, implant, and intrauterine device [IUD]), based on the first contraceptive claim. We generated descriptive statistics for contraceptive sub-type and covariates stratified by IBD status and performed bivariate comparisons. Using multivariable logistic regression, we determined adjusted odds ratios (aOR) with 95% confidence intervals (CI) for estrogen-based contraceptive use, adjusting for age, region, year, and insurance. Results We identified 802,932 young women on contraceptives, of whom 1,083 had IBD. Demographics were similar across IBD status except more women with IBD had commercial insurance (Table). Use of the estrogen-based pill, patch, and ring was similar or marginally lower for women with IBD versus without IBD (67.6% vs 68.8%, 2.7 vs 3.1%, and 1.5 vs 1.4%). Women with IBD had a slightly higher proportion of implant use and similar IUD use versus those without IBD (16.1% vs 14.2%; 1.8% vs 1.7%,) (Table, Figure). After adjustment, young women with IBD were 0.82 times as likely to use estrogen-based contraceptives compared to those without IBD (aOR 0.82; 95% CI 0.71-0.94). Conclusion Young women with IBD on contraceptives are only slightly less likely to use estrogen-based methods as those without IBD, despite the recommendation for LARC over estrogen-based contraceptives in IBD. This finding suggests a need for reproductive health education efforts and contraceptive safety studies specific to young women with IBD.

Developmental programming of the neuroendocrine axis by steroid hormones: Insights from the sheep model of PCOS.

The reproductive neuroendocrine system is a key target for the developmental programming effects of steroid hormones during early life. While gonadal steroids play an important role in controlling the physiological development of the neuroendocrine axis, human fetuses are susceptible to adverse programming due to exposure to endocrine disrupting chemicals with steroidal activity, inadvertent use of contraceptive pills during pregnancy, as well as from disease states that result in abnormal steroid production. Animal models provide an unparalleled resource to understand the effects of steroid hormones on the development of the neuroendocrine axis and their role on the developmental origins of health and disease. In female sheep, exposure to testosterone (T) excess during fetal development results in an array of reproductive disorders that recapitulate those seen in women with polycystic ovary syndrome (PCOS), including disrupted neuroendocrine feedback mechanisms, increased pituitary responsiveness to gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) hypersecretion, functional hyperandrogenism, multifollicular ovarian morphology, and premature reproductive failure. Similar to a large proportion of women with PCOS, these prenatally T-treated sheep also manifest insulin resistance and cardiovascular alterations, including hypertension. This review article focuses on the effects of prenatal androgens on the developmental programming of hypothalamic and pituitary alterations in the sheep model of PCOS phenotype, centering specifically on key neurons, neuropeptides, and regulatory pathways controlling GnRH and LH secretion. Insights obtained from the sheep model as well as other animal models of perinatal androgen excess can have important translational relevance to treat and prevent neuroendocrine dysfunction in women with PCOS and other fertility disorders.

Challenges accessing contraceptive care and interest in over-the-counter oral contraceptive pill use among Black, Indigenous, and people of color: An online cross-sectional survey

ObjectiveTo examine challenges accessing contraception in the past year and their association with interest in using an over the counter (OTC) oral contraceptive pill (OCP) among Black, Indigenous, and people of color (BIPOC) in the United States. Study DesignFrom May 2021 to March 2022, a collaborative research team conducted a cross-sectional online survey using convenience sampling to recruit people who identify as Asian American, Native Hawaiian, or Pacific Islander, Black or African American, Indigenous, or Latina/Latinx and used or wanted to use a contraceptive method in the past year. Respondents were recruited through reproductive justice and community-based organizations. ResultsAmong 727 respondents, 45% reported experiencing at least one challenge accessing contraception in the past year of which 37% reported a logistical challenge, and 20% reported an interpersonal challenge. Sixty-seven percent of respondents said they were likely to use an OTC OCP. Respondents who reported experiencing at least one challenge accessing contraception in the past year were more likely to say they would use an OTC OCP. Fifty-seven percent of respondents who were not using a contraceptive method in the past year reported they were likely to use an OTC OCP. ConclusionAmong people in this study, interest in an OTC OCP is high, particularly among those who have faced challenges accessing contraception, and among those who are not currently using a contraceptive method. ImplicationsAvailability of an OCP OTC has the potential to address challenges accessing contraceptive care among BIPOC in the United States, who are often impacted by structural inequities and racism. Findings from this study can inform future OTC implementation strategies to ensure OTC access addresses logistical and interpersonal challenges.

Sex and gender in hypertension guidelines.

This paper reviews 11 current and previous international and some selected national hypertension guidelines regarding sex and gender-related differences. Those differences can be attributed to biological sex and to gender differences that are determined by socially constructed norms. All reviewed guidelines agree on a higher hypertension prevalence in men than in women. They also concur that evidence does not support different blood pressure thresholds and targets for treatment between men and women. Differences refer in addition to the differences in epidemiological aspects to differences in some morphometric diagnostic indices, e.g., left ventricular mass or the limits for daily alcohol intake. Concerning practical management, there are hardly any clear statements on different procedures that go beyond the consensus that blockers of the renin-angiotensin system should not be used in women of childbearing age wishing to become pregnant. Some further sex-specific aspects are related to differences in tolerability or drug-specific side effects of BP-lowering drugs. There is also a consensus about the need for blood pressure monitoring before and during the use of contraceptive pills. For management of pregnancy, several guidelines still recommend no active treatment in pregnant women without severe forms of hypertension, despite a wide consensus about the definition of hypertension in pregnancy. A disparity in treatment targets when treating severe and non-severe hypertension in pregnancy is also observed. Overall, sex-specific aspects are only very sparsely considered or documented in the evaluated guidelines highlighting an unmet need for future clinical research on this topic.

The relationship between the insulinemic potential of diet and lifestyle and risk of breast cancer: a case-control study among iranian adult women

BackgroundBreast cancer (BC) is the most prevalent cancer, with a higher mortality rate in women worldwide. We aimed to investigate the association of the insulinemic potential of diet and lifestyle with the odds of BC using empirical indices, including the empirical dietary index for hyperinsulinemia (EDIH), empirical lifestyle index for hyperinsulinemia (ELIH), the empirical dietary index for insulin resistance (EDIR), and empirical lifestyle index for insulin resistance (ELIR).MethodsThis hospital-based case-control study was conducted among Tehranian adult women aged≥30 years. The final analysis was performed on 134 women newly diagnosed with histologically confirmed BC as a case and 267 healthy women of the same age as control. A 168-food item food frequency questionnaire was used for assessing dietary intakes at baseline. The odds ratios (ORs) and 95% confidence intervals (CIs) of BC across tertiles of EDIH, ELIH, EDIR, and ELIR were determined using multivariable-adjusted logistic regression.ResultsThe mean ± SD of age and BMI of participants were 47.9±10.3 years and 29.4±5.5 kg/m2, respectively. EDIH score was related to the higher risk of BC based on fully adjusted models (OR:2.24;95%CI:1.21–4.12, Ptrend=0.016). Furthermore, subgroup analysis showed a higher BC risk with increasing EDIH score in postmenopausal women (OR:1.74, 95%CI:1.13-2.69) and those without a history of the oral contraceptive pill (OCP) use (OR:1.44;95%CI:1.02–2.04). Moreover, ELIH scores were positively associated with an increased risk of BC in postmenopausal women (OR; 1.98; 95% CI: 1.35 – 2.89), those with a family history of cancer (OR:1.94;95%CI:1.10–3.42), and in individuals who did not use OCP (OR:1.46; 95% CI:1.00–2.12).ConclusionOur results showed a possible link between EDIH and higher BC risk. Also, higher EDIH and ELIH scores were strongly associated with a higher risk of BC in postmenopausal women, those with a family history of BC, and those who do not use OCP.

Teenagers’ and parental attitudes towards the use of placebo pills

The placebo response a significant therapeutic improvement after a placebo intervention — can be high in children. The question arises of how optimal advantages of placebo treatment in pediatric clinical care be achieved. In this era of shared-decision making, it is important to be aware of patients’ and parental attitudes. Therefore, the aim of the current study was to assess teenagers’ and parental views on the use of placebo pills in pediatric clinical care. All patients (aged 12–18 years) and parents of children (aged 0–18 years), visiting the pediatric outpatient clinic between March 2020 through December 2020, were invited to participate in this study multicenter survey study. Of 1644 distributed questionnaires: 200/478 (47%) teenagers and 456/1166 (45%) parents filled out the complete survey. More parents were positive towards prescribing placebo medication than teenagers (80% vs. 71%, p = .019), especially when the clinician disclosed the use of a placebo to parents and teenagers, respectively (76% vs. 55%, p = .019). Increasing age of teenagers was positively associated with the willingness for placebo interventions (OR 0.803, 95%CI 0.659–0.979), as was a higher level of parental education (OR 0.706, 95%CI 0.526–0.949). Conclusion: This study emphasizes the willingness of teenagers and parents to receive placebo medication. Placebo medication becoming more acceptable and integrated into daily care may contribute to a decrease in medication use.What is Known:• A placebo is a treatment without inherent power to produce any therapeutic effect, but can result in significant therapeutic improvement, the so-called placebo response.• Treatment response rates after placebo interventions in children can be high, ranging from 41 to 46% in pediatric trials.What is New:• Most teenagers (71%) and parents (80%) find it appropriate for healthcare professionals to prescribe placebo medication.• Compared to adult care, pediatrics has a unique feature to disclose placebo treatment to parents while concealing it for the young patient: the majority of teenagers (85%) and parents (91%) agree to disclose placebo treatment to parents exclusively.

Validity of donor-reported iron supplementation practices obtained at the time of donation.

Iron supplementation (IS) improves blood donors' iron stores and allows more frequent blood donation. Understanding the accuracy of self-reported IS is helpful for potential application of IS practices to donor eligibility or donation intervals. Successful whole blood and red cell apheresis donors completed a survey at donation on the use of select dietary supplements. Respondents reporting use of either iron pills (IP) or multivitamins (MV) were invited by email to complete a similar follow-up survey 6-8 weeks later and to provide the quantitative iron content of IS by referring the donor to the pill bottle label. Consistency between baseline and follow-up responses was assessed overall and by pill type and demographic variables. Of 2444 donors answering the baseline survey, 40% (978) reported MV or IP at donation, 354 of whom completed the follow-up survey. A majority of survey respondents (56%-61%) reported taking iron across the two surveys, and 21%-24% took MV but were uncertain if their pills contained iron. Of 215 reporting IS at baseline, overall concordance at follow-up was 68% and was higher for donors who were female, ≥50-years old, and taking iron as an iron pill rather than in a multivitamin. Consistency of donor responses may be insufficient for use in guiding donor eligibility. Referring donors to their pill bottles was unsuccessful in improving the high frequency of uncertain responses. Incorporating IS into donor eligibility determinations is a complex endeavor that will benefit from careful planning and from post-implementation monitoring.

Technologies of protest in Irish abortion activism

ABSTRACTIn the decades before the historic legalization of abortion in the Republic of Ireland in 2018, activists used creative methods to educate, agitate, and advocate for changes in abortion law and access. In the 2000s, the availability of the “abortion pills,” mifepristone and misoprostol, began to affect patterns of illegal abortion access, as well as the methods of protest used by those advocating for legal abortion. This article examines protest actions orchestrated by Irish abortion activists from 2014 to 2018 that used abortion pills as technologies of protest. I argue that abortion pill protests introduced a new “protest logic” to abortion activism, both in Ireland and around the world (De Zordo, Mishtal, and Anton 2017). By using abortion pills as a central object in public protests, activists repackaged abortion pills from “technologies of access” to “technologies of protest.” These new tactics were not without controversy. I suggest that the conflicts that emerged from abortion pill protests helped shape new activist claims about abortion access and ultimately led to positive social and legislative change. As abortion pill use increases globally in the face of growing restrictions, the use of pills as technologies of protest will continue to affect abortion activism and other social movements.

Over-the-Counter Use of Medical Abortion Pills: A Prospective Cohort Study

Introduction: Medical abortion is a safe intervention in the first trimester that requires access to accurate information and the support of a trained healthcare provider. However, women often use medical abortion pills on their own or with guidance from friends, relatives, quacks, or pharmacists due to the easy availability of these drugs over-the-counter without a medical prescription. Aim: To study the effects of over-the-counter use of medical abortion pills on maternal health and to explore the possible reasons for it. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. The study duration was one year and five months, from June 2020 to October 2021. A total of 98 women who reported unsupervised consumption of medical abortion pills over a period of 17 months were included in the study. Demographic and obstetric profiles, clinical presentation, diagnosis, outcomes, and complications were analysed. Reasons for unsupervised intake were also explored. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 98 women, with the majority (54.08%) belonging to the 25-31 years age group. Out of these, 49 (50%) women took the abortion pills between 7-12 weeks, 32 (32.65%) before seven weeks, and 17 (17.35%) between 13-20 weeks. Pregnancy was confirmed with a Urine Pregnancy Test (UPT) kit in 64 (65.30%) women, with Ultrasonography (USG) in 22 (22.45%) women, while 12 (12.25%) took pills based solely on missed periods. The most common clinical presentation was excessive vaginal bleeding in 70 (71.42%) cases. Incomplete abortions were observed in 77 (78.56%) women, missed abortions in 10 (11.22%) women, and septic abortions in 4 (4.08%) women. Laparotomy was needed in six women with ectopic pregnancy. Two women required hysterectomy, one due to uterine perforation after suction evacuation in a private hospital, and the other due to intractable haemorrhage. Blood transfusion was needed in 25 (25.5%) women, and Intensive Care Unit (ICU) care in 15 (15.3%) women. However, none experienced acute kidney injury, Disseminated Intravascular Coagulation (DIC), or mortality. The main reasons for over-thecounter use of abortion pills were privacy or non-disclosure of pregnancy in 48 (48.9%) cases, opposition from the husband in 31 (31.6%) cases, avoiding a hospital visit in 25 (25.51%) cases, and easy availability of the pills in 27 (27.55%) cases. Conclusion: Unsupervised intake of pills increases the risk of complications like incomplete or missed abortion, sepsis, and ectopic pregnancy, which may require blood transfusion, ICU admission, and major surgeries like laparotomy or hysterectomy in a few cases. Therefore, there is a need for supervised intake of pills to reduce maternal morbidities.

Prevalence of different sleep problems in patients with respiratory diseases presented to a respiratory outdoor clinic

Introduction: A patient with compromised respiratory system due to some diseases, may have disturbed sleep to a great extent. It has been proved in various community based epidemiologic studies. Though most of such studies available had concentrated on single respiratory disease like Chronic Obstructive Pulmonary Disease (COPD) or Asthma in the community. But such studies are hardly available for patients attending a respiratory clinic, where all respiratory ailments were evaluated with concurrent sleep problems. The present study is one such. Methods: Total 163 patients were screened and among them 100 were selected as the study group. The patients were enquired with a standard questionnaire provided to them. In addition, they were given separate questionnaire as STOP BANG, Insomnia Severity Index Score, RLS questionnaire. Those persons with STOP BANG > 5, were also advised for a polysomnography (PSG), if not already done. Descriptive statistical analysis has been carried out in the present study. Results: The present study is a cross-sectional depiction of relationships between various respiratory diseases and sleep problems. As per this study, most patients were asthmatic and commonest sleep problem was OSA. A subgroup analysis was done to determine the significance of difference of various parameters between the three groups of asthmatic patients, patients having COPD and the “Other” group. Discussion: Subjective sleep problems were significantly more in Asthma group than COPD group (P < 0.0362). The mean STOP BANG was more in COPD group than the Asthma group (P < 0.0301). Though OSA was the commonest sleep problem between the three groups, but the prevalence was not statistically significant between them. More patients in the COPD group had insomnia, but it was not statistically significantly more than in Asthma group. Sleeping pill use was significantly more in COPD group than the Asthma group (P < 0.0039). Conclusion: Sleep problems are common in patients with respiratory diseases and OSA is the most common problem according to the present study. Asthma patients had more subjective sleep problems. Sleeping pill use was more common in COPD patients instead of having less subjective sleep complaints than asthma patients.

Perception of Condoms and Emergency Contraceptive Pill Use among Students in the University of Bamenda

Background: Globally, university students fall in the youth group prone to unattended sexual risks which may lead to unwanted pregnancy and STI/HIV. In Cameroon, more than a third of maternal deaths occur among adolescent girls and young mothers. Unwanted pregnancies results from the infrequent use of modern contraceptive methods and is one of the main causes of death in this population. Condoms are barrier contraceptive that have a beauty of dual protection-against pregnancy and transmission of STI/HIV, meanwhile emergency contraceptives has just one function which is protection against unwanted pregnancy. Aim: To assess the perception of condoms and emergency contraceptive pill use among students in the university of Bamenda, Cameroon. Materials and Methods: A university-based cross-sectional study was conducted among students in the University of Bamenda, North West Region of Cameroon, a cosmopolitan area approximately about 19 km from Bamenda main town (Commercial Avenue). The study was carried out over a period of three months. Data were collected using a structured interviewer questionnaire administered through Google form. Data collected were extracted into excel sheet and analysed with SPSSv23. Results: The study included 719 students (318 males and 401 females). The rate of male and female condom use was 28.5% and 8.1% respectively. The mean age of our study populations was 24.5 ± 4.97 years with 52.7% of population between 20 to 24 years of age. Knowledge about condoms was high at 98.3%, however, 91.9% of participants have never used the female condoms before. Highest factor recorded for non-utilisation of the male and females condoms were reduction in sexual pleasure (47.4%) and lack of knowledge on usage (44.1%) respectively. 95% of students have knowledge on Emergency Contraceptive Pills (ECPs) but just an average (52.4%) have used it before. Fear of side effects (47.4%) was the main reason for not using ECPs. Conclusion: There is a very high knowledge about condom and emergency contraceptive pill among students. However, the rate of usage recorded was very low with highest source of information being the media/internet and lowest among relatives/family.

Association of hormonal and reproductive risk factors with breast cancer in Indian women: A systematic review of case-control studies.

The incidence of breast cancer in India has seen a rapid increase in recent years. Hormonal and reproductive risk factors for breast cancer have been affected by socioeconomic development. Studies on breast cancer risk factors in India are limited by the small sample size and specific geographical area. The current systematic review was carried out to assess the association of hormonal and reproductive risk factors with breast cancer in Indian women. A systematic review of MEDLINE, Embase, Scopus, and Cochrane database of systematic reviews were done. Relevant case-control studies published in peer-reviewed indexed journals were analyzed for hormonal risk factors such as age at menarche, menopause, and first childbirth; breastfeeding; abortion; and oral contraceptive pills use. Younger age (<13 years) at menarche was associated with high risk (odds ratio 1.23-3.72). Other hormonal risk factors with strong association were age at first childbirth and menopause, parity, and duration of breastfeeding. Abortion and the use of contraceptive pills did not have a clear association with breast cancer. Hormonal risk factors have a higher association in premenopausal disease and estrogen receptor-positive tumors. There is a strong association between hormonal and reproductive risk factors and breast cancer in Indian women. The protective effect of breastfeeding is related to the cumulative duration of breastfeeding.

Long-term behavioral effects of a school-based prevention program on illicit drug use among young adults.

Most universal drug abuse prevention efforts target early adolescents with the goal of delaying or preventing the onset of substance use. The present study examined long-term follow-up data from a large-scale randomized trial of a school-based prevention program that used cognitive-behavioral skills-training techniques to enhance social and personal competence skills and drug refusal skills. The preventive intervention was implemented in junior high schools, and pretest data were collected from students in the classroom. Approximately 13 years later, follow-up data were collected by mail from 2042 young adults. Rates of overall lifetime illicit drug use, as well as lifetime marijuana use, marijuana intoxication, and lifetime non-medical pill use, were lower among students who received the prevention program (Life Skills Training) during junior high school compared to control group participants. These findings support the hypothesis that comprehensive, universal school-based prevention programs can produce long-term effects on illicit drug use behavior.

A Literature Review Comparing Combined Oral Contraceptive Pill use and Mirena during Perimenopause

A Literature Review Comparing Combined Oral Contraceptive Pill use and Mirena during Perimenopause

The Effects of Hormonal Contraception on Auditory Emotional Memory

Emotional episodic memory is an important cognitive mechanism that has been extensively studied, however, auditory emotional memory in particular has yet to be thoroughly understood. In addition, sex hormones have been found to affect brain structure and regulate regions of the brain that support higher order cognitive functions. Considering the global usage of oral hormonal contraceptive pills, it is vitally important to investigate the effects of oral contraceptives on executive function, including memory. The aim of the present study was to investigate the extent to which oral contraceptives influence recall for an emotional auditory episodic memory compared to a neutral memory. Participants (N = 90; 45 on an oral contraceptive, 45 naturally cycling) performed a free recall task for an emotional and a neutral auditory story, and their recalls were categorized into gist and detail elements and rated for accuracy. Recall accuracy for an emotional or neutral auditory story was not different between women on oral hormonal contraceptives and women who were naturally cycling, however, both groups of women recalled more information regarding the neutral story compared to the emotional story. These findings inform how the use of hormonal contraceptive pills, combined with high emotional valence, may impact the content and accuracy of recalled episodic events.