Quality of care and contraceptive pill discontinuation in rural Egypt

Indicators of family planning service access and quality were generated using the Egypt DHS-I (1988) and the Egypt Service Availability Survey (1989), and linked to episodes of contraceptive pill use. Multilevel analysis was used to ascertain whether or not these access and quality indicators influence the continuation of pill use, net of women's socioeconomic, demographic and motivational characteristics. A model with random components at the cluster and women levels was fitted for all reasons of discontinuation, except desire for pregnancy, at 24 months of use. Net of women's background characteristics, the results show that facilities with smaller numbers of health personnel trained in family planning, a lack of access to facilities with female doctors and a lack of range of available methods are associated with a high risk of discontinuation of pill use for all reasons except desire for pregnancy.     

Determinants of contraceptive discontinuation in six developing countries.

This analysis investigates the determinants of contraceptive discontinuation in six developing countries, using data from Phase I surveys of the DHS programme. Cumulative probabilities of discontinuation at 24 months for reasons other than the desire for another child were examined. By this time, typically about 40% of couples have stopped use and most are subsequently at risk of an unwanted conception. Discontinuation of IUD use was found to be less common than for other methods, partly perhaps because cessation of use requires a deliberate decision to have the device removed. The most important results are negative ones. Neither the schooling of couples nor their type of residence exerted appreciable influence on discontinuation. The policy and programme implications are discussed. Prior use of a method, fertility preferences and the related demographic factors of age and family size emerged as pervasive predictors of discontinuation.     

Hemostatic changes induced by exercise during oral contraceptive use

Exercise-induced changes in hemostatic measurements were studied in 25 women. Twelve of the subjects were not using oral contraceptives and the remainder were using Demulen (ethynodiol diacetate (1 mg) and ethinyl estradiol (0.05 mg)). Exercise on a treadmill induced similar changes in both groups, but during the use of Demulen the levels of fibrinogen and plasminogen were higher, antithrombin level was lower, and the recalcified clotting and dilute whole blood lysis times were shorter in group 2 than in the corresponding samples obtained from the nonpill users.     

A scale to measure microbehaviors of oral contraceptive pill use

Abstract

The ways in which contraceptive methods are actually used is of increasing interest to researchers, clinicians, and policy makers. Although contraceptive “use” has multiple dimensions, existing indicators measure only one aspect of use or combine unidimensional measures to produce a questionable pastiche. This study uses a subsample of 612 respondents from a larger study of first‐time patients at a public‐health‐department family planning clinic to develop a new measure. Psychometric properties of this measure are examined and discussed.     

A scale to measure microbehaviors of oral contraceptive pill use

The ways in which contraceptive methods are actually used is of increasing interest to researchers, clinicians, and policy makers. Although contraceptive "use" has multiple dimensions, existing indicators measure only one aspect of use or combine unidimensional measures to produce a questionable pastiche. This study uses a subsample of 612 respondents from a larger study of first-time patients at a public-health-department family planning clinic to develop a new measure. Psychometric properties of this measure are examined and discussed.     

Ineffective contraceptive use and its causes in a natural fertility population in southern Jordan

Based on our interview survey of 574 randomly selected married women from a rural population in the South Ghor district, Jordan, where traditional Arab customs have been persistently maintained, in this paper we analyze the age-specific marital fertility rates (ASMFRs) and contraceptive practices, especially the prevalence and duration of contraceptive use. The ASMFRs fitted the natural fertility pattern proposed by Coale and Trussell's model, and the total fertility rate was estimated to be 7.2. Even though the prevalence rate of modern contraceptive methods has reached 14.3%, because of the recent increase among young women in particular, the users had larger numbers of children than the nonusers and the duration of contraceptive use was short, especially at young ages (e.g., about 90% 24-month discontinuation probabilities in 15-19- and 20-24-year-olds). These ineffective contraceptive uses were related to traditional Arab norms, represented by the pooled proportion of "as many as possible" and "up to God" answers to the ideal number of children (70% of men and 30% of women).     

Effects of menstrual cycle phase and oral contraceptive use on intermittent exercise

Five women using low-dose, monophasic oral contraceptive (OC) agents (OC group) and ten normally menstruating women (Non-OC group) performed a treadmill protocol to determine the effect of OCs and the menstrual cycle (MC) on intermittent exercise performance and some commonly used metabolic markers. The Non-OC group were tested once in the mid-follicular phase (MFP) and once in the late luteal phase (LLP) of the MC, while the OC group performed their first test within 1 week of taking the OC (T1) and their second test 1 week later (T2). Despite performance time being the same in both groups [mean (SD), Non-OC group: 77.7 (14.9) s versus OC group: 77.7 (21.1)s], plasma ammonia concentration ([NH₃]_pl) was higher in the Non-OC group when compared to the OC group throughout recovery (P < 0.05). No differences were found in blood lactate (BLa), maximum heart rate or aural temperature (T _au) between groups. Within the Non-OC group T _au increased with exercise in both phases (P < 0.05), however T _au was higher in the LLP at rest [36.1 (0.3)°C) and 1 min post-exercise [37.1 (0.6)°C), when compared to the MFP [35.8 (0.3) and 36.9 (0.7)°C, rest and 1 min post-exercise respectively, P < 0.05]. Within the OC group T1 resulted in a higher peak BLa [11.2 (0.4) mmol/l] and [NH₃]_pl (143.0 (26.2) Umol/l] when compared to T2 [BLa, 9.6 (0.9); [NH₃], 119.4 (48.1), P<0.05]. These results suggest that: (1) exercise performance does not vary between the MFP and the LLP of the MC, nor does it appear to be affected by the number of days using the OC, and (2) an altered metabolism occurs both between groups (Non-OC versus OC) and within the OC group. Accepted: 2 June 1998     

Effects of menstrual cycle and oral contraceptive use on calf venous compliance

Numerous studies have shown that the female sex hormones estrogen and progesterone have multiple effects on the vasculature. Thus our goal was to investigate the effects of estrogen and progesterone on calf venous compliance by looking for cyclic changes during the early follicular, ovulatory, and midluteal phases of the menstrual cycle and during high and low hormone phases of oral contraceptive use. Additionally, we wanted to compare the venous compliance of normally menstruating women, oral contraceptive users, and men. We studied eight normally menstruating women (23 +/- 1 yr of age) during the early follicular, ovulatory, and midluteal phases of the menstrual cycle. Nine triphasic oral contraceptive users (21 +/- 1 yr of age) were studied during weeks of high and low hormone concentrations. Eight men (23 +/- 1 yr of age) were studied twice within 2-4 wk. With the use of venous occlusion plethysmography with mercury in-Silastic strain gauges, lower limb venous compliance was measured by inflating a venous collection cuff that was placed on the thigh to 60 mmHg for 8 min and then reducing the pressure to 0 mmHg at a rate of 1 mmHg/s. Venous compliance was calculated as the derivative of the pressure-volume curves. There were no differences between early follicular, ovulatory, and midluteal phases of the menstrual cycle or between high and low hormone phases of oral contraceptive use (P > 0.05). Male venous compliance was significantly greater than in normally menstruating women (P < 0.001) and oral contraceptive users (P < 0.002). These data support a sex difference but also suggest that venous compliance does not change with menstrual cycle phase or during the course of oral contraceptive use.     

Effects of menstrual cycle phase and oral contraceptive use on verbal memory

Surgical or pharmacological suppression of ovarian hormones leads to declines in verbal memory, and estrogen treatment reverses these deficits. In the current study, we investigated the effects of menstrual cycle phase and oral contraceptives on verbal memory, as measured by the California Verbal Learning Test, in two groups of premenopausal women — 16 naturally cycling women and 20 current users of estrogen-based oral contraceptives (OCs). Naturally cycling women were assessed twice — once during the early follicular phase (Days 2-4) and once during the midluteal phase (Days 20-22) of the menstrual cycle. OC users were tested on the same cycle days, corresponding to inactive and active pill phases, respectively. We predicted that naturally cycling women would show improved verbal memory during the midluteal phase, when estradiol levels are high, compared with the follicular phase, when estradiol levels are low. We also predicted that OC users, who show no change in endogenous estradiol across the cycle, would show no change in verbal memory. Contrary to predictions, naturally cycling women showed no changes in verbal memory across the cycle, whereas OC users showed enhanced memory during the active pill phase (p < .05). None of the secondary cognitive outcome measures varied with cycle phase or OC use including measures of visuospatial memory, verbal fluency, visuospatial abilities, and attention. Overall, these results suggest that verbal memory performance in premenopausal women varies across the cycle with OC use, but does not vary systematically with changes in endogenous estradiol.     

Implicit motives and gonadal steroid hormones: effects of menstrual cycle phase,oral contraceptive use,and relationship status

Implicit motives for power and affiliation, salivary levels of testosterone, estradiol, and progesterone, and relationship status were measured in 18 normally cycling (NC) women, 18 women using oral contraceptives (OC), and 18 men at three assessments, corresponding to the menstrual, midcycle, and premenstrual phases of women's menstrual cycle. NC and OC women had elevated levels of affiliation motivation and decreased levels of power motivation at midcycle. Power motive changes were particularly pronounced in NC women across cycle phases. OC women and participants not engaged in an intimate relationship had significantly heightened levels of affiliation motivation, averaged across all cycle phases. Testosterone and power motivation, both averaged across all cycle phases, were positively correlated in men and in single women, but not in women engaged in an intimate relationship. Averaged levels of estradiol and power motivation were positively correlated in engaged women, but not in single women or men. Averaged levels of progesterone and affiliation motivation were negatively correlated in men, and there was evidence for a positive association between luteal affiliation motivation and periovulatory and luteal progesterone in NC women. This study therefore provides evidence that implicit motivational states fluctuate across the menstrual cycle, that the power motive is associated with testosterone and, in women, with estradiol, and that the affiliation motive and progesterone are associated in different ways in men and NC women.     

Influence of oral contraceptive use on endothelial t-PA release in healthy premenopausal women

We determined the influence of oral contraceptives (OC) on the capacity of the endothelium to release tissue-type plasminogen activator (t-PA). Twenty-three healthy premenopausal women were studied: 12 nonusers and 11 users of OC. Net endothelial release rates of t-PA were calculated as the product of the arteriovenous concentration gradient and forearm plasma flow in response to intra-arterial bradykinin (BK: 12.5-50 ng. 100 ml tissue(-1) x min(-1)) and sodium nitroprusside (SNP: 1.0-4.0 microg x 100 ml tissue(-1) x min(-1)). Net release of t-PA antigen and increment in t-PA activity across the forearm to BK increased (P < 0.01) in a dose-dependent fashion and to similar extents in the nonusers and users of OC. At the highest BK dose, net release of t-PA antigen was 64.5 +/- 8.2 and 66.2 +/- 15.4 ng x 100 ml tissue(-1) x min(-1) in the nonusers and users of OC, whereas the net increment in t-PA activity was 18.6 +/- 3.0 and 16.0 +/- 2.0 IU. 100 ml tissue(-1) x min(-1), respectively. There was no effect of SNP on t-PA release in either group. These results indicate that endothelial t-PA release is not altered in premenopausal women who use oral contraception.     

Coastal zone use and migratory behaviour of the southern population of Mugil liza in Brazil

We analysed the ratios Sr:Ca and Ba:Ca in the otoliths of 55 adults of the southern population of Mugil liza in Brazil (Paraná to Rio Grande do Sul) to investigate its coastal zone use and migratory behaviour. All individual M. liza analysed had Sr:Ca and Ba:Ca values indicating that their birth was in the marine environment, which is consistent with the southern population migration to spawn in the ocean,. Juveniles exhibited at least three coastal use and recruitment strategies (contingents): the majority (89%) of M. liza juveniles migrated toward brackish water. They entered the estuary before completing the first year of life (64%) or after (25%) their first year of life. The remaining 11% did not appear to enter brackish or freshwater water as a nursery or at any point in their life cycle. Some adults returned to the estuary after spawning in the ocean but others (of both sexes) never returned to the estuary after spawning, remaining in the marine environment. The pattern of juvenile habitat use in the Brazilian southern population of M. liza seems to be recurrent throughout the extent of its distribution as a consequence of the reproductive spawning aggregation behaviour, which mixes all contingents (with marine or estuarine preferences).     

No effect of menstrual cycle phase and oral contraceptive use on endurance performance in rowers

The aim of this study was to examine whether variables commonly used in aerobic exercise testing are influenced by menstrual cycle phases and use of oral contraceptive (OC) in female rowers. Twenty-four eumenorrheic female rowers distinguished on the basis of both menstrual status and athleticism participated in this study and were divided into competitive cyclic athletes (n = 8), recreationally trained cyclic athletes (n = 7), and recreationally trained athletes taking OC pills (ROC; n = 9). Rowers performed 2 incremental tests to voluntary exhaustion on a rowing ergometer during 2 different phases of the menstrual cycle: the follicular phase (FP) and the luteal phase (LP). The study variables were power output (Pa), heart rate (HR), oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE), the mean respiratory exchange ratio, and ventilatory equivalents of O2 (VE/VO2)) and CO2 (VE/VCO2), which were measured at maximal and at the aerobic-anaerobic transition intensities. In addition, maximal blood lactate (La) values after the test were obtained. When comparing Pa, &OV0312;o2, HR, and La values, no significant differences (p > 0.05) between FP and LP at maximal load and at threshold intensity were found in all 3 groups of the rowers studied. However, we observed higher values (p < 0.05) for VE/VCO2 at both intensities in LP compared with FP in the ROC group. In conclusion, sport-specific endurance performance was not influenced by the phase of the normal menstrual cycle and the synthetic menstrual cycle of the OC users in the rowers studied. Therefore, normally menstruating female rowers and female rowers taking OC pills should not be concerned about the timing of their menstrual cycle with regard to optimized sport-specific endurance performance.     

Rapid evaluation of ant diversity in land use systems in southern Bahia, Brazil

We aimed to compare the soil ant diversity in different land use systems from Atlantic Forest area, in Southern Bahia state, Brazil. The ants were sampled in 16 sites: two primary forest sites (un-logged forest); three young secondary forests (<8 years old); three intermediate secondary forests (8-20 years old); three old secondary forests (>20 years old); three Eucalyptus grandis plantations (3-7 years old), and two introduced pastures. Each site was sampled in three sampling points 15 m apart, and distant over 50 m from the site edge. In each sampling point we gathered the litter from a 1 m2 and extracted the ants with Winkler extractors during 48h. We found 103 ant species from 29 genera and eight subfamilies. The five richest genera were Pheidole (19 species), Solenopsis (8), Apterostigma (10), Hypoponera (7) e Paratrechina (5). The highest ant richness density was found in the primary forest (7.4 species/sample; S = 37; n = 5); followed by the old secondary forest (5.33 species/sample; S = 48; n = 9); young secondary forest (5.25 species/sample; S = 42, n = 8); eucalyptus plantation (4.22 species/sample; S = 38, n = 9), intermediate secondary forest (3.5 species/sample; S = 35, n = 10, and introduced pasture (2.67 species/sample; S = 16, n = 6). The ecosystems with higher structural complexity showed the highest ant richness density by sample. Therefore, in the Atlantic Forest region, the eucalyptus plantation is a better alternative of land use to conserve the ant biodiversity than pastures, and quite similar to native secondary forests in ant community characteristics.     

Menstrual cycle, pregnancy and oral contraceptive use alter attraction to apparent health in faces

Previous studies demonstrating changes in women's face preferences have emphasized increased attraction to cues to possible indirect benefits (e.g. heritable immunity to infection) that coincides with periods of high fertility (e.g. the late follicular phase of the menstrual cycle). By contrast, here we show that when choosing between composite faces with raised or lowered apparent health, women's preferences for faces that are perceived as healthy are (i) stronger during the luteal phase of the menstrual cycle than during the late follicular, fertile phase, (ii) stronger in pregnant women than in non-pregnant women and (iii) stronger in women using oral contraceptives than in women with natural menstrual cycles. Change in preference for male faces was greater for short- than long-term relationships. These findings indicate raised progesterone level is associated with increased attraction to facial cues associated with possible direct benefits (e.g. low risk of infection) and suggest that women's face preferences are influenced by adaptations that compensate for weakened immune system responses during pregnancy and reduce the risk of infection disrupting foetal development.     

Distribution,habitat use,and abundance of the endangered franciscana in southeastern and southern Brazil

The franciscana (Pontoporia blainvillei) is endemic to coastal waters from Brazil to Argentina. The species is regarded as one of the most threatened cetaceans in South America due to high bycatch levels. Four management units (FMAs) were defined throughout the species’ range. FMA II includes states along southeastern and southern Brazil, and represents one of the least known units. Recently, genetic analysis proposed that FMA II comprises two distinct populations and its range should be divided into FMA IIa and IIb. In December 2008 and January 2009 aerial surveys were conducted to assess the distribution and to estimate abundance of franciscanas off FMA II. A total of 54 groups were seen (average group size = 2.76, SE = 0.17) in shallow (mean depth = 7.15 m, SE = 7.08) coastal habitats (average distance from the shore = 6.48 km, SE = 6.28). Abundance corrected for perception and availability bias was estimated at 6,827 (CV = 0.26) franciscanas in FMA II, and at 1,915 (CV = 0.32) and 4,353 (CV = 0.24) franciscanas in FMA IIa and FMA IIb, respectively. This study indicates that, at least during the summer, franciscanas aggregate in shallow coastal habitats. Current estimates of incidental mortality in FMA II correspond to 4.4%–7.3% of the estimated stock size, suggesting high, likely unsustainable bycatch.     

Menstrual cycle phase and oral contraceptive effects on triglyceride mobilization during exercise.

We examined the effects of menstrual cycle phase and oral contraceptive (OC) use on triglyceride mobilization during 90 min of rest and 60 min of leg ergometry exercise at 45 and 65% peak O(2) uptake (Vo(2 peak)) in eight moderately physically active, eumenorrheic women (24.8 +/- 1.2 yr). Subjects were tested during the follicular phase (FP) and the luteal phase (LP) before OC use and during the inactive phase (IP) and high-dose phase (HP) after 4 complete mo of OC use. Glycerol rate of appearance (R(a)), a measure of triglyceride mobilization, was determined in a 3-h postabsorptive state using a primed constant infusion of [1,1,2,3,3-(2)H]glycerol. Before OC use (BOC), there were no significant differences between FP and LP in any of the variables studied. Dietary composition, exercise patterns, plasma glycerol concentrations, growth hormone concentrations, and exercise respiratory exchange ratio did not change with OC use. However, 4 mo of OC use significantly (P < 0.05) increased glycerol R(a) in HP during exercise at 45% Vo(2 peak) (6.2 +/- 0.2, 6.5 +/- 0.4, and 7.7 +/- 1.1 micromol.kg(-1).min(-1) for BOC, IP, and HP, respectively) and in IP and HP at 65% Vo(2 peak) (6.6 +/- 0.1, 8.2 +/- 0.6, and 8.1 +/- 0.7 micromol.kg(-1).min(-1) for BOC, IP, and HP, respectively). Plasma cortisol concentrations were significantly higher with OC use at rest and during exercise at 45 and 65% Vo(2 peak). In summary, although fluctuations of endogenous ovarian steroids have little effect on triglyceride mobilization, the synthetic ovarian steroids found in OCs increase triglyceride mobilization and plasma cortisol concentrations in exercising women. We conclude that the hierarchy of effects of ovarian steroids and their analogs on triglyceride mobilization in exercising women is as follows: energy flux > OC use > recent carbohydrate nutrition, menstrual cycle effects.     

The effect of prolonged oral contraceptive steroid use on erythrocyte glutathione peroxidase activity

A clinical study was undertaken to determine whether oral contraceptives (OCs) affect the activity of the enzyme glutathione peroxidase. OC users recruited for the study were volunteers attending the Redhill Family Planning Clinic in England. Their demographic characteristics were noted. Pre- and postmenopausal comparative subjects were also used. The laboratory procedures involved in the study are described. Findings are tabulated. The average erythrocyte glutathione peroxidase levels of women using OCs for more than 7 months were significantly higher than those of the pre- and postmenopausal subjects. These levels increased progressively with duration of OC use. These levels did not fluctuate with the menstrual cycle in either OC or non-OC users. Levels of erythrocyte selenium and plasma pyridoxal were not significantly altered by OC use. Riboflavin status, however, as estimated by glutathione reductase activity was substantially lower in OC users and was lowest in women who had used OCs for the longest amount of time. Riboflavin status was found to be directly correlated with erythrocyte glutathione peroxidase levels. These findings may be important because selenium is currently believed to offer protective benefits against carcinogenesis, especially breast cancer. All the OCs studied produced the same effects.