by Cheung Kwok Keung Bobbie. / Thesis (M.Ph.)--Chinese University of Hong Kong, 1988. / Bibliography: leaves 128-147.

Thesis (Ph. D.)--University of Virginia, 2000. / Spine title: Anti-sperm Ab/Ag for contraception. Includes bibliographical references (leaves 182-229). Also available online through Digital Dissertations.

Introduction This was a secondary data analysis of a prospective cohort of women enrolled in a phase III microbicide trial between October 2005 and August 2008. The study aimed to assess the pregnancy incidence rates and factors associated with pregnancy in women using barrier method and hormonal contraception, enrolled in the trial. Methods A total of 2508 participants were enrolled in the trial and followed up for up to 12 months. Of these 2437 were included in the pregnancy incidence analysis and 2171 participants were included in the multivariate analysis. Data on the main exposure, contraception, were collected by structured interview. The main outcome of interest was pregnancy, which was measured by detection of human chorionic gonadotrophin in urine using Quick Vue® test and confirmed by laboratory based testing. The incidence rate of pregnancy was calculated as number of pregnancies per 100 women years of follow up. Kaplan Meier Survival analysis was used to determine average time to first pregnancy. Univariate and multivariate analyses were conducted using Cox regression models to asses the factors associated with incident pregnancies. Data was analysed using Stata® version 10. Results A total of 2248 women years of follow up were recorded. A total of 238 pregnancies occurred resulting in pregnancy incidence of 11 per 100 women-years of follow up (95% CI: 9.32 to 12.02). The incidence of pregnancy increased with time in the study; 98 per 100 women years of follow up (95% CI: 85.09 to 112.35) in the last 3 months compared to 2 per 100 women-years of follow up (95% CI: 0.94 to 2.92) in the first 3 months of follow up. Older age and hormonal contraception use were significantly associated with a decreased risk of pregnancy. Women 35 years and older were 49% less likely to fall pregnant compared to those who were younger than 25 years, adjusted hazard ratio (AHR) 0.51(95% CI: 0.30 to 0.88, p=0.016). Women who used hormonal contraception had a reduced risk of falling pregnant AHR 0.66(95% CI: 0.46 to 0.94, p=0.02). There was no difference between the two types of hormonal contraception (injectable vs oral) with respect to pregnancy risk. Conclusion: The incidence of pregnancy increased with time in the study. Women who used hormonal contraception and who were older were less at risk of pregnancy. There was no significant difference in pregnancy risk by type of hormonal contraception (i.e. oral contraception vs injectable contraception) used.

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

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

BACKGROUND. Given the efficacy of most contraceptive options, it is of concern that most pregnancies in the USA are unplanned. Besides reducing the woman's and family's preparedness for parenting, unplanned pregnancies are at higher risk for inadequate prenatal care, perinatal morbidity, and significant postnatal problems. Little is known about the factors responsible for the high rates of unplanned pregnancy. METHODS. One hundred ten pregnant women were surveyed to examine factors relating contraception to unplanned pregnancy. RESULTS. Sixty-five percent of pregnancies were unplanned. There was a statistically significant association between having unplanned pregnancies and being single or divorced. Women who had planned their pregnancies tended to be more satisfied with contraceptives. In sexual encounters, women with unplanned pregnancies were more likely to use no contraception or to practice 'withdrawal' or use condoms rather than hormonal contraception; to be influenced by their partner regarding birth control use; and to forget to use contraception. CONCLUSIONS. All women of childbearing age who are sexually active can benefit from planning pregnancies. Counseling that accesses a woman's expectations regarding birth control, followed by a careful explanation of the side effects of a contraception choice, may reduce the rate of unplanned pregnancy. Counseling the male partner or sexually active men in contraceptive options may be equally important. Understanding factors that result in satisfaction with contraception may reduce unplanned pregnancies.

Introduction: Health service organizations and their partners are increasingly under pressure to collaborate to deliver integrated patient care. The Collective Impact framework aligns well with respectful engagement and decision making between an organization and its partners, ensuring long-term change at the systems level. Shared vision, mutually reinforcing activities, and continuous communication are key components of a collective impact effort. Communication, in particular, plays an important role in all aspects of an organization, both internally and externally. Thoughtful feedback from partners and collaborative efforts can achieve collective impact and improved patient and population outcomes. Choose Well (CW), a statewide contraceptive access initiative in South Carolina, was developed using Collective Impact principles. CW launched in 2017 and continued through 2022. CW aimed to implement best practices for contraceptive access and provision. This study examined the perceptions of CW staff towards shared vision for contraceptive access, mutually reinforced activities, and communication strategies between CW and its partners. Methods: Data were collected in 2022 via exit key-informant interviews with CW staff to reflect across-all-years of their involvement with the initiative. A semi-structured interview guide was used, and the interviews were recorded, transcribed, and coded. A codebook was developed based on the interview guide. Data from questions related to 1) shared vision, 2) communication, and 3) mutually reinforcing activities between CW staff and partners were analyzed for this study. Coding was conducted with NVivo software version 1.7. Results: A total of eight CW staff participated in the interviews. Findings indicate that participants were very satisfied with the shared vision for contraceptive access between CW and its partners. The most prevalent facilitators for shared vision were constant and ongoing communication, collaboration with partners, and CW changes in framing for the initiative. Regarding communication, most participants perceived that the level of communication and coordination among various CW partners was consistent and streamlined. Integration of communication into daily processes, open communication with partners, and use of an online communication tool were mentioned as strategies that facilitated communication. Lack of administrative and partner buy-in among some partners, staff turnover, and pandemic-related challenges were commonly mentioned by participants as barriers to communication. Most participants perceived mutually reinforcing activities to be adaptability to partner needs, funding for the full range of contraceptive methods, collaboration efforts, and feedback from the partners. Conclusion: While lack of buy-in among some partners and the pandemic posed challenges, most participants perceived that constant and consistent communication facilitated a shared vision among the CW partners. Through adaptability, collaboration, and open communication with partners, CW adjusted its work to align with their partners’ goals. The findings of this study indicate that CW has coordinated their efforts around a common goal that aligns with their partners. CW maintained effective and consistent communication and integrated partner feedback as a Collective Impact approach towards improving contraceptive access and provision in SC. Shared vision and understanding of the health issue between the organization and partners can lead to a collective impact towards solving community health problems such as contraceptive access.

Orientador: Luis Guillermo Bahamondes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-15T23:50:03Z (GMT). No. of bitstreams: 1 Doria_RaquelFerreiraFerrazdoLago_D.pdf: 2578074 bytes, checksum: 341c6ac9f1772c408e5a1ea2a499da58 (MD5) Previous issue date: 2010 / Resumo: Avaliar a prevalência de sinais e sintomas no local de inserção no braço e a opinião das mulheres com relação à satisfação com o método e com o novo padrão de sangramento em usuárias de implantes subdérmicos liberadores de levonorgestrel (LNG; Jadelle®) e etonogestrel (ENG; Implanon®). Métodos: Os totais de 233 e 226 mulheres foram aceitas nos grupos de implantes liberadores de ENG e LNG, respectivamente. Os sinais locais foram avaliados pela inspeção e as mulheres foram questionadas sobre queixas relacionadas ao local do implante aos 14 dias e 3, 6, 12, 24 e 36 meses após a inserção no Brasil e na República Dominicana. O mesmo grupo, somente de mulheres brasileiras, sendo 120 no grupo das usuárias de implantes liberadores de ENG e 127 no grupo liberador de LNG, deu sua opinião com relação à satisfação com o método contraceptivo e com o novo padrão menstrual, através de um questionário desenvolvido para o estudo. Os questionários foram aplicados pessoalmente aos 3 e 6 meses, e em seguida a cada 6 meses, até 36 meses após a inserção. Resultados: Dor e outros sintomas (principalmente prurido) foram as queixas mais frequentemente relatadas (~20%) e foram observadas em uma proporção semelhante entre as usuárias de Implanon® e Jadelle®, e parestesia foi relatada com menos frequência Hiperpigmentação foi três vezes maior entre as usuárias de Jadelle® do que em usuárias de Implanon® (p< 0,0001) e foi mais prevalente entre as usuárias nãobrancas. Todos os sintomas e sinais foram relatados muito mais frequentemente por mulheres dominicanas. Embora todos os sinais locais apresentassem uma tendência a diminuir com o tempo de uso, não houve diferenças significativas quando comparadas as ocorrências aos 12, 24 e 36 meses de uso de ambos os tipos de implantes. No entanto, as usuárias do Jadelle® não apresentaram declínio na ocorrência de hiperpigmentação. O modelo de regressão logística ajustada pela cor e índice de massa corporal (IMC; kg/m2) mostrou que as mulheres brancas usuárias de Implanon® apresentaram risco (OR) menor de hiperpigmentação quando comparadas às usuárias de Jadelle® (OR 0,26; IC 95% 0,14-0,48; OR 0,34; IC 95% 0,14-0,81), respectivamente. Não houve correlação entre dor, parestesia e hiperpigmentação e a utilização dos dois tipos de implantes. Hiperpigmentação foi mais prevalente entre usuárias de Jadelle® de pele escura. Em relação à satisfação foram analisados 1200 questionários. A maioria das usuárias dos dois tipos de implantes estava satisfeita com o método, e a insatisfação foi de aproximadamente 15% ao longo dos 3 anos de observação. Além disso, cerca de 70% das mulheres declararam que a utilização dos implantes trouxe benefícios e só aproximadamente 5% referiram que o uso provocou danos. Com relação ao novo padrão menstrual, as usuárias estavam muito satisfeitas ou satisfeitas em aproximadamente 70%, independente do tipo de implante. A vida sexual das usuárias não apresentou alteração em mais de 70% das usuárias, independentemente do tipo de implante. As usuárias indicariam o método para outra mulher e em sua grande maioria o método foi aprovado pelo marido. Conclusões: Informar as usuárias de implantes sobre sinais e sintomas no local de inserção do implante indica uma boa qualidade de atendimento; no entanto não é necessário avaliar o local de inserção a cada visita em usuárias assintomáticas. Os resultados sobre a opinião das usuárias quanto à satisfação com o método foram similares aos de trabalhos anteriores. No entanto, os resultados devem ser interpretados com cautela porque as mulheres que participaram deste estudo não eram usuárias comuns de uma clínica de planejamento familiar, o que levou a maior orientação durante todo o estudo. Não se pode ignorar a possibilidade de que a alta satisfação seja uma consequência da insatisfação com outros métodos contraceptivos / Abstract: Objectives: The study was conducted to assess the prevalence of local signs and symptoms at the insertion site in the arm, and the evaluation of the women's satisfaction with the method and with the new bleeding patterns among users of subdermal releasing-implants, levonorgestrel (LNG, Jadelle®) and etonogestrel (ENG, Implanon®) systems. Methods: A total of 226 and 233 women were enrolled in the ENG and the LNG group, respectively. Local signs were evaluated and women were questioned regarding complaints related to the insertion site at 14 days and 3, 6, 12, 24, and 36 months after insertion in Brazil and Dominican Republic. The same Brazilian women were randomly enrolled in the satisfaction study of ENG group (120) and the LNG group (127), respectively. The opinion of satisfaction with the bleeding pattern and with the method was evaluated through a questionnaire developed for the study. The questionnaires were applied face- toface at the 3, 6, and every 6 months thereafter up to 36 months after insertion. Results: Pain and other symptoms (mostly pruritus) were the most frequently reported complaints (~20%), and were observed in a similar proportion among both Implanon® and Jadelle® users; paresthesia was less frequently reported. Hyperpigmentation was three fold higher among users of Jadelle® than Implanon® users (p< 0.0001) and was more prevalent among non-white users. All symptoms and signs were reported much more frequently by Dominican women. The logistic regression model adjusted by race and body mass index (BMI; kg/m2) showed that users of Implanon® and white women presented lower risk of hyperpigmentation when compared to Jadelle's users (OR 0.26, 95% CI 0.14-0.48; OR 0.34, 95% CI 0.14-0.81, respectively). There was no relation between pain, paresthesia and hiperpigmentation and the use of the implants. Hiperpigmentation was more prevalent between users of Jadelle® in non-white women. The total number of questionnaires for the satisfaction study was 1,200. The results showed that most of these users of contraceptive implants were satisfied with both implants at the different visits and the regret with the method did not reach ~15% at any time through the 3 years of observation. In addition, almost 70% of the women declared that the use of the implants offered benefits for her and only ~5% referred that the use provoke harm for her. Regarding the women's response to changes in their bleeding patterns following insertion of the implant, the percentage who stated that they were very satisfied or satisfied was 70% in both methods. There was no change in the reported frequency of sexual interc urse during use of the implants and no change in their libido. Moreover, all the women in both groups stated that they would recommend the method to a friend or relative and most of them declared that their partner approved of this contraceptive method. Conclusions: Although information relating to local symptoms and signs at the implant site should be provided to current and potential users as a component of good quality of care, we do not recommend evaluation of the insertion site at every visit in women with no complaints. The results about satisfaction with the method are in agreement with previous findings. However, the results must be interpreted with caution because the women are participating in a research study and were not common clients of a family planning clinic. We cannot ignore the possibility that the high satisfaction was a consequence of dissatisfaction with alternative methods / Doutorado / Tocoginecologia / Doutor em Tocoginecologia