Contraceptive choice of limiters ages 35-44 in the United States: an examination of selection of method from among a number of possible choices

A subsample from the 1970 National Fertility Survey and discriminant analysis were used in an effort to isolate, for the sample employed, those characteristics of contraceptive adopters which best differentiate among adopters of the various methods. The attempt was also made to isolate those contraceptive method characteristics which are most important to the potential adopter in determining method choice. Analysis of contraceptive choice initially included 7 choices -- rhythm, foam, condom, diaphragm, oral contraceptive (OC), IUD, and sterilization. There were 241 respondents in the sample. The analysis was divided into 2 parts: the choice from among the 6 methods usually thought of as contraceptives; and 2) the choice between sterilization and the 6 methods. 2 significant characteristic dimensions were isolated. The 1st dimension was interpreted as a distinction among methods from non-effective to less-effective and the 2nd as representing an aesthetics-health dimension, dividing methods between coitus-related versus non-coitus-related dimension. Income and number of births to be averted were found to play an important role in the choice of sterilization.     

Building the Infrastructure, Modeling the Nation: The Case of Birth in Palestine

This article explores the intersection between the professional politics of medicine and national politics during the second Palestinian uprising, which erupted in 2000. Through an analysis of stories about childbirth from actors in the birth process--obstetricians, midwives and birth mothers--it examines two overlapping movements that contributed to building the public health infrastructure, the movement of sumud or steadfastness (1967-87) and the popular health movement (1978-94), as well as their contemporary afterlife. Finally, it deals with relations between medicine and governance through an analysis of the interpenetration of medical and political authority. The birth stories bring to light two contrasting visions of a nation in the context of restrictions on mobility and a ground chopped up by checkpoints. The quasi-postcolonial condition of Palestine as popular construct, institutional protostate organism, and the lived experience of its experts and of its gendered subjects underlie the ethnographic accounts.     

Recycling expensive medication: why not?

New (and proposed) advances in packaging, preserving, labeling, and verifying product integrity of individual tablets and capsules may allow for the recycling of certain expensive medicines. Previously sold, but unused, medication, if brought back to special pharmacies for resale or donation, may provide a low-cost source of patent-protected medicines. Benefits of such a program go beyond simply providing affordable medication to the poor. This article suggests that medicine recycling may be a possibility (especially if manufacturers are mandated to blister-package and bar-code individual tablets and capsules). This early discussion of medication recycling identifies relevant issues, such as: need, rationale, existing programs, available supplies, expiration dates, new technology for ensuring safety and potency, environmental impact, public health benefits, program focus, program structure, and liability.     

Plasmin and kallikrein reduce HDL-induced cholesterol efflux from foam cells

Arterial intima contains metabolically active factors such as proteases, which may act on high-density lipoprotein (HDL) and impair its ability to accept cholesterol. In this study we treated human HDL(3) with human plasmin and human plasma kallikrein, two proteases also found in the human arterial intima, in order to study their effect on the ability of HDL(3) to promote cholesterol efflux from human macrophage foam cells. After exposure to plasmin or plasma kallikrein for 15 min, HDL(3) showed a decrease of about 60% in its ability to promote cholesterol efflux from the macrophage foam cells. SDS-PAGE analysis of the degraded HDL(3) particles showed that plasmin had generated cleavage products less than 15 kDa in size and plasma kallikrein had generated a major product of about 19 kDa. However, there was only a slight loss of intact apolipoproteins, suggesting degradation of a small subpopulation of HDL(3) particles. Agarose gel electrophoresis showed that a decrease in cholesterol efflux was accompanied by total loss of the HDL(3) with prebeta-mobility, but no apparent change in those with alpha mobility. These results suggest that the presence of active plasmin or plasma kallikrein in the atherosclerotic arterial intima promotes atherogenesis by blocking cholesterol efflux from macrophage foam cells.     

Contraceptive knowledge and attitudes in urban Ilorin, Nigeria

In Nigeria as in other African countries, population growth negatively affects economic development, and high parity affects maternal health. Breastfeeding, a common practice traditionally, is declining in some situations. This study was carried out in Ilorin, Nigeria. A sample population of 932 households stratified to represent different socioeconomic groups was used. 913 currently married women aged 15-35, who were in their prime childbearing ages, were interviewed on their contraceptive knowledge and on their attitudes towards modern contraception. In a bivariate statistical analysis, of 8 variables examined (i.e. ownership of a television, radio, religion, and other) only the woman's education, age, and area of residence within the city have significant independent effects on contraceptive knowledge. A linear logistic regression technic was also applied. 90% of the women interviewed thought that women should be free to practise family planning. Also, 95% of all the women believed that too frequent births could endanger the health of the mother and her children. Only the women with previous contraceptive knowledge overwhelmingly (80%) thought that the best way to prevent too frequent births is by family planning. 66.5% of those without previous contraceptive knowledge before this study suggested that traditional abstinence should be used and only 28.9% suggested family planning. Adequate awareness of the availability and usefulness of family planning methods can influence attitudes of women towards contraception and may also enhance contraceptive use. Better use can be made of broadcasting media, and efforts should be made to target younger, more fecund women, since there was evidence that more knowledge of family planning existed among women 30+ years old.     

Effective antibiotic resistance mitigation during cheese fermentation

Controlling antibiotic-resistant (ART) bacteria in cheese fermentation is important for food safety and public health. A plant-maintained culture was found to be a potential source for ART bacterial contamination in cheese fermentation. Antibiotics had a detectable effect on the ART population from contamination in the finished product. The decrease in the prevalence of antibiotic resistance (AR) in retail cheese samples from 2010 compared to data from 2006 suggested the effectiveness of targeted AR mitigation in related products.     

Prevalence of viral hepatitis among the hospital staff in CSR between 1980 and 1982

The hepatitis morbidity data were used to study prevalence rate of manifest viral hepatitis among the hospital staff members in CSR over a 3-year period between 1980 and 1982. This study showed that the overall hepatitis morbidity rate was 2.68 per 1,000 health personnel and was 3.6 times as high as that recorded in a normal population matched by age. The mean HBsAg positivity rate was 1.67 per 1,000 and was 5.8 times the rate in the control population group. The rate of HBsAg-negative cases of hepatitis was 1.01 per 1,000 health personnel and was higher than double the rate of morbidity encountered in an age-matched normal population. The highest morbidity rates were recorded in the lower-grade and auxiliary health personnel. When compared with an age-matched normal population the hospital staff members at all departments had distinctly higher morbidity rates than the general population, but the highest risk of acquiring viral hepatitis was evidently run by the personnel at departments of renal dialysis, biochemistry, hematology, infectious diseases, internal medicine, surgery, urology and TRD (tuberculosis and respiratory diseases). Of a total number of recorded cases of viral hepatitis those with HBsAg positivity predominated, especially at departments of urology, TRD, internal medicine, renal dialysis, psychiatry and hematology. Analyzed by specialty and professional status of personnel these viral hepatitis morbidity rates encountered among the hospital staff members seem to point to at least two conclusions: this infection in the health personnel is work-related and its transmission and spread is dependent on the frequency and intensity of contact with the blood and other secretions of infectious patients.     

Factors affecting acceptability of long-acting contraceptive injections in a rural Egyptian community

This study was carried out in 4 adjacent villages in Lower Eghypt with a combined population of 24,000. A team of social workers and physicians worked together to introduce the injectable contraceptive depomedroxyprogesterone acetate as a post-partum long-acting contraceptive to the community leaders and the villagers at several meetings and individual home visits. Post-partum women who agreed to use the drug were defined as acceptors (591) and those who did not were defined as rejectors (715). The incidence of polygamy was higher among the rejectors, and rejectors' husbands had more children from their other wives. Acceptors had more previous pregnancies and children of both sexes than rejectors. The interval between the last 2 pregnancies was shorter among the rejectors. A greater % of acceptors had previously used another contraceptive. The commonest reasons for rejection were desire for further pregnancy (69%), health problems (11%), and desire for another method of contraception (8%). Religious factors figured in only 3% of cases.     

Modeling the Potential Effects of New Tobacco Products and Policies: A Dynamic Population Model for Multiple Product Use and Harm

Background

Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products.

Methods and Findings

We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors.

Conclusion

Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.     

Incidence of Induced Abortion and Post-Abortion Care in Tanzania

Background

Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence.

Objectives

To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar).

Methods

A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology.

Results

In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15–49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone.

Conclusions

The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies.     

The evolution of nonsteroidal antiestrogens to become selective estrogen receptor modulators

The discovery of the first nonsteroidal antiestrogen ethamoxytriphetol (MER25) in 1958, opened the door to a wide range of clinical applications. However, the finding that ethamoxytriphetol was a “morning after” pill in laboratory animals, energized the pharmaceutical industry to discover more potent derivatives. In the wake of the enormous impact of the introduction of the oral contraceptive worldwide, contraceptive research was a central focus in the early 1960’s. Numerous compounds were discovered e.g., clomiphene, nafoxidine, and tamoxifen, but the fact that clinical studies showed no contraceptive actions, but, in fact, induced ovulation, dampened enthusiasm for clinical development. Only clomiphene moved forward to pioneer an application to induce ovulation in subfertile women. The fact that all the compounds were antiestrogenic made an application in patients to treat estrogen responsive breast cancer, an obvious choice. However, toxicities and poor projected commercial returns severely retarded clinical development for two decades. In the 1970’s a paradigm shift in the laboratory to advocate long term adjuvant tamoxifen treatment for early (non-metastatic) breast cancer changed medical care and dramatically increased survivorship. Tamoxifen pioneered that paradigm shift but it became the medicine of choice in a second paradigm shift for preventing breast cancer during the 1980’s and 1990’s. This was not surprising as it was the only medicine available and there was laboratory and clinical evidence for the eventual success of this application. Tamoxifen is the first medicine to be approved by the Food and Drug Administration (FDA) to reduce the risk of breast cancer in women at high risk. But it was the re-evaluation of the toxicology of tamoxifen in the 1980’s and the finding that there was both carcinogenic potential and a significant, but small, risk of endometrial cancer in postmenopausal women that led to a third paradigm shift to identify applications for selective estrogen receptor (ER) modulation. This idea was to establish a new group of medicines now called selective ER modulators (SERMs). Today there are 5 SERMs FDA approved (one other in Europe) for applications ranging from the reduction of breast cancer risk and osteoporosis to the reduction of menopausal hot flashes and improvements in dyspareunia and vaginal lubrication. This article charts the origins of the current path for progress in women’s health with SERMs.     

Effect of estradiol-filled polydimethylsiloxane subdermal implants in adult male rats on the reproductive system, fertility, and progeny outcome

Combinations of testosterone and estradiol have been proposed as potential male contraceptives. For any compound to be an acceptable male contraceptive, it must be demonstrated either to prevent pregnancy completely or, if contraceptive failure occurs, to not have any adverse effect on pregnancy outcome. We have previously established that increasing doses of testosterone given via subdermal implants to adult male rats will decrease spermatogenesis and fertility but will not result in an increased incidence of pre- or postimplantation loss or in abnormal progeny. In the present study, we have monitored the effects of a dose of estradiol that has been proposed for the contraceptive regimen, as well as doses three and seven times as large, on progeny outcome. Adult male Sprague-Dawley rats received s.c. implants of estradiol-filled polydimethylsiloxane capsules of varying lengths and, after three months, were each mated twice to two females in proestrus. The smallest dose of estradiol (the dose used in the contraceptive formulation) did not have any significant effects on any of the measured parameters of the male reproductive system, or on the incidence of pre- or postimplantation loss or on progeny outcome. With increasing doses of estradiol, there was a marked reduction in fertility. This reduction in fertility was not associated with a sufficient decrease in epididymal sperm reserves to account for the decrease in number of females impregnated, but was associated with a major reduction in seminal plugs; this would suggest that the large doses of estradiol were decreasing male sexual behavior.(ABSTRACT TRUNCATED AT 250 WORDS)     

Personalised Medicine: A Critique on the Future of Health Care

In recent years we have seen the emergence of “personalised medicine.” This development can be seen as the logical product of reductionism in medical science in which disease is increasingly understood in molecular terms. Personalised medicine has flourished as a consequence of the application of neoliberal principles to health care, whereby a commercial and social need for personalised medicine has been created. More specifically, personalised medicine benefits from the ongoing commercialisation of the body and of genetic knowledge, the idea that health is defined by genetics, and the emphasis the state places on individual citizens as being “responsible for” their own health. In this paper I critique the emergence of personalised medicine by examining the ways in which it has already impacted upon health and health care delivery.     

Self-fitting shape memory polymer foam inducing bone regeneration: A rabbit femoral defect study

Although tissue engineering has been attracted greatly for healing of critical-sized bone defects, great efforts for improvement are still being made in scaffold design. In particular, bone regeneration would be enhanced if a scaffold precisely matches the contour of bone defects, especially if it could be implanted into the human body conveniently and safely. In this study, polyurethane/hydroxyapatite-based shape memory polymer (SMP) foam was fabricated as a scaffold substrate to facilitate bone regeneration. The minimally invasive delivery and the self-fitting behavior of the SMP foam were systematically evaluated to demonstrate its feasibility in the treatment of bone defects in vivo. Results showed that the SMP foam could be conveniently implanted into bone defects with a compact shape. Subsequently, it self-matched the boundary of bone defects upon shape-recovery activation in vivo. Micro-computed tomography determined that bone ingrowth initiated at the periphery of the SMP foam with a constant decrease towards the inside. Successful vascularization and bone remodeling were also demonstrated by histological analysis. Thus, our results indicate that the SMP foam demonstrated great potential for bone regeneration.     

Sub-National Targeting of Seasonal Malaria Chemoprevention in the Sahelian Countries of the Nouakchott Initiative

Background

Seasonal malaria chemoprevention (SMC) has been shown to be highly efficacious against clinical malaria in areas where transmission is acutely seasonal. SMC targeting depends on a complex interplay of climate, malaria transmission and population distribution. In this study a spatial decision support framework was developed to identify health districts suitable for the targeting of SMC across seven Sahelian countries and northern states of Nigeria that are members of the Nouakchott Initiative.

Methods

A spatially explicit decision support framework that links information on seasonality, age-structured population, urbanization, malaria endemicity and the length of transmission season was developed to inform SMC targeting in health districts. Thresholds of seasonality, population and receptive risks were defined to delineate SMC suitable health districts and define the age range of children for targeting. Numbers of children were then computed for the period 2015–2020 in SMC districts. For 2015, this was combined with maps of length of malaria transmission seasons and WHO recommended treatment regimen to quantify the number of tablets required across the SMC health districts.

Results

A total of 597 Sahelian health districts were mapped, out of which 478 (80.1%) were considered suitable for SMC based on seasonality and endemicity thresholds. These districts had an estimated 119.8 million (85%) of the total population in 2015. In the six years from 2015–2020, it is estimated that a total of 158 million children 3m to <5 years, 121 million of whom were in rural areas, will need SMC to achieve universal coverage in the Sahel. If the upper age limit of SMC targeted children was increased to <10 years in low transmission districts, a total 177 million overall, of whom 135 million were rural children, will require chemoprevention in 2015–2020. In 2015 alone, an estimated 49–72 million SP tablets and 148–217 million AQ tablets will be needed to cover all or rural children respectively under the different scenarios of upper age limits.

Conclusions

Our proposed framework provides a standardised approach to support targeting and scale up of SMC by the countries of the Nouakchott Initiative. Our analysis suggests that the vast majority of the population in this region are likely to benefit from SMC and substantial resources will be required to reach universal coverage each year.     

Studies on safety aspects of contraceptive Magainin-A in rabbits.

We have previously reported the contraceptive potential of Magainin-A in rats and rabbits under in vitro and in vivo condition. In this report we evaluated the effect of Magainin-A on the structural organisation of vaginal epithelium in rabbits. The effect of this compound on the erythrocytes and its rate of absorption and clearance from systemic circulation was also studied. The effective contraceptive dose of Magainin-A (1 mg) when administered intra-vaginally for five consecutive days did not induce any structural or morphological abnormalities in vaginal epithelial cells. No adverse effect was observed on the erythrocytes. The rate of Magainin-A absorption and clearance from the circulation was found to be rapid. These results suggest that Magainin-A may be used as a safe intra-vaginal contraceptive compound in future.     

Precision wildlife medicine: applications of the human‐centred precision medicine revolution to species conservation

The current species extinction crisis is being exacerbated by an increased rate of emergence of epizootic disease. Human‐induced factors including habitat degradation, loss of biodiversity and wildlife population reductions resulting in reduced genetic variation are accelerating disease emergence. Novel, efficient and effective approaches are required to combat these epizootic events. Here, we present the case for the application of human precision medicine approaches to wildlife medicine in order to enhance species conservation efforts. We consider how the precision medicine revolution, coupled with the advances made in genomics, may provide a powerful and feasible approach to identifying and treating wildlife diseases in a targeted, effective and streamlined manner. A number of case studies of threatened species are presented which demonstrate the applicability of precision medicine to wildlife conservation, including sea turtles, amphibians and Tasmanian devils. These examples show how species conservation could be improved by using precision medicine techniques to determine novel treatments and management strategies for the specific medical conditions hampering efforts to restore population levels. Additionally, a precision medicine approach to wildlife health has in turn the potential to provide deeper insights into human health and the possibility of stemming and alleviating the impacts of zoonotic diseases. The integration of the currently emerging Precision Medicine Initiative with the concepts of EcoHealth (aiming for sustainable health of people, animals and ecosystems through transdisciplinary action research) and One Health (recognizing the intimate connection of humans, animal and ecosystem health and addressing a wide range of risks at the animal–human–ecosystem interface through a coordinated, collaborative, interdisciplinary approach) has great potential to deliver a deeper and broader interdisciplinary‐based understanding of both wildlife and human diseases.     

Assessing the reproductive behavior of on- and off-reservation American Indian females: characteristics of two groups in Montana

Only limited fertility and general reproductive health data exist on American Indians. Using data from the 1987 Montana American Indian Health Risk Assessment, we found that the fertility of American Indians in Great Falls and on the Blackfeet Reservation was similar to blacks in the U.S. and relatively high when compared with fertility of whites in the United States. The influence of the direct determinants of fertility (nuptiality, contraceptive use, and lactation) was very different for the populations examined in this study. Great Falls American Indians and the U.S. black population were similar regarding age at first sexual intercourse (very young), breastfeeding (low prevalence and short duration), planning status of pregnancies (high unplanned), and contraceptive use (only moderate use). In contrast, Blackfeet women on the reservation and the U.S. white population married relatively late, had very high contraceptive use, used effective methods of contraception, and had moderately high levels of breastfeeding. However, Blackfeet fertility was much higher than that of whites. Three interrelated reasons are suggested as possible explanations. Blackfeet couples either wanted high fertility, were relatively poor users of family planning methods, or used less effective methods until they had exceeded their desired family size after which time they turned to sterilization. These finds raise numerous questions concerning the social and economic factors that may account for these group similarities and differences. Further studies with much larger data sets are needed to address these issues adequately.     

Community Demand for Doctors in the next 10 Years

The demand for doctors has increased despite improved community health, because the prevalence of chronic disease has increased, and because affluence, better education, and the growth of specialization have all stimulated demand.Most authorities have recommended an increase in the supply of doctors to meet the increasing demand. Nevertheless, a supply which preserves the present ratio of doctors to population might be adequate if medical productivity were raised. Moreover, an increase of the supply stimulates further demand; perhaps demand would fall if the supply were reduced, and community health might not deteriorate as a result of this.Other social institutions besides medicine have a claim on the available pool of talent from which doctors are recruited. It is possible that medicine already receives its fair share.