The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

Objective

This study assessed whether immediate postpartum insertion of levonorgestrel contraceptive implants is associated with a difference in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 and 6 months postpartum compared to delayed insertion at 6 to 8 weeks postpartum.

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.     

Mifepristone in Italy: the case of a drug trapped between ethics and clinical practice

In Italy mifepristone is not yet marketed. Gynaecologists in our hospital asked to use this medication as a less traumatic method for voluntary abortions. We followed the standard procedure defined by the Italian Health Ministry (IMH) for purchasing drugs from abroad but encountered several unexpected barriers. Starting from this case, this paper is aimed at identifying these barriers which we found to be not only professional, but also ethical, religious and moral.     

Contraception and sexually transmitted diseases: Interactions and opportunities

Today "safe sex" means protection from both unintended pregnancy and sexually transmitted disease and human immunodeficiency virus. These parallel complications of sexual activity have serious biologic and clinical sequelae that should be considered at the time of contraceptive selection. In addition, there is ongoing debate regarding potential interactions between antibiotic intervention and contraceptive steroids. This article assesses the impact of hormonal contraception, spermicides, barrier methods, intrauterine devices, and douching on the pathogenesis of sexually transmitted disease and the human immunodeficiency virus infection. It discusses the direct and indirect effects of contraception methods on clinical physiology and host immune responses while also considering the possible consequences on maternal and infant health if pregnancy results from the use of ineffective contraception. Counseling and care for both family planning and infectious disease protection must be provided to all sexually active individuals. (Ann J OBSTET GVNECOL 1993;168:2033-41.)     

人工神经网络在避孕研究中的应用

人工神经网络作为一门新兴的边缘学科,已开始在许多领域应用.本文将神经网络的方法应用于避孕方法选择方面,并通过ROC曲线比较了神经网络方法与传统的多元LO-gistic回归分析方法对训练样本和检验样本的表现.结果提示,神经网络方法有望在统计学、医学领域得到进一步应用和发展.     

重庆城乡育龄妇女中介生育率变量研究

影响妇女生育率的直接因素,如妇女已婚比、避孕及人工流产等的定量分析是卫生人口统计分析中的重要内容。本文应用美国人口学者Bongaarts提出的中介生育率变量模型就重庆城乡妇女生育率直接影响因素作一定量研究     

已婚育龄妇女避孕措施变化趋势分析

目的:了解已婚育龄妇女避孕措施的变化趋势,为指导计划生育服务工作提供科学依据。方法:收集1983~2005年苏州市已婚育龄妇女避孕方法的资料,并用统计软件对其变化趋势进行了分析。结果:已婚育龄妇女节育率在88.38%~92.94%范围波动,长效避孕措施现用率从75.19%下降至71.27%,而短效避孕措施从12.86%上升至17.11%。宫内节育器的现用率从50.09%上升到66.50%;避孕套从1.94%上升到14.21%;其他避孕方法的现用率均呈下降趋势,其中女性绝育现用率从24.42%下降到4.50%。结论:节育率维持在较高水平;长效避孕措施现用率下降而短效避孕措施现用率上升;避孕方法使用趋于多样化,需要提供满足个性化需求的指导和服务。     

参加新婚教育人群对紧急避孕的知识、态度和实践

为探讨新婚前后人群对避孕方法(特别是紧急避孕方法)的知识、态度和使用以及新婚前后人群对紧急避孕的需求及对推广EC的意愿的建议。采用描述性流行病学研究方法,以郑州市新婚学校为研究现场,直接收集第一手数据。采用EPI INF6.04软件包,和SPSS7.5 FOR WINDOW95软件包,进行数据处理、统计与分析。统计分析的主要指标有:频数分布,单因素分析,logistic多元回归分析等。结果平均年龄26.41岁,女性占49.4％。在第一次同房时,仅有46.4％的人使用过避孕方法。第一次同房时最常用的避孕方法是避孕套(76.1％)。在女性应答者中,25岁以下开始同房者占76.6％,有9.3％的人有过人工流产史。88.2％的人每周有1～6次同房。有43.2％的人听说过EC方法,有35.9％的人听说过紧急避孕片,有29.9％的人知道使用EC片有时间限制,有24.7％的人听说过上环可作为紧急避孕方法,有17.4％的人知道上环紧急避孕方法有时间限制。仅有12.9％的人使用过某种事后避孕方法,其中有事后3天内使用者占82.0％。92.6％的人赞成开展EC教育。73.7％的人认为,应在未婚青少年中开展EC教育。80.7％的人认为,在本单位进行EC教育是可行的。应答者认为,最易的接受的EC教育形式依次为:阅读材料(40.4％),录相(20.6％)和讲课(15.7％)。认为EC的最可靠的信息来源