Search

Introduction: More than one-third of annual pregnancies reported worldwide are unintended or unplanned. Counselling on various methods of combined hormonal contraception (CHC) has been shown to be effective in optimizing women's contraceptive choices and has led to improvements in continuation and adherence. Objectives: The Contraceptive Health Research of Informed Choice Experience (CHOICE) program was designed to evaluate women's contraceptive decisions, their reasons for making those decisions, and their perceptions of CHC methods in 11 countries. It was also intended to assess the effects of a counselling program in which information about CHC methods is administered in a standardized format. In this report, data from women participating in Israel's CHOICE program are presented. Methods: Women 18 to 40 years of age who consulted their healthcare professional (HCP) about contraception and would consider a CHC method were qualified to participate. Participants indicated which CHC method they preferred and were then counselled about 3 CHC methods: the daily pill, weekly patch, and monthly vaginal ring. After counselling, women were asked to complete a questionnaire, providing information on their perceptions of contraceptive methods, the method actually chosen, and reasons for their choice. Results: A total of 1802 women in Israel were included. They were aged (mean ± SD) 26.7±6.0 years, and 85.2% (n = 1522) reported being in a steady relationship with a partner. Overall, 19.4% reported unplanned pregnancies, and 15.8% had induced abortions. All (100%; n = 145) participating HCPs were gynaecologists. Most women (90.3%) agreed that the pill prevented pregnancy; fewer than half of women believed that the patch (37.2%) and ring (42.8%) effectively prevented pregnancy. Less than half of women believed that the pill, patch, and ring had many side effects (42.4%, 10.4%, and 7.9%, respectively). Before counselling, 68.8%, 7.1%, and 7.3% of women indicated that they might use the pill, patch, and ring, respectively. After counselling, 55.9%, 12.1%*, and 22.7%* of women actually selected the pill, patch, and ring, respectively (*P < 0.0001; versus before counselling). The most common reasons (cited by >40% of women) for selecting the pill were: "convenience", "easy to use", "regular menstrual bleeding", "I am used to it", and "relief from menstrual pain"; for selecting the patch: "weekly use", "will not forget it", "convenience", "easy to use", "recommended by doctor", "regular menstrual bleeding", and "low chance of side effects"; and for selecting the ring: "monthly use", "will not forget it", "convenience", "easy to use", "recommended by my doctor", "steady low hormone levels", "regular menstrual bleeding", and "low chance of side effects". Conclusions: Overall, Israeli women had positive opinions of CHC safety and tolerability; their opinions on CHC efficacy were mixed. Israeli participants have demonstrated a considerably higher degree of knowledge about oral contraceptives in all questionnaires' parameters compared to the patch and the vaginal ring, even after counselling. Counselling appeared to influence women's contraceptive decisions; the result of such counselling could influence a woman to choose her physician's contraceptive preference. Many physicians had a preference for the transdermal patch and vaginal ring, which may be due to their participation in CHOICE. The results demonstrate that if women are more extensively counseled about all CHC methods instead of only the method they request, significantly more women select the transdermal patch and the vaginal ring. [ABSTRACT FROM AUTHOR]

Background: In order to provide women with an informed choice of contraception, responsible health professionals need to be well educated and trained for providing consultation in that area. The objective of the study was to better understand the actual situation regarding education and training of health care providers (HCPs) for contraceptive service delivery., Methods: A specially designed questionnaire was sent to 74 individuals who were either former or current country representatives in the Board, or members of the Expert groups of the European Society of Contraception and Reproductive Health (ESC). Data were obtained from 27 respondents from 21 countries., Results: Contraceptive services are delivered by different medical professionals and organisational units. Gynaecologists are involved in comprehensive contraceptive care in the majority of countries, general practitioners (GPs) provide hormonal contraception in nine, and midwifes/nurses in six countries. Undergraduate and postgraduate education and training of HCPs pertinent for contraceptive care is at a satisfactory level in less than half of the investigated countries. International educational and training programmes are being underutilized in around half of the countries., Conclusion: Different models of contraceptive care exist across Europe. Education of relevant HCPs need to be improved and harmonized in the majority of investigated countries., Competing Interests: Declaration of Competing Interest The authors declared that there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling., Methods: CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models., Results: The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP < 60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern., Conclusions: Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.

Five new members of the actinomycin family, actinomycins G2-G6 (2-6), are produced by Streptomyces iakyrus strain DSM 41873. Their structures were established by spectroscopic methods. Unlike actinomycin D (1), the alpha-ring of the novel compounds contains the unusual amino acid 3-hydroxy-5-methylproline, while the beta-ring includes N-methylalanine and either a chlorinated or hydroxylated threonine moiety. The chlorine-containing actinomycin G2 (2) is the main product; it exhibits strong cytotoxic and antibacterial activities. Actinomycin G5 (5) is the first actinomycin with an additional ring closure between the beta-peptidolactone and the actinoyl chromophore. Actinomycin G6 (6) resulted from the 4-hydroxythreonine-containing actinomycin G3 (3) by a 2-fold acyl shift of the beta-unit, which has not been observed before for this class of chromopeptides. The structural modification of compounds 5 and 6 goes along with an evident reduction of the biological activity. The biosynthesis of aniso-actinomycins is discussed.