HEALTH ISSUE: Contraception choices affect the long-term sexual health and fertility of women and men. Data from the 1998 Canadian Contraception Study and the 2000\\/2001 Canadian Community Health Survey were assessed for measures of contraceptive use and familiarity with various methods among Canadian women. KEY FINDINGS: The oral contraceptive (OC) pill is the dominant method of contraception for Canadian women.
Sharon McMahon MA; Lisa Hansen; Janice Mann; Cathy Sevigny; Thomas Wong; Marlene Roache
Objective Women who become pregnant during the conduct of biomedical HIV prevention trials are taken off the study product for safety reasons. High pregnancy rates can compromise statistical integrity in these trials. The comprehensive contraceptive curriculum developed for the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial was evaluated for its ability to enhance contraceptive uptake, reduce pregnancy rates, and preserve statistical integrity. Methods Contraceptive- and pregnancy-related eligibility criteria were specified in the protocol. We enrolled women who opted for a non-barrier method of contraceptive and provided hormonal contraceptives on-site at no cost. At each monthly study visit, we provided pregnancy prevention counselling and performed pregnancy testing. Study product was withheld on pregnancy diagnosis, but women continued with monthly follow-up. Results Contraceptive usage was high throughout the study with 100% uptake at baseline and 94.71% use after a mean of 18 months follow-up at exit. Injectable progestins, particularly medroxyprogesterone acetate, remained the preferred choice of contraceptive. After 30 months of follow-up, 54 pregnancies were reported out of 889 participants, giving a pregnancy incidence rate of 3.95 per 100 woman-years (95% CI: 2.96 to 5.17). Of all pregnancies, 2/3 (64.81%) resulted in a full-term live birth, while 18.52% and 11.11% pregnancies culminated as miscarriage and terminated pregnancies, respectively. There were no congenital anomalies in the early neonatal period. Pregnancies resulted in 1.56% of woman-years of study follow-up lost due to temporary product withdrawal. Conclusion The CAPRISA 004 contraceptive curriculum was an effective strategy for maintaining low pregnancy rates, thereby minimizing product withdrawal and loss of follow-up time.
Sibeko, Sengeziwe; Baxter, Cheryl; Yende, Nonhlanhla; Karim, Quarraisha Abdool; Karim, Salim S Abdool
The Islamic Republic of Iran pursued a frankly pronatalist policy during the first decade of her life. The result was a tremendous rise in fertility and the population rose at an a nnual rate of 3.9 percent between 1976-1986. Partly in response to this rapid growth, the government adopted an anti-natalist policy and the long suspended national family planning program
A. H. Mehryar; B. Delavar; G. A. Farjadi; M. Hosseini-Chavoshi; M. Naghavi; M. Tabibian
BACKGROUND: Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies. METHODS: This is a cross-sectional descriptive study based a nationally representative sample
Eugene J Kongnyuy; Varda Soskolne; Bella Adler
Oral contraceptives containing a high dose of oestrogen reduce the sebum excretion rate (SER) and improve acne vulgaris, but more progestogenic preparations may exacerbate acne. The effect on the SER of several oral contraceptives with varying progestogenic potencies was studied in 81 women. The predominantly progestogenic pills (Eugynon 30, Gynovlar) produced no significant change in SER, whereas the rate in women taking a more oestrogenic pill (Minovlar) was significantly reduced compared with the rate in controls. Progestogens therefore do not exacerbate acne by inducing seborrhoea, but in the doses we studied they nullified the inhibitory effect of oestrogens on the sebaceous glands. Acne-prone women who require an oral contraceptive should be given a predominantly oestrogenic preparation.
Pye, R J; Meyrick, G; Pye, M J; Burton, J L
We determined the knowledge of, attitude to and practice of contraception and the associated sociodemographic factors among a representative sample 1130 Qatari married women aged 18-49 years. Data were collected by questionnaire. The mean age of the women was 32.5 (SD 7.6) years. The vast majority (94.6%) knew about contraception but of these 1070, only 694 (64.9%) were in favour of contraception. Knowledge of contraception increased with increasing level of education (P < 0.001), but decreased the lower the household income (P = 0.002). Only 511 (47.8%) women were currently using contraceptives, which was significantly associated with age, husband's age, years of marriage, education level, income level and attitude to family planning. The most commonly known and used contraceptives were intrauterine device and pills. Friends were the most common source of knowledge about family planning method (80.0%). PMID:21735796
Arbab, A A; Bener, A; Abdulmalik, M
Background Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies. Methods This is a cross-sectional descriptive study based a nationally representative sample of 4486 sexually active women aged 15–49 years who participated in the 2004 Cameroon Demographic and Health Survey. Results The overall HIV prevalence was 7.4% (332/4486). The HIV prevalence was higher in the 25–35 year age group (10.03%), urban residents (9.39%), and formerly married (18.48%), compared to their compatriots. The prevalence was lower in women with five or more living child (3.67%), women in the low wealth index category (3.79%) and women who had no formal education (3.37%). The HIV prevalence was higher among women who had two or more partners in the last 12 months (10.26%) and women who reported to have had four or more partners in their lifetime (12.40%). The prevalence of HIV was higher among current hormonal contraceptive users (6.63%) compared to the current non-users (3.06%), among ever users of hormonal contraception (13.27%) compared to the never users (7.11%). Conclusion We conclude that the prevalence of HIV among sexually active women in Cameroon varies according to sociodemographic characteristics, sexual behaviour and hormonal contraceptive use. Our findings underscore the need to counsel women using hormonal contraception to be aware that hormonal methods do not protect against HIV infection. Given the biologic plausibility of the link between hormonal contraception and HIV infection, future research should focus on carefully designed prospective studies to establish the temporal relationship and estimate the incidence of HIV infection among women using and not using hormonal contraceptive methods.
Kongnyuy, Eugene J; Soskolne, Varda; Adler, Bella
Objective. To describe the prevalence and correlates of dual-contraceptive methods use (condoms and an effective pregnancy prevention method) and barriers to their use among married persons living with HIV (PLHIV) in India. Methods. We conducted a quantitative survey (93 men, 97 women), 25 in-depth interviews, seven focus groups, and five key informant interviews. Results. Prevalence of dual- contraceptive method use increased from 5% before HIV diagnosis to 23% after diagnosis (P?0.001). Condoms were the most common contraceptive method, with prevalence increasing from 13% before diagnosis to 92% after diagnosis (P?0.001). Barriers to using noncondom contraceptives were lack of discussion about noncondom contraceptives by health care providers, lack of acceptability of noncondom contraceptives among PLHIV, and lack of involvement of husbands in family planning counseling. Conclusion. There is a need for interventions, including training of health care providers, to increase dual-contraceptive methods use among married PLHIV.
Chakrapani, Venkatesan; Kershaw, Trace; Shunmugam, Murali; Newman, Peter A.; Cornman, Deborah H.; Dubrow, Robert
A household survey conducted in the Albany Health Region in New York State in 1974 revealed that the use of contraception by married women was very similar to that found in a national survey in 1973. In both surveys the majority of married women were currently using a contraceptive method, and most were using the most effective methods. Results of the Albany Health Region survey show that women residing in lower socioeconomic areas, women with less education, and Catholic women were less likely to be using any method. Despite these differences, the majority of women in all these groups were practicing contraception. Private physicians were found to be the most important source of contraceptive methods. Overall, contraceptive protection could be increased by providing services to those women not currently using contraception who are unable to give good reasons for not being protected, and by shifting women using less effective methods toward more effective methods of contraception. The survey was conducted to obtain information on correlates of planned and unplanned fertility, family planning practices, and the sexual experience and contraceptive practice of unmarried women. This report describes the prevalence of use and the source of contraception for married women in the Albany Health Region Survey. The Albany Health Region Family Planning Survey was a household probability sample of all women 15-44 years of age living in the 18-county Albany Health Region area. Interviews were completed for 90% of the sampling of 2291 women. If nonusers are excluded, of all women using contraceptives, 1/3 were using oral contraceptives, 1/4 were contraceptively sterilized or their partners were, 1/8 were condom users, and 1/10 were using IUDS; these 4 methods account for 81% of all users compared with about 83% in 1973 U.S. estimates. Reflecting the greater proportion of Catholics, the rhythm method is used to a greater extent in the Albany Health Region, 9.1 vs. 4.1% of all users. Of the married women who are using contraceptives, 32% are not using the most effective methods - oral contraceptives, IUDs, and sterilization. Lack of access does not appear to be the reason for nonuse, but lack of motivation is apparently important because indifference and nonspecific reasons account for a large number of nonusers. PMID:266124
Anderson, J E; Morris, L; Stroh, G; Conn, J; Gesche, M C
Contraceptive Prevalence Survey: Model Questionnaire (Encuesta de Prevalencia del Uso de Anticonceptivos: Cuestionario Modelo)(Etude de Predominance des Methodes Contraceptives: Questionnaire Modele).
Contraceptive Prevalence Survey (CPS) is an international research program designed to assist developing countries in carrying out periodic surveys of use and knowledge of family planning. This document presents a model questionnaire designed to elicit co...
Background To determine prevalence and incidence of bacterial vaginosis (BV) and risk factors in young sexually-active Australian women. Methods 1093 women aged 16–25 years were recruited from primary-care clinics. Participants completed 3-monthly questionnaires and self-collected vaginal smears 6-monthly for 12-months. The primary endpoint was a Nugent Score?=?7–10 (BV) and the secondary endpoint was a NS?=?4–10 (abnormal flora [AF]). BV and AF prevalence estimates and 95% confidence intervals (95%CI) were derived, and adjusted odds ratios (AOR) calculated to explore epidemiological associations with prevalent BV and AF. Proportional-hazards regression models were used to examine factors associated with incident BV and AF. Results At baseline 129 women had BV [11.8% (95%CI: 9.4–14.2)] and 188 AF (17.2%; 15.1–19.5). Prevalent BV was associated with having a recent female partner [AOR?=?2.1; 1.0–4.4] and lack of tertiary-education [AOR?=?1.9; 1.2–3.0]; use of an oestrogen-containing contraceptive (OCC) was associated with reduced risk [AOR?=?0.6; 0.4–0.9]. Prevalent AF was associated with the same factors, and additionally with >5 male partners (MSP) in 12-months [AOR?=?1.8; 1.2–2.5)], and detection of C.trachomatis or M.genitalium [AOR?=?2.1; 1.0–4.5]. There were 82 cases of incident BV (9.4%;7.7–11.7/100 person-years) and 129 with incident AF (14.8%; 12.5–17.6/100 person-years). Incident BV and AF were associated with a new MSP [adjusted rate ratio (ARR)?=?1.5; 1.1–2.2 and ARR?=?1.5; 1.1–2.0], respectively. OCC-use was associated with reduced risk of incident AF [ARR?=?0.7; 0.5–1.0]. Conclusion This paper presents BV and AF prevalence and incidence estimates from a large prospective cohort of young Australian women predominantly recruited from primary-care clinics. These data support the concept that sexual activity is strongly associated with the development of BV and AF and that use of an OCC is associated with reduced risk.
Fairley, Christopher K.; Chen, Marcus Y.; Tabrizi, Sepehr N.; Donovan, Basil; Kaldor, John M.; McNamee, Kathryn; Urban, Eve; Walker, Sandra; Currie, Marian; Birden, Hudson; Bowden, Francis; Garland, Suzanne; Pirotta, Marie; Gurrin, Lyle; Hocking, Jane S.
Despite worldwide fertility declines, global population continues to grow. Most of the decline in fertility is due to contraceptive use, accounting for 80% of the variance in the total fertility rate between countries. Yet, some countries have much higher or lower fertility levels than countries with the same contraceptive prevalence levels, indicating that other factors also influence fertility rates. These factors are generally cultural. Africa is the only area where contraceptive prevalence is still low in most countries (e.g., 13% for Sub-Saharan Africa vs. 57% for Latin America). Use of individual contraceptive methods varies from country to country. For example, most contraceptive users in Japan use the condom, while those in India depend on female sterilization (about 75% and 75%, respectively). Between the late 1970s and the late 1980s, contraceptive prevalence increased 1 percentage point annually in 64% of all countries. In those developing countries where contraceptive prevalence rates have approached those of developed countries (e.g., Columbia and Thailand), the growth in contraceptive use is slowing. Important determinants of contraceptive use include rural/urban residence, education level, and income per capita. The difference in use rates between rural and urban areas are largely due to availability of family planning services in urban areas. Since contraceptive use plays such a significant role in fertility reduction and the slowing of population growth, improved contraception is needed worldwide, regardless of socioeconomic class. Desires of the population and not those of the scientists should be considered when developing new contraceptives. An analysis of users' needs should be done before developing new contraceptives. Such an analysis would require social and behavioral research. The approach of listening to the needs and beliefs of users should result in an increase of contraceptive use, which will benefit everyone. PMID:8006132
Progestogen-only contraceptive implants are highly effective. In most studies, 5-year cumulative pregnancy rates are less than 1.5/100 women for Norplant and Norplant II. No study has yet reported any failures with Implanon. Weight over 70 kg and age at insertion under 25 years both increase the failure rate of Norplant and Norplant II; however, data are as yet lacking for Implanon. The effectiveness of other progestogen-only implants for which there are as yet few data are unlikely to be any different. Continuation rates are high compared with other hormonal methods and with the intrauterine device. In most cohorts at least 35% of women, and often many more, are still using Norplant by the end of 5 years. Rates vary according to a number of factors, including population studied, age, and parity. Menstrual disturbance is by far the most common reason for discontinuation, with headache, acne, weight gain, and desire for pregnancy accounting for other common reasons for implant removal. Fertility returns rapidly following implant removal, and pregnancy rates (76-100% 1 year after removal) are usually no different from those following discontinuation of any other contraceptive method. There is no increase in the risk of ectopic pregnancy, fetal malformation, or impaired infant health in pregnancies conceived either during implant use or after removal. PMID:11861053
The prevalence of gallstone disease and associated factors in the entire population of subjects aged 15–65 years born and resident in Chianciano Terme (Siena — Tuscany) was examined in the years 1985 and 1986. The investigation included gallbladder ultrasonography, administration of a questionnaire on personal and family history, physical examination and blood chemistry. A total of 1809 subjects (attendance rate
Michele A. Dilengite; Mara Bozzoli; Francesca Carubbi; Roberto Messora; Romano Sassatelli; Marco Bertolotti; Auro Tampieri; Pier Luigi Tartoni; Mariateresa Cassinadri; Mario Delia Ciana; Maurizio Contemori; Nicola Save; Bruno Sordi; ulio Alimenti; brizio Fabrizi; gelo Buciuni; Nicola Carulli
Although women with serious mental illness have high rates of lifetime sexual partners, they infrequently use contraception. Consequently, the prevalence of sexually transmitted infections is high in this population. In addition, while the overall rate of pregnancy in women with schizophrenia of child-bearing age is lower than in the general population, the percentage of pregnancies that are unwanted is higher than that in the general population. The objective of this paper is to help clinicians explore knowledge of appropriate methods of contraception for women who suffer from schizophrenia. The authors reviewed recent literature on the use of contraceptive methods by women with schizophrenia treated with antipsychotic and adjunctive medications. Contraceptive counseling to women and their partners is an important part of comprehensive care for women with serious and persistent mental illness. Women with schizophrenia who smoke, are overweight, or have diabetes, migraine, cardiovascular disease, or a family history of breast cancer should be offered non-hormonal contraception. Women with more than one sexual partner should be advised on barrier methods in addition to any other contraceptive measures they are using. Clinicians should be alert for potential interactions among oral hormonal contraceptives, smoking, and therapeutic drugs. Long-lasting contraceptive methods, such as intrauterine devices, progesterone depot injections, or tubal ligation are reasonable options for women having no wish to further expand their families. PMID:21775827
Seeman, Mary V; Ross, Ruth
Orthorectic eating behaviour is characterised by a fixation on a healthy diet and rigidity regarding self-imposed nutrition standards. Besides malnutrition, subjective distress and social isolation might be consequences of clinical relevance. So far there are few reliable data about nosology and prevalence rates, so that it is not yet possible to evaluate the clinical significance of orthorectic eating behaviour. This article discusses nosological classifications of orthorexia and presents prevalence rates of extremely healthy eating behaviour in general population as well as in several specific subgroups. To summarise, orthorectic eating behaviour seems to be most likely an eating disorder with healthy dieting as an overvalued idea. Data on prevelance of orthorectic eating behaviour, assessed with the recently developed Düsseldorfer Orthorexie Skala, suggest a rate of 1 to 2% in general population. PMID:22700108
Barthels, Friederike; Pietrowsky, Reinhard
Modern contraceptive methods represent more than a technical advance: they are the instrument of a true social revolution-the "first reproductive revolution" in the history of humanity, an achievement of the second part of the 20th century, when modern, effective methods became available. Today a great diversity of techniques have been made available and-thanks to them, fertility rates have decreased from 5.1 in 1950 to 3.7 in 1990. As a consequence, the growth of human population that had more than tripled, from 1.8 to more than 6 billion in just one century, is today being brought under control. At the turn of the millennium, all over the world, more than 600 million married women are using contraception, with nearly 500 million in developing countries. Among married women, contraceptive use rose in all but two developing countries surveyed more than once since 1990. Among unmarried, sexually active women, it grew in 21 of 25 countries recently surveyed. Hormonal contraception, the best known method, first made available as a daily pill, can today be administered through seven different routes: intramuscularly, intranasally, intrauterus, intravaginally, orally, subcutaneously, and transdermally. In the field of oral contraception, new strategies include further dose reduction, the synthesis of new active molecules, and new administration schedules. A new minipill (progestin-only preparation) containing desogestrel has been recently marketed in a number of countries and is capable of consistently inhibiting ovulation in most women. New contraceptive rings to be inserted in the vagina offer a novel approach by providing a sustained release of steroids and low failure rates. The transdermal route for delivering contraceptive steroids is now established via a contraceptive patch, a spray, or a gel. The intramuscular route has also seen new products with the marketing of improved monthly injectable preparations containing an estrogen and a progestin. After the first device capable of delivering progesterone directly into the uterus was withdrawn, a new system releasing locally 20 microg evonorgestrel is today marketed in a majority of countries with excellent contraceptive and therapeutic performance. Finally, several subcutaneously implanted systems have been developed: contraceptive "rods," where the polymeric matrix is mixed with the steroid and "capsules" made of a hollow polymer tube filled with free steroid crystals. New advances have also been made in nonhormonal intrauterine contraception with the development of "frameless" devices. The HIV/AIDS pandemic forced policy makers to look for ways to protect young people from sexually transmitted diseases as well as from untimely pregnancies. This led to the development of the so-called dual protection method, involving the use of a physical barrier (condom) as well as that of a second, highly effective contraceptive method. More complex is the situation with antifertility vaccines, still at a preliminary stage of development and unlikely to be in widespread use for years to come. Last, but not least, work is in progress to provide effective emergency contraception after an unprotected intercourse. Very promising in this area is the use of selective progesterone receptor modulators (antiprogestins). PMID:17308130
Benagiano, Giuseppe; Bastianelli, Carlo; Farris, Manuela
Based on our interview survey of 574 randomly selected married women from a rural population in the South Ghor district, Jordan, where traditional Arab customs have been persistently maintained, in this paper we analyze the age-specific marital fertility rates (ASMFRs) and contraceptive practices, especially the prevalence and duration of contraceptive use. The ASMFRs fitted the natural fertility pattern proposed by
Shuju Sueyoshi; Ryutaro Ohtsuka
Based on our interview survey of 574 randomly selected mar- ried women from a rural population in the South Ghor district, Jordan, where traditional Arab customs have been persistently maintained, in this paper we analyze the age-speciÞc marital fertility rates (ASMFRs) and contraceptive practices, especially the prevalence and duration of contraceptive use. The ASMFRs Þtted the natural fertility pattern proposed
Shuji Sueyoshi; Ryutaro Ohtsuka
Afghanistan has one of the highest maternal mortality ratios and lowest contraceptive prevalence rates globally. Limited information is known regarding Afghan men and women's attitudes toward childbearing, child spacing, and contraceptive use, which is essential for delivery of appropriate services. We conducted a qualitative study among postpartum couples enrolled at maternity hospitals in Kabul, Afghanistan. We identified important themes that
Sadia Haider; Catherine Todd; Malalay Ahmadzai; Shakira Rahimi; Pashtoon Azfar; Jessica L. Morris; Suellen Miller
Although short-acting reversible hormonal contraceptives, such as oral contraceptives and the contraceptive patch and vaginal ring, remain the most commonly used contraceptive methods in the United States, they are also associated with the highest failure rates. Long-acting reversible contraception (LARC) methods, such as intrauterine devices and contraceptive implants, offer high continuation rates and very low failure rates, and are safe for use in most women. The provision of LARC methods to adolescent, young adult and nulliparous women is a relatively new concept that offers an innovative option for these populations. PMID:24138662
Peck, Susan A
Despite the safety and effectiveness of low oestrogen-dose oral contraceptives (OC) and postmenopausal hormone replacement there is poor continuity of use of these agents by women. Patterns of use and the reasons affecting different frequencies of use in different countries are presented. Continuity and discontinuation rates are difficult to assess accurately but it is believed that the main reasons why women discontinue use of these agents are concerns about their perceived health risks and the presence of, or fear of, adverse clinical effects, particularly unscheduled uterine bleeding and weight gain. More information is needed about OC continuation rates in order to improve the acceptability of these safe, effective agents. Most women discontinue use of postmenopausal hormonal replacement within 2 years of initiating the therapy. Reasons include disappearance of symptoms of oestrogen deficiency, lack of awareness of health benefits of oestrogen, presence of side-effects (such as breast tenderness and weight gain), presence of uterine bleeding and increasing age. Suggestions to increase continuation of OC include extensive individual pretreatment counselling with a different emphasis in different age groups, education at the time of follow-up visits and telephone calls, and extensive use of educational aids such as brochures, pamphlets and audio tapes, and improvement of pharmaceutical packaging information. In conclusion there is an urgent need to assess the value of these strategies by long-term large controlled studies. PMID:10920118
When given in a dose of 150 mg every 12 weeks, depot medroxyprogesterone acetate (DMPA) is highly effective contraceptive agent. DMPA has a pregnancy rate of 0.5/1000 woman-years of use, no life-threatening side effects, and no permanent effect on fertility. Other advantages include DMPA's lack of interference with lactation, reductions in the incidence of pelvic inflammatory disease and vaginal candidiasis, elimination of premenstrual syndrome, relief of dysmenorrhea and menorrhagia, and a reduction in homozygous sickle cell disease crises. Although DMPA has minor effects on carbohydrate metabolism, there are no significant changes in lipid metabolism, fluid/nitrogen balance, blood pressure, blood coagulation, or fibrinolysis. DMPA's disadvantages include delays in return of fertility (up to 1 year from the date of the last injection), weight gain due to increased appetite, and menstrual irregularities. Over 50% of longterm DMPA users develop amenorrhea by the end of the 1st year of use and a smaller proportion experience excessive and/or prolonged bleeding, especially in the postpartum period. Women who express an interest in injectable contraception should be informed about these side effects and be allowed time to ask questions. In general, DMPA acceptors in the UK are no longer principally women who have severe social problems, difficulties in controlling their fertility, and an inability to follow an oral contraceptive regimen. This method is increasingly being selected by career women who want effective contraception and are not bothered by the side effect of amenorrhea. PMID:2975377
PURPOSE. To determine the prevalence rates of myopia, hyper- opia, astigmatism, and anisometropia in a prevalence survey of adults in Sumatra, Indonesia. METHODS. A population-based prevalence survey of 1043 adults 21 or more years of age was conducted in five rural villages and one provincial town of the Riau Province, Sumatra, Indonesia. A one-stage household cluster sampling procedure was used
Seang-Mei Saw; Gus Gazzard; David Koh; Mohamed Farook; Daniel Widjaja; Jeanette Lee; Donald T. H. Tan
Sexual health for adolescents is based on three components: recognizing sexual rights, sexuality education and counseling, and confidential, high quality services. Contraception needs to include prevention of both STIs and pregnancies. The main options for adolescents are condoms, backed up by emergency contraception, and oral contraceptives in a longer, mutually monogamous relationship. Condoms and hormonal contraception together can be well
Dan Apter; Raisa Cacciatore; Elina Hermanson
Social marketers have certainly shown that the CSM discipline can quickly and cost-effectively harness commercial resources to increase contraceptive prevalence. But why hasn't the social marketing idea caught on in more countries? According to Social Marketing Forum, only a tiny number of countries have active programs after more than a decade of effort. The most likely reason for this lack of success is doubt and fear on the part of both developing countries' officials and donor agencies about allowing marketing enthusiasts--with our very noticeable advertising methods--to join the family planning fight. And what has our answer been? Usually, a head-on retort such as, "But look at all the condoms we've sold]" And that gets us nowhere, because the successful peddling of 1 not-so-impressive method doesn't begin to balance the fears of a possible backlash that brash condom promotions could bring down on official heads. The lesson we should be learning is that social marketers possess to narrow an outlook and promote a small range of products that don't enthuse decisionmakers. Hence, we are often perceived as condom salesmen--and not much more. What should we be doing? We should be selling the idea of using private sector experience to assist national development. That means social development, particularly improved health, family planning and women's education. These 3 activities have proven effective in reducing fertility and would add up to a marketing opportunity--a longterm challenge that should enthuse dicisionmakers, private sector entrepreneurs and donor agencies alike. Further, our model--the commercial sector--is renowned for branching out and secceeding in a broad range of endeavors. As an example, Procter and Gamble uses separate divisions to market different products. Initiatives already exist in many countries to harness the private sector as a development tool. Social marketers should be leading the initiative--and benefitting from it, too. PMID:12266330
Objective To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives. Design A longitudinal national population-based registry study. Setting The Swedish prescribed drug register. Participants All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226?211). Main outcome measures A tendency to switch the type of hormonal contraceptive within 6?months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians’ and midwives’ prescription patterns concerning the women's continuation rates of oral hormonal contraceptive type. Results In Sweden, there were 782?375 women born between 1977 and 1994 at the time of the study. Of these, 226?211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6?months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6?months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories. Conclusions Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6?months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.
Josefsson, Ann; Wirehn, Ann-Britt; Lindberg, Malou; Foldemo, Anniqa; Brynhildsen, Jan
This study was undertaken to establish the prevalence rates at birth of the skeletal dysplasias that can be recognised in the perinatal period. Using the data base of the Latin-American Collaborative Study of Congenital Malformations (ECLAMC), for the years 1978 to 1983, on 349 470 births (live and stillbirths), a crude prevalence rate of 2.3\\/10 000 was observed. However, several
I M Orioli; E E Castilla; J G Barbosa-Neto
High parity, early age at first full-term pregnancy (FTP), and long-term oral contraceptive (OC) use increase cervical cancer risk, but it is unclear whether these variables are also associated with increased risk of acquisition and persistence of human papillomavirus (HPV) infection, the main cause of cervical cancer. Information on reproductive and menstrual characteristics and OC use were collected from 14
Salvatore Vaccarella; Rolando Herrero; Min Dai; Peter J. F. Snijders; Chris J. L. M. Meijer; Jaiye O. Thomas; Pham Thi; Hoang Anh; Catterina Ferreccio; Elena Matos; Hector Posso; Silvia de Sanjose; Hai-Rim Shin; Sukhon Sukvirach; Eduardo Lazcano-Ponce; Guglielmo Ronco; Raj Rajkumar; You-Lin Qiao; Nubia Muno; Silvia Franceschi
Activated protein C resistance caused by factor V Leiden mutation is the most common inherited cause of an underlying predisposition to pulmonary embolism (PE) and deep venous thrombosis (DVT). We studied the frequency of the factor V Leiden mutation in 50 women who had PE and\\/or DVT during or after pregnancy or during oral contraceptive use. Ten (20%; 95% Cl
Denise R. Hirsch; Katriina M. Mikkola; Peter W. Marks; Edward A. Fox; David M. Dorfman; Bruce M. Ewenstein; Samuel Z. Goldhaber
|This report provides an overview of research activities and needs in the area of contraceptive development. In a review of the present state, discussions are offered on the effectiveness and drawbacks of oral contraceptives, intrauterine devices, barrier methods, natural family planning, and sterilization. Methods of contraception that are in the…
Troen, Philip; And Others
The measured success of family planning policy in the developing world rests on increases in the ‘modern’ methods of contraception. By extension, ‘traditional’ methods of contraception are equated with traditional mentalities and insufficient motivation to control fertility. But contraceptive use differentials in India suggest that in fact it is the most ‘modern’ women (those with a college education and living
Alaka Malwade Basu
The city of Dundee has the highest teen pregnancy and abortion rate in Scotland. In the heart of the city, The Corner is a health and information drop-in center for people aged 12-25 years which has provided a range of health promotion activities, contraception services, and general information and advice since April 1996. 8000 inquiries were posed from young people in Dundee and the surrounding areas in The Corner's first full year of operation, one-third on sexual health. A survey conducted last December found that 55% of the center's clients were aged 12-15. Young people helped to design the center, creating a cafe atmosphere in the main drop-in area with tables, chairs, and loungers. Reference literature is on display, music plays, and a series of computers is linked to health information databases. In this environment, clients can hang out, ask questions, and receive condoms or other contraceptive services without the embarrassment of attending a local family planning clinic. The examination and counseling rooms are also relaxed and warmly-appointed. The Corner has also offered emergency contraception since January, one of the few places in Scotland where nurses can provide it. While The Corner has received some local criticism, it is operating within the laws and codes of professional practices. The center is jointly funded by Tayside Health Board, Dundee City Council, and the Scottish Office. Finally, the center has a travel program which offers a package of activities based upon a different foreign country each week. PMID:9326014
Objective High rates of mental disorders have been reported for prison populations worldwide, particularly in low- and middle-income countries (LMICs). The present study aimed to establish prevalence rates of mental disorders in Chilean prisoners. Method A nationwide random sample of 1008 prisoners was assessed in 7 penal institutions throughout Chile. Twelve-month prevalence rates were established using the Composite International Diagnostic Interview (CIDI) and compared to the prevalence rates previously published for the general population. Results Prevalence rates were 12.2% (95% CI, 10.2-14.1) for any substance use disorder, 8.3% (6.6-10.0) for anxiety disorders, 8.1% (6.5-9.8) for affective disorders, 5.7% (4.4-7.1) for intermittent explosive disorders, 2.2% (1.4-3.2) for ADHD of the adult, and 0.8% (0.3-1.3) for non-affective psychoses. Significantly higher prevalence rates among prisoners as compared to the general population in Chile were seen for major depression (6.1% vs. 3.7% males, Z=2.58, p<0.05) and illicit drug use (3.3% vs. 0.6% males with drug abuse, Z=2.04, p<0.05; 2.6% vs. 0.1% females with drug abuse, Z=5.36, p<0.001; 3.4% vs. 1.1% males with drug dependence, Z=3.70; p<0.001). Dysthymia (6.5% vs. 15.6%, Z=-2.39, p<0.05), simple (3.3% vs. 11.5%, Z=-3.13, p<0.001) and social phobias (3.9% vs. 9.7%, Z=2.38, p<0.05) were significantly less frequent in the female prison population than in the general population. One-year prevalence rates of alcohol abuse (2.3% vs. 3.9%; Z=-2.04; p<0.05) and dependence (2.7% vs. 8.2%; Z=-5.24; p<0.001) were less prevalent in the male prison population than in the general population. Conclusions Service provision for prison populations in Chile should acknowledge high rates of depression and illicit drug use. Overall prevalence rates are lower than reported in other LMICs. Previous research in prison populations in LMICs might have overestimated prevalence rates of mental disorders.
Mundt, Adrian P.; Alvarado, Ruben; Fritsch, Rosemarie; Poblete, Catalina; Villagra, Carolina; Kastner, Sinja; Priebe, Stefan
Obesity is a major public health concern affecting an increasing proportion of reproductive-aged women. Avoiding unintended pregnancy is of major importance, given the increased risks associated with pregnancy, but obesity may affect the efficacy of hormonal contraceptives by altering how these drugs are absorbed, distributed, metabolized or eliminated. Limited data suggest that long-acting, reversible contraceptives maintain excellent efficacy in obese women. Some studies demonstrating altered pharmacokinetic parameters and increased failure rates with combined oral contraceptives, the contraceptive patch and emergency contraceptive pills suggest decreased efficacy of these methods. It is unclear whether bariatric surgery affects hormonal contraceptive efficacy. Obese women should be offered the full range of contraceptive options, with counseling that balances the risks and benefits of each method, including the risk of unintended pregnancy. PMID:24007251
Robinson, Jennifer A; Burke, Anne E
In development for more than 20 years, the first vaginal ring contraceptive (NuvaRing®) was approved by the Food and Drug\\u000a Administration in 2001 and marketed in 2002. Like oral contraceptive (OC) pills, the ring is safe, effective, and rapidly\\u000a reversible (1). It offers the lowest estrogen dose of any estrogenprogestin contraceptive product marketed in the United States. It is\\u000a worn
Susan A. Ballagh
|Objective: To compare college students' perceived disease risk with disease prevalence rates. Methods: Data were analyzed from 625 college students collected with an Internet-based survey. Paired t-tests were used to separately compare participants' perceived 10-year and lifetime disease risk for 4 diseases: heart disease, cancer, diabetes, and…
Smith, Matthew Lee; Dickerson, Justin B.; Sosa, Erica T.; McKyer, E. Lisako J.; Ory, Marcia G.
BACKGROUND. More widespread use of emergency contraception could help to reduce the number of unwanted pregnancies. AIM. The objective of this study was to assess women's knowledge of emergency contraception. METHOD. A questionnaire was distributed to 1290 women aged between 16 and 50 years attending 14 general practice surgeries in London over a two-week period in 1990. RESULTS. The response rate was 70%. Over three quarters of the women had heard of emergency contraception; these were mainly women who used contraception, who had higher educational qualifications or who were not Muslim. Women who were the most likely to need and to use emergency contraception--those using barrier methods--had no more accurate knowledge than women using any other method of contraception. Only 53% of barrier method users knew emergency contraception could be used as a backup when other methods failed. Only one fifth of women had heard about this method from their general practitioner or any other health professional, while half had obtained their information from the media. CONCLUSION. These results suggest that including information on emergency contraception in consultations with users of barrier methods of contraception is a small step which general practitioners and practice nurses could take to increase the use of emergency contraception.
George, J; Turner, J; Cooke, E; Hennessy, E; Savage, W; Julian, P; Cochrane, R
This article describes the urgent need for modern family planning (FP) services and supplies in the Soviet Union, and presents the nation's high induced abortion rate as one of its most serious medical and social problems. With more than 6 million legal abortions per year, and another estimated 6 million performed illegally, the problem of induced abortion is placed on par with heart disease and cancer in the Soviet Union. Induced abortion is the primary method of birth control, responsible for terminating 2 out of 3 pregnancies. Many abortion seekers, especially those employing illegal services, suffer complications resulting in loss of ability to work or even death. The maternal mortality rate for 1988 was 43.0/10,000. Efforts to decrease the level of abortion have increased during reconstruction, and have been witness to a decline in the number of abortions by 866,000 over the period 1985-1988. Contributory factors behind this decline, as well as the decrease of the abortion ratio, are an increased contraceptive prevalence level totalling 13.7% of reproductive-age women, stabilization of the birth rate at a low level, a smaller proportion of reproductive-age women in the population, and rate reporting changes. Nonetheless, inadequate family planning services prevail in the Soviet Union. Instead of focusing upon abortion and contraception, services focus upon diagnosing and treating infertility, and offer neither FP information nor services for premarital youths. Moreover, contraceptive supplies suffer serious, ongoing shortages. Research is needed on the social, demographic, medical, and biological aspects of reproductive behavior in the Soviet Union. Regional differences, abortion law, public opinion on illegitimate pregnancy, abortion methods, health personnel training, and maternal and child health are also discussed. PMID:12284299
Khomassuridze, A G
Of 261 women who completed a self-rating scale for measuring depression, 168 were taking oral contraceptives and 93 were using physical methods of contraception. Of the group of women taking oral contraceptives 6·6% were more severely depressed than any of the control group. There was a significant variation in the depth of depression related to the day of the menstrual cycle in the control group. This association was not found in the oral contraceptive group, where premenstrual depression was limited to the one or two days preceding menstruation. Women taking a contraceptive containing lynoestrenol 2·5 mg. and mestranol 0·075 mg. showed a significantly increased incidence of pessimism, feelings of dissatisfaction, crying, and tension, compared with women taking other oral contraceptives and the control group.
Herzberg, Brenda N.; Johnson, Anthony L.; Brown, Susannah
Despite the availability of effective contraceptive methods, unintended pregnancy continues to be a significant health problem for women throughout the world. The reasons for unplanned pregnancy include failure to use contraception, incorrect use of contraception, unplanned consensual intercourse, and rape. Emergency contraception was once heralded as a means of reducing the rates of unintended pregnancy, elective abortion, and unwanted childbirth. But more than three decades after the first oral form was introduced, the use of emergency contraception remains suboptimal-even in the United States, where it is available to most women of childbearing age without a prescription. Nurses can help narrow this clinical gap in women's health care by increasing awareness of emergency contraception, correcting common misconceptions about its mechanism of action and potential adverse effects, and facilitating patient access. PMID:22421320
Devine, Kit S
The objective of research in contraceptive evaluation is to improve the ability of individuals to choose contraceptive methods best suited to their needs and circumstances and to provide information that will lead to the development of safer and more effective methods. There are usually three considerations in judging the importance of a method of…
Hulka, Barbara S.; And Others
Functional necessity to use a particular range of dose rate and total dose of ?-initiated polymerization to manufacture a novel polymeric hydrogel RISUG® (reversible inhibition of sperm under guidance) made of styrene maleic anhydride (SMA) dissolved in dimethyl sulphoxide (DMSO), for its broad biomedical application explores new dimension of research. The present work involves 16 irradiated samples. They were tested by fourier transform infrared spectroscopy, matrix assisted laser desorption/ionization-TOF, field emission scanning electron microscopy, high resolution transmission electron microscopy, etc. to see the interrelation effect of gamma dose rates (8.25, 17.29, 20.01 and 25.00 Gy/min) and four sets of doses (1.8, 2.0, 2.2 and 2.4 kGy) on the molecular weight, molecular weight distribution and porosity analysis of the biopolymeric drug RISUG®. The results of randomized experiment indicated that a range of 18-24 Gy/min ?-dose rate and 2.0-2.4 kGy ?-total doses is suitable for the desirable in vivo performance of the contraceptive copolymer.
Jha, Pradeep K.; Jha, Rakhi; Gupta, B. L.; Guha, Sujoy K.
The Equity in Prescription Insurance and Contraceptive Coverage Act, introduced in Congress in 1997 and still unpassed, seeks to redress health insurers’ failure to pay for birth control as they pay for other prescription drugs, most paradoxically Viagra. In 1936 the International Workers Order (IWO), a fraternal society, became the first insurer to include contraception in its benefits package. A forerunner in the movement for prepaid medical care, the IWO offered its members primary care and contraceptive services for annual flat fees. Founded at a time when the legal status of contraception was in flux, the IWO’s Birth Control Center was the only such clinic to operate on an insurance system. Recent state laws and judicial actions have revived the IWO’s groundbreaking view of contraception as a basic preventive service deserving of insurance coverage.
Contraceptive failure is the primary cause of unintended pregnancy in the United States. With obesity rates at epidemic proportions, any association between obesity and strategies that prevent undesired pregnancies constitutes a significant public health and economic concern. Unfortunately, the relationship between obesity and contraception has not been extensively studied. Evidence from several epidemiological studies suggests that obesity may increase failure
The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided. PMID:22200252
Goyal, Vinita; Borrero, Sonya; Schwarz, Eleanor Bimla
Objective: To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. Options: The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. Outcomes: Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. Evidence: Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. Values: The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). Benefits, Harms, and Costs: These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. Sponsor: The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C). PMID:22971457
Dunn, Sheila; Guilbert, Edith
Objective To determine lifetime prevalence rates of sleep paralysis. Data Sources Keyword term searches using “sleep paralysis”, “isolated sleep paralysis”, or “parasomnia not otherwise specified” were conducted using MEDLINE (1950-present) and PsychINFO (1872-present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles. Study Selection Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected. Data Extraction Weighted percentages were calculated for each study and, when possible, for each reported subsample. Data Synthesis Aggregating across studies (total N = 36533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians. Conclusions Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions.
Barber, Jacques P.
Like many Communist or post-Communist nations, Russia has one of the highest abortion rates in the world. These rates have created a legacy of significant medical problems. Complications from abortion are the cause of more than one in four maternal deaths...
Currently, college students live in a social environment where contraceptive technology is highly effective, contraceptive information and methods are widely available, and premarital sexual activity is generally condoned. Paradoxically, data indicate that these students are poor contraceptive users, and that pregnancy and abortion rates among college students are surprisingly high. Since these social conditions should result in adequate contraceptive usage,
Kathryn Dohrmann Rindskopf
Unwanted pregnancy may have serious negative effects upon the health and well-being of individuals and families. The use of effective contraception is therefore important. Efficacy, however, is not the only factor considered by clients when choosing a contraceptive method, so counsellors and service providers should not promote methods on the sole basis of their efficacy, irrespective of client preference. With regard to method efficacy, important considerations which may affect the choice of a method are the availability of emergency contraception and access to safe abortion services in the event of method failure. Biological factors such as age, parity, and whether a woman is breast feeding may affect contraceptive efficacy and should be a consideration when choosing a method. Contraceptive efficacy is usually measured in terms of failure rates calculated from the number of pregnancies which occur during a specified period of contraceptive use. Method failure is that attributable to the method, while user failure is that attributable to incorrect use of the method in addition to method failure. The failure rates for specific methods of contraception reported in the literature vary, sometimes substantially. The article briefly considers the measurement of efficacy and human factors affecting contraceptive efficacy with regard to clients, providers, and managers. PMID:12319092
Background The reports of a rise in contraceptive practices have not been matched by a similar decrease in population: therefore, there is a need to look into the causes of this discrepancy. The objectives of this study were to determine the prevalence of different methods of contraception used by Egyptian women, to compare different contraception methods used among various socio-demographic groups and, finally, to identify the main decision makers of contraception use within Egyptian families. Methods The 2005 Egypt Demographic and Health Survey (EDHS) is a nationally representative household survey of 18134 married women aged 15–49 years. The 2005 EDHS provides a wealth of information on fertility, family planning, maternal and child health and nutrition, and violence against women. The study sample was selected using a multistage sampling technique. A face-to-face structured interview was conducted with each of the selected women. The response rate was 99.5% for completing the questionnaires. Results The prevalence of contraception was 57.5%, nearly one third of the participants (33.1%) used IUD as a method of contraception. Both male and female were responsible for decision making regarding the use of contraception among different educational levels. Most women reporting use of contraceptive methods were 30–39 years old, were employed, were rich, educated and belonged to urban governorates. Conclusion More than half of the participants used contraception while IUDs and pills were the most commonly used methods. Whatever the level of education, the majority of women thought that family planning decisions should be made by both partners.
Awadalla, Hala Ibrahim
Male contraceptive drugs meeting the criteria of efficacy, easy applicability and reversibility -- and also having limited side effects -- are discussed. These drugs affect the hypothalamus, the hypophysis, the ductus deferens, and the testes. Gestagens inhibit the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Gonadotropic hormones inhibit spermatogenesis by producing intratesticular concentration of testosterone. Recently, a combination of gestagen and androgen has been used to avoid decreased libido. Oral medroxyprogesterone acetate and percutaneous testosterone produce azoospermia, but with serious side effects, i.e., hirsutism and acne; however, they can be reduced by iv administration. Cyproterone acetate inhibits androgen secretion, and a daily dosage of 5-10 mg slightly reduces the sperm count; however, higher doses can lead to thromboembolitic effects. Combining cyproterone with an androgen prevents negative effects on the libido. Buserelin administered iv or as a nasal spray stimulates the secretion of LH and FSH from the hypophysis 20-40 times more effectively than does natural LH release of the hormone (LH-RH). Gossypol exerts its inhibitory effect on the epithelium of testes, but can cause hypokalemia. It has been used successfully in a Chinese experiment involving 9000 men who received daily oral doses of 20 mg for 60-70 days. Cytostatic agents also produce azoospermia, but are not recommended. Implantation of a copper wire into the ductus deferens has been tried in animal experiments with mixed results. Vasectomy has been performed on 50 million men since the 1960's (48,000 in 1981 in Denmark). It has to be regarded as a partially irreversible operation. The oral administration of the adrenergic blocking agent, phenoxybenzamine, at the rate of 20 mg per day has produced azoospermia; however, more research is needed to understand its side effects. Finally, chlorohydrin is not usable because of its neurotoxic and nephrotoxic effects. PMID:3775919
Study ObjectiveTo prospectively evaluate the repeat teen pregnancy rates, within one year of delivery, among adolescents who choose the contraceptive patch (Ortho Evra) versus oral contraceptive pills (OCP) versus Depot Medroxyprogesterone Acetate (Depo Provera, DMPA) for postpartum contraception.
Andrea Ries Thurman; Natalie Hammond; Helen E. Brown; Mary Ellen Roddy
Background Pakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society – a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in rural areas of Pakistan. Methodology We used a quasi-experimental study design with controls, selecting one intervention district and one control district from the Sindh and Punjab provinces. In each district, we chose a total of four service providers. A baseline survey was carried out among 4,992 married women of reproductive age (MWRA) in February 2009. Eighteen months after the start of intervention, an independent endline survey was conducted among 4,003 women. We used multilevel logistic regression for analysis using Stata 11. Results Social franchising used alongside free vouchers for long term contraceptive choices significantly increased the awareness of modern contraception. Awareness increased by 5% in the intervention district. Similarly, the ever use of modern contraceptive increased by 28.5%, and the overall contraceptive prevalence rate increased by 19.6%. A significant change (11.1%) was recorded in the uptake of IUCDs, which were being promoted with vouchers. Conclusion Family planning franchise model promotes awareness and uptake of contraceptives. Moreover, supplemented with vouchers, it may enhance the use of IUCDs, which have a significant cost attached. Our research also supports a multi-pronged approach- generating demand through counselling, overcoming financial constraints by offering vouchers, training, accreditation and branding of the service providers, and ensuring uninterrupted contraceptive supplies.
Khurram Azmat, Syed; Tasneem Shaikh, Babar; Hameed, Waqas; Mustafa, Ghulam; Hussain, Wajahat; Asghar, Jamshaid; Ishaque, Muhammad; Ahmed, Aftab; Bilgrami, Mohsina
Based on our interview survey of 574 randomly selected married women from a rural population in the South Ghor district, Jordan, where traditional Arab customs have been persistently maintained, in this paper we analyze the age-specific marital fertility rates (ASMFRs) and contraceptive practices, especially the prevalence and duration of contraceptive use. The ASMFRs fitted the natural fertility pattern proposed by Coale and Trussell's model, and the total fertility rate was estimated to be 7.2. Even though the prevalence rate of modern contraceptive methods has reached 14.3%, because of the recent increase among young women in particular, the users had larger numbers of children than the nonusers and the duration of contraceptive use was short, especially at young ages (e.g., about 90% 24-month discontinuation probabilities in 15-19- and 20-24-year-olds). These ineffective contraceptive uses were related to traditional Arab norms, represented by the pooled proportion of "as many as possible" and "up to God" answers to the ideal number of children (70% of men and 30% of women). PMID:15757242
Sueyoshi, Shuji; Ohtsuka, Ryutaro
Between January 1970 and December 1972 22 women aged between 31 and 45 years were admitted to the coronary care unit with acute myocardial infarction and six of these (27%) had been taking oral contraceptives. There were nine women aged 40 or less and five of them (55%) had been on oral contraceptives while three of the other four had been sterilized by tubal interruption. Both these figures of prevalence of oral contraceptive use are significantly greater than estimates for the general population of women of similar age. For those aged 30-44 years, current estimates suggest that it is between 8 and 11%. All the women in this study had risk factors recognized as being associated with the premature development of ischaemic heart disease, and the prevalence of these risk factors was similar in those taking oral contraceptives as in those not doing so. Oral contraceptives probably enhance the chance of developing myocardial infarction in women whose risk is increased for other reasons.
Radford, Dorothy J.; Oliver, M. F.
Cultures were made from the cervix, rectum, and oropharynx of 2,019 women to determine the prevalence of gonorrhea. For patients of similar race and age, the rates of cervical gonorrhea among users of oral contraceptives (10.6/100) or IUD users (9.5/100) were significantly greater than observed with patients using barrier methods, condom-diaphragm-foam (1.7/100). On the other hand, there were no significant differences in rates of rectal or oral infection by method of contraception. Postpartum patients were found to have similar infection rates at all three sites as a comparable group of nonpuerperas. Recommendations for utilization of barrier methods are made for suitable patients, including those in the immediate puerperium. PMID:1010762
Keith, L; Berer, G S; Moss, W
Contraceptive failure is a major source of unintended pregnancy. This chapter will review sources of data and measurement of contraceptive failure, summarize results from the literature on the risks of contraceptive failure during typical and perfect use for available methods of contraception, provide a tool for communicating risks of contraceptive failure to clients, examine determinants of contraceptive failure, and identify methodological pitfalls in the published literature.
In a private practice an increasing number of young women or girls are being observed with sudden onset of acute stomach pains of unknown origin. Clinically the pancreas is sensitive to pressure and there is an alpha-amylase elevation in the urine often accompanied by moderate leukocytosis. A slight elevation of the transaminase count is usual in such cases. There are no indications of alchohol abuse or pancreatic disorders in the anamnese and x-rays reveal an adequately functionning gall bladder without stones. Without exception all the women have been on oral contraceptives. With spasmolytics and a diet low in fats the symptoms disappear, often without discontinuation of the contraceptive. More data are needed on this problem, and prospective research should determine which additional factors must be present for the activation of such pancreatic disorders. PMID:4684016
Objectives: To estimate the interest in using intrauterine contraception among women seeking emergency contraception or walk-in pregnancy testing. Methods: We surveyed 412 women who requested emergency contraception or pregnancy testing at four family planning clinics in Pittsburgh, PA. The 41-item survey assessed knowledge of, attitudes towards, and interest in using intrauterine contraception (IUD). Data were analyzed using ?2 and Fisher's exact tests and multivariable logistic regression methods. Results: The response rate was 85%. Twelve percent (95% CI 9%-15%) of women surveyed expressed interest in same-day insertion of an IUD and 22% (95% CI 18%-26%) wanted more information about IUDs. Interest in same-day IUD insertion increased with higher education level, prior unwanted pregnancy, and experience with barriers to use of contraception. Conclusion: Same-day IUD insertion may be a reasonable way to increase the use of highly-effective contraception among women seeking emergency contraception or walk-in pregnancy testing.
Schwarz, Eleanor Bimla; Kavanaugh, Megan; Douglas, Erika; Dubowitz, Tamara; Creinin, Mitchell D.
Background There are few published studies on microtia-anotia frequency. Methods Using data from birth defects surveillance programs around the world, we conducted a systematic review on the frequency of microtia-anotia to further explore the differences in prevalence across countries. Ninety-two birth defects surveillance programs were evaluated with a total of 8,917 cases of microtia-anotia. We computed the prevalence per 10,000 births for each surveillance program for total cases of microtia-anotia (microtia types I to IV), microtia (types I to III), and anotia (type IV). Prevalence ratios were calculated by large geographical areas, race/ethnicity, and by surveillance methodologies. Results The overall prevalence were for microtia-anotia 2.06 (CI: 2.02–2.10), for microtia 1.55 (CI: 1.50–1.60), and for anotia 0.36 (CI: 0.34–0.38). Higher prevalence was observed in the Americas, Northern Europe and Asia, among Hispanics and Asians, and among active ascertainment and hospital-based surveillance programs. Conclusions We observed marked variation in the prevalence of microtia-anotia across surveillance programs and within countries. These results must be interpreted cautiously as this variability may be explained mainly by differences in surveillance methods. However, given the magnitude of some of the differences, other factors may also be involved. This study contributes to the knowledge on the prevalence of microtia-anotia by providing a critical analysis of the existing data. In addition, it supports the need for a coding system that allows complete phenotype characterization of microtia-anotia, including severity and laterality; as well as further studies on the variation of its frequency related to race and ethnicity.
Luquetti, Daniela Varela; Leoncini, Emanuele; Mastroiacovo, Pierpaolo
In Pakistan, fertility rates and intended family size have fallen, but contraceptive use remains low. This has led to a high prevalence of unintended pregnancies, a large proportion of which result from disagreement between spouses about how to confront them. This study aims to understand how Pakistani couples view family planning, and how they communicate and make decisions surrounding fertility
Iram Kamran; M. Shafique Arif; Katherine Vassos
The objective of this study is to describe the prevalence of postpartum contraceptive use among women experiencing a live\\u000a birth in Florida in 2004–2005. To examine the association between family planning counseling during prenatal care visits and\\u000a the use of effective contraceptive methods among postpartum women. Matched data from Florida PRAMS and Vital Statistics were\\u000a used (n = 3,962). Weighted logistic regression
Leticia E. Hernandez; William M. Sappenfield; David Goodman; Jennifer Pooler
The two main objectives of adolescence contraception are the eviction of involuntary pregnancies and the prevention of sexually transmitted infections. In France, in spite of our rich contraceptive arsenal and a widely spread information, the rate of voluntary termination of pregnancy keeps growing among the teenagers population — and this, probably because the gap between theoretical effectiveness and practice of contraception
G. Robin; P. Massart; B. Letombe
In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three
K. B. Smith; Z. M. van der Spuy; L. Cheng; R. Elton; A. F. Glasier
Women with epilepsy face unique challenges in maintaining steroidal contraceptive efficacy because some antiepileptic drugs (AEDs) increase the rate of hepatic metabolism of contraceptive steroids, leading to higher potential for contraceptive failure in this population. Planned pregnancy is of great clinical and social importance for women with epilepsy because of the increased risk of birth defects from fetal exposure to
Ian Thorneycroft; Pavel Klein; James Simon
Planning the gambling environment requires protection of the public's health, safety and welfare. Whereas most public gaming provisions and statutes address the public's fears of organized crime as well as some welfare needs, rarely do they safeguard the public's health regarding the spread of the mental disease known as pathological gambling. Measurement of the prevalence and incidence of this disease
Robert P. Culleton
|Emergency contraception is most effective at preventing unintended pregnancy when taken as early as possible following unprotected sexual intercourse. Advance provision of this medication supports more timely and effective use. In the midst of rising teen pregnancy rates, current policies often limit access to emergency contraception for…
Adamji, Jehan-Marie; Swartwout, Kathryn
|This study examined the prevalence rates of bully victimization and risk for repeated victimization among students with disabilities using the Special Education Elementary Longitudinal Study and the National Longitudinal Transition Study-2 longitudinal datasets. Results revealed that a prevalence rate ranging from 24.5% in elementary school to…
Blake, Jamilia J.; Lund, Emily M.; Zhou, Qiong; Kwok, Oi-man; Benz, Michael R.
OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING: A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine
Carlos Toufen Junior; André Luiz Dresler Hovnanian; Suelene Aires Franca; Carlos Roberto Ribeiro Carvalho
|A total of 1,535 4-12 year-old children were screened with the Conners' rating scales, followed by diagnostic confirmation by the diagnostic interview schedule for children-IV-parent version. The prevalence of ADHD was estimated to be 10.03%, and only 3.9% of children had received medication for the treatment of ADHD symptoms. Prevalence rates…
Montiel, Cecilia; Pena, Joaquin A.; Montiel-Barbero, Isabel; Polanczyk, Guilherme
Objective: Explore the effect of mental health on the physiological disease susceptibility (prevalence rate) of college students and provide scientific basis for psychological counsel, physical and mental health education, disease prevention, psychological treatment of college students. Methods: The psychological health conditions and physiological diseases (prevalence rate) of college students were investigated by the method of questionnaire survey using self evaluation
Unintended pregnancy is a social issue that severely jeopardizes the quality of life for parents and their children. College age women between the ages of 20-24 have one of the highest rates of unintended pregnancies due to lack of contraceptive use and unsafe sexual practices. Since 80% of college females are sexually active and not seeking to become pregnant, it is important to provide these women with effective contraceptive options. Among this population, Black and Hispanic woman have a disproportionate rate of unintended pregnancies. The purpose of this study was to examine contraceptive attitudes and demographic characteristics among female college students. Participants were grouped into those who use contraceptives consistently, intermittently, or not at all. The sample consisted of 120 racially diverse female college students who were sexually active within the past 3 months. Participants completed the Contraceptive Attitude Scale, contraceptive use tool, and demographic tool. The results showed that there was no significant difference in demographic characteristics and contraceptive attitudes for race, age, marital status, years of college education and income between the contraceptive groups. A majority of participants had a positive attitude regarding contraceptives. Women with higher contraceptive attitude scores were significantly more likely to be consistent contraceptive users. Uninterrupted contraceptive users had significantly higher mean contraceptive attitude scores than intermittent users and nonusers. The results of this study may enable healthcare providers to develop more effective methods of increasing contraceptive use and simultaneously decrease unintended pregnancy rates. Nurses play an integral role by providing women with contraceptive counseling that will assist these women in making an informed decision about contraception use. PMID:19278182
Bryant, Kellie Dionne
To measure the prevalence of allergic rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population- based survey in Belgium, France, Germany, Italy, Spain, and the UK was undertaken. Step one of the study involved screening for allergic rhinitis by telephone interview, based on history of symptoms and\\/or self-awareness of the condition. Step two undertook confirmation
V. Bauchau; S. R. Durham
Substantial improvements have been made in oral contraceptives, a new injectable contraceptive (Norplant), and the intrauterine device (IUD). Major risks with oral contraceptives have declined substantially, and a number of noncontraceptive health benefits have been discovered. Norplant is probably the first new contraceptive in recent years, and offers long-term contraception with high efficacy and modest risks. The IUD, by carefully selecting users, is a safe and efficacious contraceptive method. The major risk, pelvic inflammatory disease (PID), is far less common if one avoids use in the presence of risk factors for PID. PMID:2128711
Burkman, R T
PURPOSE: This paper presents a cross-sectional method for deriving age-specific hysterectomy prevalence. The influence of hysterectomy prevalence on uterine and ovarian cancer incidence rates and probabilities is illustrated.METHODS: Hysterectomy prevalence estimates are derived from cross-sectional data using a life table method. Analysis is based on hysterectomy data from the Utah Hospital Discharge Data Base and cancer cases recorded by the
RM Merrill; JL Lyon; C Wiggins
Recently the population-based large data set of the Hungarian Congenital Abnormality Registry showed an increase in the recorded total (birth + fetal) prevalence rate of informative offspring with Down syndrome. This finding was checked and confirmed in the completed data set due to the field study including all cytogenetic labs and prenatal diagnostic centres. The previous birth prevalence of 1.17
Julia Métneki; Andrew E. Czeizel
Incarceration and obesity rates have both increased in the United States. An implication is that there will be more obese inmates, which likely will raise the prevalence of obesity-related diseases, affecting the cost and performance of correctional health care. Other issues include increased costs of transport, restraint, and housing. There is surprisingly little published information on inmate obesity prevalence. The
Meaghan A. Leddy; Jay Schulkin; Michael L. Power
An interview survey of 450 Muslim women in a rural village of south Jordan under the early stage of fertility transition was conducted to explore major causes of contraceptive use, taking both their sociodemographic attributes and fatwa (Islamic jurisprudence)-based perception into account. Discriminant analysis, which was performed for the subject women divided into 15- to 29-, 30- to 39-, and 40- to 49-year age groups, revealed that "the number of living children" in the former and "to do contraception for good care of children" in the latter played significant roles in discrimination into contraceptive user and nonuser groups for any age groups. To cope with demographically and socioeconmically vulnerable situations, contraceptive prevalence rate should be increased by means of government-led family planning programs in cooperation with the imam (Muslim religious leaders and priests) through fatwa, in which special attention is paid to traditional norms, represented by good childcare. PMID:20589988
Sueyoshi, Shuji; Ohtsuka, Ryutaro
In Canada and most other comparatively rich countries, the total fertility rate (TFR) declined from approximately 2.5 in 1970 to 1.6-1.9 in 1990. The reduction was even greater in some countries such as China, Korea, Singapore, Mauritius, Barbados, Cuba, Guadeloupe, and Puerto Rico. TFR, however, has fallen little, if at all, in many poor countries; it remains at 8.1 in Kenya and has increased from already previously high levels in Somalia, Benin, Malawi, and Rwanda. The use of contraception has been instrumental in reducing fertility. An estimated 70% of married women in rich countries use contraceptives, and a larger proportion in Eastern Asia, but only less than 15% in Africa. Education for women generally increases the level of contraceptive use. Rates, however, depend upon the degree of both acceptance and availability. An estimated 20% of births in developing countries are unwanted, so it would seem that greater availability and variety of contraceptives could lead to reductions in fertility. Research into better contraceptive technology is frustrated by paternalism, most organized religions, concern over possible future legal liability, and fear of adverse health side effects, especially in North America. Depo-Provera and RU-486, for example, have yet to be licensed in Canada for use as contraceptive agents. Research nonetheless moves forward. A vaccine against pregnancy is reportedly being developed which may be available before the turn of the century. Clinical trials have been held, and the vaccine has been found to be effective in most women, lacking in side effects, and reversible. The prototype requires a series of injections. Elsewhere, the Alza Corporation of California is working on a transdermal patch to control fertility, while some success has been reported in trials of testosterone, alone or combined with a gonadotropin-releasing hormone, to suppress sperm production in men. PMID:12289008
In Pakistan, population growth rate is 2.2% and Total Fertility Rate (TFR) is as high as 5.4. It is the result of low Contraceptive Prevalence Rate (CPR) of only 28%. Due to low CPR, women have high rate of unwanted births in Pakistan. In this study using probit estimation on primary data, we have analyzed the woman=s characteristics responsible for low contraceptive prevalence among married women in urban areas of Punjab (Pakistan). For the purpose one thousand married women in the age group of 15-49 years, who were not currently pregnant were interviewed from urban areas of Bahawalpur and Lahore. The individual characteristics of married women were focused, although household characteristics, socio-economic conditions of the community where woman is living, religious and cultural factors are also important. It is found that age of woman, education of woman, woman`s status, her economic activity, income level and age at marriage were found major determinants of contraceptive prevalence in women. The policies towards the education of women, status of women, labor force participation of women and legal interventions towards the increase in marriage age are stressed to increase the CPR.
Khan, Rana Ejaz Ali; Khan, Tasnim
The aim of the study is to describe the prevalence of Combined Oral Contraceptive use and explore the relationship between\\u000a Combined Oral Contraceptive use and depressive symptoms in a sample of Turkish women. This descriptive study consisted of\\u000a 210 married women. We describe the women as Combined Oral Contraceptive users if she has been using Combined Oral Contraceptive\\u000a at least
Belgin AkinEmel EgeNihayet Aksullu; Emel Ege; Nihayet Aksüllü; Nesime Demirören; Hatice Erdem
This research presents estimates of HIV prevalence rates among injection drug users (IDUs) in large US metropolitan statistical\\u000a areas (MSAs) during 1992–2002. Trend data on HIV prevalence rates in geographic areas over time are important for research\\u000a on determinants of changes in HIV among IDUs. Such data also provide a foundation for the design and implementation of structural\\u000a interventions for
Barbara Tempalski; Spencer Lieb; Charles M. Cleland; Hannah Cooper; Joanne E. Brady; Samuel R. Friedman
A total of 1,535 4-12 year-old children were screened with the Conners' rating scales, followed by diagnostic confirmation by the diagnostic interview schedule for children-IV-parent version. The prevalence of ADHD was estimated to be 10.03%, and only 3.9% of children had received medication for the treatment of ADHD symptoms. Prevalence rates and…
Montiel, Cecilia; Pena, Joaquin A.; Montiel-Barbero, Isabel; Polanczyk, Guilherme
Patterns of contraceptive use among married urban women in Taiwan were investigated. A convenience sample of 150 women attending health clinics for reasons other than contraceptive care were interviewed about their contraceptive use. The most prevalent contraceptive method used by these women was the intrauterine device, followed by the condom and birth-control pills. Participants had used only one or two contraceptive methods throughout their contraceptive careers, and many stated they were satisfied with their current method. Many participants were able to name the methods of birth control promoted by the Taiwan family-planning promotion program. Knowledge of alternative methods did not significantly relate to current method in use or to desire to change methods. PMID:1955408
Lethbridge, D J; Wang, R
Psychological aspects of contraception in adolescence tend to be of interest primarily because of the belief that better understanding of psychological resistence to contraception would lead to more effective use and a lower rate of pregnancy. The failure of adolescents to use contraception appears to be due in part to irresponsibility but in part also to a variety of other factors. There is no ideal contraceptive for adolescents. The pill has potentially serious side effects whose significance may be exaggerated by adolescents, and the price of the contraceptive sponge may be prohibitive. Contraceptives themselves are perceived by adolescents as belonging more to parents, physicians, or the media than to themselves. Low-dose pills considered appropriate for adolescents are often abandoned because of their annoying minor side effects. Most adolescents do not seek contraception in an independent way, but out of fear that they are already pregnant or, if they have been sexually active for some time without using contraception, out of fear of infertility. Use of contraception may also be initiated by the partner, or the mother wishing to protect her daughter against pregnancy or to regularize the menstrual cycle. Contraceptive use by adolescents is complex because it signifies delaying rather than spacing or terminating pregnancy. The long duration of use that may be required until the time is right for pregnancy and the need to foresee future consequences are difficult given the cognitive level of adolescents. There are also difficult problems of access, prescription, and follow-up. Prescription of contraceptives for an adolescent is likely to invoke ambivalent feelings. Follow-up should be scheduled at fairly short intervals because of the fragility of motivation for contraceptive use at this age. The constraints of contraceptive use are not adapted to the sporadic and unplanned nature of much adolescent sexual activity. Society has an image of the adolescent as preoccupied with sexuality, but in fact adolescents are seeking to know and understand the new realities of their identity in a process in which the sexual quest plays only a secondary part. In order to improve the contraceptive performance of adolescents, a 3rd party other than a parent is needed to interact in a complementary way with the adolescent and to allow the adolescent to be heard. The objective of the interaction should not be to avoid abortion but to work to replace the rigid complementary interaction of adolescents with parents and other authority figures with a symmetrical model of communication open to the search for identity. PMID:12280865
Viala, M; Sperandeo, D; Duprez, D
In order to achieve planned demographic targets set for the period 1982-86, the government announced a new comprehensive population control policy in December 1981. This new set of policies calls for: 1) improving the current operation and management systems of the national family planning program; 2) strengthening the innovative social support policies including the incentive and disincentive schemes which encourage the small family; 3) integrating the family planning programs with other developed programs; and 4) establishing an end to these programs. As a result of government efforts to set up population measures, the number of those undergoing sterilization with 2 or fewer children and the contraceptive acceptance rate have increased greatly since 1982. The contraceptive practice rate for those ages 15-44 went to 58% in 1982. The total fertility rate dipped from 2.7 births/woman in 1981 to 2.4 in 1983. However, regional differentials in fertility rates are clearly observed. The urban fertility rate is lower than the rural and the regional differentials in fertility seem to derive from the strong son preference which is quite prevalent in the rural sector. The increase in contraceptive practice rate has contributed to the improvement of maternal health by preventing induced abortion. Since the inception of the family planning slogan focusing on the 1-child family, the proportion of respondents who said 1 child was enough rose from 16% in 1982 to 65% in 1984. With appropriate incentives, this figure is likely to increase. What remains is to lower the fertility rate for those in the 20-29 age group who currently account for over 80% of the total annual births. The current program management systems must recruit new acceptors among the younger age groups and must persuade them to resort to temporary contraceptive methods for birth spacing. The social support policies must be strengthened by providing preferential treatment for those with only 1 child and eliminating the son preference. The commercial sector programs must also be strengthened by providing preferential treatment to the contraceptive manufacturing companies and by providing educational programs for private physicians and pharmacists. Among the future directions mentioned above, Korea's foremost population control policy should address the eradication of son preference by instituting bold socal support policies including incentive systems for the 1 child family. (author's modified) PMID:12313503
Cho, N H; Kong, S K; Lim, J K
To approach the question of motivation toward contraception, the new French law on contraception passed in 1967, and the mode of action and risks of pills, IUDs, and diaphragms are reviewed. The new law governs import sale, prescription, placement of IUDs, consent for minors, and facilities of the clinics that issue contraceptives. Physicians dislike the prescription registration system, the written consent, lack of reimbursement by social security, and neglect of abortion. Oral contraceptives act on gonadotropin release, cervical mucus, and endometrial development. The can cause nausea, weight gain, bleeding, and thromboembolism. The relationship of medicine phobia, forgetting pills, and religion to success with pills remains to be studied. IUDs act on tubal and uterine motility and the endometrium. They frequently cause bleeding, pain, and expulsion, and rarely infection or perforation. Their failure rate is .5-2%. They are indicated when contraception must be separated from sexuality. Diaphragms and caps require technical fastidiousness and usually are preferred by older women. Their failure rate is 10-12% Now that contraceptive research can be done openly in France, more information about contraceptive motivation will become available. PMID:5757871
Background This cross-sectional study estimated the prevalence of contraceptive methods and investigated whether abortion rates influence contraceptive behaviour among injection drug-using (IDU) women in St Petersburg, Russia. Methodology A self-administered questionnaire of behaviour in the last 3 months was applied to a convenient sample of IDU women. Results Of 80 sexually active participants, 67% had had an abortion. No participant reported using hormonal contraceptives or intrauterine devices (IUDs). The only valid method of contraception used was condoms, which was reported by half of the participants. Consistent condom use was reported by 22% of participants and was no more likely among those who had an abortion. Condom use was significantly associated with having multiple or casual sex partners [prevalence ratio (PR) 1.75, 95% (confidence interval) CI 1.11–2.78, p = 0.01], having an IDU sex partner (PR 0.55, 95% CI 0.36–0.85, p = 0.029) and with a negative attitude toward condoms (PR 0.53, 95% CI 0.33–0.84, p = 0.01). Abortions were less likely among those who had multiple or casual sex partners (PR 0.69, 95% CI 0.49–0.97, p = 0.03). Conclusions Despite the high prevalence of abortions among IDU women, none reported the use of hormonal contraception or IUDs. Having had an abortion was not associated with greater likelihood of using condoms. Participants mostly used condoms with casual or multiple sex partners, suggesting that condoms were used mainly to prevent HIV/sexually transmitted infection transmission and not to prevent pregnancy. Programmes to prevent unwanted pregnancies and reduce abortion-related health risks among this understudied vulnerable group are needed.
Abdala, Nadia; Kershaw, Trace; Krasnoselskikh, Tatiana V; Kozlov, Andrei P
Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain. The aim of this study was to evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non-users and if it differs between women taking part in different sports. A questionnaire was sent to female elite athletes in volleyball (n = 205), basketball (n = 150), and soccer (n = 361) as well as to age-matched controls (n = 113). The questionnaire comprised questions about age, constitution, occupation, parity, and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems. The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups, with an average of 30%, whereas only 18% of the controls suffered from low back pain (p 0.01). The prevalence of low back pain within each group--athletes as well as controls--was similar in women who used and did not use oral contraceptives. This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity are probably more important. PMID:9351415
Brynhildsen, J; Lennartsson, H; Klemetz, M; Dahlquist, P; Hedin, B; Hammar, M
Study Objective: Studies suggest significant rates of female sexual assault (SA); the majority of SAs remain unreported, and few victims receive medical care. The purpose of this study was to determine lifetime prevalence rates of SA in an emergency department population and to assess reporting patterns to police, physicians, and social service agencies. Methods: A verbally administered survey was given
Kim M. Feldhaus; Debra Houry; Robin Kaminsky
The purpose of this paper was to describe the transition of sterilization in Finland from an eugenic tool to a contraceptive. Historical data were drawn from earlier reports in Finnish. Numbers of and reasons for sterilizations since 1950 were collected from nationwide sterilization statistics. Prevalence, characteristics of sterilized women, and women's satisfaction with sterilizations were studied from a 1994 nationwide
Elina Hemminki; Anja Rasimus; Erja Forssas
In most developed countries contraception is available and relatively cheap. In Britain 50% of women use reversible contraception and over the age of 35 more than 50% of women (or their partners) have been sterilised. Nevertheless large numbers of unplanned pregnancies still occur in all countries. Annual abortion rates (per 1000 women aged 15-44) are 5.6 in the Netherlands, 13 in Britain and 28 in the USA. In Britain about 50% of all conceptions are unplanned. Ambivalent attitudes to sex mean that there is inadequate public discussion about contraception. The media publicise adverse effects of oral contraceptives more than their benefits. Advertising of condoms is restricted, and the marketing of oral contraceptives to doctors emphasizes their side-effects. Contraception should be made more accessible to potential users, particularly the young, who are at greatest risk of unwanted pregnancy. Opinion among teenagers and their parents is in favour of more sex education at school. Efforts should be directed towards providing young people with better education on sex and contraception. PMID:8324606
Drife, J O
A Norplant capsule releasing 30 mcg/day of levonorgestrel (LNG), Norplant II rods releasing 30 mcg/day LNG, an IUD releasing 20 mcg/day LNG, and a model TCu 380Ag model copper T IUD were used in trials by 2748 women at 7 centers during 1882-90. 372 women requested removal by the end of 1990. 10-12% of implant subjects and 17-20% years and mean parity was 1.75. The 12-month life-table rate of pregnancy was 82/100 for those planning pregnancy. 2 years later the rate was 89/100 achieved for in the first years before age 30; and 93/100 of younger women got pregnant 2 years after removal. Duration of use for or= 3 years resulted in a pregnancy rate of 84/100, while use 3 years yielded 81/100. The rates were 85/100 at 1 year and 92/100 at 2 years for women desiring more children compared with the 70 and 81/100 rate of family limiters. Age was a major factor: under 30 years with or= 37 months of contraceptive use the pregnancy rate was 93/100, while age or= 30 years and use of 37 months produced a rate of 58/100 at 1 year. 58% of former users of Norplant II rods, 34% of LNG-releasing IUD users. 43% of copper T IUD, and 37% of Norplant capsules became pregnant within 3 months. Amenorrhea of 90 days occurred in LNG IUD users at removal with 1st month pregnancy of 5/100, but the conception rate reached 80- 92/100 at 1 year. 88% of pregnancies ended with live births: 2 newborns with weight of 2500 gm and tubal pregnancy in a former Norplant II rod user. Female neonates made up 50.5% of births. The recovery of fertility outcomes were not adversely affected by these methods. PMID:1566771
Sivin, I; Stern, J; Diaz, S; Pavéz, M; Alvarez, F; Brache, V; Mishell, D R; Lacarra, M; McCarthy, T; Holma, P
The past several years have seen an expansion in contraception options. Emerging data support the use of long-acting reversible contraception (LARC) such as the intrauterine device and subdermal implant as the most effective methods of contraception with the highest continuation rates and very high levels of patient satisfaction. In addition, the appropriate target population for the use of the intrauterine device now includes nulliparous women and adolescents. When a patient considers initiating a new contraceptive method, it is important to consider the characteristics of each method, including the side effects, effectiveness, and patient acceptability. Additionally, medical comorbidities must also be evaluated prior to choosing a method. In this article, we provide a brief overview of available reversible contraceptive methods, with an emphasis on LARC.
Mestad, Renee E.; Kenerson, Jessica; Peipert, Jeffrey F.
The past several years have seen an expansion in contraception options. Emerging data support the use of long-acting reversible contraception (LARC) such as the intrauterine device and subdermal implant as the most effective methods of contraception with the highest continuation rates and very high levels of patient satisfaction. In addition, the appropriate target population for the use of the intrauterine device now includes nulliparous women and adolescents. When a patient considers initiating a new contraceptive method, it is important to consider the characteristics of each method, including the side effects, effectiveness, and patient acceptability. Additionally, medical comorbidities must also be evaluated prior to choosing a method. In this article, we provide a brief overview of available reversible contraceptive methods, with an emphasis on LARC. PMID:19641264
Mestad, Renee E; Kenerson, Jessica; Peipert, Jeffrey F
Background Previous studies indicate that the sexual beliefs and mores of students in medical professions may influence their capacity to care for patients’ sexuality and contraception issues. Students also represent a large sample of reproductive-age individuals. In this study, we examined contraceptive usage patterns in North American medical students. Study Design Students using online medical student social and information networks enrolled in allopathic and osteopathic medical schools in North America between February and July of 2008 were invited to participate via email and published announcements in an Internet-based survey consisting of a questionnaire that assessed ethnodemographic factors, year in school and sexual history. We also collected information about current use of contraceptive and barrier methods. Descriptive statistics and logistic regression were utilized to analyze responses. Results Among our 2269 complete responses, at least one form of contraception was being utilized by 71% of men and 76% of women. Condoms were the most popular form of contraceptive, utilized by 1011 respondents (50% of men and 40% of women). Oral contraceptive pills were the contraceptive of choice for 34% of men and 41% of women. Decreased rates of contraception use were associated with being black or Asian, not being in a relationship and having more sexual dysfunction in female respondents. Students who reported comfort discussing sexual issues with patients were more likely to use effective contraceptive methods themselves. Ten percent of this of sexually active medical students was not currently using contraception. Conclusions There are significant differences in contraceptive use based on demographics, even at the highest education levels. The personal contraception choices of medical students may influence their ability to accurately convey information about contraception to their patients. In addition, medical students may personally benefit from improved knowledge of effective contraceptive practices.
Rowen, Tami S.; Smith, James F.; Eisenberg, Michael L.; Breyer, Benjamin N.; Drey, Eleanor A.; Shindel, Alan W.
Pressure ulcer prevalence rates provide useful information about the magnitude of this health problem. Only limited information on pressure ulcers in Germany was available before 2001. The purpose of this study was to compare results of seven pressure ulcer prevalence surveys which were conducted annually between 2001 and 2007 and to explore whether pressure ulcer prevalence rates decreased. The second
Jan Kottner; Doris Wilborn; Theo Dassen; Nils Lahmann
The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion. PMID:12269214
Haspels, A A; Van Santen, M R
To counsel patients about their contraceptive options, general practitioners must be knowledgeable about recent refinements of hormonal methods and the development of new and easier modes of hormone delivery. This article, intended for family physicians in Australia, reviews the results of recent studies in the area of contraceptive selection and use. Particular emphasis is given to the debate over third-generation oral contraceptives (OCs), the association between OC use and the risk of breast cancer, developments in progestogen-only contraception, emergency contraception, and use of RU-486 for medical abortion. The levonorgestrel-releasing IUD (Mirena) will soon be available in Australia and represents a good option for women who desire both contraception and control of menorrhagia. PMID:9612998
This article presents findings from a reproductive health survey conducted in Hunan Province, China, in 1996. The sample included 3714 married women aged 20-35 years. Findings indicate that 3434 women (92.5%) had ever used contraception. 3338 (89.9%) were current users. 54.3% relied on sterilization, 40.3% used the IUD, and 5.4% relied on other methods. During 1992-96, the contraceptive prevalence rate changed significantly among persons aged 25-29 years and 29-34 years. The percentage of women aged 20-24 years and 25-29 years accepting sterilization declined sharply during 1992-96. The total rate of sterilization remained stable. IUD users tended to remain with this method. Among the 3338 contraceptive users, 1252 users (37.5%) selected their contraceptive method at the recommendation of local family planning (FP) workers, and 1168 (35.0%) selected their method by themselves. 918 (27.5%) relied on recommendations and their own decision-making. Findings reveal that the extent of satisfaction in the method chosen was higher among women who made an active choice by themselves than a passive choice by taking the recommendation of FP workers. The extent of satisfaction was affected the most significantly by choice patterns, followed by educational attainments and other factors, such as the method itself and childbearing. PMID:12294258
Xiao, Z; Li, B
Clients have more contraceptive alternatives available today than at any time in the past. While most clients have some knowledge of the various contraceptive methods, they frequently require more specific information from the health-care professional to determine the suitability of a particular method for individual use. Nurse practitioners are trained to provide clients with accurate information and to help them explore individual needs and preferences for a contraceptive method. PMID:6562262
Cupit, L G
Background The nationwide statistical analysis of hematologic malignancies in Korea has not been reported yet. Methods The Korea Central Cancer Registry and the Korean Society of Hematology jointly investigated domestic incidence rates and prevalence of hematologic malignancies occurred between 1999 and 2008, and analyzed survival rates of patients who were diagnosed between 1993 and 2008. Data of hematologic malignancies from 1993 to 2008 were obtained from the Korean National Cancer Incidence Data base. The crude incidence rates, age-specific incidence rates, age-standardized incidence rates, annual percentage change of incidence, and prevalence from 1999-2008 were calculated. Survival rates for patients diagnosed in 1993-2008 were estimated. Results In 2008, a total of 8,006 cases of hematologic malignancies were occurred, which comprised 4.5% of all malignancies. In all genders, non-Hodgkin lymphoma, myeloid leukemia, and multiple myeloma were most frequent diseases. In terms of age, ages between 60 and 69 were most prevalent. From 1999 to 2008, the age-standardized incidence rates increased from 10.2 to 13.7, and the annual percentage change was 3.9%. The 5-year survival rate increased from 38.2% during 1993-1995 to 55.2% during 2004-2008. As of January 2009, number of patients with 10-year prevalence was 33,130, and with 5- to 10-year prevalence was 10,515. Conclusion This is the first nationwide statistical report of hematologic malignancies in Korea. It could be used as the basic information to help investigate epidemiologic characteristics, evaluate progress during the past years, and establish future strategies for hematologic malignancies. Periodic statistical analysis of hematologic malignancies in Korea should be continued.
Park, Hyeon Jin; Park, Eun-Hye; Jung, Kyu-Won; Kong, Hyun-Joo; Won, Young-Joo; Lee, Joo Young; Yoon, Jong Hyung; Park, Byung-Kiu; Lee, Hyewon; Eom, Hyeon-Seok
In order to ascertain prevalence rate of premarital sexual intercourse, unintended pregnancy and abortion, and evaluate associated factors of unintended pregnancy among undergraduates from all over China, the representative sample of unmarried undergraduates was obtained by using a multi-stage, stratified, probability cluster design, and data were collected by using a survey questionnaire. 62 326 available responders were gained. 11.6% of them acknowledged having experiences of premarital sexual intercourse (standardized prevalence rate of sexual intercourse was 13.8%). 31.5% of students active in premarital sex acknowledged undergoing unintended pregnancy. 76.2% of pregnant students selected abortion to end it. Of students active in premarital sex, 46.2% used contraception at the first sexual intercourse, 28.2% replied "always" using contraception in sexual intercourse. The rate of using condoms, oral contraceptives (OCs), and withdrawal among students who had used contraception was 52.0%, 31.0%, and 27.2% respectively. "No preparation for sex" (40.3%), "pleasure decrement" (32.1%), "won't-be-pregnancy in occasional sexual intercourse" (30.2%) were their common excuses for using no contraception. The identified risk factors for unintended pregnancy among students active in premarital sex by multivariate analysis were as follows: having no steady lover [having no steady lover vs having a steady lover: odds ratio (OR), 1.875; 95% confidence interval (CI), 1.629-2.158], unaware of the course of conception (unaware vs aware: OR, 2.023; 95% CI, 1.811-2.260), considering abortion not endanger women's physical and mental health (no endangerment vs endangerment: OR, 2.659; 95% CI, 2.265-3.121), nonuse of contraception (never use vs always use: OR, 1.682; 95% CI, 1.295-2.185). Medical students were not less likely to experience an unintended pregnancy than nonmedical students (OR, 1.111; 95% CI, 0.906-1.287). The substantial proportion of unintended pregnancy among undergraduates indicates a need for convenient and targeted contraceptive education and services. PMID:21823000
Zhou, Yuanzhong; Xiong, Jinwen; Li, Jie; Huang, Shiyun; Shang, Xuejun; Liu, Guohui; Zhang, Meimei; Yin, Pin; Wei, Sheng; Xiong, Chengliang
Japan's contribution to the research and development of contraceptives remains insignificantly small despite the fact that Dr. H. Nakajima was appointed general secretary of WHO in 1988. Unlike other industrialized nations Japanese couples still rely on such traditional methods of contraception as condoms (82.1% in 1986) and Ogino Method (11.3% in 1986). Relatively high tolerance of abortion among Japanese men and women, passive attitude toward sex and contraception among young Japanese women and ignorance of contraception among Japanese men all contribute to this peculiar pattern of birth control practice. IUD, which was introduced in 1930, was no legalized officially till 1974. Family planning movement legacy of post-WWII Japan, is conducted from the standpoint of maternal-child health, for the prevention of unwanted pregnancy and resulting abortion. WHO's Special Programme of Research, Development and Research Training in Human Reproduction which was started in 1972, is described in part. Task Force on Long-acting Systemic Agents for Fertility Regulation explores long-acting agents and alternative to oral contraceptives such as injections and cervical rings with progesterone. Task Force on Vaccine for Fertility Regulations explores vaccines which paramedical staff can readily give in developing nations where doctors are scares. Task Force of Post-ovulatory Methods studies effects of combined RU-486 and prostaglandins. Task Force on Plants for Fertility Regulation studies pharmacological effects of chemical substances extracted from plants in great apes. Task Force on Diagnosis and Treatment of Infertility gears toward United States, where birth rate and population increase are high but frequency of infertility is also high. Japanese participation in these task forces is yet to see. PMID:12283951
BackgroundHigher rates of unwanted pregnancies and lower rates of contraceptive use have been reported among Hispanic women than among non-Hispanic whites. Despite these differences, it is unclear how these groups differ with respect to various psychosocial factors that are associated with contraceptive decision making, including contraceptive knowledge, attitudes, self-efficacy and social support.
Haleh Sangi-Haghpeykar; Nina Ali; Sam Posner; Alfred N. Poindexter
First-year university students may be more at risk for experiencing Major Depressive Disorder (MDD) than the general population given associated risk factors of this age range. A two-phase procedure was used to estimate the one-year prevalence rate of MDD and comorbid Major Anxiety Disorders among first-year university students at a small Canadian…
Price, E. Lisa; McLeod, Peter J.; Gleich, Stephen S.; Hand, Denise
The positive correlation between gun prevalence and homicide rates has been widely documented. But does this correlation reflect a causal relationship? This study seeks to answer the question of whether more guns cause more crime, and unlike nearly all previous such studies, we properly account for the endogeneity of gun ownership levels. We discuss the three main sources of endogeneity
Gary Kleck; Tomislav Kovandzic; Mark E Schaffer
The aim of the present study was to evaluate the association and impact of occupational exposure and diseases of the shoulder and neck. Prevalence rates, odds ratios, aetiological fractions, and their confidence intervals were computed for pooled and non-pooled data of previous published reports. By comparison with office workers and farmers, dentists had an increased odds ratio for cervical spondylosis
M Hagberg; D H Wegman
|This prospective study of 276 Virginia public high schools found that the prevalence of teasing and bullying (PTB) as perceived by both 9th-grade students and teachers was predictive of dropout rates for this cohort 4 years later. Negative binomial regression indicated that one standard deviation increases in student- and teacher-reported PTB…
Cornell, Dewey; Gregory, Anne; Huang, Francis; Fan, Xitao
Obtaining consistent and accurate rates of women's sexual assault experiences and men's history of sexual aggression has proved difficult and rates vary tremendously throughout the literature [Koss, M.P. (1993a). Detecting the scope of rape: A review of prevalence research methods. Journal of Interpersonal Violence, 8 (2), 198–222].It has been suggested that methodological factors influence the detection of women's sexual assault
Elizabeth D. Kolivas; Alan M. Gross
The contraceptive utilization of a sample of sexually active, urban, high school males (Black, Hispanic, and White) was examined by anonymous questionnaire. Contraceptive use was haphazard, but White males tended to be more effective contraceptors than the other two groups. Reasons for nonuse were also studied. (Author/SJL)
Finkel, Madelon Lubin; Finkel, David J.
The alleged adverse effects of oral contraceptives and intrauterine devices have led to increased consumer and physician demand for vaginal contraceptive devices. The efficacy and the advantages and disadvantages of vaginal sponges, cervical caps and diaphragms are discussed and compared in this article.
Smith, M.; Barwin, B. N.
Contraceptives are used for reversible reproductive control in genetically valuable wild felids, as permanent reproductive control in generic wild felids, and as an economically practicable means to control feral cats. The progestin contraceptives, megestrol acetate, melengesterol acetate, medroxyprogesterone acetate, and levonorgestrol (administered orally, in implants, or as depot injections), are effective in preventing pregnancy. However, long-term use is associated with
Contraception is an essential component of sexual and reproductive health issues, especially in Nigeria, which has a high fertility rate. The intrauterine contraceptive device (IUCD) is one of the most frequently used contraceptive methods. Countless researches have helped establish the fact that an intrauterine device IUCD is a safe and effective contraceptive method for most women regardless of their health status. However, many complications associated with the IUCD have also been described. In this report, we present an unusual complication of the IUCD in which the device perforated the uterus and migrated to the ileum, with the IUCD string still visible per vaginum. PMID:23919205
Mbamara, Su; Omojuwa, Io
The 5-year-old community contraceptive distribution program developed by PROFAMILIA, Colombia's private family planning organization, has given excellent results, but several cost-effectiveness comparisons with social marketing programs have suggested that commercial distribution programs are superior. The community contraceptive distribution program has a high content of information and education activities, which produced significant increases in knowledge and use of contraception in the communities covered. It has been a fundamental support for the social marketing program, creating much of the demand for contraceptive products that the social marketing program has filled. The social marketing program has given good results in terms of volume of sales and in cost-effectiveness since 1976, prompting calls for replacement of the community contraceptive distribution program by the social marketing program in those sectors where knowledge and use of contraception have achieved acceptable levels. An experiment in the Department of Santander in 1984 and 1985 gave very favorable results, suggesting that community contraceptive distribution programs should be replaced by social marketing programs in all more developed markets. But economic problems in 1985 and the decision of manufacturers to decrease the profit margin for PROFAMILIA jeopardized the social marketing program. The community distribution program covered about 20% of the market. Reduced profits in the social marketing program threatened its continued expansion, at the same time that potential demand was growing because of increases in the fertile aged population and increased use of contraception. To meet the need, PROFAMILIA combined the community contraceptive distribution and social marketing programs into a new entity to be called community marketing. The strategy of the community marketing program will be to maintain PROFAMILIA's participation in the market and aid the growth of demand for contraceptives through educational and informational activities. The distribution scheme must continue to cover all the established points of sale in pharmacies despite the reduced profit margins. PMID:12315076
Urrutia, J M
|Describes the 1998 Canadian Contraception Study, a mailed survey which asked women about contraceptive practices past, present, and future (including use of oral contraceptives, condoms, and sterilization); familiarity with and opinion about different contraception methods; and general sexual and reproductive health. The paper also examines…
Fisher, William A.; Boroditsky, Richard; Bridges, Martha L.
This report reviews some of the new studies regarding new hormonal contraceptive formulations (e.g., Yaz, Qlaira®, extended-cycle or continuous combined contraceptives, subcutaneous depot medroxyprogesterone acetate, and ulipristal acetate as an emergency contraceptive). Recent data on the relationship between hormonal contraceptive use and bone health are also reviewed.
Li, HW Raymond
This study examined the prevalence rates of bully victimization and risk for repeated victimization among students with disabilities using the Special Education Elementary Longitudinal Study and the National Longitudinal Transition Study-2 longitudinal datasets. Results revealed that a prevalence rate ranging from 24.5% in elementary school to 34.1% in middle school. This is one to one and a half times the national average for students without disabilities. The rate of bully victimization was highest for students with emotional disturbance across school levels. Findings from this study also indicated that students with disabilities who were bullied once were at high risk of being bullied repeatedly. Elementary and middle school students with autism and high school students with orthopedic impairments were at the greatest risk of experiencing repeated victimization. Implications of the findings are discussed. PMID:23294235
Blake, Jamilia J; Lund, Emily M; Zhou, Qiong; Kwok, Oi-Man; Benz, Michael R
Information about pressure ulcer prevalence, prevention, and optimal management strategies in the long-term acute care hospital (LTACH) setting is sparse. Although care processes in other patient care settings have been reported to affect pressure ulcer prevalence rates, the effect of such programs in the LTACH is unknown. To reduce perceived above-average pressure ulcer prevalence rates and improve care processes, a 108-bed LTACH used a failure mode and effects analysis to identify and address high-priority areas for improvement. Areas in need of improvement included a lack of 1) wound care professionals, 2) methods to consistently document prevention and wound data, and 3) an interdisciplinary wound care team approach, as well as a faulty electronic medical record. While prevalence data were collected, policies and procedures based on several published guidelines were developed and incorporated into the pressure ulcer plan of care by the newly established wound care team. Improved assessment and documentation methods, enhanced staff education, revised electronic records, wound care product reviews, and a facility-wide commitment to improved care resulted in a reduction of facility-acquired pressure ulcer prevalence from 41% at baseline to an average of 4.2% during the following 12 months as well as fewer missing electronic record data (<1% of charts had missing data). These study results suggest that staff education, better documentation, and a dedicated wound care team improves care practices and reduces pressure ulcer prevalence in the LTACH. Studies to increase knowledge about the LTACH patient population and their unique needs and risk profiles are needed. PMID:19387096
Milne, Catherine T; Trigilia, Donna; Houle, Tracy L; Delong, Sandra; Rosenblum, David
In the early 1950s, the Soviet Union and several of its Eastern European satellites completed their transition from high to low fertility before the US and Western Europe. They did this even though there were not enough modern contraceptives available to meet the needs of its citizens. As late as 1990, the Soviet Union had no factories manufacturing modern contraceptives. A gynecologist in Poland described domestically produced oral contraceptives (OCs) as being good for horses, but not for humans. The Romanian government under Ceaucescu banned all contraceptives and safe abortion services. Therefore, women relied on abortion as their principal means of birth control, even in Catholic Poland. The legal abortion rates in the Soviet Union and Romania stood at 100/1000 (1985) and 91/1000 (1987) as compared to 18/1000 in Denmark and 13/1000 in France. All too often these abortion were prohibited and occurred under unsafe conditions giving rise to complications and death. Further, the lack of contraceptives in the region precipitated and increase in AIDS and other sexually transmitted diseases. On the other hand, abortion rates were minimalized in Czechoslovakia, East Germany, and Hungary due to the availability of modern contraceptives and reproductive health services. Hungary and East Germany even manufactured OCs. OC use in these 2 nations rated as among the world's highest. East Germany also treated infertility and sexually transmitted diseases. The region experienced a political opening in latecomer 1989. In 1989, IPPF gave approximately 15 million condoms and 3000 monthly OC packets to the Soviet Union to ease the transition. More international assistance for contraceptive supplies and equipment and training to modernize abortion practices is necessary. PMID:12283401
Jacobson, J L
Contraception has been little investigated in bipolar disorder, an illness associated with impulsive sexual behavior and use\\u000a of medications that are unsafe during pregnancy. In this cross-sectional survey of 136 women with bipolar disorder, prevalence\\u000a of contraception use was 58.8%. Use of any method was associated in the multivariable analysis with being married, younger\\u000a than 40 and having had previous
Pedro Vieira da Silva Magalhães; Flávio Kapczinski; Marcia Kauer-Sant’Anna
Background and methodologyGiving young women access to newer contraceptives such as the combined contraceptive patch, combined contraceptive vaginal ring and single-rod implant may help reduce teenage pregnancies. However, little is known about young people's attitudes towards these contraceptives. This cross-sectional survey, using a self-completion questionnaire, aimed to explore young people's attitudes towards these contraceptives in order to develop understanding of
Rebecca Say; Diana Mansour
BACKGROUND: In Brazil, a Ministry of Health report revealed women who underwent an abortion were predominantly in the use of contraceptive methods, but mentioned inconsistent or erroneously contraceptive use. Promoting the use of contraceptive methods to prevent unwanted pregnancies is one of the most effective strategies to reduce abortion rates and maternal morbidity and mortality. Therefore, providing post-abortion family planning
Ana Laura CG Ferreira; Ariani I Souza; Raitza A Lima; Cynthia Braga
Context: Trends in contraceptive use have implications for shifts in pregnancy rates and birthrates and can inform clinical practice of changes in needs for contraceptive methods and services. Methods: Information on current contraceptive use was collected from a representative sam- ple of women of reproductive age in the 1995 National Survey of Family Growth (NSFG). This information is compared with
Linda J. Piccinino; William D. Mosher
Objective To estimate the prevalence and incidence of dementia and cognitive impairment without dementia (CIND) in the Mexican population. Methods The MHAS study is a prospective panel study of health and aging in Mexico with 7,000 elders that represent 8 million subjects nationally. Using measurements of cognition and activities of daily living of dementia cases and CIND were identified at baseline and follow up. Overall incidence rates and specific rates for sex, age and education were calculated. Results Prevalence was 6.1% and 28.7% for dementia and CIND, respectively. Incidence rates were 27.3 per 1,000 person-years for dementia and 223 per 1,000 persons-year for CIND. Rates of dementia and CIND increased with advancing age and decreased with higher educational level; sex had a differential effect depending on the age strata. Hypertension, diabetes and depression were risk factors for dementia but not for CIND. Discussion These data provide estimates of prevalence and incidence of dementia and cognitive impairment in the Mexican population for projection of future burden.
Mejia-Arango, Silvia; Gutierrez, Luis Miguel
Background: Preordinate attitudes and beliefs about contraception may influence acceptance or rejection of a particular method. Purpose: We examined the attitudes about contraception methods held by undergraduate students (N=792) at two large southeastern universities in the United States. Methods: Twelve methods were rated on 40 semantic…
McDermott, Robert J.; Malo, Teri L.; Dodd, Virginia J.; Daley, Ellen M.; Mayer, Alyssa B.
Despite the availability of contraception, the rates of abortion among young women in South Africa continue to increase. We designed a study to examine young people's attitudes about abortion and contraception. One hundred and eighty-eight South African university students (97 females and 91 males) completed the survey. While we found moral objections to abortion for the sample as a whole,
Cynthia J. Patel; Trisha Kooverjee
Background Unintended pregnancy (mistimed or unwanted) remains an important health issue for women. The purpose of this study was to determine the prevalence of and factors associated with risk of unintended pregnancy in a sample of Victorian women attending family planning clinics. Methods This cross-sectional survey of three Family Planning Victoria Clinics from April to July 2011 recruited women aged 16-50 years with a male sexual partner in the last 3 months, and not intending to conceive. The questionnaire asked about contraceptive behaviours and important factors that influence contraception use (identified from a systematic literature review). Univariate analysis was calculated for the variables of interest for associations with contraceptive use. An overall multivariate model for being at risk for unintended pregnancy (due to inconsistent or ineffective contraceptive use or non-use) was calculated through backward elimination with statistical significance set at <0.05. Results 1006 surveys were analyzed with 96% of women reporting contraception use in the last 3 months. 37% of women were at risk for unintended pregnancy due to imperfect use (61% inconsistent users; 31% ineffective methods) or never using contraception (8%). On multivariate analysis, women at risk for unintended pregnancy compared with women not at risk were <25 years old (OR 1.8, 95% CI 1.2-2.7); had no university/postgraduate degree (OR 1.7, 95% CI 1.2-2.4); and had >1 partner in the last 3 months (OR 3.2, 95% CI 2.3-4.6). These women were dissatisfied with current contraception (OR 2.5, 95% 1.8-3.5); felt “vulnerable” to pregnancy (OR 2.1, 95% CI 1.6-3.0); were not confident in contraceptive knowledge (OR 2.6, 95% CI 1.5-4.8); were unable to stop to use contraception when aroused (OR 2.1, 95% CI 1.5-2.9) but were comfortable in speaking to a doctor about contraception (OR 2.3, 95% CI 1.1-4.1). Conclusion Despite reported high contraceptive usage, nearly 40% of women were at risk for unintended pregnancy primarily due to inconsistent contraceptive use and use of ineffective contraception. Strategies for improving consistency of effective contraception use or greater emphasis on long-acting contraception may be needed for certain subpopulations at higher risk for unintended pregnancy.
OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2
Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S
CONTEXT Teenagers have a high unintended pregnancy rate, in part because of inconsistent use or nonuse of contraceptives. It is important to determine how partner and relationship characteristics are related to contraceptive use and consistency within adolescents’ first sexual relationships. METHODS Logistic and multinomial logistic regression analyses of data from 1,027 participants in the first two waves of the National Longitudinal Study of Adolescent Health examined the influence of relationship and partner characteristics on ever-use and consistent use of contraceptive methods during teenagers’ first sexual relationships. RESULTS Teenagers who had waited a longer time between the start of a relationship and first sex with that partner, discussed contraception before first having sex or used dual contraceptive methods had significantly increased odds of ever or always using contraceptives. Adolescents who had taken a virginity pledge, had an older partner, had a greater number of close friends who knew their first partner, or reported having a relationship that was not romantic but that involved holding hands, kissing and telling their partners they liked or loved them had decreased odds of contraceptive use or consistency. As relationship length increased, teenagers were more likely to ever have used a method, but less likely to always have used a method. CONCLUSIONS Parents and programs should encourage teenagers to delay sexual intercourse, discuss contraception with partners before initiating sex and be vigilant about contraceptive use, particularly in long-term sexual relationships and in relationships with older partners.
Manlove, Jennifer; Ryan, Suzanne; Franzetta, Kerry
Using data from China's population-based 2000 census, this ecological study examined the association between gender equity and women's contraceptive use in 30 provinces. Five province-level indicators of gender equity were used: sex ratio at birth, health, employment, education, and political participation. With the exception of sex ratio, all indices were comprised of several components. The indicators and components were grouped into tertiles. Generalized linear models were used to examine the associations between these indicators and contraceptive use. Provinces in the middle tertile of political participation had higher prevalence of contraceptive use than those in the lowest tertile (? = 0.27, 95% CI: 0.02-0.52, p < 0.034). Compared to regions in the lowest tertile, regions in the highest tertile of the proportion of females in provincial-level parties and government (? = 0.25, 95% CI: 0.04-0.46, p < 0.020) and middle tertile of female employment in all the economic activities except agriculture, industry and construction (? = 0.25, 95% CI: 0.04-0.46, p < 0.021) had a higher prevalence of contraceptive use. Regions in the middle tertile of female illiteracy (? = -0.25, 95% CI: -0.42-0.07, p < 0.006) had a lower prevalence of use of contraceptives than those in the lowest tertile. The authors of this study found mixed evidence of an association between gender equity and contraceptive use in China. PMID:22185289
Xu, Yao; Bentley, Rebecca J; Kavanagh, Anne M
Asthma is an important public health challenge. The objective of this research was to investigate the relationship of air pollution and weather to adolescent asthma prevalence and attack rate. A 6-month mass screening asthma study was conducted from October 1995 to March 1996 in Taiwan. The study population included junior high school students from throughout the country (1,139,452 students). Eighty-nine
Wen-Chao Ho; William R. Hartley; Leann Myers; Meng-Hung Lin; Yu-Sheng Lin; Chih-Hui Lien; Ruey-Shiung Lin
This study aimed to determine the prevalence rates of helmet use, and of correct helmet use (chinstrap firmly fastened) among motorcycle riders and their passengers in Zhongshan, Guangdong Province, China. A cross-sectional survey involving direct observation of motorcycle riders was conducted at 20 randomly selected intersections. A total of 13,410 motorcycles were observed during a 10-day period in February 2009.
Yu Xuequn; Liang Ke; Rebecca Ivers; Wei Du; Teresa Senserrick
Results. The prevalence rate of UI was of 11.2% among men and of 21.6% among women. Among those reporting the condition, approximately 53% of women and 59% of men reported experiencing incontinence daily or weekly. As- sociation of UI was found for participants older than 70 years in both men (odds ratio (OR) 2.49, 95% confidence inter- val (CI) 1.45-4.28)
Stefania Maggi; Nadia Minicuci; Jean Langlois; Mara Pavan; Giuliano Enzi; Gaetano Crepaldi
Objectives Disease activity and medication use can complicate pregnancies in SLE. We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. Methods In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use, stratified by treatment with teratogenic medications, and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use. Results Among 206 women, 86 were at risk for unplanned pregnancy. Most (59%) had not received contraceptive counseling in the last year; 22% reported inconsistent contraceptive use, and 53% depended solely on barrier methods. Intrauterine contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to use contraception consistently, or to use more effective contraceptives. History of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives. Conclusions Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve provision of contraceptive services to women with SLE.
Yazdany, Jinoos; Trupin, Laura; Kaiser, Rachel; Schmajuk, Gabriela; Gillis, Joann Zell; Chakravarty, Eliza; Schwarz, Eleanor Bimla
This study aimed to determine the prevalence rates of helmet use, and of correct helmet use (chinstrap firmly fastened) among motorcycle riders and their passengers in Zhongshan, Guangdong Province, China. A cross-sectional survey involving direct observation of motorcycle riders was conducted at 20 randomly selected intersections. A total of 13,410 motorcycles were observed during a 10-day period in February 2009. The overall prevalence of helmet use was 72.6% (95% CI: 71.8-73.3%) among drivers and 34.1% (95% CI: 32.7-35.5%) among pillion passengers. The prevalence of correct use was 43.2% (95% CI: 42.4-44.0%) and 20.9% (95% CI: 19.8-22.1%) for drivers and passengers respectively. The helmet wearing rate on city streets was almost 95%, however city riders were more likely than rural riders to wear non-motorcycle helmets while riding. In multivariate analyses, factors associated with increased helmet use included riding on city streets, male gender, being a driver, carrying less passengers and riding a registered motorcycle. The results indicated enforcement and education activities need to be strengthened with respect to both helmet use and helmet quality, especially in rural areas, in order to improve wearing rates. PMID:21094316
Xuequn, Yu; Ke, Liang; Ivers, Rebecca; Du, Wei; Senserrick, Teresa
Given the observed variation in birth prevalence and recurrence rates of neural tube defects, it is important to obtain such data specific to a given locality for research and genetic counseling purposes. A review of hospital medical charts, the patient lists of the Medical Genetics and Myelomeningocele clinics at Alberta Children's Hospital and data from the Canadian Congenital Anomalies Surveillance System revealed the annual birth prevalence rate of neural tube defects in southern Alberta in 1970-81 to be 1.62/1000 total births. This figure suggests southern Alberta to be a low-frequency area. There was no significant variation in the annual rates of spina bifida, encephalocele or all neural tube defects combined over the study period. A significant linear decline in the frequency of births of anencephalic infants, however, was noted (p = 0.025). Information on the total reproductive history of the mothers revealed that the empiric risk of recurrence of a neural tube defect was 2.2%, and the risk to all siblings was estimated to be 2.3%. In future prevalence studies multiple sources of case ascertainment should be used, including data on pregnancies terminated because of a fetal neural tube defect.
Thunem, N Y; Lowry, R B; Tucker, B J; Medd, B W
This artical examines the risks and benefits associated with use of the oral contraceptive pill (OCP) by adolescents and the various alternatives and methods of prescribing OCPs. Any adolescent who is either sexually active or contemplating sexual activity should be offered a contraceptive method that is appropriate to her individual needs. The contraceptive needs to be highly effective, safe and within the means and desires of the adolescent. For the majority of teenagers, the contraceptive of choice will be the OCP. The IUD should almost never be prescribed to the adolescent. Most OCPs marketed today are combination pills containing both an estrogen and a progestin in each pill. A variety of contraceptive actions combines to create a contraceptive method that is 99.3-99.9% effective. OCPs provide some protection against the development of pelvic inflammatory disease (PID). Oral contraceptives also decrease the incidence of anemia by decreasing the amount and duration of menstrual flow. Ovarian cysts do not form in the ovaries of the OCP user. On the other hand, a serious risk of the use of OCPs is the increased danger of thromboembolic events including deep venous thrombosis, pulmonary embolus, and myocardial infarction. The increased risk of myocardial infarction in OCP users is additive with other risk factors including hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes mellitus, and age. OCP use seems to provide some protection against development of endometrial or ovarian cancer. Oral contraceptives are associated with the development of benign hepatocellular adenomas. A variety of metabolic and hormonal alterations also occur in pill users. Most appropriate for the adolescent is a formulation containing a low dose of estrogen because of the decreased risk of thromboembolic complications. Dysmenorrhea effects more than 1/2 of female adolescents, and can best be treated with ibuprofen. PMID:3546224
Cholst, I N; Carlon, A T
Recent legal developments affecting planned parenthood in Ireland are reported. The Criminal Law Amendment Act, 1935, which first prohibited the import and sale of contraceptives, and the Censorship of Publications Act, 1929, which prohibits the distribution of printed material advocating "the unnatural prevention of conception" have never been repealed. In the 1960s, the Fertility Guidance Company Ltd. was established. The organization opened a fertility guidance clinic in February 1969 which was attended mostly by people from the upper and middle classes. In 1971, the Company opened another clinic closer to poorer families, and the name was changed to the Irish Family Planning Association (IFPA). The pill is available in most pharmacies under the pretense that it is a menstrual cycle regulator. Many of the other contraceptives had to be acquired by the client through the mail either from Northern Ireland or from the IPPF Regional Despatch Center in London. Women requiring IUDs were referred to Belfast where the Northern Ireland FPA cared for them. In December 1972, a new organization, Family Planning Services Ltd., was established to provide mail-order contraceptives, since the customs authorities were increasingly confiscating imported contraceptives. In 1973, the Supreme Court ruled it unconstitutional for the law to prohibit the import of contraceptives for personal use. The problem of legislating for the distribution, sale, and advocacy of contraceptives remains. It is believed there is now some urgency to change the law since, with the sudden legality of importing contraceptives, there is no means of regulating their distribution. In December 1973, the IFPA received a summons as did the Family Planning Services Ltd. The summonses are to be answered in a Dublin District Court on February 19, 1974. They concern the selling of contraceptives and the distribution of a family planning booklet. PMID:12178323
Abstract Background To determine the prevalence and correlates of prior pregnancy termination and unmet need for contraception among female sex workers (FSWs) in Afghanistan. Methods FSWs in Jalalabad, Kabul, and Mazar-i-Sharif were recruited between June 2006 and December 2007 through outreach programs. Participants completed an interviewer-administered survey describing demographics, behaviors associated with risk of sexually transmitted infections (STIs) and unplanned pregnancy, and medical history. Correlates of prior pregnancy termination and current unmet need for contraception were assessed with logistic regression analysis, controlling for site. Results Of 520 FSWs, most (82.3%) had been pregnant at least once (mean 4.9?±?2.7, range 1–17), among whom unplanned pregnancy (36.9%) and termination (33.2%) were common. Jalalabad participants were more likely to report both prior unplanned pregnancy (60.6% vs. 48.3% in Kabul or 20.7% in Mazar, p?0.001) and prior termination (54.9% vs. 31.8% in Kabul or 26.8% in Mazar, p?0.001). Most FSWs (90.0%) stated pregnancy was not currently desirable, and 85.2% were using contraception. Unmet need for contraception (14.7% of participants) was positively associated with having sold sex outside their city of residence (adjusted odds ratio [AOR] 1.88, 95% confidence interval [CI] 1.28-2.77) and inversely associated with illicit drug use (AOR 0.41, 95% CI 0.31-0.53). Conclusions Although FSWs in Afghanistan report high rates of contraceptive use, unplanned pregnancy is common. Reproductive health services should be included in programming for FSWs to reduce unplanned pregnancies and to reduce HIV/STI risks.
Nasir, Abdul; Raza Stanekzai, Mohammad; Scott, Paul T.; Strathdee, Steffanie A.; Botros, Boulos A.; Tjaden, Jeffrey
No text of the Koran explicitly prohibits birth limitation, and a contraceptive method, coitus interruptus, is even mentioned. Numerous works dealing with contraception and family planning by Islamic physicians attest to the interest of the Islamic world in the subject. Early writings suggest that there was no religious condemnation of fertility control at the beginning of the Islamic era; Muslim theologians did not consider the topic until the 11th century. A 1953 Muslim conference in Cairo concluded that permanent contraception is illicit and a 1969 conference in Riad concluded that all contraceptive methods are illicit, but elsewhere use of contraception has been tolerated or recommended in some circumstances. 2 opposing positions were held on induced abortion, the 1st tolerating abortion in the 1st 120 days of pregnancy before the fetus receives a soul and the 2nd condemning abortion at any stage of pregnancy. In 1984, a Muslim physician informed a UNESCO conference that physical, chemical, and mechanical contraception is tolerated but permanent sterilization is regarded as illicit in the eyes of Islam. The adjunct rector of the Mosque in Paris declared abortion prohibited by Islam except to save the life of the mother. Many Moslem women in France, mainly younger women less strongly influenced by tradition, use oral contraception. They tend to experience a high rate of side effects, apparently reflecting a deep psychic nonacceptance of their sexuality. Others, mainly older multiparas, select IUDs. Spermicides and traditional methods are used less and less. Cultural differences of Moslem women in France should be accepted and family planning education and services for them should be adapted to reflect the differences. PMID:3648968
Background The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs) in Vancouver. Methods The study sample was obtained from a community-based prospective cohort study (2006-2008) of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody), and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4) were examined. Results Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5). The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR): 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3), apprehension (median = 2; IQR:1-4) and adoption (median = 1; IQR:1-2) among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45]), and permanent contraceptives (e.g., tubal ligation and hysterectomy) (OR = 2.76; [95%CI = 1.36-5.59]) were both significantly associated with having five or more pregnancies. Conclusion These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver.
Between 1980 and 2010 there were 1 million homicides in Brazil. Dramatic increases in homicide rates followed rises in inequality, more young men in the population, greater availability of firearms, and increased drug use. Nevertheless, disarmament legislation may have helped reduce homicide rates in recent years. Despite its very high rate of lethal violence, Brazil appears to have similar levels of general criminal victimization as several other Latin American and North American countries. Brazil has lower rates of drug use compared to other countries such as the United States, but the prevalence of youth drug use in Brazil has increased substantially in recent years. Since 1990, the growth of the Brazilian prison population has been enormous, resulting in the fourth largest prison population in the world. Through a systematic review of the literature, we identified 10 studies assessing the prevalence of self-reported offending in Brazil and 9 studies examining risk factors. Levels of self-reported offending seem quite high among school students in Brazil. Individual and family-level risk factors identified in Brazil are very similar to those found in high-income countries.
Murray, Joseph; Cerqueira, Daniel Ricardo de Castro; Kahn, Tulio
National rates of unintended births are a major public health concern. The availability of highly effective long-acting contraceptives has prompted some public officials to promote the coercive use of these methods to reduce such problems as intergenerational poverty and child abuse. Broad-brush public policies that require long-term contraceptive use are unethical. However, persuasion to use these methods can be appropriate. One place for exerting ethically justified influence is in family planning counseling. The dominant nondirective counseling model, which excludes the possibility of vigorous persuasion, is overly rigid. Family planning professionals should develop practice protocols that permit and guide the exercise of directive counseling to use long-acting contraception.
Moskowitz, E; Jennings, B
Reported livebirth prevalence of Down syndrome (DS) may be affected by the maternal age distribution of the population, completeness of ascertainment, accuracy of diagnosis, extent of selective prenatal termination of affected pregnancies, and as yet unidentified genetic and environmental factors. To search for evidence of the latter, we reviewed all published reports in which it was possible to adjust both for effects of maternal age and for selective termination (where relevant).?We constructed indices that allowed direct comparisons of prevalence rates after standardising for maternal age. Reference rates were derived from studies previously identified as having near complete ascertainment. An index value significantly different from 1 may result from random fluctuations, as well as from variations in the factors listed above. We found 49 population groups for which an index could be calculated. Methodological descriptions suggested that low values could often be attributed to underascertainment. A possible exception concerned African-American groups, though even among these most acceptable studies were compatible with an index value of 1. As we have reported elsewhere, there was also a suggestive increase in rates among US residents of Mexican or Central American origin. Nevertheless, our results suggest that "real" variation between population groups reported to date probably amounts to no more than ±25%. However, reliable data in many human populations are lacking including, surprisingly, some jurisdictions with relatively advanced health care systems. We suggest that future reports of DS livebirth prevalence should routinely present data that allow calculation of an index standardised for maternal age and adjusted for elective prenatal terminations.???Keywords: Down syndrome; prenatal diagnosis; maternal age standardisation; epidemiology
Carothers, A.; Hecht, C.; Hook, E.
Contraceptive technology has recently provided the market place with new barrier methods, new progestin oral contraceptives, an injectable contraceptive, the female condom, new male condoms, and the contraceptive implant. During the last decade, epidemiologists have clearly defined the non-contraceptive benefits of current contraceptive methods that include decreased infections, protection from various cancers, protection from many gynecologic problems that lead to surgery, as well as symptomatic relief from many gynecologic conditions. In conjunction with medical specialists, contraceptive researchers have established the increased safety and benefits of various contraceptive choices in women with medical conditions that, until recently, were contra-indications for their use. That these advances have occurred despite multiple legal and scientific assaults gives hope that the field will continue to grow. PMID:8818532
This study analyzes data from the Sri Lanka Fertility Survey not published in the Survey's First Report in order to identify the determinants of contraceptive use and to estimate the births averted by female sterilization, Sri Lanka's main contraceptive m...
The purpose of this study is to investigate the prevalence rate and risk factors of depression in outpatients who were diagnosed with PE. Therefore, between September 2009 and September 2011, 1801 outpatients at andrology clinics were enrolled and consented to participate in our survey by completed a verbal questionnaire. It included the following: (1) demographic data (e.g., age, body mass index), (2) PE duration, medical history, and sexual history, (3) self-estimated intravaginal ejaculatory latency times, (4) the Zung Self-rating Depression Scale (SDS), and (5) the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and (6) the International Index of Erectile Function (IIEF-5). The results showed that a total of 1,206 patients were diagnosed with PE. The prevalence rate of depression in these PE patients was 26.78%. Depression was associated with PE duration, NIH-CPSI score, and IIEF-5 score. Risk factors for depression specifically included PE durations for 13–24, 25–60, or ?61 months, CPSI scores of 15–30 or ?31, and IIEF-5 scores <22. These findings suggested that several associated factors (PE duration, CPSI scores, and IIEF-5 scores) were the risk factors of depression in men with PE.
Zhang, Xiansheng; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun; Liang, Chaozhao
The purpose of this study is to investigate the prevalence rate and risk factors of depression in outpatients who were diagnosed with PE. Therefore, between September 2009 and September 2011, 1801 outpatients at andrology clinics were enrolled and consented to participate in our survey by completed a verbal questionnaire. It included the following: (1) demographic data (e.g., age, body mass index), (2) PE duration, medical history, and sexual history, (3) self-estimated intravaginal ejaculatory latency times, (4) the Zung Self-rating Depression Scale (SDS), and (5) the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and (6) the International Index of Erectile Function (IIEF-5). The results showed that a total of 1,206 patients were diagnosed with PE. The prevalence rate of depression in these PE patients was 26.78%. Depression was associated with PE duration, NIH-CPSI score, and IIEF-5 score. Risk factors for depression specifically included PE durations for 13-24, 25-60, or ?61 months, CPSI scores of 15-30 or ?31, and IIEF-5 scores <22. These findings suggested that several associated factors (PE duration, CPSI scores, and IIEF-5 scores) were the risk factors of depression in men with PE. PMID:23844361
Zhang, Xiansheng; Gao, Jingjing; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun; Liang, Chaozhao
Aim: Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stage. The main objective of the study was to determine the prevalence rate of supernumerary teeth in the patients who reported to the Department of Oral Medicine and Radiology and to study the associated clinical complications. Materials and Methods: A longitudinal observational study was conducted of 2216 patients for a period of 4 months with the documentation of demographic data, the presence of supernumerary teeth, their location, and associated complications such as mechanical trauma, dental caries, and associated pathology. Results: The study recorded 27 supernumerary teeth from the examined 2216 patients. This yields a prevalence of 1.2%, with greater frequency in males which was 1.49% and in females the frequency was 0.85%. The greatest proportion of supernumerary teeth was found in the maxillary anterior region (77.8%). Out of this, 85.7% were classified as mesiodens based on their location. The displacement of adjacent teeth was the most common finding, followed by dental caries. Conclusion: The prevalence of supernumerary teeth in this study was 1.2% which is in agreement with that reported in similar studies and the maxillary mesiodens was the most common location. Displacement of adjacent teeth was the most common finding.
Mahabob, M. Nazargi; Anbuselvan, G. J.; Kumar, B. Senthil; Raja, S.; Kothari, Sucitha
A systematic electronic PubMed, Medline and Web of Science database search was conducted regarding the prevalence, correlates, and effects of personal stigma (i.e., perceived and experienced stigmatization and self-stigma) in patients with schizophrenia spectrum disorders. Of 54 studies (n=5,871), published from 1994 to 2011, 23 (42.6%) reported on prevalence rates, and 44 (81.5%) reported on correlates and/or consequences of perceived or experienced stigmatization or self-stigma. Only two specific personal stigma intervention studies were found. On average, 64.5% (range: 45.0-80.0%) of patients perceived stigma, 55.9% (range: 22.5-96.0%) actually experienced stigma, and 49.2% (range: 27.9-77.0%) reported alienation (shame) as the most common aspect of self-stigma. While socio-demographic variables were only marginally associated with stigma, psychosocial variables, especially lower quality of life, showed overall significant correlations, and illness-related factors showed heterogeneous associations, except for social anxiety that was unequivocally associated with personal stigma. The prevalence and impact of personal stigma on individual outcomes among schizophrenia spectrum disorder patients are well characterized, yet measures and methods differ significantly. By contrast, research regarding the evolution of personal stigma through the illness course and, particularly, specific intervention studies, which should be conducted utilizing standardized methods and outcomes, are sorely lacking. PMID:23737425
Gerlinger, Gabriel; Hauser, Marta; De Hert, Marc; Lacluyse, Kathleen; Wampers, Martien; Correll, Christoph U
A systematic electronic PubMed, Medline and Web of Science database search was conducted regarding the prevalence, correlates, and effects of personal stigma (i.e., perceived and experienced stigmatization and self-stigma) in patients with schizophrenia spectrum disorders. Of 54 studies (n=5,871), published from 1994 to 2011, 23 (42.6%) reported on prevalence rates, and 44 (81.5%) reported on correlates and/or consequences of perceived or experienced stigmatization or self-stigma. Only two specific personal stigma intervention studies were found. On average, 64.5% (range: 45.0–80.0%) of patients perceived stigma, 55.9% (range: 22.5–96.0%) actually experienced stigma, and 49.2% (range: 27.9–77.0%) reported alienation (shame) as the most common aspect of self-stigma. While socio-demographic variables were only marginally associated with stigma, psychosocial variables, especially lower quality of life, showed overall significant correlations, and illness-related factors showed heterogeneous associations, except for social anxiety that was unequivocally associated with personal stigma. The prevalence and impact of personal stigma on individual outcomes among schizophrenia spectrum disorder patients are well characterized, yet measures and methods differ significantly. By contrast, research regarding the evolution of personal stigma through the illness course and, particularly, specific intervention studies, which should be conducted utilizing standardized methods and outcomes, are sorely lacking.
Gerlinger, Gabriel; Hauser, Marta; De Hert, Marc; Lacluyse, Kathleen; Wampers, Martien; Correll, Christoph U
Stroke is a devastating disease affecting millions of people worldwide every year. Female stroke victims have higher mortality rates and they do not re-cover as well as men. Women's longevity and different vascular risk factor burden like a larger prevalence of atrial fibrillation play a role. Women also have unique risk factors such as oral contraception, pregnancy, estrogen decrease after the menopause and hormone replacement therapy, which should all be evaluated and taken into consideration in treatment decisions both in the acute phase of stroke and in secondary prevention. In this review, the evidence regarding these hormonal aspects and the risk of stroke in women are evaluated. The relevant guidelines are studied and research gaps identified. Future topics for research are recommended and current treatment possibilities and their risks discussed. PMID:22724472
Rantanen, Kirsi; Tatlisumak, Turgut
|Background: The Netherlands are lacking reliable national empirical data in relation to the development of birth prevalence of Down syndrome. Our study aims at assessing valid national live birth prevalence rates for the period 1986-2007. Method: On the basis of the annual child/adult ratio of Down syndrome diagnoses in five out of the eight…
de Graaf, G.; Haveman, M.; Hochstenbach, R.; Engelen, J.; Gerssen-Schoorl, K.; Poddighe, P.; Smeets, D.; van Hove, G.
At this time, private research efforts to discover new contraceptives are threatened. Drug companies, particularly in the US, have reduced their interest in contraceptive development due to concern over the rising cost of product liability insurance, the cost of lawsuits in defense of liability claims, and the fear of extremely high awards by juries in product liability cases. The current form of private-public collaboration, now threatened by the liability crisis, works under a few simple principles of agreement. Private industry agrees to supply its patented chemical compounds for assessment as contraceptive agents, to be willing to enter into negotiations with public sector organizations to develop the contraceptive drugs if initial tests warrant it, and to release compounds to another company if the patent-holder declines to proceed with contraceptive development. The public-sector program agrees to fund the studies, keep the industry informed, and maintain confidentiality. When the technology is discovered by the public sector and is of potential interest to private industry, the collaboration involves other issues. The public agency agrees to supply manufacturing know-how and all biological and clinical information, to license under applicable patents, and to permit cross reference to regulatory agency filings. Private industry agrees to use its best efforts to bring the product to market, to manufacture the product at reduced cost for public sector use, or to provide know-how for others to do so. It also agrees to assume product liability and to grant the public sector agency licenses to any patented improvement in its product. Contraceptive research both within and outside the US is feeling the effects of the US litigious atmosphere. Companies from abroad now wish to steer clear of contraceptive research, even though these companies would be prepared to meet the requirements of the Food and Drug Administration. Contraceptives, considered to be high risk targets for lawsuits, are receiving little of the research budgets of pharmaceutical companies. Opposition anti-abortion forces also has had an effect. When the Population Council received new drug approval for the Copper-T-200, it was the 1st time the FDA had issued approval to a noncommercial sponsor. This unprecedented event established a new phase in the cooperative efforts between industry and the nonprofit sector to develop contraceptive products. It showed that given adequate funding, nonprofit agencies can carry out full product development, including the initial regulatory agency clearances. PMID:12341234
Segal, S J; Coutinho, E
\\u000a Today, diabetic women have an increasing variety of safer and effective contraceptive methods. While more contraceptive trials\\u000a in diabetic women are needed, data from existing studies and extrapolation from clinical trials in healthy women support the\\u000a use of most contraceptive methods. This chapter will review contraception in women with type 1 (DM1) and type 2 (DM2) diabetes\\u000a mellitus, with or
Siri L. Kjos
Reports in the contraceptive literature and our own data concerning the MLCu375 intrauterine device indicate that the high-load ML model is effective, safe, and well tolerated. It is more effective than the MLCu250 without increase in the other cardinal event rates. Consequently, we consider the MLCu375 an improved ML model.
M. Thiery; H. Van Der Pas; H. Van Kets
Although the ideal contraceptive has not been found, intrauterine contraceptive devices offer distinct advantages and provide adequate contraception. Unfortunately, they have side-effects, complications and failures. Their use is contraindicated in pregnancy, abnormalities of the uterine cavity, uterine hypoplasia, infection and abnormal uterine bleeding. Patients who have had an ectopic pregnancy, who are prone to endocarditis, who have allergies to copper, or who are taking anticoagulants also should not use IUCDs, Insertion is best performed during menstruation, and the patient should be seen in follow up to assess placement and any side-effects, including cramps, bleeding, vaginal discharge, or discomfort during intercourse. Pregnancy may occur when the IUCD is in place, and prompt diagnosis is mandatory. Depending on the type of IUCD used, replacement time varies from one to three years.
BACKGROUND: Almost two thirds of Iranians eligible for using contraceptive methods use these methods. Their dissatisfaction with the methods would directly and indirectly affect the quality of family planning services and would bring about detrimental results for the service recipients and consequently for other family members. Therefore, identification and evaluation of the factors leading to dissatisfaction with contraceptive methods can help the authorities responsible for family planning services to provide some solutions to increase satisfaction with these methods. METHODS: This research was a qualitative phenomenological study. The study population consisted of the women using intrauterine device (IUD) or contraceptive pills only as contraception, referred to 14-Masoum, Amir Hamzeh, Ebn-e Sina, Shahid Motamed, and Navab Safavi clinical centers. Sampling was goal-based, and 14 individuals participated in the study. Data collection was carried out in four months using deep interview. Data analysis was performed using seven-step Colaizzi's method. RESULTS: The findings of the interviews were assigned 104 codes categorized into three groups; 1- physical and psychological harms experienced by the method, 2- the shortcomings of the methods, and 3- continuation in spite of dissatisfaction with the method. CONCLUSIONS: According to the results, the users of contraceptive methods would have some experiences, which lead to their dissatisfaction with the methods. Since dissatisfaction with the methods will result in a decrease in continuation of use of the methods or discontinuation of the method, providing some policies to increase the satisfaction with contraceptive methods can cause more effective use of the methods and continuation of their use.
Fathizadeh, Nahid; Salemi, Parisa; Ehsanpour, Soheila
Objective To develop new methods for estimating the sputum smear-positive tuberculosis case detection rate (CDR) in a country where infection with HIV is prevalent. Methods We estimated the smear-positive tuberculosis CDR in HIV-negative and HIV-positive adults, and in all adults in Kenya. Data on time trends in tuberculosis case notification rates and on HIV infection prevalence in adults and in
Brian Williams; Suzanne Scheele; Katherine Floyd; Christopher Dye; Joseph Sitienei
Contraception can reduce the dual burden of high fertility and high HIV prevalence in sub-Sahara Africa, but significant barriers remain regarding access and use. We describe factors associated with nonuse of contraception and with use of specific contraceptive methods in HIV positive and HIV negative Rwandan women. Data from 395 HIV-positive and 76 HIV-negative women who desired no pregnancy in the previous 6 months were analyzed using univariate and multivariate logistic regression models to identify clinical and demographic characteristics that predict contraceptive use. Differences in contraceptive methods used were dependent on marital/partner status, partner's knowledge of a woman's HIV status, and age. Overall, condoms, abstinence, and hormonal methods were the most used, though differences existed by HIV status. Less than 10% of women both HIV+ and HIV? used no contraception. Important differences exist between HIV-positive and HIV-negative women with regard to contraceptive method use that should be addressed by interventions seeking to improve contraceptive prevalence.
Adedimeji, Adebola A.; Hoover, Donald R.; Shi, Qiuhu; Cohen, Mardge H.; Gard, Tracy; Anastos, Kathryn
National prevalence estimates of scoliosis in adults, based on the reading of 6594 chest X-rays from the first National Health and Nutrition Examination Survey, are presented by age, sex and race. Among US adults aged 25-74 years in 1971-75, the prevalence rate of scoliosis was 8.3%. The prevalence of scoliosis increased across age groups among women (p less than 0.001), but not among men. Women had about twice the prevalence of scoliosis as men; 10.7% versus 5.6% (p less than 0.001). Because scoliosis prevalence rates differed by age and sex, prevalence rates and means for scoliosis status subgroups were adjusted for age and sex. Blacks had a higher rate, although not statistically significant (using alpha = 0.10), of scoliosis than whites: 9.7% versus 8.1%. Bone density of the radius was lower for scoliotics than for non-scoliotics: (287.0 versus 294.0 aluminum equivalency units, p less than 0.001), suggesting a possible association between scoliosis and osteoporosis. The percentage with delayed menarche was higher for scoliotics than non-scoliotics: 37.8 versus 30.8% (p = 0.01). Scoliotic women also had a lower mean age of menstruation termination than non-scoliotic women: 43.4 years versus 44.8 years (p = 0.07). This is the first study to present national prevalence estimates for scoliosis among adults in the US. PMID:3501989
Carter, O D; Haynes, S G
Contraceptive vaginal rings (CVR) offer a new, effective contraceptive option, expanding the available choices of hormonal contraception. Various ring prototypes have been evaluated: progestin-only rings and combined progestin-estrogen rings, as well as different combination of progestins and estrogens. The progestin-only ring is intended for continuous use, whereas the combined ring has been designed for cyclic 3-week in/1-week out use, although several studies have explored alternative schemes of extended use. However, only two ring designs have reached the market: NuvaRing, a 1-month combined ring that releases etonogestrel and ethinylestradiol, and Progering, a 3-month progesterone-releasing ring for use in lactating women. A one year Nestorone/ethinyl estradiol CVR is approaching the final stages of development, as the Population Council is preparing to submit a new drug application to the Food and Drug Administration. The main advantages of CVRs are their effectiveness (similar or slightly better than the pill), ease of use without the need of remembering a daily routine, user ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring, in comparison with oral contraceptives. Current prototypes in development include rings releasing progesterone receptor modulators, which would provide estrogen-free contraception, as well as combined rings releasing estradiol, instead of ethinyl-estradiol, providing a safer profile. Furthermore, intensive efforts towards developing dual protection rings, providing both contraception and protection against reproductive tract infections, offer hope that this greatly needed technology will soon undergo clinical testing and will be in the hands of women worldwide in the near future. PMID:23040125
Brache, Vivian; Payán, Luis José; Faundes, Aníbal
Oral contraceptives remain a popular method of contraception over 50 years after their introduction. While safe and effective for many women, the failure rate of oral contraception is about 8%. Concerns about the risk of venous thromboembolism continue to drive the search for the safest oral contraceptive formulations. The oral contraceptive NOMAC-E2 contains nomegestrol acetate (NOMAC) 2.5 mg + 17b-estradiol (E2) 1.5 mg. The approved dosing regimen is 24 days of active hormone, followed by a 4-day hormone-free interval. NOMAC is a progestin derived from testosterone, which has high bioavailability, rapid absorption, and a long half-life. Estradiol, though it has a lower bioavailability, has been successfully combined with NOMAC in a monophasic oral contraceptive. Two recently published randomized controlled trials demonstrate that NOMAC-E2 is an effective contraceptive, with a Pearl Index less than one pregnancy per 100 woman-years. The bleeding pattern on NOMAC-E2 is characterized by fewer bleeding/spotting days, shorter withdrawal bleeds, and a higher incidence of amenorrhea than the comparator oral contraceptive containing drospirenone and ethinyl estradiol. The adverse event profile appears to be acceptable. Few severe adverse events were reported in the randomized controlled trials. The most common adverse events were irregular bleeding, acne, and weight gain. Preliminary studies suggest that NOMAC-E2 does not seem to have negative effects on hemostatic and metabolic parameters. While no one oral contraceptive formulation is likely to be the optimum choice for all women, NOMAC-E2 is a formulation with effectiveness comparable with that of other oral contraceptives, and a reassuring safety profile.
The fact that oral contraceptives may predispose to thrombosis is not disputed, although its frequency is still debated. Any reliable assessment of the prevalence of this complication must in the main depend on careful statistical studies of well controlled groups, because the isolated case may well be coincidental when conditions such as coronary thrombosis, cerebral thrombosis, and pulmonary embolism are not extreme rarities in adult women. However, occasionally the clinical and pathological findings are so striking that they afford compelling evidence. The patient to be described presented with clinical features of pancreatitis that did not initially suggest an association with oral contraception. A hitherto undescribed state of multiple infarcts was found at post-mortem. This also illustrates the way in which the official figures for thrombotic complications can be underestimated. ImagesFig. 1
Foster, M. E.; Powell, D. E. B.
The aim of the study was to determine the level of awareness of emergency contraception in women seeking pregnancy counselling and to investigate their attitudes towards emergency contraception. All women presenting for pregnancy counselling at a Melbourne women's health clinic in October 1997 were invited to complete a questionnaire detailing their contraceptive practices. One hundred and sixty-six questionnaires were distributed and 153 were completed (92% response rate). The majority of this sample population had heard of some form of emergency contraception and knew where to access it. However only 26% knew that emergency contraception should be taken within 72 hours of unprotected intercourse. Although 80% of the sample had heard of emergency contraception (or the morning after pill) only 9% used it in an attempt to prevent this pregnancy. The majority of the women surveyed support the increased availability of emergency contraception by rescheduling it to a non-prescription item and re-packaging as a single treatment. PMID:10687764
McDonald, G; Amir, L
Drug companies have been at work throughout the 1960s, 1970s, and 1980s trying to reduce the steroid content of their oral contraceptives (OCs). Researchers have been successful in reducing steroid content while maintaining effectiveness, thereby making OCs safer. In the 1st half of the natural menstrual cycle, a woman secretes estrogen as the dominant steroid product. In the 2nd half, estrogen is the principal reproductive hormone. Estrogens inhibit ovulation, possibly by inhibiting implantation, altering ovum transplant, or in some way preventing corpus luteum function, which is necessary to maintain early pregnancies and the endometrium. There are still only 2 estrogens and 6 progestins on the market today. They are probably the most thoroughly studied chemical ever seen in the history of pharmacy or medicine. 1 of the estrogens, mestranol, is really a drug of the past. In the body, mestranol is converted to ethinyl estradiol, the other estrogen on the market. Consequently, there is no reason to use mestranol itself. Within the dose range of 50-100 mcg, there's little difference in contraceptive effect. Progestins are the other active ingredient in the combination OC. Their principal action is the thickening of the cervical mucus, which prevents sperm penetration. Also, with sufficient progesterone, ovulation is inhibited, but this happens in only 40% of those patients taking, for instance, the "mini-pill" (which consists of progesterone only). The progestins and the estrogens work in concert to make OCs a highly effective contraceptive method. Recent surveys conducted by the Centers for Disease Control and National Cancer Institute looked into the relative effectiveness of OCs. Nordette had a use effectiveness failure rate of 3.5; Ovral, 3.6. Loestrin 1/20 -- norethindrone acetate, 1 mg, and estinyl estradiol, 20 mcg -- shows a failure rate of 4.5. This indicates that the threshold for an effective dose of estinyl estradiol in OCs is 30 mcg. For 1 mini-pill, Ovrette, the failure rate is 9.5 -- much higher. Depo-Provera has a failure rate of 0.7. The primary complaint from women taking OCs is spotting and breakthrough bleeding during the cycle. 30-50% of women given OCs stop taking them within a year. OC side effects include nausea, fluid retention, breast tenderness, leukorrhea, hypomenorrhea, headaches, spotting around the face, hypertension, and visual changes. 1 of the risks of birth control pills may be cervical dysplasia -- changes in the cells of the cervix. The relative risk of cervical cancer with OCs after 5-9 years is approximately 1.8. Clinical cases of deep vein thrombosis number 1/1000 per year among nonusers of OCs. Among users, the rate is 3 times as high: 3/1000. The most serious potential adverse effect is myocardial infarction. Of the excess deaths attributed to OCs (23.3 total per 100,000 users), 22.7 are due to myocardial infarctions and hemorrhage. The discussion also briefly reviews other methods of contraception -- Depo-Provera, male contraceptives, implants, the diapragm, and IUDs. PMID:4050670
Ruggiero, R J
Contraception counselling should be an integral part of any adolescent or adult congenital heart disease program. Both the cardiovascular safety and contraceptive efficacy of each contraceptive method should be considered for each cardiac condition. The method recommended should combine acceptability to the woman with the highest efficacy and safety profile. Agent with low dose estrogen combined with varying amounts of progestin referred to as combined oral contraceptives is one of the most effective contraception and is the most used in France. But the thrombogenicity of the estrogen component of combined hormonal contraceptives makes this method unsuitable for many women with severe congenital heart disease. Progestogin only methods offer a good alternative when estrogen is contraindicated, but efficiency differs according contraceptive preparation. PMID:23687768
Ladouceur, Magalie; Cohen, Sarah; Bidet, Maud; Legendre, Antoine; Iserin, Laurence
Background The widespread increase in the use of contraception, due to multiple factors including improved access to modern contraception, is one of the most dramatic social transformations of the past fifty years. This study explores whether the global progress in the use of modern contraceptives has also benefited the poorest. Methods and Findings Demographic and Health Surveys from 55 developing countries were analyzed using wealth indices that allow the identification of the absolute poor within each country. This article explores the macro level determinants of the differences in the use of modern contraceptives between the poor and the national averages of several countries. Despite increases in national averages, use of modern contraception by the absolute poor remains low. South and Southeast Asia have relatively high rates of modern contraception in the absolute poor, on average 17% higher than in Latin America. Over time the gaps in use persist and are increasing. Latin America exhibits significantly larger gaps in use between the poor and the averages, while gaps in sub-Saharan Africa are on average smaller by 15.8% and in Southeast Asia by 11.6%. Conclusions The secular trend of increasing rates of modern contraceptive use has not resulted in a decrease of the gap in use for those living in absolute poverty. Countries with large economic inequalities also exhibit large inequalities in modern contraceptive use. In addition to macro level factors that influence contraceptive use, such as economic development and provision of reproductive health services, there are strong regional variations, with sub-Saharan Africa exhibiting the lowest national rates of use, South and Southeast Asia the highest use among the poor, and Latin America the largest inequalities in use.
Gakidou, Emmanuela; Vayena, Effy
OBJECTIVE:: To promote the use of long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and implants) and provide contraception at no cost to a large cohort of participants in an effort to reduce unintended pregnancies in our region. METHODS:: We enrolled 9,256 adolescents and women at risk for unintended pregnancy into the Contraceptive CHOICE Project, a prospective cohort study of adolescents and women desiring reversible contraceptive methods. Participants were recruited from the two abortion facilities in the St. Louis region and through provider referral, advertisements, and word of mouth. Contraceptive counseling included all reversible methods but emphasized the superior effectiveness of LARC methods (IUDs and implants). All participants received the reversible contraceptive method of their choice at no cost. We analyzed abortion rates, the percentage of abortions that were repeat abortions, and teenage births. RESULTS:: We observed a significant reduction in the percentage of abortions that were repeat abortions in the St. Louis region compared with Kansas City and nonmetropolitan Missouri (P<.001). Abortion rates in the CHOICE cohort were less than half the regional and national rates (P<.001). The rate of teenage birth within the CHOICE cohort was 6.3 per 1,000, compared with the U.S. rate of 34.3 per 1,000. CONCLUSION:: We noted a clinically and statistically significant reduction in abortion rates, repeat abortions, and teenage birth rates. Unintended pregnancies may be reduced by providing no-cost contraception and promoting the most effective contraceptive methods. LEVEL OF EVIDENCE:: II. PMID:23037916
Peipert, Jeffrey F; Madden, Tessa; Allsworth, Jenifer E; Secura, Gina M
Despite high rates of unintended pregnancy among women aged 18 to 30 years, little research has been conducted to understand the factors associated with their contraceptive use. Eighteen focus groups were conducted with young adult women (N = 106) who were mostly white, non-Hispanic. Results suggested that contraceptive use was negatively affected by low contraceptive knowledge; use of alcohol; a
Shelly Campo; Natoshia M. Askelson; Erica L. Spies; Mary Losch
During the first decades of the 20th century, many Swedish women were severely injured or died in complications following illegal abortions. Since legal abortion was forbidden, contraceptives were the only way to avoid pregnancy. But in the year 1910, a new Swedish law "Preventivlagen" prohibited any kind of advertising och public information considering contraceptives. They could still be sold in pharmacies or special medical stores, but it was no longer allowed to speak publicly about contraceptives in a leading manner. The punishment for disobeying was prison or fines. Some physicians and people involved in women liberation, public health and/or public education, claimed that the law brought negative medical, social and economic consequences, while others opposed the law being too soft. The law made the more than 100 years old question about contraceptives or not, a part of the medical, political and social agenda for the society. Some argument against contraceptives was concerned about the decreasing nativity rate--more use of contraceptives could make an even worse situation. Another reason was the fear of an increasing promiscuity if the contraceptives were more available. Still, many physicians and womens liberators did not se this as any big and important problems. They were more concerned about the women's health and her right to give birth to children at the time she wanted. Women had their right to be in charge of their lives, and should no longer be seen as victims of their biological nature. The right to contraceptives was not the only topic to be discussed during the late 19th century and the first decades of the 20th century. Another central right to be claimed, was the possibility for people, especially young people, to be educated in sexual questions. Many women and also women physicians fought for young peoples right to this information. The law "Preventivlagen" was abolished in 1938. After that, women hade their legal right to choose for themselves at what time they wanted to get pregnant and also the number of children. PMID:18548951
Charchafche, Helena; Nilsson, Peter M
Objective: To evaluate the relationship between estimated glomerular filtration rate (eGFR) and cardiometabolic risk factors (CMRF) in an outpatient pediatric population with high prevalence of obesity. Design and Methods: eGFR was evaluated in 901 children unselected for chronic kidney disease (CKD) of whom 694 were overweight/obese (6-16 years) and 207 were age- and sex- matched normal weight (NW). We generated three categories of eGFR: mild-low eGFR (< 20(th) percentile), high eGFR (>80(th) percentile) and intermediate eGFR (20-80(th) percentile), considered as the reference category Results: Children with either mild-low or high eGFR category showed a 2-4 fold higher Odds ratio of high blood pressure, left ventricular hypertrophy and microalbuminuria compared with children of the intermediate eGFR category. In addition, children with mild-low eGFR levels showed a 1.5-2 fold higher Odds ratio of impaired fasting glucose and high white blood cell count compared with children with intermediate eGFR levels. Conclusions: In outpatient children with high prevalence of obesity, children with either mildly reduced or high eGFR have an increased burden of CMRF. Children with eGFR <97 mL/min/1.73 m(2) show a worse CMR profile. This finding supports the usefulness to assess eGFR to identify children with unfavorable CMR profile. PMID:23616281
Di Bonito, Procolo; Sanguigno, Eduardo; Forziato, Claudia; Di Fraia, Teresa; Moio, Nicola; Cavuto, Luigi; Sibilio, Gerolamo; Iardino, Maria Rosaria; Di Carluccio, Carla; Capaldo, Brunella
Lactation's contraceptive effect cannot be relied upon for more than 6 weeks postpartum, and ovulation often occurs in advance of the 1st postpartum menstrual period. Although breastfeeding mothers should adopt a contraceptive method, care must be taken to select a method that will not adversely affect the production and composition of breast milk. Of greatest concern is the effect of synthetic hormones transmitted via breast milk on the developing infant. Possible alternatives are the Billings ovulation detection natural family planning method, diaphragms and caps, IUDs, and sexual sterilization. While combined oral contraceptives (OCs) are contraindicated because of their harmful effects on the fat and protein composition of breast milk and on milk production, the progestogen-only OC does not appear to interfere with the quality of breast milk and less than 0.1% of the progestogen passes on to the infant. Depo-Provera, and other injectable progestogens, appear to be appropriate for breastfeeding women, although the 1st injection should be postponed until 6 weeks postpartum to reduce the likelihood of heavy bleeding. Under investigation is a nasal spray containing buserelin, a luteinizing hormone-releasing hormone agonist, that shows promise as a reliable, acceptable, and easily administered nonsteroidal contraceptive that does not interfere with lactation. A biodegradable buserelin implant, which would last as least 3 months, also is being developed and would be especially useful in developing countries where storage of a nasal spray might be problematic. PMID:3650668
Dewart, P J; Loudon, N B
Hormonal emergency contraception (EC) is engendering fierce moral disagreement that is bleeding over into politics and policy. This paper considers Catholic positions on this issue, as they are the fullest and best developed. Its most extreme opponents, such as representatives of the Vatican, hold that EC is an abortifacient that should be banned. Moderates like Sulmasy believe that it should
|Abstinence-based sexuality education includes a discussion about the various types of contraception available today. This lesson addresses the knowledge and skills identified in the National Health Education Standards, and can be used with two different audiences-students and teachers. Included in the lesson are step-by-step procedures, a…
Ellis, Edith B.; Miller, Deborah A.
This paper presents data on financial support of the reproductive sciences and contraceptive development assembled in the course of a two-year review of research funding by an international group of scientists and scientific administrators. Until the mid-1960s, research in reproduction was supported primarily by university budgets, philanthropic funds, and pharmaceutical firms. This research received only an insignificant share of the
O. Harkavy; F. S. Jaffe; Marjorie A. Koblinsky; S. J. Segal
Sexually transmitted AIDS represents 72-82% of the cases reported. While the proportion of cases transmitted heterosexually is still small (7%), this will increase over time (it was only 1% in 1981). Heterosexual AIDS affects 4 times more women than men and occurs essentially in partners of HIV+ subjects, those with AIDS, and subjects at high risk. Many in vitro and in vivo studies have shown that the correct and systematic use of condoms is the sole means of preventing sexual AIDS. In vitro spermicides (nonoxynol-9 and benzalkonium chloride) inactivate the HIV virus. Having many sexual partners, rectal contact, and the STDs increase the risk of HIV transmission. Only mutual monogamy and sexual relations between seronegative subjects (taking into account the serological lag period of a few weeks to 6 months) are safe. In all other cases, it is necessary to systematically use a good quality condom (along with a spermicide), even if other contraception is used, avoid anal contact, and decrease the number and improve the selectivity of sexual partners if possible. Heterosexual males and females at high risk of HIV infection should use an effective method of contraception (the oral contraceptive) in addition to condoms. According to WHO, IUDs are not recommended. Seropositive heterosexuals or those affected by AIDs should abstain from all sexual contact involving penetration, whether vaginal, anal, or oral. They should use the same contraception as high risk heterosexuals. The WHO is undertaking research programs on possible beneficial or detrimental interactions between the modern methods of contraception and HIV infection. PMID:12282189
Objectives To update UK studies begun in the early 1990s on the annual prevalence and incidence rates of autism in children; undertaken in response to a March 2012 press release, widely covered by the media, from the US Centre for Disease Control (CDC) reporting that the autism prevalence rate in 2008 in 8-year-old US children was 1 in 88, a 78% increase from a CDC estimate in 2004. This finding suggested a continuation of the dramatic increase in children diagnosed as autistic, which occurred in the 1990s. Design Population study using the UK General Practice Research Database (GPRD). Methods Annual autism prevalence rates were estimated for children aged 8?years in 2004–2010 by dividing the number diagnosed as autistic in each or any previous year by the number of children active in the study population that year. We also calculated annual incidence rates for children aged 2–8?years, by dividing the number newly diagnosed in 2004–2010 by the same denominators. Results Annual prevalence rates for each year were steady at approximately 3.8/1000 boys and 0.8/1000 girls. Annual incidence rates each year were also steady at about 1.2/1000 boys and 0.2/1000 girls. Conclusions Following a fivefold increase in the annual incidence rates of autism during the 1990s in the UK, the incidence and prevalence rates in 8-year-old children reached a plateau in the early 2000s and remained steady through 2010. Whether prevalence rates have increased from the early 2000s in the USA remains uncertain.
Taylor, Brent; Jick, Hershel; MacLaughlin, Dean
Humans have tried to control fertility for centuries. Primitive, preliterate societies practiced infanticide and abortion. When primitive women understood the advantages of conception control, they tried, when possible, to use contraception. In the 4th century B.C., Plato and Aristotle advocated a one-child family. Greek medical literature reported a hollow tube inserted through the cervix into the uterus and a potion as contraceptives. Islamic physicians had much knowledge about conception control. The attitudes toward contraception. In the 5th century B.C., Saint Augustine condemned contraception, even among married couples. The condom emerged in the early modern period. Yet, they were usually worn to protect against disease, e.g., bilharzia in Egypt and syphilis in Europe. The cervical cap and the diaphragm are examples of occlusive pessaries. By 1880, contraceptives and spermicides were advertised. In 1928, the IUD joined the existing contraceptives. Today we have combined oral contraceptives. Judaic law requires husbands to fulfill their wives sexual needs, separate from their duty to procreate. It also calls men, not women, to procreate and forbids men from masturbating, thus Judaic law does not forbid women from practicing contraception. The Roman Catholic church forbids contraceptive use because it is a sin against nature. Some Protestant denominations have allowed contraceptive use. Islamic law states that children are gifts from Allah. Some Moslems believe that they must have many children, but Allah and the Prophet state that children have rights to education and future security. These rights allow couples to prevent pregnancy. Neither Hinduism nor Buddhism prohibit contraceptive use. Differences in husband-wife communication, sex roles, access to contraceptives, and traditional family values will have more of an effect on contraceptive use and fertility than theological barriers or the social class of religious groups. PMID:8365507
Schenker, J G; Rabenou, V
Oral contraceptive steroids play a major role in modern family planning. With the present tendency to decrease the doses of both estrogens and progestogens, any factor that reduces the bioavailability of the lower-dose preparations may have an impact on contraceptive protection. Although ethinyl estradiol, the most commonly used oral estrogen, is liable to an enterohepatic circulation as unchanged drug, the commonly used progestogens are not. At present, no convincing evidence exists in the human subject that disruption of the enterohepatic circulation by antibiotics or antacids does reduce contraceptive efficacy of the pill. Oral contraceptive steroids are mainly absorbed from the small bowel, and contraceptive efficacy depends on its absorptive capacity. Enhanced passage of gastrointestinal contents or impaired absorption may thus contribute to contraceptive failures in patients who have chronic inflammatory disease, diarrhea, ileostomy, or jejunoileal bypass. PMID:2256527
Hanker, J P
The choice of a contraceptive drug can be challenging for women with epilepsy due to possible interactions between antiepileptic drugs (AEDs) and hormonal contraception. Enzyme-inducing AEDs can cause hormonal contraception to fail and can increase the risk of teratogenicity. Higher doses of oral contraceptives can overcome pharmacologic failure but may create additional risks. The effects of reproductive hormones on individual AEDs have recently been clarified, providing helpful guidelines for physicians and patients. Studies show that lamotrigine has a significantly increased clearance (> 50%) when used with combined oral contraceptives, which results in an increased seizure frequency in most patients. Useful alternatives to oral contraceptives include depot injections and intrauterine devices. Subdermal implants may increase the risk of pregnancy in women with epilepsy on enzyme-inducing AEDs. Depot medroxyprogesterone acetate is effective but can increase side effects. Intrauterine devices are an alternative to pharmacologic approaches because they lack drug-drug interactions and side effects. PMID:19587632
Burakgazi, Evren; Harden, Cynthia; Kelly, John J
A relatively new multivariate life-table technique has permitted the effect of socioeconomic characteristics on first-year contraceptive failure rates to be determined to a greater degree of precision than was possible in the past. This technique is employed in this article to determine the one-year rates of contraceptive discontinuation among currently married U.S. women, using data from the 1973 and 1976 National Surveys of Family Growth (NSFG). The results indicate that poor women, black women and younger women are all relatively more likely to stop using contraceptives for reasons other than method-switching or the desire to become pregnant, as are women who have not completed high school, Catholic women and those who have never had a birth. Of all methods, the IUD is associated with the lowest rate of discontinuation. Pill users over age 30 are more likely to stop using their method than are comparable women using the IUD, diaphragm or condom. Women relying on spermicides are generally most likely to cease using a method. Finally, the subgroups of women who are most likely to stop using a particular method also are generally the groups that are most likely to experience contraceptive failures, while those that are least likely to discontinue use are also least likely to fail. Two exceptions are women who rely on rhythm and those who use the pill. The former experience relatively high rates of failure but are relatively less likely to stop using the method, and the latter have relatively high rates of discontinuation despite a low rate of failure. PMID:6714376
Hammerslough, C R
Oral contraceptives (OCs) and surgery are both recognized risk factors for thromboembolism. Observation of a postoperative deep venous thrombosis and pulmonary embolism in a 21-year-old OC user prompted the authors to define the risk of OC use in surgical patients through a review of the literature. The patient had no other relevant risk factors except a moderate smoking habit. Surgery increases risk of thromboembolism because of the postoperative hypercoagulation state with declines in AT III, elevation of fibrinogen and products of degradation of fibrin, decline of plasminogen, and elevation of antiplasmin. The risks are greater in the immobile postsurgical phase and are increased as well by direct vascular lesions during surgery. Estimates of rates of deep venous thrombosis are very variable according to different authors because of the difficulties of diagnosis, heterogeneity of risk factors encountered, and variety of prophylactic methods employed. The most thrombogenic surgery is believed to be that on the legs; 1 literature review produced a range of estimates from 45-70% without prophylaxis and with 2% involving fatal pulmonary emboli. Another study estimated the risk of deep venous thrombosis at 2% for young subjects in good health undergoing minor surgery lasting less than 30 minutes and at 10-40% for subjects over 40 undergoing moderately serious general surgical procedures. No ideal method of prevention has been found that is well accepted by patients, nurses, and physicians. OC use entails multiple physiopathologic modifications including among others alterations of the vascular walls with endothelial proliferation and/or thickening of the media, increased blood viscosity, hyperaggregability of platelets, and increases in certain coagulation factors. Synthetic estrogens play the major role in modifications but progestins diminish venous tone and increase stasis. Large epidemiologic studies in the US and Great Britain found a significantly increased thromboembolic risk in OC users beginning in the 1st month of use and persisting until 3-4 weeks after termination of treatment. Most authors believe that OC use increases the postsurgical risk of thromboembolism by a factor of about 3. More selective choice of OC users, reduced estrogen doses, and better surveillance of users appear to have diminished the risk of thromboembolic disease with OC use. But unfortunately there are no sure predictors of thromboembolic disease. All authors recognize the reversibility of modifications caused by OCs on hemostasis by 4 weeks after termination. If therefore is recommended that OC use be interrupted 1 cycle before surgery. PMID:2691023
Houssel, P; Gouezec, H; Malledant, Y; Nolain, E; Le Bouquin, V; Orain, C; Saint-Marc, C
A "reader's exchange" question solicited information on how readers respond when asked what is wrong with contraception. One letter-writer maintained that the use of contraception prohibits true love, total commitment, and complete acceptance on the part of a married couple. Contraception attempts to create a utopia and obviates the pain and suffering which are necessary in order to find true love and true happiness. PMID:12345572
During the past 20 years, contraceptive steroids have undergone significant changes as the result of an increased understanding of their metabolic, pharmacologic, and hormonal activities. During this time, prospective and retrospective epidemiologic studies have elucidated several noncontraceptive health benefits of oral contraceptive steroids, including their therapeutic effects for endometriosis, dysmenorrhea, polycystic ovarian disease, and benign breast disease. From this review it appears that the benefits of oral contraceptive steroids in young, healthy, nonsmoking women far outweigh their more publicized, infrequent risks. PMID:6470632
Starks, G C
Estrogen and progestins have been used by millions of women as effective combined contraceptives. The safety of hormonal contraceptives\\u000a has been documented by years of follow-up and serious adverse events that may be related to their use are rare in the young\\u000a population exposed to these agents. The balance between the benefits and the risks of contraceptive steroids is generally
Regine Sitruk-Ware; Anita Nath
Epilepsy is the most common neurological disease of females in reproductive age. Problems concerning contraception, reproduction, teratogenicity and antiepileptic therapy preceding and during pregnancy are discussed and recommendations made. We underline the advantages of a planned pregnancy with optimal adjustment of antiepileptic drug therapy and recommend prophylactic treatment with folic acid before and during, and with vitamin K towards the end of pregnancy. PMID:8413747
Leppert, D; Wieser, H G
Sexual health encompasses 'sexual development and reproductive health, as well as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; express affection, love and intimacy in ways consistent with one's own values'. The 2008 WHO Consensus Statement additionally noted that 'responsible adolescent intimate relationships' should be 'consensual, non-exploitative, honest, pleasurable and protected against unintended pregnancy and STDs if any type of intercourse occurs'. Young people (YP) must, therefore, be able to access sexual health information and services that meet their needs.For most YP, interest in sexual activity begins with puberty, and this is associated with increasingly sexualised behaviour, including exploration of themselves and others.Most YP find this a confusing time, and so it is important that health professionals are able to offer advice regarding the wide range of sexual health issues, including sexuality, choice of partner, contraception, risk and management of sexually transmitted infections (STI) in a confident and approachable manner. YP have never had so much choice or information available to them, and this can be confusing for them. There is good evidence that YP who get information from their parents are likely to initiate sexual activity later than their peers who access information from their friends. However, there is also evidence that some YP would prefer to get sexual health information from health professionals. It is therefore imperative that all health professionals who see YP have an awareness of sexual health issues, and know where to signpost YP should they need more specialist sexual health advice and/or treatment.Where appropriate, one-to-one sexual health advice should be provided to YP on how to prevent and get tested for STIs, and how to prevent unwanted pregnancies. Advice should also be given on all methods of reversible contraception, including long-acting reversible contraception, emergency contraception and other reproductive issues. PMID:22843336
Straw, Fiona; Porter, Charlotte
Sexual health encompasses 'sexual development and reproductive health, as well as the ability to develop and maintain meaningful interpersonal relationships; appreciate one's own body; interact with both genders in respectful and appropriate ways; express affection, love and intimacy in ways consistent with one's own values'. The 2008 WHO Consensus Statement additionally noted that 'responsible adolescent intimate relationships' should be 'consensual, non-exploitative, honest, pleasurable and protected against unintended pregnancy and STDs if any type of intercourse occurs'. Young people (YP) must, therefore, be able to access sexual health information and services that meet their needs. For most YP, interest in sexual activity begins with puberty, and this is associated with increasingly sexualised behaviour, including exploration of themselves and others. Most YP find this a confusing time, and so it is important that health professionals are able to offer advice regarding the wide range of sexual health issues, including sexuality, choice of partner, contraception, risk and management of sexually transmitted infections (STI) in a confident and approachable manner. YP have never had so much choice or information available to them, and this can be confusing for them. There is good evidence that YP who get information from their parents are likely to initiate sexual activity later than their peers who access information from their friends. However, there is also evidence that some YP would prefer to get sexual health information from health professionals. It is therefore imperative that all health professionals who see YP have an awareness of sexual health issues, and know where to signpost YP should they need more specialist sexual health advice and/or treatment. Where appropriate, one-to-one sexual health advice should be provided to YP on how to prevent and get tested for STIs, and how to prevent unwanted pregnancies. Advice should also be given on all methods of reversible contraception, including long-acting reversible contraception, emergency contraception and other reproductive issues. PMID:22983512
Straw, Fiona; Porter, Charlotte
In 2004, the Department of Health and Human Services estimated that about 47% of female and 46% of male teenagers had had\\u000a sexual intercourse at least once (1). Sexually active teenagers report that they use a contraceptive method only 75 to 90% of the time. Among the developed countries,\\u000a the United States continues to have one of the highest adolescent
The aim of the present study was to evaluate the association and impact of occupational exposure and diseases of the shoulder and neck. Prevalence rates, odds ratios, aetiological fractions, and their confidence intervals were computed for pooled and non-pooled data of previous published reports. By comparison with office workers and farmers, dentists had an increased odds ratio for cervical spondylosis (two studies) and for shoulder joint osteoarthrosis. Meat carriers, miners, and "heavy workers" also had significantly higher rates of cervical spondylosis compared with referents. Compared with iron foundry workers, civil servants had a significant odds ratio (4.8) of cervical disc disease and a 0.79 aetiological fraction. Whether this was due to exposure or healthy worker effect was not clear. In four occupational groups with high shoulder-neck load an odds ratio of 4.0 was found for thoracic outlet syndrome with an aetiological fraction of 0.75. Rotator cuff tendinitis in occupational groups with work at shoulder level (two studies) showed an odds ratio of 11 and an aetiological fraction of 0.91. Keyboard operators had an odds ratio of 3.0 for tension neck syndrome (five studies). Unfortunately, owing to the scanty description of the work task, the exposure could be analysed only by job title. Examination of published reports shows clearly that certain job titles are associated with shoulder-neck disorders. High rates and aetiological fractions for rotator cuff tendinitis and tension neck syndrome suggest that preventive measures could be effective. Although job descriptions are brief, the associations noted suggest that highly repetitive shoulder muscle contractions, static contractions, and work at shoulder level are hazardous exposure factors. In reports of cross sectional studies of occupational shoulder-neck disorders presentation of age, exposure, and effect distribution may help for future meta-analysis.
Hagberg, M; Wegman, D H
In the very rare cases where a pregnancy occurs during oral contraceptive use, the blame is usually laid against the patient for having forgotten to take the pill. Evidence has started to accumulate to suggest that neither the patient nor the pill is at fault in some contraceptive failures. It may be because the patient is taking other medicines and these may be preventing the pill from suppressing ovulation. Most drug interactions reducing or negating contraceptive activity are due to concomitant use of drugs having microsomal enzyme-inducing activity (e.g., some antibiotics, especially rifampicin, and anticonvulsants, including phenobarbital, phenytoin, and primidone. Other antibiotics (e.g., tetracycline) may also interact by interruption of the enterohepatic circulation of contraceptive steroids. Less well appreciated, oral contraceptive steroids may themselves modify the metabolism and pharmacological activity of various other drugs (e.g., anticoagulants, benzodiazepines, beta-blockers, caffeine, corticosteroids, and tricyclic antidepressants); in this respect the oral contraceptives are acting as enzyme inhibitors. Contraceptive steroids may also interact with drugs that cause enzyme inhibition and this delays the metabolism of the hormonal agents. Interactions of this type would be expected to potentiate the action of the contraceptive steroids. It is suggested that the effects of such interaction might be presented in terms of increased incidence of side effects, including water retention, diabetogenic effects, hypertension, and an increased risk of thromboembolic disorders. The spectrum of interactions with oral contraceptives is presented in three tables. PMID:3519141
D'Arcy, P F
Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this. PMID:19539934
Weisberg, Edith; Fraser, Ian S
The authors had the opportunity to follow a case of fatal ischemic bilateral cerebral infarctus which occurred in a 28 year old female with a history of migraine (but without any anti-migrainous drug). She had been using a low dose (0.05 mg ethinyl estradiol) oral contraceptive (OC) for 2 years. The previous pathological data of subendothelial thickening and fibrosis with thrombosis were confirmed, but for the 1st time, a marked giant cell reaction was found in close contact with lesions of the internal elastic membrane. Thus, there was evidence of inflammatory thrombo-angeitis obliterans. Biological and immunological abnormalities such as a high rate of anti-ethinyl estradiol antibodies in the serum (polyclonal immunoglobulin IgC) and circulating blood immune complexes seem to be closely related to this inflammatory thrombo-angeitis. These biological and histological findings suggest that vascular accidents related to OCs may be induced by an immunological mechanism. (author's) PMID:7034891
Nick, J; Bakouche, P; Beaumont, V; Vedrenne, C
Modern contraceptive technology is more than a technical advance: it has brought about a true social revolution, the 'first reproductive revolution' in the history of mankind. This latter was followed in rapid succession by other major changes in human reproductive strategies. In the human species, sexual activity began to lose its exclusive reproductive meaning at an early stage of its evolution. Human beings must have practiced non-conceptive sex from the outset and therefore must have had a need to avoid, rather than to seek conception during intercourse from time immemorial. The search for methods to control fertility went on for millennia, but a valid solution was only found during the twentieth century, when the population explosion had forever changed the shape of humanity: in only one century the total population of the planet had grown from some 1.6 billion to more than 6 billion. That increase will remain unique in the history of Homo sapiens. At the global level, contraception provided a tool to deal with overpopulation and, in only 50 years, went a long way towards its resolution. However, to solve the problem, national and international family planning initiatives were required. For individuals, contraception also meant a revolution. It allowed sexual intercourse without reproduction. Only 25 years later, in vitro fertilisation permitted childbearing without sexual intercourse. Other advances followed and now cloning, that is, reproduction without the two gametes, looms on the horizon. Such a series of rapid, major changes in human reproductive strategies has confused many. For this reason, a constructive dialogue between sociology and biology is mandatory. Contraception is a powerful tool to promote equity between sexes; it improves women's status in the family and in the community. Avoiding pregnancy during the teens increases opportunities for a young woman's education, training and employment. By controlling their fertility, women get a chance to contribute economically to their household, which in turn may give them a greater share in decision-making. There are other specific areas in which contraception has produced beneficial social effects, first and foremost in reducing the need for induced abortion. It has also helped avoiding sexually-transmitted infections and is a very useful tool for educating youngsters to adopt more responsible sexual behaviors. Interventions in the field of family planning are among the most cost-effective health interventions. PMID:17455038
Benagiano, Giuseppe; Bastianelli, Carlo; Farris, Manuela
The relationship between contraceptive use and religion remains a subject of considerable debate. This article argues that this relationship is rooted in context-specific institutional and organizational aspects of religious belonging and involvement. Drawing upon unique recent data from a population-based survey of women conducted in a predominantly Christian high-fertility area of Mozambique, this study examines the connections between religion and contraception from two complementary angles. First, differences in current use of modern contraceptives across main denominational groups are analyzed. The results show higher prevalence of modern contraceptive use among Catholics and, to a lesser extent, traditional Protestants net of other individual- and community-level factors. Second, an analysis of religious involvement reveals that frequent church attendance has a net positive association with modern contraceptive use regardless of denominational affiliation. These findings are situated within the historical context of religious, demographic, and socio-political dynamics of Mozambique and similar sub-Saharan settings. PMID:24006073
Data from the National Survey of Family Growth are analyzed to estimate the prevalence of contraceptive use during lactation. Approximately 20 per cent of lactating women were sexually active and did not use a method in months two through six, postpartum. Among method users, the largest proportion chose barrier methods but 14 per cent used oral contraceptives in the early postpartum period. Between 1973 and 1976 there was an increase in the percentage of women who utilized a contraceptive method during lactation and a decrease in the per cent using oral contraceptives.
Labbok, M; Ford, K; Gray, R H
Side effects of combined oral contraceptives are the most common reason why women discontinue them. Over the past half century, an elaborate mythology about these ill effects has evolved, fueled by rumor, gossip and poor-quality research. In contrast, placebo-controlled randomized trials document that nonspecific side effects are not significantly more common with combined oral contraceptives than with inert pills. These reported nonspecific side effects may reflect the nocebo phenomenon (the inverse of a placebo): if women are told to expect noxious side effects, these complaints occur because of the power of suggestion. Alternatively, nonspecific complaints may simply reflect their background prevalence in the population. Because Level I evidence documents no important increase in nonspecific side effects with oral contraceptives, counseling about these side effects or including them in package labeling is unwarranted and probably unethical. When in doubt, clinicians should err on the side of optimism. PMID:21134497
Grimes, David A; Schulz, Kenneth F
|Prevalence rates and reasons for substance use were studied in a sample of 172 male construction industry apprentices who had a mean age of 20 years. Results were compared with those of men in similar age groups in Victoria, and regional and age differences were explored. Findings indicate that more metropolitan apprentices had experimented with…
du Plessis, Karin; Corney, Tim
Aims: This study compared different methods of assessing self-reported alcohol use among emergency room patients in order to explain the variations in reported prevalence rates. Methods: Alcohol use prior to patient's injury or illness was assessed in one hospital by a self-report questionnaire in three different ways: (i) administered by emergency room staff, (ii) administered by research staff, or (iii)
SALVATORE G. VITALE; DIKE VAN DE MHEEN; HENK F. L. GARRETSEN; ALBERT VAN DE WIEL
Alcohol use among college students has become a considerable public health problem. Among this group, intercollegiate athletes are at a particularly high risk for excessive alcohol consumption and resulting negative alcohol-related consequences. The purpose of our review was to systematically examine three main issues related to alcohol consumption among intercollegiate athletes: (a) the prevalence rates and alcohol consumption patterns of
Matthew P. Martens; Kristen Dams-O'Connor; Niels C. Beck
Contraceptive implants provide long-acting, highly effective reversible contraception. The etonogestrel implant (ENG implant) is a single rod implant that offers three years of efficacy. The ENG implant was designed to provide contraceptive efficacy by inhibiting ovulation and Pearl Index scores reported for this method are similar to other long-acting reversible contraception as well as similar to sterilization. The implant has been shown to be safe during breast feeding and may improve symptoms of dysmenorrhea and endometriosis. Irregular bleeding patterns can be expected with the device’s use and should be addressed in order to decrease rates of discontinuation.
This study explores the contraceptive attitudes and practices of a sample of adolescent mothers who participated in a teen parents project at Howard University. Members of the sample were interviewed 3 times; twice prior to their entry into the intervention program and once afterwards. Concern over the side effects of contraceptives was the primary reason that mothers in this sample gave for not using contraception at the time they became pregnant. Motivational factors were secondary, and lack of information about contraception and fertility ranked 3rd. Recommendations are made for the dissemination of more complete information about contraceptive methods to inner city adolescents and for closer follow-up of teenage clients from family planning facilities. PMID:6655708
Washington, A C; Rosser, P L; Cox, E P
Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional study was performed at Bellevue Hospital. A questionnaire was given to women in the gynecology outpatient clinics asking about: oral contraceptive pills (OCP's), injectable contraception (DMPA), the Intrauterine device (IUD) and the Ortho-Evra Patch (Patch). In the 102 complete surveys, self identified Latina women were not convinced of the safety of OCPs and DMPA (less than 50% perceived them to be safe) and largely uncertain about the Patch and IUD. Latinas also demonstrated more negative beliefs about the side effects of OCPs and DMPA. In particular, they were concerned about weight gain, method reversibility, and bleeding. There was no substantial correlation between religiosity and contraceptive beliefs. Low level acculturated women were more likely to believe that the IUD and OCPs were harmful, as opposed to their more acculturated counterparts who demonstrated more negative beliefs about the Patch. Overall, Latina women in this study tended to overrate the risks associated with contraceptive use, particularly OCPs and DMPA. The markedly low method confidence suggested by high rates of "unsure" answers is a possible explanation for why Latinas are less adherent with birth control than their white counterparts. PMID:18498045
Venkat, Pavithra; Masch, Rachel; Ng, Eliza; Cremer, Miriam; Richman, Sue; Arslan, Alan
This article reviews the contraceptive methods levonorgestrel implants and depot medroxyprogesterone acetate. These methods provide effective and safe contraception for adolescents and adults. This review focuses on the use of these contraceptive techniques in the adolescent population, discussing patient selection, side effects, and controversies concerning the methods. Future hormonal contraceptive methods are also discussed. PMID:7581638
O'Connell, B J
The history of liability claims in the US against contraceptive products is among the issues that discourage manufacturers from investing in discovery and development in this field. Other factors are the high cost of new drug development, elevated insurance rates for contraceptives, and the desire to avoid controversy that can disturb corporate tranquility. General features of the American legal system influence the large number and cost of product liability claims in the US compared to Europe. These differences pertain to issues such as the role of judges, how lawyers receive their compensation, and the use of expert scientific testimony. The history of litigation in the US against pharmaceutical products and devices pertaining to women's health suggests that interventions that involve the reproductive system are held to different standards or elicit different emotional responses than other pharmaceutical products or devices. PMID:10661751
Segal, S J
Subdermal implants are contraceptive systems that release low, stable amounts of synthetic progestins from Silastic or other materials for periods of months to several years. Unlike other hormonal delivery systems, they do not cause unnecessary peaks in progestin levels and do not use estrogens, and thus their health risks are minimal. Norplant has been studied more extensively than any other subdermal contraceptive implant. More than 60,000 women have participated in clinical trials, which demonstrated that this approach is one of the most effective reversible contraceptive methods available (1% pregnancy rate in 5-year users). The implant also reduces the incidence of ectopic pregnancy to a level much below noncontraceptive users and about equivalent to TCu380A intrauterine device users. Exposure to the sustained, low dose of levonorgestrel delivered by Norplant has shown only minor metabolic changes. Side effects are minor but often bothersome, causing some discontinuation of the method. First-year continuation rates range from 76% to 90%. Fertility return after discontinuation is prompt. Difficulty in removal of the implant capsules by the less experienced practitioner has motivated researchers to develop systems that are easier to use, less obvious under the skin, and biodegradable. The Norplant 2 system is faster, easier, and less painful to insert and remove. Implants under investigation release desogestrel and other progestins; Capronor and subdermal norethindrone pellets are biodegradable systems. PMID:8178903
Darney, P D
Because of contraception, pregnancy need not be viewed by women as punishment for sexual activity but as a planned and desired event. Most of the contraceptive methods used in developing countries at present were introduced during the 1960s, but use of contraception has a long history and some methods date back to antiquity. Contraceptive pills were already used around 2000 BC in the form of mercury and arsenic tablets. Their effectiveness was questionable. The role of hormones in human reproduction began to be understood only in the early 1900s. The discovery of progesterone in a Mexican iguana in the 1940s permitted production of progesterone on a large scale. Estrogens had been identified around 1930. Human trials of a contraceptive pill beginning in 1956 in Puerto Rico demonstrated that progestins could prevent pregnancy by suppressing ovulation. Later on, estrogen was added to reduce menstrual irregularities. The 1st generation of combined oral contraceptives contained very high levels of hormones associated with high rates of side effects. Numerous formulations with lower hormonal contents became available beginning around 1970 and constitute the principal formulations in use today. A number of long acting hormonal methods based on progestins have been developed, including injectables, some IUDs and vaginal rings, and implants. The 1st commercially available injectable, norethisterone enanthate, did not acquire the wide distribution of medroxyprogesterone acetate, sold as Depo Provera and used to treat various pathological conditions as well as for contraception. The 1st true IUDs were small stones placed within the uteri of camels by nomads to prevent pregnancy during long caravans. An IUD was developed in 1909 by Richter, and the 2 most widely used models before 1960 were the Grafenberg and Ota silver rings. Use of the 2 rings became rare for medical reasons after 1935 despite their efficacy. Safe plastic IUDs which appeared beginning in the early 1960s were flexible and capable of returning to their original shape after insertion. The Lippes loop was the 1st highly successful IUD. Bioactive IUDs containing copper were developed in the 1970s. Research is underway to develop IUDs which will resist expulsion, reduce bleeding, be more appropriate for multiparas, and last longer. IUDs are used to treat intrauterine adhesions as well as for contraception. A gummy substance used to block the cervix was described in Egypt in 1850 BC. Japanese and Chinese prostitutes of antiquity placed oiled bamboo paper at the cervical opening for contraception. Diaphragms and cervical caps were developed in the 19th century in Germany. Large scale production became possible after 1880 with the development of better, more durable, and cheaper rubber. An Egyptian writing in 3500 BC began the study of spermicides. Numerous substances such as lemon juice and honey have been placed in the vagina to avoid pregnancy. Such substances are available to all women and some were reasonably effective. Current research is directed toward development of spermicides which will also prevent sexually transmitted diseases. The 1st condoms were made of animal skins by an English physician to prevent transmission of venereal diseases. Rubber condoms appeared in the early 20th century and are widely utilized in some family planning programs. Pregnancy vaccines and a reversible hormonal method for men are among methods under development. PMID:12268230
Women with high cholesterol, who are successfully controlling it by diet, exercise, medication, or a combination of these treatments, may be able to safely use oral contraceptives (OCs). OCs change the lipid profile but keep it within the normal range. They do not increase the risk of the types of heart disease linked to high cholesterol. Women who use the higher dose OCs do not have an increased risk of heart attack, stroke, or other cardiovascular disease. Animal studies show that the OC protects against development of atherosclerosis. The estrogen component may provide this protection. It may protect against the development of coronary heart disease. Women with a rare genetic form of high cholesterol or severely high cholesterol that does not respond to medication may need to use another contraceptive method than OCs. Other risk factors for cardiovascular disease in women are sedentary lifestyle, cigarette smoking, diabetes mellitus, obesity (30% above ideal weight), high blood pressure, and a family history of heart disease. Older OC users should not smoke. If so, they should use another method. The first steps to lower cholesterol are exercise and modifying the diet, especially reducing the amount of saturated fat. Foods high in saturated fat are meat, dairy products, and eggs. If these fail, persons with high cholesterol need medication. PMID:12290847
Overpopulation is a global problem of significant magnitude, with grave implications for the future. Development of new contraceptives is necessary, as existing forms of birth control are unavailable, impractical and/or too expensive for many individuals due to sociological, financial or educational limitations. Immunocontraception and, in particular, the targeting of antibodies to sperm-specific antigens implicated in sperm-egg binding and fertilisation offers an attractive approach to control fertility. Sperm-specific antibodies may impair fertility by inhibiting sperm motility, by reducing penetration of the cervical mucus by sperm, or by interfering in sperm capacitation or the acrosome reaction; alternatively, antisperm antibodies may invoke the complement cascade, resulting in sperm lysis. The antibodies raised against sperm-specific antigens have proved to be extremely effective at reducing sperm-egg interactions in vitro; fertility trials in subhuman primates will eventually be needed to prove the effectiveness of the sperm antigens in terms of contraceptive efficacy before trials in humans can be justified. In addition, existing and emerging strategies (such as sperm proteomics, the determination of molecular and structural details of sperm proteins, and the modelling of protein-ligand interactions using X-ray and/or NMR structures to name a few) are expected to provide the experimental foundation for the design of small molecule inhibitors with antifertility effects. The technology underpinning vaccine development is constantly being developed and the introduction of DNA/RNA vaccines is certain to impact upon the field of immunocontraception. PMID:15833075
Vaccination for birth control has several advantages over currently available methods of family planning and should prove an attractive addition to the contraceptive armamentarium both in developing countries and in a developed country such as Australia. Concerns have been voiced by consumer health advocates that vaccines, like other long acting contraceptive methods, may be abused by health authorities in developing countries and by their use in vulnerable groups such as aborigines in our own country. These concerns need to be recognised and addressed. More difficult to accommodate are the anxieties expressed by feminist groups about the 'loss of control' and 'lack of body awareness' inherent in a method, such as a vaccine, that is relatively easily administered and has no overt side effects. There is no evidence that these concerns are shared by women in general. The antifertility vaccine that will most likely be applied first in family planning programmes is one directed against the pregnancy hormone hCG. A WHO vaccine directed against the C-terminal peptide of beta-hCG provokes a specific and safe immune response and will enter Phase 2 trials in Sweden this year. Subsequent developments with this vaccine will include the replacement of the current emulsion vehicle by a delivery system based on biodegradeable microspheres which will give a more sustained antigen release and duration of effectiveness. PMID:7848209
Jones, W R
Objectives To determine insomnia prevalence and variations in prevalence with age among older Veterans and examine the relationships among insomnia, self-rated health, and talking to a doctor about sleep problems. Design A cross-sectional postal survey. Setting: VA Greater Los Angeles Healthcare System - Sepulveda Ambulatory Care Center (SACC) Participants: Veterans over age 60, who received outpatient care at SACC in the prior 12 months and resided within 25 miles of SACC (n=9080) Interventions: None Measures Data were collected from a postal survey, which included items addressing the diagnostic criteria for insomnia (difficultly falling or staying asleep, early awakening, insufficient/non-restorative sleep, daytime symptoms, duration of sleep problems) plus demographics, self-rated health, and whether the Veteran had previously talked to a doctor about sleep problems. Results Of 9080 surveys 4758 were returned. Of responders 51.5% met International Classification of Sleep Disorders (ICSD) insomnia diagnostic criteria. An unadjusted logistic regression model showed that individuals in the 60–65 year age bin were at the highest risk for insomnia, with the odds of having insomnia decreasing with each successively older age group (all P<.05). Veterans with poor self-rated health had higher insomnia prevalence, more daytime symptoms of insomnia, and reported fewer hours of sleep compared to Veterans with good self-rated health. In a regression model, poorer self-rated health, meeting insomnia criteria, younger age, and more daytime symptoms were significant independent predictors of discussing sleep problems with a doctor. Conclusion Older Veterans had high rates of insomnia, but contrary to most prior work, insomnia became less prevalent as age increased. Greater efforts are needed to help older Veterans recognize and disclose sleep problems, and doctors should routinely screen for insomnia and account for comorbidities when treating insomnia patients.
Martin, Jennifer; Alessi, Cathy
A "reader's exchange" question solicited information on how readers respond when asked what is wrong with contraception. One correspondent couple wrote that their response is dependent upon their assessment of the questioner's perspective. Responses they use are 1) that the Catholic Church teaches that contraception is wrong and it is okay to accept this teaching in faith; 2) the Church teaches that every act of sexual intercourse must be open to life; 3) the God-given gift of intercourse involves pleasure and procreation, it is wrong to accept only part of the gift; 4) oral contraceptives have abortifacient properties; and 5) natural family planning involves temperance whereas contraception allows behavior which is similar to gluttony. A second correspondent wrote that the use of contraception makes humans behave like animals and allows them to be "takers" rather than "givers." A third letter-writer maintained that the use of contraception prohibits true love, total commitment, and complete acceptance on the part of a married couple. Contraception attempts to create a utopia and obviates the pain and suffering which are necessary in order to find true love and true happiness. PMID:12345571
Rice, L; Rice, B
In affluent societies, median age at menarche has dropped to below 13 years. Younger age at menarche is associated with earlier sexual activity. To avoid unintended teenage pregnancies, barriers to contraception provision must be kept low, i.e. availability without prescription or through a low-threshold prescription system, low-cost options and long-term prescriptions or easy refills. Since many adolescents are (over)concerned about side effects, these should be addressed. A gynaecological examination prior to prescription is no longer recommended. All effective reversible contraceptive methods are available to adolescents: user-based hormonal contraceptives, trimonthly depot medroxyprogesterone acetate (DMPA), and long-acting reversible contraception (LARC). User-based hormonal contraceptives carry a small absolute risk of venous thromboembolism (~4 per 10,000 patient-years), but the risk is more than tenfold higher among young women with an inherited clotting defect. DMPA reduces bone mineral accumulation, but this is a reversible effect; the metabolic risks, including weight gain and insulin resistance, appear to be greater. LARC, including intrauterine contraceptive devices and the progestogen-containing implant, is gaining popularity among teenagers; abnormal bleeding is the main side effect. Any effective contraceptive should preferably be combined with consistent condom use to prevent sexually transmitted infections ("the double Dutch"). PMID:22318432
Background & Aims: Lifestyle factors have been shown to influence prognosis in Crohn's disease. The purpose of this study was to prospectively assess the effects of smoking and oral contraceptive use on clinical relapse rates. Methods: Placebo-treated patients formed a prospective cohort, followed up for 48 weeks or until relapse. The influence of smoking and the use of oral contraceptives
Antje Timmer; Lloyd R. Sutherland; Francois Martin
|Teens typically fail to use contraceptives consistently, which contributes to high rates of unintended pregnancy and sexually transmitted infections (STIs) among this age group. Existing research has focused primarily on how teens' own characteristics are related to contraceptive use, but has paid less attention to how the characteristics of…
Holcombe, Emily; Carrier, David; Manlove, Jennifer; Ryan, Suzanne
BackgroundMigrant Asian women reportedly have low levels of contraceptive use and high rates of abortion in New Zealand. Chinese make up the largest proportion of migrant Asian in New Zealand. This study aimed to describe the contraceptive choices of Chinese women seeking abortion; to examine method choice in relation to demographic characteristics (including length of stay) and to determine whether
Sally B. Rose; Zhang Wei; Annette J. Cooper; Beverley A. Lawton
The rate at which young women enter managerial \\/professional occu- pations begain to rise steadily in the early1960s, when oral contraceptives …rst became available in the US. The fact that young mothers are com- paratively rare in these occupations suggests that the advent of more eective contraception may have played an important role in the occupa- tional trend. This paper
Abstract Objective To compare experiences, attitudes, and beliefs of immigrant and nonimmigrant women presenting for abortion with regard to contraception, and to identify difficulties involved in accessing contraception in Canada. Design A survey of immigrant and nonimmigrant women asking about women’s experiences with and attitudes toward contraceptives and any barriers to contraceptive access they have encountered. Demographic data including ethnicity, country of origin, and length of residence in Canada were collected. Setting Two urban abortion clinics. Participants Women presenting for first-trimester abortion. Main outcome measures Type of contraception used when the unwanted pregnancy was conceived, attitudes to contraceptives, and barriers to access of contraceptives. Results A total of 999 women completed questionnaires during the study period (75.9% response rate); 466 of them (46.6%) were born in Canada. Immigrant women presenting for abortion were less likely to be using hormonal contraception when they got pregnant (12.5% vs 23.5%, P < .001) and had more negative attitudes toward hormonal contraception (62.6% vs 51.6%, P < .003). They reported having more difficulties accessing contraception before the abortion (24.8% vs 15.3%, P < .001) than nonimmigrant women did. About half of all the women expressed fear about intrauterine device use. The longer immigrant women had lived in Canada, the more likely they were to have similar responses to those of Canadian-born women. Conclusion The information provided by this study might be valuable for family doctors and other clinicians to improve contraceptive information resources for immigrants to address existing knowledge gaps and other culturally relevant concerns. As about half of all women presenting for abortion expressed negative attitudes toward the more effective methods of contraception, it is important that family doctors educate all women at risk for unintended pregnancies.
Background In Ethiopia maternal mortality rate is very high more than one in five women die from pregnancy or pregnancy related causes. The use of contraceptives to prevent unwanted pregnancies and unsafe abortion is an important strategy to minimize maternal mortality rate. Among various forms of contraception, emergency contraceptives are the only one that can be used after sexual intercourse offering chance to prevent unwanted pregnancy. The aim of this study was to assess the knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital (JUSH). Methods Institution base cross-sectional study on knowledge, attitude and practice of emergency contraceptive was conducted at JUSH from April to June, 2011Data was collected using structured questionnaire and analyzed using SPSS version 17.0. Results In this study 89 women were interviewed. More than half of them (48) were from urban area and 41 were from rural area.46 (51.7%) of them were single. Of all the respondents only nine women had awareness about emergency contraceptive. Seven of the women mentioned pills as emergency contraception and only two of them mentioned both pills and injectable as emergency contraception. All of them have positive attitude towards emergency contraception but none of them have ever used emergency contraceptives. Conclusion and recommendation The finding revealed pregnancy among women of 15-19 years was very common. The knowledge and practice of emergency contraception is very low. But there is high positive attitude towards emergency contraceptives. Since there is much deficit on knowledge of women on emergency contraceptives, in addition to making them accessible; programs targeted at promotion and education of emergency contraceptives is helpful to prevent unwanted pregnancy.
Contraceptive failure is the primary cause of unintended pregnancy in the United States. With obesity rates at epidemic proportions, any association between obesity and strategies that prevent undesired pregnancies constitutes a significant public health and economic concern. Unfortunately, the relationship between obesity and contraception has not been extensively studied. Evidence from several epidemiological studies suggests that obesity may increase failure of some hormonal contraceptives resulting in unplanned pregnancies. Obesity may make procedure-dependent contraceptive methods (i.e., sterilization and intrauterine devices) more technically challenging for the provider to perform. Hormonal contraceptives, on the whole, do not appear to adversely affect body weight and provide important noncontraceptive benefits (i.e., cancer protection). Some surgical interventions to treat bariatric issues may compromise the efficacy of orally dosed contraceptive methods. Overall, the Society of Family Planning strongly encourages the use of both hormonal and nonhormonal methods of contraception in obese women desiring pregnancy prevention with very few restrictions. Further studies are needed to determine the interrelationship between obesity and contraception. In addition, future contraceptive efficacy studies need to include women of differing BMIs to better reflect the population of women using these methods. PMID:19913155
Platelet aggregation has been found to be significantly accelerated with the coagulation-induced Chandler's tube technique in women taking combined oestrogen-progestin oral contraceptives, though this was less than in the third trimester of pregnancy. Women taking the pure progestogen, chlormadinone acetate, have not shown this change up to the sixth month of study. In contrast the accelerated platelet aggregation resulting from conventional oral contraception became normal one month after changing to the progestogen. There was no change in the platelet aggregation response to adenosine diphosphate (A.D.P.) during oral contraception.
Poller, L.; Priest, Celia M.; Thomson, Jean M.
The success in social marketing of the PROFAM brand of subsidized contraceptives, by a nonprofit private institution that supports the Mexican government program, is related here. PROFAM began in 1978, when half of contraceptives were purchased commercially from drugstores: they were neither economical, consistently distributed, nor advertised. Comprehensive market research revealed that a great demand existed. It generated information for choice of items to market, package design, and instructions. In 1979, pills, condoms, foam, cream and vaginal suppositories, all locally produced were distributed. A serious problem initially was the impropriety of using the word "contraceptive" in the media. The first phase of advertising targeted newspapers. After 3 months, 40% of Mexico's drugstores carried PROFAM. The second phase of advertising, in radio, magazines and newspapers, approached consumers with information tailored to the specific socioeconomic group involved. The third phase, geared to rural areas and general stores, concentrates on advantages of each method. Other aggressive aspects of the campaign include house to house sampling and a mail-in question and answer service. Evidence of success in broadcasting the PROFAM message is the frequent reference to PROFAM in jokes in the media and even in graffiti. The government's goal is to reduce the growth rate form 2.9 percent annually to 1 percent by 2000. PMID:12315136
De La Macorra, L
Between 1960-80, the adolescent population increased significantly. The concept of adolescence changes from 1 period to another and is difficult to delimit precisely. There are 4 main tasks of adolescence: 1) affective emancipation from parents and adults in general 2) acquisition of economic independence 3) psychosexual differentiation and 4) establishment of self-identity. Adverse economic conditions tend to retard the process and postpone entrance into active life and confrontation with reality. Adolescents of today tend to suffer a profound malaise and to live from day to day with little enthusiasm for the future. The circle of friends assumes greater and greater importance in the face of the breakup of families. Adolescents' sexuality is affected by the same tendencies as the rest of their experience. The age at 1st intercourse is dropping steadily. Usually sexual activity is hidden from the parents because of their probable disapproval. Society presents contradictory messages, promoting sexual pleasure but condemning it in the young. Most adolescents live in a sort of serial monogamy in which relations may be intensely felt and couples may be together a year or more on average. Characteristics of adolescent sexual relationships are the tendency of complete sexual relations not to occur immediately, sporadic and unplanned nature, and reduced number of partners. Adolescents frequently fail to use contraception when they become sexually active because they do not believe they can become pregnant. To assist the adolescent in using contraception, it is necessary to know whether she is seeking a method on her own account or was sent by someone else, what the partner thinks about contraception, how often sexual relations occur, and whether a method has been used in the past. The choice should be made by the patient. Pills are the preferred method, followed by IUDs and spermicides. Condoms, although they protect against sexually transmitted diseases, are poorly adapted to adolescent psychology because they require forethought and a wait. Follow-up should be arranged before the adolescent leavs the family planning center in order to encourage and facilitate regular usage by the client. PMID:6553985
Examined prevalence of and factors associated with pregnancy and abortion among vocation school students in northern Thailand. Age, current contraceptive use, early initiation of sexual intercourse, alcohol and drug use, and sexual coercion were associated with self or partner pregnancy. High rates of pregnancy and abortion indicate the need for…
Manopaiboon, Chomnad; Kilmarx, Peter H.; van Griensven, Frits; Chaikummao, Supaporn; Jeeyapant, Supaporn; Limpakarnjanarat, Khanchi; Uthaiworavit, Wat
|Examined prevalence of and factors associated with pregnancy and abortion among vocation school students in northern Thailand. Age, current contraceptive use, early initiation of sexual intercourse, alcohol and drug use, and sexual coercion were associated with self or partner pregnancy. High rates of pregnancy and abortion indicate the need for…
Manopaiboon, Chomnad; Kilmarx, Peter H.; van Griensven, Frits; Chaikummao, Supaporn; Jeeyapant, Supaporn; Limpakarnjanarat, Khanchi; Uthaiworavit, Wat
Background: The coexistence of allergic diseases and chronic urticaria (CU) is not uncommon. Our aim was to show the prevalence of allergic diseases in chronic urticaria patients and whether possible risk factors precipitate the development of these conditions. Methods: The data of 953 patients diagnosed with CU in our adult allergy clinic between January 1991 and June 2006 were retrospectively
S. Rana Isik; Gul Karakaya; Serhart Celikel; Ahmet U. Demir; A. Fuat Kalyoncu
Hospice patients may be particularly at risk for pressure ulcer development due to several factors. Identifying populations at risk for pressure ulcer development, such as hospice patients, and providing prevention and risk protocols for these populations can substantially reduce the prevalence and incidence of pressure ulcers. However, are hospice patients prone for skin break-down despite prevention and treatment efforts? This
Darlene S. Hanson; Diane Langemo; Bette Olson; Susan Hunter; Christine Burd
This study analyzes the reciprocal relationship between a direct measure of gun availability and three types of violent crime across the 120 most populous counties in the USA. Survey data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System are used to construct a measure of household gun prevalence. Hypotheses derived from four competing perspectives concerning
Background: Cost effective means of assessing the levels of risk factors in the population have to be defined in order to monitor these factors over time and across populations. This study is aimed at analyzing the difference in population estimates of the mean levels of body mass index (BMI) and the prevalences of overweight, between health examination survey and telephone
F. PACCAUD; V. WIETLISBACH; M. RICKENBACH
Many HIV prevalence surveys are plagued by the problem that a sizeable number of surveyed individuals do not consent to contribute blood samples for testing. One can ignore this problem, as is often done, but the resultant bias can be of sufficient magnitude to invalidate the results of the survey, especially if the number of non-responders is high and the reason for refusing to participate is related to the individual’s HIV status. One reason for refusing to participate may be for reasons of privacy. For those individuals, we suggest offering the option of being tested in a pool. This form of testing is less certain than individual testing, but, if it convinces more people to submit to testing, it should reduce the potential for bias and give a cleaner answer to the question of prevalence. This paper explores the logistics of implementing a combined individual and pooled testing approach and evaluates the analytical advantages to such a combined testing strategy. We quantify improvements in a prevalence estimator based on this combined testing strategy, relative to an individual testing only approach and a pooled testing only approach. Minimizing non-response is key for reducing bias, and, if pooled testing assuages privacy concerns, offering a pooled testing strategy has the potential to substantially improve HIV prevalence estimates.
Studies of hospitalized "spontaneous" abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population. PMID:611030
Rushwan, H; Doodoh, A; Chi I-C; Bernard, R P
A series of 26 white women aged under 50 who developed hepatocellular carcinoma in a non-cirrhotic liver were studied for the possible role of oral contraceptives. Eighteen of the women had used the \\
J Neuberger; D Forman; R Doll; R Williams
The systemic side effects of oral contraceptives are mentioned, and the incidence and variety of ocular complications are discussed. Experimental studies on the ocular effects of oral contraceptives in laboratory animals have shown only increased permeability of the lens and possibly vascular dilatation. Numerous case reports, however, have been published which describe neuroophthalamic, vascular, retinal and macular, aqueous humor dynamic, cornea and contact lense, lens, color vision, and other miscellaneous effects. These reports are reviewed as are the 6 reported prospective studies. These prospective studies reveal only changes in kerotometry readings. Thus the large number of case reports may represent a low overall incidence or may be normal findings in the population as a whole or may be caused by other systemic factors. Until multicenter prospective studies provide definitive guidelines, the risk associated with oral contraceptive use must be kept in its proper perpsective and ocular histories should contain information on oral contraceptive use. PMID:306593
Wood, J R
Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus. PMID:20356388
Tesher, Melissa S; Whitaker, Amy; Gilliam, Melissa; Wagner-Weiner, Linda; Onel, Karen B
Sexually active adolescents, including young women with lupus, are at high risk for unplanned pregnancy. Unplanned pregnancy among teens with lupus is associated with an elevated risk of poor maternal and fetal outcomes. The provision of effective contraception is a crucial element of care for a sexually-active young woman with lupus. Unfortunately, providers may be hesitant to prescribe contraception to this group due to concerns about increasing the risk of lupus complications. This article reviews the risks and benefits of currently-available contraceptives for young women with lupus. Providers are encouraged to consider long-term, highly-effective contraception, such as implantables and intrauterine devices, for appropriately selected adolescents with lupus.
Statistics, based on data collected in 1973, are presented on the use of contraception by currently married women, never married women with offspring of their own living in the household, and widowed, divorced, and separated women. The percentage of women...
The purpose of prescribing combined oral contraceptives (OCs) is achievement of good cycle control and effective contraception with the least side effects, using an OC with the lowest possible dose of estrogen. Triphasil, Triquilar, Nordette, Microgynon 30, and Brevinor are good 1st choices because of the low estrogen dose (30-35 mcg). Women who probably cannot tolerate breakthrough bleeding and who need simple packaging should use a monophasic, more progestogenic OC, e.g., Nordette or Microgynon 30. Physicians should suggest a low dose estrogen and low dose antiandrogenic progestogen (OC) (e.g., Diane-35 ED) for women who have acne. They should advise patients that when they take OCs, their menstrual periods usually become shorter, regular, and lighter. Women need not take a break from OC usage. Vitamin C, antibiotics, griseofulvin, rifampicin, and anticonvulsants (except sodium valproate) interact with OCs. Women using warfarin and oral hypoglycemics and wanting to start using OCs need to consult their physician about changing requirements for warfarin and oral hypoglycemics. The effectiveness of OCs can be diminished by diarrhea and vomiting. Absolute contraindications to OCs include pregnancy, use during the first 2 weeks postpartum, history of thromboembolism, undiagnosed abnormal vaginal bleeding, focal migraine, coronary heart disease, steroid-dependent tumors, recent impaired liver function, and cardiovascular accidents. Some relative contraindications are older than 35 years old and smoking, breast feeding, and hypertension. This article provides a section on how to manage common side effects. For example, if the side effect is acne, the physician should prescribe an OC with increased estrogen and reduced progestogen (e.g., Triphasil/Triquilar to Biphasil/Sequilar). This article lists trade names of various OCs and their estrogen and progestogen doses, e.g., Nordette has 30 mcg ethinyl estradiol and 150 mcg levonorgestrel. PMID:1476509
Miller, C; Murtagh, J
Although a significant impact of cycle phase on olfactory thresholds has been shown in females, limited data exist regarding discrimination and identification. Therefore, we investigated a broader range of olfactory performance and analyzed the impact of cycle phase and oral contraception. We measured 80 healthy Caucasians, including 20 females taking oral contraceptives and 40 females without oral contraception who were further divided into follicular and luteal phase. Olfactory performance of all participants was assessed twice using the “Sniffin’ Sticks” battery and intensity and pleasantness ratings of n-butanol were collected. Data analysis revealed that females outperformed males in odor discrimination and odor identification. In the luteal phase, higher thresholds and higher intensity ratings for n-butanol emerged. Duration of oral contraception correlated positively with olfactory performance pointing to better performance with longer intake. Hence, our data show that odor performance is affected by menstrual cycle phase and duration of oral contraception intake and thus can be modulated by hormonal changes.
Derntl, Birgit; Schopf, Veronika
Despite the wide variety of reversible contraceptives, unintended pregnancy rates in developed nations are still considered markedly elevated by most epidemiologists and clinicians. Indeed, the US has one of the highest unintended pregnancy rates among the industrialized nations of the world. Although many factors appear to influence this problem, what may play an important role in this apparent paradox is the process by which a woman obtains contraception. Although most nonbarrier methods have similar efficacy, the ability to use that method consistently and correctly will determine whether it provides maximal contraception. Oral contraceptives are the most popular method in the US; accordingly, the process by which US women obtain their contraception may not take into account the desire of many women to use nondaily methods. The recent introduction of nondaily methods in the US and elsewhere has provided more choice so that a successful contraceptive decision can be made in the first instance rather than after an adverse clinical outcome or unintended pregnancy with a method not as well suited to that woman's lifestyle. These new methods are not characterized by improved safety or efficacy; rather, they have novel components or delivery systems that may provide important options to women who may not be able to or willing to use existing methods of contraception. The transdermal patch, vaginal ring, and monthly injectable are combination estrogen/progestogen methods characterized by novel delivery systems and compliance regimens. The single rod implant is a facile and well accepted method that has not yet been approved for use in the US but has been an increasingly popular choice elsewhere. The levonorgestrel intrauterine system has been used in Europe for over 10 years and has recently been introduced in the US. This intrauterine contraceptive provides high efficacy and reliability, and may have considerable noncontraceptive benefit with regard to the nonsurgical treatment of uterine bleeding problems and endometrial protection for menopausal hormone therapy. The increasing popularity of these methods can be considered a testament to the desire of women to consider nondaily contraceptives as first-line, mainstream options. It is hoped that increasing use of these methods will lead to a considerable decrease in the rate of unintended pregnancy. PMID:15966560
Shulman, Lee P
A prospective, randomized trial compared client experiences with three popular oral contraceptives--Triphasil, Ortho-Novum 7/7/7 and Ortho-Novum 1/35. After one year, no significant relationship was found between the contraceptive prescribed and either breakthrough bleeding or satisfaction with the medication. The monophasic formulation, Ortho-Novum 1/35, was associated with amenorrhea more often. PMID:2352250
Reiter, S L; Baer, L J
We evaluated Clostridium difficile prevalence rates in 2,807 clinically indicated stool specimens stratified by inpatient (IP), nursing home patient (NH), outpatient (OP), age, gender, and specimen consistency using bacterial culture, toxin detection, and polymerase chain reaction (PCR) ribotyping. Rates were determined based on the detection of toxigenic C. difficile isolates. We identified significant differences in the rates between patient populations and with age. Specimens from NH had a higher rate (46%) for toxigenic C. difficile than specimens from IP (18%) and OP (17%). There were no gender-related differences in the rates. Liquid specimens had a lower rate (15%) than partially formed and soft specimens (25%) and formed specimens (18%) for the isolation of toxigenic C. difficile. The nontoxigenic rate was lowest for NH (4%) and highest for patients<20 years of age (23%). We identified 31 different toxigenic ribotypes from a sampling of 190 isolates that showed the lowest diversity in NH. Fluoroquinolone resistance was observed in 93% of the 027 isolates, all of the 053 isolates, and in four other ribotypes. We observed different rates for toxigenic C. difficile in stratified patient populations, with the highest rate for NH, a low overall nontoxigenic rate, and fluoroquinolone resistance. PMID:22167256
Boone, J H; Goodykoontz, M; Rhodes, S J; Price, K; Smith, J; Gearhart, K N; Carman, R J; Kerkering, T M; Wilkins, T D; Lyerly, D M
OBJECTIVE--To determine the level of knowledge of emergency contraception among 14 and 15 year olds. DESIGN--Confidential questionnaire survey. SETTING--10 secondary schools in Lothian, south east Scotland. SUBJECTS--1206 pupils predominantly (98.7%) aged 14 and 15 in the fourth year of secondary school. MAIN OUTCOME MEASURES--Knowledge of the existence of emergency contraception; of its safety, efficacy, and time limits; and of where to obtain it. RESULTS--1121 (93.0%) fourth year pupils aged 14-16 had heard of emergency contraception. 194 girls (32.7%) and 168 boys (27.5%) had experienced sexual intercourse. Of girls who had experienced sexual intercourse, 61 (31.4%) had used emergency contraception. Knowledge of correct time limits was poor, sexually active girls being the most knowledgeable. Pupils attending schools ranked lower than the national average for academic attainment were less likely to have heard of emergency contraception and more likely to have been sexually active. 861 (76.8%) pupils knew they could obtain emergency contraception from their doctor. 925 (82.5%) pupils believed emergency contraception to be effective but 398 (35.5%) thought it more dangerous than the oral contraceptive pill. CONCLUSIONS--One third of sexually active girls aged under 16 in Lothian have used emergency contraception. This may help explain the fairly constant teenage pregnancy rates despite increasing sexual activity. Scottish teenagers are well informed about the existence of emergency contraception. However, many do not know when and how to access it properly. Health education initiatives should target teenagers from less academic schools as they are more likely to be sexually active at a young age and are less well informed about emergency contraception.
Graham, A.; Green, L.; Glasier, A. F.
Background Unsafe abortion is a major public health problem in low-and-middle income countries. Young and unmarried women constitute a high risk group for unsafe abortions. It has been estimated that widespread use of emergency contraception may significantly reduce the number of abortion-related morbidity and mortality. The purpose of this study was to evaluate the knowledge, attitudes and experiences on emergency contraceptive pills by the university students in Cameroon in order to develop and refine a national health programme for reducing unwanted pregnancies and their associated morbidity and mortality. Methods A convenient sample of 700 students of the University of Buea (Cameroon) was selected for the study. Data was collected by a self-administered, anonymous and pre-tested questionnaire. Results The response rate was 94.9% (664/700). General level of awareness of emergency contraceptive pills was 63.0% (418/664). However, knowledge of the general features of emergency contraceptive pills was low and misinformation was high among these students. Knowledge differed according to the source of information: informal source was associated with misinformation, while medical and informational sources were associated with better knowledge. Although the students generally had positive attitudes regarding emergency contraceptive pills, up to 65.0% (465/664) believed that emergency contraceptive pills were unsafe. Those with adequate knowledge generally showed favourable attitudes with regards to emergency contraceptive pills (Mann-Whitney U = 2592.5, p = 0.000). Forty-nine students (7.4%) had used emergency contraceptive pills themselves or had a partner who had used them. Conclusion Awareness of emergency contraception pills by Cameroonian students is low and the method is still underused. Strategies to promote use of emergency contraception should be focused on spreading accurate information through medical and informational sources, which have been found to be reliable and associated with good knowledge on emergency contraceptive pills.
Kongnyuy, Eugene J; Ngassa, Pius; Fomulu, Nelson; Wiysonge, Charles Shey; Kouam, Luc; Doh, Anderson S
Background Ethiopia is the second most populous country in Sub-Saharan Africa. Total Fertility Rate of Ethiopia is 5.4 children per women, population growth rate is estimated to be 2.7% per year and contraceptive prevalence rate is only 15% while the unmet need for family planning is 34%. Overall awareness of Family Planning methods is high, at 87%. The prevalence of long acting and permanent contraceptive methods (LAPMs) in Tigray region was very low which accounts for 0.1% for implants and no users for intra-uterine contraceptive device (IUCD) and female sterilization. Moreover almost all modern contraceptive use in Ethiopia is dependent on short acting contraceptive methods. The objective of this study was to assess factors associated with utilization of long acting and permanent contraceptive methods (LAPM) among married women of reproductive age group in Mekelle town. Methods A cross sectional community based survey was conducted from March 9-20, 2011. Multistage sample technique was used to select the participants for the quantitative methods whereas purposive sampling was used for the qualitative part of the study. Binary descriptive statistics and multiple variable regressions were done. Results The study consisted of quantitative and qualitative data. From the quantitative part of the study the response rate of the study was 95.6%. Of the qualitative part two FGDs were conducted for each married women and married men. 64% of the married women heard about LAPMs. More than half (53.6%) of the married women had negative attitude towards practicing of LAPMs. The overall prevalence of LAPMs use was 12.3% however; there were no users for female or male sterilization. The main reason cited by the majority of the married women for not using LAPMs was using another method of contraception 360 (93.3%). Mothers who had high knowledge were 8 times more likely to use LAPMs as compared with those who had low knowledge (AOR = 7.9, 95% CI of (3.1, 18.3). Mothers who had two or more pregnancies were 3 times more likely to use LAPM as compared with those who had one pregnancy (AOR = 2.7, 95% CI of (1.4, 5.1). Conclusion A significant amount of the participants had low knowledge on permanent contraceptive particularly vasectomy. More than half (53.6%) of married women had negative attitude towards practicing of LAMPs. Few of married women use female sterilization and none use of female sterilization and or vasectomy. Positive knowledge of LAMPs, women who had two and above pregnancies and women who do not want to have additional child were significantly associated. Information education communication should focus on alleviating factors hinder from practicing of LAPMs.
Some brands of combined oral contraceptive pills, when taken in higher than usual doses, can reduce by at least 75% the risk of becoming pregnant if taken within 72 hours of an episode of unprotected sexual intercourse. Such contraception is known as emergency contraception, and the pills known as morning-after pills. Emergency contraceptive pills have had little use worldwide since they were introduced as emergency contraception in the 1970s. On February 25, the US Food and Drug Administration (FDA) formally announced that 6 brands of combined oral contraceptive pills, when taken in specified doses, are safe and effective for use as emergency contraception. The FDA's announcement clears the way for pharmaceutical manufacturers to apply to include the pills' use for emergency contraception in drug packaging and labeling information. Adding the potential use of the approved contraceptive pills as emergency contraception should considerably expand the levels of awareness and use of the emergency contraception family planning option. Next year, a contraceptive pill is expected to be marketed exclusively for use as emergency contraception in the US. PMID:12294488
We analyzed the ethical and policy issues surrounding mandatory HIV testing of pregnant women in areas with high HIV prevalence rates. Through this analysis, we seek to demonstrate that a mandatory approach to testing and treatment has the potential to significantly reduce perinatal transmission of HIV and defend the view that mandatory testing is morally required if a number of conditions can be met. If such programs are to be introduced, continuing medical care, including highly active antiretroviral therapy, must be provided and pregnant women must have reasonable alternatives to compulsory testing and treatment. We propose that a liberal regime entailing abortion rights up to the point of fetal viability would satisfy these requirements. Pilot studies in the high-prevalence region of southern African countries should investigate the feasibility of this approach. PMID:17538051
Schuklenk, Udo; Kleinsmidt, Anita
We analyzed the ethical and policy issues surrounding mandatory HIV testing of pregnant women in areas with high HIV prevalence rates. Through this analysis, we seek to demonstrate that a mandatory approach to testing and treatment has the potential to significantly reduce perinatal transmission of HIV and defend the view that mandatory testing is morally required if a number of conditions can be met. If such programs are to be introduced, continuing medical care, including highly active antiretroviral therapy, must be provided and pregnant women must have reasonable alternatives to compulsory testing and treatment. We propose that a liberal regime entailing abortion rights up to the point of fetal viability would satisfy these requirements. Pilot studies in the high-prevalence region of southern African countries should investigate the feasibility of this approach.
Schuklenk, Udo; Kleinsmidt, Anita
Background: Combined oral contraceptive pills were the first contraceptive method to provide sexual freedom of choice for women through reliable, personal and private control of fertility. They are the most widely used hormonal contraceptives and also the most popular non-surgical method of contraception. Objective: To review the profile of acceptors of combined oral contraceptive pills at the University of Uyo Teaching Hospital, Uyo. Methodology: An 8 year review of all clients that accepted combined oral contraceptive pills in the family planning clinic. Results: There were 1,146 new contraceptive acceptors during the period of study out of which 309 (27.9%) accepted the pills. Majority of the clients were between 20 and 29 years of age (54.0%), were multiparous (72.8%), Christians (99.7%) and 61.2% had tertiary level education. Two hundred and fifty-five women (82.5%) desired to use combined oral contraceptive pills to space births while 7.8% wanted to limit child bearing. There was a high discontinuation rate among the women (45.0%) and out of these 87.9% of the clients changed to other contraceptive methods. All the clients commenced their pills within seven days of menstruation and only the low dose monophasic preparations were available in the family planning unit and thus were given to the clients. Conclusion: Women who accept to initiate combined oral contraceptive pills in our center are young, well educated, multiparous women who want to space their pregnancies. However, due to the high discontinuation rate among the clients, there is need for further studies evaluating reasons for the high discontinuation rate, exploring interactions between clients and providers’ and also providers’ attitude towards combined pills in our environment.
Abasiattai, A. M; Utuk, M. N; Ojeh, S. O; Eyo, U E
The results of a community-based contraceptive distribution program using village women canvassers in Cheju Island province, Korea, are evaluated. This rural province had the highest fertility and lowest contraceptive use before the project began. After pre-testing in another area, township-level family planning field workers recruited 365 new female canvassers per 150 women at risk of pregnancy, compared to 10,000-25,000 per worker in the previous scheme. The canvassers were to contact every household, offering them pills or condoms, or vouchers for an IUD or sterilization from the clinic. The former target system, which in reality had limited the numbers of acceptors, was suspended, necessitating an increase in budget outlays for family planning in Cheju province. By 1985 the contraceptive prevalence had doubled, and fertility fell 40.1 and 32.4% in the 2 Cheju counties. Costs per couple-year for the Cheju program were lower than those in other areas. The results of this project suggested that increasing the number of community workers or canvassers in rural areas helps reduce barriers to the use of contraceptives. PMID:12281487
In a population based case-control study 433 New Zealand women aged 25-54 with newly diagnosed breast cancer were compared with 897 women selected at random from the electoral rolls. The relative risk of breast cancer in women who had ever used oral contraceptives was 0.94 (95% confidence interval 0.70 to 1.25). The relative risk in women aged 25-34 at diagnosis was estimated to be 2.2 (95% confidence interval 0.47 to 9.9) and in older women less than 1. Analyses of risk by duration of use of oral contraceptives, age at first use, and time since first use showed no adverse effect of the pill. In particular, there was no increased risk in women who had used oral contraceptives before the age of 25 or before their first pregnancy, even for prolonged periods. Given the high prevalence of use in New Zealand, this study provides strong evidence against the hypothesis that use of oral contraceptives at young ages increases the risk of breast cancer.
Paul, C; Skegg, D C; Spears, G F; Kaldor, J M
The Smoking History Generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975–2000.
Jeon, Jihyoun; Meza, Rafael; Krapcho, Martin; Clarke, Lauren; Byrne, Jeff; Levy, David T.
The relationship between contraceptive education and teenage male contraceptive behavior was investigated. Findings indicated that brief or moderately in-depth contraceptive education had little effect on contraceptive behavior. The teenage pregnancy and other sex-related problems may make parents and schools more amenable to comprehensive…
Taylor, Mary E.; And Others
This article consists of excerpts from a speach made on October 19th at the 1986 annual meeting of the Association of Planned Parenthood Professionals by Dr. Luella Klein, President of the American College of Obstetricians and Gynecologists (ACOG) between 1984-85. The speaker described the reaction of US television network to the ACOG's request that the networks air a public service announcement encouraging responsible sexual behavior among the nation's young people. In 1984 the ACOG initiated a public information program aimed at reducing the high number of unwanted births among young people. The ACOG with the help of an advertising agency developed a 27-second public service announcement stressing responsible parenthood and informing young people that they could write or call for further information. A booklet, entitled "Facts," was prepared for distribution to those who inquired. It advised young people to consider postponing sexual intercourse but to use the most effective methods of contraception if they decided to be sexually active. Oral contraceptives for females and condoms for males were recommended as the most effective methods. When the 3 major television networks, i.e., the American Broadcasting Company (ABC), the National Broadcasting Company (NBC), and the Columbia Broadcasting System (CBS), were requested to carry the announcement, all 3 networks claimed the announcement was too controversial to air. These same networks do not hesitate to show blatant, irresponsible sexual behavior repeatedly during their entertainment programming, and commercials with sexual innuendos are routinely accepted for airing by the networks. In July, 1986, the ACOG called a news conference in New York City to inform the news media about the rejection of the announcement by the networks. The conference stimulated considerable interest, and the story was carried by many newspapers and by radio and television news programs. Many of the news accounts of the story contained the public service announcement itself. As a result, young people began calling and writing for the booklet. Editorials critical of the networks' handling of the ACOG request appeared in numerous publications. The author then wrote to the presidents of each network asking them to reconsider the ACOG request. The presidents of ABC and CBS flatly rejected the request, but the president of NBC agreed to meet with the ACOG to work out an acceptable announcement. The networks must be encouraged to promote a more responsible and realistic image of sexual behavior than the image currently being conveyed in television programs and ads. PMID:12340617
At the present growth rate, the world population is estimated to reach a phenomenal 8.9 billion people by the year 2050, posing a great risk of overpopulation. Therefore, new strategies of contraception are required. A novel contraceptive strategy that is receiving considerable attention is that of immunocontraception. Spermatozoa have proteins that are unique, cell specific, immunogenic and accessible to antibodies. The targeting of antibodies to gamete-specific antigens implicated in sperm function, sperm-egg binding and fertilisation could block sperm binding and thus fertilisation. The present review highlights the current status, relative merits and future directions for various sperm-based candidate antigens with regard to the development of a contraceptive vaccine. PMID:16153335
An increasing concern to nurses is the possibility of drug interactions involving oral contraceptives. Information regarding the mechanisms, significance, and management of drug interactions with oral contraceptives is provided. Approaches to counseling patients also are discussed. PMID:6355611
Stoehr, G P; White, J
In the UK, long-acting reversible contraceptives have been welcomed by sexual health policy-makers and many practitioners as a particularly effective way of preventing unintended pregnancy, especially teenage conception. However, little is known about women's individual experiences of these forms of contraception beyond limited data on retention rates and reasons for discontinuation. The main aims of this research were to gain a fuller understanding of why some young women have their implants removed, and what may help them maintain this method of contraception if they wish to do so. The contraceptive choices of 20 young women (aged 16-22) who had chosen the implant, and later discontinued it, were examined. They had experienced unacceptable side effects that they attributed to the implant, and interpreted as a threat to their bodily control, which they were not prepared to tolerate. These feelings were exacerbated if they then encountered delays after requesting removal. Although they remained concerned to avoid unintended pregnancy, they generally moved to a less reliable form of contraception following implant removal and felt discouraged from trying other long-acting contraception. We suggest that principles of contraceptive choice should include facilitating the discontinuation of unsatisfactory methods; implant removal should therefore be readily available when requested, regardless of the length of time the implant has been in place. Long-acting forms of contraception do not suit all women, and will not obviate the need for other forms of reproductive control, including legal abortion. PMID:23684202
Hoggart, Lesley; Newton, Victoria Louise
The rate of contraceptive use in Iran is high, but because abortion is illegal, many unintended pregnancies among married women are likely to be terminated by clandestine and often unsafe procedures, resulting in adverse health outcomes. Drawing upon data from the 2009 Tehran Survey of Fertility, this study estimates the levels and trends of unintended pregnancy and examines determinants of pregnancy intentions for the most recent birth, using multinomial logistic regression analysis. The level of unintended pregnancy decreased from 32 percent in 2000 to 21 percent in 2009, while contraceptive use increased. Unintended pregnancies in the five years preceding the 2009 survey resulted from failures of withdrawal (48 percent) and of modern contraceptive use (20 percent), together with contraceptive discontinuation (26 percent) and nonuse (6 percent). Multivariate findings show that, compared with women experiencing withdrawal failures, the risk of unintended pregnancy was higher among women reporting modern contraceptive failure and lower among those reporting contraceptive discontinuation and nonuse. The high risk of unwanted pregnancy among women experiencing failures in practicing withdrawal or using modern contraceptive methods points to an unmet need for family planning counseling and education rather than to a shortage of contraceptive methods. PMID:24006075
The importance of meeting the unmet need for contraception is nowhere more urgent than in the countries of sub-Saharan Africa, where the fertility decline is stalling and total unmet need exceeds 30 per cent among married women. In Ghana, where fertility levels vary considerably, demographic information at sub-national level is essential for building effective family planning programmes. We used small-area estimation techniques, linking data from the 2003 Ghana Demographic and Health Survey to the 2000 Ghana Population and Housing Census, to derive district-level estimates of contraceptive use and unmet need for contraception. The results show considerable variation between districts in contraceptive use and unmet need. The prevalence of contraceptive use varies from 4.1 to 41.7 per cent, while that of the use of modern methods varies from 4.0 to 34.8 per cent. The findings identify districts where family planning programmes need to be strengthened. PMID:22553978
Amoako Johnson, Fiifi; Padmadas, Sabu S; Chandra, Hukum; Matthews, Zoe; Madise, Nyovani J
The 1st published study of efficacy of a hormonal male contraceptive, by the WHO Special Programme of Research, Development and Research Training in Human Reproduction, employed weekly deep intramuscular injections of testosterone enanthate. 271 fertile married men at 10 centers worldwide participated for 18 months. The goal of this preliminary study was to determine if azoospermia was necessary or sufficient for effective contraception. Azoospermia was produced in 157 men, who then participated in a 12-month trial. There was 1 pregnancy, for a failure rate of 0.8 per 100 person-years, highly effective in comparison with oral contraceptives, IUDs and injectables. There was a 12% annual discontinuation rate reasons cited were acne (4%), behavioral effects such as aggression or increased libido (1%), and other medical reasons (1%), e.g. weight gain, polycythemia, hyperlipidemia or hypertension. Recruitment of study subjects was difficult in developed countries until direct public appeals met with success. Future developments in the male hormonal contraceptive field will require a more acceptable administration route. To develop this, longer-acting injectables or implants utilizing testosterone cybutanate (20AET-1), or other combinations of testosterone with a progestin or a gonadotropin-releasing hormone antagonist are envisioned. The effect of incomplete azoospermia and the fertilizing capacity of remaining sperm is a serious issue for research. Each more crucial is resolution of the social, political and legal problems involved in male hormonal contraceptive research. Probably reform of the US product liability litigation procedures will do more to advance contraceptive development than any other single factor. PMID:1994193
Handelsman, D J
Purpose: To explore knowledge, attitudes toward, and experience with, the emergency contraceptive pill (ECP) among teenagers in Sweden.Methods: A questionnaire with 23 questions concerning the students’ demographics, knowledge of, attitudes toward, and experience of the ECP was delivered to a random sample of 20 classes in senior high school in two medium-sized cities in Sweden. The participation rate was 100%
Elisabet HäggstrÖm-Nordin; Tanja Tydén
Contraceptive implants are increasingly being used for fertility regulation all over the world. Reversible long-term use is their most appealing feature for many users. They have the practical advantage of overcoming the risks of user failure and low continuation rates associated with other methods that require continuous attention or motivation.
K. Singh; G. C. Chye
|The high incidence of abortion and pregnancy among college students is indicative of their increasing rate of sexual activity. College students refute the use of contraceptives for reasons which include: (1) difficulty in acknowledging oneself and others as sexual beings; and (2) shame and guilt over sexual activities. (JN)|
Rindskopf, Kathryn Dohrmann
Previous attempts to replace ethinylestradiol (EE) with 17?-estradiol (E2) in combined oral contraceptives (COCs) have proved unsatisfactory in terms of bleeding outcomes. A review of previous studies of E2-based COCs has shown that, despite good ovulation inhibition, bleeding irregularities affected up to 100% of women, often resulting in high rates of discontinuation (up to 42%). Suggested reasons for the bleeding
Franca Fruzzetti; Johannes Bitzer
Modern hormonal contraceptives and intrauterine contraceptive devices have multiple biologic effects. Some of them may be the primary mechanism of contraceptive action, whereas others are secondary. For combined oral contraceptives and progestin-only methods, the main mechanisms are ovulation inhibition and changes in the cervical mucus that inhibit sperm penetration. The hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive
Roberto Rivera; Irene Yacobson; David Grimes
This research project, conducted in the Spring of 1973, had two objectives: (a) to estimate the difference between rates of drug usage determined by the random urine testing currently in use by the Army and rates of usage found by use of an anonymous, sel...
J. M. Reaser J. A. Richards S. L. Hartsock
Background Smoking is an important cause of morbidity and mortality worldwide. It is widely accepted as a major risk factor for metabolic and cardiovascular disease. Smoking reduces insulin sensitivity or induces insulin resistance and enhances cardiovascular risk factors such as elevated plasma triglycerides, decreases high-density lipoprotein cholesterol and causes hyperglycemia. Several studies show that smoking is associated with metabolic abnormalities and increases the risk of Metabolic Syndrome. The aim of this study was to estimate the prevalence of the metabolic syndrome in a group of light and heavy smokers, wishing to give up smoking. Methods In this cross-sectional study all the enrolled subjects voluntary joined the smoking cessation program held by the Respiratory Pathophysiology Unit of San Matteo Hospital, Pavia, Northern Italy. All the subjects enrolled were former smokers from at least 10 years and had no cancer or psychiatric disorders, nor history of diabetes or CVD or coronary artery disease and were not on any medication. Results The subjects smoke 32.3?±?16.5 mean Pack Years. The prevalence of the metabolic syndrome is 52.1%: 57.3% and 44.9% for males and females respectively. Analysing the smoking habit influence on the IDF criteria for the metabolic syndrome diagnosis we found that all the variables show an increasing trend from light to heavy smokers, except for HDL cholesterol. A statistical significant correlation among Pack Years and waist circumference (R?=?0.48, p?0.0001), Systolic Blood Pressure (R?=?0.18, p?0.05), fasting plasma glucose (R?=?0.19, p?0.005) and HDL cholesterol (R?=??0.26, p?=?0.0005) has been observed. Conclusions Currently smoking subjects are at high risk of developing the metabolic syndrome. Therapeutic lifestyle changes, including smoking cessation are a desirable Public health goal and should successfully be implemented in clinical practice at any age.
The objective of this study was to determine the effect of oral contraceptive pills on bone turnover. The design consisted of a cross-sectional analysis of a prospective cohort. There were 52 women taking oral contraceptives and 156 nonuser controls from a large cohort of 1039 healthy women, aged 31–89 years (OFELY study). Most users were taking combined oral contraceptives containing
P. Garnero; E. Sornay-Rendu; P. D. Delmas
The records of a sample of Family Planning acceptors were examined to identify those factors which influenced the choice of a contraceptive and the drop-out rate in the period 1970--1977 inclusive. It was found that although a full range of contraceptives was theoretically available, as the 1970s advanced the effective choice appeared to lie between the two hormonal contraceptives, medroxyprogesterene acetate (Depo Provera) and the oral contraceptive pill with family size being the deciding factor. The drop-out rate as also influenced by family size with nulliparous women showing the highest rate. Explanations for the drop-out rates and the percentage of single visits made to the clinics were sought through the utilization of partial correlations. In both cases the average distance between the acceptor's home and the clinic appeared to play a decisive role. PMID:6217552
Bailey, W; Powell, D
This article presents two opposing views on the importance of artificial contraceptives. It is noted that in the April 19 issue of the Manila Bulletin, Ms. Ethel Soliven wrote in her column that the position of the Catholic Church on artificial contraceptives is standing in the way of success of the Philippine family planning campaign. To this effect, Sister Mary Pilar Versoza of the Religious of the Good Shepherd, sent a letter of rebuttal saying that the church has never been remiss in emphasizing the true meaning of sexual act, love and relationship, marriage, and family responsibilities. Sister Pilar contended that ligation and condoms do not solve husbands¿ selfishness. In response, Soliven argued in another issue of the Manila Bulletin that she believes in the need to provide access to artificial contraceptives. Soliven asserted that destitute couples who cannot provide their families with even the barest necessities of life should be provided with the means with which to prevent unwanted pregnancies. PMID:12322661
In groups of women taking oral contraceptives and in control groups of women, the serum levels of cortisol, protein-bound iodine, and total thyroxine were measured together with the T3 binding index. The daily excretion in the urine of free cortisol, 17-hydroxycorticosteroids, 17-ketosteroids, pregnanediol, pregnanetriol, total oestrogens, total catecholamines, and 4-hydroxy-3-methoxymandelic acid was also assayed. The frequency distribution of the values obtained indicates that oral contraceptives have a marked influence on the endocrine environment. The smallest deviations were observed in urinary excretion of total catecholamines and of 4-hydroxy-3-methoxymandelic acid. In some individuals the hormone assays were continued throughout the menstrual cycle. The morning and afternoon levels of serum cortisol tended to increase during the period when the oral contraceptive was being taken.
Lucis, O. J.; Lucis, R.
For 30 years, the combined oral contraceptive pill has been an almost automatic choice for effective contraception in sexually active adolescent women. Nevertheless, consideration of the criteria of a hypothetical "ideal" contraceptive suggests that long-acting progestogen-only methods may have considerable advantages for some adolescents. These would include greater efficacy, easier compliance, avoidance of estrogenic side effects, and potentially greater privacy. The disadvantages of menstrual irregularity, progestogenic side effects including weight gain, and the initial greater medicalization of the method, particularly implants, must be weighed against the wishes and preferences of the adolescent. A number of studies of the uptake and utilization of these methods in adolescence have arisen, particularly from the United States. These are reviewed together with experience from programs in the United Kingdom. PMID:9238299
Bromham, D R
Our study objective was to assess changes in effective contraceptive use among women at risk of unintended pregnancy in Florida in 2008 and 2009 compared with 2002 and 2004. Contraceptive use questions were available from Florida's Behavioral Risk Factor Surveillance System (BRFSS) for both periods (n = 4,606). Log binomial regression was used with appropriate methods to account for complex sampling in the BRFSS. We examined the change in four effective contraceptive use groups: sterilization, long-acting reversible contraceptive (LARC), short-acting reversible contraceptive (SARC), and barrier methods. Prevalence ratios comparing the two time periods were adjusted by demographic characteristics, employment, insurance status, children at home, poverty level, health behaviors, and health status. No evidence of change was found in sterilization (Adjusted Prevalence Ratio APR = 0.96; 95 % CI: 0.84-1.10) or SARC (APR = 1.01; 95 % CI: 0.87-1.18). The overall use of LARC increased and use of barrier methods decreased significantly over the two periods (APR = 1.68; 95 % CI: 1.09-2.60 and APR = 0.77; 95 % CI: 0.61-0.98, respectively). Only two population groups experienced significant changes in prevalence in the four use groups over this period. Non-Hispanic White women increased their use of LARC (APR = 2.89; 95 % CI: 1.58-5.29) and women who have never been married decreased their use of barrier methods (APR = 0.51; 95 % CI: 0.33-0.77). Contraceptive use in Florida continues to be low overall with some shift towards more effective long-term methods. New efforts are needed to promote and increase family planning practices, which include the use of effective contraceptives. PMID:22965733
Hernandez, Leticia E; Sappenfield, William M; Clark, Cheryl; Thompson, Daniel
Administered in high doses, certain types of oral contraceptives (OCs) can be used after unprotected intercourse to prevent pregnancy. This regimen is safe and 75% effective; it appears to alter the uterine lining, thereby preventing implantation. The usual regimen consists of a dose of at least 100 mcg of ethinyl estradiol and 0.5 mg of levonorgestrel taken within 72 hours of unprotected sex and repeated 12 hours later; alternatively, 0.75 mg of levonorgestrel administered within 48 hours and repeated 12 hours later can be used. The US Food and Drug Administration has identified the following OCs as appropriate for use as emergency contraception: Wyeth's Ovral, Nordette, Lo/Ovral, or Triphasil and Berlex Laboratories' Levlen or Tri-Levlen. Despite the high doses required, these OCs can be taken safely for emergency purposes even by women with contraindications to regular OC use. A single dose of 600 mg of RU-486 or insertion within 5 days of a copper-bearing IUD represent two other approaches. In the US, more widespread use of emergency contraception has been hindered by equation of the method with abortion, the misperception that pills must be taken the morning after unprotected sex, lack of staff training, lack of consumer awareness of its availability and source, concerns women will substitute the method for consistent contraceptive use, and the lack of any formulation specifically marketed for this purpose. On the other hand, the method is used widely in parts of Africa to protect women from the risks of illegal abortion. The Consortium for Emergency Contraception plans to work with industry to produce an inexpensive emergency contraceptive that will be introduced in up to 15 developing countries over the next 5 years. PMID:12291586
Blaney, C L
Relevant research efforts in male contraception involve: 1) hormonal approaches to block sperm production by inhibiting the hypothalamic-pituitary-gonadal axis, 2) disruption of sperm production by drugs that act directly on the testes, 3) interruption of sperm transport, and 4) alteration of secretions of the accessory sex glands and their subsequent effect on the spermatozoa. Both agonistic and antagonistic synthetic analogs of the hypothalamic gonadotropin releasing hormone (GnRH) factor cost too much and lack an effective mode of administration. Recent studies indicate that over 90% of Chinese and Indonesian men can develop complete azoospermia following either a testosterone or a progestin and an androgen combination treatment. Vaccines that utilize GnRH and follicle stimulating hormone as the active antigens have been introduced in clinical studies in the US and India. Drugs such as sulfasalazine, pyrimethamine, nitrofurane, and bis(di-chloracytal) diamines reduce male fertility but side effects make them unacceptable. Dinitropyrroles, halopropanedils, chlorosugars, and indazole carboxylic acids have been tried in laboratory animals. Gossypol rendered men infertile in large-scale clinical studies conducted in China but synthesis of safer analogs has not succeeded. Extracts of another plant, tripterigium wilfordii, are used in China as a popular herbal medicine. Vasectomy has improved with no-scalpel vasectomy and by the novel technique of blocking the vas with cured in situ polymeric plugs. Preliminary data suggest that men prefer condoms made from polyurethane as opposed to latex rubber increasingly used to protect against AIDs and sexually transmitted diseases. The antifungal agents, imidazoles, have spermicidal activity and synthetic variants may reduce undesirable side effects. Research on male-oriented methods has intensified during the last 10-15 years, but a new product is not likely to appear in the next 5-10 years. PMID:12286189
Bialy, G; Alexander, N J
Oral contraceptives can cause liver damage and jaundice but this is very rare in women in the United Kingdom. The drugs are contraindicated where there is a history of recurrent intrahepatic cholestasis of pregnancy and acute or chronic disturbance of liver function which can be congenital or acquired. It is not yet known whether the oestrogenic or progestogenic components of oral contraceptives cause the hepatic abnormalities. The available data suggest that neither oestrogens nor progestogens in low doses impair hepatic excretory processes. The full implications of the continued administration of oestrogens and progestogens for many years on liver proteins are not yet known.
Norplant, Depo-Provera, and the progestin-only pill are good for 35-50 year old women, since they are safe and have low failure rates. A beneficial feature of progestin-only contraceptives is the lack of thrombotic complications. They are good for couples considering sexual sterilization. Neither antibiotics nor antiseizure medicines reduce Depo-Provera's effectiveness. The only drug which reduces its effectiveness is aminoglutethimide (Cytadren), used to suppress adrenal function in some people with Cushing syndrome. Research indicates that Depo-Provera even reduces the frequency of seizures. Antiseizure medicines (except valproic acid) and the antibiotic, rifampin, greatly reduce the effectiveness of Norplant to prevent pregnancy. Antiseizure drugs increase hepatic enzymes, resulting in the breakdown of levonorgestrel. In those cases where women who already have Norplant need an antiseizure drug or rifampin, family planning practitioners should advise them to use another contraceptive. Many women using Depo-Provera experience amenorrhea (30-50% at 1 year, 70% at 2 years, and 80% at 5 years), but most find it to be a benefit. The most undesirable side effect of Depo-Provera is weight gain (5.4-16.5 lbs. after 1-6 years use, respectively), likely due to increased appetite. Women who use Norplant for 5 years gain on average a little less than 5 lbs. Once a woman is injected with Depo-Provera, she cannot immediately discontinue it, and its effects cannot be stopped. It takes 6 to 8 months to clear the body. Only 2 women have experienced anaphylactic reactions to Depo-Provera. Despite this rare event, it is important for practitioners to have epinephrine, steroids, and diphenhydramine to treat severe allergic reactions. A study finds reduced bone density among longterm Depo-Provera users, but it did not match for parity or smoking and did not determine bone density prior to injections of Depo-Provera. Further research on bone density and progestin-only contraceptives is needed. PMID:12286999
Hatcher, R A; Schnare, S
Recent research has suggested that the use of alcohol or drugs in conjunction with sexual intercourse is associated with nonuse of contraception, particularly in first intercourse experiences. This paper reports findings from a nationally representative sample of adolescents and young adults aged 18-30 who were asked a number of questions about the circumstances and characteristics of the first time they had intercourse. Results showed that drinking at the time of first intercourse was more prevalent among those who first had sex prior to 1985; moreover, members of this cohort were less likely to use condoms or other forms of birth control at the time of first intercourse. Drinking was associated with nonuse of contraception only among those who had their first sexual experience prior to 1985. The results are discussed in terms of historical changes in the sexual climate of the AIDS era. PMID:7595954
Leigh, B C; Schafer, J; Temple, M T
More knowledge on the reasons for refusal of the influenza vaccine in elderly patients is essential to target groups for additional information, and hence improve coverage rate. The objective of the present study was to describe precisely the true motives for refusal. All patients aged over 64 who attended the Medical Outpatient Clinic, Univer- sity of Lausanne, or their private
Laurence Canova; Myriam Birchmeier; Valérie D'Acremont; Gilbert Abetel; Maxime Mancini; François Verdon; Alain Pécouda; Blaise Genton
This paper draws on primary and secondary data sources to document an increasing number of visually handicapped children. The paper discusses socioeconomic trends, increased rates of handicapping conditions in general, increased number of legally blind schoolchildren, and evidence of an increase in retinopathy of prematurity. (JDD)
|This paper draws on primary and secondary data sources to document an increasing number of visually handicapped children. The paper discusses socioeconomic trends, increased rates of handicapping conditions in general, increased number of legally blind schoolchildren, and evidence of an increase in retinopathy of prematurity. (JDD)|
The administration of oral contraceptives which contain oestrogen increases non-protein-bound plasma cortisol levels at 9 am as well as protein-bound and total cortisol levels. These increases are dependent on the dose of oestrogen; they are not usually seen with progestogen-only or `low-dose' oestrogen (0·05 mg mestranol or less) preparations. `Standard' oral contraceptives (0·1 mg mestranol or equivalent) produce some elevation of unbound cortisol levels at 9 am (from a normal mean of 0·66 ?g/100 ml to 1·02 on the `pill') but this elevation is less than that associated with high-dose oestrogen treatment of, for example, prostate cancer (mean 1·8 ?g/100 ml). Since unbound cortisol levels in plasma are controlled by a hypothalamic feedback mechanism, it appears that oral contraceptives have some effect on this mechanism. Possible long-term effects of oral contraceptives on hypothalamopituitary function require examination. However, the plasma unbound cortisol to which the tissues are exposed at 9 am does not measure the overall exposure of tissues to cortisol throughout the 24 hours. Neither does measurement of cortisol production rate or urinary metabolite excretion accurately reflect the exposure of tissues to cortisol during oestrogen treatment, because of the complex effects of oestrogen on hepatic metabolism of steroids, steroid-protein binding, and the increased size of the extracellular cortisol pool. The overall exposure of tissues to unbound cortisol is measured better by urinary free cortisol excretion. Urinary free cortisol excretion is a measure of the integrated area under the diurnal curve of plasma unbound cortisol, ie, of the 24-hour exposure of tissues to unbound cortisol. Urinary free cortisol excretion is normal in women taking low-dose oestrogen or progestogen-only contraceptives, and is only trivially increased by the standard `pill'. Thus increased exposure of tissues to unbound cortisol is likely to be only a minor factor in the metabolic responses to oral contraceptives. In contrast, urinary free cortisol excretion (mean normal 38 ?g/24 hours) is increased by high-dose oestrogen administration for prostatic cancer (mean 110 ?g/24 hours); this is because the diurnal rhythm of unbound cortisol is impaired. It is thus unwise to ascribe effects of oral contraceptives to increased exposure of tissues to cortisol, except in the liver where it is possible that the increased concentration of protein-bound cortisol they cause may exert metabolic effects. The preparations which cause least change in cortisol metabolism are the low-dose oestrogen or progestogen-only contraceptives.
Burke, C. W.
The USA, a country with widespread access to the full range of modern methods of contraception, continues to have one of the highest abortion rates among developed countries. Forty-nine per cent of women reported ever experiencing an unintended pregnancy in 2001; 48% of these conceptions occurred during a month that contraception was used. We explored the extent to which people
Ann M. Moore; Susheela Singh; Akinrinola Bankole
The patent application relates to an intrauterine contraceptive device which will fold-up for insertion and deploy into the desired shape after it is introduced into the uterus. The device, adapted to be non-surgically placed into the uterus to protect ag...
R. G. Wheeler
We reviewed 52 studies published since 1970 investigating interpersonal factors related to the contraceptive behavior of unmarried adolescents and young adults. The studies focused largely on white, middle?class women from student and clinic populations. Methodological problems included poorly defined samples and procedures, a relative lack of random sampling techniques, and a heavy reliance on subjects' self?reports. Methodological strengths included generally
Richard J. Milan Jr; Peter R. Kilmann
The possible relationship of oral contraception use to breast cancer is a concern to physicians and their patients. In this article, the authors present a review of the major studies conducted during the last 10 years, from an epidemiologic viewpoint. PMID:2259330
Gay, J W; Cardwell, M S
The case histories are reported of six women who developed chorea while taking oral contraceptive drugs. The chorea that results from taking compounds containing oestrogen and progestogen has many features in common with chorea gravidarum, and the pathogenesis is probably similar. In some of the patients, however, the sudden onset of symptoms suggests a vascular aetiology.
Riddoch, Donald; Jefferson, Michael; Bickerstaff, Edwin R.
This study evaluated the sexual knowledge (including contraceptive and reproductive knowledge), contraceptive use, and self-esteem among a sample of 158 male and female United States Navy sailors assigned to Navy ships. In spite of the fact that men and women viewed themselves as relatively knowledgeable with respect to contraception, results showed substantial knowledge deficits. Women demonstrated significantly greater sexual knowledge than men, and contraceptive/ reproductive knowledge was highly correlated with self-reported use of contraceptives. Finally, self-esteem was highly correlated with sexual knowledge and certain contraceptive use behaviors. PMID:9110557
Gallagher, C K; Lall, R; Johnson, W B
Estrogen and progestins have been used by millions of women as effective combined contraceptives. The safety of hormonal contraceptives has been documented by years of follow-up and serious adverse events that may be related to their use are rare in the young population exposed to these agents. The balance between the benefits and the risks of contraceptive steroids is generally positive in particular when comparing to the risks of pregnancy and especially in women with risk factors. The metabolic changes induced by the synthetic steroids used in contraception, such as lipoprotein changes, insulin response to glucose, and coagulation factors have been considered as potential markers of cardiovascular and venous risk. Observations of these effects have led to modifications of the composition of hormonal contraceptive in order to minimize these changes and hence potentially decrease the risks. The synthetic estrogen Ethinyl-Estradiol (EE) exerts a stronger effect that natural estradiol (E2) on hepatic metabolism including estrogen-dependent markers such as liver proteins. This stronger hepatic impact of EE has been related to its 17?-ethinyl group which prevents the inactivation of the molecule and results in a more pronounced hepatic effect of EE as compared to estradiol. Due to its strong activity, administering EE via a non-oral route does not prevent its impact on liver proteins. In order to circumvent the metabolic changes induced by EE, newer products using more natural compounds such as estradiol (E2) and estradiol valerate (E2V) have been introduced. The synthetic progestins used for contraception are structurally related either to testosterone (T) (estranes and gonanes) or to progesterone (pregnanes and 19-norpregnanes). Several new progestins have been designed to bind more specifically to the progesterone receptor and to minimize side-effects related to androgenic, estrogenic or glucocorticoid receptor interactions. Dienogest (DNG), and drospirenone (DRSP) and the 19-norpregnanes including Nestorone® (NES), nomegestrol acetate (NOMAc) and trimegestone (TMG) have been combined with estrogen either EE or E2 or estradiol valerate (E2V). Risks and benefits of the newer progestins used in contraception depend upon the type of molecular structure, the type and dose of estrogen associated in a combination and the route of administration. The lower metabolic impact of estradiol-based combinations may result in an improved safety profile, but large surveillance studies are warranted to confirm this plausible hypothesis. So far, the contraindications and warnings for use of current COCs also apply to the estradiol-based COCs. PMID:21538049
Sitruk-Ware, Regine; Nath, Anita
There is a very small correlation, if any, between the prior use of OCs and congenital malformations, including Down's syndrome. There are few, if any, recent reports on masculinization of a female fetus born to a mother who took an OC containing 1 mg of a progestogen during early pregnancy. However, patients suspected of being pregnant and who are desirous of continuing that pregnancy should not continue to take OCs, nor should progestogen withdrawal pregnancy tests be used. Concern still exists regarding the occurrence of congenital abnormalities in babies born to such women. The incidence of postoperative infection after first trimester therapeutic abortion in this country is low. However, increasing numbers of women are undergoing repeated pregnancy terminations, and their risk for subsequent pelvic infections may be multiplied with each succeeding abortion. The incidence of prematurity due to cervical incompetence or surgical infertility after first trimester pregnancy terminations is not increased significantly. Asherman's syndrome may occur after septic therapeutic abortion. The pregnancy rate after treatment of this syndrome is low. The return of menses and the achievement of a pregnancy may be slightly delayed after OCs are discontinued, but the fertility rate is within the normal range by 1 year. The incidence of postpill amenorrhea of greater than 6 months' duration is probably less than 1%. The occurrence of the syndrome does not seem to be related to length of use or type of pill. Patients with prior normal menses as well as those with menstrual abnormalities before use of OCs may develop this syndrome. Patients with normal estrogen and gonadotropin levels usually respond with return of menses and ovulation when treated with clomiphene. The rate for achievement of pregnancy is much lower than that for patients with spontaneous return of menses. The criteria for defining PID or for categorizing its severity are diverse. The incidence of PID is higher among IUD users than among patients taking OCs or using a barrier method. The excess risk of PID among IUD users, with the exception of the first few months after insertion, is related to sexually transmitted diseases and not the IUD. Women with no risk factors for sexually transmitted diseases have little increased risk of PID or infertility associated with IUD use. There appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users. All present methods of contraception entail some risk to the patient. The risk of imparied future fertility with the use of any method appears to be low.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2209874
Huggins, G R; Cullins, V E
The concomitant use of antibiotics and oral contraceptives should be included in the assessment of contraceptive failure. A case of unwanted adolescent pregnancy during the use of a semisynthetic penicillin and an oral contraceptive is presented and discussed. Advising a different contraceptive method or an additional contraceptive modality may be indicated in adolescents taking long-term antibiotic medication. PMID:6643209
Silber, T J
Taking into account the biological and psychosocial changes during the transition from childhood to adulthood adolescents would need a contraceptive method which ideally would be very effective, independent of compliance, without major health risks during use and no negative impact on the future health of the adolescent, protective against STI, favorable for bone development, with no or only few side effects and having some preventive and therapeutic potential with respect to frequent health problems of adolescent girls. Combined oral contraceptives (COC) used regularly and consistently have a more than 99% efficacy to prevent a pregnancy. COCs have a very low health risk (almost exclusively thromboembolic disease) which seems to differ marginally with respect to dosage and type of the components. Progestogen only oral contraceptives do not have any major negative health impact. The leading side effect is irregular bleeding which in COC users is mainly during the first 3 months and in progestogen only users during the period of use. Other side effects are reported but their frequency is similar to placebo. COC protect against endometrial and ovarian cancer and they may have beneficial effects on a variety of menstrual complaints and acne, which are frequent problems during adolescence. To be effective COCs have to be taken regularly which is frequently not the case. This diminishes considerably their effectiveness depending on the individual compliance. They do not protect against STI and may even have an inhibitory effect on the use of condoms. For most adolescents the risk benefit profile of oral contraceptives is favorable and makes this method valuable. At the same time the prescription of oral contraceptives for adolescents need to be individualized by taking into account the individual risk/benefit profile. Specialized counseling with a high degree of confidentiality adapted to the knowledge and needs of the individual adolescent is desirable. PMID:23384748
This guide to choice of oral contraceptives, for U.S. clinicians, includes a review of the available types of pills, the pharmacology of the steroids in pills, safety issues regarding thrombosis, arterial disease and hypertension related to estrogens and progestins in pills, common side effects, and therapeutic uses of orals. Choice of an oral contraceptive narrows down to which of the 5 available progestins and their formulation, since all contain ethinyl estradiol as the estrogen. While Briggs' theory espoused picking a pill with the minimal metabolic effect, recent evidence suggests that some estrogenic activity may be preferable to the unopposed progestagen, actually an anti-estrogenic receptor effect, to prevent adverse lipid and blood pressure effects in users. Current pills with low doses of estrogens probably are not significant risks for women as regards thrombosis, particularly if predisposed women and smokers are excluded. Pills containing 0.35 mg ethinyl estradiol and 0.5 mg norethindrone, based on large population trials, are probably the minimal effective dose yet even these are more effective than most other contraceptive methods. Breakthrough bleeding and spotting have been further minimized, however, with multiphasic pills. It is best to start with a 0.30-0.35 mg estrogen oral contraceptive, such as Loestrin, Demulin, Orthonovum 1.35, Orthonovum 7/7/7 or Nordette, encouraging the patient to accept early side effects for 3 months before switching to others. Disorders that can be managed with oral contraceptives include recurring and pre-existing ovarian cysts, endometriosis, dysfunctional uterine bleeding and dysmenorrhea. Brief guidelines for handling normal side effects and treatment of the above disorders are included. PMID:2743645
Stubblefield, P G
This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical
Sara E. Yeatman; Joseph E. Potter; Daniel A. Grossman
Early in the 21 st century modern contraception -- primarily hormonal methods, advanced IUDs, sterilization and condoms -- has become the main instrument of birth regulation in Northern and Western Europe and gaining ground in Southern Europe and the formerly state socialist countries of Central and Eastern Europe. Legal induced abortion use, which was highly prevalent in Central and Eastern
Abstract Objective To estimate the potential impact of using hormonal contraceptives on rates of infection with human immunodeficiency virus type 1 (HIV-1) and pregnancy by theoretically removing the use of hormonal contraceptives from a study population. Methods A prospective cohort study included 3704 HIV-negative women who were enrolled in two biomedical trials that tested two vaginal microbicides (PRO 2000 and Carraguard®) for the prevention of HIV-1 in Durban, South Africa, in 2004–2009. Cox proportional hazards regression models along with partial population attributable risks (PARs) and their 95% confidence intervals (CIs) were calculated to assess the relative population-level impact of the use of hormonal contraceptives on HIV-1 seroconversion rates and on pregnancy rates. Findings Women who reported using hormonal contraceptives at enrolment in the trial had a higher risk of HIV-1 seroconversion (adjusted hazards ratio: 1.24; 95% CI: 0.97–1.58) than women who reported using other types of contraceptives at enrolment. At the population level, the use of hormonal contraceptives (pills or injectables) at baseline and during study follow-up accounted for approximately 20% (95% CI: 16–22) of HIV-1 seroconversions. However, the partial PAR indicated a relative impact of 12% (95% CI: 9.0–15.7). On the other hand, 72% (95% CI: 66–77) of the pregnancies could have been avoided if all women had used hormonal contraceptives. Conclusion Women using hormonal contraceptives need comprehensive counselling on simultaneous prevention of HIV-1 infection.
Contraceptive choices are being reduced rather than being expanded in many parts of the world, particularly in Western countries. Although this paper presents an Australian perspective, the concerns are shared by family planners in other countries. The reasons for this are multiple and complex and often interrelated but ultimately depend on commercial considerations. The community expectation is that an ideal contraceptive can and does exist, but the media sensationalization of contraceptive problems has given many contraceptive methods a poor image. Contraceptive availability is also affected by liability issues, which have increased the cost of product liability insurance, and medical liability insurance of health professionals, increasing both the cost of contraceptives to the individual and the availability of services such as IUD insertions and sterilization, as practitioners withdraw their services, due to cost of insurance. The cost of marketing a new contraceptive from the time the idea is first developed until it is approved for marketing also deters manufacturers from developing new contraceptives. Delays in drug evaluation procedures in many countries deters companies with already well established contraceptives from marketing them in such countries. The effect of political stands by radical feminists or consumer groups, also effect both the image and the availability of contraceptives, as can be seen with the saga of Depo-Provera, RU486 and intrauterine devices. Similarly, the moral perceptions of anti-abortion groups and health care providers is also a threat to fertility control services. Possible solutions to some of these problems are offered in the paper. PMID:1950710
Use of emergency contraception is low in South Africa despite high rates of unplanned and unwanted pregnancies. Existing studies have demonstrated that women access emergency contraception from commercial pharmacies rather than from public health facilities at no charge. Research has also demonstrated that awareness of emergency contraception is a key barrier to improving uptake, especially in the public health sector. This study investigates the low use of emergency contraception in South Africa and employs a qualitative value chain analysis to explore the role of market and regulatory structures in creating an enabling environment for the supply and promotion of emergency contraception. The results suggest that there are several 'market imperfections' and information barriers impacting on the effective supply of emergency contraception to women who are dependent on the public health sector for their health care. Balancing commercial interests with reproductive health needs, it is argued, may form a crucial part of the solution to the low uptake of emergency contraception in South Africa. PMID:20695135
Rogan, Michael; Nanda, Priya; Maharaj, Pranitha
User compliance is not a problem for the recently approved subdermal, longterm contraceptive delivery system, Norplant. It delivers 50-80 mcg of levonorgestrel/day during the 1st year and 30-35 mcg for years 2-5. The levonorgestrel is encased in 6 36 mm x 2.4 mm capsules which are placed in the upper arm in 5-10 minutes using local anesthesia. Since the implants systemically release levonorgestrel, the shock to the liver experienced in oral contraceptive (OC) users does not occur. Levonorgestrel prevents pregnancy by decreasing luteinizing hormone and follicle stimulating hormone which prevents ovulation, reducing the rate of ovum transfer in the tube, making the endometrium incompatible for implantation, and making the cervical mucus too thick and scanty for sperms to migrate if ovulation does occur. 1-year pregnancy rates for Norplant users are much lower than for women who use other contraceptives (0.6/100 users vs. 2.3/100 for OC users and 2.4/100 for IUD users). The ectopic pregnancy rate is also low (1.47/1000 Norplant users). The 1-year continuation rate is 80% compared with 50% for OC users. Fertility returns within 3 months for 50% of users and within 1 year for 80%. Because Norplant does not adversely affect lipid metabolism there is no increase in the risk of atherogenesis. Menstrual irregularities are the leading side effect of Norplant. The irregular cycles tend to occur during the 1st 3-6 months after insertion. Other side effects include headaches, acne, breast discharge, weight gain, and transient ovarian cysts. Contraindications are abnormal uterine bleeding, possible pregnancy, active liver disease, and women taking phenytoin. The cost for the initial exam and insertion of the Norplant capsules is $500 at Planned parenthood of the Rocky Mountains in Colorado (mean=$8.30/month vs. $13/month for 5 years of taking OCs). Due to the possibility of exploitation of women and involuntary infertility, nurse practitioners must thoroughly explain the system to each patient and answer all questions so the patient can give informed consent. PMID:1565306
Lynn, M M; Holdcroft, C
More knowledge on the reasons for refusal of the influenza vaccine in elderly patients is essential to target groups for additional information, and hence improve coverage rate. The objective of the present study was to describe precisely the true motives for refusal. All patients aged over 64 who attended the Medical Outpatient Clinic, University of Lausanne, or their private practitioner's office during the 1999 and 2000 vaccination periods were included. Each patient was informed on influenza and its complications, as well as on the need for vaccination, its efficacy and adverse events. The vaccination was then proposed. In case of refusal, the reasons were investigated with an open question. Out of 1398 patients, 148 (12%) refused the vaccination. The main reasons for refusal were the perception of being in good health (16%), of not being susceptible to influenza (15%), of not having had the influenza vaccine in the past (15%), of having had a bad experience either personally or a relative (15%), and the uselessness of the vaccine (10%). Seventeen percent gave miscellaneous reasons and 12% no reason at all for refusal. Little epidemiological knowledge and resistance to change appear to be the major obstacles for wide acceptance of the vaccine by the elderly. PMID:14745655
Canova, Laurence; Birchmeier, Myriam; D'Acremont, Valérie; Abetel, Gilbert; Favrat, Bernard; Landry, Pierre; Mancini, Maxime; Verdon, François; Pécoud, Alain; Genton, Blaise
Objective This study was conducted to assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan. Study design Medically-eligible (e.g., conditions not requiring urgent medical attention, such as eclampsia, or not imminently delivering (dilation ?8 cm)) obstetric patients admitted to three Kabul public hospitals were consecutively enrolled in this cross-sectional study. An interviewer-administered questionnaire assessed demographic information, health utilization history, including prior contraceptive use, and intent to use contraception. Correlates of prior contraceptive use were determined with logistic regression. Results Of 4452 participants, the mean age was 25.7 years (SD±5.7 years), 66.4% repoited pregnancy prior to the presenting gestation, 88.4% had ?1 prenatal care visit, and 82.4% reported the current pregnancy was desired. Most (67.4%) had no formal education. One-fifth (22.8%) reported using contraception prior to this pregnancy. Among women with any pregnancy prior to the current gestation (98.6% of prior users), prior contraceptive use was independently associated with having lived outside Afghanistan in the last five years (AOR=1.35, 95% CI: 1.12 – 1.63), having a skilled attendant at the last birth (AOR=1.35, 95% CI: 1.07 – 1.71), having a greater number of living children (AOR=1.30, 95% CI: 1.20 – 1.41), longer mean birth interval (years) (AOR=1.21, 95% CI: 1.11 – 1.38), and higher educational level (AOR=1.16, 95% CI: 1.09 – 1.22). Immediate desire for another pregnancy and spousal disapproval were the most common reasons for not utilizing contraception. Conclusion Prior contraceptive use is low among women in Kabul, Afghanistan, particularly for younger, less educated women. Programming in Kabul to strengthen postpartum contraceptive counseling should address barriers to contraceptive use, including immediate desire for pregnancy and spousal attitudes.
Todd, Catherine S.; Isley, Michelle M.; Ahmadzai, Malalay; Azfar, Pashtoon; Atiqzai, Faridullah; Smith, Jeffrey M.; Ghazanfar, Sayed Alef Shah; Strathdee, Steffanie A.; Miller, Suellen
Unintended pregnancies are a recognized occurrence among women using oral contraceptives (OCs) as a consequence of both user and method failure. However, OCs also influence the occurrence of unintended pregnancies through an additional, poorly recognized, route: cessation of OC use by women who do not wish to become pregnant but stop using OCs because of side effects or other reasons. Many such women fail to immediately substitute a new contraceptive and/or adopt a less reliable contraceptive. This is a particularly important consideration for the approximately 3.7 million women who begin taking OCs in the United States each year since this group commonly experiences side effects and has a high discontinuation rate. Using a decision tree to follow a cohort of OC users over one year, we estimate that over 1 million unintended pregnancies are related to OC use, misuse or discontinuation. The greatest proportion of these, 61%, occur in women who discontinue OCs; of these, 66.6% occur in women who fail to immediately substitute other contraceptives and 33.3% because of the adoption of less reliable contraceptive methods. Of continuing OC users, the majority, exhibiting good compliance, contribute 24% of pregnancies because of their large numbers. Continuing OC users who are poor compliers, though many fewer, are responsible for 15% due to their high pregnancy rate. Unintended pregnancies in women who discontinue OCs account for approximately 20% of the 3.5 million annual unintended pregnancies in the United States, incurring costs of nearly +2.6 billion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7608875
Rosenberg, M J; Waugh, M S; Long, S
Objectives Information on pregnancy rates and factors associated with pregnancy and contraceptive use is important for clinical trials in women in sub-Saharan Africa where withdrawal of investigational products may be required in the event of pregnancy with a consequent effect on sample size and trial power. Methods A prospective cohort analysis of pregnancy and contraceptive use was conducted in Tanzanian women enrolled in a randomised placebo-controlled trial of herpes simplex virus-suppressive therapy with acyclovir to measure the effect on HIV incidence in HIV-negative women and on genital and plasma HIV viral load in HIV-positive women. The cohort was followed every 3?months for 12–30?months. Women at each visit were categorised into users or non-users of contraception. Pregnancy rates and factors associated with pregnancy incidence and contraceptive use were measured. Results Overall 254 of 1305 enrolled women became pregnant at least once during follow-up (pregnancy rate: 12.0/100?person-years). Younger age, being unmarried, higher baseline parity and changes in contraceptive method during follow-up were independently associated with pregnancy. Having paid sex and being HIV positive were associated with lower risk of pregnancy. Uptake of contraception was associated with young age, being unmarried, occupation, parity and the number and type of sexual partners. Conclusions Data on use of contraceptive methods and risk factors for pregnancy can help to guide decisions on trial eligibility and the need for additional counselling. Mandatory reliable contraceptive use in study participants may be required to reduce pregnancy rates in studies where pregnancy is contraindicated.
Odutola, Aderonke; Baisley, Kathy; Hayes, Richard J; Rusizoka, Mary; Tanton, Clare; Weiss, Helen A; Changalucha, John; Ross, David A
BACKGROUND: This study was conducted to determine whether use of hormonal contraceptives is associated with cervical dysplasia and cancer in a population where there is widespread use of hormonal contraception and the rates of cervical cancer remain high at 27.5\\/100,000. METHODS: A case-control study was conducted among women visiting the colposcopy and gynaelogical clinics at a tertiary referral hospital. Two
Norma McFarlane-Anderson; Patience E Bazuaye; Maria D Jackson; Monica Smikle; Horace M Fletcher
Background Vietnam shows a paradoxical situation where high contraceptive prevalence goes together with high abortion rates. This study examined the associations between self-reports of having received voluntary family planning (VFP) services and induced abortions. Methods A cross sectional survey was conducted in Thai Nguyen province, covering a total of 1281 women. Data were derived from a sample of 935 married women aged 18–49?years who were ever-users (93.5%) and current users of contraceptives (84%), and had completed birth histories. The dependent variables were the likelihood of having an induced abortion and repeated (two or more) induced abortions. The main independent variable was having received the three VFP dimensions (counselling, broader information, and access to availability). The association was examined using multivariate logistic regressions, taking into account women’s socio-demographic characteristics. Results The overall induced abortion percentage was 19.4 per 100 pregnancies. None of the three VFP dimensions was significantly associated with the odds of having an induced abortion or having repeated induced abortions. Mother’s age of 35 or older, having more than three living children, and ever used female contraception methods significantly doubled or more the odds of having an induced abortion and significantly tripled the odds of having repeated abortions. Conclusions Results indicate that women receiving VFP services were not less likely to have induced abortions. The provision of family planning counselling, information on contraceptive method mix, and management skills to ensure availability, are in need of reinforcement in a new set of policy and program strategies in the future.
...2010-04-01 2010-04-01 false Contraceptive diaphragm and accessories. 884...Therapeutic Devices Â§ 884.5350 Contraceptive diaphragm and accessories. (a) Identification. A contraceptive diaphragm is a closely...
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Evra (Janssen-Cilag) is the first contraceptive to be available as a skin patch. In promotional material aimed at healthcare professionals, the company claims that Evra offers a "once-weekly method of contraception" with "more than 99% effectiveness and excellent compliance". The company's website for women using Evra carries the slogan "Evra The Right Contraceptive Choice" and claims that the patch is "just as effective as the contraceptive pill". Each patch is intended to be worn for 7 days, in contrast to combined oral contraceptives (COCs), which need to be taken daily. Here we assess whether Evra offers real advantages over COCs and consider its place as a contraceptive option. PMID:14723093
Sex steroids in oral contraceptives exert several effects on the central nervous system and are therefore of concern when used by neurologically compromised women. In general, oral contraceptives do not aggravate epileptic seizures and are not contraindicated in cases of tension headache. Oral contraceptives can be used in cases of migraine without focal neurologic symptoms as long as headache symptoms do not worsen. Levels of sex steroids can be diminished through enzyme induction by antiepileptic drugs, giving rise to the possibility of contraceptive failure and exposure of the fetus to the teratogenic properties of antiseizure medications. Women with common migraine (without focal neurologic symptoms) who are taking oral contraceptives should be monitored for possible exacerbation of their symptoms. Women who do experience worsening of headache symptomatology when taking the pill should consider alternate means of contraception. PMID:8512048
Mattson, R H; Rebar, R W
Homeless women have both a higher rate of pregnancy and a higher proportion of unintended pregnancies than other American women. The authors sought to learn about contraception services offered by providers of health care to homeless women and barriers to provision of long-acting, reversible contraception in these settings. A survey of the 31 member organizations in the national Health Care for the Homeless Practice-Based Research Network was conducted, inquiring about services provided and barriers to service provision. Among the 20 responding organizations (65% response rate), 17 directly provided contraceptive services; two referred patients elsewhere, and one provided no contraceptive services. All 17 that provided such services provided condoms; 15 provided oral contraceptives; 14 provided injectable contraception; 6 provided intrauterine devices, and 2 provided contraceptive implants. Barriers to providing the last two methods included lack of provider training, lack of resources for placement, costs, and concerns about complications. The present survey results suggested very limited access for homeless women across the country to the two most effective means of long-acting, reversible contraception. Modest investments of resources could reduce a number of barriers to providing these services. PMID:22458291
Saver, Barry G; Weinreb, Linda; Gelberg, Lillian; Zerger, Suzanne
Development of the so-called modern methods of contraception has somewhat eclipsed interest in traditional methods. However, spermicides are still important for many couples and their use appears to be increasing. A brief history of the use of and research into spermicidal contraceptives is presented. The limitations of spermicides are: the necessity for use at the time of intercourse, and their high failure rate. Estimates of the failure rates of spermicides have ranged from .3 pregnancies per 100 woman-years of use to nearly 40, depending on the product used and the population tested. Just as their use depends on various social factors, so does their failure rate. Characteristics of the user deterine failure rates. Motivation is important in lowering failure rates as is education, the intracouple relationship, and previous experience with spermicides. Method failure is also caused by defects in the product, either in the active ingredient of the spermicide or in the base carrier. The main advantage of spermicidal contraception is its safety. Limited research is currently being conducted on spermicides. Areas for improvement in existing spermicides and areas for possible innovation are mentioned. PMID:12261805
Examines communication about contraception and specific knowledge of oral contraceptives (OCs) in a sample of Norwegian high school students. More females than males discussed contraception at least monthly. Discussions were predominantly held with peers and not adults. Females were far more knowledgeable about OCs than males. The most significant…
Hansen, Thomas; Skjeldestad, Finn Egil
There are over a hundred contraceptives currently on the market in the USA. In this paper, we present a discourse analysis of the stand-alone websites for 43 contraceptives in an effort to understand what contraceptive manufacturers are selling consumers along with their products. Manufacturers tailor marketing messages to promote conventional sex and gender norms using a scientific discourse. In particular,
Stephanie R. Medley-Rath; Wendy Simonds
|Examines communication about contraception and specific knowledge of oral contraceptives (OCs) in a sample of Norwegian high school students. More females than males discussed contraception at least monthly. Discussions were predominantly held with peers and not adults. Females were far more knowledgeable about OCs than males. The most…
Hansen, Thomas; Skjeldestad, Finn Egil
Involuntary movements developed in five women taking oral contraceptives. In one, the sudden onset of a unilateral disturbance suggested a cerebral thrombosis; this case is considered to be a further example of the increased risk of cerebrovascular disease associated with oral contraception. The four other patients suffered a relapse of Sydenham's chorea between one and four months after starting an oral contraceptive regimen. Possibly an underlying vascular mechanism was responsible for these relapses.
Lewis, P. D.; Harrison, M. J. G.
This article reports a case of acute pancreatitis in a patient taking the oral contraceptive pill. A 32 year old mother had been on combined contraceptive pills since 1975. In 1978 she started having upper abdominal and retrosternal pain. She became critically ill with peripheral circulatory collapse, dyspnoea and cyanosis. A superficial thrombophlebitis was noted on the medial aspect of the right thigh. The diagnosis of pancreatitis was considered with history of recurrent abdominal pain. After several tests and supportive therapy (intravenous fluids, antibiotics, steriods), the woman started showing improvements in 48 hours and recovered in 10 days. This case differs from previously described cases in that the cholesterol and triglyceride levels were normal. The hypoglycemia has not been described previously. PMID:7320005
Mehrotra, T N; Mital, H S; Gupta, S K
An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors. PMID:18087898
Siziya, S; Ntata, P R T; Rudatsikira, E; Makupe, C M; Umar, E; Muula, A S
Owing to the increasing epidemiological and therapeutic challenges associated with infections due to ESBL producers, ESBL prevalence rate among some bacteria isolates from healthy and non-healthy human population in a metropolitan Nigerian setting was evaluated. A total of one hundred and forty-five (145) bacteria strains were isolated from a total of four hundred and sixty (460) samples collected from urine, wound, throat and anal swabs of 220 healthy volunteers in the community and from 240 patients in 2 secondary and 2 tertiary hospitals (altogether, 4) in Enugu metropolis. The presumptive confirmatory test used for ESBL detection was the Double Disc Synergy Test (DDST) method. Conjugation and plasmid curing studies were also done for resistance factor determination. Of the 145 isolates, 20 were ESBL producers with 35% of these ESBL producers being of community origin and 65% from hospitals. This translates to 4.8% and 9% incidences (comparably higher than established prevalence of 4.4% and 7.5 respectively) for community and hospital infections respectively. The ESBL isolates showed high resistance to tetracycline, gentamicin, pefloxacin, ceftriaxone, cefuroxime, ciprofloxacin and Augmentin(®) (Amoxicilin and clavulanic acid combination). Conjugation studies for Resistance plasmid transfer showed non-transference of resistance determinants between the ESBL transconjugants and recipient strains. Correspondingly, the plasmid curing studies revealed that the acridine orange could not effect a cure on the isolates as they still retained high resistance to the antibiotics after the treatment. This study confirms the growing incidences/pool of ESBL strains in Nigeria and call for widespread and continuous monitoring towards an effective management of the potential therapeutic hurdle posed by this trend. PMID:21619555
Afunwa, Ruth A; Odimegwu, Damian C; Iroha, Romanus I; Esimone, Charles O
Objective: To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices.Design: Multinomial logit regression of sterilization.Patient(s): Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households.Intervention(s):
Larry L Bumpass; Elizabeth Thomson; Amy L Godecker
Since the beginning in 1971 of the Planned Parenthood Federation of America's international program, Family Planning International Assistance (FPIA), US$54 million has been contributed in direct financial support for the operation of over 300 family planning programs in 51 countries; over 3000 institutions in 115 countries have been supplied with family planning commodities, including over 600 million condoms, 120 cycles of oral contraceptives, and 4 million IUD; and about 1 million contraceptive clients were served by FPIA funded projects in 1982 aone. Since 1971, however, the world's population has increased from 3.7 billion to around 4.7 billion people. About 85 million people are added to the world each year. There is consensus that without organized family planning programs, today's world population would be even higher. FPIA measures its progress in terms of expanding the availability of contraceptive services in devloping countries. FPIA supported projects have helped make services available in areas previously lacking them, and has helped involve a wide variety of organizations, such as women's groups, youth organizations, and Red Cross Societies, in family planning services. A prime concern of FPIA, which has limited resources, is what happens to projects once FPIA support is terminated. FPIA has been paying attention to local income generation to help projects become more self-supporting and to increas staff members' management skills. The more successful income-generating schemes appear to be directly related to family planning, selling contraceptives and locally produced educational materials, and charging fees for family planning and related medical services and tuition for training courses. FPIA funded to projects use management by objectives (MBO) to help improve management skills. MBO helps grantees improve their ability to set objectives, plan, monitor, report, and do day-to-day project management. PMID:12266275
Most ungulate species are herd animals. In captivity, and increasingly so in the wild, space constraints limit natural behaviors associated with group dynamics, possibly resulting in inbreeding and/or overpopulation. This situation has necessitated research regarding contraception of various species of hoofstock. Differing management situations mandate different contraception protocols to achieve optimal results. Fertility control in hoofstock has been achieved through a number of different contraceptive methods predominantly surgical sterilization, mechanical contraception, synthetic steroid hormones, and immunocontraception. In this study successes and limitations of these techniques are reviewed. Zoo Biol 26:311-326, 2007. (c) 2007 Wiley-Liss, Inc. PMID:19360583
Patton, M L; Jöchle, W; Penfold, L M
Selection of a method of contraception in patients with liver disease can be complicated. Tubal ligation should be considered in the setting of chronic liver disease for those patients who have completed families. Multiple reversible methods of contraception are currently available but may affect hepatic disease. Estrogen-containing contraceptive methods are contraindicated in patients with acute liver disease. Progestin contraceptives appear to be safe and multiple delivery systems are available. With rare exception, barrier methods and the intrauterine device may be offered as alternative methods. PMID:9638912
Connolly, T J; Zuckerman, A L
Outlined is a protocol for the administration of emergency contraceptive pills. The indication for such treatment is unprotected intercourse within the past 72 hours. Absolute contraindications include the possibility of an existing pregnancy and a family history of stroke, heart attack, thrombophlebitis, breast or endometrial cancer, or liver tumor. Possibly excluded, depending on evaluation by a physician, are women with abnormal vaginal bleeding, active hepatitis, active gallbladder disease, high blood pressure, acute focal migraine, breastfeeding women, and those unable to understand instructions. The recommended regimen consists of six tablets of Ovral (two taken immediately, two more in 12 hours) or 12 tablets of Lo/Ovral, Nordette, or Levlen (four taken immediately, repeat dosage in 12 hours). The extra pills are to be used in cases of vomiting within three hours of pill ingestion. Women with a history of oral contraceptive-related nausea and vomiting should be provided with Compazine. Women should be informed that this method is effective in only about 92% of cases. All women who receive emergency contraception should be counseled that this is strictly a back-up method and helped to formulate a long-term birth control strategy. PMID:12287980
The purpose of this review was to test contraceptive efficacy, cycle control, tolerability, and acceptability as found in the non-comparative studies with NuvaRing® by those found in the randomized trials comparing NuvaRing and combined oral contraceptives (COCs). All large non-comparative studies and all relevant randomized controlled trials (RCTs) between NuvaRing and a COC up to and including December 2006 were analyzed. Two large multi-center registration studies, 1 large daily clinical practice study, and 6 RCTs comparing NuvaRing and a COC were identified. The findings in the non-comparative studies were confirmed in the RCTs. Contraceptive efficacy was high showing no significant differences in comparison with the COC; cycle control was good and consistently better than that of the COC; compliance was high and comparable with that of the pill; the incidence of adverse events such as breast tenderness, headache, and nausea was low, but not lower than with the COC despite a halving of the systemic exposure to ethinyl estradiol (EE) with NuvaRing compared with a 30-?g EE-containing COC; the incidence of local and ring-related events was low but higher than with the COC, leading to higher discontinuation rates among NuvaRing users; acceptability was high and comparable between both contraceptives, resulting in a global improvement of sexual function with both methods. After study completion, women using NuvaRing were more likely to continue with their method than women using a COC. The good results with respect to contraceptive efficacy, cycle control, tolerability, and acceptability as achieved with NuvaRing in the large non-comparative registration studies were confirmed in the RCTs comparing NuvaRing with different COCs.
Roumen, Frans JME
This article discusses the legal and epidemiologic status of abortion in Italy, and its relationship to fertility and contraception. Enacted in May 1978, Italy's abortion law allows the operation to be performed during the 1st 90 days of gestation for a broad range of health, social, and psychological reasons. Women under 18 must receive written permission from a parent, guardian, or judge in order to undergo an abortion. The operation is free of charge. Health workers who object to abortion because of religious or moral reasons are exempt from participating. Regional differences exist concerning the availability of abortion, easy to procure in some places and difficult to obtain in others. After an initial increase following legalization, the abortion rate was 13.5/1000 women aged 15-44 and the abortion ratio was 309/1000 live births -- an intermediate rate and ratio compared to other countries. By the time the Abortion Act of 1978 was adopted, Italy already had one of the lowest fertility levels in Europe. Thus, the legalization of abortion has had no impact on fertility trends. Contrary to initial fears that the legalization of abortion would make abortion a method of family planning, 80% of the women who sought an abortion in 1983-88 were using birth control at the time (withdrawal being the most common method used by this group). In fact, most women who undergo abortions are married, between the ages of 25-34, and with at least one child. Evidence indicates widespread ignorance concerning reproduction. In a 1989 survey, only 65% of women could identify the fertile period of the menstrual cycle. Italy has no sex education in schools or national family planning programs. Compared to most of Europe, Italy still has low levels of reliable contraceptive usage. This points to the need to guarantee the availability of abortion. PMID:12284546
Spinelli, A; Grandolfo, M E
Species diversity has been shown to decrease prevalence of disease in a variety of host–pathogen systems, in a phenomenon\\u000a termed the Dilution Effect. Several mechanisms have been proposed by which diversity may decrease prevalence, though few have\\u000a been tested in natural host-pathogen systems. We investigated the mechanisms by which diversity influenced the prevalence\\u000a of Sin Nombre virus (SNV), a directly
Christine A. Clay; Erin M. Lehmer; Stephen St. Jeor; M. Denise Dearing
Reported are biliary lipid composition and secretion, bile acid composition and kinetics, and gallbladder function in a group of healthy, nonobese women taking a contraceptive steroid preparation. A comparable group of healthy women served as controls. Biliary lipid secretion rate was measured by the marker perfusion technique. Bile acid distribution was determined by gas-lipid chromatography. The pool size, FTR, and synthesis rate of each bile acid were measured by using CA and CDCA labeled with the stable isotope of carbon, /sup 13/C. In some of the subjects gallbladder storage and emptying were measured during the kinetic study, by real-time ultrasonography. Contraceptive steroid use was associated with a significant increase in biliary cholesterol saturation and in the lithogenic index of bile. The rate of cholesterol secretion in the contraceptive steroid group was 50% greater than in the control (p << 0.001) and the rate of bile acid secretion was reduced (p < 0.02). The total bile acid pool size was significantly increased by contraceptive steroids. The major increase occurred in the CA pool (p < 0.04). The daily rate of enterohepatic cycles of the bile acid pool was decreased by contraceptive steroids from 6.6 to 4.3 (p < 0.01). The only effect of contraceptive steroids on gallbladder function was a slower emptying rate in response to intraduodenal amino acid infusion. No index of gallbladder function correlated significantly with any parameter of bile acid kinetics in this small group of subjects. The findings confirm the lithogenic effect of contraceptive steroids and indicate that its causes are an increase in cholesterol secretion and a decrease in bile acid secretion.
Kern, F., Jr. (Univ. of Colorado, Denver); Everson, G.T.; DeMark, B.; McKinley, C.; Showalter, R.; Braverman, D.Z.; Szczepanik-Van Leeuwen, P.; Klein, P.D.
In China, the interval between first marriage and first childbearing has declined. This study examined the relationship between sociopsychological and demographic factors and contraceptive usage among newly married couples in Shanghai districts of Luwan and Hongku between August 15, 1987, and August 14, 1988. A random sample of 7872 newlyweds who intended to postpone childbearing were interviewed; 12.5% of the 15,938 registered marriages desired postponement of childbearing. Premarital courtship spanned an average of 35.1 months with a standard deviation of 23.2 months. 73% of couples did not desire two children. 13.8% desired two children. 77% of couples were dependent on parents after 3 months of marriage. 11% had sexual relations before registration and 20% before the wedding. 87% used contraception before marriage registration and 89% before the wedding. 6% failed to use any contraception. Those using contraception has sexual relations less frequently than those not using contraception. 70% did not use contraception after the wedding because of unavailability of pills, fear of side effects from pills, and lack of knowledge about nonpill contraception. In a univariate analysis, 17 independent variables were selected for the logistic models: education level of the couple and husband's parents, wife's age at marriage, monthly income of couple, premarital romance period, wife's and husband's occupation, husband's family position as the only son, work shifts, residence with their parents, desire for 2 children, channel for information about contraception, wife's contraceptive knowledge and communication, and expected pregnancy date. The results indicated that wives with high educational levels use contraception more frequently. A 1% increase in education yields a 28.1% increase in likelihood of contraceptive use. Official channels of information are more likely to result in contraceptive use. Wives who exchange contraceptive knowledge with many others are better contraceptors. Greater likelihood of use was also related to employment in state-owned enterprises. In models excluding couple's desire for children and wife's contraceptive knowledge, 10 variables were found to have a stabilizing effect as evidenced in assessment at 3 different points after marriage registration. These were wife's age at marriage, educational level of the couple, wife's occupation, premarital romance period, work shifts, desire for 2 children, channel of communication, wife's interaction with others about contraception, residence with parents, and husband's work unit. PMID:12317923
Guo, Y; Lin, D; Shi, Y; Lou, C; Fang, K; Li, H; Gao, E; Zhang, D
Background In 2001, the U.S. government’s Healthy People 2010 initiative set a goal of reducing contraceptive failure during the first year of use from 13% in 1995 to 7% by 2010. We provide updated estimates of contraceptive failure for the most commonly used reversible methods in the United States, as well as an assessment of changes in failure rates from 1995 to 2002. Study design Estimates are obtained using the 2002 National Survey of Family Growth (NSFG), a nationally representative sample of U.S. women containing information on their characteristics, pregnancies, and contraceptive use. We also use the 2001 Abortion Patient Survey to correct for underreporting of abortion in the NSFG. We measure trends in contraceptive failure between 1995 and 2002, provide new estimates for several population subgroups, examine changes in subgroup differences since 1995, and identify socioeconomic characteristics associated with elevated risks of failure for three commonly used reversible contraceptive methods in the U.S.: the pill, male condom and withdrawal. Results In 2002, 12.4% of all episodes of contraceptive use ended with a failure within 12 months after initiation of use. Injectable and oral contraceptives remain the most effective reversible methods used by women in the U.S., with probabilities of failure during the first 12 months of use of 7% and 9%, respectively. The probabilities of failure for withdrawal (18%) and the condom (17%) are similar. Reliance on fertility-awareness-based methods results in the highest probability of failure (25%). Population subgroups experience different probabilities of failure, but the characteristics of users that may predict elevated risks are not the same for all methods. Conclusion There was no clear improvement in contraceptive effectiveness between 1995 and 2002. Failure rates remain high for users of the condom, withdrawal and fertility-awareness methods, but for all methods, the risk of failure is greatly affected by socioeconomic characteristics of the users.
Kost, Kathryn; Singh, Susheela; Vaughan, Barbara; Trussell, James; Bankole, Akinrinola
The absolute need to limit and program pregnancies in diabetic women demands choice of an adequate contraceptive method. Combined oral contraceptives (OCs) do not seem appropriate because of their diabetogenic effects and the added vascular risks they present to already fragile women. The diabetogenic effects of combined OCs are believed to result from a reduced number and affinity of insulin receptors, augmented secretion of STH, vitamin B6 deficiency, or hepatic effects. Some progestagens have been shown to stimulate deleterious effects of estrogens on OCs. The estrogen component of OCs is associated with elevation of triglyceride levels and stimulation of very low density lipoprotein synthesis. To these vascular risks are added an augmented blood pressure which reaches hypertensive levels in 50% of cases. The effects of synthetic estrogens on coagulation factors and vessel walls have been well deomonstrated. Macrodosed progestagen pills taken in 20-day cycles appear to be an interesting alternative, but those with the most constant antigonadotropic activity are derived from nortestosterone and all have to some degree an anabolizing androgenic effect which may result in weight gain. Derivatives of 17-hydroxyprogesterone appear to be without secondary metabolic effects. Cyproterone acetate should be evaluated as a possible OC for diabetic women. Continuous-dose progestagen micropills are highly recommended for diabetic women because of their excellent metabolic tolerance. The action of this type of pills is essentially peripheral. The pill may cause menstrual irregularity, spotting, or amenorrhea, and an increased rate of ectopic pregnancy. The Pearl index is between .8-2/1009 IUDs are a possibility for diabetic women, but because of their increased vulnerability to infection, such women should be carefully screened for prior adnexial or uterine infection, the device should be inserted in completely aseptic conditions, the woman's hygiene should be impeccable, the women should be informed about sexually transmitted diseases and regular follow-up should be arranged. A diaphragm with spermicide is without side effects and is effective if use properly. After age 40, tubal ligation is an ideal method, but it should not be proposed just because a woman has diabetes. Vaginal rings, which avoid most shortcomings of OCs, will surely be of interest to diabetic patients in the future as they become commercially available. Male contraceptive methods also deserve consideration. PMID:6358615
Athea, N; Kuttenn, F
This paper assesses the ways in which the availability of family planning program outlets influences the likelihood of contraceptive use in rural Thailand. It focuses on a village-level measure of actual availability of sources rather than respondent perceptions of availability. Individual-level and village-level data collected as part of the second Thailand Contraceptive Prevalence Survey are used to test three hypotheses about the effects of actual availability: that (a) availability of family planning outlets increases the likelihood of contraceptive use; (b) it enhances the effect of a desire for no more children on the likelihood of use; and (c) it weakens the positive relationship between education and the likelihood of use. PMID:6519323
Entwisle, B; Hermalin, A I; Kamnuansilpa, P; Chamratrithirong, A
This is a report on a study that examined the characteristics of three types of commercial providers of oral contraceptives, as well as users and users' husbands. The study also examined how and from whom users and/or their husbands obtain oral contraceptives and instructions for use. The socioeconomic level of providers and user-couples was, on average, higher than for the general population. Husbands were particularly important for obtaining supplies from the commercial sector and acting as instructors. The findings suggest that: a special effort will be required if social marketing techniques are to increase oral contraceptive prevalence among the rural poor in Bangladesh, and family planning researchers and managers should give more attention to husbands in countries where men dominate communication networks. PMID:3617122
Davies, J; Mitra, S N; Schellstede, W P
This study explored the prevalence of reported sexual activity of a cohort of children entering out-of-home care and the ability of selected factors to explain reported sexual activity and use or nonuse of contraceptives. It found that children as young as age 8 reported sexual activity, and that more than one-third of the children age 8 to 18 reported being sexually active. Of those who were sexually active, more than one-third were not using contraceptives. Using logistic regression, five variables are identified as having importance in explaining sexual activity. Two variables had some limited ability to explain contraceptive use. Implications of these findings are discussed and suggestions for policy and practice are made. PMID:9218339
Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and non-negative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n=5401) of which 98.7% (n=5329) were confirmed at ? LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ? carisoprodol > fentanyl > cannabinoids ? tramadol > cocaine > amphetamines ? propoxyphene ? buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients. PMID:22004671
Heltsley, Rebecca; DePriest, Anne; Black, David L; Robert, Tim; Marshall, Lucas; Meadors, Viola M; Caplan, Yale H; Cone, Edward J
Study design and aim This was a longitudinal chart review of a diverse group (cohort) of patients undergoing HGH (Human Growth Hormone) treatment. Clinical and radiological examinations were performed with the aim to identify the presence and progression of scoliosis. Methods and cohort 185 patients were recruited and a database incorporating the age at commencement, dose and frequency of growth hormone treatment and growth charts was compiled from their Medical Records. The presence of any known syndrome and the clinical presence of scoliosis were included for analysis. Subsequently, skeletally immature patients identified with scoliosis were followed up over a period of a minimum four years and the radiologic type, progression and severity (Cobb angle) of scoliosis were recorded. Results Four (3.6%) of the 109 with idiopathic short stature or hormone deficiency had idiopathic scoliosis (within normal limits for a control population) and scoliosis progression was not prospectively observed. 13 (28.8%) of 45 with Turner syndrome had scoliosis radiologically similar to idiopathic scoliosis. 11 (48%) of 23 with varying syndromes, had scoliosis. In the entire cohort, the growth rates of those with and without scoliosis were not statistically different and HGH treatment was not ceased because of progression of scoliosis. Conclusion In this study, there was no evidence of HGH treatment being responsible for progression of scoliosis in a small number of non-syndromic patients (four). An incidental finding was that scoliosis, similar to the idiopathic type, appears to be more prevalent in Turner syndrome than previously believed.
Day, Gregory A; McPhee, Ian Bruce; Batch, Jenny; Tomlinson, Francis H
Some reports suggest variation in physiological responses and athletic performance, for female athletes at specific phases of the menstrual cycle. However, inconsistent findings are common due to the inappropriate verification of menstrual cycle phase, small subject numbers, high intra- and interindividual variability in estrogen and progesterone concentration, and the pulsatile secretion of these hormones. Therefore, the oral contraceptive (OC) cycle may provide a more stable environment in which to evaluate the acute effect of reproductive hormones on physiological variables and exercise performance. To date, most of the OC research has compared differences between OC use and nonuse, and few researchers have examined within-cycle effects of the OC. It is also apparent that OC use is becoming far more prevalent in athletes; hence the effect of the different exogenous and endogenous hormonal profiles on athletic performance should be investigated. Research to date identifies potential for variation in aerobic performance, anaerobic capacity, anaerobic power and reactive strength throughout an OC cycle. The purpose of this review is to present and evaluate the current literature on the physiology of exercise and athletic performance during the OC cycle. PMID:19567919
Rechichi, Claire; Dawson, Brian; Goodman, Carmel
Research using expectancy models has shown contraceptive choice among adults to be a rational process in that intentions and behaviors reflect an individual's beliefs, values, attitudes, and perceptions of social norms. This study examined whether such an approach could accurately represent adolescents' contraceptive decision-making. It used the…
Adler, Nancy E.; And Others
Both the career model and the decision model have been proposed to explain patterns of contraceptive use in teenagers. The career model views contraceptive use as a symbol of a woman's sexuality and implies a clear decision to be sexually active. The decision model is based on the subjective expected utility (SEU) theory which holds that people…
Whitley, Bernard E., Jr.; Schofield, Janet Ward
Despite the existence of a family planning program in Pakistan since 1965 and widespread knowledge among Pakistanis about contraception, there is a high level of unmet need for family planning. One recent survey found that while 53% of married women express the desire to avoid pregnancy, less than 20% use contraception. A recent Population Council study conducted in urban and rural areas of Punjab province investigated personal beliefs, family circumstances, social norms, and gender relations among 1310 married women and 554 of their husbands. The unmet need for contraception was highest among women over age 30 years, those with more living children, less educated women, and women living in rural areas. The study found that while most Pakistanis approve of family planning, obstacles to contraceptive use exist in most marriages. 97% of respondents who wanted another child wished for a boy. That preference for sons influences contraceptive use behavior. The fear of social disapproval of contraceptive use, perceived opposition from in-laws and husbands, and fear of health side effects and divine punishment were major reasons identified against contraceptive use. Female contraceptive users were more autonomous and likely to make domestic decisions without consulting their husbands, while husbands defer to social and cultural norms. PMID:12292988
We present a patient with diffuse baldness related to low dose oral contraceptive (LD-OC). Although LD-OC scarcely induce troublesome side effects if prescribed in accordance with Managing Contraceptive Pill Patients Guideline, this trouble might become a source of poor compliance to LD-OCs. PMID:11998965
Yokoyama, Y; Sato, S; Saito, Y
Excluding Hollerbach (1980), previous fertility researchers have paid little attention to contraceptive power bases, relationships that become the source of changes in birth control values and behavior. Eight contraceptive power bases, each evaluated as a direct or obvious strategy, were identified in a pilot study involving 25 college students as participants and 10 undergraduate raters. Two-hundred college students completed a
Naomi B. McCormick; William Gaeddert
Approximately one-half of all female adolescents are sexually active. Family physicians whose patients include female adolescents must be able to provide them with information and advice about contraception. In this article, adolescent contraception is examined in detail and a number of strategies for achieving optimum compliance are presented.
Three cases are reported of tumour-like lesions of the liver in women who had been on oral contraceptives for long periods. These malformations have a prominent vascular component and may present with haemoperitoneum and shock. The possibility of an association between liver hamartomas and oral contraceptive therapy has to be considered. ImagesFIG. 1FIG. 2FIG. 3FIG. 4
O'Sullivan, J. P.; Wilding, R. P.
In countries of the CCEE region (Countries of Central and Eastern Europe) the very high incidence of pregnancy termination is characteristic of family planning and the notion ‘contraception instead of abortion’ has not yet been achieved. The causes and consequences of this unfortunate situation will be reviewed: the reproductive health indicators in the area; the status of contraceptive use and
Contraceptive techniques applied to males have potential to mitigate diverse instances of overpopulation in human and animal populations. Different situations involving different species dictate that there is no ideal male contraceptive, and emphasizes the value of varying approaches to reducing male fertility. A majority of work in this field has focused on non-surgically destroying the testes or obstructing the epididymis,
R. A. Bowen
In a series of in vitro experiments, the authors investigated the different aspects of the aggregation curves of human blood platelets taken from a group of women who received oral contraceptives, another group of women who did not receive oral contraceptives and a group of men. The platelets were subjected to ADP stimulation. The authors showed that at the lower
C. M. D. Montanari; A. Vittoria; U. Rossi; P. Sala
METHODS: A representative sample of 974 currently homeless women surveyed in Los Angeles County in 1997 includ- ed 229 who were chronically homeless and at risk for unintended pregnancy. The relationships between perceived de- terrents among these women and their frequency of contraceptive use were evaluated using chi-square tests. Logistic regression analyses were performed to identify independent predictors of contraceptive
Lillian Gelberg; Barbara Leake; Michael C. Lu; Ronald Andersen; Hal Morgenstern; Carole Browner
Intrauterine devices (IUDs) provide highly effective, long-term, safe, reversible contraception, and are the most widely used reversible contraceptive method worldwide. The levonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped IUD with a steroid reservoir containing 52 mg of levonorgestrel that is released at an initial rate of 20 ?g daily. It is highly effective, with a typical-use first year pregnancy rate of 0.1% – similar to surgical tubal occlusion. It is approved for 5 years of contraceptive use, and there is evidence that it can be effective for up to 7 years of continuous use. After removal, there is rapid return to fertility, with 1-year life-table pregnancy rates of 89 per 100 for women less than 30 years of age. Most users experience a dramatic reduction in menstrual bleeding, and about 15% to 20% of women become amenorrheic 1 year after insertion. The device’s strong local effects on the endometrium benefit women with various benign gynecological conditions such as menorrhagia, dysmenorrhea, leiomyomata, adenomyosis, and endometriosis. There is also evidence to support its role in endometrial protection during postmenopausal estrogen replacement therapy, and in the treatment of endometrial hyperplasia.
Bednarek, Paula H; Jensen, Jeffrey T
To date, 13 studies have provided data on the risk of venous thromboembolism associated with combined oral contraceptives containing drospirenone or the norelgestromin-containing contraceptive patch. The studies varied in their conclusions about whether these methods are associated with higher risks than combined oral contraceptives containing other progestins: the primary reported measures of association (adjusted odds ratios, incidence rate ratios, or hazard ratios) ranged from 0.9 to 3.3. All of the studies had weaknesses in population selection, data validity or completeness, or analysis that may have led to biased or spurious findings. Venous thromboembolism is rare; if the contraceptive methods of interest do confer a higher risk of thromboembolism, only an additional 5-10 per 10,000 users per year would be affected. The important message for patients, clinicians, and policy makers is that the benefits of all contraceptive methods markedly outweigh their risks, primarily because they prevent pregnancy, an inherently hazardous condition. Product labels for hormonal contraceptives should emphasize their substantial health benefits and established safety. PMID:22525916
Raymond, Elizabeth G; Burke, Anne E; Espey, Eve
During the interval 1968-74, 17,032 women aged 25-39 years were recruited to the Oxford-Family Planning Association contraceptive study, more than half of whom were using oral contraceptives. These women have been followed up over the years and breast cancer has been diagnosed in 189 of them. We have analysed the available data in two ways. First, we have calculated standardised breast cancer incidence rates in non-users and users of oral contraceptives according to total duration of use, interval since first use, interval since last use, duration of use before first term pregnancy and duration of use before age 25. Secondly, we have conducted case-control within cohort analyses to examine the possible effects of different types of pill and to search for evidence of a latent effect of oral contraceptive use before first term pregnancy on breast cancer risk. We have found no evidence of any adverse effect of oral contraceptive use on the risk of breast cancer in this study. There was, however, little exposure to the pill before first term pregnancy among the participants and virtually no such exposure at a very young age (i.e. below 20 years). Accordingly, the results of this study strengthen the evidence that oral contraceptive use by mature women does not increase breast cancer risk, but add little to the uncertainty about the effects of early use.
Vessey, M. P.; McPherson, K.; Villard-Mackintosh, L.; Yeates, D.
Objectives: To compare HIV prevalence estimates (total number infected) by using extrapolation from surveys on infection rate and risk behaviour (EIR) in specific segments of the population and back-calculation (BC) on reported AIDS cases. To discuss potential sources of bias and error, and to identify areas for improvement of the methodology. Design: Systematic comparison and epidemiological assessment of data input,
Hans Houweling; Siem H. Heisterkamp; Lucas G. Wiessing; Roel A. Coutinho; Jan K. van Wijngaarden
Many males still perceive contraception as a woman's responsibility. This paper describes male contraceptives and their effectiveness and draws implications for school and community health education professionals. More equitable sharing of the responsibility for contraception might result in more effective contraception. (PP)
Chng, Chwee Lye
This paper reviews literature on teenage contraceptive behavior and teenage contraceptive decision making. The paper describes the persistence of a sexual double standard in terms of moral motivation to use contraception and in terms of the relative lack of communication about contraception among young partners. (Author)
|We assessed the contraceptive needs of women in jails and their sexually transmitted disease (STD) history and risk to determine effective contraceptive methods for this population. A survey of demographics, sexual health, contraceptive use, and preferred method of contraception was completed by participants recruited at jails in a medium-sized…
Oswalt, Krista; Hale, Galen J.; Cropsey, Karen L.; Villalobos, Gabriella C.; Ivey, Sara E.; Matthews, Catherine A.
|There are many contraceptive choices available to people today. Learning about them can be dry, but the game "Name that Contraceptive!" can be a fun and interactive way to review, remember, and retain the details about contraceptive options. Name that Contraceptive is a card game in which students "bid" on the number of clues it will take them to…
Rosenthal, Martha S.
unintended pregnancy associated with patterns of long-term contraceptive use. Moreover, no studies of long-term con- traceptive use have compared teenagers and adult women. Given these limits, it is all the more trou- bling that researchers seldom validate measures of contraceptive use. With the exception of contraceptive failure analy- ses, studies often assess risk factors relat- ed to poor contraceptive use,
Dana A. Glei
The objective of this study was to calculate estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr) and\\u000a to estimate the prevalence of chronic kidney disease (CKD) in patients with coronary heart disease (CHD) in China. This was\\u000a a cross-sectional study using data from China Heart Survey (CHS). Glomercular filtration rate was estimated with the Modified\\u000a Diet in Renal
Hao Liu; Jinming Yu; Fang Chen; Jue Li; Dayi Hu
Misconceptions exist in Nigeria about the effects of hormonal contraceptives on weight, which may have negative effects on contraceptive use. Data from case notes of clients attending the reproductive health centre at the Ahmadu Bello University Teaching Hospital, Zaria, between 1993 and 1995, were analysed to determine the effects of hormonal contraceptives on body weight, comparing them to clients using intrauterine contraceptive devices. Weight changes were not significantly different in clients using hormonal contraceptives and those using intrauterine contraceptive devices. This information will be beneficial in contraceptive counselling for clients in this environment and provide a baseline for further research. PMID:16485589
Sule, Saadatu; Shittu, Oladapo
We surveyed two general population samples aged 8 to 64 living in the unpolluted, rural area of the Po Delta (northern Italy) (n = 3289) and in the urban area of Pisa (central Italy) (n = 2917). Each subject filled out a standardized interviewer-administered questionnaire. The Pisa sample was divided into three groups according to their residence in the urban-suburban areas and to outdoor air pollution exposure (automobile exhaust only or industrial fumes as well). Significantly higher prevalence rates of all the respiratory symptoms and diseases were found in Pisa compared with the Po Delta. In particular, rhinitis and wheezing symptoms were higher in all the three urban zones; chronic cough and phlegm were higher in the zone with the automobile exhaust and the additional industrial exposure. Current smoking was more frequent in the rural area, but the urban smokers had a higher lifetime cigarette consumption. Childhood respiratory trouble and recurrent respiratory illnesses were evenly distributed. Exposure to parental smoking in childhood and lower educational level were more frequent in Po Delta, whereas familial history of respiratory/allergic disorders and work and indoor exposures were more often reported in the city. Multiple logistic regression models estimating independently the role of the various risk factors showed significant odds ratios associated with residence in Pisa for all the symptoms but chronic phlegm. For example, those living in the urban-industrial zone had an odds ratio of 4.0 (4.3-3.7) for rhinitis and 2.8 (3.0-2.6) for wheeze with respect to those living in the Po Delta.(ABSTRACT TRUNCATED AT 250 WORDS)
Viegi, G; Paoletti, P; Carrozzi, L; Vellutini, M; Diviggiano, E; Di Pede, C; Pistelli, G; Giutini, G; Lebowitz, M D
Aims\\/hypothesis Increasing diabetes prevalence has been reported in most European countries in the last 20 years. In this study we report\\u000a on the development of prevalence and incidence of diabetes from 1972 to 2001 in Laxå, a rural community in central Sweden.\\u000a \\u000a \\u000a \\u000a Materials and methods A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based
S. P. O. Jansson; D. K. G. Andersson; K. Svärdsudd
Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use disorder, and substance use disorder were 28%, 18%, and 32%, respectively. Only about 40% of veterans with any diagnosed disorder received some form of treatment. For alcohol use disorder, the estimate of unmet treatment need was 84%, which is particularly worrisome given that excessive alcohol use was the greatest substance use problem.
Vazan, Peter; Golub, Andrew; Bennett, Alex S.
Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use disorder, and substance use disorder were 28%, 18%, and 32%, respectively. Only about 40% of veterans with any diagnosed disorder received some form of treatment. For alcohol use disorder, the estimate of unmet treatment need was 84%, which is particularly worrisome given that excessive alcohol use was the greatest substance use problem. PMID:23869460
Vazan, Peter; Golub, Andrew; Bennett, Alex S
It is estimated that 10-15 million women use oral contraceptives in the U.S. The 2 types of pills available are combination products containing both an estrogen and progestin, and single entity products with only progestin. Although more side effects are associated with estrogen, combination pills are the preferred prescription. Most often side effects are mild and disappear after continued use or switching to another type of pill. Some of the side effects are nausea; weight gain; chloasma; cervical extrophia and leukorrhea; hypermenorrhea; spotting and breakthrough bleeding; galactorrhea and pituitary tumors; choreiform movement disorder; endometrial cancer; and, hepatic effects. Fetal exposure to exogenous estrogens and progestins has been reported to result in increased risk for the heart and neural tube defects. Teratogenic effects subsequent to discontinuation of OCs does not appear to be a risk. The beneficial side effects of oral contraceptives are that the incidence of menorrhagia, benign breast neoplasm, dysmenorrhea, iron-deficiency anemia, premenstrual tension, acne, and ovarian cysts are lower in OC users. Thryoid diseases may be reduced by OCs. PMID:503375
In this paper, it is argued that oral contraceptives should be available without prescription. Prescription status entails heavy costs, including the dollar, time, and psychological costs of visiting a physician to obtain a prescription, the financial and human costs of unintended pregnancies that result from the obstacle to access caused by medicalization of oral contraceptives, and administrative costs to the health care system. After a review and evaluation of the reasons for strict medical control of oral contraceptives in the United States, safety concerns anticipated in response to the proposal discussed here are addressed. Also, concerns that prescription status is necessary for efficacious use are evaluated. It is concluded that neither safety nor efficacy considerations justify prescription status for oral contraceptives. Revised package design and patient labeling could allow women to screen themselves for contraindications, to educate themselves about danger signs, and to use oral contraceptives safely and successfully. Several alternatives to providing oral contraceptives by prescription with current package design and labeling and selling them over the counter are suggested; the proposals discussed would make these safe and effective contraceptives easier to obtain and to use. PMID:8342715
Trussell, J; Stewart, F; Potts, M; Guest, F; Ellertson, C
In this paper, it is argued that oral contraceptives should be available without prescription. Prescription status entails heavy costs, including the dollar, time, and psychological costs of visiting a physician to obtain a prescription, the financial and human costs of unintended pregnancies that result from the obstacle to access caused by medicalization of oral contraceptives, and administrative costs to the health care system. After a review and evaluation of the reasons for strict medical control of oral contraceptives in the United States, safety concerns anticipated in response to the proposal discussed here are addressed. Also, concerns that prescription status is necessary for efficacious use are evaluated. It is concluded that neither safety nor efficacy considerations justify prescription status for oral contraceptives. Revised package design and patient labeling could allow women to screen themselves for contraindications, to educate themselves about danger signs, and to use oral contraceptives safely and successfully. Several alternatives to providing oral contraceptives by prescription with current package design and labeling and selling them over the counter are suggested; the proposals discussed would make these safe and effective contraceptives easier to obtain and to use.
Trussell, J; Stewart, F; Potts, M; Guest, F; Ellertson, C
Objective To estimate the prevalence of premenstrual symptoms in women from the general population in Southampton, UK, and examine their association with lifestyle factors and contraceptive usage. Design Cross-sectional survey. Setting The City of Southampton, UK. Population 974 women aged 20-34 years (53% of the 1,841 women invited to participate). Methods Interviews, questionnaires and completion of a prospective six-week menstrual symptom diary recording on a daily basis the presence and severity of eleven common premenstrual symptoms. Main outcome measures Premenstrual symptoms were identified from the diaries by two clinicians who reviewed them independently using a pre-defined algorithm to assess the onset and decline of symptoms in relation to the start of menstruation. Results 24% of the women were considered to have premenstrual symptoms (95% confidence interval [CI] 21% to 27%). Women were less likely to have symptoms if they had higher levels of educational attainment and suffered less from stress. No associations were found between premenstrual symptoms and diet, alcohol or strenuous exercise, nor after adjustment for other factors, with age, smoking or body mass index. Use of any form of hormonal contraceptives was associated with a lower prevalence of premenstrual symptoms (prevalence ratio 0.66 (95%CI:0.52 to 0.84)). Conclusions Premenstrual symptoms were common in this cohort. Use of hormonal contraceptive methods was associated with a lower prevalence of these symptoms.
Sadler, Carrie; Smith, Helen; Hammond, Julia; Bayly, Rosie; Borland, Sharon; Panay, Nick; Crook, David; Inskip, Hazel
Introduction: Newly-weds choose to use contraception either to spend the first years of their marriage more freely, because of economic reasons or because of the increase in working career women. We studied the reasons for infertility and the rate of contraception use in the first years of marriage among couples with primary infertility and evaluated the use of a spermiogram
Hakan Kiran; Deniz Cemgil Arikan; Ayhan Coskun; Mustafa Kaplanoglu; Gurkan Kiran; Ozgur Ozdemir; M. Turan Cetin
The serious health and social consequences of adolescent pregnancy call for the examination of the laws that affect adolescents' access to contraception and abortion. The general law of any country relating to the availability, sale, or distribution and financing of contraceptives affects adolescents. Similarly, a country's general law on abortion applies to adolescents faced with unwanted pregnancy and affects them accordingly. In addition, special legislation relating to adolescents, particularly legislation or court decisions concerning parental consent for contraception or abortion for a minor, has an important influence on the access that sexually active young people have to services. PMID:4060209
This seven-case anecdotal report is presented to alert physicians to the possibility of the formation of functional ovarian cysts during use of phasic contraceptive pills. The patients were studied by the combination of history, physical examination, ultrasound examination, and in two cases surgery. The occurrence of functional ovarian cysts during the use of phasic contraceptive pills is well established while not well appreciated by practicing physicians. This seven-case presentation strongly suggests that phasic contraceptive pills may be a threat to patient health and safety. It is suggested that further studies be undertaken to better understand the pathophysiology. PMID:3296761
Caillouette, J C; Koehler, A L
This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.
There are currently more options available to pediatricians caring for sexually active adolescents who wish to prevent pregnancy. The two progestin-only methods, levonorgestrel subdermal implants and DMPA injections, minimize or entirely remove the obstacle of patient compliance from contraceptive efficacy. Adolescents considering a progestin-only method of contraception should be counseled explicitly about the likelihood of menstrual irregularity with use. Perhaps more importantly, adolescents should be reminded that hormonal methods of contraception do not provide protection from sexually transmitted disease. Thus, male condom use should not only be recommended, but also concrete discussion and instruction on appropriate use should be given. PMID:7596649
Gold, M A
Women who had gestational diabetes must have their glycemia closely checked after delivery to insure complete normalization. Few studies are published but breast feeding does not seem to modify the metabolic profile of the mother or the children. Contraception must take account associated risk factors. Very few studies are published and none notified a significant modification of the carbohydrate metabolism with hormonal contraception, either estroprogestative or progestative only. But associated obesity, hypertension or dyslipidemia need the prescription of a contraception with no vascular secondary effect. In these cases an intrauterine device represents a very good choice. PMID:21185480
The haemorheological profile of the menstrual cycle was determined in 12 women who did not take oral contraceptives and compared with that in two groups of women (n = 8 and n = 30) who had been taking oral contraceptives for at last six months. Packed cell volume, platelet count, erythrocyte deformability, plasma fibrinogen concentration, and plasma and whole-blood viscosity varied cyclically throughout the menstrual cycle in the 12 non-users. This variation was abolished by the use of oral contraceptives, and the values of these indices were raised by an amount likely to predispose to thrombosis.
Buchan, P C; Macdonald, H N
Background Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1–0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. Aim The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. Methods All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. Results A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7–18.2, p<0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4–10.8, p<0.001). Conclusions The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool.
Eldin, Ghada Shiekh; El-Segaier, Milad; Galal, Mohammed Omer
Background : Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1-0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. Aim : The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. Methods : All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. Results : A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7-18.2, p<0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4-10.8, p<0.001). Conclusions : The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool. PMID:24107708
Shiekh Eldin, Ghada; El-Segaier, Milad; Galal, Mohammed Omer
Background Certain medications are identified by the U.S. Food and Drug Administration (FDA) as class D or X because they increase the risk for birth defects if used during pregnancy. Objective To assess pregnancy rates and the frequency of contraceptive counseling documented with prescriptions for class D or X drugs filled by women of reproductive age. Design Description of prescriptions filled in 2001. Setting A large health maintenance organization in northern California in 2001. Patients 488 175 women age 15 to 44 years who filled a total of 1 011 658 class A, B, D, or X prescriptions. Measurements Medications dispensed, contraceptive counseling, and pregnancy testing. Results A class D or X prescription was filled by 1 of every 6 women studied. Women who filled a prescription for class D or X medications were no more likely than women who filled prescriptions for safer, class A or B medications to have received contraceptive counseling, filled a contraceptive prescription, or been sterilized (48% vs. 51% of prescriptions). There was little variation by clinical indication in rates of contraceptive counseling with class D or X prescriptions, except for isotretinoin. Women who filled a class D or X prescription were only slightly less likely to have a pregnancy documented within 3 months than women filling a class A or B prescription (1.0% vs. 1.4% of prescriptions). Limitations International Classification of Diseases, Ninth Revision, codes underestimate contraceptive counseling. Documentation of a positive pregnancy test after filling a prescription may overestimate medication use in early pregnancy. Women who filled several prescriptions are overrepresented in prescription analyses. Conclusion Prescriptions for potentially teratogenic medications are frequently filled by women of childbearing age without documentation of contraceptive counseling.
Schwarz, Eleanor Bimla; Postlethwaite, Debbie A.; Hung, Yun-Yi; Armstrong, Mary Anne
Uniplant is a single contraceptive implant intended for one year use. It contains the progestogen nomegestrol acetate. The clinical performance and the effect of its use during the first postpartum year on breastfeeding performance and growth and health of the infants were studied and compared to the findings in a parallel group who used an intrauterine contraceptive device (IUD) in a prospective, non-randomized study. This was carried out in Assiut, Egypt. Two-hundred-forty fully breastfeeding mothers asking for initiation of contraception early postpartum were assigned according to their choices into either nomegestrol subdermal contraceptive implant (Uniplant) (120 women) or intrauterine contraceptive device (CuT 380A) (120 women). The mother and infant pairs were followed up at monthly intervals during the first three months and at two-month intervals thereafter up until the first birthday of the baby. No pregnancy occurred in the two groups. Amenorrhea was significantly more prolonged in the Uniplant group than in the IUD group. There were no significant differences in net continuation rates between the two groups (88.3 versus 92.4 per 100 women, respectively). There were no significant differences between the two groups in the number of breastfeeding episodes, time of weaning, and the cumulative rates of full and partial breastfeeding. There were no significant differences between the two groups in infant weight, weight gain per day, or in infant linear growth. There were no significant differences in the incidence of important health problems affecting the infants of the two groups. However, there were seven infant deaths, six of them were in the Uniplant group. Uniplant subdermal contraceptive implants can be offered as a new contraceptive option suitable for nursing mothers. PMID:8934061
Abdel-Aleem, H; Abol-Oyoun el-S, M; Shaaban, M M; el-Saeed, M; Shoukry, M; Makhlouf, A; Salem, H T
Objectives To determine the knowledge and attitudes on modern contraceptive use of women living in an inner city area of Osogbo. Materials and methods Three hundred and fifty nine women of childbearing age were studied utilizing a community-based, descriptive, cross-sectional study design. A multistage random sampling technique was used in recruiting respondents to the study. A four-part questionnaire was applied dually, by interviewers and by respondents’ self administration, and the data was analyzed using the SPSS software version 17.0. Results The mean age of respondents was 28.6 ± 6.65 years. The majority (90.3%) of respondents were aware of modern methods of family planning (FP), 76.0% claimed awareness of where to obtain FP services, and 74.9% knew of at least five methods. However, only 30.6% had ever used contraceptives, while only 13.1% were current users. The most frequently used method was the male condom. The commonly perceived barriers accounting for low use of FP methods were fear of perceived side effects (44.0%), ignorance (32.6%), misinformation (25.1%), superstition (22.0%), and culture (20.3%). Some reasons were proffered for respondents’ nonuse of modern contraception. Predictors of use of modern contraceptives include the awareness of a place of FP service provision, respondents’ approval of the use of contraceptives, higher education status, and being married. Conclusion Most of the barriers reported appeared preventable and removable and may be responsible for the reported low point prevalence of use of contraceptives. It is recommended that community-based behavioral-change communication programs be instituted, aimed at improving the perceptions of women with respect to bridging knowledge gaps about contraceptive methods and to changing deep-seated negative beliefs related to contraceptive use in Nigeria.
Asekun-Olarinmoye, EO; Adebimpe, WO; Bamidele, JO; Odu, OO; Asekun-Olarinmoye, IO; Ojofeitimi, EO
Background: In 2001, the Chinese Government published the Population and Family Planning Law which gave citizens the right to know the facts about, and to choose, methods of birth control. Since then, the percentage use of different contraceptive methods has changed. More and more women have been using male condoms for birth control, which has resulted in an increasing prevalence
H. Li; D. Q. Li; Y. T. Diao
Abstract Objective To explore physicians’ knowledge, attitudes, and practices related to sexual and mood side effects of hormonal contraceptives, and to compare residents with practising doctors. Design A mixed-method study with faxed or e-mailed surveys and semistructured telephone interviews. Setting British Columbia. Participants A random sample of family doctors, all gynecologists, and all residents in family medicine and gynecology in the College of Physicians and Surgeons of British Columbia registry. A subsample was interviewed. Main outcome measures Estimates of rates of mood and sexual side effects of contraceptives in the practice population and how the physicians informed and advised patients about these side effects. Results There were 79 residents and 76 practising doctors who completed the questionnaires (response rates of 42.0% and 54.7% of eligible residents and physicians, respectively). The reference sources most physicians reported using gave the rates of sexual and mood side effects of hormonal contraceptives as less than 1%, and yet only 1 (0.6%) respondent estimated similar rates for mood side effects, and 12 (7.8%) for sexual effects among their patients. The most common answers were rates of 5% to 10%, with residents reporting similar rates to practising doctors. Practising doctors were more likely to ask about sexual and mood side effects than residents were (81.1% vs 24.1% and 86.3% vs 40.5%, respectively; P < .001). Practising doctors were also more likely to recommend switching to barrier methods (37.3% vs 16.5%; P = .003) or intrauterine devices (54.7% vs 38.0%; P = .038) than residents were and more likely to give more responses to the question about how they managed sexual and mood side effects (mean of 1.7 vs 1.1 responses, P = .001). In 14 of the 15 interviews, practising doctors discussed how they had learned about side effects mainly from their patients and how this had changed their practices. Conclusion Physicians’ perceived rates of mood and sexual side effects from hormonal contraception in the general population were higher than the rate of less than 1% quoted in the product monographs. Practising doctors reported that they learned about the type, frequency, and severity of side effects from their patients.
Wiebe, Ellen; Kaczorowski, Janusz; MacKay, Jacqueline
Purpose Understanding reasons for contraception decisions is critical to improving our ability to reduce rates of unintended pregnancies. We used an in-depth qualitative approach to examine the contraceptive decision-making process, with special attention to the role of the social network, among a group of young, postpartum urban minority women. Methods Brief surveys and semi-structured interviews were conducted with 30 consenting postpartum women. In-person one-on-one interviews were then reviewed for themes using an iterative process. Qualitative analysis techniques identifying emergent themes were applied to interview data. Results In this cohort of African American (63%) and Hispanic (37%) women (median age 26), 73% had unplanned pregnancies. The social network, including friends, mothers, and partners, were key sources of contraception myths, misconceptions, and vicarious experiences. Women also utilized media, including the internet, as an additional source of information. Information relayed by the social network had a direct influence on contraceptive decisions for many women. Conclusions The experiences and opinions of the social network influence contraceptive decisions in this population of young, minority women. The social network, including friends, family members, and media sources, are a key source of contraceptive information for many women. Comprehensive contraception counseling should explore the experiences and opinions of the patient’s social network to the extent possible.
Yee, Lynn M.; Simon, Melissa
The USA, a country with widespread access to the full range of modern methods of contraception, continues to have one of the highest abortion rates among developed countries. Forty-nine per cent of women reported ever experiencing an unintended pregnancy in 2001; 48% of these conceptions occurred during a month that contraception was used. We explored the extent to which people use contraception and abortion interchangeably to achieve their fertility goals via focus groups (n = 4) and semi-structured in-depth interviews (IDIs) (n = 18) with men and women between the ages of 18 and 35 in New York City in 2006. While there was a consensus that abortion cannot replace contraceptive use, poor couple communication, lack of planning, lack of acceptable contraceptive methods and the pleasures that people associate with having unprotected sex result in the perception that some individuals rely on abortion over contraception to prevent unintended births. Men and women both identified women as solely in charge of avoiding an unwanted pregnancy and resolving it should one occur. No one supported repeat abortions for themselves or others, and many respondents perceived multiple abortions to lead to infertility, which strengthens their position that substituting abortion for contraception is unacceptable. PMID:21590556
Moore, Ann M; Singh, Susheela; Bankole, Akinrinola
In a five-year analysis of an oral contraceptive trial by the Council for the Investigation of Fertility Control venous effects were the third most troublesome group of side-effects with both combined and sequential therapy. Vein complaints, leg cramps, and thrombophlebitis were significantly more frequent with the combined preparations that contained a relatively low dose of progestogen and a high dose of oestrogen than with the other groups tested. No cases of thrombophlebitis occurred in women taking the strongly oestrogenic sequential groups. Histological examination of uterine curettings showed that most progestogenic combined preparations were associated with a high incidence of dilated endometrial sinusoids, while the oestrogenic sequential regimens and low-dose progestogen-only regimens had a low incidence. The incidence of stromal condensation round the sinusoids correlated with the incidence of leg cramps, and these effects appeared to be specific for each preparation tested.
Grant, Ellen C. G.
Although approximately 49 oral contraceptive products are available in the U.S., most have similar pharmacologic action. Only compounds containing norgestrel are metabolized by a different route. PMID:3088272
... use of older, more frequently prescribed contraceptives at the sites selected. ... of young reproductive age women, reasons for selecting study sites ... More results from www.fda.gov/drugs/drugsafety
Text Version... November 21, 2011 Addendum to Report: Combined Hormonal Contraceptives (CHCs) and the Risk of Cardiovascular Disease Endpoints ... More results from www.fda.gov/downloads/drugs/drugsafety
Pakistan with an estimated population of around 142.5 million in mid 2001 is the seventh most populous country in the world and fourth in Asia and Pacific countries. The historical trends indicate a continuously increasing growth in population (Table 1). The population of the area now constituting Pakistan was 16.6 million in 1901. Since then the population has increased over
The objectives of this study were to determine the prevalence of Campylobacter jejuni and Campylobacter coli in retail beef, beef livers, and pork meats purchased from the Tulsa (OK, USA) area and to further characterize the isolates obtained through antimicrobial susceptibility testing. A total of 97 chilled retail beef (50 beef livers and 47 other cuts), and 100 pork samples were collected. The prevalence of Campylobacter in beef livers was 39/50 (78%), while no Campylobacter was isolated from the other beef cuts. The prevalence in pork samples was 2/100 (2%). A total of 108 Campylobacter isolates (102 beef livers isolates and six pork isolates) were subjected to antimicrobial resistance profiling against sixteen different antimicrobials that belong to eight different antibiotic classes. Of the six pork Campylobacter coli isolates, four showed resistance to all antimicrobials tested. Among the beef liver isolates, the highest antibiotic resistances were to tetracyclines and ?-lactams, while the lowest resistances were to macrolides, aminoglycosides, lincosamides, and phenicols. Resistances to the fluoroquinolone, macrolide, aminoglycoside, tetracycline, ?-lactam, lincosamide, and phenicol antibiotic classes were significantly higher in Campylobacter coli than Campylobacter jejuni isolates. Multidrug Resistance (MDR) among the 102 Campylobacter (33 Campylobacter jejuni and 69 Campylobacter coli) beef liver isolates was significantly higher in Campylobacter coli (62%) than Campylobacter jejuni (39%). The high prevalence of Campylobacter in retail beef livers and their antimicrobial resistance raise concern about the safety of these retail products.
Noormohamed, Aneesa; Fakhr, Mohamed K.
End-stage renal disease is an important and costly health problem. Strategies for its prevention are urgently needed. Knowledge of the population-based prevalence of re- nal insufficiency in nondiabetic adults would inform such strategies. Black and white nondiabetic adult participants in the Third National Health and Nutrition Examination Survey were analyzed. The analysis was stratified by age, gender, and race, and
CATHERINE M. CLASE; AMIT X. GARG; BRYCE A. KIBERD
Prevalence surveys have been part of the Danish infection control programme since 1974. Nationwide surveys were carried out in 1978, 1979, 1980, 1991 and 1999. The results indicate a net reduction of approximately 25%, mainly due to a reduction of urinary tract infections (UTIs) in medical patients. Results from the nationwide surveys are validated by results of occasional independent surveys
M. Christensen; O. B. Jepsen
BACKGROUND More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV. METHODS Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception. RESULTS Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04–2.1). Hormonal contraception does not interfere with antiviral drug effectiveness. CONCLUSIONS All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
Heikinheimo, Oskari; Lahteenmaki, Pekka
Objective: The study was designed to evaluate the experience and acceptability of emergency hormonal contraception service for inner-city women in Planned Parenthood clinics.Methods: In 1995, emergency hormonal contraception was introduced as a new service in three clinics of New York City’s Planned Parenthood that served low-income women. Shortly after inception of this service, the agency undertook a survey to investigate
Enayat Hakim-Elahi; Vicki Breitbart
The control of fertility constitutes a global health issue, since overpopulation and unintended pregnancy have both major personal and societal impact. Although some regions of the world are seeing neutral or negative population growth, many developing countries are seeing explosive growth of their populations and these population changes will affect the entire globe. It is estimated that in a decade, the largest cohort of young women worldwide in human history will reach adolescence thus necessitating the need for a wide range of contraceptive options that can be used by both females and males. The contraceptive revolution that occurred in the 1960s with the development of the hormonal-based oral contraceptive for women has subsequently made a significant impact on societal dynamics in several cultures, yet there has been virtually no innovation in this field since that time. This lack of innovation contrasts dramatically with the vast enhancement of our knowledge base of the basic processes of reproduction. The genomic and proteomic revolutions have provided new tools and new targets for contraceptive development, and the results of such approaches have identified gene products that play critical roles in female and male reproduction, thus expanding the array of targets for novel and innovative female- and male-based contraceptives. This normally would herald a renaissance in contraceptive development, yet the commitment of industry to this endeavor is limited to a few firms due to the economics of contraceptive development. This chapter will consider the types of targets being considered in the development of new generations of contraceptives and will also focus on the challenges that industry has in meeting these goals. PMID:17566288
Kopf, G S
OBJECTIVE:To evaluate the evidence on possible drug interactions between antibiotics and oral contraceptives (OCs) that may lead to OC failure.DATA SOURCES:MEDLINE and Lexis\\/Nexis Medical Library searches for 1966–1999 using the key word “oral contraceptives,” cross-indexed with the terms “antibiotics,” “adverse effects,” and “pregnancy,” and MEDLINE search using the additional MeSH term “drug interactions.” No language restrictions were used.METHODS OF STUDY
Barry D Dickinson; Roy D Altman; Nancy H Nielsen; Melvyn L Sterling
This trial was designed to determine the differences in effectiveness, clinical acceptability, and one-year discontinuation rates of two low-dose oral contraceptives: Lo-Estrin (norethindrone acetate 1.5 mg plus ethinyl estradiol 0.030 mg) and Lo-Femenal (norgestrel 0.30 mg plus ethinyl estradiol 0.030 mg) in 148 Mexican women. In addition, the effects of both oral contraceptive preparations on blood lipids were prospectively evaluated
J. Garza-Flores; M. Martínez; V. Valles de Bourges; L. Vázquez-Estrada; S. McMullen; R. Dunson; G. Pérez-Palacios
In this study, we utilized observational methods to identify maternal values and concerns accompanying contraceptive use advice\\u000a in Latina mother–daughter sexuality conversations. The sample included non-sexually active early adolescents around 12 years\\u000a of age and their mostly Spanish-speaking Latina mothers. Videotaped conversations were coded for the prevalence of messages\\u000a related to four sexual values (abstinence, delay sex until older, sex is
Laura F. Romo; Magali Bravo; Maria Elena Cruz; Rebeca M. Rios; Claudia Kouyoumdjian
A meta-analysis of controlled studies between 1966 and 1993 was conducted by means of a Medline computer search. A total of 588 articles were reviewed for controlled studies. 1 randomized trial, 6 follow-up studies, and 8 case-control studies were included. Summary thrombosis risk for oral contraceptive users, number needed to discontinue oral contraceptives to prevent one (recurrent) thrombosis, comparison of additional unwanted pregnancies, and postpartum thrombosis between alternative birth-control methods were the main outcome measures. The studies proved highly heterogeneous with regard to size and direction of the risk estimate. The summary relative risk of first thrombosis during oral contraceptive use was 2.9 (95% CI 0.5-17). The reported risks were higher in case control (RR 4.2) than in follow-up studies (RR 2.1). Various hypothetical assumptions were advanced wherein women would continue to take oral contraceptives after a first episode of thrombosis, or switch to use of an IUD, condom, or the progestogen-only pill. The cost-benefit ratio of advising against the use of oral contraceptives after a first thrombosis varied tremendously. The outcome with regard to pregnancies and thrombosis in 5 hypothetical cohorts of 100,000 post-thrombotic women monitored for 1 year indicated that under all but the highest assumption for recurrence risk, among typical couples the number of unexpected pregnancies as well as thrombotic episodes would be highest among condom users. IUDs would result in a reduction of at least 30% in the number of venous thrombotic episodes and accidental pregnancies. The lowest expected failures rates would lead to a decrease in thrombosis for both IUD and condom use. These findings indicate that there is a lack of necessary data for recurrence risk of venous thrombosis during continuing use of oral contraceptives, or after switching to other modes of contraception. PMID:7608644
Koster, T; Small, R A; Rosendaal, F R; Helmerhorst, F M
The effects of 2 oral contraceptives, Ovulen and Norlestrin, were studied in monkeys fed adequate protein and low protein diets. The experiment was carried out in parts. In the first one, the administration of contraceptives was cyclic and similar to that employed in human subjects. In the other experiments, the contraceptives were given continuously and an attempt was made to exaggerate the deleterious effects of the oral contraceptive on the liver by including small doses of a known hepatotoxic agent, aflatoxin (AT). In Experiment 1, 45 female monkeys were divided into 2 groups of 20 and 25 and received an adequate protein (16%) and low protein diet (4%) respectively. Each monkey was fed 1/5 of a tablet of Ovulen or Norlestrin orally for 3 weeks, and then administration was discontinued for 1 week. In Experiment 2, 35 female monkeys were divided into 7 groups of 5 each. All the animals recieved 4% protein diet. 5 groups were tube fed at the rate of 100 cal/kg body weight, while 2 groups were given diet ad libitum. Group I received the diet alone while groups II-V received 10 mcg AT, 25 mcg AT, 10 mcg AT plus 1/5 Ovulen tablets, and 25 mcg AT plus 1/5 Ovulen tablet respectively daily. Groups VI and VII received the diet ad libitum but were orally fed 75 mcg AT and 75 mcg AT plus 1/5 Ovulen tablet respectively. Serum glutamic-oxalacetic transaminase activity and alkaline phosphatase activity were studied at regular intervals after the administation of oral contraceptives in the experiments. Serum proteins and hemoglobin were also determined. Monkeys fed oral contraceptives showed increased serum glutamic-oxalacetic transaminase and alkaline phosphatase activities irrespective of the level of protein in the diet. Livers of animals receiving oral contraceptives were morphologically similar to the controls fed respective diets. The experiments were conducted for a period of almost 2 years. PMID:4205142
Belavady, B; Krishnamurthi, D; Mohiuddin, S M; Rao, P U
This study examines the relationship between male-to-female physical domestic violence and unwanted pregnancy among women in three economically and culturally diverse areas of India. A central methodological focus of the study is the examination of retrospective and prospective measures of pregnancy unwantedness, contrasting their usefulness for specifying levels of unwanted pregnancy and its relationship with domestic violence. Data from India's 1998–99 National Family Health Survey and a 2002–03 follow-up survey for which women in four states were reinterviewed are analyzed, and the factors associated with the intersurvey adoption of contraception and the experience of an unwanted pregnancy are examined. Women who experience physical violence from their husbands are significantly less likely to adopt contraception and more likely to experience an unwanted pregnancy. A prospectively measured indicator of unwanted pregnancy identifies a higher prevalence of unwanted pregnancies than do the traditionally employed retrospective measures and is more successful in establishing a relationship between unwanted pregnancies and domestic violence. The results demonstrate a clear relationship between a woman's experience of physical violence from her husband and her ability to achieve her fertility intentions. The need to improve the measurement of pregnancy intendedness is clear, and a move toward using prospective measures as the standard is necessary.
Stephenson, Rob; Koenig, Michael A.; Acharya, Rajib; Roy, Tarun K.
Contraceptive prevalence has been central to family planning research over the past few decades, but researchers have given surprisingly little consideration to method mix, a proxy for method availability or choice. There is no 'ideal' method mix recognized by the international community; however, there may be reason for concern when one or two methods predominate in a given country. In this article method skew is operationally defined as a single method constituting 50% or more of contraceptive use in a given country. Of 96 countries examined in this analysis, 34 have this type of skewed method mix. These 34 countries cluster in three groups: (1) sixteen countries in which traditional methods dominate, most of which are in sub-Saharan Africa; (2) four countries in which female sterilization predominates (India, Brazil, Dominican Republic and Panama); and (3) fourteen countries that rely on a single reversible method (the pill in Algeria, Kuwait, Liberia, Morocco, Sudan and Zimbabwe; the IUD in Cuba, Egypt, Kazakhstan, Kyrgyz Republic, Moldova, Turkmenistan and Uzbekistan; and the injectable in Malawi). A review of available literature on method choice in these countries provides substantial insight into the different patterns of method skew. Method skew in some countries reflects cultural preferences or social norms. Yet it becomes problematic if it stems from restrictive population policies, lack of access to a broad range of methods, or provider bias. PMID:16762087
Sullivan, Tara M; Bertrand, Jane T; Rice, Janet; Shelton, James D
Using data from the National Longitudinal Study of Adolescent Health, the authors examine the association between contraceptive use patterns in teens' first sexual relationships and their knowledge of, perceptions of, and motivations for contraception and pregnancy prevention. Results from logistic regression analyses show that knowledge,…
Ryan, Suzanne; Franzetta, Kerry; Manlove, Jennifer
A sample of 339 girls aged 13-19 who requested postcoital contraception from the Centri Educazione Matrimoniale e Prematrimoniale in Milan between 1983 and 1987 is analyzed in terms of contraceptive behavior. The majority were aged 16-19, although 8.8% were 15. 75.5% had had their 1st sexual experience between age 17 and 19. 43% had relied on withdrawal; 20% had used no contraceptive; and 51.2% had used condoms, and broken or improperly used condoms accounted for 36.8% of the requests for postcoital contraception. 41% came to the Center within 3 months of commencing sexual activity. 50% returned to the Center to request contraceptives; in 78% of the cases they chose the pill. Several cogent facts about adolescents' knowledge and attitudes emerged from the analysis. Many of the girls had only vague or inaccurate knowledge of reproductive physiology and menstruation. Many considered contraception unnecessary because they had intercourse only occasionally. Many feared the side effects of contraceptives. Adolescents often do not use contraceptives because they fear that their parents will find out. Others fear going to a gynecologist, and often the girls say that the boys do not want to use a condom. PMID:12178345
Merra, R; Repossi, A; Fantini, D
|Using data from the National Longitudinal Study of Adolescent Health, the authors examine the association between contraceptive use patterns in teens' first sexual relationships and their knowledge of, perceptions of, and motivations for contraception and pregnancy prevention. Results from logistic regression analyses show that knowledge,…
Ryan, Suzanne; Franzetta, Kerry; Manlove, Jennifer
The Adjusted Contraceptive Score (ACS), a new scoring method that was designed to help health providers and acceptors to select the most appropriate behavioral or barrier contraceptive method, was found to positively affect contraceptive performance. In this study, 100 women who applied to an Italian clinic for contraceptive counseling were administered the ACS and 100 controls also attending the clinic were given conventional contraception counseling. The following methods were available to cases and controls: diaphragm, condom, basal temperature, Billings method, Ogino method, and coitus interruptus. At a follow-up interview 12-15 months after the initial clinic visit, study participants were questioned about the number and type of contraceptive methods they had been using. Cases who were administered the ACS reported a significantly lower number of contraceptive choices at follow-up (150 choices total) compared with at the initial visit (224 choices) or the number reported by controls at follow-up (181 choices). Also recorded among those administered the ACS were reduced use of coitus interruptus and the Ogino method and increased reliance on the diaphragm and basal body temperature. Moreover, the occurrence of pregnancy in the follow-up period was markedly less among women administered the ACS (4.2%) than among controls (10.8%). Use of the ACS thus appears to represent a means of achieving effective fertility control among women who cannot use oral contraceptives or the IUD. PMID:12341907
Custo, G; Saitto, C; Cerza, S; Sertoli, G
Oral contraceptives (OCs) should be used with additional caution in combination with other drugs in certain disease states. This discussion focuses on only those interactions which are due to identifiable pharmacokinetic processes. Pharmacological interactions between OCs and other compounds may be of 2 kinds: drugs may impair the effectiveness of the OCs to cause breakthrough bleeding or to allow pregnancy to occur; and OCs may interfere with the metabolism of other componds. In general, interactions of the 1st kind are due to interference with the absorption, metabolism, or excretion of estrogens, and interactions of the 2nd kind are due to competition for metabolic pathways. It is difficult to obtain estimates of the frequency of interactions, but it seems likely that, as low-dose preparations become more widely used, interactions of the 1st type will become more common and those of the 2nd type less common. Although it is probably only those women with low plasma hormone concentrations who are at risk that other drugs may interfere with contraceptive efficacy, and women with high plasma concentrations of estrogen who are at risk of side-effects and that OCs may interfere with other drugs, there is no way of detecting women in either category. Consequently, it is safer for the present to assuume that all women who take OCs might be at risk of some form of interaction. Significant drug interactions in which contraceptive efficacy is reduced are more likely to occur in the early part of the cycle when circulating hormone concentrations are of critical importance. It is well known that infective diarrhea can induce OC failure by increasing gastrointestinal motility and reducing hormone absorption. Thus, any drug which reduces gut transit time and causes diarrhea is potentially likely to reduce circulating concentrations of OCs. The sulphat