Aim The overall aim was to investigate Swedish elite athlete’s perceptions about the effects of the menstrual cycle on sports performance. The research questions applied was: 1. How do elite athletes perceive the effects of the menstrual cycle on performance, and do they adjust training or competition accordingly? 2. How do elite athletes perceive the knowledge and beliefs within the area, among their coaches? Method A cross-sectional study design was applied using an online questionnaire for data collection. The study group of interest were female Swedish elite athletes, from both team and individual sports. Teams and athletes defined as ‘elite athletes’ were contacted and offered participation. All data collected from the questionnaire was processed in IBM SPSS® where both descriptive and analytic statistics was performed. The Shapiro-Wilk test was used to test the assumptions of normality for the data, Chi2-tests and Fisher’s exact test were used to examine relationships between variables in the sample and the statistical significance level for analysis was set at p ≤ 0.05. Results Both menstrual- and premenstrual symptoms (PMS) effected the athletes in the sample. The psychological PMS affected close to 70% of the sample in at least one aspect and the symptoms menstrual bleeding affected majority of the sample (82%). The phases were athletes perceived themselves perform the best and the worst were different, with majority of the sample perceiving their worst performance being close to bleeding. This may be an effect of the negative symptoms associated with the bleeding phase. Both coaches’ and athletes’ perceived knowledge were considerably low, as well as athletes’ possibilities to discuss menstrual problems with their coach. Conclusions Elite athletes perceive negative effects of the menstrual cycle and somewhat experience variations in performance throughout the cycle. The knowledge within the area, especially for people involved in female sports, needs to improve. / Syfte och frågeställningar Det övergripande syftet var att undersöka svenska elitidrottares uppfattningar om effekterna av menstruationscykeln på deras prestationsförmåga. Frågeställningarna var: 1. Hur uppfattar elitidrottare effekterna av menstruationscykeln på deras prestation och anpassar de träning eller tävling i enlighet med detta? 2. Hur uppfattar elitidrottare kunskapen och åsikterna inom det specifika området, bland sina tränare? Metod En tvärsnittsstudie genomfördes med hjälp av webb-enkät för datainsamling. Studiegruppen av intresse var kvinnliga svenska elitidrottare, från både lag och individuella idrotter. Lag och idrottare som kunde definieras som "elitidrottare" kontaktades och erbjöds deltagande. All insamlade data från enkä̈ten behandlades i IBM SPSS där både beskrivande och analytisk statistik genomfördes. Shapiro-Wilk’s test användes för att testa antaganden om normalfördelning för data, Chi2-test och Fisher’s exakta test användes för att undersöka samband mellan variabler i urvalet och den statistiska signifikansnivån för analys var ≤ 0.05. Resultat Både menstruella- och premenstruella symptom (PMS) påverkade idrottarna i studiegruppen. De psykologiska PMS påverkade nära 70% av deltagarna i åtminstone ett avseende och symptom vid menstruationsblödning drabbade majoriteten av gruppen (82%). De faser i menstruationscykeln där idrottarna upplevde sin bästa- respektive sämsta prestation var olika, med en majoritet av gruppen som upplevde sin sämsta prestation i samband med blödning. Detta kan vara en effekt av de negativa symtom som är förknippade med blödningsfasen. Både tränares och idrottarnas upplevda kunskap var förhållandevis låg, liksom idrottarnas möjligheter till att diskutera menstruationsproblem med sin tränare. Slutsatser Elitidrottare upplever negativa effekter av menstruationscykeln och upplever vissa variationer i prestation under cykeln. Kunskapen inom området, speciellt för de involverade i kvinnlig idrott, behöver förbättras.

More than 50 million people were forcibly displaced from their homes at the end of 2014, the highest number since World War II; 38 million of these were displaced within their own country rather than crossing an international border. Many have been displaced multiple times by chronic and recurring conflict. Complex humanitarian emergencies caused by armed conflict are characterized by social disruption, population displacement and the breakdown of national health systems. The negative impact of war and displacement on women has long been recognized, including by compromising their right to sexual and reproductive health (SRH) services. The ten countries with the highest maternal mortality ratios in the world are affected by, or emerging from, war; these countries are also characterized by low contraceptive prevalence. The provision of SRH services is a minimum standard of health care in humanitarian settings; however access to these services is still often compromised in war. A 2012-2014 global evaluation on the status of SRH in humanitarian settings showed that although access to SRH services has improved in humanitarian settings, gaps persist and the availability of contraceptive services and information is still weak relative to other SRH components. This dissertation addresses this gap by providing evidence that good quality contraceptive services can be implemented in humanitarian settings and that women and couples will choose to start and continue contraceptive use. The first paper of this dissertation, a systematic review, explored the evidence regarding SRH services provided in humanitarian settings and determined if programs were being evaluated. In addition, the review explored which SRH services received more attention based on program evaluations and descriptive data. Peer-reviewed papers published between 2004 and 2013 were identified via the Ovid MEDLINE database, followed by a PubMed search. Papers on quantitative evaluations of SRH programs, including experimental and non-experimental designs that reported outcome data, implemented in conflict and natural disaster settings, were included. Of 5,669 papers identified in the initial search, 36 papers describing 30 programs met inclusion criteria. Some SRH technical areas were better represented than others: seven papers reported on maternal and newborn health (including two that also covered contraceptive services), six on contraceptive services, three on sexual violence, 20 on HIV and other sexually transmitted infections and two on general SRH topics. In comparison to the program evaluation papers identified, three times as many papers were found that reported SRH descriptive or prevalence data in humanitarian settings. While data demonstrating the magnitude of the problem are crucial and were previously lacking, the need for SRH services and for evaluations to measure their effectiveness is clear. Contraceptive services were mostly limited to short-acting methods and received less attention overall than other SRH technical components. In response to this lack of evidence for the implementation of contraceptive services in humanitarian settings, two contraceptive services programs implemented by CARE and Save the Children among conflict-affected populations in eastern Democratic Republic of the Congo (DRC) were evaluated. DRC has experienced chronic conflict for two decades, ranging from acute to post conflict phases. People have been displaced internally for many years while others have experienced repeated cycles of displacement and return. First, cross-sectional surveys in 2008 (n=607) and 2010 (n=575) of women of reproductive age using a multi-stage cluster sampling design and facility assessments were conducted in Maniema province. Data on the numbers of clients who started a contraceptive method were also collected monthly from supported facilities. Current use of any modern contraceptive method doubled from 3.1% to 5.9% (adjusted OR 2.03 [95%CI 1.3-3.2]). Current use of long-acting and permanent methods (LAPM) increased from 0 to 1.7%, an increase that was no longer significant after adjustment. Program changes were made to improve service quality in 2010; provider skills and counseling improved and commodities became consistently available. Service statistics indicate that the percentage of clients who accepted a LAPM at supported facilities increased from 8% in 2008 to 83% in 2014. This study demonstrates that when good quality contraceptive services, including LAPM, are provided among conflict-affected populations, women will choose to use them. Second, a retrospective cohort study measured 12-month contraceptive continuation in North Kivu province. A total of 548 women (304 short-acting and 244 long-acting method acceptors) were interviewed about their contraceptive use in the previous year. At 12 months, 81.6% women reported using their baseline method continuously, with more long-acting than short-acting method acceptors (86.1% versus 78.0%, p=.02) continuing method use. Use of a short-acting method (HR 1.74 [95%CI 1.13-2.67]) and desiring a child within two years (HR 2.32 [95%CI 1.33-4.02]) were associated with discontinuation at 12 months. Given the association between service quality and contraceptive continuation, the program’s focus on service quality including improvements to provider skills and activities to address provider attitudes likely contributed to these results. The impressive continuation rates found here indicate that delivering high quality contraceptives services in these settings is possible, even in a difficult and unstable setting like eastern DRC. This dissertation represents a major contribution to the field of SRH in humanitarian settings, and has implications for research and programs. First, these results strengthen the evidence base for the implementation of contraceptive services in humanitarian settings, and demonstrate to implementers and donors of humanitarian aid that effective programs resulting in adoption and continuation of contraceptive methods can be successfully implemented in these challenging settings. Second, these programs were implemented in full collaboration with the Ministry of Health (MOH), supporting MOH facilities and health workers, thus strengthening the health system. Third, the programs achieved these impressive results in rural DRC where they attracted early adopters, most of them first time contraceptive acceptors. In addition, these programs were implemented by multi-sectoral, as opposed to SRH-specific, non-governmental organizations that made good quality contraceptive services a priority, further reinforcing the inclusion of contraceptive services as a routine component of humanitarian health response. Finally, both programs evaluated in this dissertation focused strongly on improving the quality of contraceptive services with specific attention to training, supervision, provider attitudes, data use and commodities management. This program focus on quality contributed to the positive findings. Making good quality contraceptive services available is challenging and requires sustained commitment, funding and program adjustments, but, in the programs studied here, was ultimately successful. Given true choice, when a range of methods was routinely available, women, many of whom had no prior experience with contraceptive use, were able to choose the method that best served their needs and continued to use their preferred method. These results add to the limited evidence on contraception in humanitarian settings, and demonstrate that even in remote and unstable settings, when good quality contraceptive services, with a choice of short-acting, long-acting and permanent methods, are in place, women will not only choose to start, but also continue, to use contraception to exercise their right to reproductive choice.

This systematic review consolidates and discusses all the advantages and disadvantages of each contraceptive method, organized by mammalian species, with emphasis on reversible immune-contraception, obtained from the international scientific literature. The objective is to deepen the knowledge and elucidate adequate solutions to a serious global problem of wildlife population control. Furthermore, serving as pre-project to the next stage of development of a contraceptive method, economically viable, with better attributes, high effectiveness of the action, better and safer techniques of application, and more importantly, ensure overall health and population genetics. Finalizing this review by offering in a brief and concise manner, an updated understanding of reversible contraceptive methods, organized by methods, taxon, drugs, and associated risks / Esta revisão sistemática, consolida e discuti todas as vantagens e desvantagens de cada método contraceptivo, organizada por espécies de mamíferos, com ênfase em imunocontracepção reversível, obtidos em literatura científica internacional. O objetivo é aprofundar os conhecimentos e elucidar soluções adequadas para o grande problema mundial do controle das populações de animais silvestres. Além disto, pode servir como pré-projeto para a próxima fase de desenvolvimento de um método contraceptivo economicamente viável, com melhores atributos, alta eficácia da ação, técnicas de aplicação melhores e mais seguras, e mais importante, garantir saúde geral e genética das populações. Finalizando, esta revisão oferecer de forma breve e concisa, uma atualização sobre o conhecimento de métodos contraceptivos reversíveis, organizada por métodos, táxon, fármacos, e riscos associados

Orientador: Luis Guillermo Bahamondes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-07T16:42:18Z (GMT). No. of bitstreams: 1 Juliato_CassiaRaquelTeatin_D.pdf: 2310620 bytes, checksum: fd8518fdd702439cfec0703cbfc61af7 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi avaliar a densidade mineral óssea (DMO) em usuárias de dois tipos de contraceptivos injetáveis combinados (CIC) mensais e comparar com controles. SUJEITOS E MÉTODOS: Estudo de corte transversal com 97 mulheres de 20 a 45 anos, usuárias de CIC com 25mg de acetato de medroxiprogesterona e 5mg de cipionato de estradiol (AMP/CypE2, Cyclofemina) por 12 a 82 meses (n=64) ou 50mg de enantato de norestisterona e 5mg de valerato de estradiol (NET-EN/ValE2, Mesigyna) por 12 a 60 meses (n=33), pareadas por idade (± 1ano) e índice de massa corpórea (IMC, kg/m2) (± 1) com usuárias de DIU TCu 380A como grupo de controle. A DMO foi avaliada nas regiões distal e ultradistal do rádio, no braço não dominante, utilizando a técnica de absorciometria óssea, com feixe duplo de raios-X (DXA). RESULTADOS: A DMO no midshaft da ulna foi de 0,457 ± 0,007 nas usuárias de Cyclofemina® e 0,465 ± 0,007 nos controles. Nas usuárias de Mesigyna® a DMO foi 0,463 ± 0,008 e 0,458 ± 0,009 nos controles. No rádio distal, a DMO foi 0,399 ± 0,011 e 0,401 ± 0,010 nas usuárias de Cyclofemina® e controles, e 0,400 ± 0,009 e 0,388 ± 0,10 nas usuárias de Mesigyna® e controles, respectivamente. Não houve diferença na DMO entre as usuárias de CIC e o grupo de controle. Não houve diferença entre as usuárias dos dois tipos de CIC e também não houve diferença entre as usuárias de CIC com relação ao tempo de uso menor ou igual e a partir de três anos. CONCLUSÕES: Mulheres com idade entre 20 e 45 anos, usuárias de CIC com AMP/CypE2 ou NET-EN/ValE2, apresentaram DMO similar entre os dois tipos de CIC e controles (usuárias do DIU TCu 380A), quando pareadas por idade e IMC / Abstract: BACKGROUND: The objective of this study was to compare bone mineral density (BMD) between users of two kinds of once-a-month combined injectable contraceptives (CIC) and controls. SUBJECTS AND METHODS: This crosssectional study included 97 women of 20 to 45 years of age, using CIC containing either 25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate (MPA/E2Cyp, Cyclofemina) (for 12 to 82 months) or 50 mg of norethindrone enanthate and 5mg of estradiol valerate (NET-EN/E2Val, Mesigyna) (for 12 to 60 months) matched by age (± 1 year) and body mass index (BMI, kg/m2) (± 1) with users of the TCu 380A intrauterine device as controls. BMD was evaluated at the midshaft of the ulna and at the distal section of the radius of the nondominant forearm using double X-ray absorptiometry. RESULTS: The BMD at the midshaft of the ulna was 0.457 ± 0.007 and 0.465 ± 0.007 in the MPA/oE2Cyp group and controls, respectively, and 0.463 ± 0.008 and 0.458 ± 0.009 in the NET-EN/oE2Val group and controls, respectively. At the distal radius, the BMD was 0.399 ± 0.011 and 0.401 ± 0.010 in users of MPA/oE2Cyp and controls, respectively and 0.400 ± 0.009 and 0.388 ± 0.010 in users of NET-EN/oE2Val and controls, respectively. There were no differences in BMD between users of either CIC and non-users at either section of the forearm studied. There were also no differences in BMD between users of the two CIC at either section of the forearm. CONCLUSIONS: Women aged 20 to 45 years old, currently using one of these two kinds of CIC, presented similar BMD to controls paired by age and BMI (kg/m2) and similar between both CIC / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Durante as diferentes fases da vida, ocorrem alterações nos níveis dos hormônios sexuais no organismo. Estes períodos estão diretamente associados com episódios de inflamação periodontal exacerbada. Por isso, a relação entre níveis alterados dos hormônios sexuais e variações no grau de inflamação gengival tem sido estudada. Como os contraceptivos orais alteram artificialmente os níveis dos hormônios sexuais, o objetivo deste estudo é avaliar a influência de contraceptivos orais combinados atuais na condição periodontal de 25 mulheres entre 19 e 35 anos de idade que fazem uso deste medicamento pelo período mínimo de 12 meses em comparação ao grupo controle de 25 mulheres, dentro do mesmo limite de idade, que não fazem uso de contraceptivos orais. As pacientes foram avaliadas por examinador único, previamente treinado, cego em relação ao uso do contraceptivo, quanto às medidas de profundidade de sondagem, nível de inserção clínica, índice de sangramento do sulco e índice de placa. Os dados obtidos foram analisados estatisticamente segundo o teste t não pareado, teste de correlação de Pearson e teste de correlação de Spearman. Os resultados obtidos indicaram que mulheres que fazem uso de contraceptivos orais há mais de um ano apresentam maior profundidade de sondagem (2,228±0,011 x 2,154±0,012; p<0.0001), perda de inserção (0,435±0,01 x 0,412±0,01; p=0.11) e índice de sangramento do sulco (0,229±0,006 x 0,148±0,005, p<0.0001) do que o grupo controle, embora o índice de placa tenha sido menor no grupo teste do que no controle (0,206±0,007 x 0,303±0,008; p<0.0001). Não houve correlação entre o tempo de uso do medicamento, idade e nenhum dos parâmetros periodontais clínicos. Esses achados sugerem que o uso de contraceptivos orais combinados disponíveis atualmente no mercado pode influenciar a condição periodontal das pacientes, independentemente da quantidade de placa presente e do tempo de uso dos contraceptivos, resultando em maior inflamação da gengiva marginal. / During the different life phases, sexual hormones levels can be altered. These periods are directly associated to episodes of increased periodontal inflammation. Because of this, the relation between altered levels of sexual hormones and degree of gingival inflammation has been studied. As oral contraceptives artificially modify sexual hormones levels, the aim of this study is to evaluate the effects of this drug in the periodontal condition of 25 women aged 19-35 years old that have been taking oral contraceptives for at least one year compared to a control group composed of 25 patients at the same age range that do not report the use of oral contraceptives. Patients were evaluated by a previously trained, single blinded examiner according to pocket probing depth, clinical attachment level, bleeding on probing and plaque index. Data was statistically evaluated by unpaired t test, Pearsons correlation test and Spearmans correlation test. The results obtained indicated that women taking oral contraceptives for at least one year show increased probing pocket depth (2.228±0.011 x 2.154±0.012; p<0.0001), attachment loss (0.435±0.01 x 0.412±0.01; p=0.11) and bleeding on probing (0.229±0.006 x 0.148±0.005, p<0.0001) than the control, although plaque index was slightly inferior in test than in control group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptives intake, age and periodontal parameters was observed. These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal condition of the patients, independent from plaque accumulation and the duration of use of the medication, resulting in increased gingival inflammation.

Reducing the percentage of unwanted pregnancies has been one of the top objectives of the national health promotion "Healthy People" since the early 1980s. As the increase of unwanted pregnancies continues, research is necessary to uncover factors that influence the decisions women make about their contraceptive methods. The current study examines the topics and the sources of memorable messages regarding LARCs. To address the research questions, this study will analyze interviews conducted with young women about memorable messages regarding LARC methods. This study is a formative research of memorable messages in the context of contraceptive methods, specifically long-acting reversible contraceptives (LARCs). This study gives insight into characteristics to better target young women when promoting contraceptive methods, especially LARCs. Debunking myths and misconceptions about LARCs and improve overall health literacy about these methods among young women and their mothers should be a top priority.

Abstract not available

<p>The subject of sexuality has been one of the most heated issues of the Popes throughout the history of the Catholic Church. The topics discussed by the various popes over the years, regarding sexuality, are limited to marriage, the conjugal act, the decline in morals, natural and artificial birth control, abortion, as well as more recently, modern methods of assisted reproduction. </p><p>Moral changes and trends in modern society have had an impact on Catholic Religion. Modern society faces a culture that influences norms and expectations and seems to accept free sexuality. The popes respond slowly or not at all to these cultural trends.</p>

The vagina is the port of entry for sexually transmitted diseases in women. Its epithelium constitutes the luminal border, thus comprising an important defence barrier. The objective of this work was to investigate the mechanisms of importance in the immune defence of the vaginal epithelium of healthy, fertile women, and possible menstrual cycle changes. Effects of hormonal contraceptive usage on oestrogen receptor (ER) and progesterone receptor (PR) expression were studied. The contribution of epithelial cell to the immune defence was estimated by assaying their expression of antimicrobial defensins and the epithelial thickness. Vaginal biopsies and serum samples were collected during the follicular and luteal phases in regularly menstruating women (controls) and in users of combined oral contraceptives (COCs), levonorgestrel implants (LNGs), or depot-medroxyprogesterone acetate injections (DMPAs). Fifteen healthy women (aged 20–34 years) were enrolled in each group. Morphometry was performed on vaginal tissue stained with haematoxylin/eosin and by immunohistochemistry using monoclonal antibodies against immune cell markers, PR, and ER. Expression of mRNA for human α-defensins HD-5 and HD-6, and human β-defensins (HBD) 1 to 4 were determined by real-time qRT-PCR and in situ hybridization. In controls, the epithelium was 261 ± 16 μm thick and harboured 241 ± 35 leukocytes (CD45+) per mm2. T lymphocytes (CD3+) dominated. Both αβ T cells and γδ T cells were present with an approximate 4-fold dominance of αβ T cells. Cytotoxic T cells (CD8+) were more frequent than T helper cells (CD4:CD8 ratio: 0.7 ± 0.1). Macrophages (CD68+) constituted the second-largest population, followed by Langerhans cells (CD1a+). B cells, natural killer cells, monocytes and granulocytes were generally absent. No differences were found between the follicular and luteal phase. All four β-defensins analysed for were detected in vaginal epithelium and most samples expressed at least two. HBD-2 and HBD-3 were most frequent. HBD-3 and HBD-4 expressing cells were localized in the parabasal and intermediate cell layers. α-defensins were not detected. The epithelium was significantly thicker (333 ± 9 μm) in COC, LNG, and DMPA users than in controls, and commonly showed hyperplasia. In DMPA and LNG users the frequency of intraepithelial leukocytes (CD45+) was increased, explained by increased frequencies of both αβ and γδ T cells. In DMPA users there was also a selective increase in CD8+ T cells. PR expression was significantly reduced in DMPA users compared with controls, COC and LNG users. COC and particularly DMPA users often had undetectable levels of serum E2. In conclusion, both adaptive immunity, i.e. intraepithelial T cells, and innate defence mechanisms, i.e. intraepithelial macrophages and β-defensins, are believed to contribute to the immune defence in the human female lower genital tract. These parameters did not change during the menstrual cycle but hormonal contraceptive usage, especially DMPA, affected the quality of the epithelium. The use of DMPA and LNG was correlated with the accumulation of T cells within the epithelium. The effects of these changes on the risk of contracting infections are yet to be determined.

The subject of sexuality has been one of the most heated issues of the Popes throughout the history of the Catholic Church. The topics discussed by the various popes over the years, regarding sexuality, are limited to marriage, the conjugal act, the decline in morals, natural and artificial birth control, abortion, as well as more recently, modern methods of assisted reproduction. Moral changes and trends in modern society have had an impact on Catholic Religion. Modern society faces a culture that influences norms and expectations and seems to accept free sexuality. The popes respond slowly or not at all to these cultural trends.