Understanding how contraceptive choices and access differ for women having medication abortions compared to aspiration procedures can help to identify priorities for improved patient-centered ...postabortion contraceptive care.
The objective of this study was to investigate the differences in contraceptive counseling, method choices, and use between medication and aspiration abortion patients.
This subanalysis examines data from 643 abortion patients from 17 reproductive health centers in a cluster, randomized trial across the United States. We recruited participants aged 18–25 years who did not desire pregnancy and followed them for 1 year. We measured the effect of a full-staff contraceptive training and abortion type on contraceptive counseling, choice, and use with multivariable regression models, using generalized estimating equations for clustering. We used survival analysis with shared frailty to model actual intrauterine device and subdermal implant initiation over 1 year.
Overall, 26% of participants (n = 166) had a medication abortion and 74% (n = 477) had an aspiration abortion at the enrollment visit. Women obtaining medication abortions were as likely as those having aspiration abortions to receive counseling on intrauterine devices or the implant (55%) and on a short-acting hormonal method (79%). The proportions of women choosing to use these methods (29% intrauterine device or implant, 58% short-acting hormonal) were also similar by abortion type. The proportions of women who actually used short-acting hormonal methods (71% medication vs 57% aspiration) and condoms or no method (20% vs 22%) within 3 months were not significantly different by abortion type. However, intrauterine device initiation over a year was significantly lower after the medication than the aspiration abortion (11 per 100 person-years vs 20 per 100 person-years, adjusted hazard ratio, 0.50; 95% confidence interval, 0.28–0.89). Implant initiation rates were low and similar by abortion type (5 per 100 person-years vs 4 per 100 person-years, adjusted hazard ratio, 2.41; 95% confidence interval, 0.88–6.59). In contrast to women choosing short-acting methods, relatively few of those choosing a long-acting method at enrollment, 34% of medication abortion patients and 53% of aspiration abortion patients, had one placed within 3 months. Neither differences in health insurance nor pelvic examination preferences by abortion type accounted for lower intrauterine device use among medication abortion patients.
Despite similar contraceptive choices, fewer patients receiving medication abortion than aspiration abortion initiated intrauterine devices over 1 year of follow-up. Interventions to help patients receiving medication abortion to successfully return for intrauterine device placement are warranted. New protocols for same-day implant placement may also help patients receiving medication abortion and desiring a long-acting method to receive one.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Population policies, programmes and the environment Speidel, J. Joseph; Weiss, Deborah C.; Ethelston, Sally A. ...
Philosophical transactions of the Royal Society of London. Series B. Biological sciences,
10/2009, Volume:
364, Issue:
1532
Journal Article
Peer reviewed
Open access
Human consumption is depleting the Earth's natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 ...years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least $5 billion of the total, however, current donor assistance is less than a quarter of this funding target.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Abstract Background Placement of long-acting reversible contraceptives (LARC) — intrauterine devices (IUDs) and the implant — directly after an abortion provides immediate contraceptive protection ...and has been proven safe. Study Design We conducted a survey of National Abortion Federation member facilities ( n =326; response rate 75%) to assess post-abortion contraceptive practices. Using multivariable logistic regression, we measured variations in provision of long-acting contraception by clinic factors and state contraceptive laws and policies. Results The majority (69%) of providers surveyed offered long-acting methods, but fewer offered immediate post-abortion placement of intrauterine devices (36%) or implants (17%). Most patients were provided with contraception; 6.6% chose LARC methods offering the highest level of protection. Post-abortion provision of these methods was lower in stand-alone abortion clinics (p≤.001), but higher with recent clinician training (p≤.001) and in the absence of clinic flow barriers (p≤.001). State policies had a significant impact on how women paid for contraception and the likelihood of LARC use. Patient use was higher in states with contraceptive coverage mandates (p≤.01) or Medicaid family planning expansion programs (p≤.05). Conclusions Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Although obstetrician–gynecologists recognize the importance of managing fertility for the reproductive health of individuals, many are not aware of the vital effect they can have on some of the ...worldʼs most pressing issues. Unintended pregnancy is a key contributor to the rapid population growth that in turn impairs social welfare, hinders economic progress, and exacerbates environmental degradation. An estimated 215 million women in developing countries wish to limit their fertility but do not have access to effective contraception. In the United States, half of all pregnancies are unplanned. Voluntary prevention of unplanned pregnancies is a cost-effective, humane way to limit population growth, slow environmental degradation, and yield other health and welfare benefits. Family planning should be a top priority for our specialty.
We determine the exact symbol error probability of M-ary phase shift keying (M-PSK) for multihop communication systems with regenerative relays, where the source terminal transmits data to the ...destination terminal via a set of intermediate relay stations, which perform hard decisions on the received symbols before forwarding them to their respective successor node. Both, time-invariant additive white Gaussian noise channels as well as frequency-flat fading channels are considered and we derive generic expressions, which might be easily evaluated numerically or even be given in closed-form for various cases.
We investigate two iterative channel estimators for mobile orthogonal-frequency division multiplexing. The first estimator is based on iterative filtering and decoding whereas the second one uses an ...a posteriori probability (APP) algorithm. The first method consists of two cascaded one-dimensional Wiener filters, which interpolate the unknown time-varying two-dimensional frequency response in between the known pilot symbols. As shown, the performance can be increased by feeding back the likelihood values at the output of the APP-decoder to iteratively compute an improved estimate of the channel frequency response. The second method applies two APP estimators, one for the frequency and the other one for the time direction. The two estimators are embedded in an iterative loop similar to the turbo decoding principle. As shown in detail, this iterative estimator is superior and its performance is independent of whether the chosen time-frequency pilot grid satisfies the two-dimensional sampling theorem or not. The bit-error rate as a function of the signal-to-noise ratio is used as a performance measure. In addition, the convergence of the iterative decoding loop is studied with the extrinsic information transfer chart.
CONTEXT: Long-acting reversible contraceptive (LARC) methods (lUDs and implants) are the most effective and cost-effective methods for women. Although they are safe to place immediately following an ...abortion, most clinics do not offer this service, in part because of the increased cost. METHODS: In 2009, telephone interviews were conducted with 20 clinicians and24 health educators at 25 abortion care practices across the country. A structured topic guide was used to explore general practice characteristics; training, knowledge and attitudes about LARC; and postabortion LARC counseling and provision. Transcripts of the digitally recorded interviews were coded and analyzed using inductive and deductive processes. RESULTS: Respondents were generally positive about the safety and effectiveness of LARC methods; those working in clinics that offered LARC methods immediately postabortion tended to have greater knowledge about LARC than others, and to perceive fewer risks and employ more evidence-based practices. LARC methods often were not included in contraceptive counseling for women at high risk of repeat unintended pregnancy, including young and nulliparous women. Barriers to provision were usually expressed in terms of financial cost—to patients and clinics—and concerns about impact on the smooth flow of clinic procedures. Education and encouragement from professional colleagues regarding LARC, as well as training and adequate reimbursement for devices, were considered critical to changing clinical practice to include immediate postabortion LARC provision. CONCLUSIONS: Despite evidence about the safety and cost-effectiveness of postabortion LARC provision, many clinics are not offering it because of financial and logistical concerns, resulting in missed opportunities for preventing repeat unintended pregnancies.
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BFBNIB, DOBA, FZAB, GIS, IJS, INZLJ, IZUM, KILJ, NLZOH, NMLJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ, ZRSKP
Introduction The intraocular lens (IOL) can be used as a slow-release drug carrier in cataract surgery to alleviate posterior capsular opacification (PCO). The following is a systematic development ...of an IOL using methotrexate and the solvent casting process with poly (lactic-co-glycolic acid) (PLGA) as a carrier polymer. Methods Different solvents for PLGA and methotrexate were tested for dissolution properties and possible damage to the IOL. The required biological concentration of methotrexate was determined in human capsular bags implanted with an IOL. To detect fibrosis, α-SMA, f-actin, and fibronectin were labelled by immunofluorescence staining. Cell proliferation and extracellular matrix contraction were observed in a lens epithelial cell line (FHL-124). Finally, the IOL was designed, and an ocular pharmacokinetic model was used to measure drug release. Results Solvent mixtures were found to allow coating of the IOL with drug and PLGA without damaging it. PCO in the capsular bag model was inhibited above 1 μM methotrexate ( p = 0.02). Proliferation in FHL-124 was significantly reduced above a concentration of 10 nM ( p = 0.04) and matrix contraction at 100 nM ( p = 0.02). The release profile showed a steady state within therapeutic range. Conclusion After determination of the required physicochemical manufacturing conditions, a drug releasing IOL was designed. A favourable release profile in an ocular pharmacokinetics model could be shown.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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