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Penetration of some O-and/or N-methylated norepinephrine derivatives through the rat blood brain barrier.

Methods for the determination of a number of O and/or N-methylated derivatives of norepinephrine were developed. The IP injection of these compounds into rats shows quick absorption and short half-lives in plasma, liver and brain. Most compounds do not cross the Blood-Brain-Barrier (BBB) due to low lipid solubility. However, lipid solubility is not a sole determinant. Compounds which have at least one of the 2 phenolic hydroxyl groups methylated and possess a tertiary amino group do cross the BBB readily.

Animals↗

Pelvic inflammatory disease: the influence of contraceptive, sexual, and social life events.

In order to determine associations between pelvic inflammatory disease (PID) and contraceptive, sexual, and social life events, 620 Danish women aged 15-54 were invited to participate in an in-depth interview. Of 585 participating women, 459 were consecutive gynecological in- or outpatients, and 126 were randomly selected from visitors in general practice. Data were analyzed by multivariate test statistics. The mean number of PIDs thereby retrospectively assessed was 1.0. Two-thirds had never had PID, one third had had on average 3 PIDs. The sexual parameter which had the highest predictive value for later PID was the coital debut. Women with coital debut before the 16th year had double the number of PIDs, as women with sexual debut at age 18 or later. Likewise, the mean coital frequency was positively correlated to the number of PIDs. The number of sexual partners, on the other hand, was merely a risk-indicator without a direct influence on PID. Women who used barrier methods (condom and/or diaphragm) for 2 years or more had 23% fewer PIDs than women who had used barrier methods for less than two years. The small number of PIDs among women at high socioeconomic levels could be explained alone by a later coital debut and longer use of barrier methods than that among women at low socioeconomic levels.

Adolescent↗

Barrier versus oral contraceptive use: a study of female college students.

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.

Adolescent↗

Women's knowledge of emergency contraception.

BACKGROUND: More widespread use of emergency contraception could help to reduce the number of unwanted pregnancies. AIM: The objective of this study was to assess women's knowledge of emergency contraception. METHOD: A questionnaire was distributed to 1290 women aged between 16 and 50 years attending 14 general practice surgeries in London over a two-week period in 1990. RESULTS: The response rate was 70%. Over three quarters of the women had heard of emergency contraception; these were mainly women who used contraception, who had higher educational qualifications or who were not Muslim. Women who were the most likely to need and to use emergency contraception--those using barrier methods--had no more accurate knowledge than women using any other method of contraception. Only 53% of barrier method users knew emergency contraception could be used as a backup when other methods failed. Only one fifth of women had heard about this method from their general practitioner or any other health professional, while half had obtained their information from the media. CONCLUSION: These results suggest that including information on emergency contraception in consultations with users of barrier methods of contraception is a small step which general practitioners and practice nurses could take to increase the use of emergency contraception.

Adolescent↗

Oral contraceptives and postmolar trophoblastic disease.

One hundred patients, managed for molar pregnancy at the New England Trophoblastic Disease Center, were selected at random to determine if the contraceptive method following molar evacuation influenced the incidence of postmolar trophoblastic disease. Following molar evacuation, 58 (58%) patients used oral contraceptives and 42 (42%) patients used barrier methods (foam, condom, and/or diaphragm). Postmolar trophoblastic disease developed in 11 (18.9%) patients using oral contraceptives and in 6 (14.3%) patients using barrier methods (P greater than .10). The mean human chorionic gonadotropin (hCG) regression time after molar evacuation was 7.0 weeks in patients using oral contraceptives and 7.2 weeks in patients using barrier methods. The 2 groups of patients were comparable in age, gravidity, molar histology, pretreatment hCG titers, and exposure to prophylactic chemotherapy. Oral contraceptives do not appear to increase the risk of postmolar trophoblastic tumors and therefore may be safely prescribed after molar evacuation during the entire interval of gonadotropin monitoring.

Adolescent↗

Chlamydia trachomatis and oral contraceptive use: a quantitative review.

OBJECTIVES: Chlamydia trachomatis is now recognised as a major sexually transmitted disease; oral contraceptive use is rapidly increasing particularly in developing countries. There are thus important public health implications of the many reports that isolation of C trachomatis is more frequent among users of oral contraceptives. The aim of this analysis was to assess the strength and consistency of this association by summarising published studies between 1972 and 1990. DESIGN: Studies identified were grouped according to whether they were prospective or case-control studies. Data were extracted and pooled estimates of the unadjusted odds ratios were made for all studies, as well as for sub-groups defined by an index of study quality, background prevalence of C trachomatis, and the contraceptive comparison being made. LOCATION: Studies in the analysis were mainly conducted in Europe and North America; the meta-analysis was done at the Harvard School of Public Health, Boston, MA, USA. RESULTS: The pooled estimated unadjusted odds ratio for 29 case-control studies examined was 1.93 (95% CI, 1.77-2.11), indicating an almost twofold increased risk of chlamydial infection for oral contraceptive users. Neither study quality nor prevalence of C trachomatis modified this risk. When compared to the use of barrier contraceptives, however, the risk of infection for women using oral contraceptives increased to 2.91 (95% CI, 1.86-4.55). The pooled estimated protective effect of barrier methods in these studies was 0.34 (95% CI, 0.22-0.54). CONCLUSIONS: Cross-study comparisons of the relationship between oral contraceptive use and chlamydial infection are limited by the design and analysis of many component studies which did not control for confounding factors such as sexual behaviour and age. The almost twofold risk of increased chlamydial infection for oral contraceptive users, supported by the findings of two prospective studies, however, points to the importance of considering the risks and benefits of oral contraceptive use in women who are likely to be exposed to C trachomatis and other STDs. The protective effect of barrier methods emphasizes the continued need for promoting barrier methods of contraception.

Case-Control Studies↗

Oral progestogen-only contraception may protect against loss of bone mass in breast-feeding women.

BACKGROUND AND OBJECTIVES: A worldwide trend towards increasing life expectancy has meant that osteoporosis is emerging as an important public health problem. The loss of bone mineral density and its restoration in association with a premenopausal but physiological hypo-oestrogenic state may serve as an important model for research into the pathogenesis and prevention of osteoporosis. With this in mind we have undertaken a longitudinal study of changes in bone mineral density over one year in women after childbirth. DESIGN: Observational study of 31 women in the first year following childbirth; 11 intending to breast-feed and use barrier methods of contraception, 9 intending to breastfeed and to use the progestogen-only pill and 10 intending to artificially feed and to use barrier methods. PATIENTS: Recruitment was from the antenatal clinics of the Simpson Memorial Maternity Pavilion. Only non-smokers who had regular menstrual cycles prior to conception were included. MEASUREMENTS: Bone mineral density was measured at the lumbar spine within 3 weeks of childbirth and repeated at 6 and 12 months post partum. Plasma oestradiol, prolactin and osteocalcin concentrations were measured at each visit. RESULTS: Breast-feeding women using barrier methods lost a mean +/- SE of 4.9 +/- 1.5% of bone mineral density in the first 6 months following delivery. This was however reversible since by one year the bone mineral density was no different from that measured immediately post partum. Breast-feeding women using the progestogen-only pill lost a significantly smaller percentage of bone mineral density in 6 months and by one year bone mineral density was 2.95 +/- 0.75% higher than post partum. Artificially feeding women had a steady increase in bone mineral density in the first year and bone mineral density was on average 4.3 +/- 1.2% higher. CONCLUSION: Breast-feeding results in a reversible reduction in spinal bone mineral density. The small amounts of gestagen in the progesterone-only pill would appear to protect against this loss. The mechanism of this loss in bone mineral density and the potentially bone protective effects of gestagens require further study.

Adult↗

Determinants of cervical Chlamydia trachomatis infection in Italy. The Italian MEGIC Group.

OBJECTIVE: to analyse the prevalence of cervical chlamydia infection and its determinants in an Italian population of women attending outpatients services for contraceptive counselling or routine gynaecological examination. METHODS: between November 1989 and November 1990 we conducted a cross-sectional study on the prevalence of cervical Chlamydia trachomatis infection among women attending the outpatients service of seven university clinics in Northern (three centres), Central (three centres) and Southern (one centre) Italy. Eligible for the study were subjects with symptomatic low gynaecological tract infection (a total of 2071 women), a history of recurrent abortions (two or more miscarriages and no livebirth (416 subjects)), or sterility (371 subjects), plus a sample of asymptomatic women observed for contraceptive counselling or routine gynaecological examination identified on randomly selected days at the participating centres (1321 subjects). During the gynaecological consultation women were asked about their general characteristics, reproductive history, contraceptive and sexual habits, and history of sexually transmitted diseases (STD) using a standard questionnaire. An endocervical specimen was obtained with a plastic swab. The direct smear immunofluorescent antibody test (IFA test) was used to detect chlamydia antigens. RESULTS: out of the 2071 women with genital infection, 104 (5.0%) had cervical chlamydia infection; the corresponding percentages were 4.6 (19/416), 5.4 (20/371) and 3.9 (51/1321) respectively in women with recurrent abortions, sterility and in asymptomatic subjects. The risk of chlamydia infection was higher in women reporting a history of STD: in comparison with those without a history of STD, the relative risk of chlamydia infection was 1.4 (95% confidence interval, CI, 1.0-2.0). Among women reporting current use of a contraceptive method the risk of cervical chlamydia infection was lower in current users of barrier methods; in comparison with oral contraceptive users, the RR was 0.4 (95% CI, 0.2-0.8) in barrier methods users and 0.5 (95% CI, 0.2-1.1) in intrauterine device or other methods users. No consistent relationship emerged with age, reproductive history or number of sexual partners over the last 12 months. CONCLUSION: in this Italian population the frequency of cervical chlamydia infection appeared to be lower than in other selected groups from Northern European and American countries. Users of barrier contraception methods were at reduced risk of infection.

Abortion, Habitual↗

Long-term use of the female condom among couples at high risk of human immunodeficiency virus infection in Zambia.

BACKGROUND: Few studies have measured female condom use for more than a 6-month period or among persons at high risk of STD. OBJECTIVE: To measure long-term use of the female condom among couples at high risk of HIV infection and to evaluate the effect of female condom use on unprotected coital acts. STUDY DESIGN: Ninety-nine Zambian couples with symptomatic sexually transmitted diseases (STD) received female condoms, male condoms, and spermicides and were counseled to use either condom plus spermicide for each coital act. Couples were followed up at 3-, 6-, and 12-month visits. Barrier contraceptive use was measured prospectively by coital log. RESULTS: Among the 99 couples enrolled, 51, 38, and 30 couples were successfully followed up for 3, 6, and 12 months, respectively. Female condoms were reportedly used in 24%, 27%, and 23% of coital acts and by 86%, 79%, and 67% of the returning couples during each time interval. Higher-level female condom users used male condoms less often but had fewer unprotected coital acts (5% vs. 14%; p < 0.05) than lower-level female condom users. CONCLUSION: A majority of couples at high risk of HIV infection used the female condom in conjunction with other barrier methods over a 1-year period. The addition of female condoms accompanied by appropriate counseling to the barrier method mix may reduce unprotected sex among couples at high-risk of HIV infection.

Adult↗

Sexual behavior of natural family planning users in Germany and its changes over time.

For 10 years, a prospective study has been taking place in Germany to examine the use of natural family planning (NFP). As natural methods are behavioral methods, use-effectiveness, acceptability and continuation rates are very much influenced by patterns of sexual behavior. Therefore we performed an analysis of the sexual behavior of NFP users. Out of the data base of 1211 clients and 12,591 cycles we could identify a group of 300 women, all NFP beginners, with 5900 contraceptive cycles, who contributed at least 12 cycles with reliable recording of their sexual activity. Different groups were analyzed with methods of analysis of variance and regression models to find out significant differences in their sexual behavior with respect to sociodemographic structure and time of use. Nearly half of all the women systematically combine the fertility awareness part of NFP with other family planning methods. They use barriers in more than 60% of their cycles. The other half never or only in about 7% of their cycles use additional barrier methods. The latter show a clear decrease in barrier use in the course of time, whereas the frequent barrier users constantly combine the advantages of two family planning methods. Regarding the frequency of intercourse they are the sexually more active ones and show distinct sociodemographic characteristics. We could confirm the existence of three groups of NFP users, which differ significantly in their use of NFP as a family planning method. Despite these differences the low pregnancy rates indicate the conscious and risk-related sexual behavior of the group members.

Adult↗

Prevalence of gonorrhoea among women using various methods of contraception.

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

Adult↗

A study of the vaginal contraceptive sponge used with and without the fertility awareness method.

The actual effectiveness rates of natural and barrier methods of family planning are lower than the theoretical ones. If couples accurately defined the limits of the fertile phase and used barriers at that time, then actual effectiveness might increase. A randomized, controlled clinical trial was initiated to determine the effectiveness of the contraceptive sponge used only during the fertile time and to compare this with sponge use at every intercourse. Recruitment problems and discontinuation forced the early termination of this study, but qualitative information about compliance and acceptability was collected. Common sponge problems were reported as were misuses of the sponge, but problems and misuse were not related. Determination of the fertile phase was reportedly easy, but complaints of and discontinuation for inconvenience occurred. For unplanned pregnancies, contraceptive behaviors around the time of conception are presented.

Adolescent↗

Acceptability of female condom use among women exchanging street sex in New York City.

Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.

Adult↗

Collagen sponge as vaginal contraceptive barrier: critical summary of seven years of research.

Extensive testing of collagen sponge as a vaginal contraceptive (mechanical and chemical) showed that the original expectations regarding the safety, convenience, and efficacy were not met. The collagen sponge was tested both as a cylinder and as a diaphragm and used as such or impregnated with spermicidal detergent or with zinc salt. The collagen sponge must be larger than 6 cm in diameter in order to serve as a mechanical barrier that will not be dislodged during physical activity. This creates problems with the ease of insertion and with the partners' awareness of the barrier. When the collagen sponge containing ejaculate is left in the vagina greater than 48 hours, it develops an offensive odor. The original acidity of the collagen sponge (pH 3.5, 0.1 mol/L) is soon neutralized by the large volume of alkaline vaginal secretions. In vitro studies showed that up to 10 mg of nonoxynol 9 per milliliter of growth medium did not inhibit the growth of Staphylococcus aureus. These effects, as well as the large surface area of the resilient sponge, present a potential risk for growing staphylococci within the collagen sponge. The capacity of the collagen sponge to absorb a large volume of cervical and vaginal fluid produced two symptoms that were annoying to the volunteers: an awareness of either vaginal dryness during intercourse or, conversely, saturation of the sponge from the vagina. Postcoital studies showed viable spermatozoa in the cervical mucus in 25% of the tests with the nonmedicated cylindrical sponge but in only 6% of tests with the sponge containing nonoxynol 9. The results of clinical trials conducted at four centers support the view that collagen sponge as a vaginal contraceptive barrier method is inconvenient to both partners, not effective enough to compete with present methods of vaginal contraception, and possibly might be unsafe because of the capacity to grow bacteria. Despite the negative end result of this goal-oriented research, we believe that our studies have contributed to a better understanding of vaginal physiologic features, the safety and effectiveness of spermicidal detergents, and the mechanisms of vaginal malodor. Although the acceptability study showed some advantages of the collagen sponge over the rubber diaphragm, the overall acceptability of the collagen sponge diaphragm was no better than that of the rubber diaphragm. For all these reasons, including the possible risk of an increased incidence of toxic shock syndrome, we have discontinued further testing of either type of collagen sponge as a vaginal barrier method.

Collagen↗

Contraceptive practice and attitudes in Sweden 1994.

OBJECTIVE: To investigate current contraceptive practice in Sweden and Swedish women's attitudes towards various contraceptive methods. METHODS: In 1994, a random sample of Swedish women (n = 2330), aged 15-45 years (stratified according to age and geographic distribution), were invited by telephone to participate in the study. Women (n = 1788) who accepted the invitation to participate were sent a postal questionnaire. RESULTS: Completed questionnaires were returned by 1422 women (overall response rate: 61.0%). The sample was somewhat skewed towards higher educational level, but in other demographic respects no great deviations from the parent population were observed. The distribution of contraceptive methods in fertile, sexually active women who wished to avoid pregnancy was as follows: oral contraceptives (OCs) 33%, OC plus barrier method 5%, intrauterine device 21%, barrier methods 23%, sterilization 5% (female 3%; male 2%) and injectable steroids 2%. The overall pattern of contraceptive use in women aged 15-45 years had changed very little compared to results of a similar survey performed in 1987. However, the use of less effective methods (periodic abstinence, coitus interruptus and no method grouped together) was considerably lower among teenagers in 1994 (3%) than in 1987 (18%). The use of these traditional methods was still high in women aged over 35 years (15-17%). A large number of women considered medical methods of contraception to be reliable and easy to use but many were concerned about the safety for health of medical methods. CONCLUSIONS: Contraceptive practice changed towards more frequent use of medical, effective methods among young Swedish women, but not in the total female population. The latter was among others related to the relatively high use rates of less effective methods among women aged over 35. Women were concerned about the health safety of medical methods and relatively low percentages of women reported having received advice from health care professionals to use effective methods.

Adolescent↗

The cervical cap.

The Prentif cavity rim (PCR) cervical cap offers American women a barrier method alternative that is safe, effective, and convenient. Despite its many advantages and benefits, disadvantages have been documented. These include limited availability and side effects, such as cap dislodgement, partner discomfort, and bad odor of the cervical cap. However, many women decide the benefits and advantages associated with the PCR cervical cap outweigh the risks and possible side effects, making it an appealing alternative.

Adult↗

Preventing the heterosexual spread of AIDS: what is the best advice if compliance is taken into account?

It has been recently advocated that avoiding partners who may be at high risk of carrying HIV provides 5000-fold better protection against HIV infection than usage of condoms [1]. In this paper, it is demonstrated that this guideline is largely based on unrealistic assumptions. If the sensitivity of identifying high-risk partners, realistic estimates of the efficiency of mechanical and chemical barrier methods, and the compliance in following either strategy are taken into account, use of condoms and/or suppositories containing nonoxynol-9 might be more effective than the attempt to avoid high-risk partners. Thus, both barrier methods should be strongly recommended for casual sexual heterosexual contacts.

Acquired Immunodeficiency Syndrome↗

Fertility following discontinuation of different methods of fertility control.

The possibility of permanent sterility following use of modern contraceptive agents is a concept which causes great concern amongst members of the lay public. However, a thorough review of the literature gives a great deal of reassurance on this topic. The combined oral contraceptive pill causes slight delay, and the injectable contraceptives a moderate delay in the return of fertility following discontinuation, but there is no evidence of a greater likelihood of permanent infertility than in the normal population. The progestogen-only minipill should be risk-free, but final data are lacking. Epidemiological studies do not indicate an increased risk of infertility following IUD use, but it seems likely that there must be a very small number of IUD users who develop permanent infective damage to the Fallopian tubes. Barrier methods and periodic abstinence probably do not have any significant effect on subsequent fertility. Barrier methods could be protective. Therapeutic abortion may have a small deleterious effect on long-term reproductive success, but the data are inconclusive. Detailed information on fertility following use of other methods is not available.

Abortion, Induced↗