Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

The development of antibody-based drugs is continuing to expand at a rapid pace, especially for use at mucosal surfaces to prevent or treat infectious diseases and other conditions. A better understanding of how the Fc region of antibodies interacts with Fc-binding proteins at mucosal sites can inform an optimal design for antibody-based drugs. The Human Contraception Antibody (HCA) is a human IgG1 monoclonal antibody currently under development as a topical vaginal contraceptive. HCA binds to sperm via its Fab domains and causes rapid agglutination with other sperm in close proximity resulting in near complete immobilization of sperm over a wide area. In order to determine whether HCA participates in Fc-mediated functions in the female reproductive tract (FRT), we assessed the activity of HCA and engineered variants in three assays of Fc-mediated functions: complement-dependent cytotoxicity (CDC), antibody-dependent cellular phagocytosis (ADCP), and mucus trapping. The physiological relevance of CDC was confirmed by characterizing complement levels and activity in cervical mucus. Finally, we described the activity of a novel Fc receptor expressed by vaginal epithelium. With complement, HCA significantly reduced sperm motility and increased the number of lysed sperm via CDC. Additionally, human cervical mucus was found to have sufficient levels of complement to induce the classical complement cascade. HCA-opsonized sperm associated with macrophages and were phagocytosed via ADCP. HCA also trapped sperm in ovulatory human cervical mucus, significantly reducing their progression. Variants of HCA with mutated or obstructed Fc domains had decreased abilities to perform these Fc functions, while multivalent IgM-like and IgA variants of HCA were very effective in both sperm agglutination and Fc assays. We also investigated the novel expression of Fc alpha RI (CD89) by human vaginal epithelium and provide evidence that this Fc receptor may transport IgA through the mucosa. Basal application of IgA resulted in IgA in apical supernatants which was significantly reduced following treatment with a CD89 blocker. In summary, these studies provide an improved understanding of the possible Fc functions of HCA and other antibodies in the human FRT, including interactions with complement, cervical mucus, and Fc receptors. Determining which interactions can occur in vivo and which are desired for a specific indication can inform the design of mucosally applied antibody-based drugs like HCA, a much-needed novel contraceptive antibody.

Ensuring that women have timely access to safe, effective and affordable emergency contraception (EC) is of critical importance. There are four primary modalities of EC available in Canada: the levonorgestrel emergency contraceptive pill (LNg-ECP), the copper-T intrauterine device (IUD), ulipristal acetate (UPA) and the Yupze method (combined oral contraceptive pills). This is a mixed methods study dedicated to exploring women’s knowledge of, access to and experiences with EC in New Brunswick (NB). This study consisted of a two-part mystery client study, a community-based survey, and in-depth, semi-structured interviews with women in NB. The results of the mystery-client study indicate that 180 (87%) pharmacies had at least one brand of LNG-ECPs in stock. Although availability and knowledge of LNG-ECPs among NB pharmacists is relatively high, some are still providing incorrect medical and regulatory information. The findings of this study illustrate where improvement in pharmacy provision of LNG-ECPs in NB is required. Knowledge of EC among women in NB is relatively low, especially with respect to the IUD and UPA. Continuation of education efforts among pharmacists and sexual education teachers concerning ECPs in NB appears warranted. Exploring the barriers that NB women face in obtaining ECPs is not only imperative for improving access, but also yielding better quality reproductive health services in the province.

Seventy-eight low-income pregnant women in Roanoke, Virginia were sampled by means of a questionnaire in an effort to study what factors influence their family planning practices. The questionnaire measured the sample's contraceptive awareness, knowledge, and use, and their attitudes concerning contraception and its use. Other attitudes studied were related to pregnancy and parenthood. The questionnaire used was developed by the researcher, and was, in part, based on materials from the research of Dr. John Kanter of John Hopkins University. A factor analysis was performed which delineated factors influencing the family planning practices of the sample studied. The results indicated that younger, single, black women in the sample tended to be less aware of and less likely to use contraception. They also expressed attitudes concerning single parenthood which tended to disregard generally held social norms. A tendency also existed for white, married women, who were school drop-outs to give the reason that they "didn't mind if they became pregnant" for their lack of contraceptive use. This appeared to indicate a lack of motivation for contraceptive usage. It was concluded that other investigations should be made to substantiate the results and provide additional information relevant to the development of services aimed at family planning among low income families. / Master of Science

In the United Kingdom (UK) there is easy access to a wide range of contraceptive methods, available at no cost. In addition, oral emergency contraception (EC) (1.5 mg levonorgestrel) is now widely available from the community pharmacy. In spite of this, unintended pregnancy is common. In 2014 in England and Wales, 184,571 induced abortions were performed, and in Scotland, the corresponding figure was 11,475. Long acting reversible methods such as contraceptive implants and intrauterine contraception, are amongst the most effective methods available and National Institute for Health and Care Excellence (NICE) recommends that increased uptake can lead to fewer unintended pregnancies. However, uptake of long acting reversible contraceptive (LARC) methods remains low. The majority of women who require to use EC do so following unprotected sex or an accident with a condom. Increasingly women in Great Britain prefer to attend a pharmacy for EC rather than a sexual and reproductive health (SRH) service or general practitioner (GP). Starting an effective on-going method of contraception after EC use is clearly important if women are to avoid unintended pregnancy. Community pharmacists in the UK and most other high income countries are usually unable to provide any on-going contraception except condoms. So we have created a situation where EC is provided almost solely from settings where other more effective methods of contraception cannot be immediately provided. Novel strategies are therefore required to facilitate both uptake and continuation of the most effective methods of contraception, in order to prevent unintended pregnancy for more women. This thesis presents a mixture of biomedical, clinical and health services research to evaluate a series of strategies aimed at improving uptake of the most effective methods of contraception. Two studies investigated patient knowledge and information provision relating to contraceptive methods. The first sought to determine if women held misconceptions about intrauterine methods of contraception, and revealed that although myths persist in a small number of women, a lack of knowledge about these methods was also evident. The second study aimed to determine if the use of a digital video disc (DVD) to provide contraceptive information was acceptable and informative to women, and identified that it is, and could possibly enhance patient consultations. Studies three, four and five investigated strategies aimed at increasing the uptake of effective on-going contraception, following emergency contraception provided from a community pharmacy, and patient and health care provider attitudes to such approaches. They showed that simple interventions such as supplying one month of a progestogen only pill (POP), or offering rapid access to a family planning clinic (FPC), hold promise as strategies to increase the uptake of effective contraception after EC and that both women and clinicians were positive about such measures. Additionally, the problems encountered in conducting these studies provided valuable feedback to inform further development of research methods in the community pharmacy setting, and larger scale studies of such interventions. Community SRH services may be well placed to deliver more abortion care in the UK, and consequently this may result in greater uptake of contraception post abortion. Study six aimed to determine the views of health professionals working in SRH regarding their attitudes towards providing more abortion services and also the views of staff within one community SRH centre in Scotland where a service providing early medical abortion was due to commence. It showed there is clear support amongst health professionals in community SRH in the UK towards greater participation in provision of abortion care services.

Xiao, Lijia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 139-158). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

<p>It is not mandatory for the student to declare a pregnancy to her educational institution. It does however become more complicated for the student nurse, because she has to provide a health service while she is a student during her clinical placement. The researcher has noticed that student nurses do fall pregnant during their undergraduate studies at the University of the Western Cape. The researcher was unsure why this phenomenon is occurring amongst undergraduate nursing students. He identified the need to measure the level of knowledge of pregnancy prevention amongst undergraduate nurses, their level of utilization of such services and their attitudes towards falling pregnant during their studies. This study is of a quantitative nature whereby the researcher made use of a descriptive design. The method of data collection utilized was an anonymous self administered questionnaire form. The population under study was the registered undergraduate nursing students in 2008 at the University of the Western Cape. This population consisted of 1031 individuals. Their ethnic background represents the South African demography. An exhaustive sampling approach was used and 401 individuals gave consent to participate in the study. Through this research the researcher hypothysed and proved that the level of knowledge of contraception amongst undergraduate student nurses is indeed inadequate and that this low level of knowledge on the subject area leads to incorrect and inconsistent and non use of contraception in their own lives.</p>

Texte remanié de: Thèse de doctorat--Médecine--Paris 7, 2004. Titre de soutenance : La contraception et l'avortement dans les études médicales : quelle formation à un modèle relationnel inédit ? / Bibliogr. p. 231-244.

Mémoire de sage-femme : Médecine : Nancy 1 : 2009. / Titre provenant de l'écran-titre. Bibliogr.

The purpose of this study was to use the Theory of Planned Behavior (TPB) to predict university students’ intention to use emergency contraception (EC). The study explored the utility of the TPB model constructs (attitude [A], subjective norm [SN], perceived behavioral control [PBC]) as well as recent past behavior (RPB) to predict students’ intention to utilize EC. The study also investigated the significance of demographic and personal characteristics—age and gender in particular—as they relate to the TPB components and RPB. A web-based survey, developed from three structured focus groups, was pretested and emailed to 2,000 university students. An overall usable response rate of 21.0 percent was obtained. In general, university students intended to use EC should the need occur, held favorable attitudes toward the use of EC, were somewhat influenced by social norms regarding EC use, and perceived themselves to have some control over EC utilization. For direct measures (TPB), A, SN, and PBC were significant predictors of intention to use EC. The direct model explained 49.2 percent of the variance in intention. Using indirect measures, A and SN were significant predictors of intention, but PBC was not; the indirect model accounted for 41.3 percent of the variance in intention to take EC. Attitude was the strongest TPB predictor for both models, followed by SN and PBC. The RPB variable did not significantly improve the TPB model. While hypothesized age differences were not significant, gender differences showed female students having a more favorable A and SN as well as a stronger PBC (direct measures) toward the use of EC. In addition, several statistically significant relationships occurred between demographic/personal characteristics and the TPB constructs. In summary, this study identified several key factors that partially explain why university students either intend or do not intend to use EC if needed. The TPB has utility in predicting utilization of EC in university students. Focusing particular attention on A, as well as SN and PBC, will allow researchers, educators, healthcare professionals, and legislators to develop strategies and educational programs to enable men and women to use EC responsibly. / text