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PubMed1995

[Factors possibly associated with the age at the onset of menopause. Multicenter study].

A transversal study was performed in 1987 to examine 9,844 postmenopausal women aging from 39 to 59 years, residents from the cities of Durango, Monterrey, Guadalajara and Leon. They had their last menstruation at least 12 months before the interview and they were not pregnant. The objective was to know if the menarche, number of deliveries, use of contraceptive methods and smoking could affect the age of menopause. A case control analysis was performed. Based on frequency distribution of the age on which the menopause appeared, cases were classified as early and late menopause when a median value minus 2 SD and plus 2 SD were found, respectively. For control subjects a median + 1 SD was selected. Two and three controls were randomly assigned for early and late menopause, respectively. In total 1,610 subjects were studied. As a measure of association it was used the odds ratio with a confidence level of 95%. It was performed an analysis of confusion and interaction of variables in this study. The most relevant results were; a significant association between smoking 15 packages of cigarettes a year with an OR of 2.31 (1.05-5.17), to have more than five pregnancies with an OR of Mantel and Haenzel of 0.51 (0.33-0.76) for the early menopause. No association with late menopause was observed. It was found that the mean age of menopause was 45.5 years + 4.5 SD (n = 9,844).

Adult↗
PubMed2005

Consultations concerning contraception and induced abortions among university students--trends in Finland 1986-2003.

The Finnish Student Health Service (FSHS) provides primary health care services to university students in Finland. The material for this study was drawn from the statistics of the FSHS. From 1986 to 2003, the number of students increased by 50%, while physician consultations did not, indeed to the contrary. The numbers of family planning consultations fell from 358 to 217 per 1000 female students. The induced abortion rates among university students are very low compared with the population in general and decreased from 4 to 3 per 1000 female students. Students are responsible, and because they want to postpone pregnancy after studies, they use contraceptives effectively. The FSHS has succeeded in guaranteeing contraception services and in preventing unwanted pregnancies and minimizing the need for induced abortions among university students while at the same time decreasing physician consultations. This was possible by changing the distribution of tasks among physicians and nurses, and by adding telephone contacts instead of face-to-face consultations with physicians.

Abortion, Induced↗
PubMed1981

Contraception and lactation.

Lactation worldwide is estimated to prevent more births than all organized family planning programs, and thus has a definite contraceptive action. In addition, it contributes to better infant nutrition and well-being. In some societies women do not cohabit while lactating and therefore need no contraception. This situation is being eroded, and in any case does not apply generally. The risk of pregnancy increases with the length of lactation, and thus some form of added contraception needs to be adopted during lactation. Because of the nutritional value of lactation, the CMC deprecates the exploitative commercial advertising and promotion of bottlefeeding that exists in many parts of the world. It recommends that the IPPF and its member associations should actively promote breastfeeding. Since pregnancy can occur during lactation, additional contraception is desired. It should be remembered that IUDs, spermicides, mechanical methods, depot medroxyprogesterone acetate, progestagen-only oral contraceptives (OCs), and sterilization have no adverse effects on lactation. Evidence is accumulating that combined OCs have an adverse effect on the quantity and possibly the quality of breastmilk. Therefore, much greater caution should be exercised in distributing combined OCs than previously. Combined OCs should not be started until lactation is well established, and ideally not before 6 months or until the infant is weaned, whichever occurs 1st. If, however, no alternative contraception is available then OCs may be used earlier.

Breast Feeding↗
PubMed1988

Problem visits to a family planning clinic.

In order to obtain information necessary for optimum delivery of services, data were collected on the nature of the services provided at a family planing clinic. Clinic visits were divided into initial, annual, routine, problem, supply, educational and unknown. An analysis of the "problem" visits was undertaken to assess various epidemiologic aspects of such visits and to identify areas of clinic efficiency that could be improved. Problem visits were defined as any visits for which the patient had a presenting complaint. Age, level of education, method of contraception and parity were statistically associated with problem visits. When compared to Pill users, diaphragm users, intrauterine device users and non-users had a higher-than-expected number of problem visits. Less educated women and teenagers had a lower-than-expected number of problem visits when compared to more educated and older women. Socioeconomic status and problem visits were not statistically associated. Problem visits required more time, utilized more medical services and resulted in more referrals to the gynecology clinic than did other visit types. As a result of this analysis, we have increased our educational efforts for patients at high risk of problem visits and have instituted a special problem-oriented family planning clinic in which a full complement of house staff and ancillary personnel are available. This arrangement makes the uncomplicated family planning clinic run more smoothly and efficiently and obviates the need for time-consuming and cost-ineffective referrals.

Adolescent↗
PubMedDate not supplied

Sources of prescription contraceptives and subsequent pregnancy among young women.

For more than four in 10 teenage women who first obtained a prescription contraceptive from a private doctor or family planning clinic prior to pregnancy, marriage or interview in 1979, that method was the first they had ever used. Whites were over two times more likely to have previously used a nonprescription method than were blacks. Blacks, on the other hand, were two times more likely than whites to have been virgins before first using a prescription method. Slightly more than half of all young women who used a prescription method first obtained it from a family planning clinic, and the remainder got it from a private physician. Blacks were much more likely to have gone to a clinic than were whites. Nine in 10 of those who obtained a prescription method chose the pill. Among blacks, there was no appreciable difference between those who got the method from a clinic and those whose source was a private doctor. Whites who obtained their method from a private doctor, however, were somewhat more likely to choose the pill than were those who got it from a clinic. Of all who had been sexually active before ever using a prescription method, about eight out of 10 whites, but only about five in 10 blacks, had previously used a nonprescription method. Overall, there was an interval of about one year between first intercourse and the time the young women first got a prescription method. Among whites, there was no difference in parental education or family stability between clinic and private physician patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Emergency contraception. General practitioner knowledge, attitudes and practices in New South Wales.

OBJECTIVES: To assess the knowledge, attitudes and practices of general practitioners in New South Wales regarding the provision of emergency contraception. DESIGN: Randomised group comparison of 100 rural and 100 urban general practitioners (GPs) by questionnaire. RESULTS: Eighty-four rural and 76 urban GPs responded. More rural GPs were knowledgeable about emergency contraception than urban GPs (95% v. 78%), and more women knew about it than men. More urban GPs frequently prescribed emergency contraception than rural GPs (26% v. 6%) and female GPs prescribed it more readily than male GPs (22% v. 12%). There was great variation in the regimens prescribed, especially among rural GPs. Twenty-five per cent of urban GPs and 31% of rural GPs did not offer women information about emergency contraception, while 16% of both groups included such information in any discussion about contraceptive options, and 18% gave information only if requested by the woman. More than 60% of the GPs would provide information about emergency contraception as a back-up to use of barrier methods. CONCLUSIONS: The sex, attitude and knowledge of the GPs influence the likelihood of women being made aware of or being given emergency contraception in NSW. There is a need to further educate both the public and practitioners about emergency contraception.

Attitude of Health Personnel↗
PubMed1976

Abortion research in Latin America.

Surveys dealing with abortion in Latin America have provided useful information despite problems in the collection and use of the data. Considerations that should be taken into account in designing abortion surveys and using the resultant information have been discussed here. Special attention has been paid to the need for a broad definition of "abortion" in order to overcome difficulties in gathering information about abortion in Latin America. Surveys have shown increasing incidence of abortion throughout Latin America in the recent past. In examining changes over time it is crucial to interpret clearly and carefully the summary measures of proportion of pregnancies ending in abortion and abortion rates per 1,000 women. It is also important to realize that the level and direction of change of the abortion rate depends on both the rate at which women are becoming pregnant and the proportion of pregnancies ending in abortion. Better survey design and techniques and more careful use of the resulting information will aid in the planning and evaluation of programs aimed at reducing abortion in Latin America.

Abortion, Induced↗
PubMed2002

Surface vascularization and endometrial appearance in women with menorrhagia or using levonorgestrel contraceptive implants. Implications for the mechanisms of breakthrough bleeding.

BACKGROUND: Women using progestogen-only contraceptives are commonly troubled by irregular bleeding. Endometrial vessel breakdown and repair is thought to be locally regulated under the indirect influence of sex steroids. Most information about endometrial vessels is derived from blind biopsies taken in an outpatient setting. Hysteroscopy allows in-vivo observation of the whole endometrial surface, including vessel morphology, distribution and areas of bleeding, as well as information about non-vascular structures that may not be accessible from biopsies. METHODS: Hysteroscopies were performed on 34 women using the levonorgestrel contraceptive implant system (Norplant(TM)) and in a comparison group of 20 women complaining of menorrhagia due to ovulatory dysfunctional bleeding. The images were captured and vascular appearances assessed using image analysis. RESULTS: The percentage of the superficial endometrium covered with blood vessels was found to be significantly greater in Norplant users compared with the comparison group (P = 0.0006). More superficial vessels were seen in those with recent frequent or prolonged bleeding and spotting (P < 0.0001). In Norplant users, but not in the comparison group, superficial vascular distribution was predominantly patchy (P < 0.0001). Unusual vascular appearances classified as 'neovascular' (P < 0.0001) and 'mosaic' (P < 0.0001) patterns were commonly seen in Norplant users but not in the comparison group. The hysteroscopic appearance of the endometrial epithelium, glands and stroma also differed between Norplant users and women with menorrhagia. Apparent shedding of the superficial endometrium was commonly seen by hysteroscopy in Norplant users during a bleeding episode (P < 0.0001). Prominent gland openings with thick mucus were commonly seen in Norplant users and small sessile polyps were seen in six cases. CONCLUSIONS: These hysteroscopic observations provide further evidence that exposure to progestogens alters the superficial endometrial vasculature and may interfere with angiogenesis.

Adult↗
PubMed1985

Determination of reference intervals for 10 serum proteins measured by rate nephelometry, taking into consideration different sample groups and different distribution functions.

Reference intervals were established for 10 serum proteins (IgA, IgG, IgM, transferrin, haptoglobin, complement C3, complement C4, alpha 1-acid-glycoprotein, alpha 1-antitrypsin, alpha 2-macroglobulin) measured by rate nephelometry. The reference individuals - 200 blood donors - were divided into 5 subgroups: men aged 19-39 and 40-60 years, women aged 19-39 and 40-60 years and women aged 19-48 years using oral contraceptives. Where possible, two or more subgroups were combined to give reference sample groups. Criteria for this procedure are given. The reference limits of the sample groups were estimated by parametric methods. Assuming that for a specified serum protein the type of distribution is the same in each subgroup, the data were standardized with estimated group specific parameter values and combined into one big sample. This permitted an improved determination of the underlying type of distribution. As a possible form of distribution we also considered the normal distribution truncated on the left side at c greater than or equal to 0. In some cases, after determination of an optimal c, this unusual distribution fitted the data significantly better than the generally used normal or log-normal distribution.

Adult↗
PubMedDate not supplied

The emergency contraception collaborative prescribing experience in Washington State.

OBJECTIVE: To describe how prescribers and pharmacists view the Emergency Contraceptive Pills (ECP) program, and to evaluate pharmacists' performance through the use of a consumer survey. DESIGN: Self-administered provider satisfaction surveys were mailed 6 months after the program's inception. Consumer satisfaction surveys were distributed at the point of ECP service for return by mail. SETTING: The program encouraged pharmacists and prescribers in western Washington to enter into collaborative prescribing agreements, increasing consumers' access to ECP. PATIENTS OR OTHER PARTICIPANTS: Pharmacists who had attended ECP training sessions, prescribers who had authorized pharmacists to prescribe ECP, and women who had been prescribed ECP by pharmacists. MAIN OUTCOME MEASURES: Providers' reasons for participating, attitudes toward the ECP program, and experiences with ECP as a result of the program; feedback from women receiving ECP from pharmacists. RESULTS: 309 pharmacist surveys and 55 prescriber surveys were sent, of which 159 (51%) and 27 (49%), respectively, were returned. Meeting patient needs and having a professional responsibility to participate were commonly reported reasons for ECP program involvement. Both pharmacists and prescribers (92%) reported being "satisfied" or "very satisfied" with their prescribing agreements. On the 470 consumer surveys returned out of 7,000 distributed (6.5%), pharmacists were rated highly satisfactory for their interactions with patients and the quality of information about ECP use given, but less satisfactory for information about adverse effects, recognition and follow-up of ECP failure, and regular contraceptive methods. CONCLUSION: All participants expressed satisfaction with the ECP program. This example should support the initiation of similar programs in other states.

Adult↗