RESUMEN

We aimed to assess the acceptability of a variety of formulations of female-controlled methods of protection against HIV and STDs among men and women in south-western Uganda. Pilot interviews were carried out with 50 men and 55 women and 25 focus group discussions (FGDs) were held with 138 women and 42 men. The female condom, foaming tablets, sponge, foam, gel and film were demonstrated to 146 women and 35 of their male partners, who then tried out 2 of the products. They were interviewed 7 times during the course of 5 months. At the end experiences were evaluated during a second series of FGDs. Sixty-five (45%) women completed the trial. The main reasons for non-completion were related to geographical mobility. Product preference after the initial demonstration was similar to that at the end of the trial. The most popular formulations were the sponge (25% of the women), foaming tablets (23%), and the female condom (19%). The foam was of medium popularity (16%). The gel (9%) and film (7%) were least popular. Ten per cent of the women and 14% of the men reported products interfering with sexual enjoyment; 24% of the women and 67% of the men said products increased enjoyment. 'Dry sex' is not popular in this area and increased lubrication was an important determinant of acceptability. Age, level of education and location did have some effect on preference. Although secrecy was a dominant theme in the FGDs, 87% of the women had informed their partners by the end of the trial. The products were generally well received. Female control was an important issue for both sexes. Male attitudes were ambivalent because female ownership of products increased women's control. Although they have clear preferences, women appear to accept the products generally and might use a single available product just as readily if choice was limited, as long as it conforms to general cultural preferences, such as those relating to wet/dry sex.

Asunto(s)

Condones Femeninos , Control Interno-Externo , Aceptación de la Atención de Salud , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Femenino , Grupos Focales , Infecciones por VIH/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Encuestas y Cuestionarios , Uganda , Salud de la Mujer

RESUMEN

PIP: Ovulation begins to decline between the ages of 38 and 42 years accompanied by the decrease in circulating levels of estrogen. In a pilot study of 75 mid-life women at a large mid-Atlantic medical center, women were divided into 2 groups: those aged 45 through 49 years and those aged 50 through 55 years. In the study, 31 of the 75 women were already menopausal. The diaphragm was the major method used among the 65.3% of women using birth control, but its use by perimenopausal women is questionable, as a diaphragm may not fit as tightly as it had previously. Condoms with foams were found to be the second most frequent contraceptive method used. Condoms and foam may be the most functional method of birth control for the perimenopausal woman, as foam can be a lubricating source alleviating any dyspareunia. Condoms may be unpopular with older men already experiencing decreasing penile sensitivity. IUD use is limited, although 4 women continued to use either the hormone IUD, Progestaset, or the newer copper T-IUD. The major side effect has been the development of pelvic inflammatory disease possibly resulting in infertility. The IUD is contraindicated if the woman has experienced menorrhagia, uterine fibroids, or previous cervical surgery. The device has to be removed prior to the true menopausal state to prevent the IUD from becoming embedded in the uterine wall. Although the use of oral contraceptives by perimenopausal women remains controversial, 3 women in the study were taking them. If the woman does not smoke, is not obese, and is considered healthy, oral contraceptives containing 50 mcg estrogen have been shown to be safe for older women and without significant link to cardiovascular mortality. Oral contraceptives also can reestablish a regular menstrual cycle, prevent menopausal symptoms, and retard osteoporosis. Abstinence may prove a viable method. Nurse practitioners can also present the pros and cons of hormone replacement therapy and help women choose appropriate contraceptive methods during the perimenopausal years.^ieng

Asunto(s)

Conducta de Elección , Anticoncepción/métodos , Menopausia , Adulto , Anticoncepción/psicología , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto

RESUMEN

Condoms for men are currently the most effective of the nonprescription contraceptive methods. They are readily available, simple to use, and relatively inexpensive, and they are not associated with major adverse effects. If used both properly and consistently, condoms can significantly reduce the risk of transmission of HIV and other STDs. The protection offered by the latex condom may be increased by the concurrent use of a vaginal foam or cream containing nonoxynol 9. The practicing pharmacist should know about the variety of condoms available, be able to explain their correct use to maximize effectiveness, and compare condom use with other types of contraceptives. The practitioner should be available to answer patrons' questions and provide counseling on contraceptives and "safe sex" practices.

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PIP: In the US. condoms for males are made of either lamb cecum or latex. Lamb cecum condoms are less elastic than latex condoms. Thus, they can come off the penis making them less effective form of protection from sexually transmitted diseases (STDs). They are also more expensive. Condoms come in several varieties (reservoir end and lubricated with a spermicide, nonoxynol 9) and in several sizes (standard and large). Their contraceptive effectiveness ranges from 64% to 97%. Study design, patient characteristics, and socioeconomic status may explain this broad range. Breaking, improper use, and inconsistent use account for contraceptive failures. Use with vaginal foam reduces the failure rate to 1 to 3%. Some advantages identified by consumers and health workers were peace of mind, ease of use, convenience, preventing, STDs, arousing to put on, easily obtained, safe and effective, no side effects or toxicity, inexpensive, medical supervision not required, and can be used as a backup contraceptive. Some disadvantages include reduced sensation, breakage or slippage and improper use. Men and women sometimes suffer allergic reactions from the lubricants, spermicides, or chemicals used in manufacturing. Pharmacists could advise consumers to switch to another condom brand. If this does not stop the irritation, the consumer should see a physician because an STD may be causing the irritation. In vitro studies indicate that nonoxynol 9 kills or inactivates many STD pathogens including herpes simplex virus and HIV. A female condom should be available by the end of 1992. Trials show it to protect effectively against pregnancy and STDs. Even though neither the female condom nor diaphragm cause vaginal trauma, the condom does not change the vaginal flora significantly. Pharmacists should familiarize themselves with the different types of male and female condoms and be able to adequately counsel customers about their correct use and safe sex practices.

Asunto(s)

Conducta de Elección , Condones , Farmacéuticos , Anticoncepción , Femenino , Humanos , Masculino , Educación del Paciente como Asunto , Embarazo , Enfermedades de Transmisión Sexual/prevención & control

RESUMEN

PIP: For the 1st time since 1969 the findings of the Annual Birth Control Study conducted by R.W. Johnson Pharmaceutical Research Institute, an Ortho research division, were released to the public. The mail-survey had more than 8000 respondents aged 15-50, out of 12,500. 78% of respondents gave the pill a favorable rating, even if they did not use it. That was the highest favorable rating of any contraceptive. The pill is also the most widely used with 28%, sterilization was 2nd with 24%, condoms were 3rd with 16%. The IUD was the least favorable method with 52% rating it unfavorable and 54% saying they would never use it. Surprisingly the 1% who do use the IUD are the most satisfied, with 98% of women with IUDs saying they are happy with them. Foam users were 2nd with 993% followed by pill users with 92%. Withdrawal was the least favorable method with only 78%. Women stay on the pill longer with the average lifetime use rate of 4.8 years. 37% have taken it for 5 or more years. Condoms have become more popular with 16% of the respondents reporting their use compared to 12% in 1988. 20% of women use condoms in conjunction with another method. 21% of pill users also use condoms. The survey indicates to the Ortho company what women like and dislike about contraception. The study has led to predictions of improved formulations of the pill for all users and specialized formulation for groups of women with different needs. Ortho is currently researching biodegradable implants, long-acting injectables, and patches. Speculation that Ortha may get back into the IUD market exists, although there was no official announcement.^ieng

Asunto(s)

Condones , Conducta Anticonceptiva , Anticoncepción , Anticonceptivos Orales , Conocimientos, Actitudes y Práctica en Salud , Dispositivos Intrauterinos , Aceptación de la Atención de Salud , Esterilización Reproductiva , Cremas, Espumas y Geles Vaginales , Américas , Recolección de Datos , Países Desarrollados , Servicios de Planificación Familiar , América del Norte , Investigación , Muestreo , Espermicidas , Estados Unidos

RESUMEN

PIP: A researcher conducted a case study of the Family Planning Social Marketing Project (FPSMP) in Bangladesh between 1974-1987 to point out the irreducible qualitative differences between the commercial and social contexts and between the developed and developing world. The research consisted of interviews with chief personnel of the technical assistance contractor Population Services International (PSI), project documentation, a review of marketing principles and methods, and summary reports on contraceptive social marketing projects in various countries. FPSMP, a vertical marketing organization, marketed 3 condom brands, 2 oral contraceptive brands, and 1 vaginal foam tablet. At least 70% of the advertising budget was allocated for conventional media (television [TV], radio, and newspapers), even though the poor and illiterate target population did not own a radio or TV and could not read a newspaper. In fact, conventional media were basically accessible to the urban elite. A PSI leader defended the use of conventional media because opinion leaders (urban elite) exert considerable influence on the population so they must receive the family planning messages in order to support family planning. Yet this assumption had not been tested, but was based on the experience of technical assistance contractors from previous projects in developing countries. Moreover, FPSMP based acceptability of message content on the elite's definition and not on the definition of the target group. Its information strategy included emphasis on the sales indicator and the creation of positive product associations while downplaying information about side effects and contraindications. This indicated that FPSMP did not consider client health and well being as important. Another issue was the need to satisfy USAID and the government. More research on other social marketing projects is needed.^ieng

Asunto(s)

Publicidad , Condones , Anticoncepción , Anticonceptivos Orales , Planificación en Salud , Necesidades y Demandas de Servicios de Salud , Entrevistas como Asunto , Liderazgo , Comercialización de los Servicios de Salud , Medios de Comunicación de Masas , Factores Socioeconómicos , Cremas, Espumas y Geles Vaginales , Asia , Bangladesh , Comunicación , Recolección de Datos , Países en Desarrollo , Economía , Servicios de Planificación Familiar , Conocimientos, Actitudes y Práctica en Salud , Organización y Administración , Investigación , Espermicidas

RESUMEN

Use of oral contraceptives by married women declined markedly between 1973 and 1982, but analysis of data from the 1988 National Survey of Family Growth shows that this decline stopped between 1982 and 1988. Reliance on female sterilization continued to increase, however, and it remained the leading method among currently married and formerly married women. Among women of all marital statuses, IUD use dropped by two-thirds between 1982 and 1988, from 2.2 million to 0.7 million women. As the proportion of less-educated, low-income, black and Hispanic contraceptive users choosing the IUD decreased, the proportion relying on female sterilization increased. Among college-educated white women, use of female sterilization did not increase; instead, pill use rose in this group. Condom use increased most sharply among teenagers and rose among never-married white and black women, but the pill was still the leading method by far in these groups, regardless of race. Among never-married black women, reliance on sterilization increased significantly between 1982 and 1988, with female sterilization becoming the second leading method. Use of the diaphragm declined sharply over the same period among never-married white women and among those who intended to have more children, as did use of periodic abstinence (rhythm and natural family planning) and foam.

Asunto(s)

Anticoncepción/estadística & datos numéricos , Adolescente , Adulto , Anticoncepción/tendencias , Escolaridad , Etnicidad , Femenino , Humanos , Matrimonio/etnología , Análisis Multivariante , Factores Socioeconómicos , Estados Unidos/epidemiología

RESUMEN

Printed materials meant to convey health messages are apt to make a more striking and lasting impression on their audience if they are well illustrated. But coming up with good illustrations takes time, effort and care. The Program for Appropriate Technology in Health (PATH) has found that the best way of ensuring that illustrations will be understood and accepted is to develop them with the help of representatives of the target audience.

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PIP: Its experiences in Nigeria and Pakistan have shown the Program the Appropriate Technology in Health (PATH) the importance of enlisting the aid of the intended audience when developing illustrated print materials for health education. Good illustrations generally make any print material more interesting, and make it easier for the audience to grasp and remember the message. This is especially true when dealing with an audience of low educational status. Furthermore, illustrations serve as a good medium for addressing culturally sensitive issues. Audience involvement in the form of focus groups and pretesting ensures that the materials is accurate, understandable, and acceptable to the target population. One of PATH's projects in developing illustrated materials took place in Nigeria. The aim was to instruct to population on the dangers associated with harmful traditional practice such as female circumcision, early childhood marriage, and nutritional taboos during pregnancy. This report traces the effort to develop illustrated material specifically dealing with female circumcision, from the initial efforts of to gather information through focus groups, to the 3 pretesting phases (the report includes the initial draft and subsequent revisions). The report also describes a experiences of a project designed to take a contraceptive package insert developed in the United Kingdom and adapt it for use in Pakistan. The material dealt with the use of contraceptive foam, and the challenge was to make it culturally sensitive and easy to understand. These experiences show that audience involvement is useful when creating new materials, adapting existing materials, or evaluating the effectiveness of materials once completed.

Asunto(s)

Libros Ilustrados , Servicios de Planificación Familiar/educación , Educación en Salud/métodos , Humanos , Nigeria , Pakistán

RESUMEN

A case-control study was conducted in Utah between 1984 and 1987 to examine risk factors for cervical cancer. Interviews were completed with 266 histologically confirmed carcinoma in situ and invasive squamous cell cervical cancer cases who were categorically matched by age to 408 controls. Among the factors identified as altering risk for cervical cancer, after adjustment for age, education, church attendance, and cigarette smoking, were: having numerous sex partners (odds ratio (OR) = 8.99 for 10 or more partners); the current mate having several sex partners (adjusted OR for 10 or more partners = 8.62); using foam or jelly as a contraceptive method (OR, adjusted for number of sex partners, = 0.44); reported Trichomonas infection (OR, adjusted for number of sex partners, = 2.10); and herpes simplex virus type 2 infection as determined by 2:1 neutralization index values above 100 (OR = 2.70). A protective effect was noted from the use of diaphragms (OR = 0.67) or condoms (OR = 0.53) in women who reported more than one sex partner. These data support the hypothesis that cervical cancer is a sexually transmitted disease.

Asunto(s)

Carcinoma in Situ/etiología , Carcinoma de Células Escamosas/etiología , Anticonceptivos Femeninos , Conducta Sexual , Parejas Sexuales , Enfermedades de Transmisión Sexual/etiología , Neoplasias del Cuello Uterino/etiología , Adulto , Factores de Edad , Femenino , Infecciones por Herpesviridae/complicaciones , Humanos , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Utah

RESUMEN

PIP: Practical tips for using home pregnancy tests, for maximizing the hygienic effects of spermicides, and for minimizing the risk of toxic shock syndrome during use of contraceptive sponges are summarized here. All home pregnancy tests are comparable in accuracy: they differ in cost, type of read out and clarity of instructions. The most important tips to follow are to read directions and to wait 10 days after the missed period. It is best to do 2 tests, to visit a physician if the results differ, to continue contraception even if the first test is negative. Be wary of factors that may influence the result, such as drug intake, stress, weight loss and athletic training. Toxic shock syndrome, indicated by fever above 102 degrees Farenheit, brief rash, very low blood pressure, vomiting, diarrhea, muscle pain and later by peeling skin on hands and feet, is not associated unduly with using sponges. Those who have had toxic shock, or are menstruating, should not use sponges, nor should anyone wear one for more than 30 hours continuously. Spermicides, whether in foams, suppositories, creams, films or jellies, help to kill organisms causing sexually transmitted gonorrhea, Chlamydia, and pelvic infections. Their effectiveness is increased by consistent use such as adhering strictly to time limitations on the label, tabulated in this newsletter.^ieng

Asunto(s)

Chlamydia , Anticoncepción , Anticonceptivos Femeninos , Dispositivos Anticonceptivos Femeninos , Enfermedad , Honorarios y Precios , Administración Financiera , Gonorrea , Infecciones , Enfermedad Inflamatoria Pélvica , Pesarios , Pruebas Inmunológicas de Embarazo , Pruebas de Embarazo , Autocuidado , Choque Séptico , Espermicidas , Cremas, Espumas y Geles Vaginales , Técnicas de Laboratorio Clínico , Anticonceptivos , Diagnóstico , Economía , Servicios de Planificación Familiar , Productos para la Higiene Menstrual , Enfermedades de Transmisión Sexual , Terapéutica

RESUMEN

Results are reported for a comparative 12-month study of Neo Sampoon foaming vaginal tablets containing 60 mg of the spermicide, menfegol, and Emko vaginal foam containing an 8.0% concentration of the spermicide, nonoxynol-9. Conducted in cooperation with the Family Planning Association in Alexandria, Egypt, the trial included 349 women who were randomly allocated to use one of the two contraceptive products. The twelve-month cumulative life-table rate for accidental pregnancy (per 100 women) was 2.8 for Neo Sampoon tablet users and 2.1 for Emko foam users. The 12-month continuation rates were 77.6 and 77.2 per 100 women for the tablet and foam groups, respectively. In both groups, the majority of discontinuations from the study were for personal reasons, including lack of confidence in the method, messiness, partner's objection and a burning sensation. Few women reported a product-related complaint while using their assigned contraceptive method. The most commonly reported complaint for both methods was that use of the product led to an uncomfortable burning sensation for the woman and/or her partner. This complaint, however, was cited by less than 5% of the women in each group. Thus, a combination of low pregnancy rates, few complications and complaints and high continuation rates confirm the relative acceptability, effectiveness and short-term safety of these methods of contraception among this sample of Egyptian women.

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PIP: Results are reported for a 12-month study of Neo Sampoon foaming vaginal tablets containing 60mg of the spermicide, menfegol, and EMKO vaginal foam containing an 8.0% concentration of the spermicide, nonoxynol-9. Conducted in cooperation with the Family Planning Association in Alexandria, Egypt, the trial included 349 women randomly allocated to use 1 of 2 contraceptive products. The 12-month cumulative life-table rate for accidental pregnancy (per 100 women) was 2.8 for Neo Sampoon tablet users and 2.1 for Emko foam users. The 12-month continuation rates were 77.6 and 77.2/100 women for the tablet and foam groups, respectively. In both the majority of discontinuations from the study were for personal reasons, including lack of confidence in the method, messiness, partner's objection and a burning sensation. Few women reported a product-related complaint while using their assigned contraceptive method. The most commonly reported complaint for both methods was that use of the product led to an uncomfortable burning sensation for the woman and/or her partner. This complaint, however, was cited by 5% of the women in each group. Thus, a combination of low pregnancy rates, few complications and complaints and high continuation rates confirm the relative acceptability, effectiveness and short-term safety of these methods of contraception among this sample of Egyptian women.

Asunto(s)

Bencetonio/administración & dosificación , Anticonceptivos Femeninos/administración & dosificación , Servicios de Planificación Familiar , Polietilenglicoles/administración & dosificación , Compuestos de Amonio Cuaternario/administración & dosificación , Administración Intravaginal , Adulto , Bencetonio/efectos adversos , Ensayos Clínicos como Asunto , Anticonceptivos Femeninos/efectos adversos , Combinación de Medicamentos/administración & dosificación , Combinación de Medicamentos/efectos adversos , Egipto , Femenino , Estudios de Seguimiento , Humanos , Polietilenglicoles/efectos adversos , Embarazo , Distribución Aleatoria , Cremas, Espumas y Geles Vaginales

RESUMEN

PIP: The Guatemala Social Marketing Program reported 1986 increases after social marketing promotion in the sales of Panther and Scudo condoms, Perla oral contraceptives, and Lirio vaginal foaming tablets. Sale of Panther condoms was highest in February; all the other products peaked in June and July. Sales fell in December due to Christmas holidays. Sale patterns are illustrated graphically for all 4 products.^ieng

Asunto(s)

Publicidad , Comercio , Condones , Anticoncepción , Anticonceptivos Femeninos , Anticonceptivos Orales , Comercialización de los Servicios de Salud , Espermicidas , Estadística como Asunto , Cremas, Espumas y Geles Vaginales , Américas , América Central , Anticonceptivos , Países Desarrollados , Países en Desarrollo , Economía , Servicios de Planificación Familiar , Guatemala , América Latina , América del Norte

RESUMEN

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

Asunto(s)

Dispositivos Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Orales/efectos adversos , Choque Séptico/etiología , Esterilización Tubaria/efectos adversos , Tampones Quirúrgicos/efectos adversos , Vaginitis/complicaciones , Dispositivos Anticonceptivos Masculinos , Femenino , Humanos , Riesgo , Factores de Tiempo , Vasectomía

RESUMEN

The choice of a contraceptive method is complex and difficult. This study identifies issues for concern for women in selecting a birth control method, examines the accuracy of a self-administered questionnaire based upon these outcomes in predicting actual use, and in a preliminary fashion evaluates the usefulness of such an instrument as a decision aid. A questionnaire was designed to assess women's perceptions of the likelihood of each issue of concern for four birth control methods--oral contraceptives, intrauterine device (IUD), diaphragm, and foam or condoms--as well as the relative value of each issue. It was then tested among a convenience sample of 106 women. A weighted score was constructed by combining likelihood and value estimates for each contraceptive method. The method with the highest score was compared with actual contraceptive use and the intention to use such methods in the future. Positive predictive values were highest for pill use (83 percent) and lowest for IUD use (40 percent). While 65 percent of the sample were satisfied with their current method, 60 percent also found the questionnaire helpful. This attitude was most prevalent among younger, unmarried women. A decision aid for contraceptive decision making appears to be reasonably predictive of actual contraceptive use and helpful in thinking about the choice of a birth control method.

Asunto(s)

Anticoncepción/métodos , Toma de Decisiones , Adolescente , Adulto , Conducta Anticonceptiva , Dispositivos Anticonceptivos Femeninos , Dispositivos Anticonceptivos Masculinos , Anticonceptivos Orales , Femenino , Humanos , Dispositivos Intrauterinos , Probabilidad , Encuestas y Cuestionarios

RESUMEN

PIP: The nonprescription forms of birth control now receive much attention due to the ongoing controversy about the prescription contraceptive methods. Condoms, 1 of these nonprescription methods, are the most effective nonprescription contraceptives available and among the most widely used. They are simple to use, inexpensive, and not associated with any major adverse effects. Condoms are unique in that they are a reliable contraceptive for males. It is estimated that 1 of 3 people who use contraception worldwide will rely on a male method. In the US this figure is somewhat lower, 18%. In other countries, such as Japan, condoms are the chief contraceptive method. If properly used, the failure rate for condoms is quite low; the lowest observed failure rate is 2%. In contrast, with typical users, the failure rate approaches 10%. The industry has taken several quality control measures to produce a safe and reliable condom. The principal material tested is usually either of the 2 ingredients used to make them, latex or collagenous tissue taken from the lamb cecum. Condoms definitely can protect against sexually transmitted diseases, simply because they prevent the infecting organisms from being transferred across the condom wall. The contraceptive efficacy of the condom is greatly enhanced when a spermicide is used at the same time. In terms of effectiveness, of 100 users that start the year using foams, creams, jellies, or vaginal suppositories containing nonoxynol 9 and used them consistently, the lowest observed rate of failure has been 3-5%. In actual use, the pregnancy rate is probably closer to 18%. Few side effects have been reported with spermicides. The most common of these is a burning sensation. The foaming suppository has been widely promoted as an effective vaginal contraceptive. It does not really offer any advantage over any of the other dosage forms except for convenience. It is the combination of foam and condom that pharmacists need to pay particular attention to because it is these 2 nonprescription methods that, used concurrently and correctly, can rival the efficacy of oral contraceptives. 1 of the newest dosage forms for a vaginal spermicide is a disposable polyurethane foam sponge which is impregnated with nonoxynol 9, but vaginal irritation has been reported frequently as an adverse effect.^ieng

Asunto(s)

Anticonceptivos , Dispositivos Anticonceptivos , Dispositivos Anticonceptivos Masculinos , Humanos , Masculino

RESUMEN

The use-effectiveness and continuation rates of 4 methods of contraception were studied during a 2 year follow-up period in a group of 405 teenage girls. Results were compared in 2 groups of adolescents, 1 of highly motivated, high socioeconomic status girls (A) and 1 of poorly motivated, low socioeconomic status adolescent clinic patients (B). The method of contraception was selected by the girls, who were instructed in their proper use. Results showed good rates of continuation among girls of the 1st group as compared to those of the 2nd group. Pregnancy rates after 24 months of use, as calculated by Pearl's formula, was 3.6 and 5.4 respectively with the use of a condom, and 5.8 and 10.8 when the diaphragm was used. When using vaginal foam alone, the rates were 4.2 and 12.3 and with the rhythm method, 8.5 and 13.1. The foam-alone method was unpopular in both groups. No serious side effects or complications were recorded. The study demostrated a reasonable acceptability and use-effectiveness for barrier contraceptives. It is suggested that these harmless and complication-free methods, especially the condom and diaphragm, may be reasonable alternatives for the more modern methods in teens of all socioeconomic strata; an effort must be made to educate and instruct the poorly motivated and encourage them to present themselves for regular follow-up.

Asunto(s)

Adolescente , Conducta , Condones , Conducta Anticonceptiva , Anticoncepción , Anticonceptivos Femeninos , Dispositivos Anticonceptivos Femeninos , Recolección de Datos , Economía , Estudios de Evaluación como Asunto , Servicios de Planificación Familiar , Métodos Naturales de Planificación Familiar , Aceptación de la Atención de Salud , Índice de Embarazo , Embarazo en Adolescencia , Investigación , Conducta Sexual , Factores Socioeconómicos , Espermicidas , Estadística como Asunto , Cremas, Espumas y Geles Vaginales , Factores de Edad , Tasa de Natalidad , Anticonceptivos , Demografía , Fertilidad , Pacientes Desistentes del Tratamiento , Población , Características de la Población , Dinámica Poblacional

RESUMEN

PIP: A questionnaire was administered to 52 females with sickle disease of genotypes Hgb SS, SC, and S-thalassemia, and to 80 control subjects. They answered questions pertaining to their contraceptive habits, their reproductive habits, and their sexual activity. It was found that sexual activity differed significantly for the 2 groups: only 38% of the females in the sicle cell group reported sexual activity compared with 81% of the females in the control groups. Contraception was used less frequently by the sickle cell group (33% vs. 66%). The most commonly used method was an oral contraceptive. However, barrier methods were chosen by the cumulative majority. The 2 groups exhibited similar rates of contraception but differences in the outcome of the pregnancies--sickle cell patients experienced more miscarriages and premature births. There was a greater percentage of cesarean sections among sickle cell patients (46%) compared to 18% in the control group.^ieng

Asunto(s)

Anemia de Células Falciformes/psicología , Anticoncepción/psicología , Reproducción , Aborto Espontáneo , Adolescente , Adulto , Familia , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Conducta Sexual

RESUMEN

The purpose of this study was to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. Therefore, the in vitro antimicrobial activity of six intravaginal contraceptives and BetadineR against the eight serotypes of the organism was investigated. The results indicate that some of these contraceptives produce partial inhibition of the Ureaplasma at low dilutions, while BetadineR produces a ureaplasmacidal effect up to dilutions of 1:64. These effects appear not to be due primarily to the pH of these agents. Thus, some of these agents may have a potential role in controlling transmission of Ureaplasma urealyticum.

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PIP: An in vitro study was conducted in an effort to find a barrier contraceptive agent capable of controlling infections and sexual transmission of Ureaplasma urealyticum from the female genital tract, especially to help reduce nongonococcal urethritis in males caused by this organism. The in vitro antimicrobial activity of 6 intravaginal contraceptives and Betadine against the 8 serotypes of the organism was investigated. All 8 serotypes of Ureaplasma urealyticum exhibited a uniform response to each of the different products tested. Metabolic inhibition of Ureaplasma was examined at 24, 48, and 72 hours. At 24 hours, metabolic inhibition was observed with 6 of the 8 agents tested. 2 of the agents, Betadine solution and Betadine vaginal gel, produced inhibition up to 1:64. 4 agents -- Emko foam, Delfen foam, Kormex ii, and Conceptrol -- exhibited inhibition at either 1:16 or 1:32. The 2 other agents, NeoSampoon and Encare Oval, failed to produce inhibition of the lowest dilution tested. There was no change in the observed endpoint of 1:64 for the Betadine preparations at 48 and 72 hours. 4 of the agents demostrated a decrease in the endpoint upon prolonged incubation to 72 hours, with growth of the organism in the lowest dilutions of Emko and Delfen foams. Results of subcultures of all dilutions of the agent-broth mixtures at 5 minutes showed that Betadine in its 2 forms tested, Koromex II and Conceptrol, produced apparent killing of Ureaplasma at dilutions of 1:32, 1:4, and 1:4 respectively. Subcultures after 24 hours of contact between the agent and Ureaplasma indicated a killing effect up to dilutions of 1:64 for the Betadine preparations and 1:4 for Meko foam. All other endpoints remained unchanged at 24 hours. The measurements of the pH of the emulsions and the pH of 1:1 mixture of U9B medium with the agent emulsion ranged from 4.0 (Concetrol) to 7.9 (NeoSampoon) for the agent emulsons and from 4.2 Conceptrol) to 7.3 (Neo Sampoon) for the the U9B-emulsion mixtures. Betadine solution and gel were found to have a pH of 2.5 in saline dilution and 3.5 in solution with U9B broth. On the basis of these "in vitro" experiments, the intravaginal contraceptives may have a role in the prevention of sexually transmissble infection or colonization by Ureoplasma.

Asunto(s)

Anticonceptivos Femeninos/farmacología , Povidona Yodada/farmacología , Povidona/análogos & derivados , Enfermedades de Transmisión Sexual/prevención & control , Ureaplasma/efectos de los fármacos , Uretritis/prevención & control , Vaginitis/prevención & control , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Enfermedades de Transmisión Sexual/microbiología , Uretritis/microbiología , Vaginitis/microbiología

RESUMEN

PIP: A table presents the latest available statistics on social marketing program sales and status in the countries of Bangladesh, the Caribbean, Ecuador, Egypt, El Salvador, Guatemala, Honduras, India, Jamaica, Mexico, and Nepal. The Bangladesh Family Planning Social Marketing Program was implemented in 1975 and is active at this time. Over the June 1983 to May 1984 period, 87,034,000 Raja condoms, 4,242,000 Panther condoms, 1.157,000, Maya pills, 846,000 Ovacon low-dose pills, and 4,332,000 Joy foaming tablets were sold for 1,109,000 couple years of protection (CYP). Over the March 1984 to May 1984 period, the Caribbean Social Marketing Project, implemented in 1983, sold 16,000 Panther condoms, 1000 Perle pills, and 1000 Perle low-dose pills. Sales are expected to begin in Ecaudor's program in August 1984. Egypt's program is active. Data for July 1983 to June 1984 show that 6,722,000 condoms, 1,988,000 Amman foaming tablets, 114,600 Cu-T IUDs, 66,600 Cu-7 IUDs, and 578,000 Norminest low-dose pills were sold for a total of 515,000 years of protection. Over the March 1983 to February 1984 period, El Salvador's program sold 537,000 Condor condoms, 125,000 Perla pills, and 61,000 Suave foaming tablets for 16,000 CYP. There have been no sales as yet in Guatemala's program. Sales for the Honduras program began in March 1984, but no data are available as yet. India's Nirodh Marketing program was implemented in 1968. For the January 1983 to September 1983 period, 83,140,000 Nirodh condoms were sold for 1,109,000 CYP. Over the May 1983 to April 1984 period, Jamaica's program sold 1,031,000 Panther condoms and 330,000 Perle oral contraceptives for 35,000 CYP. Mexico's Profam, implemented in 1978, sold 6,602,000 condoms, 18,000 pills, and 9000 injectables for 35,000 CYP for the May 1983 to June 1984 period. Nepal's Contraceptive Retail Sales Corporation was implemented in 1976. For the May 1983 to April 1984 period, 2,833,000 condoms, 82,000 Gulaf pills, 15,000 Nilocon low-dose pills, and 167,000 Kamal foaming tablets were sold for a total of 37,000 CYP.^ieng

Asunto(s)

Condones , Conducta Anticonceptiva , Anticoncepción , Anticonceptivos Femeninos , Anticonceptivos Orales , Atención a la Salud , Estudios de Evaluación como Asunto , Servicios de Planificación Familiar , Planificación en Salud , Administración de los Servicios de Salud , Inyecciones , Dispositivos Intrauterinos , Comercialización de los Servicios de Salud , Organización y Administración , Proyectos de Investigación , Espermicidas , Cremas, Espumas y Geles Vaginales , África , África del Norte , Américas , Asia , Bangladesh , Región del Caribe , América Central , Anticonceptivos , Países Desarrollados , Países en Desarrollo , Economía , Ecuador , Egipto , Guatemala , Salud , Honduras , India , América Latina , México , Medio Oriente , Nepal , América del Norte , Evaluación de Programas y Proyectos de Salud , Investigación , América del Sur , Estadística como Asunto

RESUMEN

PIP: The vaginal contraceptive sponge, approved on April 1, 1983 by the US Food Administration (FDA) for sale in the US as a single use, disposable, over-the-counter contraceptive, is made of polyurethane and designed to be biocompatible with the vaginal environment. The sponge is available in a single size, is round, and about 5.5 cm in diameter and 2.5 cm thick. An indentation on 1 side helps to ensure the sponge's correct placement against the cervix. A polyester retrieval loop attached to the sponge facilitates removal. Postcoital tests of the sponge without the spermicide indicated that it was ineffective in preventing sperm from entering the cervical canal. Before insertion, the contraceptive sponge is moistened with tap water to activate the spermicide and is inserted into the vagina with the indentation placed against the cervis. The sponge has been designed to provide continuous protection against pregnancy for at least 24 hours after insertion. Following a successful phase ii clinical trail of the sponge, in 1979 comparative phase iii clinical trials were initiated by Family Health International. The following trials were conducted: sponge versus the diaphragm (arcing-spring) used with a spermicide (nonoxynol-9) at 13 clinics in the US (1439 subjects) and at 2 clinics in Canada and the UK (502 subjects); sponge versus a foaming spermicidal (menfegol) suppository at 5 clinics in Yugoslavia, Taiwan, and Bangladesh (1386) subjects); and sponge versus spermicidal (nonoxynol-9) foam at 2 clinics in Israel and Thailand (366 subjects). In all trials the contraceptive methods were raondomly assigned. Clinics were required to follow up subjects for 1 year. Only the US study has been completed. In the comparative trials of the sponge and diaphragm (both US based and overseas) the pregnancy rates were significantly higher for the sponge. In the comparative trials of the sponge and foaming suppositories or spermicidal foam there were no significant differences between the pregnancy rates of the sponge and the other contraceptive methods. In the US based trial of the sponge the differences between cumulative 12 month pregnancy rates were relatively small--16.8 and 12.5 pregnancies/100 women for sponge and diaphragm users, respectively. No cases of toxic shock syndrime (TSS) or other serious omplications have occurred among 1848 women who have participated in the clinical trials of the sponge and who have accounted for 1068 woman years of sponge use. Advantages of the sponge include: it can be purchased without prescription and is easy to use and is not messy; sexual spontaneity is enhanced in that it may be inserted up to 24 hours before sexual intercourse; a single size fits all women; and after insertion, it immediately provides protection against pregnancy for at least 24 hours.^ieng

Asunto(s)

Anticoncepción , Anticonceptivos Femeninos , Dispositivos Anticonceptivos Femeninos , Estudios de Evaluación como Asunto , Servicios de Planificación Familiar , Proyectos de Investigación , Espermicidas , Cremas, Espumas y Geles Vaginales , Anticonceptivos , Enfermedad , Infecciones , Investigación

RESUMEN

To examine the relationship between menstrual regulation (MR) and subsequent use of contraception in Bangladesh, we studied the birth control practices of a 6-month cohort of 4359 family-planning acceptors in a family-planning clinic in Dacca. We compared their use of birth control measures before and after MR. We attempted to examine the subsequent pregnancy and induced-abortion rates of 1671 of these women through a 3-year non-concurrent prospective study. Of those 1172 made their first visit to the clinic to obtain an MR and the remaining 499 women, who served as a comparison group, made their first visit to obtain contraceptive services not associated with MR. Three years' followup data were available for 558 women in the MR group and 228 women in the comparison group. Based on these data, the 3-year pregnancy rate for the MR group was 37.6/100 women and the induced abortion rate was 4.3/100 women. The 3-year pregnancy rate for the comparison group was 39/100 women and the induced abortion rate was 3.5/100 pregnancies. Thus, during a 3-year period women in the MR group did not obtain abortions significantly more often than women in the comparison group.

Asunto(s)

Aborto Inducido , Conducta Anticonceptiva , Servicios de Planificación Familiar , Aborto Inducido/tendencias , Aborto Legal , Bangladesh , Femenino , Humanos , Embarazo , Estudios Prospectivos