Emergency contraception is an effective backup for contraceptive failure. In Hong Kong, levonorgestrel emergency contraceptive pill is a prescription drug. In most developed countries, it is provided in advance or over-the-counter to eliminate the barrier to access. The objective of this thesis is to evaluate the feasibility and acceptability of these novel delivery modes in Hong Kong. Four studies were conducted to study pertinent subject matters. A retrospective review on 11014 clinical records of The Family Planning Association of Hong Kong on emergency contraception prescription between 2006 and 2008 was performed to delineate the characteristics of emergency contraceptive users. One-year follow-up data was available in 4728 records, with 89.4% used emergency contraception once and 8.5% used it twice. The proportion of subjects not using ongoing contraceptives reduced from 20.6% at the emergency contraception visit to 4.5% at post-treatment follow-up, 3.9% at 6th month and 3.3% at 12th month. Young age was not associated with not using ongoing contraceptives and repeat use of emergency contraceptives. A randomized controlled trial with 1030 women was conducted to compare the behavior of those given three courses of levonorgestrel emergency contraceptive pills in advance against those who had to get them from clinics when needed. After one year, 29.9% of women in the advanced provision group had used the pills versus 12.9% in the control group (odds ratio 2.87, 95% confidence interval 2.07-3.97). The advanced provision group used three times more pills than the control group (278 versus 95 courses, p<0.001). The median coitus-treatment interval in the advanced provision group was significantly shorter than the control group (11 h versus 20 h; p<0.001). Most women used condoms before (90%) and during (89%) the study. In both groups, consistency of use was higher after emergency contraception (65%) than before (60%) (p<0.001). This study confirmed that advanced provision increased the utilization of emergency contraceptive pill, facilitated its early use and did not hamper ongoing contraceptive use. A questionnaire survey was conducted to evaluate the acceptability of novel use of emergency contraceptive pill among women practicing contraception. Of the 1405 questionnaires analyzed, 46.3% of women supported more advertising on emergency contraception; 48.7% supported advanced provision of emergency contraceptive pill and 25.7% supported over-the-counter provision. Another questionnaire survey assessed the attitude of physicians who provide family planning services. Half (54.2%) of them supported advanced provision of emergency contraceptive pill; 32.5% supported advanced provision to girls aged 16 and below and 40.2% supported over-thecounter provision. Among 352 physicians who provided emergency contraception, only 21.7% of private family physicians and 15.9% of private obstetrician-gynaecologists prescribed emergency contraceptive pills in advance. In conclusion, local women used emergency contraception responsibly and remained vigilant with ongoing contraception even when they got pills in advance. Minority of physicians practice advanced provision. The acceptance of advanced provision, among women and physicians who do not know much about it, is around 50%. It is thus possible to improve when more education on advanced provision is provided. The support for over-the-counter provision was too weak to boost. / published_or_final_version / Medicine / Master / Doctor of Medicine

No description available.

Thesis (Ph. D.)--Drexel University, 2007. / Includes abstract and vita. Includes bibliographical references (leaves 103-110).

Made available in DSpace on 2014-06-11T19:29:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-01-20Bitstream added on 2014-06-13T20:19:14Z : No. of bitstreams: 1 ackermann_cl_me_botfmvz.pdf: 1838578 bytes, checksum: 9af8620d409cc960f6c129984e6ce9f1 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do presente estudo foi avaliar os efeitos do acetato de deslorelina como contraceptivo em felinos domésticos. Foram utilizados 15 gatos domésticos (10 fêmeas e 5 machos). As fêmeas foram acompanhadas através de citologias vaginais (CV), observação do comportamento sexual a cada 72 horas e dosagem de progesterona plasmática a cada 7dias. Quando em interestro/diestro as gatas foram submetidas à associação anestésica e um implante de acetato de deslorelina (Suprelorin® Peptech Animal Health Pty Limited, Austrália; 4,7 mg/animal) foi aplicado, permanecendo por 90 dias depois. Dez dias após a retirada do implante o estro e a ovulação foram induzidos com eCG e Hcg; três dias após as fêmeas foram submetidas à ovariosalpingohisterectomia. As tubas uterinas e útero foram lavados e o liquido recuperado foi observado para identificação e contagem de possíveis oócitos. Os oócitos foram isolados e corados para avaliação da viabilidade, os corpos lúteos quantificados e o cálculo da taxa de recuperação oocitária foi realizado.. Os ovários e útero foram avaliados quanto à histologia. Alterações histológicas foram descritas e as concentrações plasmáticas de progesterona foram submetidas a teste de normalidade e posteriormente submetidas ao Teste de Kolmogorov-Smirnov. Os demais resultados estão descritos em forma de média e desvio padrão. Os machos foram submetidos a duas avaliações andrológicas (M1 e M2) sempre precedidas de anestesia geral, imediatamente após a M2, um implante de acetato de deslorelina (Suprelorin® Peptech Animal Health Pty Limited, Austrália; 4,7 mg/animal) foi aplicado em cada gato. Após o inicio do tratamento foram realizadas mais três avaliações andrológicas (M3, M4 e M5) com intervalo de 30 dias. Após a M5, os implantes foram retirados e uma hemi orquiectomia realizada. Mais duas avaliações... / This study aimed evaluates the deslorelin acetate effects as a contraceptive in domestic felids. Fifteen domestic cats (10 females and 5 males) were used. The females were evaluated trough vaginal cytology (VC) and sexual behavior every 72 hours, and progesterone plasmatic concentration every 7 days. When in interestrous/diestrous the queens were submitted to an anesthetic protocol and receive one deslorelin acetate implant (Suprelorin® Peptech Animal Health Pty Limited, Australia; 4.7 mg/animal), remaining in treatment for 90 days. Teen days after the implant removal the estrous and ovulation were induced with eCG and hCG; three days after, all females were submitted to surgical castration. The oviduts and uterus were washed and the recovered liquid was observed for oocytes identification and count. The recovered oocytes were isolated and stained for viability evaluation, the corpus luteum were quantified and the oocyte recovery tax was calculated. Histologic evaluation was carried out in the ovary and uterus. The histologic evaluations were described and progesterone plasmatic concentration were submitted to Kolmogorov-Smirnov test. The remaining results were described as mean and standard deviation. Males were submitted to two andrological evaluations (M1 and M2), always preceded by anesthetic protocol. Immediately after M2, every cat receives one deslorelin acetate implant (Suprelorin® Peptech Animal Health Pty Limited, Australia; 4.7 mg/animal). After contraceptive treatment beginning, three andrological evaluations were conducted (M3, M4, and M5) with 30 days interval. After M5, the implants were removed and a hemiorquiectomy was performed. Other two andrological evaluations were performed (M6 and M7) with 30 days interval and at M7 the remaining testicle were removed. The testicles were submitted ...(Complete abstract click electronic access below)

Orientador: Maria Denise Lopes / Banca: Carlos Roberto Teixeira / Banca: Marcelo Alcindo de Barros Vaz Guimarães / Resumo: O objetivo do presente estudo foi avaliar os efeitos do acetato de deslorelina como contraceptivo em felinos domésticos. Foram utilizados 15 gatos domésticos (10 fêmeas e 5 machos). As fêmeas foram acompanhadas através de citologias vaginais (CV), observação do comportamento sexual a cada 72 horas e dosagem de progesterona plasmática a cada 7dias. Quando em interestro/diestro as gatas foram submetidas à associação anestésica e um implante de acetato de deslorelina (Suprelorin® Peptech Animal Health Pty Limited, Austrália; 4,7 mg/animal) foi aplicado, permanecendo por 90 dias depois. Dez dias após a retirada do implante o estro e a ovulação foram induzidos com eCG e Hcg; três dias após as fêmeas foram submetidas à ovariosalpingohisterectomia. As tubas uterinas e útero foram lavados e o liquido recuperado foi observado para identificação e contagem de possíveis oócitos. Os oócitos foram isolados e corados para avaliação da viabilidade, os corpos lúteos quantificados e o cálculo da taxa de recuperação oocitária foi realizado.. Os ovários e útero foram avaliados quanto à histologia. Alterações histológicas foram descritas e as concentrações plasmáticas de progesterona foram submetidas a teste de normalidade e posteriormente submetidas ao Teste de Kolmogorov-Smirnov. Os demais resultados estão descritos em forma de média e desvio padrão. Os machos foram submetidos a duas avaliações andrológicas (M1 e M2) sempre precedidas de anestesia geral, imediatamente após a M2, um implante de acetato de deslorelina (Suprelorin® Peptech Animal Health Pty Limited, Austrália; 4,7 mg/animal) foi aplicado em cada gato. Após o inicio do tratamento foram realizadas mais três avaliações andrológicas (M3, M4 e M5) com intervalo de 30 dias. Após a M5, os implantes foram retirados e uma hemi orquiectomia realizada. Mais duas avaliações ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed evaluates the deslorelin acetate effects as a contraceptive in domestic felids. Fifteen domestic cats (10 females and 5 males) were used. The females were evaluated trough vaginal cytology (VC) and sexual behavior every 72 hours, and progesterone plasmatic concentration every 7 days. When in interestrous/diestrous the queens were submitted to an anesthetic protocol and receive one deslorelin acetate implant (Suprelorin® Peptech Animal Health Pty Limited, Australia; 4.7 mg/animal), remaining in treatment for 90 days. Teen days after the implant removal the estrous and ovulation were induced with eCG and hCG; three days after, all females were submitted to surgical castration. The oviduts and uterus were washed and the recovered liquid was observed for oocytes identification and count. The recovered oocytes were isolated and stained for viability evaluation, the corpus luteum were quantified and the oocyte recovery tax was calculated. Histologic evaluation was carried out in the ovary and uterus. The histologic evaluations were described and progesterone plasmatic concentration were submitted to Kolmogorov-Smirnov test. The remaining results were described as mean and standard deviation. Males were submitted to two andrological evaluations (M1 and M2), always preceded by anesthetic protocol. Immediately after M2, every cat receives one deslorelin acetate implant (Suprelorin® Peptech Animal Health Pty Limited, Australia; 4.7 mg/animal). After contraceptive treatment beginning, three andrological evaluations were conducted (M3, M4, and M5) with 30 days interval. After M5, the implants were removed and a hemiorquiectomy was performed. Other two andrological evaluations were performed (M6 and M7) with 30 days interval and at M7 the remaining testicle were removed. The testicles were submitted ...(Complete abstract click electronic access below) / Mestre

The purpose of this study was to attain an understanding of knowledge, attitudes and use of contraception amongst learners attending a high school in Mdantsane. A quantitative, descriptive survey was conducted. Data were collected using a semi-structured questionnaire which was self-administered by 150 female learners. These learners were doing grade 10-12 and were aged between 18-20 years. The findings indicated that 86.67% of the learners understood contraception as prevention of pregnancy, only 8.67% understood contraception as prevention of sexually transmitted diseases. The 66.3% of learners had positive attitude towards contraceptives. The 77.27% of the learners were using injectable contraceptives. The main reason for stopping use of contraception was side effects. Majority of learners had basic knowledge of contraceptives, but knew few types and did not know their mechanism of action. Most learners had positive attitude and were using contraceptives. / Health Studies / M.A. (Health Studies)

The purpose of this study was to attain an understanding of knowledge, attitudes and use of contraception amongst learners attending a high school in Mdantsane. A quantitative, descriptive survey was conducted. Data were collected using a semi-structured questionnaire which was self-administered by 150 female learners. These learners were doing grade 10-12 and were aged between 18-20 years. The findings indicated that 86.67% of the learners understood contraception as prevention of pregnancy, only 8.67% understood contraception as prevention of sexually transmitted diseases. The 66.3% of learners had positive attitude towards contraceptives. The 77.27% of the learners were using injectable contraceptives. The main reason for stopping use of contraception was side effects. Majority of learners had basic knowledge of contraceptives, but knew few types and did not know their mechanism of action. Most learners had positive attitude and were using contraceptives. / Health Studies / M.A. (Health Studies)

The novel emergency contraceptive Ulipristal acetate (UPA) belongs to the progesterone receptor modulator family. A single oral dosage of 30mg UPA within 120 hours of unprotected intercourse could delay ovulation and differentiation of endometrium. Yet, whether UPA affect embryo implantation remains largely unknown. This study aims to investigate whether UPA affect endometrial gene expressions and embryo attachment onto endometrial epithelial cells. The PR-expressing human endometrial carcinoma cell line Ishikawa was used and treated with 10nM estrogen, 1μM progesterone or 4μM UPA for 24 hours. Changes in transcriptome profiles were analyzed by Affymetrix Human Gene 1.0 ST array GeneChip. Gene clustering showed the gene expression pattern after UPA treatment was similar to control (0.1% ethanol); while estrogen treated group was different from all the other groups. Totally, 8 genes were significantly increased and 1 was decreased (≥2-fold, p<0.05) after UPA treatment. All except one of the 8 up-regulated genes were also up-regulated by estrogen; while only one of them increased after progesterone treatment. Most genes that were altered by UPA were involved in angiogenesis and vascular remodeling. The effect of UPA on human embryo-endometrium attachment was carried out using an in vitro multi-cellular spheroids-endometrial epithelial cell co-culture model. Human choriocarcinoma cell line JAR and Ishikawa were used. UPA (0.04-4μM) treatment for up to 48 hours did not affect the proliferation of JAR or Ishikawa cells. Similarly, the attachment of JAR spheroids onto Ishikawa cells after 1 hour co-culture was not affected by UPA treatment. The molecules of Wnt/β-catenin signaling pathway, a pathway that is actively involved in embryo implantation, such as the β-catenin and GSK-3β, and endometrial receptive marker E-cadherin were not changed after UPA treatment. In Ishikawa cells, the expression of PR-A was induced after UPA (0.04-4μM) treatment; while PR-B increased when 0.04 or 4μM UPA used. However, the PR-A/PR-B ratio remained unchanged after all concentration of UPA treatment. The effect of UPA on spheroids attachment was further investigated with cultured human primary endometrial epithelial cells. Endometrial glandular epithelial cells were digested and isolated from endometrial biopsy taken from IVF patients on day 7 after luteinizing hormone surge (LH+7). A co-culture assay was optimized with JAR spheroids and endometrial epithelial cells that were growing on Matrigel. The attachment rate of JAR spheroids is approximately 60% after 3 hours incubation. However, after 24 hours of exposure to 4μM UPA, the attachment remained comparable to that of the control group. In conclusion, UPA could alter the expression of genes in Ishikawa cells mainly related to angiogenesis. It is likely that UPA may affect stromal decidualization and blastocyst invasion after attachment. However, UPA did not affect the expression of Wnt-signaling molecules and attachment of JAR spheroids onto either Ishikawa or human primary endometrial epithelial cell. / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy

Women who use hormonal contraceptives have been shown to report more intense affective responses to partner infidelity than women with a natural cycle. Also, previous research suggests that female jealousy is sensitive to hormonal changes when naturally cycling, with a peak around ovulation, while women using hormonal contraceptives are less sensitive. This research is aimed at exploring women`s perception of couple conflicts in line with predictions derived from evolutionary theory. A factor analysis yielded four dimensions within 19 couple conflicts that were related to jealousy, emotional support, time and effort, and commitment. We tested the hypotheses that women who use hormonal contraceptives will react more strongly to jealousy-provoking scenarios and overall conflicts compared to women with a natural menstrual cycle. We also tested the hypotheses that naturally cycling women would show an increase in their emotional response to jealousy-provoking scenarios at days with high fertility risk. We expected that their emotional response to the scenarios infidelity, lack of emotional support, time and effort and lack of commitment, would increase if they perceived their partners as attractive. By using an online questionnaire, we followed women who were currently in a relationship with age ranging from 18 to 30 years weekly for 12 weeks. Results show a significant difference between women using hormonal contraceptives and naturally cycling women. Women using hormonal contraceptives responded to be more upset by scenarios indicating infidelity, than did naturally cycling women (p &lt; .05), but not on the overall conflicts. However, some unexpected differences on the single scenarios where discovered. For the analysis concerning the fertility-effect, no significant main effect was found. However, our hypotheses were not supported (p &gt; .001), Our results did, however, reveal a non-significant trending in the predicted direction indicating that the partner`s attractiveness interact with fertility status and affect how women respond to situations regarding Jealousy and couple conflicts.

The study took as its point of departure the Children’s Act No 38 of 2005 that emanated from the Bill of Rights enshrined in the Constitution of the Republic of South Africa (Act 108 of 1996). This Act has as its primary aims, to promote the preservation and strengthening of families and to give effect to the rights of children as enshrined in the Constitution of the Republic of South Africa, including: protection of children from maltreatment, neglect, abuse or degradation and the fact that the best interest of a child are of paramount importance in every matter concerning children. It was anticipated that the areas of the Children’s Act with its emphasis on the rights of children would empower them in relation to their protection and development in that particular context. When the Act was introduced, it evoked mixed reactions with certain segments of society applauding the government for its efforts, and others condemning the government’s approach towards reproductive health issues affecting children. The primary aim of the research project was to explore the views of a group of parents in the Johannesburg Metro Region 11 regarding reproductive health care as embedded in the Children’s Act. The study took the form of a small-scale, mixed methods, descriptive, cross-sectional survey research design as it sought to elicit participants’ views on those specific clauses in the Act. In addressing the aims and objectives of the study, interview schedules were administered to 35 participants on an individual, face-to-face basis. Participants were adults drawn from Johannesburg Metro Region 11 and the data collected was analysed using descriptive statistics and thematic content analysis. The main findings that emerged from the study were that, participants did not participate in the process leading up to the promulgation of the Children’s Act No 38 of 2005. Consequently, participants had little knowledge about the Act and did not have any knowledge about its objectives. The fact that participants did not support certain clauses has implications for amendment of the Act with reference to the clauses on reproductive health care.