[The family planning central unit and public health medicine].
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A survey of cap use and efficacy of women who initially purchased a cervical cap at the University of California at Berkeley Student Health Service is described. It reports the follow-up of 65 U.C. women students who purchased either Vimule or Cavity-rim cervical caps from May, 1978 through June, 1981 and raises questions about cervical cap use and efficacy. Participants were divided into two groups: regular and irregular users. Of the 33 regular users, 16 experienced unplanned pregnancy during the study. Survival probabilities were 80% at 6 months, 73% at one year and 52% after 2 years. Life table analysis of the 33 regular users indicated a 20% probability of pregnancy in the first 6 months of use, 27% by 1 year and 48% by the end of 2 years.
In a large prospective study, set up to determine whether reproductive outcomes are affected by prior contraceptive use, 34,344 women were recruited at their first antenatal visit and followed until pregnancy termination. This paper summarizes the study methods and describes the demographic differences between subjects who used various contraceptives shortly before conception, and those who experienced contraceptive failures. Thirty percent of the women had used oral contraceptives (OCs) during the 5 months prior to conception and 2.4% had continued using them after their LMP. IUDs had been used by 5.8% of women before conception and 1.1% after. If these rates are also true for the whole population of the U.S., they indicate that approximately 70,000 babies are born each year following pill-failures and 30,000 following failures of IUD's. Exposure to other fetal hazards was common, with 48% of pregnant women drinking alcohol, 28% smoking, and 15% receiving diagnostic X-rays. OC use was more common among smokers and drinkers, and OC failures were significantly associated with the use of anti-epileptics, aspirin, and with exposure to radiation.
We believe our data suggests that pregnancy among adolescent diabetics is more frequent than would be expected from the general population at a time when diabetic control is at its worse. Thus patients and their offspring are exposed to extreme morbidity. Current recommendations regarding contraception in patients with diabetes are not appropriate for the adolescent population and therefore tend to support this phenomenon rather than relieve it. Because of the peculiar physiological and developmental characteristics of this population, more medical research is necessary regarding various hormonal preparations available to determine the safest acceptable contraceptive for the adolescent diabetic. To be truly effective, these new alternatives must be presented to the patient in the context of a counseling program that (1) recognizes that this population does have an unusually high frequency of pregnancy for reasons unknown, and that (2) stresses the need for the patient to take control of the diabetes prior to becoming pregnant.
The prevalence rate of vaginal colonization with E. coli was studied prospectively among 495 healthy premenopausal women, and factors associated with vaginal carriage of E. coli were examined. Vaginal colonization with E. coli was found in 12% of women, and was significantly correlated with phase of the menstrual cycle (p less than 0.05), prior use of antibiotics (p less than 0.05), current genital complaints (p less than 0.05), history of previous urinary tract infection (p less than 0.001), and use of diaphragm or cervical cap for contraception (p less than 0.005). The high prevalence rate among diaphragm or cervical cap users remained significant when other confounding factors were kept constant (p less than 0.05). This observation may explain the association of diaphragm use and urinary tract infection demonstrated in previous epidemiologic studies and confirmed in the present study (p less than 0.05).
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We have examined factors influencing the rate of first referral to hospital for urinary tract infection among the 17,032 women taking part in the Oxford Family Planning Association contraceptive study. The risk of first referral declined with age, was higher in nulliparous women than in parous women, was higher in non-obese than in obese women and was higher in current users of the diaphragm than in current users of other methods or no method of contraception. The main increase in the risk of referral in current diaphragm users occurred during the first 24 months when overall rates were 2-3 times higher in users than in non-users or ex-users of the diaphragm. The negative association between hospital referral for urinary tract infection and obesity was unexpected. It was not explicable in terms of age, parity or diaphragm use. It may be that obese women are less likely to receive trauma to the genital area during sexual intercourse than non-obese women because adipose tissue offers them some protection. Another possibility is that increased oestrogenization in obese women, resulting from peripheral conversion of androstenedione to oestrone, has a beneficial effect on the bladder and urethra, thus reducing the liability to infection.
The prevalence of asymptomatic bacteriuria was assessed in women using different contraceptive methods. Three hundred and twenty women attending a family planning centre were studied, 80 in each of the following groups: diaphragms, intrauterine contraceptive devices (IUCDs), oral contraceptives (OCs) and no contraception. The numbers with asymptomatic bacteriuria in the 4 groups were as follows: diaphragm - 12 (all E coli); IUCD - 3 (E coli; P mirabilis; S saprophyticus); OC - 5 (all E coli); no contraception - 4 (3 E coli; 1 S saprophyticus). The prevalence of Gram-negative bacteriuria in women using diaphragms was significantly higher than for women in the other groups (chi 2 = 8.98; p less than 0.05). Factors such as parity, numbers of sexual partners and frequency of sexual intercourse had no apparent effect. The use of diaphragms may contribute to the risk of Gram-negative urinary tract infections in sexually active women.
This study was undertaken to assess whether the vaginal flora was affected by the method of contraception, and in particular as to whether the incidence of vaginal candidiasis increased when oral contraceptives were used. One thousand and two consecutive vaginal or cervical swabs from women attending a family planning centre were cultured. Candida albicans was isolated from 13% of women using no contraception, 16% using oral contraceptives, and from 9%, 19% and 18% of those using diaphragms, intrauterine contraceptive devices (IUCD) and condoms respectively. These differences were not statistically significant. Women using an IUCD had significantly more Gram-positive cocci cultured than women in any other group, while those using diaphragms had significantly more Gram-negative bacilli. Our clinical impression that the use of oral contraceptives led to an increase in vaginal candidiasis, was not confirmed by this study.
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The different methods used to explore the blood-brain barrier (made up of cerebral capillary vessels), and notably, at molecular level, isolated microvessel preparations, have greatly improved our knowledge in this particular field. Some of these methods could be used to evaluate the protective effects of therapeutic substances, such as Ginkgo biloba extract, on the blood-brain barrier.
We aimed to assess the acceptability of a variety of formulations of female-controlled methods of protection against HIV and STDs among men and women in south-western Uganda. Pilot interviews were carried out with 50 men and 55 women and 25 focus group discussions (FGDs) were held with 138 women and 42 men. The female condom, foaming tablets, sponge, foam, gel and film were demonstrated to 146 women and 35 of their male partners, who then tried out 2 of the products. They were interviewed 7 times during the course of 5 months. At the end experiences were evaluated during a second series of FGDs. Sixty-five (45%) women completed the trial. The main reasons for non-completion were related to geographical mobility. Product preference after the initial demonstration was similar to that at the end of the trial. The most popular formulations were the sponge (25% of the women), foaming tablets (23%), and the female condom (19%). The foam was of medium popularity (16%). The gel (9%) and film (7%) were least popular. Ten per cent of the women and 14% of the men reported products interfering with sexual enjoyment; 24% of the women and 67% of the men said products increased enjoyment. 'Dry sex' is not popular in this area and increased lubrication was an important determinant of acceptability. Age, level of education and location did have some effect on preference. Although secrecy was a dominant theme in the FGDs, 87% of the women had informed their partners by the end of the trial. The products were generally well received. Female control was an important issue for both sexes. Male attitudes were ambivalent because female ownership of products increased women's control. Although they have clear preferences, women appear to accept the products generally and might use a single available product just as readily if choice was limited, as long as it conforms to general cultural preferences, such as those relating to wet/dry sex.
BACKGROUND: Various contraceptive practices and reproductive factors have been associated with cervical neoplasia in case-control studies worldwide. METHODS: To investigate contraceptive and reproductive risk factors associated with high-grade cervical dysplasia in southwestern Hispanic and non-Hispanic white women, we carried out a clinic-based case-control study among university-affiliated clinic attendees. RESULTS: Oral contraceptive use ever (odds ratio [OR] = 0.4, 95% confidence interval [CI]: 0.2-0.9) and past diaphragm use (OR = 0.3, 95% CI: 0.1-0.8) were protective for dysplasia in analyses adjusted for age, ethnicity, sexual behaviour, and for cervical papillomavirus (HPV) infection. After further adjustment for Pap smear screening interval, oral contraceptive use ever remained protective for dysplasia. Vaginal deliveries were strongly associated with dysplasia with > 2 vaginal deliveries associated with a 3.9-fold increase in risk after adjustment for age, ethnicity, sexual behaviour, and HPV infection. Using logistic regression models to simultaneously control for effects of multiple factors as potentially related to cervical dysplasia, we found low educational attainment, cervical HPV infection, cigarette smoking, history of any sexually transmitted disease, and having one or more vaginal deliveries to be associated with dysplasia; oral contraceptive use and past diaphragm use also remained protective for high-grade cervical dysplasia in these regression analyses. CONCLUSIONS: The data suggest that use of oral contraceptives (ever) and past diaphragm use are protective for high-grade cervical dysplasia among Hispanic and non-Hispanic white women in New Mexico. The clinic-based perspective of this research (versus population-based studies) may help explain some of these findings.
OBJECTIVE: To describe the epidemiology of endometriosis in women attending family planning clinics with special reference to contraceptive methods. DESIGN: Non-randomised cohort study with follow up of subjects for up to 23 years. Disease was measured by first hospital admission rates since endometriosis can be diagnosed with accuracy only at laparotomy or laparoscopy. SETTING: 17 family planning centres in England and Scotland. SUBJECTS: 17,032 married white women aged 25-39 years at entry during 1968-74 who were taking oral contraceptives or using an intrauterine device or diaphragm. About 99% of the women approached agreed to participate and annual loss to follow up was about 0.3%. MAIN OUTCOME MEASURES: Diagnosis of endometriosis, age, parity, and history of contraceptive use. RESULTS: Endometriosis was significantly related to age, peaking at ages 40-44 (chi 2 for heterogeneity = 30.9, p < 0.001). Endometriosis was not linked to duration of taking oral contraceptives. Nevertheless, the risk of endometriosis was low in women currently taking oral contraceptives (relative risk 0.4; 95% confidence interval 0.2 to 0.7), but higher in women who had formerly taken them (1.8; 1.0 to 3.1 in women who had stopped 25-48 months previously) compared with women who had never taken the pill. A similar pattern was seen for use of intrauterine devices (relative risk 0.4 (0.2 to 0.7) in current users and 1.4 (0.4 to 3.2) in users 49-72 months previously compared with never users). No association was found between endometriosis and use of the diaphragm. CONCLUSIONS: Oral contraceptives seem to temporarily suppress endometriosis. Endometriosis may be diagnosed late in women using intrauterine devices as pain and bleeding occur with both.
A standard test is needed to evaluate condoms as barriers against sexually transmitted diseases, particularly those caused by viruses. The proposed method presented here consists of a previously published simple method using physiologic-based conditions plus improvements to increase test sensitivity and decrease confounding factors such as contamination. Limitations of the method were determined by measuring virus penetration through small, well-defined holes. The method can detect penetration of 2 nL (2 x 10(-6) mL) of challenge virus suspension as well as a hole of 2 microns diameter in a latex condom. The data also indicated that virus penetration of latex condoms occurred quickly, and the hole was then apparently closed or blocked.
Two experimental techniques have been utilized to explore the barrier properties of lecithin/decane bilayer membranes with the aim of determining the contributions of various domains within the bilayer to the overall barrier. The thickness of lecithin/decane bilayers was systematically varied by modulating the chemical potential of decane in the annulus surrounding the bilayer using different mole fractions of squalene in decane. The dependence of permeability of a model permeant (acetamide) on the thickness of the solvent-filled region of the bilayer was assessed in these bilayers to determine the contribution of this region to the overall barrier. The flux of acetamide was found to vary linearly with bilayer area with Pm = (2.9 +/- 0.3) x 10(-4) cm s-1, after correcting for diffusion through unstirred water layers. The ratio between the overall membrane permeability coefficient and that calculated for diffusion through the hydrocarbon core in membranes having maximum thickness was 0.24, suggesting that the solvent domain contributes only slightly to the overall barrier properties. Consistent with these results, the permeability of acetamide was found to be independent of bilayer thickness. The relative contributions of the bilayer interface and ordered hydrocarbon regions to the transport barrier may be evaluated qualitatively by exploring the effective chemical nature of the barrier microenvironment. This may be probed by comparing functional group contributions to transport with those obtained for partitioning between water and various model bulk solvents ranging in polarity or hydrogen-bonding potential. A novel approach is described for obtaining group contributions to transport using ionizable permeants and pH adjustment. Using this approach, bilayer permeability coefficients of p-toluic acid and p-hydroxymethyl benzoic acid were determined to be 1.1 +/- 0.2 cm s-1 and (1.6 +/- 0.4) x 10(-3) cm s-1, respectively. From these values, the -OH group contribution to bilayer transport [delta(delta G0-OH)] was found to be 3.9 kcal/mol. This result suggests that the barrier region of the bilayer does not resemble the hydrogen-bonding environment found in octanol, but is somewhat less selective (more polar) than a hydrocarbon solvent.
This study describes the payment category of 397 low-income Hispanic women and the relationship to compliance with family planning visits the first year postbirth. Only one-fourth of the women returned for the one-year family planning visit, when they would have received well-woman care. Pay category was not a factor in identifying those who returned. Health system barriers, patient cultural beliefs, and life circumstance may explain why women enter and then leave apparently seamless systems of care. To increase preventive care, more study is needed of interventions that build on women's existing cultural prescriptions for health behavior by health professionals who portray postbirth checks as wellness checks.
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