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GPs, schoolgirls and sex. A cross cultural background comparison of general practitioner attitudes towards contraceptive service provision for young adolescent females in Scotland.

No previous studies have examined the influences of cultural background on the provision of contraceptive services to females under 16 years of age. A research project was undertaken to investigate any differences between general practitioners trained in the United Kingdom and those trained in the Indian sub-continent in relation to contraceptive service provision to females under 16 years of age. A self-completion postal questionnaire survey was distributed to 230 unrestricted principal general practitioners across Scotland. Subjects were identified from the Medical Register. Half of the sample consisted of all those working in Scotland who had been trained in the Indian sub-continent. The other half were a comparable group that had been trained in the United Kingdom and were selected by quasi-random quota sampling. The response rate was 57 per cent (131/230). General practitioners in the study who had trained in the Indian sub-continent were found to be significantly less likely to provide contraceptive services to a female under 16 years of age than those who had trained in the United Kingdom. Cultural background may be influential in general practitioner provision of contraceptive services to females below the legal age of consent for sexual intercourse. In order to obtain more conclusive evidence a larger study is necessary. Such investigations must be undertaken with appropriate sensitivity and social awareness.

Adolescent↗

Energy balance and reproduction.

The physiological mechanisms that control energy balance are reciprocally linked to those that control reproduction, and together, these mechanisms optimize reproductive success under fluctuating metabolic conditions. Thus, it is difficult to understand the physiology of energy balance without understanding its link to reproductive success. The metabolic sensory stimuli, hormonal mediators and modulators, and central neuropeptides that control reproduction also influence energy balance. In general, those that increase ingestive behavior inhibit reproductive processes, with a few exceptions. Reproductive processes, including the hypothalamic-pituitary-gonadal (HPG) system and the mechanisms that control sex behavior are most proximally sensitive to the availability of oxidizable metabolic fuels. The role of hormones, such as insulin and leptin, are not understood, but there are two possible ways they might control food intake and reproduction. They either mediate the effects of energy metabolism on reproduction or they modulate the availability of metabolic fuels in the brain or periphery. This review examines the neural pathways from fuel detectors to the central effector system emphasizing the following points: first, metabolic stimuli can directly influence the effector systems independently from the hormones that bind to these central effector systems. For example, in some cases, excess energy storage in adipose tissue causes deficits in the pool of oxidizable fuels available for the reproductive system. Thus, in such cases, reproduction is inhibited despite a high body fat content and high plasma concentrations of hormones that are thought to stimulate reproductive processes. The deficit in fuels creates a primary sensory stimulus that is inhibitory to the reproductive system, despite high concentrations of hormones, such as insulin and leptin. Second, hormones might influence the central effector systems [including gonadotropin-releasing hormone (GnRH) secretion and sex behavior] indirectly by modulating the metabolic stimulus. Third, the critical neural circuitry involves extrahypothalamic sites, such as the caudal brain stem, and projections from the brain stem to the forebrain. Catecholamines, neuropeptide Y (NPY) and corticotropin-releasing hormone (CRH) are probably involved. Fourth, the metabolic stimuli and chemical messengers affect the motivation to engage in ingestive and sex behaviors instead of, or in addition to, affecting the ability to perform these behaviors. Finally, it is important to study these metabolic events and chemical messengers in a wider variety of species under natural or seminatural circumstances.

Animals↗

A prospective controlled study of the effect on blood pressure of contraceptive preparations containing different types and dosages of progestogen.

A prospective controlled study investigated the effects of oral contraceptives on blood pressure in 485 women who were between 17 and 46 years of age and had blood pressures of less than 140/90 mmHg at entry. The women were divided into seven groups depending on the chosen method of contraception: intrauterine device or barrier method (control group): ethinyl oestradiol 30 micrograms plus levonorgestrel 150 micrograms (Microgynon-30 or Ovranette); norethisterone 350 micrograms (Micronor); norgestrel 75 micrograms (Neogest); norethisterone oenanthate 200 mg intramuscularly every 2 months for the first 6 months, then every 3 months thereafter; ethinyl oestradiol 30 micrograms plus ethynodiol diacetate 2 mg (Conova-30); and ethynodiol diacetate 500 micrograms (Femulen). Blood pressures were measured every 3 months by the family planning clinic nurse under standardized conditions using an Elag-Köln automatic sphygmomanometer. After one year, blood pressure had risen significantly (P less than 0.05) in the 137 women taking ethinyl oestradiol plus levonorgestrel (mean systolic and diastolic rises 6.4 and 2.7 mmHg respectively) and in the 91 women taking ethinyl oestradiol plus ethynodiol diacetate (mean systolic and diastolic rises 6.2 and 3.0 mmHg respectively). The 94 women taking the progestogen-only preparations and the 143 women in the control group showed no increases in blood pressure. These data were confirmed after 2 years of follow-up.

Adolescent↗

Women's health: potential for better coordination of services.

OBJECTIVE: To determine the proportion of women attending a genitourinary medicine clinic (GUMC) who are in need of contraception and the proportion of women attending a family planning clinic (FPC) who may require screening or treatment for sexually transmitted disease (STD). DESIGN: Cross-sectional survey. SETTING: A large FPC (17,600 attendances by women a year) and a large GUMC (20,060 attendances by women a year) in an inner London health district. SUBJECTS: All clients attending the two clinics in consecutive weeks (356 GUMC and 335 FPC). In addition a non-random cluster of other women attending the same clinics later in the year were interviewed in depth (21 GUMC and 20 FPC). RESULTS: Of women at the GUMC 10.4% (95% CI 7.2-13.6) were at risk of unwanted pregnancy and not using contraception. Women aged under 20 years and women not registered with a general practitioner (GP) were more likely to be in this group. A further 13.8% may have been using contraception unreliably as they were not obtaining contraception from a GP or FPC. Of women at the FPC 1.8% (95% CI 0.3-3.2) complained of symptoms of genitourinary infection. In-depth interviews showed that some women assumed the staff at both clinics would counsel them in all aspects of sexual health. CONCLUSIONS: The opportunities presented at GUMCs to reduce the incidence of unwanted pregnancy and the opportunities presented at FPCs to reduce the incidence and prevalence of STD should not be missed.

Adult↗

Pelvic inflammatory disease and its sequelae in adolescents.

Pelvic Inflammatory Disease (PID) is the most common serious complication of sexually transmitted diseases (STDs). Each year over one million women in the United States experience an episode of PID, with approximately 16-20% of cases occurring in teenagers. Acute PID increases a woman's risk for recurrent PID, chronic pelvic pain, infertility, and ectopic pregnancy. Recent reports indicating that PID rates are rising and are highest among adolescent females aged 15-19 underscore the need to remain current on the clinical as well as the epidemiologic aspects of PID. We present such an update in this article. Trends in incidence and key risk factors are discussed; besides adolescence itself and STD, other important categories of risk factors include sexual activity, contraceptive method, and previous episode(s) of PID. The polymicrobial nature of PID is discussed along with an analysis of the role of specific organisms, such as Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobic and aerobic bacteria, and mycoplasmas in PID. Early diagnosis and the institution of appropriate treatment regimens are essential to the prevention of PID's devastating sequelae. Clinicians must maintain a high index of suspicion for the wide range of clinical presentations associated with PID and be prepared to provide effective management, including proper evaluation and prompt treatment of sexual partners.

Adolescent↗

Two-phase teratology study with the synthetic prostaglandin ONO-802 given intravaginally to rats.

The synthetic prostaglandin ONO-802 was administered intravaginally to Sprague Dawley rats at doses of 1.0, 0.5, and 0.125 mg/kg on days 6 through 15 of gestation. A vehicle control group was treated with pessaries that did not contain the drug while another group remained untreated. Body weight, food, water consumption, and clinical signs were monitored during the experiment. In Phase One, 20 pregnant animals from each group were sacrificed at term, major organs were weighted, and litter and fetal data were collected. In Phase Two ten dams per group were allowed to deliver their litters, and the offspring were evaluated for survival, growth, developmental signs, and physiological function. Selected F1 offspring were retained to assess learning and emotional behavior or reproductive capacity. Administration of either 0.5 or 1.0 mg/kg of ONO-802 resulted in a slight reduction in food consumption and body weight gain. Water consumption was increased both during and after the dosing period for the mid and high dose dams. Significantly increased weights for the heart, lungs, liver, adrenals, and ovaries and decreased weights for the thymus gland were noted at term sacrifice of the 1.0 mg/kg dams, whereas the 0.5 mg/kg group had increased weights of the adrenals and ovaries only. Litter parameters were unaffected by treatment. Weights of the female fetuses of the 1.0 and 0.5 mg/kg groups were significantly reduced when compared to controls. There were no significant drug-related abnormalities among the F1 offspring and no evidence that treatment of the F0 dams affected the development, behavior, or reproductive performance of the F1 offspring. Thus, ONO-802 was not teratogenic when given to rats by the intravaginal route.

Abortifacient Agents↗

Collaborating for international research development in Malawi, Africa.

PURPOSE: To describe a collaborative research effort by a U.S. school of nursing, an African school of nursing, and the Malawian Ministry of Health. Providing assistance to women leaders in Malawi to develop and conduct research to improve the health of women and infants in villages is necessary. SCOPE: This 5-year project, 1990-1995, included organizing a workshop on the research process, developing and testing pilot projects, developing and conducting two full-scale studies, and disseminating findings. RESULTS: Two full-scale studies, one examining maternal mortality and one examining the effects of teen pregnancy, were completed with important health policy implications for Malawi. CONCLUSIONS: Successful international collaborative research yields increased knowledge for all participants and important health information. International research requires continuous communication, people skilled in group work, sensitivity to cultural differences, patience, persistence, and commitment.

Cooperative Behavior↗

Medical aspects of contraception.

It is evident that choice of contraceptive has important medical implications, whether a mechanical or a hormonal method is elected. Each technology has unique benefits and risks, constraints, applicability, and inconvenience. Wise advice in a medical context must be based on thorough familiarity with the options available to each woman.

Adult↗

Sexual behavior, contraceptive practice, and reproductive health among Nigerian adolescents.

In the context of a high and increasing incidence of unwanted pregnancy among Nigerian adolescents, a sample survey of never-married residents of the Ibadan area, aged 14 to 25 years, was conducted in 1982 to learn about their perceptions and practices relating to reproductive health. A substantial proportion of the young unmarried population is sexually active, and despite comparatively high contraceptive prevalence among that proportion, many are still engaging in sexual relations without benefit of contraceptive protection. Nearly half of the female students interviewed at both the secondary and university levels have been pregnant, as have two-thirds of those not currently enrolled in school. Among those respondents who had been pregnant, almost all reported that they voluntarily terminated their pregnancies. Existing and needed contraceptive services for the adolescent population are discussed.

Abortion, Illegal↗

Contraception with progestagens in systemic lupus erythematosus.

To test the efficacy and tolerance of progestagens as contraceptives in systemic lupus erythematosus (SLE), 200 mg IM norethisterone enanthate was administered to 10 patients, 0.03 mg/day oral levonorgestrel to 15 patients and they were compared with 18 control patients. There were 4 episodes of active SLE in 48 patient-months on norethisterone enantate and 6 episodes in 122 patient-months on levonorgestrel as compared with 9 episodes of active disease in 298 control patient-months (p = ns). There were no pregnancies and intermenstrual bleeding led to discontinuation of medication in 30% of patients. Progestagens may be an alternative contraceptive method in SLE.

Adult↗

The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers.

BACKGROUND: Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. METHODS: We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum. RESULTS: Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use. CONCLUSIONS: The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.

Adolescent↗

Factors associated with human papillomavirus infection detected by polymerase chain reaction among urban Canadian aboriginal and non-aboriginal women.

OBJECTIVES: To determine the prevalence and correlates of human papillomavirus (HPV) infection among women attending an ethnically mixed, predominantly low-income, inner-city primary care clinic. STUDY DESIGN: Cross-sectional survey (N = 1,477). Demographic, behavioral, and reproductive history data were collected by questionnaire. Cervical swabs were analyzed for gonorrhea and chlamydial infections, abnormal cytology, and HPV infection assessed by PCR followed by hybridization for types 6, 11, 16, 18, 31, 33, and 35. RESULTS: Human papillomavirus was detected in 33% of specimens, with no significant difference between Aboriginal (AB) and non-Aboriginal women. Adjusting for AB status, HPV infection was associated with marital status, condom use, number of sexual partners (last year and lifetime), age at first sexual intercourse, a history of sexual abuse, and current abnormal Papanicolaou (Pap) smear. In multivariate analyses excluding abnormal Pap smear as an independent variable, marital status and the number of lifetime sexual partners were found to be significant independent predictors of HPV infection. Comparing individuals with 20+ lifetime sexual partners and those with 1 or fewer partners, the odds ratio (OR) for HPV infection was 1.90 (95% confidence interval [CI] 1.66-2.17) among AB women and 1.54 among non-AB women (95% CI 1.36-1.73). The OR for infection with HPV types 6 and 11 was 1.39 (95% CI 1.22-1.58), whereas for the high oncogenic risk types of 16, 18, 31, 33, and 35, the OR was 1.82 (95% CI 1.65-2.01). CONCLUSIONS: No differences were found between AB and non-AB women in the detection of HPV DNA, despite the higher risk for cervical cancer and the prevalence of recognized behavioral and reproductive risk factors among AB women. This study also indicates that the association of sexual activity with HPV infection holds true for both high- and low-oncogenic HPV types.

American Indian or Alaska Native↗

Effects of cocaine hydrochloride on reproductive function and sexual behavior of male rats and on the behavior of their offspring.

Cocaine hydrochloride (30, 15, or 0 mg/kg) was administered daily subcutaneously to male rats for a minimum of 72 days. Animals receiving the 15-mg/kg and 0-mg/kg doses were pair-fed with animals receiving the higher dose. A fourth group served as a nontreated ad libitum-fed control to assess the role of cocaine-associated decreases in food and water intake. Administration of cocaine resulted in dose-related decreases in body weights, increases in locomotor activity, and decreases in estradiol levels. The high dose of cocaine was also associated with an increase in the percentage of spermatozoa with heads separated from tails. Cocaine did not affect sexual behavior, relative weights of the testis or accessory organs, histology of the testis, number of implantations, resorptions, fetal or newborn weight of offspring, or offspring weight at 21 days of age but did result in hyperactivity and increased perseverance in a T maze.

Animals↗

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