1.  Title: IAPAC recommendations to the Obama administration for the US response to the global HIV pandemic [editorial] Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):13-20. Abstract: Includes the text from a January 5, 2009 letter from the International Association of Physicians in AIDS Care (IAPAC) to the Obama-Biden Presidential Transition Team outlining top-line recommendations for the administration's response to the global HIV pandemic. Recommendations are made for HIV care and treatment, HIV prevention, HIV testing, Human resources, Access to treatment, and PEPFAR. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | PHYSICIANS | RECOMMENDATIONS | HIV PREVENTION | TITLE 19 MEDICAL ASSISTANCE | AIDS | TREATMENT | CARE AND SUPPORT | HIV TESTING | HUMAN RESOURCES | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Public Assistance | Grants | Financial Activities | Economic Factors | Medical Procedures | Medicine | Health Services | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 331305 |
| 2. Title: Plan B for 17-year olds. Source: Medical Letter On Drugs and Therapeutics. 2009 May 18;51(1312):40. Abstract: The FDA has announced that it will lower the age for over-the-counter access to the emergency contraceptive Plan B from 18 to 17 years old. In a randomized, controlled trial, the two 0.75-mg levonorgestrel tablets in Plan B, taken 12 hours apart beginning within 72 hours after unprotected intercourse, decreased the overall pregnancy rate to 1.1% (11/976) of women who requested emergency contraception. The sooner the drug is taken after coitus, the more effective it is. Nausea and vomiting can occur with Plan B. Fetal malformations have not been associated with pregnancies that occurred despite use of levonorgestrel-only emergency contraception. (full-text) Language: English Keywords: UNITED STATES OF AMERICA | USFDA | ADOLESCENTS | EMERGENCY CONTRACEPTION | ADMINISTRATION AND DOSAGE | PROGRAM ACCESSIBILITY | Developed Countries | North America | Americas | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration Document Number: 341625 |
| 3. Title: Contraceptive use among postpartum women - 12 states and New York City, 2004-2006. Author: Centers for Disease Control and Prevention (CDC) Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Aug 7;58(30):821-6. Abstract: Postpartum use of highly effective contraceptive methods can prevent unintended pregnancies and ensure adequate birth spacing. Unintended pregnancies and short interpregnancy intervals are associated with adverse maternal and infant outcomes. In 2001, the year for which the most recent data are available, 49% of all pregnancies were unintended, and 21% of women gave birth within 24 months of a previous birth. Two Healthy People 2010 goals are to increase the percentage of intended pregnancies to 70% (objective 9-1) and to reduce the percentage of births occurring within 24 months of a previous birth to 6% (objective 9-2). To estimate the prevalence and types of contraception being used by women 2-9 months postpartum, CDC analyzed data from the 2004-2006 Pregnancy Risk Assessment Monitoring System (PRAMS) from 12 states and New York City. This report summarizes those results, which indicated that 88.0% of postpartum women reported current use of at least one contraceptive method; 61.7% reported using a method defined as highly effective, 20.0% used a method defined as moderately effective, and 6.4% used less effective methods. Rates of using highly effective contraceptive methods postpartum were lowest among Asian/Pacific Islanders (35.3%), women who had wanted to get pregnant sooner (49.9%), women aged >or=35 years (53.0%), and women who had no prenatal care (54.5%). State policy makers and health-care providers can use these results to promote use of highly effective contraception among postpartum women and target interventions for those with particularly low rates of usage, including women with no prenatal care. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | DATA ANALYSIS | POSTPARTUM WOMEN | ETHNIC GROUPS | CDC | CONTRACEPTIVE USAGE | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTIVE EFFECTIVENESS | PREGNANCY, UNPLANNED | AGE FACTORS | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Research Methodology | Puerperium | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | USPHS | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Public Assistance | Grants | Financial Activities | Economic Factors Document Number: 342395 |
4.  Title: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. Author: Centers for Disease Control and Prevention (CDC) Source: MMWR. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2009 Apr 10;58(RR-4):[216] p.. Abstract: Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of opportunistic infections (OIs), especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent tuberculosis (TB) infection; 4) updated information about drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | STANDARDS | MANUAL | ADULTS | ADOLESCENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | HIV PREVENTION | TREATMENT | ANTIRETROVIRAL THERAPY | DRUG INTERACTIONS | EXAMINATIONS AND DIAGNOSES | Developed Countries | North America | Americas | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Youth | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Drugs Document Number: 339985 |
| 5. Title: Female contraception over 40. Author: The ESHRE Capri Workshop Group Source: Human Reproduction Update. 2009 May 20; Abstract: BACKGROUND The majority of women 40-49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences of an unexpected pregnancy are potentially detrimental. No contraceptive method is contraindicated by advanced reproductive age alone; thus there is a need to discuss the effectiveness, risks and non-contraceptive benefits of all family planning methods for women in this age group. METHODS MEDLINE searches were done by topic (epidemiology, age and reproduction, sexual function, delayed childbearing and specific contraceptive methods). The topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion. RESULTS The decline in fecundity in the fifth decade is insufficient for contraceptive purposes. Thus a family planning method is needed. Sterilization is by far the most common method in several countries. Copper intrauterine devices and hormone intrauterine systems have similar effectiveness, with fewer than 1% failures in the first year of typical use. Special considerations in this age group include the frequency of menstrual irregularity, sexual problems and the possibility of menopausal symptoms, all of which may respond to hormonal methods of contraception. CONCLUSIONS Women should be advised to continue with a contraceptive method until they have reached the menopause with its natural state of sterility. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | MENOPAUSE | FAMILY PLANNING | FEMALE STERILIZATION | BIOLOGICAL AGING | AGE FACTORS | Developed Countries | North America | Americas | Demographic Factors | Population | Reproduction | Sterilization, Sexual | Physiology | Biology | Population Characteristics Document Number: 341250 |
| 6. Title: Scientists recommend new design for female condom research. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2009]. [2] p. (Research Briefs on the Female Condom) Abstract: As the result of a USAID-supported workshop organized by the nonprofit organization CONRAD, scientists have proposed a new design for studies testing the effectiveness of innovations in the female condom. For a female condom to gain regulatory approval in the United States, the U.S. Food and Drug Administration (FDA) currently requires that the product be tested in a large -- and often expensive -- phase III contraceptive-effectiveness trial. CONRAD held the workshop specifically so that experts on female condoms and semen biomarkers could explore acceptable alternatives to this type of trial. The experts identified the well-studied biomarker prostate-specific antigen (PSA) as the most promising marker to pursue for this application. The new study design uses PSA to show the presence of semen in the vagina, which should be a more reliable indicator of clinical condom failure than is the incidence of pregnancy or a sexually transmitted infection. A report of the workshop and the details of the study design are published in the journal Contraception. (Excerpt) Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | STUDY DESIGN | WORKSHOPS | FEMALE CONDOMS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION RESEARCH | CONDOM FAILURE | SEMEN | ANTIGENS | VAGINA | Developed Countries | North America | Americas | Research Methodology | Education | Vaginal Barrier Methods | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Condoms | Seminal Vesicles | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Immunologic Factors | Immunity | Immune System | Genitalia, Female Document Number: 331704 |
| 7. Title: The U.S. commitment to global health: Recommendations for the public and private sectors. Author: Institute of Medicine. Committee on the U.S. Commitment to Global Health Source: Washington, D.C., Institute of Medicine, 2009 May. 4 p. (Report Brief) Abstract: In 2008, the Institute of Medicine convened the expert Committee on the U.S. Commitment to Global Health to investigate the U.S. commitment to global health and to articulate a vision for future U.S. investments in this arena. The committee concludes that the U.S. government and U.S.-based commercial entities, foundations, universities, and other nonprofit organizations have an opportunity to improve global health. The committee initially issued an interim report with recommendations aimed specifically at the U.S. government, such as prioritizing global health as a pillar of foreign policy. This subsequent report addresses other sectors as well as government. The committee identifies five areas for action by the interdisciplinary team: 1. Scale-up existing interventions to achieve significant health gains; 2. Generate and share knowledge to address problems prevalent in poor countries; 3. Invest in people, institutions, and capacity building with global partners; 4. Increase U.S. financial commitments to global health; 5. Set the example of engaging in respectful partnerships. (Excerpt) Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | GOVERNMENT | ORGANIZATIONS | PRIVATE SECTOR | HEALTH | FOREIGN AID | CAPACITY BUILDING | KNOWLEDGE | LEADERSHIP | INTERNATIONAL COOPERATION | Developed Countries | North America | Americas | Political Factors | Sociocultural Factors | Macroeconomic Factors | Economic Factors | Financial Activities | Program Sustainability | Programs | Organization and Administration Document Number: 331419 |
| 8. Title: The morning-after pill [letter] Author: Abell S Source: Clinical Pediatrics. 2009 Apr;48(3):341-2; discussion 342. Abstract: This is a question from a reader to the journal's Medical Doctor about the morning-after pill. The Dr. clearly confirms that the morning-after pill is not causing abortion. Her description helps us better understand how this pill (usually levonorgestrel), a progestin, works in preventing a pregnancy. This approach, which is now known as Plan B™, has received strong support in the prevention of unplanned pregnancies from both the American College of Obstetrics and Gynecology and the American Academy of Pediatrics in also circumventing the need for abortions in women of all ages, especially in adolescent girls. Some pharmacists have resisted filling these Plan B prescriptions, so it will be important for pediatricians to know which pharmacies in your community will accept your Plan B™ prescriptions. Sadly, teenage pregnancies continue to have a major impact on disadvantaged teenagers. This group of individuals also may have limited access to Plan B prescriptions, which requires that they should be taken within 5 days of unprotected intercourse in order for them to be effective in preventing unwanted pregnancies. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | EVALUATION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE MODE OF ACTION | ABORTION | CONTRACEPTIVE SAFETY | CONTRACEPTIVE AVAILABILITY | PHARMACY DISTRIBUTION | ORAL CONTRACEPTIVES, SIDE EFFECTS | NAUSEA | VOMITING | Developed Countries | North America | Americas | Demographic Factors | Population | Contraception | Family Planning | Fertility Control, Postconception | Safety | Public Health | Health | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Signs and Symptoms | Diseases Document Number: 331244 Notification |
| 9. Title: Prevention of invasive pneumococcal disease in HIV-infected children: expanding the toolbox [editorial] Author: Abzug MJ; Pelton SI Source: Journal of Infectious Diseases. 2009 Apr 15;199(8):1109-11. Abstract: Invasive pneumococcal disease (IPD) remains a threat to HIV-infected children, adolescents, and adults in both developed and emerging nations. In the pre-highly active antiretroviral therapy (HAART) era, Mao et al. identified a cumulative incidence of 6.1 cases per 100 patient-years through age 7 years among HIV-infected children in Massachusetts, a rate 100-300-fold that seen in HIV-uninfected immunocompetent children in the United States. Similarly, Westwood et al. reported an IPD rate of 13 cases per 100 patient-years in Capetown, South Africa, a large proportion of which were lower respiratory tract infections. With widespread use of HAART in the United States, the rate of pneumococcal bacteremia declined by 80%, to 1.9 cases per 100 patient-years; this residual rate still remained at least 10-fold greater than that among HIV-uninfected children, and children who suffered an episode of pneumococcal bacteremia were more likely to die during follow-up than were HIV-infected children without an episode. These data identify the need to protect HIV-infected children from infection with Streptococcus pneumoniae, even in populations treated with HAART. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | MASSACHUSETTS | SOUTH AFRICA | SUMMARY REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ADULTS | ADOLESCENTS | ANTIRETROVIRAL THERAPY | DISEASE PREVENTION | VACCINES | Developed Countries | North America | Americas | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341354 |
| 10. Title: Understanding the effects of personal and school religiosity on the decision to abort a premarital pregnancy. Author: Adamczyk A Source: Journal of Health and Social Behavior. 2009 Jun;50(2):180-95. Abstract: Although much research has examined the relationship between religion and abortion attitudes, few studies have examined whether religion influences abortion behavior. This study looks at whether individual and school religiosity influence reported abortion behavior among women who become pregnant while unmarried. Hierarchical Logistic Models are implemented to analyze two waves of data from the National Longitudinal Study of Adolescent Health. Findings show that personal religiosity is unrelated to reported abortion behavior. However, conservative Protestants appear less likely to obtain abortions than mainline Protestants, Catholics, and women of non-Christian faiths. Regardless of personal religious affiliation, having attended a school with a high proportion of conservative Protestants appears to discourage abortion as women enter their twenties. Conversely, women from private religious high schools appear more likely to report obtaining an abortion than women from public schools. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | LONGITUDINAL STUDIES | YOUTH | STUDENTS | SECONDARY SCHOOLS | PREGNANCY | UNMARRIED | RELIGION | ABORTION | CATHOLICISM | CHRISTIANITY | DECISION MAKING | PREMARITAL PREGNANCY | Developed Countries | North America | Americas | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Schools | Reproduction | Marital Status | Nuptiality | Sociocultural Factors | Fertility Control, Postconception | Family Planning | Behavior | Reproductive Behavior | Fertility | Population Dynamics Document Number: 342236 Notification |
| 11. Title: Implanon: a review of the literature with recommendations for clinical management. Author: Adams K; Beal MW Source: Journal of Midwifery and Women's Health. 2009 Mar-Apr;54(2):142-9. Abstract: Implanon is a new implantable, progestin-only contraceptive which was approved in the United States in July 2006. Implanon is comprised of a single ethylene vinylacetate copolymer rod that is 4 cm long and 2 mm in diameter. It is inserted subdermally in the groove between the biceps and triceps of the nondominant arm. A literature review was conducted and side effects are discussed. Implanon offers promise as a high-efficacy, long-term contraceptive and can enhance the contraceptive options offered by the women's health care providers. Clinical trial data indicate that the device is both safe and effective. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTION | CONTRACEPTIVE EFFECTIVENESS | MANAGEMENT | Developed Countries | North America | Americas | Contraceptive Agents, Female | Contraceptive Agents | Family Planning | Organization and Administration Document Number: 341634 |
| 12. Peer Reviewed Title: Expanding access to intrauterine contraception. Author: Allen RH; Goldberg AB; Grimes DA Source: American Journal of Obstetrics and Gynecology. 2009 Jun 13; Abstract: The intrauterine device is a safe, highly effective, long-lasting, yet reversible method of contraception. Expanding access to intrauterine contraception is an important measure to reduce the rate of unintended pregnancy in the United States. Clinicians should consider intrauterine contraception in appropriate candidates, including women who are nulliparous, adolescent, immediately postpartum or postabortal, and desiring emergency contraception, and as an alternative to permanent sterilization. Barriers to intrauterine contraception such as requiring cervical cancer screening before insertion, routine testing for gonorrhea and chlamydial infection in low-risk women, or scheduling insertion only during menses are unnecessary. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | ADOLESCENTS, FEMALE | IUD | CONTRACEPTIVE AVAILABILITY | MISINFORMATION | CONTRAINDICATIONS | INSERTION | PAIN | IUD EXPULSION | NULLIPARITY | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Communication | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Parity | Fertility Measurements | Fertility | Population Dynamics Document Number: 341709 |
| 13. Title: Interventions for pain with intrauterine device insertion. Author: Allen RH; Bartz D; Grimes DA; Hubacher D; O'Brien P Source: Cochrane Database of Systematic Reviews. 2009;(3):CD007373. Abstract: BACKGROUND: Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES: To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. SEARCH STRATEGY: We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. MAIN RESULTS: Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. AUTHORS' CONCLUSIONS: No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation. Language: English Keywords: UNITED STATES OF AMERICA | CHILE | DENMARK | SWEDEN | LITERATURE REVIEW | CLINICAL TRIALS | IUD | INSERTION | PAIN | DRUGS | ADMINISTRATION AND DOSAGE | MISOPROSTOL | Developed Countries | North America | Americas | Developing Countries | South America, Southern | South America | Latin America | Europe, Northern | Europe | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology Document Number: 342475 |
| 14. Title: Oral contraceptives and the risk of multiple sclerosis: A review of the epidemiologic evidence. Author: Alonso A; Clark CJ Source: Journal of the Neurological Sciences. 2009 May 7; Abstract: Multiple sclerosis (MS) is more frequent in women than in men, suggesting that sex hormones could play a role in the development of MS. For this reason, several studies have assessed whether use of oral contraceptives modifies the risk of MS. In this article, we review the methodology and results of published epidemiologic studies addressing this issue. On the whole, the existing epidemiologic evidence does not support an important effect of oral contraceptive use on the risk of MS, though it does suggest that oral contraceptives might delay the onset of the disease. Language: English Keywords: UNITED KINGDOM | UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | CENTRAL NERVOUS SYSTEM EFFECTS | RISK ASSESSMENT | EPIDEMIOLOGY | Developed Countries | Europe, Western | Europe | North America | Americas | Research Methodology | Demographic Factors | Population | Safety | Public Health | Health | Central Nervous System | Physiology | Biology | Evaluation Document Number: 341145 |
| 15. Peer Reviewed Title: Pregnancy and optimal care of HIV-infected patients. Author: Anderson BL; Cu-Uvin S Source: Clinical Infectious Diseases. 2009 Feb 15;48(4):449-55. Abstract: Human immunodeficiency virus (HIV) infection during pregnancy is a condition that requires multidisciplinary care. Care must be rendered that is appropriate for both the mother and the fetus. Prevention of mother-to-child transmission of HIV is of paramount concern. To prevent transmission, universal testing for HIV infection in pregnant women is ideal. In the United States and other developed countries, great strides have been made toward decreasing the risk of HIV transmission to infants to <2% with use of a combination of highly active antiretroviral therapy during the antepartum period and during labor and delivery, scheduled cesarean section when appropriate, avoidance of breast-feeding, and 6 weeks of zidovudine prophylaxis for infants. The continuation of antiretroviral therapy after delivery depends on the needs of the mother with regard to treatment of her own health. In resource-limited countries, where simplified and shortened courses of antiretroviral regimens have been used, reduction in mother-to-child transmission has also been shown, although not as effectively as that with highly active antiretroviral therapy. In these settings, exclusive breast-feeding for 6 months is recommended to reduce the risk of postnatal transmission. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | RECOMMENDATIONS | PREGNANT WOMEN | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | RISK FACTORS | CESAREAN SECTION | BREASTFEEDING | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Drugs | HIV | HIV Infections | Viral Diseases | Obstetrical Surgery | Surgery | Infant Nutrition | Nutrition Document Number: 342644 |
| 16. Peer Reviewed Title: Safety analysis of the diaphragm in combination with lubricant or acidifying microbicide gels: effects on markers of inflammation and innate immunity in cervicovaginal fluid. Author: Anderson DJ; Williams DL; Ballagh SA; Barnhart K; Creinin MD; Newman DR; Bowman FP; Politch JA; Duerr AC; Jamieson DJ Source: American Journal of Reproductive Immunology. 2009 Feb;61(2):121-9. Abstract: OBJECTIVE: Diaphragms are being considered for use with vaginal microbicide gels to provide enhanced protection against sexually transmitted pathogens. The purpose of this study was to determine whether use of a diaphragm with microbicide or placebo gel causes cervicovaginal inflammation or perturbations in cervicovaginal immune defense. METHOD OF STUDY: Eighty-one non-pregnant women were randomized into three groups and instructed to use Milex (CooperSurgical, Inc., Trumbull, CT, USA)diaphragms overnight for 14 days in combination with one of the two acid-buffering microbicide gels [ACIDFORM (Instead Inc., La Jolla, CA, USA) or BufferGel(trade mark) (BG; ReProtect Inc., Baltimore, Maryland)] or placebo gel (K-Y Jelly); Personal Products Inc., Raritan, NJ, USA). Cervicovaginal lavages (CVLs) were performed prior to study entry and on days 8 and 16. Nine soluble mediators of vaginal inflammation or immune defense were measured in CVLs by Bio-Plex or ELISA. RESULTS: Use of diaphragms with placebo ormicrobicide gel was not associated with increased levels of inflammation markers. Concentrations of secretory leukocyte protease inhibitor (SLPI) were markedly reduced in the BG group. CONCLUSION: Daily use of a diaphragm with placebo or acidifying microbicide gel did not cause cervicovaginal inflammation. However, diaphragm/BG use was associated with markedly reduced levels of SLPI, an important mediator of innate immune defense. Further studies are warranted to establish the safety of diaphragm/microbicide gel combinations. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | CASE CONTROL STUDIES | MICROBICIDES | VAGINAL GEL | LUBRICANTS | IMMUNITY, NATURAL | CONTRACEPTIVE SAFETY | VAGINAL DIAPHRAGM | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Studies | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Ingredients and Chemicals | Immunity | Immune System | Physiology | Biology | Safety | Public Health | Vaginal Barrier Methods | Barrier Methods Document Number: 330234 |
| 17. Title: Nitric oxide-dependent human acrosomal loss induced by PPCM (SAMMA) and by nitric oxide donors occurs by independent pathways: basis for synthesis of an improved contraceptive microbicide. Author: Anderson RA; Feathergill KA; Chany CJ 2nd; Jain S; Krunic A Source: Journal of Andrology. 2009 Mar-Apr;30(2):168-82. Abstract: PPCM (previously designated sulfuric acid-modified mandelic acid [SAMMA]) is a contraceptive microbicide in preclinical development. Its contraceptive activity is attributable in part to its ability to promote premature acrosomal loss. Prior studies showed that PPCM-induced human acrosomal loss (PAL) is Ca(2+)-dependent. This study was carried out to determine transduction elements downstream from Ca(2+) entry. PAL is inhibited by inhibitors selective for endothelial-type nitric oxide synthase. PAL is completely inhibited by 0.1 microM ODQ (soluble guanylate cyclase inhibitor). PAL is inhibited by protein kinase G inhibitors with selectivity for the type II isotype. Several inhibitors of the nitric oxide/cyclic guanosine monophosphate (cGMP)/protein kinase G pathway induce Ca(2+)-dependent acrosomal loss when added alone. These responses are inhibited by nifedipine, a blocker of Ca(v1.x) voltage-dependent channels. Acrosomal loss induced by the nitric oxide donor SNAP (SNAL) does not require added Ca(2+). Sperm production of nitric oxide is increased by PPCM, an effect inhibited by nitro-L-arginine (nitric oxide synthase inhibitor). Although inhibited by ODQ, SNAL and acrosomal loss induced by other nitric oxide donors are unaffected by KT5823 (protein kinase G inhibitor). Unlike PAL, SNAL is partially inhibited by KT5720 (protein kinase A inhibitor) and genistein (protein tyrosine kinase inhibitor). Acrosomal loss response to PPCM and SNAP added in combination suggests that these agents act by independent mechanisms. A PPCM derivative was synthesized, in which a nitric oxide donor was esterified to PPCM (NOSPPA-23). NOSPPA-23 induces acrosomal loss with or without added Ca(2+). The ED(50) of NOSPPA-23 (4.8 nM) in the presence of Ca(2+) is 35-fold less than that of PPCM. These findings suggest the following: 1) elements responsible for PAL include endothelial nitric oxide synthase, soluble guanylate cyclase, and type II protein kinase G; 2) the resting state of the nitric oxide/cGMP/protein kinase G pathway is a determinant of acrosomal status; 3) PPCM and nitric oxide donors induce acrosomal loss via nitric oxide, but through independent pathways; and 4) covalent attachment of a nitric oxide donor to PPCM provides synergistic efficacy as a stimulus of acrosomal loss. Further studies with this novel prototype as an improved contraceptive microbicide are warranted. Language: English Keywords: UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | MICROBICIDES | DRUGS | CONTRACEPTION RESEARCH | Developed Countries | North America | Americas | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | Family Planning Document Number: 331202 |
| 18. Title: Oral Contraceptives: A Risk Factor for Squamous Cell Carcinoma? Author: Applebaum KM; Nelson HH; Zens MS; Stukel TA; Spencer SK; Karagas MR Source: Journal of Investigative Dermatology. 2009 Jun 25; Abstract: Oral contraceptives (OCs) affect the risk of several cancers in women, but have been virtually unstudied for squamous cell carcinoma (SCC). We examined the hypothesis that OCs influence SCC risk in a case-control study among women and also examined whether polymorphisms in the DNA repair gene, Xeroderma pigmentosum group D (XPD), modified the risk. Incident cases of SCC were identified by a network of dermatologists and pathology laboratories. Population-based controls were frequency matched to cases by age and gender (n=261 SCC cases, 298 controls). Overall, OC use was associated with a 60% higher risk of SCC (odds ratio (OR), 1.6; 95% confidence interval (95% CI): 1.0-2.5). ORs for SCC were higher among those who last used OCs >/=25 years before diagnosis (OR: 2.1; 95% CI: 1.2-3.7), and among these women, SCC risk increased with duration of use (OR for /=7 years, 2.7; 95% CI: 0.9-8.5, P(trend)=0.01). Furthermore, the XPD Lys751Gln polymorphism was a significant modifier of the OC-SCC association (P(interaction)=0.03). These findings lead us to hypothesize a potential relationship between OCs and SCC risk, and that this could involve DNA repair pathways.Journal of Investigative Dermatology advance online publication, 25 June 2009; doi:10.1038/jid.2009.168. Language: English Keywords: UNITED STATES OF AMERICA | NEW HAMPSHIRE | RESEARCH REPORT | CONTROL GROUPS | WOMEN | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, SIDE EFFECTS | RISK FACTORS | CANCER | DERMATOLOGICAL EFFECTS | ESTROGENS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Health | Neoplasms | Diseases | Physiology | Biology | Hormones | Endocrine System Document Number: 341751 |
| 19. Peer Reviewed Title: Ovarian activity and safety of a novel levonorgestrel/ethinyl estradiol continuous oral contraceptive regimen. Author: Archer DF; Kovalevsky G; Ballagh SA; Grubb GS Source: Contraception. 2009 Sep;80(3):245-53. Abstract: BACKGROUND: A continuous regimen of oral levonorgestrel (LNG) 90 mcg/ethinyl estradiol (EE) 20 mcg was evaluated for inhibition of ovulation, time to return to ovulation after stopping treatment and safety. STUDY DESIGN: This open-label study was conducted in healthy women aged 18-35 years. Ovulation was documented before treatment, and then participants received oral tablets containing LNG 90 mcg/EE 20 mcg to be taken continuously for three 28-day intervals. Ovarian activity was assessed three times per week during the treatment period with transvaginal ultrasound scans and measurements of serum 17beta-estradiol, progesterone, follicle-stimulating hormone and luteinizing hormone concentrations. Safety assessments included physical examinations, laboratory evaluations and adverse event records. RESULTS: Thirty-seven of the 58 subjects who received treatment met predefined criteria for efficacy analysis. No on-treatment ovulations occurred in the efficacy or intent-to-treat population. There was evidence of ovulation within 37 days of stopping treatment for 46 (98%) of 47 subjects evaluated posttreatment. The final subject with a history of polycystic ovarian syndrome ovulated by Day 66. The safety profile observed during this 84-day continuous regimen was similar to that seen with other low-dose oral contraceptives administered in a cyclic regimen. CONCLUSIONS: The continuous LNG/EE regimen completely inhibited ovulation, with little evidence of follicular development and with rapid return of ovulatory capacity after stopping treatment. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | ORAL CONTRACEPTIVES | LEVONORGESTREL | ETHINYL ESTRADIOL | SAFETY | ULTRASONICS | OVARIAN EFFECTS | TREATMENT | Developed Countries | North America | Americas | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Public Health | Health | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Ovary | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 342575 |
| 20. Peer Reviewed Title: Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women. Author: Austin H; Lally C; Benson JM; Whitsett C; Hooper WC; Key NS Source: American Journal of Obstetrics and Gynecology. 2009 Jun;200:620e1-620e3. Abstract: OBJECTIVE: We evaluated the effect of oral and other hormonal contraceptive (HC) use on venous thromboembolism risk among African American women and investigated whether the association was modified by the sickle cell trait. STUDY DESIGN: We report the findings of a case-control study that included 60 African American women with an idiopathic, first episode of venous thromboembolism and 196 African American controls. RESULTS: The odds of current HC use compared with noncurrent use contrasting cases and controls is 3.8 (95% confidence interval [CI], 1.7-8.1; P < .001). Among subjects with sickle cell trait, the odds ratio is higher (odds ratio [OR], 6.7; 95% CI, 1.0-43) than the odds ratio among subjects without sickle cell trait (OR, 2.6; 95% CI, 1.1-6.2), but the difference is not statistically significant. CONCLUSION: This study provides persuasive evidence that hormonal contraceptive use increases venous thromboembolism risk among African American women and that the increase in risk may be larger among women with sickle cell trait. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CASE STUDIES | BLACKS | WOMEN | CONTRACEPTION | CONTRACEPTIVE AGENTS | THROMBOEMBOLISM | DISEASES | RISK FACTORS | Developed Countries | North America | Americas | Studies | Research Methodology | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Family Planning | Embolism | Vascular Diseases | Health Document Number: 330853 |
| 21. Peer Reviewed Title: Bleeding patterns associated with non-oral hormonal contraceptives: a review of the literature. Author: Bachmann G; Korner P Source: Contraception. 2009 Apr;79(4):247-58. Abstract: It is generally accepted that poor tolerance to changes in vaginal bleeding associated with hormonal contraceptive use may influence compliance and continuation with the chosen method. However, disparities in the collation and reporting of bleeding data hamper comparison among studies and products. In this review, we systematically assessed MEDLINE and EMBASE for articles assessing parenteral hormonal contraceptives that reported bleeding data based on reference periods as recommended by the World Health Organization (WHO). Overall, 31 studies published between 1986 and October 2007 were included in this review. The use of parenteral hormonal contraception was in general associated with a decrease in bleeding with continued use from Reference Period 1 to 4. However, this decrease was less marked with the combined hormonal depots and both progestin-only and combined hormonal vaginal rings than with progestin-only implants, depots and the levonorgestrel intrauterine system. Overall, reporting vaginal bleeding by 90-day reference periods as recommended by the WHO allows straightforward comparison of bleeding patterns between studies. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | BLEEDING | CONTRACEPTIVE IMPLANTS | VAGINAL RING | CONTRACEPTIVE AGENTS, PROGESTIN | Developed Countries | North America | Americas | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents Document Number: 330560 |
| 22. Peer Reviewed Title: Increased access to emergency contraception: why it may fail. Author: Baecher L; Weaver MA; Raymond EG Source: Human Reproduction. 2009 Apr;24(4):815-9. Abstract: BACKGROUND: To explore why increased access to emergency contraception (EC) failed to reduce pregnancies in a recent randomized controlled trial. METHODS: We used multivariable logistic regression to identify risk factors for unintended pregnancy using data from a trial involving sexually active women (n = 1490, aged 14-24 years) randomly assigned to either increased access or standard access to EC. We used predictive modeling to generate estimated pregnancy risk scores for each participant. We then examined EC use among women at low or high baseline risk of pregnancy. RESULTS: Gravidity, recent history of unprotected sex (within 14 days of enrollment to study) and lower aversion to pregnancy predicted unintended pregnancy. Women in the increased access group were more likely than women in the standard access group to use EC repeatedly. This difference was significantly stronger (P = 0.03) among low risk women than high risk women [Relative risk (RR) 10.0, 95% confidence interval (CI) 6.5-15.4 and RR 5.5, 95% CI 3.8-7.9, respectively]. CONCLUSIONS: Increased access to EC had a greater impact on women who were at lower baseline risk of pregnancy. This may explain in part why increased access to EC has had no measurable benefit in clinical trials. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PREGNANCY, UNPLANNED | INCIDENCE | RISK FACTORS | PSYCHOSOCIAL FACTORS | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Measurement | Health | Behavior Document Number: 341661 |
| 23. Peer Reviewed Title: Return to fertility after cessation of a continuous oral contraceptive. Author: Barnhart K; Mirkin S; Grubb G; Constantine G Source: Fertility and Sterility. 2009 May;91(5):1654-6. Abstract: OBJECTIVE: To evaluate the return to fertility among women planning to become pregnant after the use of a continuous regimen of levonorgestrel 90 microg and ethinyl E(2) 20 microg. DESIGN: Descriptive analysis of pregnancy outcomes after participation in a contraceptive trial. SETTING: Multicenter trial. SUBJECT(S): Participants in a phase 3 contraceptive trial who discontinued to become pregnant. INTERVENTION(S): Eligible subjects were contacted at 3 and 12 months after treatment discontinuation to determine if and when they had conceived. MAIN OUTCOME MEASURE(S): Kaplan-Meier analysis displaying the time until conception after oral contraceptive discontinuation. RESULT(S): In the phase 3 trial, 34 of 2,134 subjects cited a desire for pregnancy as a reason for discontinuation. Of these, 4 were already pregnant before stopping treatment, 4 initiated other contraception, and 5 were lost to follow-up. Of the remaining 21 subjects at risk of pregnancy, the pregnancy rate was 57% at 3 months, 81% at 12 months, and 86% (18 of 21) (95% confidence interval 64% to 97%) at 13 months after discontinuation of treatment. CONCLUSION(S): These findings suggest that a continuous oral contraceptive with levonorgestrel 90 microg and ethinyl E(2) 20 microg does not delay the return to fertility. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | ORAL CONTRACEPTIVES, LOW-DOSE | REVERSIBILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Clinical Research | Research Methodology | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Effectiveness Document Number: 341245 |
| 24. Peer Reviewed Title: Return to fertility following discontinuation of oral contraceptives. Author: Barnhart KT; Schreiber CA Source: Fertility and Sterility. 2009 Mar;91(3):659-63. Abstract: OBJECTIVES: To provide an overview of the studies that have evaluated the return to fertility following cessation of oral contraceptives (OCs), including recent evidence in women discontinuing extended-cycle and continuous-use regimens. DESIGN: Comprehensive review. PATIENT(S): None. INTERVENTION(S): Relevant articles were identified through a PubMed literature search (1960-2007) and a cross-reference of published data. MAIN OUTCOME MEASURE(S): Time to fertility following contraceptive use. RESULT(S): Numerous studies have demonstrated some delay in the time to conception in previous users of OCs who discontinued use in order to conceive, but this impairment appears to be temporary and typically limited to the early months following cessation of OC use. Reported 12-month conception rates in former cyclic OC users range from 72%-94% and are similar to those observed in women discontinuing intrauterine devices (71%-92%), progestin-only contraceptives (70%-95%), condoms (91%), and natural family planning (92%). There is a limited amount of data on the time to conception in women stopping extended-cycle and continuous-use OCs, but the data suggest that subsequent return to fertility is generally comparable to that of cyclic OCs. CONCLUSION(S): A comprehensive survey of reported data indicates that the return of fertility in former OC users (both cyclic and extended/continuous regimens) in women who stop use in order to conceive is comparable to that observed with other contraceptive methods. Language: English Keywords: UNITED STATES OF AMERICA | PENNSYLVANIA | LITERATURE REVIEW | FERTILITY | ORAL CONTRACEPTIVES | CONTRACEPTIVE USAGE | REVERSIBILITY | Developed Countries | North America | Americas | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning Document Number: 330562 |
| 25. Peer Reviewed Title: Medication abortion. Author: Bartz D; Goldberg A Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):140-50. Abstract: Medical methods for pregnancy termination in early gestation offer women an alternative to surgical evacuation and have the potential to improve access globally to safe abortion. Several drug regimens are used with varying efficacy including mifepristone plus misoprostol, misoprostol alone, and methotrexate plus misoprostol. Where available, a mifepristone plus misoprostol regimen is most frequently used and is highly effective for early abortion. We review these drug regimens along with clinical practice recommendations including patient counseling and selection, regimen administration location, expected side effects, and follow-up procedures. Overall, women who choose medical abortion report high levels of satisfaction. Language: English Keywords: UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | ABORTION | MISOPROSTOL | RU-486 | DRUGS | COUNSELING | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 342250 Notification |
| 26. Title: Sexual behavior and perceived peer norms: comparing perinatally HIV-infected and HIV-affected youth. Author: Bauermeister JA; Elkington K; Brackis-Cott E; Dolezal C; Mellins CA Source: Journal of Youth and Adolescence. 2009 Sep;38(8):1110-22. Abstract: A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9-16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were "cool" or "popular" were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were "cool" or "popular" varied by age, gender, and HIV status. Furthermore, friends' sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV. Language: English Keywords: UNITED STATES OF AMERICA | NEW YORK | RESEARCH REPORT | COMPARATIVE STUDIES | ETHNIC GROUPS | PERSONS LIVING WITH HIV/AIDS | ADOLESCENTS | PEER GROUPS | VALUE ORIENTATION | HIV INFECTIONS | SEX BEHAVIOR | Developed Countries | North America | Americas | Studies | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Youth | Age Factors | Knowledge Sources | Communication | Psychological Factors | Behavior Document Number: 342389 |
| 27. Peer Reviewed Title: Women's perspectives on family planning service quality: an exploration of differences by race, ethnicity and language. Author: Becker D; Klassen AC; Koenig MA; LaVeist TA; Sonenstein FL; Tsui AO Source: Perspectives On Sexual and Reproductive Health. 2009 Sep;41(3):158-65. Abstract: CONTEXT: Despite calls to make family planning services more responsive to the values, needs and preferences of clients, few studies have asked clients about their experiences or values, and most have used surveys framed by researchers', rather than clients', perspectives. METHODS: Forty in-depth interviews exploring lifetime experiences with and values regarding services were conducted with 18-36-year-old women who visited family planning clinics in the San Francisco Bay Area in 2007. Women were categorized as black, white, English- or Spanish-speaking Latina, or of mixed ethnicity to allow examination of differences by racial, ethnic and language group. Interviews were audiotaped, transcribed and coded thematically; matrices were then used to compare the themes that emerged across the subgroups. RESULTS: Eight themes emerged as important to women's views of services: service accessibility, information provision, attention to client comfort, providers' personalization of care, service organization, providers' empathy, technical quality of care and providers' respect for women's autonomy. Women reported that it was important to feel comfortable during visits, to feel that their decision-making autonomy was respected, to have providers show empathy and be nonjudgmental, and to see the same provider across visits. The only notable difference among racial, ethnic and language groups was that Spanish-speaking Latinas wanted to receive language-appropriate care and contraceptive information. CONCLUSIONS: Future surveys of family planning service quality should include measures of the factors that women value in such care, and efforts to improve providers' communication and counseling skills should emphasize the personalization of services and respect for clients' autonomy. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | INTERVIEWS | FAMILY PLANNING SURVEYS | WOMEN | CLIENTS | ETHNIC GROUPS | FAMILY PLANNING | LANGUAGE | HEALTH SERVICES | QUALITY OF HEALTH CARE | COMMUNICATION | COUNSELING | Developed Countries | North America | Americas | Data Collection | Research Methodology | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Cultural Background | Population Characteristics | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Clinic Activities Document Number: 342713 |
| 28. Peer Reviewed Title: Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections. Author: Ben-Ami I; Schneider D; Svirsky R; Smorgick N; Pansky M; Halperin R Source: American Journal of Obstetrics and Gynecology. 2009 Aug;201(2):154.e1-5. Abstract: OBJECTIVE: To assess whether there is an increased perioperative risk in termination of late second-trimester pregnancy after multiple cesarean sections by laminaria dilatation and evacuation. STUDY DESIGN: During the period between January 2002 and June 2008, 636 consecutive patients underwent late second-trimester (17-24 weeks) pregnancy terminations by dilatation and evacuation. Patients were divided into 3 subgroups: those with no previous cesarean section (n = 545), those with 1 previous cesarean section (n = 59), and those with several previous cesarean sections (n = 32). RESULTS: There were no significant differences in major perioperative complications, such as anesthetic complications, need for blood transfusion, and cervical lacerations comparing the 3 subgroups. Importantly, there were neither cases of uterine perforation nor retained products of conception in the 3 subgroups. CONCLUSION: Late second-trimester pregnancy termination after multiple cesarean sections by laminaria dilatation and evacuation is probably not associated with an increased perioperative risk. Larger studies are needed to empower this study. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLIENTS | WOMEN | PREGNANCY, SECOND TRIMESTER | CESAREAN SECTION | ABORTION | SAFETY | UTERINE EFFECTS | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Public Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 342611 Notification |
| 29. Title: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Author: Benacerraf BR; Shipp TD; Bromley B Source: Ultrasound In Obstetrics and Gynecology. 2009 Jun 29;34(1):110-115. Abstract: OBJECTIVE: To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices. METHODS: Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones. RESULTS: Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms wasonly detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal. CONCLUSION: A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd. Language: English Keywords: UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ULTRASONICS | IUD COMPLICATIONS | IUD MIGRATION | BLEEDING | PAIN | MYOMETRIUM | CERVIX | INSERTION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment Document Number: 341864 |
| 30. Peer Reviewed Title: Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. Author: Berenson AB; Rahman M Source: American Journal of Obstetrics and Gynecology. 2009 Mar;200(3):329.e1-8. Abstract: OBJECTIVE: The purpose of this study was to determine changes in bodyweight and composition that result from hormonal contraception. STUDY DESIGN: Dual-energy x-ray absorptiometry was performed at baseline and every 6 months for 3 years for 703 women (African American, 200; white, 247; Hispanic, 256) who were beginning the use of oral contraception (OC; n = 245), depot medroxyprogesterone acetate (DMPA; n = 240), or nonhormonal contraception (NH; n = 218). DMPA discontinuers were observed for up to 2 years to examine the reversibility of the observed changes. RESULTS: Over 36 months, DMPA users increased their weight (+5.1 kg), body fat (+4.1 kg), percent body fat (+3.4%), and central-to-peripheral fat ratio (+0.1) more than OC and NH users (P < .01). OC use did not cause weight gain. After DMPA discontinuation, NH users lost 0.42 kg in 6 months; OC users gained 0.43 kg in 6 months. CONCLUSION: Bodyweight and fat significantly increase with the use of DMPA. After discontinuation of DMPA, some decrease in bodyweight and fat occurs when NH is used. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | ORAL CONTRACEPTIVES | BODY WEIGHT | MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE USAGE | LIPIDS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents Document Number: 330467 |
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