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PubMed2005

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↗
PubMed1997

Sterilization in Finland: from eugenics to contraception.

The purpose of this paper was to describe the transition of sterilization in Finland from an eugenic tool to a contraceptive. Historical data were drawn from earlier reports in Finnish. Numbers of and reasons for sterilizations since 1950 were collected from nationwide sterilization statistics. Prevalence, characteristics of sterilized women, and women's satisfaction with sterilizations were studied from a 1994 nationwide survey (74% response rate). Logistic regression was used for adjustments. In the first half of the 20th century, eugenic ideology had influence in Finland as in other parts of Europe, and the 1935 and 1950 sterilization laws had an eugenic spirit. Regardless of this, the numbers of eugenic sterilizations remained low, and in practice, family planning was the main reason for sterilization. Nonetheless, prior to 1970 not all sterilizations were freely chosen, because sterilizations were sometimes used as a precondition for abortion. Female sterilizations showed remarkable fluctuation over time. Male sterilizations have been rare. The reasons stipulated by the law did not explain the numbers of sterilizations. In a 1994 survey, 9% of Finnish women reported they were using sterilization as their current contraceptive method (n = 189). Compared to women using other contraceptive methods, sterilized women were older, had had more births and pregnancies, and came from lower social classes. Sterilized women were satisfied with their sterilization, but there were women (8.5%) who regretted it. In conclusion, sterilizations have been and are likely to continue to be an important family planning method in Finland. The extreme gender ratio suggests a need for promoting male sterilizations, and women's expressed regrets suggest consideration of a higher age limit.

Adolescent↗
PubMed2005

Scoring men: vasectomies and the totemic illusion of male sexuality in Oaxaca.

This paper discusses research on men's reproductive health and sexuality in Oaxaca, Mexico, and specifically why some men there choose to be sterilized. Men who opt for vasectomies do so after considering numerous cultural, historical, physiological, commercial, and other concerns. Men and women in Oaxaca negotiate certain cultural folk beliefs about supposed male sexual desires and practices before arriving at the decision to get the operation. Vasectomy as a method of birth control is chosen despite folk beliefs that take the form of a totemic illusion which treats male sexuality as naturalized, something fixed, and as entirely distinct from female sexuality. Among its many consequences, this totemic illusion serves to conceal inequalities in the sphere of reproductive health and sexuality in relation to contraception.

Adolescent↗
PubMedDate not supplied

[A structural approach to the evaluation of the quality of contraception services].

The quality assessment of the contraceptive service in Belgrade in 1983 was conducted by a structural approach (investigation of the knowledge and attitudes of service providers and the availability of contraceptives). The summaries of the cited publications were used as the standard of knowledge and attitudes. A sample of 42 gynaecologists (16.6% of the total Belgrade population of gynaecologists) was investigated using a mailed questionnaire. Compared with the chosen standard:--two fields of knowledge about combined oral contraceptives (OC) appeared unknown to about 70% of the sample (OC protective effects and effects of previous OC use on the outcome of subsequent pregnancy);--knowledge of IUD as a risk factor in pelvic inflammatory disease is lacking in 33.3% of the sample;--attitudes regarding other contraceptive methods are in accord in about 60% of the investigated sample. Besides, the unavailability of contraceptives is recorded. Methodological shortcomings and a possible positive result of the study are discussed.

Adult↗
PubMed1999

Safety and efficacy of fertility-regulating methods: a decade of research.

An international venture was launched in 1985 to fill a recognized gap in post-marketing surveillance of fertility-regulating methods. For this purpose a new task force was set up by the Special Programme of Research, Development, and Research Training in Human Reproduction, which is cosponsored by the United Nations Development Programme, the United Nations Population Fund, the World Bank, and WHO. Research priorities were chosen and epidemiological studies inaugurated, involving a total of 47 countries--mostly from the developing world. Important progress has been made, especially in helping to define the beneficial and possible adverse effects of oral contraceptives on the risk of neoplasia; in showing that the injectable contraceptive depot-medroxyprogesterone acetate protects against endometrial cancer and does not increase the overall risk of breast cancer, in clarifying which groups of women are susceptible to the rare cardiovascular complications of oral contraceptives (myocardial infarction, stroke, and venous thromboembolism); and in establishing the long-term effectiveness and safety of intrauterine devices. The research has already made a significant impact on family planning policies and practice. Critical appraisal of this venture, which has been modestly funded, confirms the value of mission-oriented research. It also illustrates the potential of collaboration that bridges the global divide between developing and developed countries.

Contraception↗
PubMed1994

Who uses Norplant. A study from Finland.

OBJECTIVE: Although Norplant implantable contraceptives were introduced first in Finland, their use has been infrequent. The objective of this study was to investigate what kind of women use Norplant in Finland, who suggested its use, and from what source women get their information on Norplant. METHODS: A questionnaire was mailed to all women having had Norplant inserted one to two years before the study initiation (June 1992) in seven family-planning clinics in the Helsinki city area (n = 262). After one reminder, the response rate was 82%. RESULTS: Most of the users were 25-34 years old, and many of them had had a previous abortion. Half of the women were still considering a (subsequent) child. All the women had used some birth control method before Norplant and reported several problems with it. Women reported that they themselves had chosen Norplant, but physicians and nursing staff in the family-planning clinic were their most important information sources. Most women considered that they had received sufficient information before insertion regarding both the good and bad aspects of the method. CONCLUSIONS: Women with previous abortions are a special users' group for Norplant, even though most users are in no way exceptional women.

Abortion, Induced↗
PubMed1985

Control definition in case-control studies of ectopic pregnancy.

In case-control studies of ectopic pregnancy, the optimal sampling frame for control selection is influenced heavily by the hypothesis being tested. The selection of women completing an intrauterine pregnancy, a common choice for a control group in studies to date, is appropriate only if the hypothesis does not relate to exposures that selectively prevent an intrauterine pregnancy (e.g., use of an intrauterine device (IUD) at the time of conception). Even for other exposures, the selection of such women can yield misleading results if the exposure is related to the likelihood of completion of the intrauterine pregnancy. On the other hand, the selection of nonpregnant women as controls, while permitting a valid evaluation of the risk associated with exposure such as the use of an IUD, can introduce a substantial degree of incomparability between cases and controls with regard to other contraceptive practices and their correlates. Whichever of the two sampling frames that is chosen, an appreciation of these potential biases can lead to ways of tailoring the selection of individual controls to minimize the magnitude of the bias.

Abortion, Induced↗
PubMed1983

Progesterone levels before and after laparoscopic tubal sterilization using endotherm coagulation.

Tubal sterilization can be performed by several surgical methods. It has often been reported that menstrual disorders appear after the operations, probably caused by hormonal disturbance. However, there is no published systematic study of the ovarian hormonal status after sterilization. In the present prospective study therefore, the plasma progesterone level has been determined during one menstrual cycle before and one after endotherm tubal laparoscopic coagulation. Plasma progesterone was chosen as normal levels of this hormone during the luteal phase reflect ovulation and an adequate corpus luteum. The endotherm coagulation method does not appear to cause any progesterone malfunction in the ovary.

Adult↗
PubMed1979

Post-abortion attitudes and patterns of birth control.

Among 63 women questioned one year after a first trimester abortion at an outpatient clinic, over 75 percent had mature, well-considered reasons for having chosen abortion and felt secure in their decision. Their feelings and attitudes toward themselves and abortion were strongly positive, with a few expressions of unresolved guilt, regret, or depression. They had become more responsible about contraceptive use, more interested in planning future pregnancies, and had experienced little change in sexual habits. Although only 21 percent (13 women) had employed contraception when they became pregnant, 76 percent (48 women) were using effective methods of birth control one year after abortion. Furthermore, over one third felt they were better able to deal with problems and had learned more about their coping capacity as a result of the crisis.

Abortion, Legal↗
PubMed2005

Sexual activity, fertility and contraceptive use in middle-aged and older men: Men in Australia, Telephone Survey (MATeS).

BACKGROUND: With limited information regarding fertility and sexual activity in the older population, men's behaviour, attitudes and concerns were explored in a representative population of middle-aged and older men using the Men in Australia, Telephone Survey (MATeS). METHODS: A stratified random national sample of 5990 men participated in a standardized computer-assisted telephone interview. Equal numbers in the age strata 40-49, 50-59, 60-69 and >or=70 years were surveyed with findings census-standardized to the national population. Broad aspects of men's health and well-being, including reproductive health, were explored. RESULTS: The majority of men were sexually active in the last 12 months (age-standardized proportion, 78.3%) with approximately 37% of men aged >or=70 years still continuing sexual activity. Overall, 12.2% of men had never fathered children, of whom most (7.7%) had chosen not to have children. Questioning on failed attempts to produce a pregnancy suggested an involuntary infertility rate of 7.6%. The age-standardized vasectomy rate was 25.1%, with 5.6% of vasectomized men having no children. Although 9.2% of vasectomized men regretted sterilization, only 1.4% had undergone vasectomy reversal. CONCLUSIONS: Continuing sexual activity, fertility and contraception needs in middle-aged and older men suggests that education and service delivery must be more appropriately directed to an ageing population.

Adult↗
PubMed2003

Marie Stopes Society, Pakistan: 1000 cases of quinacrine sterilization (QS).

OBJECTIVES: To evaluate the safety, efficacy and acceptability of QS in Karachi, Pakistan. METHODS: 1000 women who had chosen sterilization during the 4-year period 1994 to 1997 inclusive were offered QS at both stationary clinics and in a mobile van at 23 sites in the outskirts of Karachi. The protocol involved transcervical insertion to the uterine fundus of 252 mg quinacrine in 7 pellets and 55 mg of ibuprofen in 3 pellets through an IUD inserter, during the proliferative phase of the menstrual cycle. Two doses were administered one month apart. A temporary method of contraception was provided for 3 cycles, usually DMPA. Follow-up was scheduled: monthly for 3 months, quarterly for 1 year and then every 6 months for 4 years. RESULTS: The crude pregnancy rate after 4 years was 2.0%. Minor complications and complaints were reported by 59% of the patients. There was one ectopic pregnancy and no major complications. CONCLUSIONS: QS was found to be safe and effective and has become the most popular method of sterilization in our area of Pakistan.

Ambulatory Care Facilities↗
PubMed2000

Influence of smoking and hypertension on left ventricular mass.

OBJECTIVE: The present study was designed to observe the influence of smoking and hypertension on left ventricular mass (LVM), both individual and the combined effect. METHODS: This study was conducted in the Department of Medicine, SMS Medical College Hospital, Jaipur. Hundred patients were included in the study. They were divided into four groups--non smoker normotensives, non-smoker hypertensives, smoker normotensives and smoker hypertensives. They were also divided into smokers and nonsmokers and hypertensives and normotensive. Patients of age group 31-65 years of both sexes were chosen. Patients with secondary hypertension, diabetes mellitus, dyslipidemia, cardiomyopathies, valvular heart disease women on oral contraceptives were excluded from the study on the basis of history and relevant laboratory tests. An M-mode echocardiography was done and the LV mass was calculated by the formula proposed by Devereux et al. LV mass = 0.8 [1.04 (IVSd + LVIDd + LVPWd)3 - (LVIDd)3] + 0.6 gms RESULTS: The mean LV mass (in gms) in the four groups of nonsmoker normotensives, nonsmoker hypertensives, smoker normotensives and smoker hypertensives are 106.77 +/- 25.78, 165.3 +/- 42.55, 154.53 +/- 24.6 and 228.78 +/- 56.88 respectively. The comparison of mean LV mass (in gms) of smokers and nonsmokers were 191.66 +/- 40.74 and 136.04 +/- 36.16 (P < 0.001) respectively. The comparison of the mean LV mass (in gms) of hypertensives and nonhypertensives were 197.25 +/- 49.72 and 126.29 +/- 25.19 (P < 0.001) respectively. Comparison of the mean LV mass (in gms) of patient with two risk factors i.e., smokers hypertensives with patients without any risk factor i.e., nonsmoker normotensive were 228.78 +/- 56.88 and 106.77 +/- 25.78 (P < 0.001) respectively. While comparison of the mean LV mass (in gms) of patients with one risk factor each i.e., smoker normotensives and nonsmoker hypertensives were 165.3 +/- 42.55 and 154.53 +/- 24.6 (P < 0.05) respectively. CONCLUSION: Both smoking and hypertension cause an increase in LV mass, hypertension causing a more increase, than smoking, individually. Both smoking and hypertension combine together to increase the LV mass, more than either of them individually. Smoking by itself can cause an increase in LV mass independent of hypertension.

Adult↗
PubMed1990

Modern oral contraceptives and dysmenorrhoea.

Women with primary dysmenorrhoea not sufficiently helped by triphasic oral contraceptives (OCs) were offered a modern, low-dose monophasic OC containing 30 micrograms of ethinylestradiol and 150 micrograms of desogestrel. The study shows that for these women, the monophasic pill was the better alternative. The fact that 19 of 23 women who continue treatment on the monophasic OC indicates that this type of pill may be chosen as the first alternative for women with primary dysmenorrhoea.

Adolescent↗
PubMed2005

Increasing male involvement in family planning decision making: trial of a social-cognitive intervention in rural Vietnam.

We tested a social-cognitive intervention to influence contraceptive practices among men living in rural communes in Vietnam. It was predicted that participants who received a stage-targeted program based on the Transtheoretical Model (TTM) would report positive movement in their stage of motivational readiness for their wife to use an intrauterine device (IUD) compared to those in a control condition. A quasi-experimental design was used, where the primary unit for allocation was villages. Villages were allocated randomly to a control condition or to two rounds of intervention with stage-targeted letters and interpersonal counseling. There were 651 eligible married men in the 12 villages chosen. A significant positive movement in men's stage of readiness for IUD use by their wife occurred in the intervention group, with a decrease in the proportions in the precontemplation stage from 28.6 to 20.2% and an increase in action/maintenance from 59.8 to 74.4% (P < 0.05). There were no significant changes in the control group. Compared to the control group, the intervention group showed higher pros, lower cons and higher self-efficacy for IUD use by their wife as a contraceptive method (P < 0.05). Interventions based on social-cognitive theory can increase men's involvement in IUD use in rural Vietnam and should assist in reducing future rates of unwanted pregnancy.

Adult↗
PubMed1979

[Complications and psychosomatic problems after tubal sterilization].

From 1969 to 1974, 2080 patients were sterilized, 1702 by the pelviscopic method (electrocoagulation), 375 by laparotomy, and 3 vaginally. About two thirds of the sterilisations by laparotomy were carried out after delivery or during other surgical procedures. 15% of all women were sterilized for medical reasons; the other cases had to be 35 years of age or at least 30 if they had more than 3 children. The overall complication rate was 5% with both methods. Complications during pelviscopy included hemorrhage, bowel injury and burns. Postoperative complications after laparotomy were hemorrhage, thrombosis and wound dehiscence. Only half of the patients could be followed up; there were 4 pregnancies among 1308 women. In more than 50% the sexual relations had improved, in only 3% they had worsened. About 97% of the pelviscopically sterilized patients were satisfied with surgical method chosen and with their present status. It is recommended to allow sufficient time to think the decision over prior to the operation.

Adult↗
PubMed1982

Nutritional status of women attending family planning clinics.

A study was carried out to define nutritional problems of women attending family planning clinics (FPCs). Methods of nutritional assessment were chosen to examine relationships between diet and biochemical measures of folacin, riboflavin, and vitamin A status. Findings showed that in the sample of 219 FPC women, 30 percent were obese, 75 percent were low or deficient in plasma folacin, 58 percent were low or deficient in erythrocyte folacin, and 39 percent were low or deficient in riboflavin status (by erythrocyte glutathione reductase assay). Monotonous diets, low plasma folacin, and obesity were characteristic of less well-educated women. Women on contraceptive steroids had slightly lower red blood cell folacin. Riboflavin status was not related to intake of contraceptive steroids but was related to ethnicity.

Adolescent↗
PubMed1998

Concerns and cautions about prescribing and deregulating emergency contraception: a qualitative study of GPs using telephone interviews.

OBJECTIVES: We aimed to describe GPs' responses to a clinical scenario of a request for a repeat prescription for hormonal emergency contraception (EC), their views about over-the-counter availability and beliefs about absolute contraindications. DESIGN: We conducted semi-structured tape-recorded telephone interviews with 76 GPs randomly selected from the medical registers of three health authorities which were chosen for high, medium and low prescribing rates for EC. RESULTS: There was a wide variation in the number of times that GPs would be happy to prescribe EC to the same woman in a year. The content of the consultations appeared patchy. While 59 (77.6%) of the GPs said that they would discuss future contraception with the woman, only 16 (21.1%) said they would talk about possible side effects and 28 (36.3%) would discuss the timing of the next menstrual period and the possibility of method failure. Fifty-two of the practices had a family-planning-trained practice nurse, yet only four (7.7%) had arrangements whereby the nurse could provide EC. Unqualified enthusiasm for deregulation was rare. Concerns included that women would lose out on the benefits of the consultation; worries about the safety of the method; that some women might 'abuse' it by using it frequently; and that certain characteristics of the pharmacy might make it an unsuitable setting for provision of EC. CONCLUSIONS: This qualitative telephone survey revealed concerns about repeated use of EC and caution about the prospects of deregulation. Respondents were worried that pharmacists might not be able to address all of the features of the consultation that may be valued, yet in this sample nor do most GPs. Family-planning-trained practice nurses are an under-utilized resource and could act as a halfway house between provision by GPs and deregulation.

Adult↗
PubMed2003

Mifepristone: a novel estrogen-free daily contraceptive pill.

When the first synthetic progesterone antagonist (mifepristone) was synthesized over 20 years ago, it was clear that it had a potential as an antifertility agent. Research into the use of antiprogestogens for contraception have concentrated on three general approaches: (1) inhibition of ovulation, (2) inhibition of implantation and (3) disruption of implantation or "menstrual induction". The effect of mifepristone on the ovarian and endometrial cycle depends on dose, timing and frequency of administration. Doses of 10 mg per day or more suppress follicular development and estradiol levels. Ovulatory cycles are maintained in the dose of less than 2 mg although there is increased variability in cycle length. The endometrium shows some minor asynchronous changes, although these are not sufficient to prevent pregnancy. We have chosen to investigate daily doses between 2 and 5 mg which inhibit ovulation and menstruation in over 90% of cycles while still maintaining follicular development and levels of estradiol within the range found during the follicular phase. The endometrium shows proliferative or cystic changes lined by a layer of inactive glandular epithelium set in densely packed stroma. There is, however, an absence of proliferative activity as reflected by a reduced mitotic index and Ki67 staining. These unusual histological appearances are associated with downregulation of PR but a massive upregulation of AR in particularly glandular epithelium. The antiproliferative effect of mifepristone is reassuring suggesting that the risk of atypical hyperplasia due to the effect of prolonged exposure to estrogen unopposed by progesterone is low. In a pilot study, there were no pregnancies in 200 months of exposure in 50 women who used this method as their sole method of contraception. Daily mifepristone could provide a novel contraceptive method which should be devoid of the risks associated with estrogen containing combined oral contraceptive (COC), e.g. venous thromboembolism. The health benefits of avoiding the morbidity associated with menstruation are considerable. Recent surveys suggest that amenorrhoea would be popular with many women.

Cell Division↗