[Family planning in a suburban development of Mexico City].
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Adolescent↗
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Pregnancy terminating activity of a new non-hormonal anti-fertility agent, 2-(3-ethoxy-phenyl)-5,6-dihydro-s-triazole [5,1-a] isoquinoline (DL 204-IT) in the rat and the hamster. Studies on the factors affecting its activity.
The biological and the pharmacokinetic profiles of 2-(3-ethoxy-phenyl)-5,6-dihydro-s-triazole [5,1-a]isoquinoline (DL 204-IT) were explored in rats and hamsters at different stages of gestation (1st--11th day) after single and multiple (5 days) doses given in different vehicles (oily and aqueous) and by different routes of administration (s.c., i.m., i.v.). The effectiveness of the compound was demonstrated to be dependent on time of gestation, dose and vehicle. DL 204-IT did not show any pre-implantation activity. The optimal time for treatment was found to be immediately after the implantation of blastocysts. Time-course studies demonstrated that the anti-fertility action is slow and progressive with subsequent degeneration and reabsorption (rats and hamsters), or expulsion (only hamsters) of conceptuses. The biological and pharmacokinetic data show that with prolonged presence of the compound at the site of action (the utero-placental complex) lower doses are far more active in interrupting embryonal development than are much higher ones for shorter time periods.
Abortifacient Agents↗
Comparison of contraceptive implant adopters and pill users in a family planning clinic in Baltimore.
All 133 women who began using the Norplant contraceptive implant between August and December of 1991 at a Planned Parenthood clinic in Baltimore were compared with a sample of 112 women who obtained prescriptions for the pill at the same clinic during the same time period. A multivariate analysis found that women of Medicaid are significantly more likely than those who are self-paying to select the implant rather than the pill. Similarly, compared with women who have had no children, those who have had two or more are also significantly more likely to choose the implant. However, adolescents and women who have had an abortion are no more likely than other women to select the implant.
Adolescent↗
More evils of CYP.
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Community Health Planning↗
Human papillomavirus infection at the United States-Mexico border: implications for cervical cancer prevention and control.
The United States-Mexico border is a region comprised of a country with one of the highest rates of invasive cervical cancer (Mexico) and a country with one of the lowest rates (United States). Recent evidence clearly indicates that human papillomavirus (HPV) infection is the cause of cervical cancer. The distribution of specific types of HPV is known to vary in different regions of the world, as do the cofactors that may inhibit or promote HPV carcinogenesis. Estimating the prevalence of oncogenic HPV is needed for guiding vaccine development. The purpose of this study was to determine the prevalence of oncogenic and nononcogenic HPV types and risk factors for HPV among women residing along the United States-Mexico border. A cross-sectional study of 2319 women, ages 15-79 years, self-referring for gynecological care was conducted between 1997 and 1998. HPV was detected by PCR using the PYGMY 09/11 L1 consensus primer, and HPV genotyping was conducted using the reverse line blot method. Overall, the HPV prevalence was 14.4% with no significant differences observed by country after adjustment for age. HPV 16 was the most commonly detected HPV type in both the United States and Mexico. Among women with high-grade squamous intraepithelial lesions, HPV types 58, 45, 51, 31, 35, 55, and 73 were most common in Mexico, and HPV types 18, 31, 35, 51, 52, and 58 were most common in the United States. In both countries, HPV prevalence declined linearly with age from 25% among women ages 15-19 years to 5.3% among women 56-65 years. Factors significantly independently associated with HPV infection were older age [adjusted odds ratio (AOR) = 0.15 for ages 56-65 years compared with those 15-19 years], a marital status other than married (AOR = 1.58-3.29), increased numbers of lifetime male partners (AOR = 3.8 for > or =10 partners compared with 1 partner), concurrent infection with Chlamydia trachomatis (AOR = 1.79), ever use of Norplant (AOR = 2.69), and current use of injectable contraceptives (AOR = 2.29). Risk factors for HPV infection did not differ by country. Results from this study suggest that in addition to HPV 16 and 18, HPV types 31, 45, 51, and 58 should be considered for inclusion in an HPV prevention vaccine for distribution in Mexico.
Adolescent↗
Awareness, prevalence, medication use, and risk factors of acute mountain sickness in tourists trekking around the Annapurnas in Nepal: a 12-year follow-up.
Acute altitude exposure may lead to acute mountain sickness (AMS). Increased awareness of altitude-related health hazards in trekkers may accompany a decrease in AMS prevalence. We compared awareness and AMS prevalence in trekkers in two cohorts on an altitude trek up to 5400 m and assessed risk factors for AMS by repeating an observational cohort study 12 yr after an initial study. Questionnaires in English were distributed to two cohorts of 500 trekkers in 1986 and 1998. All trekkers over a several day period were asked to participate. Average participation rate was 62% (71% in 1986 and 53% in 1998). We found an increase in AMS awareness in trekkers from 80% to 95%, a decrease in AMS prevalence from 43% to 29%, and significant slower climbing profiles. We found no relationship between AMS and smoking habits, body mass index, oral contraception intake, or training status. By contrast, age was a strong independent risk factor inversely related to AMS. Subjects over 55 yr were 2.6 times less likely to suffer from AMS than subjects under 25 yr. Self-medication, including acetazolamide and analgesics, had increased importantly from 17% to 56%, and contraception intake in women had increased from 19% to 32%. In conclusion, in 1998 as compared to 1986, trekkers were older, climbed more slowly, had better awareness of altitude illness, used more medication, and suffered less from AMS.
Acclimatization↗
Imipramine disposition in users of oral contraceptive steroids.
Ten women on long-term, low-dose estrogen oral contraceptive steroids (OCS) and eight age-matched drug-free female controls received an intravenous infusion of 12.5 mg imipramine. Eleven (six OCS users and five controls) also took a 50-mg oral dose of imipramine on another occasion. After intravenous injection, volume of distribution was much the same in the OCS and control groups and clearance was of the same order (899 and 975 ml/min). Elimination t1/2 was prolonged in OCS users after intravenous doses (17.8 vs 25.5 hr) but did not change after oral doses (18.4 vs 19.1 hr). Imipramine plasma protein binding was of the same order in both groups. Absolute bioavailability increased in OCS users (from 27.1% vs 44.1%), which resulted in a trend toward decreased apparent oral clearance (from 4649 vs 2322 ml/min). Women who used OCS regularly show little change in imipramine kinetics after intravenous dosing. After oral dosing absolute systemic bioavailability increased, resulting in decreased apparent oral clearance in the absence of any change in oral elimination t1/2. Imipramine (with high first-pass hepatic extraction) is nonrestrictively cleared, with drug elimination predominantly a function of hepatic blood flow. These data are consistent with OCS inhibition of hepatic imipramine oxidation with no alteration in hepatic blood flow resulting from chronic OCS use.
Administration, Oral↗
Breast cancer and environmental risks: where is the link?
Environmental factors may play an important role in the etiology of female breast cancer. This paper reviews existing evidence to compare and analyze environmental agents in relation to breast cancer. The authors have reviewed multiple studies focusing on xenoestrogens, organochlorines, polychlorinated biphenyls, and other environmental agents, and the results are cited. Current use of oral contraceptives and prolonged use of hormone replacement therapy moderately increase risk. Evidence regarding organochlorine exposure and breast cancer risk is mixed. Atrazine is not associated with breast cancer risk, but dieldrin and lindane are. The effects of polychlorinated biphenyls vary according to specific congeners. An observational study has linked benzene to breast cancer, but another case control study has refuted the association. Risk of breast cancer with smoking is strong in families with a history of breast cancer, ovarian cancer, or both. Studies have shown a positive association of breast cancer with heterocyclic amines in women who eat well-done meat. Thus, many environmental factors have been significantly associated with breast cancer. Differing distribution of socio-demographic factors, including race/ethnicity, parity, and, possibly, nutritional status, may explain some of the inconsistencies across studies. Further research is needed to verify associations.
Breast Neoplasms↗
Consequences of intrauterine contraception in diabetic women.
A study has been performed covering the clinical consequences of copper intrauterine device insertion in 103 insulin-dependent women and in 119 nondiabetic control subjects. Furthermore, the progress of corrosion has been measured in 15 intrauterine devices removed from diabetic women, and the results were compared with data obtained from nondiabetic women. The clinical data did not reveal any differences in the total continuation rates or in the removal rates because of accidental pregnancy or pelvic inflammation between the diabetic and the nondiabetic women after 3 and 12 months. Also, the maximal depth of corrosion as well as the distribution and the biochemical constitution of the corrosion products deposited on the copper wires were found identical in the two groups studied.
Adolescent↗
Antipyrine pharmacokinetics in women receiving conjugated estrogens.
The pharmacokinetics of a single 1.0 to 1.2-g intravenous dose of antipyrine was studied in 22 healthy female volunteers aged 28 to 70 years (mean, 45 years). Eleven subjects had been taking a conjugated estrogen preparation for at least 3 months; the other 11 subjects who were not taking conjugated estrogens and who were matched for age, weight, and smoking patterns, served as a control group. Plasma antipyrine concentrations were determined by high-pressure liquid chromatography (HPLC) in multiple plasma samples drawn 24 to 48 hours after dosage. Mean +/- SE pharmacokinetic variables in control and conjugated-estrogen groups were volume of distribution, 0.57 +/- 0.02 versus 0.56 +/- 0.02 L/kg; elimination half-life, 11.0 +/- 0.82 versus 12.6 +/- 0.89 hours; and clearance, 0.63 +/- 0.06 versus 0.54 +/- 0.03 mL/min/kg. None of the differences was significant. Although antipyrine clearance is significantly impaired by oral contraceptives, there is no evidence of altered antipyrine pharmacokinetics from treatment with conjugated estrogens.
Adult↗
Intravaginal toxicity studies of a gel-microemulsion formulation of spermicidal vanadocenes in rabbits.
Bis-cyclopentadienyl complexes of vanadium(IV) or vanadocenes are rapid and potent inhibitors of human sperm motility with potential as a new class of contraceptive agents. We investigated the toxicity potential of intravaginally administered gel-microemulsion formulation of two representative vanadocenes, vanadocene acetylacetonato monotriflate (VDACAC) and vanadocene dithiocarbamate (VDDTC), in the rabbit model. New Zealand White rabbits in subgroups of three were exposed intravaginally to a gel-microemulsion with and without 0.1 or 0.25% VDACAC and VDDTC for 10 consecutive days. The doses of vanadocenes used were nearly 500- to 1250-fold and 2000- to 5000-fold higher than their respective in vitro spermicidal EC50 values. Animals were euthanized on day 11 and vaginal tissues were evaluated for local toxicity by histopathology, cell proliferating activity by immunohistochemical detection of proliferating cell nuclear antigen (PCNA), and in situ apoptosis by the terminal deoxynucleotidyl transferase-mediated FITC-deoxyuridine triphosphate nick end-labeling (TUNEL) assay and confocal laser scanning microscopy (CLSM). Blood was analyzed for clinical chemistry profiles. Vanadium content in selected organs and body fluids was determined by atomic absorption spectroscopy. None of the rabbits given 0.1% VDACAC and VDDTC intravaginally developed epithelial ulceration, edema, leukocyte influx, or vascular congestion characteristic of inflammation. Only minimal to moderate irritation was observed at 0.25% VDACAC and VDDTC. A significant decrease in epithelial and stromal PCNA expression was observed in the 0.25% dose group. However, TUNEL assay and CLSM revealed no staining in the vaginal epithelium and only minimal nonspecific staining in the stroma. Repetitive intravaginal application of 0.1 or 0.25% VDACAC and VDDTC had no adverse effects on clinical chemistry profiles. Vanadium was not incorporated into rabbit tissues and body fluids at levels above 1 microg/g. Thus, intravaginal administration of VDACAC and VDDTC at concentrations nearly 500 and 2000 times higher than their respective in vitro spermicidal EC50 values did not induce marked vaginal irritation, mucosal toxicity, or systemic absorption of vanadium in the rabbit model. The lack of significant mucosal or systemic toxicity of intravaginal vanadocenes observed may have particular clinical utility as a new class of contraceptive agents.
Administration, Intravaginal↗
Distributions and determinants of total and high-density lipoprotein cholesterol in Dutch children and young adults.
Serum total cholesterol and its putative determinants were measured in 5,089 subjects, ages 5-30 years, comprising 76% of the total population of two districts of the Dutch town of Zoetermeer. From this group, 596 subjects, ages 5-19 years, were randomly selected, and distributions and determinants of high-density lipoprotein (HDL) cholesterol were studied in 458 of them. The variables studied included body weight; Quetelet index; menarche; parental cholesterol; physical activity; consumption of coffee, alcohol, and tobacco; and use of oral contraceptives. Mean total cholesterol levels showed a decrease in both boys and girls between the ages of 10 and 16 years. Mean HDL cholesterol levels remained the same until the age of 17, after which they showed an increase for females and a decrease for males. Total cholesterol was associated with age, body weight (in those older than 15 years), and parental cholesterol concentrations. For HDL cholesterol, the most important determinants were gender, age, and body weight (the latter only for males 15 years and older). These findings suggest that during growth and maturation the determinants of serum cholesterol differ from those later on in life.
Adolescent↗
Pros and cons of intrauterine contraception--do perceptions of users and physicians differ?
OBJECTIVE: To investigate women's and physicians' opinions of IUD use. DESIGN: Two cross-sectional postal surveys; on women in 1987-1988, on physicians in 1988. SETTING: Survey on women: southernmost Uusimaa province (including Helsinki). Survey on physicians: whole of Finland. PARTICIPANTS: Of a stratified random sample of 1000 women aged 18-44 years 84% returned the questionnaire (N = 844). Of a sample of 480 physicians (including GPs and gynaecologists) 418 were eligible, 74% of whom responded (N = 311). MAIN OUTCOME MEASURES: Women's and physicians' opinions of and experiences with IUD use as reported in postal questionnaires. RESULTS: Most women considered that IUDs were a good method of contraception. Users' and physicians' reports on benefits and disadvantages of IUDs metched each other; both most often mentioned ease of use, efficacy, and lack of systemic effects. Major disadvantages reported by women were bleeding, pain, infection, and pregnancy. Physicians further pointed to the risk of ectopic pregnancy. Though reports of side-effects were commonplace, there was reasonable satisfaction with IUD use. CONCLUSION: This study reveals that most women, and physicians, have a realistic picture of the common problems related to intrauterine contraception. It also emphasizes that, when making contraceptive choices, one is bound to compare possible disadvantages with benefits offered.
Adult↗
Herpes gestationis.
Herpes gestationis is a rare, pruritic, non-viral, polymorphic dermatosis of pregnancy and the puerperium. Lesions in this disorder are typified by pruritic vesiculobullae and urticarial plaques distributed over the abdomen, buttocks, and extremities. HG tends to recur in subsequent pregnancies and often flares at delivery. Although HG usually resolves within weeks to months of parturition, patients may experience a flare of disease after taking oral contraceptives or in response to other hormonal stimuli. Biopsy specimens from lesional sites demonstrate characteristic but not diagnostic features. The diagnosis of HG is based not only on its clinical and histopathologic features but also on the demonstration of linear deposits of C3 within the epidermal BMZ of the patient's normal-appearing, perilesional skin. These deposits signify the presence of a low-titer anti-epidermal BMZ IgG antibody that binds a precise antigen within the lamina lucida, avidly fixes complement, and presumably produces an inflammatory reaction responsible for tissue damage and blister formation. It is critical to study patient skin for evidence of C3 in situ because some patients with HG show no evidence of an antiepidermal BMZ antibody in routine indirect immunofluorescence microscopy and some remain negative in specialized complement-fixation studies. An additional laboratory finding in patients with HG is their increased frequency of the HLA-B8 and HLA-DR3 haplotypes as well as the HLA-DR3, -DR4 paired haplotype. Herpes gestationis has clinical, histologic, and immunopathologic features that resemble selected aspects of BP. Although many dissimilarities exist between these diseases, studies have shown that antiepidermal BMZ antibodies in patients with HG and BP recognize related or identical antigens.(ABSTRACT TRUNCATED AT 250 WORDS)
Female↗
Effects of various factors on selection for family planning status and natural fecundability: a simulation study.
The effect of various factors on selection for family planning status and for natural fecundability is studied in a simulation that incorporates a beta distribution of fecundability among women. The mean fecundabilities of current spacers, current limiters, current nonusers, and pregnant women are compared. These ratios are influenced by duration of marriage and by desired number of children. Effects of different levels of contraception are measured. Another strategy, spacing the last two wanted births, is also studied. It is found that breast-feeding status has little effect on fecundability selection. The women usually found to have greatest fecundability are not those recently pregnant at durations of marriage five and ten years, unless they wanted fewer than two children, but rather those who are using contraception to limit the number of children.
Adult↗
[Urinary tract infections in gynecology and obstetrics].
Against the background of more recent insights into the general importance of urinary infections, specific reference is made to the demands made, in that context, on gynaecology and obstetrics. An attempt is made to expound the epidemiological chain of causes, ranging from defloration cystitis and including gestational processes as well as all sorts of gynaecological effects up to possible diseases in the menopause. The high probability of secondary diseases in adult age should be the point of departure for conclusions regarding "prophylaxis". Description of a stepwise programme for diagnosis, therefore, is followed by discussion of aspects relating to urine collection, differentiation between significant bacteriuria courses, assessment of asymptomatic bacteriuria, distribution of germs, and demands on monitoring action. Therapies are discussed separately for gynaecological patients and pregnant women. In conclusion, major emphasis is laid on the need for taking widest possible advantage of advisory centres for pregnant women and contraception consultative services for early detection of renal diseases and hypertension as well as for more efficient follow-up or extended medical care for patients whose urinary infections has been (re)discovered and treated by obstetricians or gynaecologists.
Adolescent↗
Condom use by Hispanic and African-American adolescent girls who use hormonal contraception.
PURPOSE: The purpose of the present study was to examine condom use by teens who use hormonal contraceptives [i.e., Depo-Provera, Norplant, or oral contraceptives (OCs)]. METHODS: This is a cross-sectional study of 578 Hispanic and African-American female adolescents between the ages of 12 and 21 years who came to a reproductive health care clinic. A paper-and-pencil questionnaire which addressed sexual behaviors, sexual history, and communication about sexuality was distributed to adolescent girls attending the clinic. Several important analyses included only those who had been sexually active in the last 4 weeks (n = 452). RESULTS: Adolescents who used OCs [odds ratio (OR) 1.7], long-acting agents (i.e., Depo-Provera or Norplant) (OR 1.6), were less likely to have used a condom in the last 4 weeks than teens whose only method of birth control was condoms. Only those teens who had previously been diagnosed with a sexually transmitted disease (STD) were more likely to have used a condom (OR .67 for not using a condom). Overall, condom use by teens in this sample was low, with only 19% reporting that they "always" use a condom, and 47% of the teens who had been sexually active in the last 4 weeks reporting that they had not used a condom at least once during that time. CONCLUSIONS: This study provides data which suggest that adolescent girls who use hormonal contraceptives are less likely to use condoms than other sexually active teens. Therefore, when prescribing hormonal contraception to prevent pregnancy, clinicians must provide appropriate counseling to mitigate against the potential to increase the risk of STDs.
Adolescent↗
Influence of manufacturing parameters on development of contraceptive steroid loaded injectable microspheres.
The main objective of this work was to develop a system consisting of polymeric microspheres loaded with steroid drugs. The drugs were encapsulated using biodegradable poly(lactide-co-glycolide) (PLG) and poly(epsilon-caprolactone) (PCL) by double emulsion solvent evaporation method. The lipophilic drugs, levonorgestrel and ethinylestradiol were made soluble by adding ethanol/water mixture. The effects of parameters like polymer concentration and stabilizer concentration were studied on the size, size distribution, surface properties and loading efficiencies of microspheres. The formulated microspheres were smooth, spherical and uniform in shape and size. Fourier transformed infrared spectroscopy and differential scanning calorimetry studies seemed to confirm the absence of chemical interaction between the drugs and the polymers, while the drugs were dispersed in the polymer. The increase in polymer concentrations increased the size as well as the loading efficiency of microspheres. Data obtained in this study demonstrated that the PLG/PCL microspheres may be a suitable polymeric carrier for long acting injectable drug delivery.
Biodegradation, Environmental↗