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Choice of female-controlled barrier methods among young women and their male sexual partners.

CONTEXT: Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners. METHODS: Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey RESULTS: Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively). CONCLUSIONS: Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.

Adolescent↗

[Health status in the population using contraceptives].

In order to partially understand the health status of women under contraceptive therapy and their possible social hazard of it, a descriptive, prospective and transversal study was undertaken in a 500 individuals, ages 20-35 years old, who currently were regulation their fertility. Data were obtained by means of predetermined questions from subjects attending several clinics of the IMSS. Anyone refusing to participate was discharged questions. The analysis excluded 8/500 due to incomplete responses. In 334/492, hormonal practice was in use; the IUD met 36.6% and the minor groups of 4.4 and 2.8% the method chosen was surgical or natural respectively. The IUD had been used over three years in 60/187, while in 39/145 were on the pill the same period of time; only 23/100 preferred the injectables. No previous medical advice was carried out in order to prescribe the contraceptive and furthermore in 461/492 no laboratory clinical tests were required before. In only 22% of the population the Pap-smear had been taken two years before and in 89/492 was never considered. The contraceptive strategies was induce risks in the future with no solid etiology if a prescription is decided, before the health status is evaluated. It looks like that present report is the first description associating health and risks in a non-selected population under contraceptive methodology.

Adult↗

[Applications of a simple system of aid to medical decision-making with various patients in internal medicine: SELF].

Many medical decision helping systems are very complex and require expensive computers, which restricts their diffusion and limits their use to specialized people. The idea was to find a simplified system that any practitioner--even unaccustomed to microcomputing--would be able to use. Moreover, this system had to work on widely available and inexpensive microcomputers. SELF (system in fuzzy set) is this kind of system. It has been devised as a complete interactive system of medical decision help. It is entirely parameterized, allows any kind of application and works according to such rules as "if there is premise, then there is conclusion", tempered by a coefficient. The bases of knowledge are represented on a correspondence chart where columns materialize the premises (clinical signs, laboratory results, etc.) and horizontal lines all the diagnoses and therapeutic conclusions. The system includes proceedings that create, modify and update basic knowledge. It uses the fuzzy set rules to draw conclusions. SELF was first applied to the prescription of contraceptive methods, but it has now been tested in other specialties, such as gynaecology, pneumology, haematology and so forth. In every case, the reliability of the results obtained depends on the bases chosen by the creator himself. Owing to the general character of the system, one may regard it as being open to any user who would like to create his own applications.

Decision Making, Computer-Assisted↗

Swedish students' attitudes toward abortion.

The Swedish abortion legislation of 1975 gave women the right to make a decision about abortion before the end of the 18th week of pregnancy. The number of abortions is rising in Sweden as a chosen method of birth control. The attitudes of students toward abortion were studied in 1986-1987. A questionnaire containing items on how sex education is taught, the anatomy and physiology of reproduction, contraceptives, sexually transmitted diseases, and legal abortion was answered by 421 high school students. Results pertaining to the students' attitudes toward abortion are reported. Two thirds of the students believed that the decision about an abortion should be made by the man and woman together. Nearly all respondents believed that abortion should not be considered a method of birth control. These results may be considered a guide for interventions to prevent the need for abortion. One fourth of all pregnancies in Sweden terminate in abortion. The students in the present study thought of abortion as a solution. Authors studying samples with different cultural backgrounds have reported similar attitudes.

Abortion, Legal↗

An appraisal of strategies to reduce the incidence of breast cancer.

The current focus of breast cancer research is to develop a novel strategy to prevent the disease. In this review a potential model of breast cancer development is proposed based upon the results of laboratory models of the induction of mammary carcinogenesis. It is clear that susceptibility to initiation occurs in young female animals, and a preventive strategy is more effective the sooner it is started after initiation occurs. In humans we do not know the timing or the nature of the carcinogenic insult, but epidemiologic studies suggest that the process is long and initiation is most likely to occur in young adults. Hormones are the key to promotion of the carcinogenic process and it would appear that strategically the earlier an intervention is applied after initiation the better will be the general effect on the population. Hormonal contraception could prevent breast cancer if the appropriate formulation was chosen and used by all young women. This inhibitory strategy might protect women without the need to preselect based on risk factors. Breast cancer prevention would be a side effect of the contraceptive method. Alternatively, tamoxifen, an antiestrogen, is known to prevent mammary carcinogenesis in animals and prevent the appearance of second primary breast cancers in women. This well tested therapeutic agent is currently being evaluated in clinical trials of selected high-risk women aged 35 and above. Finally, retinoids have shown promise as agents in the laboratory to prevent cell replication and inhibit mammary tumorigenesis. A trial of retinoids to prevent second primary tumors in node negative breast cancer patients is currently underway in Italy. The review discusses the relative merits and concerns about these prevention strategies and proposes additional studies to be undertaken.

Adult↗

Identification of beta subunit of the rhesus monkey chorionic gonadotropin (rmCG).

Chorionic gonadotropin (CG) is a placental derived hormone that plays a crucial role in successful implantation and establishment of early pregnancy in the primates. The rhesus monkey was chosen as a model to understand the feasibility of developing human DNA immuno-contraceptive. The coding region of rhesus monkey CG beta-subunit (rmCGbeta) was isolated by the TDRT-PCR method. The nucleotide sequence including the leader peptide was 499 nucleotide long and encoded 166 amino acids. In comparing with the previous known primates CG beta-subunits, the rmCGbeta was the highest degree of homology with baboon CG beta-subunit at the deduced amino acid sequence (94%), 79.5% homology with human CG beta-subunit and 70.4% homology with marmoset monkey CG beta-subunit. The eukaryotic expression vector pCMV4-rmCGbeta inserted full-coding cDNA sequence of rmCGbeta was constructed, and the expression of rmCG beta-subunit in HeLa cells transient expressing system in vitro and BALB/c mice in vivo was determined. The results demonstrated that the recombinant PCMV4-rmCGbeta eukaryotic expression vector could express rmCG beta-subunit in vitro and in vivo.

Amino Acid Sequence↗

Its perspective of adolescent reproductive health behaviour in a suburban town in Nigeria.

BACKGROUND: Parent/Adult Child communication has been shown to influence adolescent reproductive health behaviour Adults need to pass correct information across to youths to help them make proper decisions that will promote their health. The objective of this study was to assess the attitude of parents to adolescent reproductive health behaviour in a suburban Nigerian town. METHODS: This cross-sectional descriptive study was carried out in Ikenne, Ogun State. A Semi-structured questionnaire was used to gather information from 370 adults who were chosen by multi-staged sampling method. RESULT: About two-thirds of the adults surveyed (62.2%) were against premarital sex among adolescents. Although 46.8% said it was permissible for adolescents to use contraceptives, 87.1% will react negatively if they found contraceptives with their children. The condom was the most commonly approved contraceptive method for adolescents by 60.7% of those who approved of adolescents use of contraception, consisting of 14.6% of all the parents in the study. The major reasons against contraceptive use by adolescent were the promotion of promiscuity (41.5%) and infertility in the future (24.9%). Although gender difference was not statistically significant, the females expressed a more conservative attitude to adolescent sexuality and contraception than males; they were less likely to approve of sexual activity among young people (17.8% versus 23.6%) or contraceptive use by them (44.6% versus 49.2%). Eighty seven percent (87%) of those that had children/ward above 12 years had discussed sexuality issues with them. The major form of advice was sexual abstinence and the possibility of unplanned pregnancy. Only 8.5% had advised them about contraception. While 74.1% had approved of sex education in schools, only 31.9% approved of teaching about condom in schools. CONCLUSION: Adults are interested in the reproductive health of their children. Programmes that seek to involve parents in promoting the sexual health of youths will make significant progress if they specifically target parents (especially women) with information about the context of adolescent sexuality and address their misgivings.

Adolescent↗

Family planning in the Southeast Anatolian Project Region.

OBJECTIVES: The aim of this study was to evaluate contraceptive use by women of reproductive age in the Southeast Anatolian Project Region and the promotion of the use of family planning services. METHODS: An optimum sample size to represent the rural and urban area of the region was determined and the sample was chosen by sampling method proportional to the size. A total of 1126 houses were visited and questions about reproductive health were asked of 1019 ever-married (currently married, widows and divorced) women. RESULTS: The study showed that 48.2% of the ever-married women of reproductive age had never used any method of family planning; 37.4% were currently using a family planning method, and 14.4% had used a family planning method in the past. Of the women who were currently using a family planning method, 73.1% were using an effective method. The result of the logistic regression analysis showed that educational level, knowledge of Turkish, type of residence, and total number of living children were the main variables that affected the use of family planning methods. CONCLUSIONS: Use of family planning methods in the region was not at the expected level. In order to decrease the barriers to family planning in developing countries, we must provide obtainable, acceptable, integrated health services.

Adolescent↗

Evaluation of a new generation of oral contraceptives. The Advisory Board for the New Progestins.

OBJECTIVE: To assess the differences and similarities in efficacy, safety, and metabolic effects of oral contraceptives (OCs) containing the new progestins desogestrel, gestodene, and norgestimate. All formulations reviewed contained no more than 35 micrograms ethinyl estradiol. DATA SOURCES: Data were reported from approximately 100 published reports, dating from 1980, of comparative and noncomparative clinical studies on phasic and fixed-dose preparations culled from computer searches of several sources, including MEDLINE and Excerpta Medica. METHODS OF STUDY SELECTION: An attempt was made to select the most meaningful studies in terms of length, size, methodology, and quality of description. All clinical studies were considered; in general, review articles were not. Some preclinical studies were also included. No abstracts were used. DATA EXTRACTION AND SYNTHESIS: The indices chosen for examination were contraceptive efficacy, cycle control, coagulation, carbohydrate and lipid metabolism, and androgenicity. CONCLUSIONS: The new formulations were found to be comparable in efficacy to each other and to established agents. They also appeared to be less androgenic than current OCs and to have less impact on carbohydrate and lipoprotein metabolism. Cycle control was similar to that of older products. Changes in coagulation-promoting and antithrombotic factors were minor. Clinical relevance of the results could not be determined because of small sample size and methodologic differences between studies.

Androgens↗

Intrinsic estrogenicity of some progestagenic drugs.

The intrinsic estrogenic activity of some progestins cannot be properly evaluated by using hormone responsive systems when the chosen end-points are also sensitive to progestagenic activity, usually antagonistic of estrogenic actions. We have therefore applied to the evaluation of some drugs commonly used in contraceptive and hormone replacement formulations a recently developed in vitro method to estimate estrogenic activities, which is based on measurements of the estrogen-stimulated alkaline phosphatase activity in cells of the Ishikawa-Var I human endometrial adenocarcinoma line, a response not influenced by progestins. Whereas progesterone, medroxyprogesterone acetate and danazol were found to be devoid of estrogenic activity in this assay, Org OD-14, norethynodrel, gestrinone (R 2323), norethindrone and dl-norgestrel provoked half maximal increases in alkaline phosphatase activity at concentrations (EC-50) of 7, 14, 140, 200 and 2900 nM, respectively, under conditions in which the corresponding value for estradiol was 8 pM. This intrinsic estrogenic activity can be inhibited by antiestrogens, as verified by reversing the effect of R 2323 with 4-hydroxytamoxifen. Since prostaglandin F2 alpha output by secretory endometrium is increased by estrogens and diminished by progestins, this end-point can serve to evaluate the net effect of drugs with intrinsic estrogenic and progestagenic activities. For instance, R 2323 showed estrogenic activity in this assay whereas Org OD-14 did not. The same in vitro system can be used to evaluate estrogen antagonistic activities of test compounds, using estradiol as the agonist. These in vitro systems are useful in establishing a profile of activities of a drug on a relevant human target tissue, in the screening of synthetic or natural compounds under investigation, and in studies on structure/action relationships.

Adenocarcinoma↗

[Contraception during the perimenopause].

A PERIOD OF TRANSITION:The perimenopause is a key period in the life of an adult woman. It is characterised by the instability and unpredictability of ovulation and its onset, by an increase in estrogen-dependent diseases and by a reduction in the risk of pregnancy, which, when it occurs, is physically and mentally unacceptable. MANY POSSIBLE METHODS: The physician who must recommend a contraceptive method to a patient has a wide selection of methods, but is also confronted with many relative or absolute contraindications. Although estro-progestagen contraceptives at this stage in life are only contraindicated in smokers, low dose contraceptive pills would appear preferable. However, intra-uterine devices (IUD) are often chosen, of copper or containing levonorgestrel, depending on the particularities of menstruation. Vaginal contraception is more easily adopted by women during the perimenopause than in younger women, but eventual sexual problems in older partners should not be ignored. In France, because of its general anti-estrogenic properties and effects (mastodynia, premenstrual syndrome) a pure progestagen contraceptive is not officially indicated in the case of contraception alone. Conversely, the bioactive IUD is effective in women suffering from menorrhagia. FROM HORMONE CONTRACEPTIVES TO REPLACEMENT THERAPY: It is not always easy to know, in a woman using hormone contraceptives, the date of the menopause, at which time if she wants she can change to replacement therapy, but some recent modalities have permitted the relativized this aspect of the question.

Adult↗

Acceptability of levonorgestrel subdermal implants versus tubal ligation for long-term contraception in a rural population of Zimbabwe.

This prospective cohort study of 257 rural Zimbabwean women was designed to compare patient satisfaction with levonorgestrel subdermal implants (Norplant and reg;) versus tubal ligation (TL) as a method of long-term contraception. Women were equally satisfied with both methods. At 1 year, 96% of Norplant users and 97% of the TL group reported being "satisfied" or "very satisfied," and 98% of Norplant users, and 99% of the TL cohort would recommend their chosen method to a friend or relative. Rating scores at both 6 months and 1 year were high and equal, with women in each cohort rating their method, on average, as 9 out of 10. Norplant users were significantly more likely to rate birth spacing as a reason for satisfaction with their method, whereas women in the TL cohort were more likely to select multiparity. The 1-year continuation rate with Norplant was 90%, with 4% discontinuing in order to have more children. Selecting the most appropriate method depends primarily on the potential desire of the woman to have more children.

Adult↗

[Sexual initiation and use of condoms and other methods of contraception among 15-year-old adolescents in Poland and other countries].

OBJECTIVE PRESENTATION: (1) Frequency of sexual initiation and use of condoms and other methods of contraception among 15-year old adolescents in Poland and other countries in 2001/2002; (2) Trends of change in these sexual behaviours in Poland between 1990-2002. MATERIAL AND METHOD: Representative samples of adolescents in Poland (mean age 15.7 years) in 1990 (N=1548), 1994 (N=1540), 1998 (N=1638) and 2002 (N=2152) and in other 28 countries (mean age 15.2 - 16.1 years) in 2001/2002, were used. The surveys were carried out in the frame of Health Behaviour in School-Aged Children; a WHO Collaborative Cross-National Study (HBSC), according to an international research protocol. An international standard questionnaire (anonymous) was chosen as an instrument for data collection. It contained four questions concerning sexual behaviour. RESULTS: In Poland, 2002, 20.9% of boys and 9.2% of girls reported sexual intercourse with mean ages respectively 14.1 and 14.7 years. The frequency of sexual initiation was higher (in boys) and the mean age was lower among adolescents living in towns by comparison to those living in cities. More matured adolescents had earlier sexual initiations. 27% of sexually active adolescents reported that either they or their partners had used any methods of contraception during their last sexual encounter. This risk sexual behaviour was more frequent in than cities (respectively: in boys 30.2% and 23.9%; in girls 42.9% and 19.7%). The most common method used was a condom. Between 1990-1998, the percentage of adolescents having sex and using some methods of contraception during their encounter last sexual were observed. Between 1998-2002, frequency of sexual initiation decreased, whereas percentage of non-users increased. In comparison to other countries increased Poland's percentage of adolescents with early sexual initiation in 2001/2002 was low, but the percentage of non-users of contraceptives was the highest. CONCLUSIONS: At risk sexual behaviours are relatively common among 15-year-old adolescents, and more frequent among adolescents living in cities. In comparison to other countries, Polish adolescents the risk of unplanned pregnancies and sexually transmitted diseases is higher. Future monitoring of sexual behaviours is necessary for prevention (including school sexual education) of at risk behaviours.

Adolescent↗

Trying to prevent abortion.

It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.

Abortion, Illegal↗

Tubal sterilization or vasectomy: how do married couples make the choice?

OBJECTIVE: To examine the relative importance of husband, wife, and couple factors as determinants of sterilization method choice. DESIGN: Married couples seeking sterilization interviewed before surgery and again 1 year later. SETTING: Kaiser Permanente Medical Care Program subscribers seeking care at the Kaiser Foundation Hospital, Santa Clara, California. PARTICIPANTS: Two hundred married women seeking a tubal sterilization and their husbands and 200 married men seeking a vasectomy and their wives. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sterilization method chosen. RESULTS: In a logistic regression model, nine predictor variables correctly classified 94.9% of 395 couples (P less than 0.000). CONCLUSIONS: The choice of a sterilization method is achieved primarily through processes that involve both spouses. The motivations of both husband and wife, their mutual influence and communication, their present pattern of contraceptive use, and what they know about the satisfactions or dissatisfactions of other people who have had sterilizations are all factors that should be taken into account when the clinician helps a patient make the method-choice decision.

Choice Behavior↗

Myocardial infarction in users of low-dose oral contraceptives.

OBJECTIVE: To determine the relationship between the use of low-dose (less than 50 micrograms estrogen) oral contraceptives (OC) and myocardial infarction. METHODS: In this population-based case-control study, all incident myocardial infarctions in women, ages 15-44 years who were members of the Kaiser Permanente Medical Care Program, Northern and Southern California regions were ascertained during a 39-month period from 1991 through 1994. For each woman with myocardial infarction, up to three age- and facility-matched controls were chosen at random from female members. Information about OC use (predominantly low-dose preparations) was obtained in face-to-face interviews. RESULTS: There were 187 incident cases of myocardial infarction during 3.6 million woman-years of observation (incidence rate, 5.2 per 100,000 woman-years). The prevalence of several risk factors for myocardial infarction was lower in controls who were current users of OCs than in controls who were noncurrent (past and never) users. The odds ratio for myocardial infarction in current OC users compared with noncurrent users was 1.65 (95% confidence interval 0.45, 6.06) after adjustment for major risk factors and for race and ethnicity, corresponding to an excess risk of less than one case per 100,000 woman-years. The study had 80% power to detect a relative risk of 2.3 (one-sided test, alpha = .05). The odds ratio of myocardial infarction in past OC users was not elevated. CONCLUSION: With respect to myocardial infarction, low-dose oral contraceptives can be used safely by women who lack risk factors for coronary heart disease.

Adolescent↗

Oral contraceptives. The benefits and the cardiovascular risks.

For healthy women under 25 years of age, the benefits of oral contraceptive (OC) use far outweigh the risks. Because the agents protect against such life-threatening conditions as ovarian and endometrial cancer, pelvic inflammatory disease, and ectopic pregnancy, the number of deaths they prevent is larger than the number they cause. For nonsmokers up to age 40, OCs may offer more benefits than other available fertility-control methods, although for smokers 35 years of age or older, the risks of OC use outweigh the benefits. When risk factors for cardiovascular disease are taken into account in selecting OC users and when an appropriate agent is chosen, the likelihood of a cardiovascular accident is greatly reduced. The formulations containing low-dose estrogen and low-dose, low-potency progestins appear to be safest, as they have fewer adverse effects on serum lipids and lipoproteins.

Adolescent↗

Illness understanding in adults with congenital heart disease.

BACKGROUND: Adult patients with congenital heart disease need information regarding their clinical diagnosis, medications and side effects, endocarditis prophylaxis, reproductive issues, employment, future surveillance, treatments, and possible reoperations. Accurate understanding of chronic illness in these patients is associated with less distress, less confusion, improved satisfaction with medical care, better compliance with treatment, and a better emotional status, all key factors for good health-related quality of life. The aim of the present study was to assess the level of knowledge that adult patients with congenital heart disease followed in our Center have about their heart condition. METHODS: A questionnaire on knowledge about congenital heart disease was sent by mail to 200 adults affected by a cardiac congenital disease chosen randomly from all patients regularly followed in our department. RESULTS: Patients had good knowledge about the treatment received, the importance of follow-up, the prognosis of their condition, and the possibility of taking part in physical activities. The patients receiving drug treatment were moderately knowledgeable about their treatment. The anatomy of the heart defect, factors contributing to the onset of endocarditis, the impact of smoking and alcohol, and the possible inheritance of the heart condition were poorly understood by the patients. Most of female patients knew that the oral contraceptive pill was the most appropriate method of birth control; most of them were aware that pregnancy would cause additional risks to their health. Multiple logistic analysis showed that four correct answers were related to the age of the patient. CONCLUSIONS: Overall the results indicated that the educational efforts of all the staff (physicians and nurses) have given encouraging results, but there are still significant gaps in knowledge that need more educational work.

Adult↗