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PubMed2001

Emergency contraception: randomized comparison of advance provision and information only.

OBJECTIVE: To determine whether multiple courses of emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods. METHODS: We randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about emergency contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain emergency contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability. RESULTS: Women given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken emergency contraception, although numbers were too small to permit statistically significant inferences. No women used emergency contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about emergency contraception useful, and all those receiving only information wished they had received supplies as well. CONCLUSION: Multiple emergency contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.

Adult↗
PubMed1994

Risk factors for cervical dysplasia: implications for prevention.

This study assessed the aetiologic and public health importance of various risk factors for cervical dysplasia. A case-control design was used in which all cases had a histologically confirmed mild, moderate or severe cervical dysplasia. Controls were sampled from the general population. A total of 257 cases and 705 controls returned a postal questionnaire about marital status, sexual behaviour and contraceptive use, smoking behaviour and dietary intake of some nutrients. An increased risk was observed for women who were smokers and women who reported more than one sexual partner. For women who reported more than six sexual partners, the adjusted odds ratio was 11.5 (95% CI: 6.6-20.2); for women who smoked more than 20 cigarettes per day, an adjusted odds ratio of 2.5 (95% CI: 1.6-3.9) was found. Use of oral contraceptives for more than 10 years increased the risk: the adjusted odds ratio was 2.3 (95% CI: 1.2-4.5). The population attributable risk percentage (PAR%) of these three risk factors together was 72%, while number of sexual partners, number of cigarettes smoked and oral contraceptive use alone amounted to a PAR% of 57%, 29% and 8% respectively. Considering the preventive potential against the background of causality of the relationships and the social acceptability of the proposed changes, it is concluded that cervical cancer and its precursors might for the greater part be prevented by behavioural changes, such as reducing smoking and using contraceptive barrier methods.

Adult↗
PubMed1995

Reproductive tract infections and abortion among adolescent girls in rural Nigeria.

Few studies from developing countries have investigated reproductive tract infections or other indicators of sexual health among unmarried adolescent girls in rural areas. We have obtained baseline demographic, clinical, and microbiological data on reproductive tract infections and induced abortion in girls in a rural area of southeast Nigeria, in order to assess the need for health care for adolescents. 868 females attended for interview and examination: 458 aged 20 and above and 410 aged 12-19, the latter representing 93.4%of the adolescent population. 43.6% of those < 17 and 80.1% aged 17-19 years were sexually active and at least 24.1% had undergone an induced abortion; only 5.3% had ever used a modern contraceptive. Vaginal discharge was reported by 82.4%, though few sought treatment. 94.1% of sexually active adolescents and 97.6% of sexually active women 20 years old or over were gynaecologically examined and screened for reproductive tract infections. Of those aged less than 17, 19.8% had symptomatic candida and 11.1% trichomonas infections. Among those aged 17-19 years, chlamydia was detected in 10.5%, and symptomatic candidosis in 25.6%; this was the group most likely to have any infection (43.8%). 42.1% of sexually active adolescents had experienced either an abortion or a sexually transmitted disease. Syphilis was the only infection for which the incidence clearly increased with age. Health-care services for adolescents in this community are needed and should include sex education, contraceptive provision (especially barrier methods), and access to treatment for reproductive tract infections. Investments in health for this age group will have an effect on subsequent reproductive health.

Abortion, Induced↗
PubMed1999

What do female rats like about sex? Paced mating.

The motivational aspects of female sexual behavior have been evaluated by a variety of methodologies including: the increasing barrier method, the runway procedure, partner preference test, operant behavior and conditioned place preference. When female rats are tested for sexual receptivity under traditional laboratory conditions, usually a small open area, both appetitive and aversive components of the sexual interaction are easily observed. For example, after prolonged testing, subsequent lordosis and the intensity of this response are reduced increasing the rejection behavior by the female. However, when female rats are allowed to pace (control) the rate of sexual stimulation they received, as usually occurs under seminatural and natural conditions, the aversive properties of mating are reduced. The conditioned place preference can be use to measure the positive affect elicited by mating. We have combined pacing and conditioned place preference in an attempt to reduced the possible aversive consequences associated with mating and increase the likelihood of detecting the appetitive effects of coital interaction in female rats. Only female rats that regulated (paced) their coital interactions with a stud male through a two-compartment chamber in which only the female could freely move from one compartment to the other developed a clear place preference. As well, females that received ten or 15 paced intromissions (without ejaculation) also developed place preference. The place preference induce by paced mating is blocked by the systemic administration of naloxone suggesting that opioids are involved in the reward processes associated with paced mating. Paced sexual interactions can induce a positive affect of sufficient intensity and duration to induce conditioning.

Animals↗
PubMed1997

Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU patients.

The aim of this prospective study was to assess the relative epidemiological role of digestive tract colonization by Acinetobacter baumannii, in comparison with other body site colonizations, in patients admitted to intensive care units (ICUs). From January to May 1995, axillary, pharyngeal and rectal swabs were taken together within the first 48 h of admission, and then weekly during ICU stay. Seventy-three patients were included, 48 of them (66%) had axillary, pharyngeal, or rectal colonization with A. baumannii, nine (19%) of these 48 during the first 48 h and the remaining 28 (77%) during the first week. Twenty-one (29%) had clinical samples positive for A. baumannii and axillary, pharyngeal, or rectal colonization. In 15 of these 21 (71%), colonization on body sites occurred prior to isolation from clinical samples (mean seven days, range 1-20). Throughout admission, rates of detection of A. baumannii were 75% (36/48) for axillary or pharyngeal swabs and 77% (37/48) for rectal swabs. Combination of two body site swabs yielded culture positive rates of 90% (43/48) for axillary-pharyngeal or axillary-rectal sites, and 96% (46/48) for pharyngeal-rectal. Two epidemic clones were defined by antibiotype and pulsed-field gel electrophoresis (PFGE) of SmaI DNA digests in 48 isolates from 11 patients. We conclude that body sites of patients were a major reservoir for A. baumannii infections in the outbreak. This finding cases doubt on the value of selective decontamination of the digestive tract as an additional infection control measure in this kind of outbreak. The weekly performance of pharyngeal and rectal swabs appears to detect A. baumannii colonization early among ICU patients and enables barrier methods to be applied rapidly.

Acinetobacter Infections↗
PubMed2003

[Malaria prevention in international travel].

For travelers malaria represents the principal infectious risk of severe complications and death. Infection during traveling depends on the geographical area visited, the predominant species of parasite, the frequency of resistance to antimalarial agents, and whether preventive measures have been taken. Until a vaccine has been developed, prevention strategies consist of providing travelers with information, the use of barrier methods against vector bites, the correct use of chemoprophylaxis, and the possibility of self-diagnosis and treatment. The choice of chemoprophylaxis regimen should be individualized since no regimen guarantees 100% protection or is free of adverse effects or contraindications. The most effective drugs are doxycycline, atovaquone-proguanil and mefloquine while those producing severe adverse effects with the least frequency are atovaquone-proguanil and doxycycline.

Animals↗
PubMed2003

Receipt of renal replacement therapy in the United States: a population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II).

BACKGROUND: Persons with chronic kidney disease who need kidney replacement therapy to sustain life have health insurance. We examined whether young adults, women, blacks, less-educated persons, the poor, and persons residing in less populated areas receive treatment when health insurance is no longer a barrier. METHODS: We conducted a case-control study nested in the Second National Health and Nutrition Examination Survey Mortality Study. Cases were persons treated with kidney replacement therapy determined by linkage to the end-stage renal disease treatment registry. Controls were untreated persons with kidney disease who died not appearing in the registry. RESULTS: During 12 to 16 years, 44 persons developed treated disease, and 145 persons, untreated disease. After adjustment for sex, age, education, population of residential area, and comorbid conditions in logistic regression analysis, younger versus older age and living in a highly populated versus less populated area were both independently associated with treatment (relative odds of treatment, 5.57; 95% confidence interval, 1.72 to 18.0; and 4.33; 95% confidence interval, 2.09 to 8.97, respectively). Race, sex, education, and poverty were not associated with less treatment. CONCLUSION: We found no disparity in life-saving chronic kidney disease treatment with regard to race or socioeconomic status in this population-based study. Less receipt of treatment by older adults may reflect greater comorbid disease or choices made by persons or their providers. Strategies to render treatment in less populated areas, including incentives to deliver care to such areas, should be encouraged.

Adult↗
PubMed2004

[Application of the WHO chronic respiratory diseases programme in Sub-Saharian Africa: problems in Senegal].

INTRODUCTION: To prevent and control chronic respiratory diseases, the WHO has outlined a programme to be applied in all the countries. In Sub-Saharan countries like Senegal, its application faces many barriers. METHODS: This work is a detailed analysis of the main areas of the programme based on the socio-economic, cultural and medical realities present in Sub-Saharan Africa countries, and particularly in Senegal. RESULTS: There is a lack of political engagement resulting from the precarious socio-economical situation. The demand for care is impaired because of the prevalence of illiteracy and the practice of traditional healing methods which is the first recourse for patients. The inaccessibility and lack of adequate health structures, technical equipment and qualified medical staff, and the high cost of medications for the majority of the population is the cause of this weakness of the healthcare system. These international recommendations are both not compatible with the local realities and not known to the majority of health providers. CONCLUSIONS: The mobilisation of international and national human and financial resources, the involvement of community-based structures, the adaptation and revision of the recommendations, the introduction of medications advocated by the Bamako Initiative, the training of health providers, the adaptation of regional and continental initiatives against tobacco and the creation of smoking cessation centres are needed if this chronic respiratory diseases programme is to be efficiently implemented.

Asthma↗
PubMed1997

Infection control in the orthodontic office in Canada.

Because of the difficulty of identifying infected persons, current recommendations for infection control are to treat all patients as if they are infected with blood-borne pathogens such as human immunodeficiency virus (HIV) and the hepatitis viruses. Dentists' compliance with these recommendations has been investigated previously, however, there are few data related to orthodontists. The objective of this study was to measure the proportion of orthodontists who report the use of recommended infection control procedures and to compare the infection control practices of orthodontists and general dentists. A mailed survey with three follow-up attempts was administered to all orthodontists and general dentists in Ontario (N = 5441) in 1994. There were significant differences in the routine use of gloves (orthodontists 85%, general dentists 92%); masks (orthodontists 38%, general dentists 75%); protective eyewear (orthodontists 60%, general dentists 84%); changing gloves after each patient (orthodontists 84%, general dentists 96%); and heat sterilization of handpieces (orthodontists 57%, general dentists 84%). Hepatitis B virus (HBV) vaccination of all clinical staff was reported by 46% of orthodontists, compared with 61% of general dentists (p < 0.001). Reports of HBV vaccination of orthodontists (94%) and general dentists (92%) were not significantly different. The use of additional precautions for patients with HIV was reported by 80% of orthodontists and 78% of general dentists. More education is required to promote the use of universal precautions by both general practitioners and orthodontists. Increased use of barrier methods, HBV vaccination of clinical staff, and heat sterilization of handpieces is required to reduce the potential for cross infection in the orthodontic practice. This is particularly important with the increasing number of microorganisms that are resistant to antibiotics.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Microbicides 2000: report of an international conference, 13-16 March, Washington DC.

'Microbicide' is the name for a number of new products currently under research which could become a new class of barrier method for use in the vagina and rectum for protection against HIV, prevention and/or treatment of other sexually transmitted diseases and/or act as a contraceptive. This is a summary report of this scientific conference, at which basic science, clinical trial efficacy and design, and ethical, behavioural and public health issues were on the agenda. There are many potential products but few have yet got beyond Phase I clinical trials. There is not likely to be an approved and available product for 5-10 years at best; finding a balance of low toxicity with high efficacy is the major challenge, given how rapidly HIV infection actually infects tissue. Phase III clinical trials of these products require new protocols and procedures. It was urged by many, and underscored by HIV positive women who were present that clinical trials must be treated as an opportunity to promote a total prevention package--STD treatment, voluntary HIV testing and counselling, condom use, practising safer sex--plus microbicides and contraception. Identifying effective products and making them available as soon as possible were obviously also a priority. How to do this--ethically and scientifically--were the main subject of the meeting.

Administration, Rectal↗
PubMed2005

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Adolescent↗
PubMed1997

Gonococcal infection in cerebrospinal fluid and the presence of a ventriculoperitoneal shunt.

BACKGROUND: Neisseria gonorrhoeae is one of the most common organisms associated with pelvic disease in a woman of reproductive age. CASE: We present an unusual case of cerebrospinal fluid infection with N. gonorrhoeae in a woman with a ventriculoperitoneal shunt who complained of abdominal pain. Her shunt was removed and after adequate antibiotic therapy, it was re-inserted. CONCLUSION: Sexually active women, especially those with ventriculoperitoneal shunts, should be encouraged to use a barrier method of contraception, and should have a pelvic examination as part of their evaluation when they present with complaints of abdominal pain.

Adult↗
PubMed1997

Making the female condom a "reality" for adolescents.

Alarming rates of pregnancy, sexually transmitted diseases, and human immunodeficiency virus infection among adolescents point to the need for expanding contraceptive options for adolescents. The female condom-a female-controlled barrier method that protects both partners from sexually transmitted diseases-marks an important breakthrough in contraceptive technology. This report reviews current research on the efficacy and acceptability of the female condom and considers the feasibility of its use in the adolescent population. Specifically, the authors first consider the factors that affect teenage condom (and other contraceptive) use (efficacy, cost and availability, and acceptability) and then apply the mechanics of the female condom to these issues. Based on this analysis, recommendations for future steps to be taken by researchers, adolescent health practitioners, and the manufacturer of the female condom are presented.

Adolescent↗
PubMedDate not supplied

Natural family planning in New Zealand: a study of continuation rates and characteristics of users.

This study has determined long-term continuation rates of clients who attended clinics of the New Zealand Association of Natural Family Planning and became autonomous users. It has also identified factors which might influence the continuation of NFP use. A total of 509 female subjects, 452 of them with their male partners, were enrolled in the study at the beginning of clinic teaching. Once autonomous they were sent questionnaires at 6-monthly intervals for a period of 24 months. Time out was allowed for pregnancy. The number of female subjects entering the 2-year follow-up phase of the study was 406 (79.8%). Of these 164 completed 2 years of use with 102 (20% of study entrants) using NFP and 62 (12.2%) using fertility awareness in combination with a barrier method. Subjects for whom NFP was their first family planning method, who were Catholic or who gave religion as their reason for choosing NFP were more likely to continue long-term use. The majority of subjects (> 90%) were highly satisfied with NFP use, with the most common reasons for satisfaction being self-awareness, freedom from drugs, naturalness and effectiveness. The difficulties reported related to abstinence and cycle interpretation.

Adult↗
PubMed1998

MDCK cell cultures as an epithelial in vitro model: cytoskeleton and tight junctions as indicators for the definition of age-related stages by confocal microscopy.

PURPOSE: Madin Darby Canine Kidney (MDCK) cells were grown in culture, and age-related morphological changes in the cytoskeleton and tight junction (TJ) network were used to define stages in view of establishing an optimal in vitro model for the epithelial barrier. METHODS: Growth curves and transepithelial electrical resistance (TEER) were determined, and the cytoskeleton (actin, alpha-tubulin, vimentin) and TJ (Zonula occludens proteins ZO1, ZO2) were investigated with immunofluorescent methods by confocal laser scanning microscopy (CLSM) and digital image restoration. RESULTS: TEER measurements indicated that TJ were functional after one day. Values then remained constant. Four morphological stages could be distinguished. Stage I (0-1 day): Sub confluent cultures with flat cells; TJ established after cell-to-cell contacts are made. Stage II (2-6 days): Confluent monolayers with a complete TJ network, which remains intact throughout the later stages. Stage III (7-14 days): Rearrangement in the cytoskeleton; constant cell number; volume and surface area of cells reduced (cobble-stone appearance). Stage IV (> or = 15 days): Dome formation, i.e. thickening and spontaneous uplifting of the cell monolayer. CONCLUSIONS: Based on the structural characteristics of stage III cell cultures, which are closest to the in vivo situation, we expect them to represent an optimal in vitro model to study drug transport and/or interactions with drugs and excipients.

Animals↗
PubMed1998

Influence of chitosan microspheres on the transport of prednisolone sodium phosphate across HT-29 cell monolayers.

PURPOSE: The present study was performed to investigate the influence of chitosan microspheres on transport of the hydrophilic, antiinflammatory drug prednisolone sodium phosphate (PSP) across the epithelial barrier. METHODS: Microspheres were prepared using a precipitation method and loaded with PSP. Transport studies were performed in a diffusion cell chamber using the polarized human cell line HT-29B6. Porcine small intestine and fluorescence-labeled microspheres were used to investigate penetration ability of microspheres. RESULTS: It was shown that transport of PSP drug solution was not saturable across the cell monolayers (P = 8.68 +/- 8.24 x 10(-6) cm sec-1) and no sodium dependency could be established. EGTA treatment resulted in an increased permeability (P = 18.69 +/- 1.09 x 10(-6) cm sec-1). After binding of prednisolone to chitosan microspheres its permeability was enhanced drastically compared with the drug solution (P = 35.37 +/- 3.21 x 10(-6) cm sec-1). This effect was prevented by EGTA treatment (P = 15.11 +/- 2.57 x 10(-6) cm sec-1). Furthermore the supporting effect of chitosan microspheres was impaired by pH and ion composition of the medium, whereas the effect remained unchanged in cells treated with bacterial lipopolysaccharides. In vitro incubation of fluorescence-labeled microspheres in the lumen of freshly excised intestine revealed a significant amount of the spheres in the submucosa. CONCLUSIONS: Chitosan microspheres are a useful tool to improve the uptake of hydrophilic substances like PSP across epithelial layers. The effect is dependent on the integrity of the intercellular cell contact zones and the microparticles are able to pass the epithelial layer. Their potential benefit under inflammatory conditions like in inflammatory bowel disease, in order to establish high drug doses at the region of interest, remains to be shown.

Animals↗
PubMed2004

Cellular uptake but low permeation of human calcitonin-derived cell penetrating peptides and Tat(47-57) through well-differentiated epithelial models.

PURPOSE: To investigate whether cell penetrating peptides (CPP) derived from human calcitonin (hCT) possess, in addition to cellular uptake, the capacity to deliver their cargo through epithelial barriers. METHODS: Cellular uptake of hCT(9-32) and permeation of six hCT-derived peptides, namely, hCT(9-32), hCT(12-32), hCT(15-32), hCT(18-32), hCT(21-32), and a random sequence of hCT(9-32) were evaluated in fully organized confluent Madin-Darby canine kidney (MDCK), Calu-3, and TR146 cell culture models. For comparison, Tat(47-57) and penetratin(43-58) were investigated. The peptides were N-terminally labeled with carboxyfluorescein (CF). Uptake in the well-differentiated epithelial models was observed by confocal laser scanning microscopy (CLSM), whereas permeation through the models was analyzed by reversed-phase (RP)-HPLC. RESULTS: In MDCK epithelium hCT(9-32), Tat(47-57) and penetratin(43-58) demonstrated punctuated cytoplasmic distribution. In Calu-3, Tat(47-57) and penetratin(43-58) were simultaneously localized in a punctuated cytoplasmic and paracellular distribution, whereas hCT(9-32) showed strict paracellular distribution. By contrast, in TR146 cells, Tat(47-57) was located strictly paracellularily, whereas penetratin(43-58) showed a punctuated cytoplasmic pattern and hCT(9-32) both. The transepithelial permeability of all tested peptides and their cargo was lower than that of paracellular markers. CONCLUSIONS: The CPP uptake pattern depends on both the type of peptide and the cell culture model. In general, the investigated CPP have no apparent potential for systemic drug delivery across epithelia. Nevertheless, distinct patterns of cellular distribution may offer a potential for localized epithelial delivery.

Animals↗
PubMed2001

[Hormonal contraception for adolescents].

The new hormonal contraceptives are safe, effective and with fewer side effects than the older formulations. Their incidence of serious complications is low, particularly as compared to the health risk related to pregnancy. Adolescents must be screened for contra-indications before giving them a hormonal contraceptive. Because pills do not prevent sexually transmitted diseases, teenagers should be counselled to use a barrier methods together with COCs. Young girls need frequent follow-up and close monitoring to minimise side effects and to increase compliance and continuation in use. Long-term contraception by implants represents a valid alternative option with an increasing popularity among adolescents.

Adolescent↗