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PubMed1990

[Contraception guidance in general practice. A questionnaire study in Nordland, Troms and Finnmark].

239 (75%) of 318 general practitioners in the three northernmost counties of Norway were asked by mailed questionnaire to report the frequency of consultations on contraception, and what kind of contraception they usually recommended. 85% informed the women about at least three different alternatives; oral contraceptives, intrauterine devices and condoms. Almost 50% would ordinate an intrauterine device to a woman who never had been pregnant. 60% informed the woman about other alternatives even if she had already decided upon method prior to the consultation. The physician often brought up the subject of contraception, but as many as 15% did not, as a routine, mention birth control when a woman consulted them for a first trimester abortion. Almost 50% did not know how to fit the diaphragms.

Adult↗
PubMed1993

Family planning in the teen population.

As an increasing percentage of adolescents reach their sexual debut at younger ages, effective contraceptive methods, which will decrease the risks of unintended pregnancies and sexually transmitted diseases (STDs), become even more critical. Contraceptive methods which are less 'compliance-dependent', such as the implantable subdermal levonorgestrel and the injectable depot formulation of medroxyprogesterone acetate, are popular in adolescents but careful counseling before method selection and on-going counseling when side-effects are experienced are necessary and essential. The use of condoms to decrease the risks of STDs will continue to be important for adolescents, and it remains to be seen what impact the long-term methods will have on effective condom use. Adolescents' access to abortions when contraceptive methods fail, or when no method is used, is being challenged with state laws which mandate parental notification or permission. A greater knowledge about the option of emergency contraception could potentially lead to increased use of this method, particularly when the option of medications such as RU486 becomes available. The potential for a reduction in unintended pregnancies in adolescents, and a reduced need for abortions is a welcome prospect.

Abortion, Legal↗
PubMed1997

AIDS related knowledge and behaviours among college students, Gondar, Ethiopia: a comparative study.

AIDS-related knowledge and behaviours among students at the Gondar College of Medical Sciences, Gondar, Ethiopia were evaluated based on identical surveys conducted in 1990 and 1992. One hundred three second year students provided information in 1992. Analysis indicated that 49% were engaged in sexual intercourse and only a third of these group used condom despite their improved knowledge and belief on condom compared to their previous position in 1990 (p < 0.004). On the other hand, their sexual behaviours regarding sexual contact with high risk individuals decreased compared to 1990 (p < 0.0005). Their general level of AIDS-related preventive knowledge increased over time (p < 0.002), although there was no significant difference in knowledge observed among different sexes and departments. Among the sexually active, a large proportion of students (22%) still had sexual contact with high risk individuals and only 33% of them were using safer methods. Continuing efforts, including peer education, specific health education interventions are still crucially needed to bring a positive change in sexual behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Emergency hormonal contraception usage in genitourinary medicine clinic attenders.

OBJECTIVE: To assess the indications for usage of emergency hormonal contraception amongst a population of London genitourinary medicine clinic attenders. METHODS: In a prospective study, 150 consecutive women receiving emergency hormonal contraception (EHC) were enrolled. The attending doctor completed a questionnaire of patient details and prescribed EHC with prophylactic prochlorperazine. Follow-up was arranged three weeks later, at which time outcomes and side-effects of therapy were recorded. For those women who did not reattended as planned case notes were reviewed at three months. RESULTS: Of 150 women surveyed, 100 (66%) reported contraceptive method failure, 48 (32%) had used no contraception at the time of last sexual intercourse and two requested EHC after sexual assault. Ninety three (62%) reported condom failure, 7 (5%) oral contraceptive pill failure. Seventy five (50%) had used EHC before (range 1-10 times). Seventy one (47%) women reattended within three months. Five (3.3%) of the 150 women were pregnant; none of these cases had experienced nausea or vomiting whilst taking EHC. Side-effects were reported by 22 (31%) of the 71 patients who reattended. Nine (6%) women had been followed-up in the family planning advisory clinic. Of the 71 women who reattended, 39 (55%) reported that their preferred future method of contraception would be condoms. Of the 150 women 19 (13%) underwent tests for sexually transmissible infections within one month of presentation. CONCLUSIONS: EHC usage in this population was associated with a failure rate of at least 3.3% and an overall side effect rate of 31%. Despite requests for emergency contraception because of condom failure many elected to continue using condoms as their preferred method of contraception. The majority of women (53%) did not return for follow-up or family planning advice, and so we believe that future contraceptive plans must be addressed at the time EHC is prescribed.

Adolescent↗
PubMed1999

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies.

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35%, 47%, and 55% in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis infection were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95% confidence interval (CI) = 1.2-3.9; p = 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95% CI = 1.4-10.6; p = 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95% CI = 1.8-6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence of C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk.

Adolescent↗
PubMedDate not supplied

Seroprevalence of human immunodeficiency virus type I (HIV-1) antibodies in a family-planning population.

Blind testing of 743 women who attended an inner-city hospital family-planning clinic showed 8 (1.1%) patients to have serum antibodies to human immunodeficiency virus type I (HIV-1). A retrospective chart survey did not show an association between HIV-1 antibody seropositivity and ethnicity, marital status, education, history of sexually transmitted diseases, drug and/or alcohol use, and contraceptive method. This failure to establish previously reported correlation may be a function of methods, sample size, or reflect a different population. Nonetheless, the seroprevalence the authors found shows that all patients in a family-planning clinic setting should be offered HIV-1 antibody testing.

Adult↗
PubMed1996

Developmental sophistication among adolescents of negotiation strategies for condom use.

Condoms are an important method of reducing the risk of sexually transmitted disease among sexually active adolescents. This study used a developmental approach to examine the negotiation of condom use. The Interpersonal Negotiation Strategy Interview was administered to adolescents using two vignettes that were focused on the negotiation of "safer sex" behaviors. The sample consisted of 196 girls and 92 boys recruited from their primary care clinic or Job Corps. The mean scores for each problem-solving step were at the subjective, unilateral stage, which indicates that problems are resolved through one-way methods. Current educational strategies and the lack of mutuality in adolescents' sexual relationships influence the level of negotiation skills. Interventions need to be at the appropriate developmental level but also need to encourage progress toward collaborative relationships.

Adolescent↗
PubMed1993

Condom use among high-risk women in Honduras: evaluation of an AIDS prevention program.

In 1988, the Honduran Ministry of Health initiated an intervention study designed to increase AIDS awareness and promote preventive behavior, especially condom use, among registered commercial sex workers (CSWs). The program consisted of weekly talks and free condom distribution to all CSWs who attended the sexually transmitted disease clinic during a 10-week period. Pre- and postintervention surveys were used to evaluate change in knowledge and condom use. Condom diaries were used to measure condom use during the program. One hundred thirty-four women who participated in the intervention completed the initial and follow-up surveys. There was a statistically significant increase in mean condom use from 64% to 70% of client contacts. Condom use recorded in diaries during the program period appeared even higher. Factors found to be associated with increased use postintervention include low baseline condom use and higher client fee. The reliability of the methods of measuring condom use and the implications of the findings for future intervention studies among sex workers and their clients are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Condom and other contraceptive use among a random sample of female adolescents: a snapshot in time.

This study examined the sexual practices of 235 females aged 15 to 19 years and their readiness to use specific contraceptive methods for birth control and sexually transmitted disease (STD) prevention. The investigation was based on the stages-of-change construct from the Transtheoretical Model (Prochaska & DiClemente, 1983, 1984). Results demonstrated that despite the availability of newer contraceptive methods (e.g., Depo-Provera), most sexually active adolescents were least resistant to using condoms and were further along in the stages of change for condom use as compared with other contraceptive methods. Moreover, the females perceived the male condom as an acceptable method for prevention of both pregnancy and STDs. These findings suggest that interventions designed to target consistent and correct condom use may result in better compliance, reducing the number of unintended pregnancies and STD cases among this populations.

Adolescent↗
PubMed1992

A survey of contraceptive use and unplanned pregnancy in Perth, Western Australia.

Contraceptive use and unplanned pregnancy were studied in a stratified cluster sample of 1,511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Twenty-one couples were excluded from analysis owing to missing data. The proportion of couples using contraception was 76.8 per cent (1,144 of 1,490), and all but three of the remaining couples gave a reason for nonuse. Among users, surgical sterilisation made up 42.3 per cent (484 of 1,144) of all methods, with a slight predominance of tubal ligation over vasectomy. Oral contraceptives accounted for just over half of nonsurgical methods. Comparisons with a Victorian survey performed in 1978 suggested that surgical methods and condom use may have increased, whereas use of oral contraceptives and intrauterine devices may have fallen. Unplanned pregnancies conceived during the 12 months before the interview affected 3.4 per cent (51 of 1,490) of respondents. The incidence of unplanned pregnancy was four times higher in couples with inconsistent usage patterns of contraception.

Adolescent↗
PubMed1981

Postpartum contraception.

Recently-delivered women who wish to avoid pregnancy should initiate contraception before ovulation. Since the return of ovulation is not predictable, regardless of the woman's lactation status and duration of postpartum amenorrhea, contraception should be initiated as soon as is reasonable after delivery. The choice of contraceptive method will depend on several factors, including: the woman's lactation status, the preference of the woman and her partner, and the health status of the newborns. For women who do not wish to have additional children, tubal sterilization through a minilaparotomy incision is the procedure of choice. For other women who are not lactating, all methods, with the exception of the use of cervical caps and diaphragms, may be initiated immediately after delivery. However, preference should be given to IUD use by lactating and non-lactating woman, especially for women who may not return for any additional postpartum care.

Contraception↗
PubMed1990

Cultural differences in a family planning clinic.

An analysis of the use of contraception in a multi-racial family planning clinic in relation to age, parity and ethnicity (Asian or non-Asian) was carried out in the London Borough of Newham. Whether follow-up appointments were given and kept and the taking of cervical smears were noted. Asian patients favoured the sheath (44%) and the IUD (31%); the Pill was less used at 20% with the cap little used at 3%. Non-Asian patients favoured the Pill (50%), and IUD (22%) with the sheath being used by 15% and the cap by 13%. Parity increased with age in both groups. The 16-20-year-old Asian patients chose the Pill (54%) in preference to the sheath (27%) whereas the older Asian patients chose the sheath in preference to all other methods. When follow-up appointments were given the failure rate was equal in both groups. 29% of the Asian patients had a cervical smear taken as against 45% of the non-Asian patients.

Adolescent↗
PubMed1996

An experimental study on the neurotolerability of gadobenate dimeglumine in a rat model of focal brain ischemia.

RATIONALE AND OBJECTIVES: The neurologic safety of the new magnetic resonance imaging contrast agent gadobenate dimeglumine has been assessed in rats suffering from localized blood-brain barrier damage. METHODS: The adopted experimental model was the photochemically induced brain ischemia in the rat. Flash-evoked visual potentials were recorded simultaneously from the damaged area and from the corresponding contralateral position in conscious rats before and after the administration of the contrast medium. RESULTS: The intravenous administration of 0.9 mmol/kg of gadobenate dimeglumine did not induce any significant changes in the visual responses recorded from the ischemic side compared with the intact side. Rats treated with saline or with the reference compounds gadopentetate dimeglumine (Magnevist) and gadoteridol (ProHance) gave comparable results. CONCLUSIONS: The results are in favor of the use of gadobenate dimeglumine in patients suffering from a localized damage to blood-brain barrier.

Animals↗
PubMed1997

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

Africa↗
PubMed2005

[Changes of blood-aqueous barrier after phacoemulsification in patients with previous glaucoma filtering surgery].

OBJECTIVE: To evaluate the effect of trabeculectomy and/or phacoemulsification surgery on blood-aqueous barrier function. METHODS: Phacoemulsification with implantation of intraocular lens was performed on 46 cataract eyes of 40 glaucoma patients following previous trabeculectomy (group 1), and 64 cataract eyes of 60 patients (group 2). The aqueous flare and cells were examined preoperatively and on days 1, 7, 30, 90 postoperatively using a laser flare-cell meter (LFCM). RESULTS: The mean aqueous flare values were (15.12 +/- 2.87), (40.24 +/- 3.75), (24.33 +/- 3.38), (21.18 +/- 1.77), (16.51 +/- 1.70) photon counts/ms in group 1 preoperatively and on days 1, 7, 30, 90 after surgery (P < 0.05) respectively; and were (6.94 +/- 2.34), (26.27 +/- 10.21), (13.96 +/- 6.44), (9.07 +/- 2.67), (7.16 +/- 1.89) photon counts/ms in group 2 (P < 0.05) respectively. CONCLUSIONS: Trabeculectomy can breakdown blood-aqueous barrier permanently while phacoemulsification damage the blood-aqueous barrier transiently. Phacoemulsification combined with a previous trabeculectomy can enhance this damage.

Aged↗
PubMedDate not supplied

Female adolescent contraception.

Numerous clinical challenges confront care providers in caring for adolescents regarding contraception and sexual health issues. Strong communication skills are an integral factor in dealing with the sexually active teen. The most common contraceptive options for adolescents include Norplant, Depo-Provera, oral contraception, and condoms. Providing contraceptive care for adolescents requires knowledge of these methods, including the new FDA guidelines that standardize instructions for oral contraceptive use. Nursing responsibilities include counseling the adolescent regarding the risks of sexual activity with multiple partners, exposure to HIV, STDS, and the correct use of condoms. Educational efforts should focus on improving adolescent communication skills and encouraging discussion by sexual partners about the issue of condom use.

Adolescent↗
PubMedDate not supplied

"Condom distribution in high school" -- a rebuttal.

To challenge the distribution of condoms on school campuses with accusations of immorality and "lack of good character" appears shallow at best. Considering the home situation of many young people and their immediate environment, the act of securing a condom could be totally consistent with "good character." Certainly, abstinence up to a certain stage in a youth's life is prudent, but who is to determine the age to which, and the environment in which, abstinence must be observed universally? The litany of virtues to which Gow refers (kindness, courtesy, the Golden Rule, and so forth) all could be attributed to the youth who obtains a condom at school and uses it in an effort to protect himself and his partner. Use of a condom even by a teenager is not an unvirtuous act. Gow refers to two "misguided assumptions." The first is that "it is the legitimate function of the schools to dispense contraceptives." He maintains that parents and physicians, not schools, constitute the proper source of medical information and medication. Granted, they are the most logical and desirable sources, but what if a student has incompetent or perhaps no parental guidance and has little if any access to a physician? Schools have acted in loco parentis ever since public education first evolved. Why should it stop now during a devastating health crisis? The second "misguided assumption"--that "teen sex and pregnancies result from ignorance"--happens to be true. Ignorance is a major cause of pregnancies and AIDS. Distribution of condoms on campuses will help to counteract ignorance because it leads to explanations and discussion, two essential components of education. I find no quarrel with Gow's call for reevaluation of values and methods of communication. His belief that institutions such as churches, families, social organizations, and so forth must assume a larger role in clarification of values is logical. But until that occurs, what institution other than a public school has a better chance to reach the greatest number of young people?

Americas↗
PubMed2002

Intestinal infection with Giardia spp. reduces epithelial barrier function in a myosin light chain kinase-dependent fashion.

BACKGROUND & AIMS: Giardiasis causes malabsorptive diarrhea, and symptoms can be present in the absence of any significant morphologic injury to the intestinal mucosa. The effects of giardiasis on epithelial permeability in vivo remain unknown, and the role of T cells and myosin light chain kinase (MLCK) in altered intestinal barrier function is unclear. This study was conducted to determine whether Giardia spp. alters intestinal permeability in vivo, to assess whether these abnormalities are dependent on T cells, and to assess the role of MLCK in altered epithelial barrier function. METHODS: Immunocompetent and isogenic athymic mice were inoculated with axenic Giardia muris trophozoites or sterile vehicle (control), then assessed for trophozoite colonization and gastrointestinal permeability. Mechanistic studies using nontransformed human duodenal epithelial monolayers (SCBN) determined the effects of Giardia on myosin light chain (MLC) phosphorylation, transepithelial fluorescein isothiocyanate-dextran fluxes, cytoskeletal F-actin, tight junctional zonula occludens-1 (ZO-1), and MLCK. RESULTS: Giardia infection caused a significant increase in small intestinal, but not gastric or colonic, permeability that correlated with trophozoite colonization in both immunocompetent and athymic mice. In vitro, Giardia increased permeability and phosphorylation of MLC and reorganized F-actin and ZO-1. These alterations were abolished with an MLCK inhibitor. CONCLUSIONS: Disruption of small intestinal barrier function is T cell independent, disappears on parasite clearance, and correlates with reorganization of cytoskeletal F-actin and tight junctional ZO-1 in an MLCK-dependent fashion.

Actins↗