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Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.

PIP: An interview was conducted to ascertain knowledge, attitudes, and practices concerning emergency contraception (EC) among health care providers and potential EC users in metropolitan Mexico. Findings showed that there was a limited knowledge about EC per se and its method, but nevertheless, most of the participants were cautious to support EC in Mexico. Health care providers and clients greatly overestimated the negative health effects of EC, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believe EC should be more widely available, including in schools and vending machines, with information prevalent in the mass media and elsewhere.

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OBJECTIVE: We compared bleeding patterns following early mifepristone-misoprostol abortion with those following early surgical abortions ( < or = 56 days gestation LMP). We analyzed women's reports of their bleeding and clinical measures of blood loss, and modeled the relationships between different bleeding measures and indicators of success and satisfaction. METHOD: Using data from a multicenter trial held in China, Cuba and India, we fit bivariate and multivariate models to analyze bleeding patterns, controlling for a range of demographic, experiential and medical factors (n = 1373). RESULT: Medical abortion patients perceived their bleeding to be heavier than did the surgical patients; however, there were few statistically significant differences in clinical measures of blood loss between the two groups, and blood loss rarely represented a medical problem. Nationality, far more than actual levels of bleeding, influenced women's impressions about blood loss. Although medical abortion patients saw their bleeding as heavier than did the surgical patients, their perceptions of heavier bleeding did not prevent them from having higher satisfaction levels. One exception was that if bleeding exceeded prior expectations, women with the medical method were more likely to be dissatisfied. Pain and cramps, which often accompanied bleeding, were an independently significant factor in predicting satisfaction with the method. CONCLUSION: In order for women to know what to expect with medical abortion, they must be informed beforehand about the level of bleeding that generally accompanies the procedure vs. excessive bleeding that would signal a clinical problem.

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We have utilized liposomes constructed with individual mammalian cell membrane glycosphingolipids and latex beads conjugated with glycoproteins as models to investigate the molecular specificity and mechanism of interaction of E. histolytica with target cells. Synthetic liposomes constructed with a variety of glycosphingolipids bearing neutral, straight chain glycans with galactose or N-acetylgalactosamine termini stimulated rapid (90 sec), contact dependent polymerization of E. histolytica actin. Glycans with terminal N-acetylglucosamine residues were not, or only weakly, stimulatory. Attachment of N-acetylneuraminate to the terminal residue of stimulatory glycosphingolipids eliminated activity. Attachment of fucose to the penultimate sugar reduced glycan recognition. Latex beads conjugated with asialofetuin (galactose beta 1-4 glycan termini) adhered to amoebae more effectively than fetuin conjugated beads (N-acetylneuraminate termini) or agalactosyl asialofetuin conjugated beads (N-acetylglucosamine termini). However, none of the glycoprotein conjugated beads stimulated contact mediated polymerization of E. histolytica actin. The carbohydrate specificity of E. histolytica interaction with non-cellular particles resembles that observed with whole target cells our results demonstrate that carbohydrate recognition specificity extends to lipid as well as protein bound glycoconjugates. Further, these studies suggest that the biochemical consequences of binding to glycosphingolipids differ from those resulting from interaction with glycoprotein. This may be relevant to the mechanism of mammalian cell attack by this pathogen.

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