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PubMed1993

Quality of care in family planning in Latin America.

The majority of family planning programs in Latin America have been implemented in response to the region's population growth and aimed mainly at obtaining quantitative results, leaving quality, from the user's point of view, in second place. Recent decades have witnessed an increasing concern for quality of care in family planning because most researchers and service providers began to realize that when contraceptive methods are delivered without maintaining high quality levels, continuation rates are usually low and the image of methods and services is impaired. This paper reviews the level of quality of services in family planning in Latin America following Judith Bruce's framework and proposes, some activities that may improve it. The analysis found severe deficiencies in almost all the elements mentioned by Bruce, mainly in choice, technical competence, and mechanisms for improving continuity. The authors propose that to improve quality, services should (a) generate top management commitment to quality, (b) stay close to the client/user, (c) improve work conditions of providers/health workers, (d) measure quality, and (e) reward quality. The authors' conclusions are that (a) better quality services lead to better program results, (b) high quality is cost-effective, (c) managerial commitment is critical to improvement of quality, and (d) quality of care is not a luxury; it is necessary and possible in all settings.

Clinical Competence↗
PubMed1991

The impact of HIV upon injecting drug users: a longitudinal study.

This paper provides quantitative and qualitative material relating to concern about HIV infection and AIDS, HIV status and patterns of drug use, and sexual behaviour amongst 14 injecting drug users. It is part of a longitudinal study involving interviews with 115 regular illicit drug users conducted between December 1987 and June 1988, of whom 21 were current injectors. Follow-up interviews with 14 of these injectors were conducted between September 1989 and April 1990. Whilst there are some encouraging signs of behaviour change in relation to needle-sharing, sexual behaviour change was less apparent. It is concluded that there is still a long way to go in terms of encouraging, facilitating and supporting continued safer practices.

Adult↗
PubMed2004

The ability of a gonadotropin-releasing hormone antagonist, acyline, to prevent irreversible infertility induced by the indenopyridine, CDB-4022, in adult male rats: the role of testosterone.

Intratesticular testosterone (ITT) is known to play a critical role in the maintenance of spermatogenesis. We have used acyline, a GnRH antagonist, to suppress testosterone (T) production, and acyline and T implants to study the prevention of irreversible infertility induced by CDB-4022. Vehicle or acyline was administered to proven fertile male rats (n = 5/group) at a dose (210 microg/day) that completely suppressed (P < 0.05) T production, as measured by serum T, and testicular function, either before, concurrent with, or after vehicle or a single oral dose of 2.5 mg CDB-4022/kg (Week 0). Vehicle-treated males remained fertile, whereas acyline-treated males exhibited transitory infertility. CDB-4022 alone caused irreversible infertility in all males. Importantly, CDB-4022-treated males recovered fertility when acyline was started before CDB-4022 (Weeks -4 to 0; Weeks -4-9), but not when acyline was administered concurrently with or after CDB-4022 (Weeks 0-9; Weeks 10-19). At the end of this study (Week 34), testes weights, spermatid head counts (SHC), and tubule differentiation indices (TDI) were suppressed (P < 0.05) in infertile CDB-4022-treated males, but in rats that recovered fertility, these parameters were similar (P > 0.05) to those in vehicle-treated males. In addition, serum inhibin B and epididymal androgen-binding protein levels were nondetectable in infertile CDB-4022-treated rats. To test whether suppression of ITT was critical for prevention of CDB-4022-induced infertility, proven fertile rats (n = 7-8/group) received vehicle, acyline alone, or acyline and a T implant for 4 wk before CDB-4022 (Week 0). The T implant increased ITT in acyline-treated rats. Although ITT was lower (P < 0.05) in the T-implanted males than in untreated rats, it was sufficient to sustain spermiogenesis. Serum rFSH levels were also elevated in rats treated with acyline + T as compared with acyline alone during the treatment interval, but rFSH was still lower than in vehicle-treated rats. Rats in all treatment groups were rendered infertile initially, but the acyline + CDB-4022-treated rats recovered fertility by Week 10. In contrast, rats treated with CDB-4022 alone or acyline + T + CDB-4022 remained infertile until at least Week 16. Testes weights, SHC, and TDI were within normal ranges for acyline + CDB-4022-treated rats, but were decreased (P < 0.05) in CDB-4022- or acyline + T + CDB-4022-treated rats. Serum inhibin B levels were nondetectable by Week 1 in males rendered irreversibly infertile by CDB-4022; levels increased transiently and returned to baseline in rats protected by acyline pretreatment. These data indicate that pretreatment with acyline was able to prevent irreversible infertility in CDB-4022-treated rats, whereas posttreatment with acyline did not promote spermatogonial differentiation, as has been observed by others in rats that received GnRH analogs and various other testicular toxicants. Suppression of ITT and possibly rFSH by acyline appeared to be crucial in preventing irreversible infertility induced by CDB-4022. In this regard, our results are similar to those of investigators who have studied other testicular toxicants. Continued development of CDB-4022 as a potential male contraceptive will depend largely on its safety profile and whether its antispermatogenic activity is reversible in primates.

Animals↗
PubMed1994

The secondary müllerian system revisited.

The peritoneum is the matrix where benign and malignant proliferation of secondary müllerian epithelium occur. Endometriosis, endosalpingiosis, and endocervicosis are benign peritoneal neoplasms corresponding to endometrioid, serous, and mucinous carcinomas. These latter are concentrated predominantly, although not exclusively in the ovary, and reasons for this localization are discussed. Exposure to talc, or perhaps to the asbestos that often contaminates it, occurs in the process of powdering during infancy and may be the major initiating factor in benign and malignant disorders of the secondary müllerian system. It can be anticipated that the incidence both of endometriosis and of ovarian tumors will be reduced in those women powdered with starch instead of talc during infancy, as well as by the continued use of ovulation-suppressing agents such as contraceptive steroids.

Endometriosis↗
PubMed2003

Hormone replacement therapy and epithelial ovarian cancer: is there and association?

Recently it was estimated that about one-third of postmenopausal British women aged 50-64 years currently uses hormone replacement therapy (HRT) for treatment of climacteric symptoms and for other medical reasons. To reduce an excess risk of endometrial cancer induced by oestrogens, modern HRT regimens contain either sequential or continuous progestogens. The protective effect of parity and oral contraceptive use observed in the majority of epidemiological studies on epithelial ovarian cancer (EOC) suggest that hormonal factors are likely to operate in ovarian carcinogenesis. However, the studies where HRT was examined in relation to the risk of EOC have reported conflicting results. The objective of this epidemiological review is to evaluate the risk of EOC in relation to the use of HRT, with particular focus on the few studies where oestrogens and progestogens in HRT were assessed separately. Further, the findings regarding HRT and EOC risk will be discussed in the context of available aetiological hypotheses. Finally, any clinical implications are commented upon.

Case-Control Studies↗
PubMed2001

Tobacco use trends and correlates among students in the Madison Metropolitan School District.

Trends in cigarette use among students in grades 7-12 in the Madison Metropolitan School District were examined using data from the Dane County Youth Survey, which has been conducted every 5 years since 1980. Past year use of smoking tobacco among these students declined from 40% to 45% through 1995 to 32% in 2000. Past month cigarette use declined from 27% in 1995 to 18% in 2000; daily smoking dropped from 15% in 1990 to 8% in 2000. Among 12th grade students, 1999 national data show that 35% smoked in the past month, compared to 30% of Madison 12th graders. Bivariate analyses show significant socio-economic and race/ethnic disparities in cigarette smoking rates. Hispanic, Native American and white students reported higher rates of smoking than Asian and African American students. Students whose parents had more education were less likely to smoke, as were those students who themselves were academically successful and who had college plans. Students who smoked were far more likely than non-smokers to engage in other risky behaviors, including use of alcohol and marijuana, and to be sexually active. Parental monitoring and supervision, support in one's neighborhood, and participation in volunteer and leadership activities were associated with lower rates of smoking. Risk factors associated with increased rates of smoking included other drug use, aggressive behavior, less family disapproval of risky behavior, and self-concerns about one's own behaviors. These data can assist in targeting prevention and cessation efforts for Wisconsin adolescents. Physicians and other care providers should consider cigarette smoking as a sentinel event that signals the need for screening for potential substance abuse, sexually transmitted diseases (STDs) and contraceptive care. School-based preventive efforts should be continued, particularly at the middle school level, with cessation programs added at the high school level.

Child↗
PubMed1981

Catholic perspectives on populations issues II.

This Bulletin discusses the history and current status of the population problem from a Roman Catholic viewpoint. While upholding human rights and admitting the right of couples to control the size of their families, the Catholic Church continues to prohibit the use of artificial methods of contraception as sinful. This position hinders the Church, with its some 750 million adherents, from taking an effective lead in confronting the growing threat of global overpopulation. Rhythm has been permitted since 1930 but Pope Pius 12 in 1958 forbade contraceptive use of the pill. Despite the liberal spirit engendered by Vatican Council 2 and against the recommendation of a papal birth control commission, Pope Paul 6 in his 1968 Encyclical Humanae vitae reaffirmed the ban on artificial contraception, apparently convinced that this was necessary to combat growing sexual immorality, family breakdown, and materialism. This stance has been upheld by Pope John Paul 2 and the 1980 Synod of Bishops. The decision ignores the pleas of a number of responsible churchmen speaking for their people at the Synod and of a growing majority of Catholic theologians and laity, that Church teaching must be updated to take account of the facts of modern life. Surveys reveal that Catholic married couples increasingly find Church-approved natural family planning methods unsatisfactory and feel obliged to turn to artificial methods to regulate their family size. On the world scale, Pope John Paul 2 and the Vatican, while insisting on human rights and the need for a reordering of unjust economic, social, and political structures, seem to be neglecting the threat of civilizational breakdown that looms with the prospect of too many people in too little space with too few resources.

Abortion, Induced↗
PubMed1993

[The significance of the "routine spermiogram". A critical analysis].

A spermiogram includes the determination of the sperm count (normal range 20-250 million/ml), the percentage of motile cells (> 50%) and the percentage of abnormal cells (< 60%). Male infertility is the most important indication for a spermiogram. The values for seminal parameters, however, show only a weak correlation with conception rates, even in the case of in vitro fertilization. This may be due to the wide variability of values in an individual man, but it is also likely that the aetiopathogenesis of infertility is not only determined by parameters that can be assessed microscopically, but in addition by functional parameters that have not yet been identified. The assumption that computer-assisted image analysis of motility and morphology (CASA) would improve the predictive power of seminal parameters has not been verified. However, the spermiogram is useful in therapeutic studies of male infertility. When the extent of relevant alterations is assessed the wide intraindividual variability must be borne in mind. Treatment cannot be assumed to have been successful unless the sperm count increases by more than 50% of the initial value. Side effects of drugs affecting spermatogenesis and recovery after cessation of therapy can be demonstrated by repeated spermiograms. Evidence of the effects of environmental factors can also be seen in the spermiogram, but distinct correlations are difficult to determine. Semen analysis continues to be used in the development of male contraceptives, but is no substitute for the measurement of conception rates.

Adolescent↗
PubMed1972

Oral contraceptives and tryptophan metabolism: effects of oestrogen in low dose combined with a progestagen and of a low-dose progestagen (megestrol acetate) given alone.

The effect upon tryptophan metabolism of the use of combined oestrogen-progestagen oral contraceptives containing a low (0.05 mg) dose of oestrogen, or of the continuous administration of megestrol acetate, has been studied by determining the excretion of tryptophan metabolites in urine collected after a 2 g oral dose of the amino acid. An investigation of 10 women before being given oral contraceptives and after 21 days and three months of their use showed that xanthurenic acid excretion is increased within 21 days and that by three months the urinary levels of xanthurenic acid, kynurenine, 3-hydroxykynurenine, and 3-hydroxyanthranilic acid may all be elevated. Ten other women studied after taking a combined type of oral contraceptive for six months or longer excreted significantly higher levels of all four metabolites than did those who had been treated with these steroids for only three months. The abnormal urinary excretion of tryptophan metabolites was completely reversed by treatment with pyridoxine hydrochloride, 20 mg daily for one month. Studies of four women when they were taking an oestrogen-containing oral contraceptive and at intervals after they had discontinued its use showed that abnormal tryptophan metabolism may persist for three months or longer. Megestrol acetate, a progestagen used as an oral contraceptive, was found to have no significant effect upon tryptophan metabolism.The possible clinical significance of the effects of oral contraceptives upon tryptophan metabolism is discussed.

Chromatography, Thin Layer↗
PubMed1984

[Contraceptive effect of low-dosage ovulation inhibitors containing various progestagen agents].

The decrease of steroid dosage in oral contraceptives resulted in a decrease of serious side effects with continued effectiveness. However, a increase in subjectively disturbing bleeding abnormalities occurred at the same time. The development of triphasic preparations was designed to eliminate these abnormal bleeding episodes by stepwise changes of the estrogen and progestagen doses. Compared to the low dosage combination preparation, triphasic preparations show often a persistence of insufficiently suppressed hormone levels in single determinations but not in mean averages of determinations. This could be an explanation for the reported pregnancies. In spite of these results, the literature reports rare failures during the administration of the triphasic preparations and additional factors could determine the contraceptive effectiveness.

Adolescent↗
PubMed2000

Trends in fertility and contraception in the last quarter of the 20th century.

The late 1960s and early 1970s saw major changes in access to birth control. This article reviews trends in fertility and contraception between 1976 when the Family Formation Survey was undertaken and 1998, the latest year for which data are available. There has been an increase in mean age at childbirth over the period. Some of this increase is possibly a result of childbearing in second and subsequent relationships when the women will be older on average. This also has had an impact on their patterns of contraception use. Teenage pregnancy is high on the Government's agenda. Teenage pregnancy continues at constant levels. As the estimated age of first intercourse decreases, there is a continued need for sufficient, accessible and appropriate family planning services.

Abortion, Legal↗
PubMed1985

Gonadotrophin-releasing hormone agonists for new approaches to contraception in man.

Potent and long-acting stimulatory analogues to the hypothalamic gonadotrophin-releasing hormone (GnRH) were originally developed for profertility purposes. Paradoxically they proved to possess anti-fertility properties. Their anti-gonadal properties are at present being utilized for therapeutic purposes, e.g. contraception, treatment of central precocious puberty and sex steroid-dependent benign and malignant diseases of the reproductive organs, predominantly metastatic prostatic cancer. This review will be limited to the potential use of superactive GnRH agonists for contraception in women and men. Inhibit ion of ovulation by continuous GnRH agonist administration has been studied most extensively and will be dealt with in more detail. Other approaches to interfere with corpus luteum function (induction of in adequate luteal function, luteolysis or early abortion) have so far proved less successful. In males, complete azoospermia has not been consistently achieved by chronic high dose GnRH superagonist therapy alone. Testosterone supplementation is mandatory to avoid the unacceptable side effects associated with GnRH superagonist therapy, namely loss of libido and potency. Thus, to date, inhibition of ovulation by repeated intranasal GnRH agonist administration seems to have the greatest potential as a future contraceptive method. In long-term clinical trials, this new lead to birth control has already proved to provide safe, reliable and reversible contraception in women.

Abortion, Induced↗
PubMed2004

The Coraliance study: non-compliant behavior. Results after a 6-month follow-up of patients on oral contraceptives.

OBJECTIVES: This follow-up study was planned to establish the frequency with which women miss their contraceptive pill, and to observe their behavior when they forget it. In those women who changed from a continuous cycle to an interrupted type of cycle, or vice versa, the study also aimed to evaluate the impact of this change on the pattern of omission of pills. METHODS: The longitudinal, prospective cohort study included healthy women of child-bearing age for whom a change of pill was being prescribed by their gynecologist. Data were recorded during the 6 months preceding inclusion in the study, and for the 6 months of follow-up; the women were asked to complete a diary in which they recorded the number and exact times of pill omission, and their behavior at each omission. RESULTS: A total of 617 gynecologists included 3316 women into the study; of these, a group of 2418 (73%) revisited the same gynecologist at follow-up. The groups who either visited the same or a different gynecologist were similar with respect to age, oral contraception type, omission type and frequency. A large non-compliance rate and women's difficulties in maintaining safe contraception after missing a pill were observed in the group with follow-up. Women were never risk-free when they missed a pill; they turned to numerous sources for discordant or conflicting information; 15% of 'not-forgetting' women at the pre-inclusion cycle recorded at least one omission at the last cycle of the 6-month follow-up period. Omission fluctuations during the observational period make it difficult to designate 'forgetful' or 'non-forgetful' classes of women. Administration of the pill in a continuous cycle, and probably 'study' and 'auto-questionnaire' effects, contributed to an improvement in compliance. In the group taking the continuous cycle pill, the omission number slightly decreased, particularly on the first day and week of the cycle, irrespective of the initial cycle type. CONCLUSIONS: The importance of the phenomenon of non-compliance rate is confirmed as well as women's difficulties in knowing how to maintain contraceptive safety. The continuous cycle regimen is likely to improve women's compliance during the critical period of the cycle.

Adult↗
PubMed1999

"Not just a statistic": the history of USA and UK policy over thrombotic disease and the oral contraceptive pill, 1960s-1970s.

Today it is estimated that over 100 million women worldwide have taken the oral contraceptive pill since 1956, when the first clinical trials were undertaken. Since its introduction on to the American market in 1960 and the British one in 1961, the pill has become one of the most popular contraceptives in both countries. Unlike other forms of drugs, which have primarily been formulated to prevent or cure illness, the oral contraceptive pill was designed to be given to healthy women over long periods of time, making the necessity for regulation and medical monitoring that much more pertinent. Focusing on the USA and Britain, this paper concentrates on the different ways in which each country has monitored and secured the safety of the pill between 1960 and 1970. While the British government decided to phase-out high dose oestrogen contraceptive pills associated with thrombotic disease in 1969, such pills continued to be available in the USA through to the 1980s, with measures instead being directed towards supplying better information to patients about the possible side-effects of the pill. The paper explores the reasons for this difference in policy, showing how it was shaped by the particular research orientation of each country as well as the specific legal, medical, social and political traditions within Britain and the USA.

Contraceptives, Oral↗
PubMed2006

Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data.

BACKGROUND: Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours-sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. METHODS: We did a secondary analysis of public-access data sets in 18 African countries (132,800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. FINDINGS: Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. INTERPRETATION: Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified.

Adolescent↗
PubMed2006

Unemployment, contraceptive behaviour and reproductive outcomes among young Australian women.

AIMS: To examine whether unemployment and partnership affects pregnancy, live births and terminations among young Australian women. Unemployment has conventionally been used in epidemiological studies to examine the health effects of loss of opportunity, material resources and satisfaction associated with work. During welfare reform in the 1990s it was argued that unemployment and associated welfare receipt could influence reproductive choice. DESIGN: As part of the Australian Longitudinal Study of Women's Health, information on employment, contraceptive use and pregnancy, live births and terminations was obtained at two time points. Information on partnership, age, parental education, and area economic resources was also obtained. The sample included 9683 women aged 18-23 years in 1996 (time 1) and 2000 (time 2). ANALYSIS: Logistic regressions were conducted to assess the relationship between unemployment and contraceptive use at time 1 and the impact of unemployment at time 1 on pregnancy, live births and terminations at time 2. Analyses accounted for partnership, significant differences in contraception, age, parental education and area economic resources. RESULTS: Despite the absence of differences in overall rates of contraceptive use, rates of pregnancy and live births among young unemployed women were higher than rates among employed women. These differences became non-significant when differences in the need to use contraception and oral contraceptive use were taken into account. There were no differences in terminations due to unemployment overall but partnered unemployed women were more likely to have a termination than other women. CONCLUSIONS: The study did not support the notion that being unemployed provided incentives for single motherhood. However excess terminations suggest that unemployment might provide disincentives to continuing pregnancies among partnered and unemployed women. More detailed examination of contraception and partnership may be key in unraveling inconsistencies in past research.

Adolescent↗
PubMed1979

Underlying family-size preferences and reproductive behavior.

Although about half the married women in a US survey said they wanted one or two children, underlying family-size preferences indicate a potential for many to have larger families. Using a measure of family-size preference that probes beyond single-valued statements, it is found that identical stated family-size desires or intentions may have different meanings for different people. Differences are systematically related to the stage in family building at which contraception begins, to current (or likelihood of future) use of effective methods, to the probability of continued childbearing, and to unwanted pregnancies.

Adolescent↗