RESUMO
PURPOSE: To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease. METHODS: We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD). RESULTS: In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025). CONCLUSION: Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.
PIP: The aim of this study was to analyze efficacy, tolerance, and adverse events of reversible contraceptives in women with cardiac disease. The authors studied prospectively, during a period of 24-39 (mean = 29) months, 89 women with heart disease of mean age 25.6 (16-42) years. Rheumatic heart disease was present in 73 cases (82%), congenital heart disease in 11 (11%), coronary artery disease in 2 (2%), and cardiomyopathy in 3 (3%). The patients were divided into three groups: GCO--35 patients taking combined oral contraceptives (30 mcg ethinyl estradiol and 75 mg gestodene); GIT--27 patients using injectable progestagens (depot medroxyprogesterone acetate); and GUID--27 patients with IUDs. In the GCO group were found 4 cases (11.4%) of arterial hypertension, 1 (2.8%) of a transient cerebral ischemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amenorrhea, and 1 (2.8%) of pregnancy. Interruption of this method occurred in 4 cases (11.4%): 2 due to hypertension, 1 due to pregnancy, and 1 due to amenorrhea. In the GIT group there were 2 cases (7.4%) of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 cases (18.5%): 2 due to amenorrhea, 2 due to weight gain, and 1 due to headache. In the GUID group there was 1 case (3.7%) of infection, 1 (3.7%) of pregnancy, and 1 (3.7%) of spontaneous expulsion of the IUD. Interruption of use took place in 3 cases (11.1%): 1 due to infection, 1 due to pregnancy, and 1 due to expulsion. The comparison between the groups demonstrated a difference in the incidence of amenorrhea (p 0.005) and method discontinuation (p 0.025). Use of reversible contraceptives in women with heart disease was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups; however, intolerance was observed more in the GIT group. (author's modified)
Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Cardiopatias , Dispositivos Intrauterinos/efeitos adversos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
A comparative multicenter clinical trial of two combined oral contraceptives (OCs) was conducted at clinics located in the Sudan, Sri Lanka, Chile, the Dominican Republic and Ecuador. The trial was designed to determine if there were differences in efficacy, safety and acceptability between a triphasic and a low-dose monophasic OC. This report includes analysis of 1088 women. At each center, subjects were randomly allocated to one of the two OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. There were two accidental pregnancies attributed to user failure reported during the study period; one in the triphasic group and one in the monophasic group. Adverse experiences were mainly minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. Cycle control was good in both groups with women in the triphasic group reporting fewer complaints of intermenstrual bleeding. Both OCs were safe and effective.
PIP: Researchers compared the efficacy, safety, and acceptability of a triphasic oral contraceptive (OC), Triquilar, with those of a monophasic OC, Lo-Femenal, among 1088 women attending clinics in Chile, the Dominican Republic, Ecuador, Sri Lanka, and the Sudan. Both OCs contained levonorgestrel and ethinyl estradiol. 90% of women in each group exhibited good user compliance. Only 1 unplanned pregnancy occurred in each group, and both pregnancies were attributed to user failure. The gross cumulative efficacy rates at 11 months were 0.3/100 woman-years for the triphasic OC and 0.2/100 woman-years for the monophasic OC. The continuation rate at 11 months was lower for Lo-Femenal than it was for Triquilar (80.8% vs. 84.6%), but the difference was not significant. The leading side-effect-related reason for discontinuation in both groups was headache. Another key reason for OC discontinuation in both groups was personal reasons, such as planning a pregnancy. Most women in both groups did not have menstrual complaints (78.8% for the Triquilar group and 77.1% for the Lo-Femenal group). Intermenstrual bleeding rates were low (7.6% for the Triquilar group and 9% for the Lo-Femenal group). Significant intercenter differences for women reporting intermenstrual bleeding and side effects (e.g., headaches) existed (p .05). Women from both groups at the clinic in the Sudan always had lower reports of intermenstrual bleeding than those at the other clinics. In fact, no woman discontinued OC use because of intermenstrual bleeding in the Sudan. Women in Sri Lanka reported fewer side effects than those in other countries, suggesting they could better tolerate OCs than the other women. This multicenter study's findings indicates that both Triquilar and Lo-Femenal are effective and safe. In addition, they exhibit good cycle control.
Assuntos
Anticoncepcionais Orais Combinados , Adolescente , Adulto , Chile , Anticoncepcionais Orais Combinados/administração & dosagem , Anticoncepcionais Orais Combinados/efeitos adversos , República Dominicana , Equador , Etinilestradiol/administração & dosagem , Etinilestradiol/efeitos adversos , Combinação Etinil Estradiol e Norgestrel , Feminino , Humanos , Levanogestrel/administração & dosagem , Levanogestrel/efeitos adversos , Norgestrel/administração & dosagem , Norgestrel/efeitos adversos , Gravidez , Sri Lanka , SudãoRESUMO
The efficacy and acceptability of two widely used oral contraceptive tablets, one containing 250 mg levonorgestrel and 50 micrograms ethinyl estradiol and the other containing 150 micrograms desogestrel and 30 micrograms ethinyl estradiol, administered by the vaginal route were compared in 1055 women studied over 12,630 woman-months of vaginal contraceptive pill use. This multicenter clinical trial was performed in nine countries of the developing world by the "South to South Cooperation in Reproductive Health," an organization founded by scientists from the Third World working in the area of reproductive health, and the study was developed and coordinated by one of these centers. The findings of this study confirm the efficacy of both these tablets when administered by the vaginal route. Involuntary pregnancy rates at 1 year of 2.78 for subjects in the levonorgestrel group and 4.54 for subjects the desogestrel group showed no statistically significant difference between the two groups. However, total discontinuation rates of 47.01 for subjects in the levonorgestrel group and 56.33 for subjects in the desogestrel group showed a statistically significant difference between the two groups, and discontinuation rates attributable to prolonged bleeding of 0.6 for subjects in the levonorgestrel group and 3.2 for subjects in the desogestrel group were also significantly higher in the group of subjects using the desogestrel vaginal contraceptive pill. Blood pressure remained at admission values throughout treatment. A statistically significant weight increase from admission values occurred in both groups of subjects.
PIP: Efficacy and acceptability of 2 combined oral contraceptive pills administered vaginally are summarized. This is the 1st collaborative trial published by the South to South Cooperation in Reproductive Health. 1055 women participated in 12,630 cycles, in 9 countries, from June 1988 to May 1991. The pills were commercially available tablets containing 50 mcg ethinyl estradiol and 250 mg levonorgestrel (Schering AG, Sao Paulo, Brazil), or 30 mcg ethinyl estradiol and 15 mcg desogestrel (Organon, Sao Paulo, Brazil). Subjects were aged 17-39 younger and of lower parity from Mexico and Dominican Republic and older from Egypt and China. All had at least 1 pregnancy. 675 participated for 6 months, 470 for 1 year, 364 for 18 months, and 210 for 2 years. The 1-year discontinuation rate averaged 47.01% for the levonorgestrel group and 56.33% for the desogestrel group (p = 0.0061); 2-year discontinuation rates were 48.01% and 69.36, respectively, explained in part by higher involuntary pregnancy rates and prolonged bleeding rates in the desogestrel group. The most common medical reasons for stopping contraception were unplanned pregnancy, vaginal or vulval irritation, nausea, vaginal discharge and headache. Vaginal irritation was reported by 1%, 9 in each group. There were 32 pregnancies, 14 in the levonorgestrel and 18 in the desogestrel group. 17 were in missed pill cycles and the rest were method failures, 6 in the levonorgestrel group and 9 in the desogestrel group. The Pearl index varied from 0 in Nigeria to 12.24 in Mexico, and was 2.45 for levonorgestrel vs. 3.74 for desogestrel. There was a wide variation in discontinuation rates by center: Brazil and China had few, while many women from Dominican Republic, Mexico and Zambia left the study. Bleeding problems were common complaints, more so in the desogestrel group. There were 363 women with intermenstrual bleeding (only once in 80%), 148 with spotting (only twice in 65%). Bleeding duration was significantly less in pill cycles than baseline, pressure. Women gained an average of 1 kg over 2 years, more in the desogestrel group. The pregnancy rate of 2.78 is within the range reported for levonorgestrel rings.
Assuntos
Desogestrel/administração & dosagem , Etinilestradiol/administração & dosagem , Levanogestrel/administração & dosagem , Administração Intravaginal , Adolescente , Adulto , Desogestrel/efeitos adversos , Países em Desenvolvimento , Combinação de Medicamentos , Etinilestradiol/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Estudos Multicêntricos como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Distribuição Aleatória , VaginaRESUMO
PIP: Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods.^ieng
Assuntos
Anticoncepção , Dispositivos Anticoncepcionais Femininos , Anticoncepcionais Orais , Gossipol , Injeções , Dispositivos Intrauterinos de Cobre , Levanogestrel , Mifepristona , Vasectomia , América , Biologia , Brasil , Anticoncepcionais , Anticoncepcionais Femininos , Anticoncepcionais Masculinos , Países em Desenvolvimento , Sistema Endócrino , Serviços de Planejamento Familiar , Antagonistas de Hormônios , Hormônios , Dispositivos Intrauterinos , América Latina , Fisiologia , América do Sul , Esterilização ReprodutivaRESUMO
Energy, protein, lactose and fat were studied in the milk of mothers who were using different types of contraceptives. One hundred and eleven mothers made up the following groups. C: control (barrier and natural methods, or sterilization), n = 22; combined pill: LDP (low dose pill (levonorgestrel 0.15 mg + ethinylestradiol 0.03 mg)), n = 12 and MDP (medium dose pill (levonorgestrel 0.25 mg + ethinylestradiol 0.05 mg)), n = 13; MP (minipill (norethindrone 0.35 mg)), n = 37; DMPA (injectable progesterone (depot medroxiprogesterone acetate 150 mg)), n = 17; and IUD (plastic or copper intrauterine device), n = 10. The mean stages of lactation were, respectively, 15, 17, 5, 9, 5 and 9 weeks. The mean duration of observation for the study groups ranged from 2 to 4 weeks. Milk samples were collected before and after initiation of treatment (mean = 20 days; range = 14-103 days). The stage of lactation and the interval of nursing before sampling were recorded so that statistical account could be taken of these uncontrollable sources of variability. When incorporated as covariates, they showed that no significant differences existed between the groups tested, either before or after treatment.
PIP: Researchers compared data on 22 women using either a barrier method or a natural family planning method or had undergone female sterilization (controls) with data on 89 women using either a low dose combined oral contraceptive (OC), a medium dose combined OC, a low dose progestin only OC, the injectable Depo-Provera, or an IUD to examine the hormonal contraceptives' effects on the concentration of total protein, lipids, lactose, and energy in human milk. They recruited the women from private and public family planning clinics in Brasilia, Brazil between 1984 and 1987. The mean stages of lactation were 15 weeks for controls, 17 weeks for women using the combined low dose OC, 5 weeks for those using the combined medium dose OC, 5 weeks for those using the combined medium dose OC, 9 weeks for those using the low dose progestin only OC, 5 weeks for those using Depo-Provera, and 9 weeks for those using the IUD. Almost all the concentrations of total protein, lipids, lactose, and energy both before and after contraceptive therapy fell within the range for healthy women. The mean value of total protein in women using Depo-Provera was the only value higher than that range. The low dose OC was associated with a considerable increase in fat (3 g/dL vs. 4.8 g/dL; p=.035). Women taking the medium dose OC experienced a significant decrease in lactose (6.8 g/dL vs. 7.25 g.dL; p=.004). The time between last nursing and milk sample collection (nursing interval) caused considerable variation in fat (p=.03) and total energy (p=.02) in those samples collected before contraceptive therapy. When the researchers adjusted the data for stage of lactation and nursing interval from all 6 groups, the contraceptives had no significant effect on total protein, lipids, lactose, and energy.
Assuntos
Anticoncepcionais Femininos/farmacologia , Estrogênios/farmacologia , Leite Humano/efeitos dos fármacos , Progesterona/farmacologia , Adulto , Metabolismo Energético/efeitos dos fármacos , Feminino , Humanos , Dispositivos Intrauterinos , Lactação , Lactose/análise , Lipídeos/análise , Proteínas do Leite/análise , Proteínas do Leite/efeitos dos fármacos , Leite Humano/química , Fatores de TempoRESUMO
PIP: 69 healthy Mexican women using a new oral contraceptive (OC) containing 75 mcg of gestodene and 30 mcg of ethanol estradiol participated in a prospective study of the safety and efficacy of the method. All participants were evaluated on the s cycle day before beginning use and were questioned monthly about side effects and menstrual bleeding. 10 of the women were evaluated for cholesterol and triglyceride levels before use and after 4 and 8 months. The average age of the participants at admission into the study was 23.4 years. There were no pregnancies in 613 woman-months of use. The average blood pressure was 113.8 + or - 6.9 over 76.7 + or - 7.0 before use and 112.6 + or - 9.2 over 73.8 + or - 7.8 after 12 months of use. The average weight was 55.9 + or - 9.6 kg before use and 55.5 + or - 8.8 after 12 months of use. In the 1st treatment cycle 8 women reported spotting and 3 reported intermenstrual bleeding; the number reporting these signs gradually declined. The number reporting side effects was small and declined after the 1st treatment cycle. Dysmenorrhea declined significantly after the 1st cycle. The crude rate of termination was 44.9% after 1 year. 8 women (11.6%) terminated method use for reasons related to the method, including 2 for nausea and vomiting, 1 for nausea and dizziness, 2 for amenorrhea, and 1 each for intermenstrual bleeding, spotting, and increased blood pressure. Among the 10 women whose lipid and lipoprotein levels were tested, the average levels before and after 8 months respectively were 162.5 + or - 27.0 and 182.3 + or - 35.8 for total cholesterol, 86.5 + or - 29.5 and 120.0 + or - 45.0 for triglycerides, 45.7 + or - 9.3 and 60.6 + or - 6.5 for HDL cholesterol. In general these changes were not significant despite the tendency to increase especially of the triglycerides. The method thus appears to offer advantages for temporary fertility control among Mexican women.^ieng
Assuntos
Colesterol , Anticoncepcionais Orais Combinados , Anticoncepcionais Orais , Experimentação Humana , Lipídeos , Estudos Prospectivos , Pesquisa , América , Biologia , Anticoncepção , Anticoncepcionais , Anticoncepcionais Femininos , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , México , América do Norte , FisiologiaRESUMO
The safety and efficacy of a low-dose monophasic oral contraceptive (OC) containing a new progestogen, gestodene (GTD), combined with ethinyl estradiol (EE) is being investigated in two ongoing multicenter trails. In this interim analysis, the formulation was found to be effective and well tolerated. Subject compliance was excellent; no pills were missed in 91.2% of the cycles. The number of women who withdrew from the study was low (15%), indicating good subject acceptance. GTD + EE provided optimal cycle control. Of the total number of OC cycles analyzed, spotting occurred in 8.1%, breakthrough bleeding in 1.8%, and both spotting and breakthrough bleeding in 3.3%. The incidence of spotting decreased fairly steadily during OC administration. Amenorrhea occurred in 0.5% of the cycles. There were no unexpected or serious side effects. The incidence of side effects was low and declined with increased duration of OC use. There were no clinically significant changes in weight or blood pressure. Virtually all of the systolic and diastolic blood pressure readings were in the normal range. The results of this interim analysis indicate that the GTD + EE formulation is a safe and reliable contraceptive.
Assuntos
Etinilestradiol/farmacologia , Ciclo Menstrual/efeitos dos fármacos , Norpregnenos/farmacologia , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Mama/efeitos dos fármacos , Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Combinados/farmacologia , Etinilestradiol/efeitos adversos , Europa (Continente) , Feminino , Seguimentos , Cefaleia/induzido quimicamente , Humanos , Conformação Molecular , Estrutura Molecular , Estudos Multicêntricos como Assunto , Náusea/induzido quimicamente , Norpregnenos/efeitos adversos , Cooperação do Paciente , América do SulRESUMO
PIP: The use of hormonal contraceptives containing only progestogen is generally not recommended for adolescents. However, for some patients there may be certain advantages, e.g., for those who suffer from cardiac diseases, where more efficient contraceptive methods, such as the use of estrogenic hormonal contraceptives or IUDs are contraindicated. In Brazil today, there is 1 mini-pill on the market. It contains 0.35 mg norethindrone and 0.35 mg norethisterone, and is taken orally once a day. Its advantages include decreased dysmenorrhea and less overall blood loss than for those who do not use contraceptives. It is indicated for patients exhibiting collateral reactions to the estrogenic component of combination pills. Its adverse effects include menstrual irregularities that are not well tolerated by the adolescent and possible formation of ovarian cysts due to lack of synchronized secretion of gonadotropins. It is not recommended for patients with an absolute contraindication for combined hormonal contraceptives that contain estrogens, for prediabetic patients, for patients affected by acute mononucleosis, for patients with a history of frontal ectopic pregnancy, and for patients with genital bleeding of unknown etiology. It is concluded that the mini-pill should not be a 1st choice contraceptive for adolescents and should only be used in clearly recommended cases.^ieng
Assuntos
Adolescente , Anticoncepcionais Orais , Fatores Etários , América , Brasil , Anticoncepção , Demografia , Países em Desenvolvimento , Serviços de Planejamento Familiar , América Latina , População , Características da População , América do SulRESUMO
PIP: Guatemala's family planning association, the Asociacion Pro-Bienestar de la Familia (APROFAM) recently cut its ties with the nation's contraceptive social marketing program. The announced reasons for the disassociation was APROFAM's concerns about the legality of selling donated commodities. APROFAM helped create the program served as a member of the marketing program's board of directors, and was expected to function as the channel for the commidities donated by the US Agency for International Development (USAID). The marketing program will now be managed by the newly created Importadora de Farmaceuticos (IPROFA), a for-profit organization. This alters the legal status of the marketing program, and as a result, the program will be required to pay duties on USAID donated contraceptives. USAID cannot legally pay duties on its own contributions. Instead, the duies will be paid by IPROFA out of the revenues generated by the project. IPROFA will finance the 1st consignment of products with a bank loan, and the loan and duties on subsequent shipments will be paid out of the program's revenues. This strategy is not expected to pose legal problems for USAID, since the agency has no control over how programs use the revenues generated by selling the agency's commodities. As a result of the changed status, the marketing program must acquire it own storage and packaging facilities. According to Manuel DeLucca, the program's resident advisor, these problems will not delay the launch of the program's products scheduled for early 1985. The program plans to sell an oral contraceptive, a vaginal spermicidal tablet, and a condom. Orginal plans called for selling the low dose OC, Norminest; however, Norminest may not be approved for distribution in Guatemala, and USAID may replace Norminest with another product. As a result, the program may market Noriday, a normal dose pill instead of Norminest. Guatemalan registration of the spermicidal tablet the program is planning to sell is pending. The program is engendering considerable interest because of its unique legal status as a commercial enterprise and its freedom from bureaucractic constraints.^ieng
Assuntos
Comércio , Preservativos , Anticoncepção , Anticoncepcionais Femininos , Anticoncepcionais Masculinos , Anticoncepcionais Orais , Economia , Administração Financeira , Instituições Privadas de Saúde , Planejamento em Saúde , Marketing de Serviços de Saúde , Organização e Administração , Espermicidas , Cremes, Espumas e Géis Vaginais , América , América Central , Anticoncepcionais , Países Desenvolvidos , Países em Desenvolvimento , Serviços de Planejamento Familiar , Guatemala , América Latina , América do NorteRESUMO
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
Assuntos
Preservativos , Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais Femininos , Anticoncepcionais Orais , Atenção à Saúde , Estudos de Avaliação como Assunto , Serviços de Planejamento Familiar , Planejamento em Saúde , Administração de Serviços de Saúde , Injeções , Dispositivos Intrauterinos , Marketing de Serviços de Saúde , Organização e Administração , Projetos de Pesquisa , Espermicidas , Cremes, Espumas e Géis Vaginais , África , África do Norte , América , Ásia , Bangladesh , Região do Caribe , América Central , Anticoncepcionais , Países Desenvolvidos , Países em Desenvolvimento , Economia , Equador , Egito , Guatemala , Saúde , Honduras , Índia , América Latina , México , Oriente Médio , Nepal , América do Norte , Avaliação de Programas e Projetos de Saúde , Pesquisa , América do Sul , Estatística como AssuntoRESUMO
PIP: Ecuador's contraceptive social marketing program will be launched in January 1984 with distribution of a colored condom (Liber) and a low dose oral contraceptive (OC) (Evitex). The program, which is funded through a 3-year US$1.2 million award from the US Agency for International Development (USAID), is managed by the Ecuador family planning association. Due to the fluctuating foreign monetary exchange rate, product prices have not yet been determined. However, Liber sales are expected to benefit from a government decision that removed condoms from the list of favored import products. The products will be cautiously promoted through generic television advertisements on family planning. In Ecuador, contraceptive products are not mentioned by brand name. If public response to the general family planning messages are favorable, brand name advertisements will run in small newspapers and on the radio. Eventually, advertisements will be placed in the 2 national newspapers with the aim of stimulating support of contraceptive social marketing among key opinion makers. OCs and IUDs are the most popular birth control methods in Ecuador, but nonavailability of OCs has retarded family planning efforts. Evitex will be sold on a prescription basis through about 1800 pharmaceutical outlets, while Liber will be distributed through pharmacies and the country's 30,000 "Mom and Pop" stores. A 3rd product, a spermicidal foaming tablet (Orlinda), will be available for distribution in mid to late 1984.^ieng
Assuntos
Publicidade , Comércio , Atenção à Saúde , Prescrições de Medicamentos , Economia , Planejamento em Saúde , Administração de Serviços de Saúde , Marketing de Serviços de Saúde , Organização e Administração , Farmácias , América , Preservativos , Anticoncepção , Anticoncepcionais Femininos , Anticoncepcionais Orais , Países Desenvolvidos , Países em Desenvolvimento , Equador , Órgãos Governamentais , Saúde , América Latina , Organizações , Política , América do SulRESUMO
PIP: 171 endometrium biopsies taken from 61 patients before and during treatment with daily doses of 30 mcg of d-norgestrel were studied. It was found that continuous treatment with this drug produces a number of changes in the endometrial mucus membrane, although they are less marked than those found during treatment with oral contraceptives of the combination type. The progestational effect appeared to take place earlier, and secretion began earlier, as shown by the appearance of subnuclear vacuoles. An atrophied endometrium was found in only 1 case, but this may be due to the fact that biopsies were not taken from patients showing amenorrhea. Considerable edema was frequently found in biopsies taken at all stages in the cycle. Despite the earlier appearance of the progestational effect, the development of the endometrium appeared to be less complete than in the case of normal patients without treatment. These changes may be related to the contraceptive action of d-norgestrel.^ieng