The most common method of birth control used since 3000 B.C., is the condom. It has been used continuously in the 21st century, but several other forms have been added. Due to reformers like Marie Stopes, Margret Sanger, Katharine McCormick and Gregory Pincus contraceptive usage has become popularized in today's society. New forms of contraceptive include, but are not limited to intrauterine devices (IUDs), shots, pill, patch, and vaginal rings. These devices have been developed as both hormonal and nonhormonal products. Hormonal birth control delivers hormones such as estrogen and progestin, which affect the joining of the sperm and egg. Products that are non-hormonal are a viable alternative for women who cannot tolerate hormonal regulation. Estrogen and progestin function as contraceptives by changing various areas in the vaginal tract by changes such as the thickening of cervical mucus, thinning the uterus lining, or increasing the vagina acidity. Researchers are also trying to develop other options such as a male contraceptive option to expand and reach a target population that is not currently reached. There are also government policies currently in Congress that address the issue of the uninsured; thereby reaching those who may need contraceptives the most. The Affordable Care Act also known as Obama care is trying to provide Medicaid to people who do not and would not ever be able to afford adequate health care, including contraceptives on their own. With the passing of the Affordable Care Act more women will be able to go to a medical provider to be informed and educated on the various contraceptive methods, enabling them to make an informed decision.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A utilizaÃÃo de recursos tecnolÃgicos na Ãrea da saÃde e da enfermagem vem sendo cada vez mais presente na realidade prÃtica. Essas ferramentas sÃo desenvolvidas e aplicadas no meio assistencial, assim como no meio acadÃmico por enfermeiros e por discentes. Diante desta nova realidade, à exigido dos enfermeiros preparo, conhecimento e domÃnio da tecnologia para adequar-se a estas novas tendÃncias de aÃÃes em enfermagem, sem, contudo, afastar-se da essÃncia do cuidado ou distanciar a relaÃÃo existente entre professor e aluno. Dentre as prÃticas do enfermeiro, cita-se a atenÃÃo em planejamento familiar e anticoncepÃÃo. Passando pelos aspectos tecnolÃgicos e assistenciais, torna-se oportuno articular o uso de tecnologia, educaÃÃo e enfermagem em planejamento familiar, desenvolvendo uma hipermÃdia educacional. Assim, objetivou-se construir uma hipermÃdia educacional em planejamento familiar, com Ãnfase à contracepÃÃo. O desenvolvimento deste estudo foi baseado na teoria da interaÃÃo social de Vygostsky. O estudo à do tipo de desenvolvimento, ou seja, a construÃÃo e desenvolvimento de softwares e outras estratÃgias tecnolÃgicas que sÃo implementadas no ambiente educacional ou assistencial. A construÃÃo da hipermÃdia ocorreu no perÃodo de maio a outubro de 2009. Em seguida, foi realizada avaliaÃÃo por juÃzes especialistas em planejamento familiar-contracepÃÃo e em tecnologia. ApÃs anÃlise pelos juÃzes, foram implementadas as sugestÃes e correÃÃes, as quais resultaram na Ãltima versÃo do hipermÃdia. O desenvolvimento foi baseado na proposta de Falkembach (2005), que cita como fases de concepÃÃo e desenvolvimento de uma hipermÃdia: o planejamento; a modelagem, que consistiu na elaboraÃÃo do roteiro de aulas; implementaÃÃo, que consistiu na criaÃÃo do curso no Ambiente Virtual de Aprendizagem (AVA) Solar e na avaliaÃÃo. Esta ocorreu por meio de avaliaÃÃo de especialistas tÃcnicos e em conteÃdo, selecionados com base em critÃrios de produtividade e experiÃncia na Ãrea relacionada. Feita a avaliaÃÃo, foram realizadas as alteraÃÃes sugerias, resultando em uma Ãltima versÃo da hipermÃdia. Foram seguidos os aspectos Ãticos. Os juÃzes validaram a hipermÃdia em termos tÃcnicos e termos de conteÃdo ao atribuÃrem valoraÃÃo que classificou a hipermÃdia como adequada a ser utilizada junto a acadÃmicos de enfermagem. A hipermÃdia mostrou-se como uma ferramenta a ser utilizada no processo ensino-aprendizagem relacionado a temÃtica planejamento familiar em contracepÃÃo. A criaÃÃo e utilizaÃÃo dos recursos em tecnologia vÃm se mostrando cada vez mais Ãteis e eficientes, sendo sua aplicaÃÃo na prÃtica docente ou assistencial algo cada vez mais explorado na enfermagem e, mais precisamente no ambiente de ensino. A criaÃÃo destes recursos na enfermagem se faz de grande importÃncia para a elevaÃÃo da profissÃo e da qualidade da assistÃncia.

The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern. / Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.

Thèse d'exercice : Médecine. Médecine générale : Nantes : 2007. / Bibliogr.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references. Available also from UMI/Dissertation Abstracts International.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 149-167). Available also in a digital version from Dissertation Abstracts.

Thesis (M. Div.)--St. Vladimir's Orthodox Theological Seminary, Crestwood, N.Y., 2002. / Abstract. Includes bibliographical references (leaves 93-103) and index.

Thesis (Ph. D.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves.

This dissertation consists of three chapters on health economics, two of which focus on contraception and the third on vaccination. Chapter one examines the impact of state-level contraception insurance coverage mandates on women's fertility outcomes. It utilizes variation in mandated insurance coverage for contraception across states and over time to determine the causal impact of insurance coverage of contraception on fertility outcomes, specifically abortion rates and birth rates. State-level results indicate that a mandate decreases abortion rates by 6% in the year of introduction and decreases birth rates by 3% two years following introduction, with the magnitude of both effects remaining steady over the long run. Chapter two utilizes longitudinal data on varicella (chicken pox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19-35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with the previous cost-benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint. Chapter three utilizes variations in access to emergency contraception (EC) across states to determine the impact of over the counter access on abortion rates, birth rates, and risky sexual behavior. Using state-level data, a flexible time specification finds that giving individuals over the counter access to EC reduces births and increases risky behavior, which is captured by STD rates. These effects are larger for adults compared with teenagers, however, there are not significant differential effects by race. Finally, the effects are increasing over time following the legislation. / text

Endocrine disruptors (EDs) are exogenous substances that act like hormones in the endocrine system. They affect human health, reduce fertility, cause reproductive tract abnormalities, and distort sex ratios. 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) and Perfluorooctanoate (PFOA) are EDs that are mainly produced from industrial combustion and used as the surfactant in many daily used products, respectively, that are commonly found in wildlife and humans. TCDD affects the growth and reproductive functions in hamster, and disrupts the morphogenesis of rat preimplantation embryos. PFOA causes early pregnancy loss, compromises postnatal survival, as well as delays growth and development. Yet, how these EDs affect animal fertility and embryo implantation is not fully understood. We hypothesized that EDs affected fertility by suppressing the implantation process through down-regulation of Wnt-signaling pathway that regulates implantation process. The effects of EDs on implantation was studied using an in vitro spheroidendometrium co-culture model with the trophoblast cell lines (BeWo and JEG-3) and an endometrial carcinoma cell line (RL95-2) to mimic the embryo-endometrial implantation process. The effects of EDs on cell proliferation and expression of their receptors (TCDD: aryl hydrocarbon receptor/AhR; PFOA: peroxisome proliferator-activated receptors/PPARs) were investigated. Their antagonists (AhR: alpha-naphthoflavone/ANF; PPARs: MK886, GSK0660 and GW9662) were used to determine whether the signaling pathways is mediated through receptor binding. Moreover, Wnt-signaling activators (Wnt3a and lithium chloride/LiCl) were used to examine the interaction between the EDs and the Wnt molecules. Mouse blastocyst-endometrial cells co-culture assay was also performed to study the effects of EDs on the development and attachment of the mouse embryos in vitro. Human primary endometrial epithelial and stroma cells were isolated and cultured to investigate the effects of the EDs on the protein expression of integrins, adhesion molecules and receptivity markers. It was found that AhR and PPARs was present in the three cell lines studied. Moreover, EDs did not affect cell proliferation, viability and the expression of the AhR and PPARs. However, TCDD (1 – 10 nM) and PFOA (10 – 100 μM) significantly reduced the attachment of spheroids onto the RL95-2 monolayer. Addition of AhR antagonist (ANF) and PPARs antagonists (MK886 and GW9662), but not GSK0660 nullified the suppressive effect of EDs on spheroids attachment. Moreover, EDs reduced the expression of Wnt-signaling molecule (β-catenin), while cells treated with Wntsignaling activators (Wnt3a) or glycogen synthase kinase-3β inhibitor (LiCl) stimulated-catenin expression and reversed the suppressive effect of the EDs on spheroid attachment. TCDD but not PFOA significantly suppressed the attachment of mouse blastocysts onto the endometrial cells; while the invasion of embryos was not affected by both EDs. TCDD induced the expression of miR-133a and miR-199a in the treated mice blastocysts. In the human primary endometrial cultures, EDs suppressed the expression of the adhesion molecules (β-catenin and E-cadherin), integrins (αV and β3), and changed the expression of Mucin 1, Leukemia inhibitory factor and Osteopontin. In conclusion, the present study showed that TCDD and PFOA suppress spheroids (blastocysts surrogate) attachment, affect the expression of adhesive molecules and modulate the Wnt-signaling pathway / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy