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PubMed1996

Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives Depo-Provera and Norplant.

PURPOSE: The objectives of this study were to examine the reasons for discontinuation of the long-acting contraceptives Depo-Provera and Norplant in adolescents, and to assess the adolescents' experience after discontinuation of the methods. METHODS: A total of 35 adolescents [gynecologic age 4.7 +/- 0.3 years, and body mass index (BMI) 24.2 +/- 0.6] who discontinued Depo-Provera, and 31 adolescents (gynecologic age 3.4 +/- 0.3 years, BMI 24.1 +/- 0.9) who discontinued Norplant were periodically assessed during use of the methods and up to 12 months after discontinuation. RESULTS: The most common reasons for discontinuation of both Norplant (after 21.8 +/- 1.6 months of use) and Depo-Provera (9.2 + 0.9 months of use) were irregular menstrual bleeding (64%), weight gain (41%), and increased headaches (30%). Resumption of menstrual regularity and dysmenorrhea was noted sooner after discontinuation of Norplant, compared with Depo-Provera. The increase in BMI noted at discontinuation of Depo-Provera (1.1, P = .0005) and Norplant (1.3, P = .03) persisted up to 6 months after discontinuation of either method (0.6, P = .01 post-Depo-Provera discontinuation; and 0.9, P = 0.02 post-Norplant discontinuation). Only 62% of the adolescents reported no break in contraceptive practice. The condom was the most popular method (37%) after discontinuation of Depo-Provera, and oral contraceptive (39%) after discontinuation of Norplant. The cumulative conception proportion reached 0.93 at 12 months after discontinuation of Norplant, and was significantly higher (P = .01) compared with the cumulative proportion of conception after discontinuation of Depo-Provera (P = .50). CONCLUSIONS: Health care providers should aggressively manage physical problems associated with Depo-Provera and Norplant use, and expedite the transition to a new contraceptive method to minimize the high pregnancy rate observed after discontinuation of these methods in adolescents.

Adolescent↗
PubMedDate not supplied

Increased condom use among teenage males, 1988-1995: the role of attitudes.

CONTEXT: Understanding whether and to what degree changes in young men's attitudes explain increases in condom use over time can be useful in developing more effective disease prevention strategies. METHODS: Data from the 1988 and the 1995 National Survey of Adolescent Males are used to determine changes in attitudes toward condoms, pregnancy prevention and HIV and AIDS. Two-limit tobit models are employed to investigate the association between these attitudes and condom-use behavior and to examine how this relationship may have changed over time. RESULTS: Between 1988 and 1995, young men's attitudes toward partner appreciation of condom use, condom-use embarrassment and pleasure reduction from condom use all changed in a direction suggestive of more consistent condom use. However, attitudes related to pregnancy prevention and AIDS avoidance changed in a direction suggestive of less-consistent condom use. Changes over time in the strength of the relationship between three attitude measures (masculinity, pleasure reduction and partner appreciation) and condom use also were predictive of lower levels of condom-use consistency. Only the strength of the relationship between condom-use embarrassment and consistent condom use changed in a direction corresponding to observed increases in rates of condom use among young men. CONCLUSIONS: Many of the significant changes in young males' attitudes toward condoms do not explain the increase in consistent condom use among adolescent males that occurred between 1988 and 1995. However increasing male contraceptive responsibility and emphasizing the risks and consequences of contracting HIV appear to be viable routes for policymakers to explore. Efforts particularly need to be targeted toward Hispanics.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Use of caffeine metabolite ratios to explore CYP1A2 and xanthine oxidase activities.

Caffeine was used as a metabolic probe to screen healthy subjects for their activities of two enzymes, deduced to be CYP1A2 (an inducible cytochrome P450) and xanthine oxidase. A longitudinal study revealed modest effects of caffeine dose, ethanol intake, and time-of-day on the CYP1A2 index, without any effect on the xanthine oxidase index. The coefficients of intraindividual variation not accounted for were 5.0% for the xanthine oxidase and 17.2% for the CYP1A2 index. In a population study, both indexes showed a log normal distribution, with CYP1A2 values of most subjects covering a 6.3-fold range but only a 1.7-fold range with xanthine oxidase. The CYP1A2 index was 33% decreased in women who used oral contraceptives and substantially increased in cigarette smokers. Neither the CYP1A2 nor the xanthine oxidase index differed between volunteers of Chinese and European extraction. Four of 178 subjects showed unexplained low xanthine oxidase values (i.e., values several standard deviations below the mean).

Adult↗
PubMed2005

Urban poverty and health in developing countries: household and neighborhood effects.

In the United States and other high-income countries, there is intense scholarly and programmatic interest in the effects of household and neighborhood living standards on health. Yet few studies of developing-country cities have explored these issues. We investigated whether the health of urban women and children in poor countries is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys and modeling living standards using factor-analytic MIMIC methods, we found that the neighborhoods of relatively poor households are more heterogeneous than is often asserted. Our results indicated that poor urban households do not tend to live in uniformly poor neighborhoods: about 1 in 10 of a poor household's neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Using multivariate models, we found that household living standards are closely associated with three health measures: unmet need for modern contraception, attendance of a trained health care provider at childbirth, and young children's height for age. Neighborhood living standards exert a significant additional influence in many of the surveys we examined, especially for birth attendance.

Data Collection↗
PubMed1990

Prompting bar patrons with signs to take free condoms.

This study was designed to determine whether signs would prompt bar patrons to avail themselves of free condoms. The intervention at three "gay bars" involved placing a large sign directly above a container of free condoms; the sign gave statistics for the number of people who have died from AIDS in the state and pointed out that condoms can reduce the spread of AIDS. Additional signs placed in the restrooms gave information about safe sex practices and reminded patrons that free condoms could be obtained at a given location in the bar. An ABAB design was used, with a 2-week baseline, 2-week treatment with signs present, 2-week reversal with no signs, and 2-week reinstatement of treatment with signs present. For all three bars combined, 748 condoms were taken with signs present and 510 condoms were taken with signs absent. Overall, when signs were present, the number of condoms taken increased by 47%.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Risk factors for breast cancer in Belgrade].

Reproductive history, contraceptive use, family history of breast cancer, health behaviour and socioeconomic variables of 60 women with breast cancer were compared to those of 71 age and place of living matched hospital controls. Besides nulliparity, all known risk factors for breast cancer were more frequently present in the cases observed, although the statistical significance was not attained (age at first delivery, early menarche, positive family history of breast cancer, positive history of benign breast disease, obesity). Oral contraceptives ever used were reported for 16.7% of cases and 15.5% of controls (RR = 1.09; 95% confidence interval 0.42-2.77). Although the study is small and the difference in the risk factor distribution insignificant, it is clearly consistent with many published studies on the same subject.

Adult↗
PubMed1995

The treatment of hypertension in women.

More women than men eventually develop hypertension, but they suffer less cardiovascular damage as a consequence. Primary hypertension in women has a greater volume component, often related to commonly associated obesity. Most lifestyle modifications have more to offer women, but women respond in a similar manner to various antihypertensive drugs. However, women appear to receive less benefit from antihypertensive therapy, as measured by morbidity and mortality data in multiple large clinical trials. Women who take oral contraceptives typically have a small rise in blood pressure, and in a small percentage, the rise is sufficient to induce hypertension. The prevalence is likely lower with currently used low-dose estrogen formulations. The use of estrogen for postmenopausal replacement therapy almost never raises the blood pressure, so that concerns about hypertension should not interfere with the use of this valuable therapy.

Contraceptives, Oral, Hormonal↗
PubMed1996

Women, hormones and blood pressure.

Raised blood pressure is an important risk factor for both coronary artery disease and stroke in women. In terms of exogenous sex hormones, use of premenopausal oral contraceptives has been consistently associated with higher blood pressure levels; both estrogenic and progestogenic components have been implicated. In contrast, a randomized trial has shown no effect of post-menopausal hormone use on blood pressure. Observational studies indicate a protective effect of postmenopausal estrogen use on coronary artery disease. This is probably largely mediated through effects on lipoproteins and not blood pressure; data on post-menopausal estrogen use and stroke risk are less consistent. Treatment trials have demonstrated beneficial effects of lowering blood pressure on cardiovascular disease, particularly regarding stroke in women. The women most likely to benefit from individually-based clinical preventive interventions for cardiovascular disease, such as hypertension treatment or estrogen replacement therapy, are women who have high absolute risk of cardiovascular disease, ie, older women with high risk factor levels with a family or existing history of cardiovascular disease. Nevertheless, the large international variation in rates of cardiovascular disease indicate the large potential for prevention and suggest that most women are likely to benefit from lifestyles conducive to cardiovascular health, that is increasing physical activity, not smoking and following diets low in sodium and saturated fat and high in fruits and vegetables.

Cerebrovascular Disorders↗
PubMed1996

Cytokeratin 8, 18 and 19 in endometrial epithelium of Norplant and norethisterone enanthate injectable progestogen contraceptive users.

Cytokeratins 8, 18 and 19 are members of the cytoskeletal intermediate filament family found in all simple epithelia. Intermediate filaments are dynamic intracytoplasmic structures that can be influenced by a number of external factors. Norethisterone enanthate (NET-EN) is a long-acting progestogen contraceptive that has been found to arrest endometrial growth in the rat. Both Norplant and NET-EN cause bleeding problems among users which are responsible for > 50% of withdrawals with these methods. The aim of this study was to explore changes in the expression and distribution of cytokeratins 8, 18 and 19 in NET-EN- and Norplant-exposed endometrial epithelium which could be related to bleeding disturbances. Seven NET-EN and 37 Norplant endometrial biopsies were paraffin-embedded and stained immunohistochemically to evaluate cytokeratin expression and distribution. The results showed that women who had received NET-EN for 3-4 months had a cytokeratin distribution similar to that seen in the normal menstrual cycle. This is in contrast to endometrium from Norplant users in which cytokeratin expression was reduced and the epithelial cells were more rounded. No relationship between cytokeratin expression and breakthrough bleeding pattern was found. NET-EN and Norplant may act differently on endometrial epithelial cytokeratin.

Adult↗
PubMed1975

Physical complaints of patients with sickle cell trait.

Prospective and retrospective experience with physical complaints of 112 oral contraceptive and 67 intrauterine device Black family planning patients with sickle cell trait was evaluated by comparing their cumulative complaint rates with a randomly selected control group of non-sickle cell trait family planning patients having the same method, age and parity distribution as the sickle cell trait patients. Physical complaints considered are: dysmenorrhea, mental depression, vaginal discharge, fatigue, headaches, and nausea-vomiting. No evidence of a significant difference at level .05 is found between cumulative complaint rates of sickle cell trait and control patients for either oral or intrauterine device users for any of the complaint types. Further clinical research may be desirable in this area for dysmenorrhea and mental depression.

Anemia, Sickle Cell↗
PubMed2002

Mechanisms that explain the contraceptive action of progestin implants for women.

Four different contraceptive implants for women, in the form of capsules or covered rods, that release either one of the synthetic progestins levonorgestrel, etonogestrel, Nestorone, or Elcometrine and nomegestrol acetate were considered. These progestins act by binding to their receptors located in diverse target cells, which are distributed along the hypothalamic-pituitary-gonadal-genital tract axis. These implants differ in the extent to which each one interferes with various steps of the reproductive process and in the intensity with which each one affects the same process along its effective life, but they have in common the ability to interfere with several key processes required for gamete encounter and fertilization. The steps they interfere with most are the ovulatory process, through partial or complete inhibition of the gonadotropin surge, and by changing the quality of cervical mucus; they restrict or suppress the access of fertile spermatozoa to the site of fertilization. Changes in endometrial development also occur, but this contribution to the contraceptive action is difficult to determine at the present time.

Cervix Mucus↗
PubMedDate not supplied

Pharmacokinetic drug interactions with theophylline.

Since up to 90% of a theophylline dose is biotransformed, drugs influencing microsomal enzyme systems in the liver may affect the elimination of theophylline. Other integrated mechanisms (e.g. hepatic uptake) may also be altered by concurrent administration of other drugs. Whatever the mechanism, the interaction may be sufficient to necessitate adjustment of the theophylline dosage, preferably guided by plasma theophylline determinations. Comedication with phenobarbitone may require an increase of the theophylline dose by about 30% due to increased clearance resulting from enzyme induction. Similarly, with phenytoin and carbamazepine a dose increase of about 40 to 50% may be required. In the case of rifampicin, isoniazid or sulphinpyrazone comedication, an increase of the theophylline dose by about 20 to 25% may be needed. On the other hand, other drugs decrease theophylline clearance, making a reduction in the dose of concurrent theophylline advisable: with usual doses of erythromycin, propranolol and isoprenaline (isoproterenol), a reduction of about 25% is needed; with cimetidine and oral contraceptives by about 30% or more; and with triacetyloleandomycin (troleandomycin) by about 50%. In high doses, the xanthine oxidase inhibitor allopurinol can also retard theophylline elimination, and a reduction of the theophylline dose by about 20% may be advisable. Conflicting results have been reported on the influence of frusemide (furosemide) and influenza vaccines, while data regarding the effect of corticosteroids, benzodiazepines and verapamil on theophylline kinetics are not yet conclusive. Many drugs, however, appear not to significantly affect theophylline clearance. Some are from the same therapeutic group as the drugs mentioned above and offer clinical alternatives for coadministration with theophylline. Examples of drugs not found to have a significant effect on theophylline pharmacokinetics are ranitidine, josamycin, midecamycin, amoxycillin, tetracycline, cephalexin, cefaclor, orciprenaline, metoprolol, antacids, medroxyprogesterone acetate, metoclopramide and metronidazole. Most of the drugs discussed in this review appear not to affect the volume of distribution of theophylline significantly.

Adrenal Cortex Hormones↗
PubMed1995

A population and family study of CYP1A2 using caffeine urinary metabolites.

CYP1A2 is a cytochrome P450 which is inducible by polycyclic aromatic hydrocarbons. This induction could be mediated via the Ah locus, which encodes a cytosolic receptor responsible for the regulation of the CYP1A1 gene. Enzyme activity in vivo can be measured by the urinary caffeine metabolite ratio (AFMU + 1X + 1U)/17U. Our goal was to determine, using this ratio, the possible existence of a genetic polymorphism in CYP1A2 induction. For this purpose, a population and family study, including smokers, were undertaken. In a first step, we investigated factors influencing enzyme activity in a population of 245 unrelated individuals. The induction effect of smoking and inhibiting effect of oral contraceptive use were confirmed. None of the other factors examined (age, sex, level of cigarette consumption, nicotine or tar amounts, filter, inhalation) accounted for the interindividual variability in the metabolic ratio. Using the statistical SKUMIX method, a unimodal (one peak) distribution of the ratio was concluded in 164 unrelated smokers, since a second distribution did not significantly improve the fit to the data (chi 2(1) = 1.39, P > 0.2). Segregation analysis was performed on 68 nuclear families and no major gene effect could be shown. Furthermore, the polygenic model did not provide a higher likelihood than the sporadic one, which argues against the existence of any familial resemblance. Although we cannot rule out the possibility that some environmental factors could obscure the phenotypes and occult a genetic determinism, we conclude that genetic factors are probably negligible in the determination of CYP1A2 activity measured by this method.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Population pharmacokinetic modelling of BIBN 4096 BS, the first compound of the new class of calcitonin gene-related peptide receptor antagonists.

Pharmacokinetics (PK) of the calcitonin gene-related (CGRP) peptide receptor antagonist BIBN 4096 BS, the first compound of this new class tested in humans, has been evaluated combining the data from a phase I study performed in healthy volunteers and a phase IIa study conducted in migraine patients. A total of 94 individuals with a total of 556 plasma samples contributed to the analysis. Subjects received a single dose of 0.25, 0.5, 1, 2.5, 5 or 10 mg BIBN 4096 BS administered in a 10 min i.v. infusion. Blood samples were obtained at selected times up to 12 h. Disposition of BIBN 4096 BS was best described with a three compartment body model with first order elimination. BIBN 4096 BS showed a moderate degree (between 30 and 50%) of inter-subject variability in the apparent volume of distribution of the central compartment (V1), total plasma clearance (CL), distribution clearance between the central and deep compartment, and the apparent volume of distribution of the shallow compartment. Typical estimates of V1 were significantly (P <0.01) lower in healthy volunteers (7.16 versus 9.95 L), and typical estimates of CL were significantly lower in subjects receiving oral contraceptives (11.4 versus 17.1 L/h), although the absolute reduction in the unexplained inter-subject variability was negligible (4%). Computer simulations showed that the above mentioned covariates lack clinical significance. In conclusion, the pharmacokinetics of BIBN 4096 BS was independent of the dose and not altered by the tested covariates to a clinically significant degree.

Adult↗
PubMed2002

Profile of women presenting for abortions in Singapore at the National University Hospital.

The study was conducted to profile women seeking abortions at the National University Hospital, with particular interest in the trend of teenage pregnancies with the aim of identifying risk factors for late presentation for abortions. All patients who underwent an abortion at our center from January 1, 1996 to December 31, 2000 were recruited. Data were entered into a prepared questionnaire during the mandatory pre-abortion counseling sessions and completed at the 6-week post-abortion follow-up. This was then keyed into a database (SPSS Version 10), and the results were analyzed. Multivariate analysis was used in identifying risk factors associated with late presentation for abortions. Chi-square analysis of variables was used where relevant. A total of 1370 women presented for induced abortions during the period of study. The mean age of women was 29.6 years. Most women were either homemakers (35.3%) or semi-skilled workers (28.5%) with at least a secondary school education (58.3%). The majority were married (75.5%). There was a significant trend in the proportion of single women seeking abortions, from 18.3% in 1996 to 27.8% in 2000 (p < 0.05). At the same time, the proportion of women presenting for repeat abortions also increased from 13.8% in 1996 to 33.2% in 2000 (p < 0.05). Teenage abortions made up 117 (8.5%) of the study group, of which 95% were single women. Significant proportions (52.1%) were students at the time of abortion. In contrast to women above 20 years of age, pregnant teenagers were more likely not to have used any contraception (67.1% vs. 37.3%) and more likely to present late for abortion (18.8% vs. 10.4%). Teenage pregnancies are a major risk factor for late presentation for abortions. This emphasizes the need for availability and easy access to early abortion counseling, and the need for sex education with use of contraception starting in schools, to reduce abortions among teenagers.

Abortion, Induced↗
PubMed1997

Use of hormonal methods of birth control among sexually active adolescent girls.

OBJECTIVE: To identify factors associated with the use of various birth control methods among sexually active adolescent girls. DESIGN: A survey distributed as part of a larger study measuring compliance with hepatitis B vaccination. SETTING: A hospital-based and a school-based clinic. MEASURES: Demographic and health behavior data including sexual activity, contraceptive method, substance use, condom use, and history of sexually transmitted diseases (STDs) were collected. Birth control method was confirmed by medical record review. Associations with the outcome variable of birth control method were analyzed using chi square, Kruskal-Wallis analyses of variance, and t-tests, followed by logistic regression analysis. RESULTS: Among sexually experienced girls, 39% (n = 123) reported using oral contraceptive pills (OCPs), 5.4% (n = 17) used Depo-Provera (medroxyprogesterone acetate) or Norplant (levonorgestrel), and 55.6% (n = 175) used no hormonal method. Logistic regression analysis revealed that the factors most significantly associated with the use of hormonal methods were older age (odds ratio [OR] = 1.19; 95% confidence interval [CI], 1.07-1.33), not using a condom at last intercourse (OR = 0.55; CI, 0.34-0.90), and having had a well visit within 1 year (OR = 2.11; CI, 1.12-3.70). OCP users were less likely than Depo-Provera or Norplant users to have used alcohol (p = 0.041), cigarettes (p = 0.002), or marijuana (p = 0.018) in the past 30 days. OCP users were less likely than nonusers of hormonal methods to have smoked cigarettes (p = 0.034) or marijuana (p = 0.052). The school-based clinic had a greater proportion of subjects using long-acting progestins (p < 0.001). CONCLUSIONS: The decreased rate of condom use among those who used hormonal birth control methods and the different rates of health risk behaviors among users of various methods require targeted counseling efforts to decrease pregnancy and STD rates among young women.

Adolescent↗
PubMed1998

Recent trends in breast cancer incidence in Sweden.

Breast cancer incidence in Sweden during the period 1984-93 shows no clear trend in women aged below 40 years but a transient increase at ages 50-69 years, probably as a result of mammography screening. Our data give no indication that use of oral contraceptives or replacement hormones have affected nationwide breast cancer incidence rates.

Adult↗
PubMedDate not supplied

Uterine perforation from induced abortion at Korle Bu Teaching Hospital, Accra, Ghana: a five year review.

A total of 79 cases of perforated uterus from termination of pregnancy in Accra, an incidence of 3.6% of induced abortion were managed at Korle Bu Teaching Hospital during the period 1990-1994. The mean age and parity of patients who had perforated uterus were 21.6 +/- 2.3 years and 1.97 +/- 0.28 respectively. The specific case mortality associated with this calamity was 227.8 per 1000. The need to prevent unwanted pregnancies through improved contraceptive measures and sex education must be emphasised in developing countries.

Abortion, Illegal↗