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Biomedical subjects

V Brache

Publications and source records attributed to V Brache.

79 records · Page 5Linked to original sources
PubMedDate not supplied

Progestin-only contraceptive rings.

Several progestin-only long acting contraceptives are currently available in the form of implants or injectables. Vaginal rings are another contraceptive option in the final stages of development. These steroid-containing polymer rings are placed in the vagina, providing relatively constant drug release, thus allowing for lower effective doses. Vaginal rings have the advantage of being user-controlled and non-provider dependent, and their use is non-coital related. The first clinical study with medroxyprogesterone acetate vaginal rings was published in 1970. Since then numerous clinical trials testing different steroids and doses have followed. A large Phase III multicenter clinical trial with a levonorgestrel ring, releasing 20 microg/day, was coordinated and sponsored by WHO. The cumulative one-year pregnancy rate was 4. 5%. The principal reasons for discontinuation were menstrual disturbances (17.2%), followed by frequent expulsion of the ring (7. 1%), and vaginal symptoms (6.0%). The finding of erythematous lesions in the vagina in some women has led to the development of a more flexible device. Collaboration with industry should facilitate the manufacture of a redesigned levonorgestrel ring with a higher release rate. The Population Council is also developing a vaginal ring containing Nestorone for 6 months of continuous use. Ovulation inhibition was achieved in over 97% of the segments studied, with rings releasing either 50, 75, or 100 microg/day. No pregnancies occurred in women using the low-dose ring, while one pregnancy each occurred in the intermediate- and high-dose ring groups for a 6-month cumulative pregnancy rate of 0.0, 1.9, and 2.1%. Bleeding irregularities were common. Nestorone is orally inactive; therefore this ring is also excellent for use in lactating women.

Administration, Intravaginal↗
PubMedDate not supplied

Assessing the acceptability of NORPLANT implants in four countries: findings from focus group research.

In 1986-87, a qualitative research project was conducted in the Dominican Republic, Egypt, Indonesia, and Thailand to expand understanding of the acceptability of NORPLANT contraceptive implants beyond inferences made on the basis of continuation rates. In each of the four study sites, focus group discussions or in-depth interviews were held with potential acceptors, current NORPLANT users, discontinuers, husbands of women in these three groups, and service providers. Nonclinical participants generally had little formal education and lived primarily in urban or semi-urban areas where NORPLANT has been available for at least five years. The study focused on attitudes, perceptions, and experiences of each group regarding NORPLANT implants. Results suggest that factors having an impact on the acceptability of NORPLANT implants fall into three general categories: medical/technical, cultural/religious, and informational/educational. This article discusses each of these categories, including programmatic implications of the findings, and puts forward recommendations for enhancing NORPLANT introduction efforts on the basis of these findings.

Communication↗
PubMedDate not supplied

The clinical performance of NORPLANT implants over time: a comparison of two cohorts.

This paper reports on a study that compared the clinical performance of NORPLANT implants in two separate but similar cohorts: 200 NORPLANT users from 1975 through 1978, when the method was first introduced in the clinic, and 212 users in the same population from March 1982 through December 1983. Two different cohorts of Copper T IUD users were included as controls. Continuation rates, at one and two years of use, were significantly higher in the second group of NORPLANT users (88.1 vs. 60.5 and 76.5 vs. 40.8, respectively). Statistically significant differences between the NORPLANT cohorts were observed in discontinuation due to bleeding, amenorrhea, other medical causes, total medical causes, and personal reasons. No differences in clinical performance of the IUD were observed between the two control groups. The higher continuation rate in the second group of implant users is attributed to greater confidence and experience among the clinic staff between 1982 and 1983, and greater knowledge of and familiarity with the method among those in the target population. The study also shows that the first clinical trials of a new contraceptive method may not provide an accurate picture of that method's ultimate performance.

Adult↗