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Honduran women received no written information on contraceptive pill.

In the period 1989-1994, Honduran women participating in the Project Health Sector 2 have been exposed to a contraceptive mini-pill, Ovrette. The Institute of Honduran Social Security (IHSS) approved the program (in which Ovrette distribution is included) in May 1990. The program is partly funded by the Population Council, which is funded by USAID Registry with the Department of Health was not required under the Health Code since Ovrette had entered the country as a donation. In June 1993, a Commission of the Honduran Medical Association reported that the women were not given any written information on the drug. Ovrette is an oral contraceptive manufactured by Wyeth. Its active ingredient is a progestagen, Norgestrel. Contraindications for Ovrette include: non-lactating women who exhibit side-effects such as dizziness, water retention, migraine, etc.; non-lactating women with contraindications for estrogen; lactating women who reject other contraceptive drugs. The US Pharmacopeia and the US Food and Drug Administration do not authorize the drug for use by lactating women. As with other progestagens, Norgestrel passes through to the mother's milk. In 1993, the US Pharmacopeia reported that these hormones can cause harmful effects to the child, and recommended switching medications or discontinuation of lactation. In 1983, the WHO expressed concern about the possibility of injury caused by the progestagens. The possibilities included alterations to personality, behavior, anatomy of sexual organs, reproductive capacity, immunological function and development of neoplasia. Possible damages in puberty or during the reproductive age are not known since there is no study of exposed children that are older than 12 years of age.

Americas↗

Non-availability of the IUD and contraceptive choice.

The Copper 7 and Lippes Loop IUD are no longer distributed in the United States, and the cost of the Progestasert precludes usage in many family planning clinics. The impact of the loss of this widely used contraceptive method was assessed in a pilot study at the UCLA Family Planning Clinic. The clients who would have selected an IUD at the time of their clinic visit between March and December of 1986 instead chose oral contraceptive pills (55%) or barrier methods (45%) but their level of dissatisfaction with the methods they received was significantly greater than that of all other contraceptors, and this led to their subsequent selection of another method which, in the majority (66%), was of lower efficacy than the IUD. There were two unplanned conceptions amongst twenty women who would have chosen an IUD, both due to non-compliance with oral contraceptive pills; and at the time of survey in March 1987, no clients had opted for sterilization. Women who no longer have their choice of the IUD represent a high risk for contraceptive dissatisfaction and failure, but have not made precipitous decisions to undergo permanent sterilization.

Adolescent↗

Etiopathogenesis and prognosis of cerebral ischemia in young adults. A survey of 155 treated patients.

Etiology and long-term prognosis were prospectively investigated in 155 consecutive patients (96 men and 59 women), aged 16 to 45 years, referred to our Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-1988. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. Two-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were contraceptive pill assumption (5.8% of the total, but 15.3% within the female group), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of cases. All patients received antiplatelet medication and 16 underwent surgery. The long-term outcome at a mean follow-up of 5.8 years was favorable: 91% of subjects resumed their work on a full or part-time basis.

Adolescent↗

[Evaluation of the Norwegian Medical Association's campaign for improved contraception and fewer induced abortions].

BACKGROUND: Two thirds of the young women who want induced abortions have not used contraception, and it is likely that improved education in contraception will lead to a decline in induced abortions. The Norwegian Medical Association sees this as its responsibility, and in 1995 proposed a campaign to improve the quantity and quality of physicians' advice on contraceptive use. A booklet was produced and mailed with a poster to all general practitioners in May 1997. MATERIAL AND METHODS: Before the distribution of the information package a questionnaire on how contraception was taught was sent to a representative sample of 211 general practitioners. Six months later the same 211 received a similar questionnaire with a few questions added on the possible effect of the information package. RESULTS: 132 physicians responded the first time and 105 the second. Four out of five general practitioners have consultations where they advise on contraception at least weekly. 70% had attended courses on sexology or contraception. 80% found the booklet useful, and 12% had changed their routines as a consequence of the campaign. Routine examinations before prescription of contraceptives were more extensive than the booklet advises. There was no measurable difference in reported practice before and after the campaign, but by using the more than 20,000 potential annual consultations as the unit instead of the physicians, there were significant moves in the right direction. INTERPRETATION: Even if the evaluation cannot document improved contraception as a result of the campaign, the quality of the physicians' advice on contraception has improved.

Abortion, Induced↗

Failed contraception in Nigerian women: outcome of pregnancy and subsequent contraceptive choice.

The outcome of pregnancy in 56 patients who had contraceptive failure out of the 5,431 new acceptors at the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, between 1 January 1981 and 31 December 1989, were analysed. There were 40 IUD, 6 OC, and 4 injectable failures. Three patients had had voluntary surgical contraception (VSC) and 3 used barrier methods. The mean +/- SD age and parity were 32.2 +/- 4.4 years and 4.4 +/- 1.9, respectively. There were 17 (30.1%) live births, 34 (56.6%) terminations of pregnancy and 3 (5.2%) spontaneous abortions. Two (3.0%) patients were lost to follow-up. There was neither any statistically significant difference in the outcome of pregnancy between patients with 5 or more children and less than 5 children (p greater than 0.05), nor between patients less than 31 years of age and those older. Fifty per cent of the patients who had used the IUD continued with the method. Seven patients subsequently requested VSC. None of the patients using the injectable contraceptive or barrier methods continued with the method (p greater than 0.05).

Adult↗

A comparison of high-dose estrogens versus low-dose ethinylestradiol and norgestrel combination in postcoital interception: a study in 493 women.

Ethinylestradiol (EE), at a dosage of 5 mg/day for 5 consecutive days (5 mg EE), has generally been used for interception. A combination of 200 micrograms EE and 2 mg dl-norgestrel (EE + NG) was proposed as an effective alternative. Efficacy and tolerance of these methods were compared in a randomized, double-blind study. A group of 465 women was studied with a follow-up rate of 94.3%. In the 5 mg EE group a pregnancy rate of 0.9% was observed, and in the EE + NG group a rate of 0.4% was found. These rates differ significantly from the expected rates (P less than 0.0005, in both series). Nausea was noted in 59.1% of the 5 mg EE group and in 54.0% of the EE + NG series. Nausea and vomiting occurred in 20.8% and 15.8%, respectively. The efficacy of both methods as alternative morning-after medication was confirmed. The new method is preferable because treatment is limited to only 1 day.

Adolescent↗

Social and proximate determinants of sexual activity in rural Nigeria.

This study analyses the social, physiological and motivational determinants of sexual activity for 644 married women in rural areas of Osun State, Nigeria. The data come from the Fertility Awareness and Pregnancy Avoidance study conducted in 1993-94. Sexual activity is measured by three continuous variables: weekly frequency of (1) total sexual activity, (2) coital-only sex and (3) both coital/non-coital sex. Analyses of variance were performed to test the difference in group means between the predictor variables and measures of sexual activity. Ordinary least squares regression analyses were then performed for the three dependent variables. Two models are used: the first contains only those variables associated with an individual's demographic, social and economic status, and the second adds predictor variables associated with motivational and physiological factors. Results show that while many socioeconomic variables by themselves are significantly associated with sexual activity measures, the addition of physiological and motivational variables weakens their effects and lessens their original statistical significance. Additionally, the socioeconomic and demographic factors associated with frequency of sexual activity are not necessarily the same ones significantly associated with coital-only or combined coital/non-coital sex. While other studies have tended to focus either on socioeconomic or physiological factors, the joint examination of both types of influences seems to indicate that the latter have more proximate effects on the frequency of both coital and non-coital sexual activity of married women in this population. Contraceptive protection is shown to be highly positively associated with all three of the sexual activity measures, empirically confirming the important relationship between contraception and both coital and non-coital forms of sexual activity.

Adult↗

[Norplant contraception at the Rabta Tunis maternity hospital].

612 women had the benefit of contraceptive implants in the Maternity Hospital of La Rabta in Tunis over a period of 5 years (1988-1992). This study aimed at analysing the tolerance of this method by studying a group of 508 normal women and 104 women at risk (58 women were heart-diseased, 22 nursing, 13 diabetic, 11 hypertensive). The typical woman in this group is thirty years old, having 3 children, and weighing 61 kg. The implants were most of the cases withdrawn because of problems related to the menstrual cycle that were observed in 37% of the cases, equally distributed among both groups of the series. Contraceptive implants failed in 1.79% of the cases.

Adolescent↗

[Use of contraceptive methods by sexually active women in São Leopoldo, Rio Grande do Sul, Brazil].

In 2003, a population-based cross-sectional study was conducted in the urban area of São Leopoldo, Rio Grande do Sul, Brazil. The sample included 867 sexually active women from 20 to 60 years of age. The objective was to describe the use of contraceptive methods. Data were collected using a standardized questionnaire. The study analyzed the prevalence of contraceptive use and socioeconomic variables in women reporting an active sex life (84.5%), stratified by age groups. Some 627 (61.1%) women reported use of contraceptive methods. In the 20-49-year old group, 48.8% reported using oral contraceptives, 18.7% tubal ligation, 17.3% condoms, and 7.3% IUDs. In the 50-60-year old group, the most widely used method was tubal ligation (79.6%). Regarding tubal ligation, the schooling variable showed a linear trend, that is, women with less schooling showed a higher prevalence. Prevalence of oral contraception was higher in low-income women.

Adult↗

Oral contraceptive use and fibrocystic breast disease with special reference to its histopathology.

The relationship between use of oral contraceptives and fibrocystic breast disease was examined in a hospital-based case-control study undertaken in New Haven, Connecticut, from 1977 to 1979. Particular emphasis was placed on the extent of epithelial atypia and other histopathologic characteristics found in the biopsy specimens from the cases. Women who had ever used oral contraceptives were at a somewhat decreased risk for fibrocystic disease as a whole. Cases with high atypia and controls had similar patterns of oral contraceptive use, whereas cases with low and intermediate atypia had less oral contraceptive use than controls. Cases with intermediate atypia reported the lowest oral contraceptive use. Subjects with biopsy specimens exhibiting gross cysts, microscopic cysts, or papillomatosis were about 50% less likely to have used oral contraceptives than controls.

Adult↗

Pill knowledge amongst oral contraceptive users in family planning clinics in Scotland: facts, myths and fantasies.

OBJECTIVES: To document the extent of understanding about the combined pill amongst oral contraceptive users in Scotland. METHOD: A questionnaire was distributed to 2700 pill users in Scottish family planning clinics prior to their consultation with a clinician for a repeat prescription. RESULTS: Knowledge was patchy and usually incomplete in any given area. CONCLUSION: Counselling and teaching about oral contraceptives are important parts of the clinical consultation; even if the user appears knowledgeable about their contraceptive method, there are likely to be some areas where their knowledge could be improved.

Contraceptives, Oral, Combined↗

Implications of fertility patterns in the Republic of Korea: a study by computer simulation.

Implications of various fertility patterns in the Republic of Korea (ROK) are studied by computer simulation. These patterns include the factors: age of marriage, sex preference, abortion (induced), contraception and sterilisation. As a result of studying a large number of combinations of these factors, the following tentative conclusions, among others, are reached. If future cohorts of women in the ROK become limiters after two live births and marry according to an observed high level marriage distribution, at least two of the methods of birth control--abortion, contraception, and sterilisation--will have to be used extensively to yield a mean number of live births (MNLB) in these cohorts of the order 2-2. However, if these women marry later than the observed high level marriage distribution and, in addition, accept effective methods of contraception more widely and use them more effectively, then the MNLB experienced by these cohorts could move below 2-5 wihtout the extensive utilisation of abortion and sterilisation.

Abortion, Induced↗