A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Pharmaceutical Affairs. Johannesburg, 2003 / Quinine is a naturally occurring alkaloid found in the bark of the South American cinchona tree. It is used to treat malaria, to relieve nocturnal leg cramps and is used as an antipyretic. Anecdotal evidence, especially from community pharmacists, suggests widespread misuse of quinine sulphate. It has been taken for a range of non-indicated uses ranging from a single dose monthly contraceptive to a post coital “morning after” contraceptive. A self-administered questionnaire, together with a confidentiality and anonymity declaration, was offered to all females requesting quinine sulphate at a pharmacy in Hillbrow, Johannesburg. After completing the questionnaire, the participants were counselled on the proper indications, as well as the consequences of misuse of quinine. / IT2018

No description available.

<p>The objective of this research was to assess ultrasound image attributes of human dominant ovarian follicles in the final stages of development during natural and oral contraceptive (OC) cycles, as well as characterize ovarian follicular and endometrial development during and after continuous versus conventional dosing schemes. We utilized sophisticated computer algorithms to elucidate an association between image attributes and physiologic status of follicles in their final stage of development. We used transvaginal ultrasonography to quantify changes in the numbers and diameters of ovarian follicles and changes in endometrial thickness and pattern during and following discontinuation of two different regimens of OC. Developmental changes in ovarian follicles and corpora lutea were correlated with serum estradiol-17â and progesterone, respectively to provide a comprehensive approach to examining ovarian and uterine function. </p><p>We reported for the first time that follicles which develop during natural and OC cycles have similar image attributes, which provides preliminary evidence that image attributes of human follicles are associated with physiologic status during the growth phase. Further research should be performed to elucidate the exact correlation between image attributes during all stages of follicular development throughout the menstrual cycle, prediction of dysfunctional follicular development (i.e., hemorrhagic anovulatory follicles) and the effects of different OC formulations on follicle development. Once the association between image attributes and various scenarios of follicular development are determined, a computer program could be developed to assess follicular health with a single ultrasound examination, obviating many ethical constraints that currently prevent large scale progress in ovarian follicular research. We further documented that continuous OC administration schemes provide greater follicular suppression than conventional dosing schemes. No dominant follicles developed during three consecutive 28 day cycles of continuous OC use, whereas eight dominant follicles developed during the same time period of conventional OC use. We interpreted these findings to mean that continuous OC dosing schemes provide a more effective contraceptive with a decreased risk of escape ovulation compared to conventional dosing schemes. Most follicles ovulated in the immediate cycle following discontinuation of OC. We suggest that the delay to fertility following cessation of OC is not due to anovulation but other yet, unknown, biological factors. </p>

<p>The objective of this research was to assess ultrasound image attributes of human dominant ovarian follicles in the final stages of development during natural and oral contraceptive (OC) cycles, as well as characterize ovarian follicular and endometrial development during and after continuous versus conventional dosing schemes. We utilized sophisticated computer algorithms to elucidate an association between image attributes and physiologic status of follicles in their final stage of development. We used transvaginal ultrasonography to quantify changes in the numbers and diameters of ovarian follicles and changes in endometrial thickness and pattern during and following discontinuation of two different regimens of OC. Developmental changes in ovarian follicles and corpora lutea were correlated with serum estradiol-17â and progesterone, respectively to provide a comprehensive approach to examining ovarian and uterine function. </p><p>We reported for the first time that follicles which develop during natural and OC cycles have similar image attributes, which provides preliminary evidence that image attributes of human follicles are associated with physiologic status during the growth phase. Further research should be performed to elucidate the exact correlation between image attributes during all stages of follicular development throughout the menstrual cycle, prediction of dysfunctional follicular development (i.e., hemorrhagic anovulatory follicles) and the effects of different OC formulations on follicle development. Once the association between image attributes and various scenarios of follicular development are determined, a computer program could be developed to assess follicular health with a single ultrasound examination, obviating many ethical constraints that currently prevent large scale progress in ovarian follicular research. We further documented that continuous OC administration schemes provide greater follicular suppression than conventional dosing schemes. No dominant follicles developed during three consecutive 28 day cycles of continuous OC use, whereas eight dominant follicles developed during the same time period of conventional OC use. We interpreted these findings to mean that continuous OC dosing schemes provide a more effective contraceptive with a decreased risk of escape ovulation compared to conventional dosing schemes. Most follicles ovulated in the immediate cycle following discontinuation of OC. We suggest that the delay to fertility following cessation of OC is not due to anovulation but other yet, unknown, biological factors. </p>

Objective: To study midwives management, practice and reasoning regarding contraceptive counseling for women who are experiencing "mild" side effects of the pill Methods: Four focus groups, made up of three to five midwives per group, participated in focus group discussions. Qualitative design with the method “Think-Aloud” has been used to collect data and the material was analyzed using content analysis. Results: The study identified three categories, the first "How midwives practice regarding the side effects of the pill," shows that midwives have a systematic approach when meeting with women who are experiencing side effects of the pill. The next category "Using a holistic and professional approach for women" highlights that the midwives take women's side effects seriously and that midwives respect individual woman’s autonomy. Finally in the third category "Lack of evidence about side effects becomes a women's dilemma" here midwives describe varying ways of interpreting side effects as well as attitudes and socio-economic conditions in society that affect women's choice of contraception. Conclusion: The midwives express that side effects such as loss of libido, depression and weight gain are complex and often difficult to attribute solely to the pill. The midwives' work is characterized by a holistic approach. We see the benefits of sharing information in groups, therefor we suggest that midwives create mediums where they can learn from each other by sharing their valuable experience and knowledge.

No description available.

Orientador: Ilza Maria Urbano Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-14T22:30:01Z (GMT). No. of bitstreams: 1 Makuch_MariaValeriaBahamondes_M.pdf: 9936891 bytes, checksum: f5cea3f3dd8db3f9c34d0b9e9f0a4d3c (MD5) Previous issue date: 2006 / Resumo: Introdução: A osteoporose é uma doença sistêmica que afeta principalmente as mulheres. Alguns dos fatores que aceleram a aparição desta doença são a idade e o uso, por longa data, de métodos anticoncepcionais com somente progestágenos. O sistema intrauterino liberador de levonorgestrel (SIU-LNG) é um método difundido para a contracepção e o tratamento de diversas patologias ginecológicas. Na literatura não foram identificados estudos longitudinais prospectivos, com usuárias de longa data deste método, que avaliem seus efeitos sobre a densidade mineral óssea (DMO). Objetivos: Avaliar a DMO em usuárias do SIU-LNG aos sete anos de uso e comparar com elas mesmas aos 10 anos de uso e com um grupo-controle de usuárias de método anticoncepcional não hormonal. Sujeitos e métodos: do total de 37 mulheres que realizaram DMO no antebraço aos sete anos de uso do SIU-LNG, foi avaliada a DMO novamente aos 10 anos de uso. Cada usuária foi pareada com uma usuária de DIU TCu380A, com o mesmo tempo de uso, por idade (± 1 ano), índice de massa corporal (IMC; kg/m2) (± 1), cor da pele e número de gravidezes (± 1). A DMO foi avaliada no antebraço não dominante no rádio distal (midshaft ulna) e no rádio ultradistal usando double X-ray absorptiometry. Os dados foram avaliados pelos testes t de Student pareado, Wilcoxon, Snedecor (ANOVA) e Índice de correlação múltipla. Resultados: A DMO das usuárias do SIU-LNG aos 10 anos de uso foi estatisticamente similar que aos sete anos e similar que os seus controles, usuárias de DIU TCu380A, mesmo quando pareadas por idade (± 1 ano), índice de massa corporal [IMC; kg/m2, (± 1)], cor da pele e número de gestações (± 1). A maior DMO das usuárias do SIU-LNG aos 10 anos foi significativamente associada ao maior IMC (kg/m2) e maior DMO aos sete anos de uso. Conclusão: As DMO dos antebraços distal e ultradistal foram similares entre as usuárias do SIU-LNG aos sete e 10 anos de uso, e também quando comparadas com um grupo de não usuárias deste contraceptivo / Abstract: Introduction: Osteoporosis is a systemic disease which mainly affects women. Some of the factors which provoke an acceleration of the initiation of this disease were age and use for a long-term of progestin-only contraceptive methods. The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely introduced method for contraception and for the treatment of several gynecological pathologies. On the literature we were unable to identify prospective studies with long-term users of this method which evaluated their effect upon bone mineral density (BMD). Objectives: To assess prospectively the BMD of users of the LNG-IUS at the 7th year of use and compare with the same women at the 10th year of use and with a control group of users of a non-hormonal contraceptive method. Materials and methods: A total of 37 women who performed a forearm BMD at the 7th year of use and again at the 10th year of use. Each woman was paired with a woman who had been using a copper IUD TCu380A for at least the same length of time, who never use an LNG-IUS matched by age (±1 year), body mass index (BMI; kg/m2) (±1), ethnicity, and number of pregnancies (±1). BMD was evaluated at the distal and the ultra-distal radius of the nondominant forearm using double X-ray absorptiometry. The data was evaluated trough t-Student test for paired samples, Wilcoxon, Snedecor (ANOVA) and multiple logistic regression. Results: The BMD of LNG-IUS users at the 10th year of use was statistically similar than themselves when use at the 7th year as well as similar as controls users of the TCu380A IUD even when paired by age (± 1 year), body mass index (BMI; Kg/m2, (± 1), race and number of pregnancies (± 1). Higher BMD of the LNG-IUS at the 10th year of use was significantly associated to a high BMI (Kg/m2) and higher BMD at the 7th year of use. Conclusions: Forearm BMD at distal and ultra-distal radius was similar among users of the LNG-IUS at the 7th and at the 10th year of use and was also similar when compared users with non-users of this contraceptive method / Mestrado / Tocoginecologia / Meste em Tocoginoclogia

acase@tulane.edu / Background As a region, Francophone sub-Saharan Africa (SSA) continues to have among the highest fertility rates and lowest contraceptive prevalence rates in the world. As of the latest Demographic and Health Survey (DHS) data available for each country, total fertility rates range from 4.1 (Gabon 2012) to 7.6 births per woman (Niger 2012). Modern contraceptive prevalence rates for married women range from a low of 3.3% (Guinea 2012) to a high of 20.1% (Senegal 2014). Methods Three analyses were completed utilizing nationally representative DHS data available for each Francophone SSA country. For each paper, bivariate and multivariate analyses were performed with weighted data to take into account the two-stage cluster sampling design of the DHS survey. In paper one, we determine whether being Muslim and/or being in a polygynous union impacts the use of modern contraceptives. In paper two, we provide detailed information on the characteristics that define users of specific contraceptive methods in this region. In the final paper, we provide a clearer picture of the reproductive health dynamic in young never married women in Francophone SSA. Results In paper #1, we found that religion and marital type generally were not predictive of modern contraceptive use. The typical predictors – education, age, residence (urban/rural) – were consistently significant across the included countries. In paper #2, profiles of users of the most common contraceptive methods in each country were created. For example, condom users had the most consistent profile across the 12 countries, with marital status, parity and education being clearly associated with condom use. For paper #3, education level was found to be the key predictor of both sexual activity and becoming pregnant for young, never married women in this region. In general, those with primary or secondary and higher education were more likely to be sexually active than those with no education. Conclusion These findings provide valuable information to government, private and nongovernmental organizations working toward increasing the numbers of contraceptive users in Francophone SSA. / 1 / Margaret Farrell

Master of Public Health - MPH / Background- Sexual and Reproductive Health (SRH) problems continue to affect adolescents’ health and well-being even into their adulthood. Globally and especially within sub-Saharan Africa with a heavy burden of adolescent SRH problems, increased attention is being paid to these issues. This study looks at adolescents’ awareness, utilisation of and experiences of the available SRH services in Omaruru District, Namibia. Methodology- This analytical cross-sectional study used a two-stage cluster sampling method. Data from students aged 15-19 years in secondary schools were collected and analysed using a structured self-administered questionnaire and STATA statistical software respectively. Ethical approval was obtained from the Biomedical Research and Ethics Committee (University of the Western Cape) and the Namibian Health Ministry. Written parental/caregiver informed consent and written participant assent, as per the Namibian law were obtained. Results- While 87% of respondents had heard of SRH, 46% had ever used SRH services. Of these 44% were contraceptive services. Fifty-one percent had ever had sex (of which 17% had given birth to or fathered their first child), 56% of their first sexual experiences were between ages 15-17 years. Twelve percent had used illegal drugs three months prior to the survey. In multivariate analyses female sex, urban residence and reported sexual debut had significant independent relationships with contraception use. Use of SRH services was independently significantly associated with having had sexual debut. Among SRH services users: 71% would recommend these services to their friends, 51% and 56% found health providers welcoming, with good attitudes, and guaranteeing their privacy and confidentiality. Conclusion Greater effort is needed to curb teenage pregnancy in school-going adolescents by promoting the use of all SRH services especially contraception among sexually active adolescents. It is encouraging that respondents who had used SRH service reported that their privacy and, confidentiality were respected and that healthcare providers’ attitudes generally satisfactory. Lower SRH knowledge, service use and use of contraception and condoms needs further investigation in rural youth and then programmatic and service changes tailored to their needs. Gender norms that underpin adolescent females disadvantage in a number of SRH areas needs to be addressed

Carta al editor / Revisión por pares