Factors associated with provision of depot medroxyprogesterone acetate to adolescents by US health care providers

ObjectiveIdentify factors associated with healthcare providers' frequency of depot medroxyprogesterone acetate (DMPA) provision to adolescents.Study designWe analyzed data from surveys mailed to a nationally representative sample of public-sector providers and office-based physicians (n=1984). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of factors associated with frequent DMPA provision to adolescents in the past year.ResultsAlthough most providers (>95%) considered DMPA safe for adolescents, fewer reported frequent provision (89% of public-sector providers; 64% of office-based physicians). Among public-sector providers, factors associated with lower odds of frequent provision included working in settings without Title X funding (aOR 0.44, 95% CI 0.30–0.64), reporting primary care as their primary clinical focus versus reproductive or adolescent health (aOR 0.42, 95% CI 0.28–0.61), and providing fewer patients with family planning services. Among office-based physicians, factors associated with lower odds of frequent provision included specializing in obstetrics/gynecology (aOR 0.50, 95% CI 0.27–0.91) and family medicine (aOR 0.21, 95% CI 0.09–0.47) versus adolescent medicine, completing training ≥15 versus <5 years ago (aOR 0.27, 95% CI 0.09–0.83), and reporting that 0–24% of patients pay with Medicaid or other government healthcare assistance versus ≥50% (aOR 0.23, 95% CI 0.09–0.61). The reason most commonly reported by providers for infrequent DMPA provision was patient preference for another method.ConclusionsWhile most providers reported frequently providing DMPA to adolescents, training on evidence-based recommendations for contraception, focused on subgroups of providers with lower odds of frequent DMPA provision, may increase adolescents' access to contraception.ImplicationsAlthough >95% of providers considered depot medroxyprogesterone (DMPA) a safe contraceptive for adolescents, only 89% of public-sector providers and 64% of office-based physicians reported frequently providing DMPA to adolescents. Provider training on evidence-based recommendations for contraception counseling and provision may increase adolescents' access to DMPA and all methods of contraception.     

Engulfment of mast cell secretory granules on skin inflammation boosts dendritic cell migration and priming efficiency

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Bremazocine reduces unrestricted free-choice ethanol self-administration in rats without affecting sucrose preference

It has been postulated that opioid systems in the brain may play a role in ethanol reinforcement. In this respect, μ- and δ-opioid receptors may mediate the rewarding effects whereas κ receptors are thought to mediate the aversive effects of opioids. Accordingly, long-acting benzomorphans such as bremazocine, that simultaneously act as μ and δ receptor antagonists and κ receptor agonists may be particularly effective in reducing ethanol self-administration. Therefore, we studied the effect of bremazocine on oral ethanol self-administration in rats using a paradigm [unrestricted free-choice drinking of 10% (v/v) ethanol], previously shown to cause long-term neuroadaptations in the nucleus accumbens and caudate putamen. Bremazocine (0.1 mg/kg, once daily for five consecutive days) reduced ethanol drinking by about 50% during the active period of the animals, whereas the intake of sucrose (3–10% w/v) was affected neither in naive nor in ethanol-experienced rats. This effect of bremazocine appeared not to be secondary to its acute sedative effect or the slight increase in total fluid consumption. Unlike bremazocine, the selective κ-opioid receptor agonist U50,488H (10 mg/kg, once daily) inhibited ethanol drinking only during the first of 5 treatment days and the opioid receptor antagonist naltrexone (0.3–10 mg/kg, once daily) only caused a modest (about 20%) suppression of ethanol drinking during the first hours after drug injection. Thus, bremazocine appears to be far more potent than the clinically applied drug naltrexone in this respect. Our data further support the role of opioid receptors in ethanol reinforcement and indicate that long-acting mixed-action opioids such as bremazocine may be useful as adjuvants for the clinical management of ethanol addiction. Received: 1 July 1998/Final version: 3 September 1998     

κ-阿片受体与β1-肾上腺素受体交互作用抑制异丙肾上腺素诱导的心肌肥大

目的:观察选择性kappa阿片受体(kappaopioidreceptor,κOR)与β肾上腺素受体(βadrenergicreceptor,βAR)在心肌细胞肥大方面的交互作用。方法:以体外培养的乳鼠心肌细胞为模型,10μmol·L-1的异丙肾上腺素(β肾上腺素受体激动剂,βAR)诱导心肌肥大,观察1μmol·L-1的U50,488H(κOR激动剂,U50)对其作用。进一步探索在100nmol·L-1ICI118,551(β2AR阻断剂)存在情况下,κOR的激活对心肌肥大的作用。用Lowry’s法测心肌细胞的蛋白质含量;用消化分离法,并利用计算机图象分析系统测心肌细胞的体积;用[3H]leucine掺入法测定心肌细胞蛋白的合成。结果:异丙肾上腺素使心肌细胞总蛋白含量、体积、蛋白合成明显增加;1μmol·L-1的U50,488H使ISO诱导的心肌细胞总蛋白含量、体积、蛋白合成减少,这种作用可被选择性κOR阻断剂norBNI(norbinaltorphimine)抑制。在ICI118,551存在的情况下,U50也能起到减弱ISO诱导心肌细胞肥大的作用。结论:U50,488H通过激活κOR与β1AR交互作用抑制ISO所诱导的心肌细胞肥大。     

Role of vasoconstrictor mechanisms in the control of left ventricular performance of the normal and damaged heart.

The effect on the left ventricle of changes in the state of the arterial vasculature is best identified by utilizing calculations of pulsatile rather than steady flow phenomena. Impedance is the most satisfactory term to describe this effect. The normal ventricle compensates for changes in impedance largely by changes in preload, but the damaged heart loses this compensatory ability and its stroke volume becomes inversely related to outflow resistance. Patients with heart failure behave in a similar fashion and pharmacologic vasodilation may induce marked improvement in left ventricular pump function. Inappropriate vasoconstriction in heart failure may result from stimulation of the sympathetic or renin-angiotensin system. Early experience with converting enzyme inhibitors suggests that blockade of the formation of angiotensin II may be a useful means of treating some patients with heart failure.     

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目的评价氟保护漆在治疗金属烤瓷全冠（PFM）修复中活髓基牙预备后牙本质过敏症的疗效。方法选择2009年5月至2010年11月来德阳市口腔医院口腔修复科就诊的拟行PFM修复的患者124例（活髓基牙226颗）。按就诊顺序随机分为两组：试验组（65例,基牙116颗）采用氟保护漆脱敏;对照组（59例,基牙110颗）采用Gluma脱敏剂脱敏。分别于戴用PFM后即刻及3个月检测牙本质敏感状况。结果戴用PFM后即刻,试验组有效率为84．48％,对照组有效率为80．91％,二者差异无统计学意义（P〉0．05）;3个月时,试验组有效率为93．97％,明显优于对照组（84．55％）（P〈0．05）。结论氟保护漆可有效缓解PFM修复中活髓基牙预备后的敏感症状,值得临床广泛应用。     

U50 488H预处理大鼠诱导的延迟性心脏保护效应及其机制

目的 :trans- （± ） - 3,4 - dichloro- N- methyl- N - [2 - （1- pyrrolidinyl） cyclohexyl]- benzeneacetam ide （U 5 0 4 88H）是κ阿片受体的选择性激动剂。实验观察静脉注射 U 5 0 4 88H （10 mg/ kg） 2 4 h后对心脏的延迟性保护作用及其细胞内机制。方法 :1采用离体灌流的大鼠心脏模型 ,通过局部缺血 /再灌注 ,以心脏梗死面积作为心脏损伤的判定标准 ,观察 U 5 0 4 88H预处理 （U P）对心脏的延迟性保护作用。 2采用分离的大鼠心肌细胞模型 ,通过代谢抑制（metabolic inhibition,MI） ,观察 UP对心肌细胞内静息 Ca2 + 和电诱导 Ca2 + 瞬变的影响。结果 :1U P可显著降低心脏梗死面积 ;2 U P的大鼠心肌细胞在 MI时 ,心肌细胞内静息 Ca2 + 的升高程度较对照组显著降低 ;3U P的大鼠心肌细胞在 MI时 ,心肌细胞电诱导 Ca2 + 瞬变的降低程度较对照组显著减少。上述作用均可被 U P前 10 min腹腔注射κ阿片受体的选择性阻断剂 nor- binaltorphim ine （10 m g/ kg）阻断。结论 ::U 5 0 4 88H可通过刺激κ阿片受体产生延迟性的心脏保护作用 ,此作用与心肌细胞内的 Ca2 + 稳态的调节有关。