Os cuidados com a contracepção na adolescência são fundamentais para vivenciar a sexualidade de forma plena, evitando uma gravidez não planejada ou não desejada, bem como a transmissão de doenças. Em meio a uma realidade global de elevados índices de gravidez na adolescência e aumento na incidência de doenças sexualmente transmissíveis, é necessário pensar em uma opção contraceptiva que proporcione a dupla proteção. Neste sentido, o presente estudo propôs-se a analisar o conhecimento das adolescentes, cadastradas em um Núcleo do Programa de Saúde da Família de Ribeirão Preto-SP, em relação aos métodos anticoncepcionais, especialmente aqueles voltados para a prevenção de gravidez e doenças sexualmente ao mesmo tempo. A amostra foi composta por 90 adolescentes, do sexo feminino, na faixa etária compreendida entre 15 e 19 anos de idade. Os dados foram coletados através de entrevistadas domiciliares, com apoio de um questionário estruturado. Os resultados da pesquisa demonstraram que as adolescentes eram predominantemente brancas, solteiras, estudavam e pertenciam à categoria sócio-econômica C e D. A maioria das entrevistadas conhecia métodos de dupla proteção (54,4%) sendo o preservativo masculino o mais citado (91,8%). Quanto ao uso de métodos de dupla proteção em algum momento da vida, 58,9% das adolescentes referiram ter feito uso, o que indica que 98,5% das que iniciaram a vida sexual, já se protegeram de gravidez e doenças simultaneamente alguma vez na vida. Quanto às atitudes em relação ao uso dos métodos, a maioria teve atitude liberal (43,3%), seguida de 28,9% que tiveram atitude neutra e 27,7% atitude conservadora, o que evidenciou que as atitudes não se configuram como obstáculos para o uso dos métodos. O estudo indicou que o conhecimento sobre os métodos anticoncepcionais não garante o seu uso e as atitudes não são barreiras que impedem práticas efetivas de proteção. Assim, questões de gênero e os diversos contextos devem ser considerados para um melhor entendimento das questões que envolvem a saúde sexual e reprodutiva dos adolescentes, bem como para a concepção de ações efetivas no âmbito das políticas públicas. / Cautions against contraception during adolescence are fundamental to live sexuality in its plenitude, avoiding a not planed or desired pregnancy, as well as the transmission of some diseases. Considering the actual global reality of high levels of undesired pregnancy during adolescence and the increasing rates of sexually transmitted diseases, it is necessary to think about a contraceptive option that could offer dual protection. The aim of this study is to analyze a group of adolescents, registered in the Family Health Program (Nucleus IV) located in Ribeirão Preto, SP State, regarding their knowledge about contraceptive methods, especially those which are able to prevent pregnancy and sexually transmitted disease at the same time. The sample was composed of 90 female adolescents, at age range of 15 to 19 years old. The data were collected by domiciliary interview, supported by a structured questionnaire. The results demonstrated that the adolescents were predominantly, white (Caucasoid), single, still studying and classified as C and D in economic status. The majority of the interviewed adolescents already knew the methods of dual protection (54.4%), being the condoms the most cited (91.8%). Also according to the results, 58.9% of the interviewed reported that they had used the dual protection methods at least in one moment in life, indicating that 98.5% of the adolescents, which had initiated their sexual lives, had protected themselves simultaneously from pregnancy and IST. Regarding their position related to the usage of contraceptive methods, the results revealed that the majority (43.3%) showed to be quite liberal, whereas 28.9% of the interviewed expressed a neutral position and a conservative attitude was adopted by 27.7% of the adolescents, demonstrating that independently of their position, it did not figured as an obstacle to the use of the contraceptive methods. This study revealed that the knowledge level of the adolescents, in relation to the contraceptive methods, does not guarantee their use; and their position does not act as a barrier to the effective protection. To sum up, gender questions and several contexts must be considered to provide a better understanding of these subjects which evolve the adolescent’s sexual and reproductive health, as well as the conception of effective actions in the sphere of public health politics.

Although Sweden invests a great deal of money and effort in prevention work, STIs are a major problem in our society. Young people are at high risk both when it comes to unwanted pregnancies and STIs and several studies have revealed that the condom use is quite low. Condom use is a complex issue. There are often several factors that interact and affect the decision to use or not use condom. The result in this thesis shows that young people have behavioral expectation to use condom, especially for anal sex and vaginal sex with a casual partner (both known and unknown). At the same time, the condom use is low irrespective of type of partner and type of sex. Approximately 20 % of the participants never used a condom during the preceding 12 months. Most of the participants said that reason for their use or non-use was based on partner evaluation. However, our participants indicate that there often is a deeper reason why they do not use condoms. Women talk about their male partner’s resistance against condom use. Men in the other hand mention the problem with fit and feel especially problems related to erection problems when they have been drinking alcohol. One of the most interesting findings is that the participants’ view of sex affected their condom use. Those with a relaxed view (e.g., did not connect love with sex and had had more sexual partners during the past 12 months) had fewer occasions of unprotected vaginal intercourse compared with the participants with a traditional view (e.g., often associated sex with vaginal penetration).The most important thing we need to do is increase ’men’s sense of responsibility and involve them in the prevention work. It is also important that the condom counseling is individualized. It is not enough to simply speak about condom use in general; instead we need to relate condom use to sexual practice and partner type but also to the individuals’ specific condom problem. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Epub ahead of print. Paper 2: Manuscript. Paper 3: Manuscript.</p>

Premenstrual depressive symptoms and mood swings affect 3-8% of women in fertile age. The female hormones are believed to be the cause. Progesterone is well studied, but estrogen is not, and either are other causes such as intimate partner violence and chronic stress. The aim in this thesis was to investigate the influence of hormones as well as psychological aspects on the most common problems among women seeking care for premenstrual symptoms. In a cross-sectional study, four groups of women were included: ongoing users of oral contraceptives, with or without adverse mood symptoms and previous users, with or without experience of adverse mood. Depression and anxiety were significantly more common in both groups with reported adverse mood, in comparison with their control groups with no adverse mood. Self-reported PMS was significantly more common in those women who reported adverse mood, however, there was no difference in prospectively defined PMS or PMDD between the two groups of previous users. In a RCT with 25 women completing the study, GnRH treatment were tested in combination with two different HRT add-back doses of estradiol, in combination with progesterone and placebo. The higher dose of estrogen 1.5 mg in combination with progesterone induced significantly more pronounced symptoms than in combination with placebo. The lower dose, 0.5 mg gave less symptom recurrence in combination with progesterone. Exposure to violence was investigated among PMDD patients, healthy controls and gynecological patients. Among the participating women, gynecological patients, reported physical and/or emotional abuse significantly more often than did PMDD patients, as well as healthy controls. Chronic stress was investigated with diurnal cortisol, and low-dose dexamethasone test.  There was no difference in diurnal secretion of cortisol between PMDD patients and controls. No difference in the degree of dexamethasone suppression was found between PMDD patients and controls. According to the results from these studies, the main symptom provoking factor in women with PMDD appears to be the estradiol and progesterone fluctuations across the menstrual cycle, whereas chronic stress and intimate partner violence appears to be less relevant.

A Síndrome dos Ovários Policísticos (PCOS) é a endocrinopatia mais frequente em mulheres na idade reprodutiva, além de ser a causa mais comum de hiperandrogenismo e anovulação crônica. Diferentes fenótipos da PCOS foram identificados, e um melhor entendimento dessas diferentes apresentações clínicas se faz necessário para o reconhecimento de riscos, medidas preventivas e terapêuticas específicas para cada fenótipo. Associações entre polimorfismos de substituição de um único nucleotídeo (SNPs) em genes que codificam enzimas responsáveis pelo metabolismo androgênico e PCOS foram descritos. O anticoncepcional oral (ACO) é utilizado para o tratamento de mulheres com PCOS por seu efeito supressivo na secreção de androgênios ovarianos e melhora do hirsutismo. Entretanto, os dados na literatura são conflitantes quanto aos efeitos do ACO nos parâmetros metabólicos de mulheres com PCOS. Além disso, não está bem estabelecido se a presença de alelos polimórficos está associada com diferenças nos fenótipos da PCOS e se pode influenciar na resposta ao tratamento com ACO. Os objetivos desta tese foram investigar a influência dos SNPs -71 AG no gene AKR1C3 e SNP50 no gene CYP19 gene (substituição de G por A) na resposta de mulheres com PCOS ao tratamento com ACO e verificar se o SNP50 está associado com fenótipos da PCOS. Cento e sessenta e duas mulheres com PCOS foram estratificadas em PCOS clássicas (hiperandrogenismo e disfunção ovulatória, c-PCOS) e PCOS ovulatórias (hiperandrogenismo, ciclos ovulatórios, aparência policística dos ovários, ov-PCOS) e uma subamostra de 51 mulheres (que não apresentavam resistência insulínica evidente) completaram 6 meses de tratamento com ACO (20 ug etinilestradiol e 75 ug gestodeno, 21/28 dias por ciclo). A presença ou ausência dos alelos polimórficos foram consideradas para expressar os resultados que avaliaram os SNPs -71 AG e SNP50. O escore de hirsutismo foi similar em c-PCOS e ov-PCOS, e as diferenças nos parâmetros hormonais e metabólicos observadas foram independentes da presença do alelo A do SNP50. Após os 6 meses de tratamento com ACO, como era esperado, os níveis de testosterona total e o escore clínico de hirsutismo diminuíram, enquanto os níveis da globulina carreadora de hormônios sexuais aumentaram. Houve uma pequena redução da pressão arterial sistólica e do hormônio luteinizante. As medidas de insulina e do índice HOMA permaneceram inalteradas após o tratamento. Houve um aumento dos níveis de lipídios, mas os valores permaneceram dentro dos limites da normalidade. Nenhuma das alterações observadas esteve associada com a presença dos alelos polimórficos dos SNPs -71 AG ou SNP50. As conclusões são de que o ACO é uma alternativa eficaz para o tratamento dos sintomas do hiperandrogenismo, sem comprometimento dos parâmetros metabólicos, pelo menos naquelas mulheres sem resistência insulínica prévia ao tratamento. Os SNPs -71AG no gene AKR1C3 e SNP50 no gene CYP19 não contribuem para as melhoras observadas com o uso do ACO. Além disso, o SNP50 parece não estar associado com as diferenças existentes entre os fenótipos clássico e ovulatório da PCOS. / Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women at reproductive age, and also the most common cause of hyperandrogenism and chronic anovulation. Different phenotypes of PCOS have been identified, and a better knowledge of these clinical symptoms is necessary to recognize risks, prevention, and treatment strategies for each phenotype. Associations between single nucleotide polymorphisms (SNPs) in genes that codify enzymes responsible for the androgenic metabolism and PCOS have been described. The oral contraceptive pill (OCP) is used to treat women with PCOS due to the suppressive effect on ovarian androgen secretion, with consequent amelioration of hirsutism. However, data are conflicting in literature regarding the effects of OCP on metabolic variables in PCOS. Besides that, it is not well established whether the presence of polymorphic alleles is associated with PCOS phenotypes and whether can influence on the response to OCP treatment. The aims of this thesis were to investigate the influence of the SNPs -71 AG at AKR1C3 gene and SNP50 of CYP19 gene (G to A substitution) on the response of PCOS to treatment with oral contraceptive pills and to assess whether the SNP50 is associated with PCOS phenotypes. A hundred sixty two hirsute women were stratified into a classic PCOS group (hyperandrogenism and ovulatory dysfunction, c-PCOS) and an ovulatory PCOS group (hyperandrogenism, ovulatory cycles, polycystic ovaries, ov-PCOS), and a subsample of 51 women (without evidences of insulin resistance) completed a 6-month OCP trial (20 ug ethinylestradiol plus 75 ug gestodene, 21/28 days per cycle). We considered the presence or absence of the polymorphic alleles to express results and to perform the comparisons regarding the SNPs -71 AG and SNP50. Hirsutism score was similar in c-PCOS and ov-PCOS, and the differences in hormone and metabolic variables between phenotypes were independent of the presence of allele A for SNP50. After 6 months of OCP treatment, as expected, total testosterone and hirsutism score declined, while sex hormone binding globulin increased. There was a slight reduction in systolic blood pressure and luteinizing hormone levels. Insulin and homeostasis model assessment remained unchanged after treatment. There was an increase in lipids, but the values remained at the normal range. None of these changes were associated with the presence of polymorphic alleles for -71 AG or SNP50 polymorphisms. We conclude that OCP is an alternative to ameliorate androgenic symptoms without compromising metabolic parameters, at least in women without insulin resistance before treatment. The -71AG SNP of AKR1C3 gene and the SNP50 of CYP19 gene did not contribute to the improvements observed. Besides that, SNP50 may not be associated to the existing differences between classic and ovulatory PCOS phenotypes.

In Ethiopia the number of young people going to college is steadily increasing. This predisposes them to risky sexual behaviour which leads to unwanted pregnancy, unsafe abortions and HIV. This study has aimed to determine the patterns of sexual practice and contraceptives use and risk behaviours among those students in central Ethiopia. A descriptive cross-sectional survey was employed. Data on sexual practice, knowledge and contraceptive use were collected from 327 college students. The data were cleaned, entered and analysed using SPSS version 20. The results revealed that despite their knowledge of the methods of safe sex, there are still considerable misconceptions regarding the effectiveness of contraceptives, their side effects and their proper use. In terms of the sexual practice reported by the respondents, 142 (43.4%) practised sex and 110 (77.5%) of respondents had used contraceptives at least once. The age of the respondents, the number of years for which they stayed in college and their fields of study were significantly associated with their sexual practice. In conclusion, a significant number of college students practised sex without using contraceptives to prevent pregnancy, and a considerable number of their partners disapproved of the use of contraceptives / Health Studies / M.A. (Public Health)

A Síndrome dos Ovários Policísticos (PCOS) é a endocrinopatia mais frequente em mulheres na idade reprodutiva, além de ser a causa mais comum de hiperandrogenismo e anovulação crônica. Diferentes fenótipos da PCOS foram identificados, e um melhor entendimento dessas diferentes apresentações clínicas se faz necessário para o reconhecimento de riscos, medidas preventivas e terapêuticas específicas para cada fenótipo. Associações entre polimorfismos de substituição de um único nucleotídeo (SNPs) em genes que codificam enzimas responsáveis pelo metabolismo androgênico e PCOS foram descritos. O anticoncepcional oral (ACO) é utilizado para o tratamento de mulheres com PCOS por seu efeito supressivo na secreção de androgênios ovarianos e melhora do hirsutismo. Entretanto, os dados na literatura são conflitantes quanto aos efeitos do ACO nos parâmetros metabólicos de mulheres com PCOS. Além disso, não está bem estabelecido se a presença de alelos polimórficos está associada com diferenças nos fenótipos da PCOS e se pode influenciar na resposta ao tratamento com ACO. Os objetivos desta tese foram investigar a influência dos SNPs -71 AG no gene AKR1C3 e SNP50 no gene CYP19 gene (substituição de G por A) na resposta de mulheres com PCOS ao tratamento com ACO e verificar se o SNP50 está associado com fenótipos da PCOS. Cento e sessenta e duas mulheres com PCOS foram estratificadas em PCOS clássicas (hiperandrogenismo e disfunção ovulatória, c-PCOS) e PCOS ovulatórias (hiperandrogenismo, ciclos ovulatórios, aparência policística dos ovários, ov-PCOS) e uma subamostra de 51 mulheres (que não apresentavam resistência insulínica evidente) completaram 6 meses de tratamento com ACO (20 ug etinilestradiol e 75 ug gestodeno, 21/28 dias por ciclo). A presença ou ausência dos alelos polimórficos foram consideradas para expressar os resultados que avaliaram os SNPs -71 AG e SNP50. O escore de hirsutismo foi similar em c-PCOS e ov-PCOS, e as diferenças nos parâmetros hormonais e metabólicos observadas foram independentes da presença do alelo A do SNP50. Após os 6 meses de tratamento com ACO, como era esperado, os níveis de testosterona total e o escore clínico de hirsutismo diminuíram, enquanto os níveis da globulina carreadora de hormônios sexuais aumentaram. Houve uma pequena redução da pressão arterial sistólica e do hormônio luteinizante. As medidas de insulina e do índice HOMA permaneceram inalteradas após o tratamento. Houve um aumento dos níveis de lipídios, mas os valores permaneceram dentro dos limites da normalidade. Nenhuma das alterações observadas esteve associada com a presença dos alelos polimórficos dos SNPs -71 AG ou SNP50. As conclusões são de que o ACO é uma alternativa eficaz para o tratamento dos sintomas do hiperandrogenismo, sem comprometimento dos parâmetros metabólicos, pelo menos naquelas mulheres sem resistência insulínica prévia ao tratamento. Os SNPs -71AG no gene AKR1C3 e SNP50 no gene CYP19 não contribuem para as melhoras observadas com o uso do ACO. Além disso, o SNP50 parece não estar associado com as diferenças existentes entre os fenótipos clássico e ovulatório da PCOS. / Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women at reproductive age, and also the most common cause of hyperandrogenism and chronic anovulation. Different phenotypes of PCOS have been identified, and a better knowledge of these clinical symptoms is necessary to recognize risks, prevention, and treatment strategies for each phenotype. Associations between single nucleotide polymorphisms (SNPs) in genes that codify enzymes responsible for the androgenic metabolism and PCOS have been described. The oral contraceptive pill (OCP) is used to treat women with PCOS due to the suppressive effect on ovarian androgen secretion, with consequent amelioration of hirsutism. However, data are conflicting in literature regarding the effects of OCP on metabolic variables in PCOS. Besides that, it is not well established whether the presence of polymorphic alleles is associated with PCOS phenotypes and whether can influence on the response to OCP treatment. The aims of this thesis were to investigate the influence of the SNPs -71 AG at AKR1C3 gene and SNP50 of CYP19 gene (G to A substitution) on the response of PCOS to treatment with oral contraceptive pills and to assess whether the SNP50 is associated with PCOS phenotypes. A hundred sixty two hirsute women were stratified into a classic PCOS group (hyperandrogenism and ovulatory dysfunction, c-PCOS) and an ovulatory PCOS group (hyperandrogenism, ovulatory cycles, polycystic ovaries, ov-PCOS), and a subsample of 51 women (without evidences of insulin resistance) completed a 6-month OCP trial (20 ug ethinylestradiol plus 75 ug gestodene, 21/28 days per cycle). We considered the presence or absence of the polymorphic alleles to express results and to perform the comparisons regarding the SNPs -71 AG and SNP50. Hirsutism score was similar in c-PCOS and ov-PCOS, and the differences in hormone and metabolic variables between phenotypes were independent of the presence of allele A for SNP50. After 6 months of OCP treatment, as expected, total testosterone and hirsutism score declined, while sex hormone binding globulin increased. There was a slight reduction in systolic blood pressure and luteinizing hormone levels. Insulin and homeostasis model assessment remained unchanged after treatment. There was an increase in lipids, but the values remained at the normal range. None of these changes were associated with the presence of polymorphic alleles for -71 AG or SNP50 polymorphisms. We conclude that OCP is an alternative to ameliorate androgenic symptoms without compromising metabolic parameters, at least in women without insulin resistance before treatment. The -71AG SNP of AKR1C3 gene and the SNP50 of CYP19 gene did not contribute to the improvements observed. Besides that, SNP50 may not be associated to the existing differences between classic and ovulatory PCOS phenotypes.

A Síndrome dos Ovários Policísticos (PCOS) é a endocrinopatia mais frequente em mulheres na idade reprodutiva, além de ser a causa mais comum de hiperandrogenismo e anovulação crônica. Diferentes fenótipos da PCOS foram identificados, e um melhor entendimento dessas diferentes apresentações clínicas se faz necessário para o reconhecimento de riscos, medidas preventivas e terapêuticas específicas para cada fenótipo. Associações entre polimorfismos de substituição de um único nucleotídeo (SNPs) em genes que codificam enzimas responsáveis pelo metabolismo androgênico e PCOS foram descritos. O anticoncepcional oral (ACO) é utilizado para o tratamento de mulheres com PCOS por seu efeito supressivo na secreção de androgênios ovarianos e melhora do hirsutismo. Entretanto, os dados na literatura são conflitantes quanto aos efeitos do ACO nos parâmetros metabólicos de mulheres com PCOS. Além disso, não está bem estabelecido se a presença de alelos polimórficos está associada com diferenças nos fenótipos da PCOS e se pode influenciar na resposta ao tratamento com ACO. Os objetivos desta tese foram investigar a influência dos SNPs -71 AG no gene AKR1C3 e SNP50 no gene CYP19 gene (substituição de G por A) na resposta de mulheres com PCOS ao tratamento com ACO e verificar se o SNP50 está associado com fenótipos da PCOS. Cento e sessenta e duas mulheres com PCOS foram estratificadas em PCOS clássicas (hiperandrogenismo e disfunção ovulatória, c-PCOS) e PCOS ovulatórias (hiperandrogenismo, ciclos ovulatórios, aparência policística dos ovários, ov-PCOS) e uma subamostra de 51 mulheres (que não apresentavam resistência insulínica evidente) completaram 6 meses de tratamento com ACO (20 ug etinilestradiol e 75 ug gestodeno, 21/28 dias por ciclo). A presença ou ausência dos alelos polimórficos foram consideradas para expressar os resultados que avaliaram os SNPs -71 AG e SNP50. O escore de hirsutismo foi similar em c-PCOS e ov-PCOS, e as diferenças nos parâmetros hormonais e metabólicos observadas foram independentes da presença do alelo A do SNP50. Após os 6 meses de tratamento com ACO, como era esperado, os níveis de testosterona total e o escore clínico de hirsutismo diminuíram, enquanto os níveis da globulina carreadora de hormônios sexuais aumentaram. Houve uma pequena redução da pressão arterial sistólica e do hormônio luteinizante. As medidas de insulina e do índice HOMA permaneceram inalteradas após o tratamento. Houve um aumento dos níveis de lipídios, mas os valores permaneceram dentro dos limites da normalidade. Nenhuma das alterações observadas esteve associada com a presença dos alelos polimórficos dos SNPs -71 AG ou SNP50. As conclusões são de que o ACO é uma alternativa eficaz para o tratamento dos sintomas do hiperandrogenismo, sem comprometimento dos parâmetros metabólicos, pelo menos naquelas mulheres sem resistência insulínica prévia ao tratamento. Os SNPs -71AG no gene AKR1C3 e SNP50 no gene CYP19 não contribuem para as melhoras observadas com o uso do ACO. Além disso, o SNP50 parece não estar associado com as diferenças existentes entre os fenótipos clássico e ovulatório da PCOS. / Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women at reproductive age, and also the most common cause of hyperandrogenism and chronic anovulation. Different phenotypes of PCOS have been identified, and a better knowledge of these clinical symptoms is necessary to recognize risks, prevention, and treatment strategies for each phenotype. Associations between single nucleotide polymorphisms (SNPs) in genes that codify enzymes responsible for the androgenic metabolism and PCOS have been described. The oral contraceptive pill (OCP) is used to treat women with PCOS due to the suppressive effect on ovarian androgen secretion, with consequent amelioration of hirsutism. However, data are conflicting in literature regarding the effects of OCP on metabolic variables in PCOS. Besides that, it is not well established whether the presence of polymorphic alleles is associated with PCOS phenotypes and whether can influence on the response to OCP treatment. The aims of this thesis were to investigate the influence of the SNPs -71 AG at AKR1C3 gene and SNP50 of CYP19 gene (G to A substitution) on the response of PCOS to treatment with oral contraceptive pills and to assess whether the SNP50 is associated with PCOS phenotypes. A hundred sixty two hirsute women were stratified into a classic PCOS group (hyperandrogenism and ovulatory dysfunction, c-PCOS) and an ovulatory PCOS group (hyperandrogenism, ovulatory cycles, polycystic ovaries, ov-PCOS), and a subsample of 51 women (without evidences of insulin resistance) completed a 6-month OCP trial (20 ug ethinylestradiol plus 75 ug gestodene, 21/28 days per cycle). We considered the presence or absence of the polymorphic alleles to express results and to perform the comparisons regarding the SNPs -71 AG and SNP50. Hirsutism score was similar in c-PCOS and ov-PCOS, and the differences in hormone and metabolic variables between phenotypes were independent of the presence of allele A for SNP50. After 6 months of OCP treatment, as expected, total testosterone and hirsutism score declined, while sex hormone binding globulin increased. There was a slight reduction in systolic blood pressure and luteinizing hormone levels. Insulin and homeostasis model assessment remained unchanged after treatment. There was an increase in lipids, but the values remained at the normal range. None of these changes were associated with the presence of polymorphic alleles for -71 AG or SNP50 polymorphisms. We conclude that OCP is an alternative to ameliorate androgenic symptoms without compromising metabolic parameters, at least in women without insulin resistance before treatment. The -71AG SNP of AKR1C3 gene and the SNP50 of CYP19 gene did not contribute to the improvements observed. Besides that, SNP50 may not be associated to the existing differences between classic and ovulatory PCOS phenotypes.

Contraception through a vaccine has been a very attractive proposition and several attempts were made in the past. To achieve contraception through immunological means, several points need to be considered. First, the targeted antigen should be an important component of reproduction and interference in its actions should lead to infertility. Second, the antigen must be highly immunogenic and the antibodies elicited should be able to block the functions of the antigen. Third, the antibody titres should be effective and must sustain for longer periods. Gonadotropins fulfill all the above criteria and therefore, have been attractive targets for developing human contraceptive vaccines. The pituitary gonadotropins- Luteinizing hormone (LH) and the Follicle stimulating hormone (FSH) are the principal regulators of the reproduction process in all the mammalian species (McLachlan et al., 1995c; Moudgal et al., 1992b; Murty et al., 1979a; Selvaraj and Moudgal, 1994a; Weinbauer et al., 1991). In males, LH binds to its specific receptor-LHR, expressed on the Leydig cells and regulates the production of testosterone. This testosterone binds to the androgen receptors expressed in the Sertoli cells and along with FSH, which binds to the specific receptors present on the Sertoli cell membranes, regulate the testicular functions and the spermatogenesis (Simoni et al., 1997; Themmen and Huhtaniemi, 2000; Ulloa-Aguirre and Timossi, 1998). The well documented studies have unequivocally established that the specific immunoneutralization of either hormone by active or passive immunization, leads to disruption of the gonadal functions (Fraser et al., 1986a; Marathe et al., 1995; Moudgal et al., 1992b; Murty et al., 1979b; Shetty et al., 1996; Srinath et al., 1983b) and consequent infertility and this observation formed the basis of the human contraceptive vaccines (Moudgal et al., 1997b; Talwar et al., 2011a; Talwar et al., 2009a). Several studies using testosterone as the main male hormonal contraception method (Matsumoto et al., 1986; Matsumoto et al., 1983a) and anti-hCG vaccine as the female hormonal contraceptive vaccine reached Phase I and II clinical trials (Talwar, 1997; Talwar et al., 1994; Talwar et al., 1997) . However, these human contraceptive vaccines faced several limitations. There was a need to inhibit only particular segments of the entire reproduction process whereas others needed to remain completely unaffected. For example, in males, the FSH regulated functions, the sperm production and spermatogenesis needed to be inhibited whereas the LH/testosterone associated functions should be unaffected. Similarly in females, the functions of hCG alone, elaborated by the conceptus should be blocked without affecting either LH or FSH regulated functions, thus, maintaining the normal reproductive cycle. This however is a difficult task especially when the antigens share a large degree of homology and common subunits (Pierce and Parsons, 1981). Moreover, the issues relating to the development and sustenance of high titres of the bioneutralizing antibodies were major limitations of these human contraceptive vaccines. Therefore, despite reaching Phase I and II clinical trials, these studies did not progress further. However, the same concept of an immunocontraceptive vaccine involving the neutralization of the functions of the gonadotropins is an extremely attractive strategy for controlling the animal populations where the reproduction process could be inhibited in its entirety. The overgrowing populations of the stray animals such as dogs and cats pose problems unlike those experienced with the human overpopulation. Thus, there is an immediate need to develop the methods of controlling the populations of these animals both in the developed and the developing countries. Whereas, in countries like the US, the major emphasis is on the domestic animals, in countries like India, the populations of the stray animals need to be controlled. The current methods employed for reducing the numbers of these animals include either castration or culling of the animals. These methods are however, traumatic, unsafe and not widely accepted by the society. The animal contraceptive vaccines currently available are mostly GnRH vaccines which have high cost of production, are not safe for animal use and elicit unwanted side effects. Apart from these, the animals need multiple administrations of these vaccines to elicit high and effective antibody titres, mostly with the use of conventional but non-approved adjuvants (Boedeker et al., 2009; McCoy, 1994). As mentioned above, the gonadotropins, by virtue of their ability to control the mammalian reproduction process, are attractive targets for achieving contraception. Moreover, the ease of administration of this vaccine to neutralize the functions of the endogenous circulating hormones makes them ideal targets for developing animal immunocontraceptive vaccines. This method of neutralizing the functions of the gonadotropins is also humane and safe for the animals as opposed to the current methods which are employed to reduce their numbers. However, in case of animal contraception, particularly for strays such as dogs, where large numbers of animals need to be treated, the challenge is to develop a method to sustain the high levels of the bioneutralizing antibodies for prolonged periods preferably with a single administration of the immunogen and without the use of conventional adjuvants such as the Freund’s adjuvant. In the present study, an attempt has been made develop a strategy to achieve a sustained immune response to small quantities of the hormonal antigens, preferably with a single administration of the immunogen resulting in complete disruption of the gonadal function for prolonged periods. To achieve this goal, recent developments in the field of immunology and vaccinology have been employed. This involves targeting of the hormonal antigens to the dendritic cells. Targeting the antigens to the dendritic cells for vaccination is becoming an extremely fascinating strategy and is being used extensively to target the antigens involved in several diseases (Escudier et al., 2005; Frankel et al., 1998; Garcia et al., 2005; Nouri-Shirazi et al., 2000a; Nouri-Shirazi et al., 2000b; Steinman and Germain, 1998). Most antigens are targeted to the dendritic cells by coupling them to the antibodies specific for the receptors expressed on the dendritic cell surface. One such receptor is the DEC205, which is expressed on most of the dendritic cells (Jiang et al., 1995) and is being widely used to develop vaccines and vaccination strategies. Targeting the antigens to the dendritic cells provides advantages such as ability to induce hundred fold higher immune response to very low doses of antigen without the use of any conventional adjuvant (Bonifaz et al., 2004a). Therefore, in the present study, these features of the dendritic cells have been harnessed to target the hormonal antigens (hCG and hFSH) to the canine DEC205 receptor to induce a long-term immune response capable of disrupting the gonadal functions. Towards this goal of delivering hormonal antigens to the dendritic cells, a fragment of the canine DEC205 corresponding to the Cysteine Rich Fibronectin II domain (CR/FNII) was expressed and used to isolate several canine DEC205 specific recombinant antibodies in the form of single chain fragment variable (ScFvs) from the Tomlinson’s and the yeast human ScFv display libraries. From a pool of eight unique ScFvs screened from the Tomlinson’s libraries, three ScFvs namely B3, G10 and H4 were characterized. All these ScFvs could bind to the human DEC205 receptor but not to the mouse DEC205. Their inability to recognise the mouse DEC205 suggested that mouse could not be used as the model system for these studies and therefore, a surrogate model system was needed. As the canine CR/FNII shared a high degree of homology with the rabbit counterpart, adult rabbits have been used as the surrogate model for immunization studies after confirming the binding of the ScFvs to the rabbit dendritic cells. Since the goal of the study was to deliver the hormonal antigens to the dendritic cells, each ScFv was translationally fused to a core streptavidin fragment, thus creating bi-functional agents (ScFv-CS) capable of binding to the dendritic cells and also to any biotin-tagged antigen, thus delivering the antigen to the dendritic cells. Of the three ScFvs, the ScFv-CS-H4 which could bind to the canine CR/FNII with the KD of 25nM was used for demonstrating the ability of the ScFv-hormone complex to elicit the bioneutralizing antibody response. The ScFv-CS-H4-biotin-hCG or hFSH or both were administered to adult male rabbits along with poly IC: LC, a Toll-like receptor agonist and the antibody titres were monitored. It was possible to maintain high titres of the bioneutralizing antibodies for more than one year with a single administration of the immunogen. Testicular histology of the immunized animals showed extensive disruption of spermatogenesis with most of the germ cells being TUNEL positive undergoing apoptosis. There was complete absence of elongated spermatids and sperms in the testis indicating infertility caused by immunization with the gonadotropins. These data show that targeting the hormonal antigens to the dendritic cells leads to long-term infertility with minimal immunization. Although the ScFvs from the Tomlinson’s libraries were able to deliver the hormonal antigens to the dendritic cells and produce robust and sustained antibody response capable of disrupting the gonadal functions, the affinities of these ScFvs to DEC205 were moderate. It was felt that increasing the affinities of the ScFvs could enhance the effect with respect to the dose of the antigen that needs to be administered and the duration until which the high antibody titres could be maintained. Therefore, the yeast human ScFv display library offering higher diversity of the human ScFvs displayed, was screened for high affinity DEC205 specific binders. From a pool of several ScFvs, six unique ScFvs were characterized. The amino acid sequences of all ScFvs followed the Kabat's rules for identifying the complimentarity determining regions of the heavy and the light chains of the antibodies. All these ScFvs were unique in their amino acid sequences. The dissociation constants of all these antibodies for the canine CR/ FNII ranged from 10-9 to 10-11 M which was 20-300 fold higher than the ScFvs obtained from the Tomlinson’s libraries. The best ScFv obtained from this library was ScFv-92 with a KD value of 8 x10-11 M. All these ScFvs were able to deliver the payload antigen to both, the mouse DEC205 over-expressing cells and the bone marrow derived dendritic cells. Mice immunized with yeast display ScFvs also yielded antibody response to very small quantities of the immunogen with the highest antibody titres obtained with the ScFv-92. It was further demonstrated that all ScFvs also activated the cell-mediated immunity with significant increase in the antigen stimulated T cell proliferation. These ScFvs could also deliver the antigen to the human dendritic cells differentiated from the human monocytes in vitro, thus emphasising their utility in human vaccine development. An attempt was also made to develop nanoparticle (NP) based strategies of delivering the antigen to the dendritic cells. The PLGA-NPs, encapsulating hCG and coated with the DEC205 ScFv-92 was able to elicit high antibody response to very low doses of the antigen. This response could be sustained for 120 days and was higher than the response obtained with similar doses of hCG encapsulated NPs or hCG complexed to ScFv-92 alone. Targeting of the NPs also elicited antigen specific T cell response thus, potentiating their use in cell mediated immunity along with humoral immune responses. In conclusion, this approach of delivering the gonadotropins to the dendritic cells resulted in the production of bioneutralizing antibodies that could disrupt the gonadal functions for a prolonged period and can be effectively used in the fields for controlling the animal populations. This method fulfils all the criteria for any animal contraception. This strategy also elicits both T cell mediated and humoral immunity and can thus be used for producing vaccine against viral and parasitic infections. It can also be used for cancer immunotherapy. Another exciting feature of the strategy used in this study is the usage of ScFv-CS which allows the delivery of any biotin tagged antigen to the rodent and human dendritic cells. As discussed above, the methods for controlling the animal populations are expected to be effective, humane, safe, simple, non-surgical, single shot with long lasting effects, cheap, applicable in the fields and widely accepted by different societies. The methods presented in this study fulfill all these criteria and should be effective in controlling populations of different animal species.

<div> <div> <div> <p>The following study used a liberal feminist lens to address a gap in the literature on contraceptive method use and romantic relationships by examining the association between contraceptive method use and both relationship satisfaction and balance of power. Specifically, it surveyed married women between the ages of 20-49 using either oral contraceptives (OCs) or natural family planning (NFP). Relationship satisfaction was measured using the Couple Satisfaction Index (CSI-4). Balance of power in the relationship was measured using the Relationship Balance Assessment (RBA). It was hypothesized that women using NFP would report higher relationship satisfaction and greater balance of power than women using OCs. Instead, results of the multiple regression analyses indicated that women using NFP experienced significantly lower rates of balance of power in their relationship. There was no significant difference in relationship satisfaction between groups. Additionally, control variables of religious importance and number of children were found to be associated with balance of power. Controls of age and religious importance were found to be associated with relationship satisfaction. Clinical implications, strengths and limitations, and future directions for research were discussed. </p> </div> </div> </div>

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach's alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P < 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization.