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PubMed1999

A pragmatic intervention to promote condom use by female sex workers in Thailand.

An overview is presented of a multifaceted intervention to promote consistent condom use by female commercial sex workers in Thailand, in the context of the government's 100% condom use policy for preventing spread of human immunodeficiency virus (HIV) infection. The project is described with reference to a succession of stages including pre-programme needs assessment, intervention design, implementation and evaluation. The key elements of the intervention were video scenarios and discussions coordinated by health personnel, and video-depicted open-ended narratives aimed at helping sex workers to explore their personal and work-related dilemmas and concerns. A core objective was to enhance sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. The intervention was evaluated using a combination of qualitative (process evaluation) and quantitative (outcome) methods. The outcome evaluation was undertaken using a pretest, post-test intervention and control group quasi-experimental design. There were significant increases in consistent condom use among the intervention groups but not among the controls. Pragmatic stability is advocated for the Thai sex industry and recommendations are offered for good quality HIV prevention activities.

Adolescent↗
PubMedDate not supplied

Contraceptive use at first premarital intercourse: United States, 1965-1988.

The proportion of U.S. women who used a contraceptive method at their first premarital intercourse rose from 47 percent in 1975-1979 to 65 percent in 1983-1988. Overall, and among non-Hispanic white women, this change resulted entirely from an increase in the use of condoms by their partners. The proportion of whites who used a condom at first premarital intercourse, for example, increased from 24 percent to 45 percent. Among blacks, condom use at first intercourse increased from 24 percent to 32 percent during that period, and pill use rose from 15 percent to 23 percent. Among all women, the method most often used at first intercourse during every period in the study was the condom, followed by the pill and withdrawal. The proportion of women using a method at first premarital intercourse varies strikingly according to individual characteristics. Among the various demographic subgroups, the proportion who use a method varies from 32 percent of Hispanic women to 68 percent of Jewish women. Whites are more likely to use a method than are blacks, and fundamentalist Prostestants are less likely to use a method than are other Protestants or Catholics. The proportion using a method is higher among women whose mothers completed high school than among those whose mothers did not. In addition, the proportion rises with age at first intercourse. Multiple logistic regression showed that the independent effects of Hispanic origin, Jewish or fundamentalist Protestant religious affiliation and the education of a woman's mother are large and significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Have the AIDS campaigns changed the pattern of contraceptive usage among adolescents?

In 1984--just before the extensive public information about prevention of HIV infection by the use of the condom (the AIDS campaigns)--personal interviews about sexual experiences and use of contraception were obtained in random samples of 16-20 year old Danes. The investigation was repeated in 1989 addressing the issue of whether the behavior of adolescents regarding sexual intercourse and use of contraception has changed. In 1984 in all 286 females (respondent rate = 75.3%) and 336 males (respondent rate = 77.8%) agreed to be interviewed. The second investigation in 1989 involved new cohorts of 16-20 year olds and here 359 females (respondent rate = 77.9%) and 400 males (respondent rate = 76.3%) participated. In 1984 approximately 20% and in 1989 approximately 10% reported no use of contraception at first sexual intercourse. In both investigations oral contraception (OC) and condom were by far the predominant methods mentioned. In 1984 38.1% of females and 34.4% of males used OC and 37.2% of females and 42.1% of males employed condom. In 1989 26.7% of females and 30.8% of males used OC and 64.8% of females and 62.1% of males employed condom. No sex difference in the distribution of the various contraceptive methods could be revealed. From 1984 to 1989 the prevalence of condom increased significantly. In the first investigation 15.9% of sexually experienced females reported no present use of contraception. The most frequently used device was OC (62.7%). The second investigation collected information about contraception employed at the most recent sexual intercourse from both females and males. Approximately 5% of both sexes mentioned no use of contraception.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2002

Residents as teachers: outcomes of a brief training programme.

INTRODUCTION: Residents (RMOs) teach medical students in hospital wards, yet little evidence of efficacy is available for this activity. This study undertook to test the effectiveness of RMO teaching, and to delineate the principal barriers encountered. METHODS: Medical students in their fourth year were assessed at baseline for clinical examination skills in ophthalmoscopy, neurological examination of the legs, and rheumatological examination of the hands. One group of RMOs (n=6) taught ophthalmoscopy to the students attached to their unit, while the second group of RMOs (n=6) taught leg examination to their students. The third examination skill was not taught, but was used as a control intervention. The students were evaluated in all three skills by an observed, structured clinical examination at the beginning and end of their six-week attachments. RESULTS: There was a significant improvement in the skill of ophthalmoscopy in the intervention group (p<0.02), while the control group of students showed a decline in their abilities. The skill of examination of the legs improved after being taught, but not significantly. The RMOs universally reported that difficulty in finding time was a major barrier to their ability to teach medical students, and most set up additional teaching sessions rather than incorporate the teaching into their routine ward work. CONCLUSIONS: RMO teaching of medical students is effective, particularly for a skill which is novel. The difficulties arise in finding a suitable time for these important clinical teachers to transfer their skills.

Journal Article↗
PubMed1992

Sexual behaviour among youth clinic visitors in Sweden: knowledge and experiences in an HIV perspective.

OBJECTIVE: To study the knowledge and experience of sexuality, contraception and sexually transmitted diseases among sexually active adolescents in Sweden. SUBJECTS: Youth clinic visitors. SETTING: Seventy-four youth clinics from all over the country of Sweden. METHODS: A questionnaire with 17 multiple choice and nine open questions was distributed to all visitors at participating youth clinics during a 2-month period. RESULTS: A total of 9277 young persons answered the questionnaire. Their mean age was 17.5 years. Ninety-three percent were females. Knowledge on STD and STD protection was wide-spread and good. Chlamydia and HIV was recognised as STDs by 90% and 87% respectively. More than 99% knew of the condom method as a means for STD protection. Knowledge on contraceptive methods for pregnancy protection was also good. Ninety-three percent of the investigated adolescents had had coitus. Nine percent had experienced pregnancies and 17% STDs. The mean number of life-time sexual partners was 3.2. CONCLUSIONS: In spite of good knowledge on preventive measures among Swedish youth clinic visitors their sexual behaviour carriers risks for future health. Further interventions are needed to minimise these risks.

Adolescent↗
PubMed1992

Communication key for family planning.

4 reports published by Demographic and Health Surveys (DHS) include information from husbands of the wives interviewed in the main part of the survey. All are from Africa--Burundi (1987), Ghana (1988), Kenya (1988) and Mali (1987). These surveys of husbands indicate the importance of programs that work to improve communication between spouses about family planning. In particular, they show a positive association between contraceptive prevalence and husband and wife communication about family planning. Husbands and wives were asked how often they discussed family planning in the past year. In Kenya, with a 27% contraceptive prevalence rate--the highest among the 4 countries--about 2/3 of the couples had discussed family planning during the past year. In Ghana, with a rate of 13%, and in Burundi, at 9%, about 1.2 of the couples had discussed family planning during the year. Mali had the lowest contraception prevalence rate of 5% and the least communication among the couples, with only 1.4 discussing family planning during the year. The importance of communication also emerges in data on methods used. In all 4 surveys, the wives reported lower use of male methods than did their husbands. Estimates of use of female methods were more consistent between husbands and wives. Questions were not exactly the same in all 4 surveys, so summaries for each country vary slightly. In Burundi, about 2 of 5 husbands said they used periodic abstinence, compared to about 1 of 5 wives. Husbands said 0.7% used condoms, with 0.3% of the wives giving that response. Husbands an wives agreed that there was no use of male sterilization. The use of vasectomy in Africa is considerably lower than for other regions of the world (see chart below). Ghana showed a similar pattern. Husbands said 2.1% of couples used condoms, compared to 0.3% according to the wives. Husbands also indicated more widespread use of periodic abstinence than did the wives. In contrast, except for pill use, husbands and wives gave similar responses for use of female methods. In Kenya, 1 of every 2 husbands said they were using family planning, compared to about 1 of every 4 wives. The largest discrepancy was in the data for use of periodic abstinence, where 3 times more husbands than wives said they were using this method--26% compared to 8%. Only in Mali, where total contraceptive use is only 5%, were responses from husbands and wives consistent. Even here, husbands gave higher rates of condom use (0.5%) than did wives (none). When it comes to choosing a method of family planning, women apparently think first of female methods. In general, women assume that their husbands will not be interested in using contraception themselves. Women may, however, underestimate their husbands interest or participation in family planning. Or men could be overstating the use of male methods. These DHS husband surveys suggest that programs aimed at both men and women should encourage more and better communication between spouses about family planning. More data related to communication on family planning will soon become available. Other DHS husbands surveys in various stages of completion are from Pakistan, Cameroon, Tanzania, and Egypt.

Africa↗
PubMedDate not supplied

Adolescent males' orientation toward paternity and contraception.

Data from a nationally representative sample of 1,880 young men aged 15-19 reveal that neighborhood quality, parental education, race or ethnicity, and attitudes about male gender roles are related to young men's attitudes toward an unplanned pregnancy and to their contraceptive experiences. Young men who live in poor neighborhoods are more likely to be pleased about an unplanned pregnancy than those who have better living conditions (12% vs. 2%) and are also more likely to view impregnating a woman as enhancing their masculinity (8% vs. 3%). Among men with average living conditions, 12% of black adolescents view fathering a child as enhancing their masculinity, compared with 6% of white adolescents; among those with very good living conditions, these proportions were 10% and 2%, respectively. Young men whose parents had less education and those who held traditional male gender role attitudes were also more likely than their counterparts to view fathering a child as enhancing their masculinity. Regarding contraceptive behavior, sexually active black men and Hispanic men were more likely than white men to have discussed contraception with their last partner; black men were more likely to have used an effective contraceptive method the last time they had intercourse; and black men were more likely to have used a condom at last intercourse. However, young men who were aware that they had been responsible for a previous pregnancy were less likely than those who reported no pregnancies to have used an effective contraceptive the last time they had intercourse. These same young men were also more likely to report that fathering a child would please them and enhance their masculinity.

Adolescent↗
PubMed2000

Astrocytes increase the functional expression of P-glycoprotein in an in vitro model of the blood-brain barrier.

PURPOSE: To investigate the influence of astrocytes on P-glycoprotein (Pgp) expression and intracellular accumulation of Pgp substrates, separate from their net transcellular transport across the blood-brain barrier (BBB). METHODS: An in vitro BBB model was used, comprising of brain capillary endothelial cells (BCEC) monolayers or BCEC co-cultured with astrocytes. RESULTS: BCEC+astrocyte co-cultures seemed to express a higher level of Pgp compared to BCEC monolayers. Inhibition of Pgp results in an increased intracellular accumulation of Pgp substrates in both BCEC monolayers and BCEC+astrocyte co-cultures, and increased the sensitivity for vinblastine mediated disruption of the in vitro BBB (called the vinblastine exclusion assay). BCEC monolayers were more sensitive to vinblastine mediated disruption compared to BCEC+astrocyte co-cultures. In the latter, but not in BCEC monolayers, an inhibitable polar transport of Pgp substrates was only found from the brain to the blood side of the filter. CONCLUSIONS: Astrocytes increase the functional expression of Pgp in our in vitro BBB model. These results also illustrate that an important role for Pgp on the BBB is to protect the barrier against intracellular accumulation of cytotoxic BBB disrupting compounds.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Adolescent sexual behaviour: results from an Ontario sample. Part II: Adolescent use of protection.

This paper reports the frequency of use of protection and rates of birth control pill/condom use by age and gender among a large, sexually active group of Ontario adolescents who were followed from 12 to 17 years of age. The sample consisted of the 759 males and 690 females who reported engaging in sexual intercourse during the McMaster Teen Project. Significantly more females aged 15-17 years reported always using a method of protection, and using the birth control pill. Condom use was more frequent among males at all ages, but reached statistical significance at ages 12, 13 and 17 years. Although the numbers reporting no use of protection decreased with age, by 17 years 36% of males and 33% of females continued to report no use of protection. Large numbers of sexually active Ontario adolescents continue to be vulnerable to pregnancy, STDs and AIDS.

Adolescent↗
PubMed1992

Female condom launched in UK.

The lone-awaited female condom, Femidom, is to be launched at the end of September by manufacturers Chartex. It is being welcomed by the FPA [Family Planning Association] and other family planning experts as a valuable addition to the existing range of contraceptive methods and as an alternative to the male condom in offering effective protection against sexually transmitted diseases including HIV. A lubricated, loose-fitting polyurethane sheath, Femidom is inserted into the vagina at any time before sex. An inner ring holds the condom in place beyond the pubic bone and an outer ring lies flat against the vulva. In addition to extending choice, it is under direct control of the woman. As FPA Director Doreen Massey puts it: "We have to face the fact that some women who want safer sex can't get their partners to use condoms. for the 1st time with Femidom, you can insist that if he won't use a condom, you'll use yours." In trails of self-selected couples, up to 2/3 of women and their partners found the product acceptable. a study at the Institute of Population Studies in Exeter showed that while some couples had initial misgivings about the condom's size and appearance, especially its visibility when in position, these often declined with repeated use. Researcher Dr. Nicholas Ford pointed out that if the female condom makes a woman feel unattractive, her partner's comments may well influence these feelings. Users' experience of insertion and the condom's comfort also improved with repeated use. While there are no large studies showing ranges of effectiveness, it is likely to be as effective as the male condom (about 85%-98%). In a study of 106 women at the margaret Pyke Center in London, there were 7 unplanned pregnancies: 4 were due to inconsistent use of the method and 3 were method failures. Breakages were rare. 1/3 of participants dropped out in the 1st month. Users should continue with their existing contraceptive method until they are sure that they are using Femidom efficiently, recommended the authors. In October the FPA is launching a new free consumer leaflet on male and female condoms. 1/2 million leaflets will be distributed to UK pharmacies in October and November via the Pharmacy Healthcare Scheme as part of a safer sex campaign. a launch event will include the results of a survey asking pharmacists and consumers what they think of condoms.

Behavior↗
PubMed1984

Use of isolated brain capillaries and cultured endothelial cells to study the blood-brain barrier.

Brain capillary endothelial cells are responsible for forming the blood-brain barrier (BBB). Methods are now available to isolate microvessels from brain and study their biochemical and transport characteristics. From these investigations, new ideas have been proposed concerning the role of endothelial cells in the function of the BBB. More recently, success in culturing endothelial cells from brain microvessels has opened the way for novel approaches to the study of the regulation of endothelial cell permeability. We anticipate continued rapid progress in this area and expect that this will lead to a better understanding of the mechanisms involved in the regulation of BBB permeability and brain capillary function.

Animals↗
PubMedDate not supplied

Sexual activity, family life education, and contraceptive practice among young adults in Banjul, The Gambia.

This report presents results from a 1986-87 two-stage probability sample survey of 2,507 young men and women aged 14-24 living in the Greater Banjul region of The Gambia. Although premarital sexual activity was common and began at an early age, lack of knowledge and limited access to modern contraceptives were obstacles to the use of family planning. Of all ever sexually active single persons, only 21 percent of the young women and 7 percent of the young men had practiced contraception at the time of first intercourse. Almost half of the sexually active young adults had ever used contraceptives, with oral contraceptives and condoms being the methods most widely known and used. Results of logistic regression analyses show that attendance at family life education lectures in school had significant positive relationships to both knowledge and use of contraceptives among the young people surveyed. The study presents encouraging evidence that acceptance of modern contraceptive use is beginning to take hold among young people in urban Banjul.

Adolescent↗
PubMed1994

Young adults, alcohol and condom use: what is the connection?

PURPOSE: Concern about HIV in adolescents and young adults has led a number of investigators to examine the link between drinking and risky behavior, including failure to use condoms. Most of the studies that conclude that this link exists have used global measures of both variables and have not investigated drinking and use of condoms on the same occasion. If drinking leads to low condom use, both behaviors must occur together and the failure to find that they do weakens the hypothesis that they are causally related. METHODS: Data from three separate studies on different adolescent and young adult populations are reported. In each study the relationship between drinking behavior and condom use at last intercourse was examined. RESULTS: Drinking was not related to lower condom use in any of the populations studied. CONCLUSIONS: This negative result implies that the dis-inhibiting effect of alcohol is not a major factor in the failure of young adults to use condoms.

Adolescent↗
PubMedDate not supplied

Patterns of risk behaviour for patients with sexually transmitted diseases and surveillance for human immunodeficiency virus in Kuala Lumpur, Malaysia.

A study was conducted to determine the feasibility of establishing a sentinel human immunodeficiency virus (HIV) surveillance system involving patients with sexually transmitted diseases attending private clinics and a government sexually transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk behaviours for HIV infection were also collected. A total of 84 female and 91 male patients were interviewed and tested for HIV infection; 41.7% of the women reported working as prostitutes, other occupations included masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The most common diagnosis was gonorrhoea. Other diagnoses included non-specific genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3% of the women had a hundred or more sex partners during the previous month; 99% had 6 or more sex partners. Only 4.8% of female patients had their male partners using condoms most of the time, 11.9% hardly used condoms at all. Of the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had between 6-20 different partners in the previous year. 78.0% of them had prostitutes as their sex partners most of the time. 41.8% had experiences in Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used condoms rarely. Although all patients were tested negative for HIV antibodies, lot quality assurance sampling methods indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The study has shown that it is feasible to carry out a sentinel surveillance programme among STD patients and provided useful baseline data for future comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Contraception after heart surgery.

This study represents the different methods of contraception used by women having cardiac surgery at Ain Shams University Hospital. The study comprised of 250 women having had mitral commissurotomy, 77 women having had valve replacement including one case of triple valve repair and 3 women having had cardiac surgery for congenital heart disease. An IUCD was used by 170 women (51.5%), vaginal tablets by 4 women (1.2%), oral contraceptive pills by 7 women (2.1%), "safe period" by 7 women (2.1%), tubal ligation was performed in 10 women (3%). The husbands of 33 women (10%) used condoms, and 99 women (30%) did not use contraceptive methods. The IUCD was tolerable and was associated with bleeding in 60 women (35.2%) and leucorrhoea in 55 (32.3%). The IUCD was removed from only one woman due to severe bleeding. Three pregnancies occurred with condom users in two women who had had mitral commissurotomy and one having had valve replacement. There was no case of bacterial endocarditis in the study group.

Abortion, Spontaneous↗
PubMedDate not supplied

Contraceptive practices and trends in France.

CONTEXT: Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. METHODS: A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. RESULTS: Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. CONCLUSIONS: Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.

Adult↗
PubMed1986

Toxic shock syndrome, contraceptive methods, and vaginitis.

To elucidate further the etiology of toxic shock syndrome, we assessed the effects of certain contraceptive methods and recent history of vaginal infection on the incidence of toxic shock syndrome, with confounding effects of other risk factors controlled. We found a strong but imprecise positive association between toxic shock syndrome and tubal ligation (rate ratio = 7.9, 90% confidence interval 1.4 to 42.7). We also observed a negative association with oral contraceptives (rate ratio = 0.49, 90% confidence interval 0.22 to 1.1) and a positive association with a recent history of vaginitis (rate ratio = 2.1, 90% confidence interval 1.2 to 3.9).

Contraceptive Devices, Female↗
PubMed1993

Information needs on emergency contraception not being met.

During the 1980s, there was 2 prominent changes in family planning: more women went to general practitioners (GPs) for contraceptive advice and there was an upturn in the use of condoms due to safer sex campaigns in the mid-80s. In this study of 769 women requesting a pregnancy termination, the author's found that the greater use of condoms had appeared to increase the need for information about emergency contraception, but this was not being met. Patients advised by their GPs seemed to have a lower level of knowledge than those who obtained their contraception from clinics. The study, carried out at St. James's University Hospital in 1991-92, is compared with several studies in the 1970s and 80s which look at contraceptive usage by women with unwanted pregnancies. Differences were found between those receiving contraceptive advice from different sources (i.e. GPs, clinics, no medical source). Failure of the pill was more frequent in the GP-advised group, but failure of the diaphragm was more frequent in the clinic-advised group. Failure of non-use of condoms did not differ according to the source of advice. Knowledge of and use of emergency contraception was low. Only 14.5% of those using no contraception or recognizing a condom failure attempted to use a secondary or emergency method. Condoms should be used as well as rather than instead of other methods of contraception, and knowledge and availability of emergency contraception should be increased and promoted, recommend the authors. They concluded that problems arising from family planning provision by untrained and uncommitted doctors should be addressed urgently. (Bromham and Cartmill, British Journal of Family Planning, vol. 19, 1993, pp179-183). Commenting on the study findings, FPA Medical Information Office Jane Urwin said: "This study has furthered our knowledge in this area. It also highlights the need for further study of risk-taking behavior in relation to contraceptive use's.

Ambulatory Care Facilities↗