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PubMed1997

[Contraception in adolescents included in a family planning program].

OBJECTIVE: To describe the motives of consultation, kinds of contraceptive methods and side-effects of oral contraceptives (OCs) in adolescent users of a family planning program. DESIGN: Family planning program at the District Primary Care Unit, Cádiz, Spain. PATIENTS: 283 adolescent females who requested attendance in a family planning program from January 1993 until January 1994. MEASUREMENTS AND MAIN RESULTS: A medical history of every adolescent was carried out and every patient was examined. Those who were recommended the use of OCs passed through 3 controls: at the beginning, after the 6th month and after 1 year. These controls consisted in recording sexual risk behaviours as well as several analytic tests. RESULTS: Most adolescents requested the prescription of contraceptive methods (81.7% of the most prescribed and demanded methods were OCs). We found no serious side-effects after 1 year, so we can conclude that OCs are an usefull contraceptive choice for sexually active adolescents because of its security, acceptance and easy use.

Adolescent↗
PubMed2002

[Low-dose combination oral contraceptives use in women with uterine leiomyomas].

BACKGROUND: To evaluate the effects of the last generation of oral contraceptives (OC) on uterine leiomyomas. METHODS DESIGN: non-randomized perspective study on the effects of the last generation of oral contraceptives on uterine myomas during 24 months follow-up. SETTING: III Unit of Obstetrics and Gynecology, University of Bari. PARTICIPANTS: between 1999 and 2000 a total of 121 asymptomatic women with only one subserous and/or intramural uterine myoma, having diameter pound 25 mm have been recruited. These patients were divided into two groups: the treatment group was composed of 53 women and was treated with last generation pill containing 20 microgram of ethynilestradiol and 150 microgram of desogestrel or 20 microgram of ethynilestradiol and 75 microgram of gestodene, while the control group was composed of 68 women having no hormonal therapy. In both groups the uterine myoma size (evaluated by transvaginal ultrasonography), the duration of menstrual flow and the hematocrit at the time of recruitment, after 12 months and after 24 months were examined. RESULTS: Forty-eight (90.6%) women belonging to the study group completed 2 years of OC use; only sixty women (88.2%) belonging to the control group completed the study. The use of the last generation oral contraceptives for 2 years didn't increase significantly uterine myomas size; besides after 24 months there was a significant reduction of more than two days of menstrual flow, and a significant increase of two and a half points of hematocrit. On the contrary, in the control group, we found a significant increase of uterine myoma volume, a not significant increase of menses duration and a not significant reduction of hematocrit. CONCLUSIONS: The prolonged use of the last generation of oral contraceptives does not affect the uterine myomas volume increase and furthermore it produces a significant reduction in the duration of menstrual flow with a significant increase in hematocrit.

Adult↗
PubMedDate not supplied

Repeat abortion and use of primary care health services.

One-third (34%) of 2,001 women who sought an abortion in 1991-1992 in Wichita, Kansas, were repeat-abortion patients. Compared with first-time abortion patients, repeat-abortion patients were significantly older, more often black, and younger at their first pregnancy (p < .001). The two groups did not vary significantly by income or age at first intercourse. However, repeat-abortion patients were significantly more likely than first-time patients to have been using a contraceptive method at the time of conception (65% compared with 59%) and more likely to say they always or almost always used a method (63% and 53%, respectively). More than 40% of women in each group reported they had no personal physician. Further, 34% of repeat-abortion patients said they had no follow-up examination after their previous abortion, and 28% said they received no contraceptive counseling. Only half of women whose pregnancy was confirmed by their personal physician obtained an abortion referral from that physician.

Abortion Applicants↗
PubMed2003

Changes in contraceptive use in Vietnam.

This analysis used data, primarily from the 1997 Vietnamese Demographic and Health Survey (VN-DHS 1997), to determine the changes in contraceptive use in Vietnam. A descriptive analysis of individual, household and community characteristics was made to obtain a general description of contraceptive use. Multinomial logistic regression analyses were also performed on the currently married in (a) a sample of all women and (b) only those women who live in rural areas, to identify the strength of association that each variable has with the use of modern contraceptives. The use of any contraceptive method and the use of modern methods increased from 1988 to 1997. The primary contraceptive method utilized is the IUD and its use has increased substantially from 1988 to 1997. Younger women (aged 15-24) were less likely to use any contraceptive method. Women not desiring additional children were significantly more likely to use contraceptive methods than those desiring more children. Education has a clear impact on both contraceptive knowledge and use by women, with higher educated women being more likely to use a contraceptive method. Illiterate women with no formal education were significantly less likely to use modern methods of contraception. Differentials in contraceptive use exist regarding place of residence. Urban women are more likely than rural women to use contraception, but the difference is not large. Women living in mountainous areas are less likely to use contraception, compared with women living in the lowlands. Living standards, especially the availability of electricity in the community, have a large effect on the methods of contraception adopted by women. Religion is not strongly related to the contraceptive behaviour of women. There were significant differences in the use of contraceptives in communities with good quality of care, with increased contraceptive use corresponding to the increase in availability of family planning workers at communes, provision of counselling services at health facilities, and the volume of mass media family planning messages.

Adolescent↗
PubMedDate not supplied

[Improving the quality of care after spontaneous abortions in rural Senegal].

OBJECTIVES: To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal. PATIENTS AND METHOD: This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%. RESULTS: The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%. CONCLUSION: Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.

Abortion, Spontaneous↗
PubMed2005

Better survival in female patients with hepatocellular carcinoma: oral contraceptive pills related?

BACKGROUND: Hepatocellular carcinoma (HCC) has an indisputable male predominance. "Gender" as an independent prognostic factor for survival is, however, controversial. GOALS: Determine the influence of gender on survival in HCC patients, and identify factors that may account for the difference. METHODS: A retrospective analysis on a prospectively collected database in a 15-year period, from 1989 to 2003. RESULTS: A total of 3,171 HCC patients were managed in our institution (946 with curative treatment, 1,388 with palliative treatment, and 837 with supportive treatment) and studied. Female patients (n = 520) were 4.3 years older (P = 0.000), had a lower proportion of smokers and drinkers (P = 0.000), and were less likely to be hepatitis B carriers (P = 0.000). There was no difference in Child-Pugh status, tumor size, and the use of different treatments between genders. The overall median survival was 25.7 months longer in females after curative treatment (73.6 vs. 47.9 months; P = 0.012). The survival benefit in female patients was observed in early-stage diseases and persisted when only hepatitis B surface antigen-positive patients were analyzed (96.4 vs. 47.9 months; P = 0.044). With multivariate analysis, gender, indocyanine green test value at 15 minutes, number of tumor nodules, size of tumor, major vascular invasion, invasion of adjacent organs, and tumor rupture were the independent variables for survival. More importantly, in female patients, history of using oral contraceptive was an independent factor with survival benefit (P = 0.004). CONCLUSION: Gender is an independent variable for survival after curative treatment of HCC. A survival benefit was observed in females. History of using oral contraceptive is associated with a better long-term survival in female patients.

Carcinoma, Hepatocellular↗
PubMed2006

Using the theory of reasoned action to explain physician intention to prescribe emergency contraception.

CONTEXT: Although research has examined providers' knowledge, attitudes and prescribing behaviors with regard to emergency contraception, none has used a theory-based approach to understanding the interplay of these factors. METHODS: A cross-sectional survey of 96 faculty physicians from one Southern and three Midwestern universities was conducted in 2004 to assess factors associated with intention to prescribe emergency contraception. The theory of reasoned action guided the study hypotheses and survey design. Correlation and regression analyses were used to examine the data. RESULTS: Only 42% of respondents strongly intended to prescribe emergency contraception for teenagers, but 65-77% intended to do so for all other specified groups (women who ask for the method, who have had a method problem, who have experienced rape or incest, and who have had unprotected sex). Consistent with the theory of reasoned action, high intention to prescribe emergency contraception was associated with positive attitudes toward doing so and with the perception that specific colleagues or professional groups support prescribing it; however, the perception of support by colleagues or professional groups in general did not predict intention. Also consistent with the theory, physicians' knowledge about emergency contraception and their demographic characteristics were not significant. CONCLUSIONS: Interventions to encourage physicians to provide emergency contraception should take into account their attitudes toward the method and the components of those attitudes.

Adolescent↗
PubMed2004

The resistance to contraceptive use in young Italian women.

OBJECTIVE: To investigate the personal relationship and social factors that influence young women not to use contraceptives. METHODS: A total of 104 young women aged 14-23 years were studied using a 26-item questionnaire which was to be filled out individually. The questionnaire addressed use of contraceptives at the first intercourse and current use, together with various items related to age, educational level, self-image, fantasy about parenthood, and characteristics of the relationships with the partner and the family. A descriptive analysis and a multivariate logistic regression model investigated the relationship between contraceptive non-use and selected variables. RESULTS: Twenty-four percent of the girls did not use any effective contraceptive method at the first sexual intercourse and 21% were current non-users. The study of characteristics associated with inconsistent contraceptive use shows a complex picture where young age, poor knowledge of the partner, an older partner and living in a incomplete family nucleus or outside the family represent significant risk factors. Considering our results as a whole, contraceptive non-use is not only a marker of risk-taking behavior, but sometimes expresses irrational feelings which emerge when facing new sexual experience.

Adolescent↗
PubMedDate not supplied

Biochemical basis for the selection of oral contraceptives.

Many specific plasma proteins show dose-related changes when oral estrogens are administered. Large increases in concentration are seen in many important binding proteins, such as the sex hormone-binding globulin, transcortin, the retinol-binding protein, ceruloplasmin, and transferrin. A smaller group of plasma proteins are reduced in amount. These changes are related to altered rates of hepatic synthesis and secretion. As the overall effect of estrogen is one of increased protein synthesis, there is a reduction in the amount of plasma-free amino acids and in the pattern of distribution. Oral contraceptive (OC) users frequently show significant alterations in biochemical tests of vitamin status, at least some of which are related to alterations in plasma proteins. Other biochemical changes associated with OC use include a fasting hyperlipidemia, due mainly to increases in triglycerides, although there is often also a small increase in cholesterol. These changes are due primarily to increases in several lipoprotein fractions and are related mainly to the estrogen component. A deterioration in glucose tolerance occurs in many OC users and is probably induced by both estrogens and progestogens. There is evidence that certain clinical side effects of OCs, such as depression, are associated with specific biochemical changes.

Amino Acids↗
PubMed1996

Why pregnant adolescents say they did not use contraceptives prior to conception.

OBJECTIVE: In this study we attempted to learn why childbearing adolescents failed to use contraceptives prior to conception. We hypothesized that among adolescents who elect to bear their children, positive and/or ambivalent feelings about having a baby are the most frequently cited reasons for not having used contraceptives. STUDY DESIGN: This is a cross-sectional, clinic-based survey of a racially and ethnically diverse group of 200 consecutively enrolled, poor, pregnant, 13-18-year-old patients in an adolescent-oriented maternity program. The participants completed a self-administered questionnaire which elicited information about environmental and personal risk factors for inconsistent use of contraceptives and information about the reasons they had not used contraceptives consistently prior to conception. Student's t-tests, Chi-square, and logistic regression analyses were used. RESULTS: The most frequently cited reasons for not using contraceptives prior to conception were: "I didn't mind getting pregnant" (20%) and "I wanted to get pregnant" (17.5%), followed by "I was using birth control but it didn't work (broke)" (12%), "I thought there was something wrong with me and I couldn't get pregnant" (9%) and "I just didn't get around to it" (9%). Teenagers who cited positive and/or ambivalent attitudes toward childbearing as their primary reason for not using contraceptives at the time of conception did not differ from others with regard to age, Medicaid status, gravidity, parity, frequency of living with parents, partner's age, depressive symptoms, or perceived family support. They were, however, more likely to have known the father of the baby for more than 6 months at the time of conception [odds ratio (OR) 2.53; 95% confidence interval (CI) 1.22-5.26) and to have dropped out of school (OR) 2.15; 95% CI 1.10-4.26]. CONCLUSIONS: The study hypothesis was supported. The absence of negative attitudes toward having babies rather than negative attitudes toward contraceptives is the most commonly cited reason for nonuse of contraceptives among childbearing adolescents. The results of this study may enable health care and social service providers to design more effective programs for preventing first and subsequent adolescent pregnancies.

Adolescent↗
PubMed2004

Two-year performance of a Nestorone-releasing contraceptive implant: a three-center study of 300 women.

A 2-year trial of a single Nestorone (NES) rod implant was conducted at three Latin American centers, each enrolling 100 women. We studied the safety, effectiveness and acceptability of this progestin-releasing contraceptive implant. Three pregnancies occurred, the last at 18 months of use. Because no pregnancies were expected in the first 18 months, the trial was halted. At that time, 224 women had completed at least 18 months of use, and 99 women had used the implant for more than 24 months. Few participants used adjunctive contraception between the time the study was halted and the time they had their implant removed. No additional pregnancies occurred before the removal of the last implant. The 2-year cumulative pregnancy rate was 1.7 per 100 with a Pearl index of 0.6 per 100 for the 2-year period. The 1-year and 2-year continuation rates were 80.5 and 66.7 per 100, respectively. Menstrual and medical disturbances were the principal reasons for discontinuation, followed by planned pregnancy. Headache and weight gain frequently led to discontinuation. The NES implant had little important effect on most clinical chemistry and lipid parameters. Over the study course, the mean change in hemoglobin was <1%. Slight modification of the design of this single 2-year implant, restoring features previously examined in clinical trials, is likely to improve its effectiveness. A single NES implant appears to provide acceptable contraception for women.

Adolescent↗
PubMed2006

Characteristics of women at low risk of STI presenting with pelvic inflammatory disease.

OBJECTIVE: To investigate the background and reproductive history of women who are considered at low risk of sexually transmitted infection (STI) presenting with acute pelvic inflammatory disease (PID). METHODS: Case-control study, investigating 51 women admitted to hospital with a diagnosis of acute PID and 50 healthy women attending for routine gynecological checkup. RESULTS: Women with PID were older (p = 0.003) and more often unemployed (p = 0.008), and had a lower educational level (p = 0.000003). Healthy women reported more regular routine attendance to gynecologists (p = 0.0008) and were less often smokers (p = 0.0009). There was no difference between groups regarding age at first sexual intercourse, number of sex partners during life, duration of current sexual partnership, and frequency of sexual intercourse, total number of deliveries, spontaneous abortions, ectopic pregnancies and outcome of last pregnancy. The number of induced abortions was significantly higher in the PID group (p = 0.0004). There were no differences between the groups with regard to previous episodes of PID. Healthy controls more often reported a history of STI (p = 0.00007). IUD was the most commonly reported current contraceptive method in both groups, and there was no difference in contraceptive practices between groups. CONCLUSION: Women with PID differed from healthy controls only with regard to socio-demographic characteristics and not with regard to common risk factors for PID.

Acute Disease↗