birth-control-24.matches:
birth control pill
Portosystemic shunt versus orthotopic liver transplantation for the Budd-Chiari syndrome.

Shaked A, Goldstein RM, Klintmalm GB, Drazan K, Husberg B, Busuttil RW.

Department of Surgery, University of California, Los Angeles.

We have analyzed the indications and results of shunt operation versus orthotopic liver transplantation (OLT) in 22 patients with Budd-Chiari syndrome (BCS). The underlying cause of the syndrome was similar between the two groups and was related to myeloproliferative disorders or the use of birth control pills in 18 of 22 patients. The results of biopsies of the liver showed centrilobular congestion and necrosis in all candidates who underwent shunting and the presence of fibrosis and cirrhosis in the OLT candidates. The indications for shunts included symptoms related to portal hypertension only and well-preserved synthetic hepatic function. Ten patients were treated with 12 shunt procedures, including mesoatrial (eight patients) and side to side portacaval shunt (four patients). Significant complications after shunt procedure included fulminant (one of ten patients) and progressive (one of ten patients) hepatic failure requiring urgent OLT; one death occurred because of pulmonary sepsis. Indications for OLT were signs of end stage liver expressed by severe portal hypertension and variceal bleeding (four of 14 patients), progressive encephalopathy (seven of 14 patients) and poor synthetic function (bilirubin greater than 3 milligrams per deciliter in eight of 14 patients and albumin less than 3.0 grams per liter, or both, in ten of 14 patients). Fourteen patients were treated with 16 OLT, three patients had retransplantation for primary nonfunction graft (two of 14 patients) or chronic rejection (one of 14 patients). There were two early deaths in the group. With a follow-up period between two months to five years, 12 of 14 patients undergoing OLT are alive, fully functional and have normal liver function tests. Seven of ten patients who had shunts are alive, six are able to maintain normal activity and one has progressive end stage hepatic disease and is not a candidate for OLT. However, the hepatic function continues progressively to be abnormal. Various options are available for the treatment of the syndrome. Portosystemic decompression is effective and should be considered at the early stage of the disease, prior to the development of significant hepatic failure. However, few of the patients will continue to have slow, but progressive hepatic failure and may require OLT. The only effective treatment for end stage hepatic disease secondary to the BCS is OLT.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1595020&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Age and Pap smear history as a basis for intervention strategy.

Spurlock C, Nadel M, McManmon E.

Division of Epidemiology, Kentucky Department for Health Services, Frankfort 40621.

As a means of developing effective intervention strategies for promoting Pap smear screening, we analyzed data from a population-based women's health survey (N = 603) in a 36-county area in southeastern Kentucky. The cervical cancer mortality rate for white women in this area is one of the highest in the United States. By using selected sociodemographic, health-care utilization, health knowledge, and health behavior variables in age-specific logistic regression models, we discriminated between women who had had a Pap smear within 3.5 years and those who had not. Several variables predicted Pap screening status regardless of the woman's age. Women of all age groups who had not been recently screened had encounters with the medical-care system. A key variable that affected use of screening services was ever use of birth control pills. The main differences between the three age groups were as follows: the 18-44 age group was less likely to see a private physician and less likely to seek medical care of any type, except for care related to pregnancy; only the 45-59 age group believed that cost of medical care was a problem; and only for the 60 or older age group were socioeconomic variables associated with not having recently had a Pap test.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1602047&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Family planning, obstetrical and gynecological health care provision in the Soviet Far East.

Thomsen RJ.

Bassett Army Community Hospital, Fort Wainwright, AK 99703.

The Soviet model for both obstetrical and gynecological care and family planning provision seems entrenched in the Soviet Far East as found during a July 1991 visit to the Magadan and Chukotka Regions. Modern birth control is minimally practiced, but does include use of the older Soviet Loop intrauterine contraceptive device (IUD), recent introduction of the new Soviet Copper-T IUD and sporadic availability of condoms and foreign made birth control pills. Without male or female surgical sterilizations being performed, the consequence is that the major form of family planning is first trimester abortion. During this visit, I introduced the use of the NORPLANT Subdermal Contraceptive System and the Copper-T380A IUD to physicians at Anadry and Pevek regional hospitals. Gynecological surgery was also performed and fairly typical ob-gyn care units were toured. Ob-Gyn physicians in the Soviet Far East were found to be highly motivated. They look to the West for help in upgrading family planning and ob-gyn health care in the face of severe shortages after a half decade of perestroika.

PIP: The structure, strengths, and deficiencies of the Soviet model of both obstetrical and gynecological care and family planning provision in the Soviet Far East is described as found during a July 1991 medical expedition to the Magadan and Chukotka Regions. The mainstay of family planning is usually 1st trimester abortion. In the Chukotka Autonomous Region, in 1989, there were 198 registered abortions performed/100 live births while in 1990 there were 166 registered abortions/100 births. However, it is possible that the abortion rate is nearly 300/100 live births in the Soviet Far East. The main goal of the visit was to update professionals on the international status of modern birth control. Presentations were made on the Tcu380A IUD (Paragard), and the NORPLANT Subdermal Contraceptive System. NORPLANT or the Tcu380A IUD provide 5 and 6 years of contraction, respectively. A number of NORPLANT insertions were also performed at 2 hospitals. Modern birth control is minimal including the use of the older Soviet Loop IUD, a nonsterile Loop IUD copied after the Lippes Loop. Recently the new Soviet Copper-T IUD was introduced, and condoms (imported from China and Austria) and foreign-made birth control pills are available sporadically. There are no oral contraceptives manufactured in the Soviet Union. There was no evidence of widescale use of condoms in the Soviet Far East. AIDS is discussed widely and tested for in a limited way. Very few tubal sterilizations are performed on women, and no vasectomies are done. At the Pevek Regional Hospital assistance was rendered in surgery of 2 supracervical hysterectomies. There is limited availability of labor monitors, ultrasound, and life-saving equipment in the newborn nurseries. In the Chukotka Autonomous Region, the 1990 perinatal death rates were 18.9/100 live births for Russian women and 16.9/100 live births for native women. A medical effort and assistance from the West could improve these statistics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1605341&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Bringing parents into school clinics: parent attitudes toward school clinics and contraception.

Santelli J, Alexander M, Farmer M, Papa P, Johnson T, Rosenthal B, Hotra D.

Comprehensive School Health Services Program, Baltimore City Health Department, Maryland.

Prior to implementing a change in school clinic policy to allow dispensing of contraceptives, parents of school-based clinic (SBC) enrollees were surveyed regarding attitudes toward clinic quality of care, desired services, and contraceptive distribution. Telephone interviews were conducted with a systematic sample of 262 parents who normally are in charge of the adolescent's health care. Parental opinion was felt to be crucial in shaping Baltimore SBC contraception policy. Parents overwhelmingly endorsed current clinic services including family planning for sexually active teens, annual physicals, and drug and alcohol counseling. Most parents rated the SBC as excellent (25%) or very good (36%), although a substantial minority found it difficult to rate the clinics (27%, "don't know"). Parents with prior verbal contact (45%) were more likely to rate the clinic as excellent (35% versus 16%) and less likely to respond "don't know" (13% versus 38%, p less than 0.001). Parent attitudes toward contraception was context specific: 63% endorsed and 27-30% opposed prescribing and dispensing. If a boy (or girl) was already having sex, 76% (or 75%) of parents supported and 14% (or 17%) opposed providing birth control pills or condoms. With parental permission, 93% supported contraception and only 3% were opposed. No differences were found by age, race, gender, or grade of student. Prior verbal communication with the clinic did not affect parent attitudes toward contraception. Consideration of parent attitudes was critical to changing SBC contraceptive dispensing policy in Baltimore. Contraceptive distribution, after counseling and necessary medical care, was initiated in September 1990. The parent and community response has been very supportive.

PIP: Prior to implementing a change in school clinic policy concerning the dispensing of contraceptives, parents of school-based clinic (SBC) enrollees were surveyed concerning attitudes toward clinic quality of care, desired services, and contraceptive distribution. Telephone interviews were conducted with a systematic sample of 2622 parents who are normally in charge of the adolescent's health care. Parental opinion was felt to be crucial in shaping Baltimore SBC contraception policy. Parents overwhelmingly endorsed the current clinic services which included family planning for sexually active teens, annual physical, and drug and alcohol counseling. Most parents rated the SBC as excellent (25%) or very good (36%), although a substantial minority found it difficult to rate the clinics (27%; didn't know). Parents with prior verbal contact (45%) were more likely to rate the clinic as excellent (35% vs. 16%) and less likely to respond "don't know" (13% vs. 38%; p0.001). Parental attitude toward contraception was context-specific--63% endorsed and 27-30% opposed prescribing and dispensing. If a boy (or girl) was already engaging in sex, 76% (or 75%) of the parents supported and 14% (or 17%) opposed the provision of birth control pills or condoms. With parental permission, 93% supported contraception and only 3% were opposed. No differences were seen by age, race, gender, or grade of student. Prior verbal communication with the clinic did not affect parental attitudes toward contraception. consideration of parental attitudes was critical to changing SBC contraceptive dispensing policy in Baltimore. Contraceptive distribution, after counseling and necessary medical care, was initiated in September 1990. The parental and community response has been very supportive. author's modified

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1610841&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Menstrual history in altitude chamber trainees.

Schirmer JU, Workman WT.

Armstrong Laboratory, Hyperbaric Medicine Division, Brooks AFB, TX.

Previous studies have determined a higher rate of altitude-induced decompression sickness (DCS) in women than in men. Women are reportedly at higher risk for developing DCS during menses. A study of menstrual history in women completing altitude chamber training without developing DCS has never been accomplished. The purpose of this study was to collect and analyze menstrual history in these women. Thirteen U.S. Air Force Aerospace Physiology Units participated in a USAF-approved survey for 1 year. After completing altitude chamber flights, data on age, day of menstrual cycle (DMC), birth control pill use (BCP), and mean durations of menstrual cycle and menses were collected. There were 508 responses analyzed. There was no differences between mean duration of menstrual cycle and menses in the Yes (Y) and No (N) BCP groups. Y and N BCP groups were equally distributed across the menstrual cycle. Women completing altitude chamber training without developing DCS appear to be evenly distributed across their menstrual cycle, with use of BCPs not affecting their susceptibility to DCS.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1616439&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Determinants of maternal tolerance of vaccine-related risks.

Freeman TR, Bass MJ.

Department of Family Medicine, University of Western Ontario, Canada.

In a time when informed consent requires knowledge of the risks and benefits of medical care and technology to be communicated to the public, perceptions of benefits and risks of these techniques and procedures take on special importance. The purpose of the present study was to examine the determinants of maternal tolerance of vaccine-related side-effects in their children. A questionnaire was sent to 226 mothers of young children in southwestern Ontario seeking their opinion of the benefits and risks of selected medical procedures. It asked them to identify the risk of serious reactions they would tolerate for a new vaccine with benefits similar to that of pertussis vaccine. The response rate to the questionnaire was 92%. This group of young, well-educated mothers had high regard for some of the most common procedures and treatments used in family practice. The less common and more invasive procedures (heart surgery, brain surgery) were viewed as carrying almost as much risk as benefit. Abortion was perceived as involving more risk than benefit. Levels of acceptable risk with respect to a hypothetical new childhood vaccine were determined. A risk level of 1 in 1 million was the most popular level of acceptable risk, chosen by 25% of the respondents. The next most frequently chosen risk level was 1 in 100,000, chosen by 22%. Tolerance of possible vaccine side-effects did not differ with maternal age, education or prior experience with adverse vaccine or drug reactions. A summary net benefit score was derived for four technologies commonly used in family practice (antibiotics, vaccinations, birth control pills and X-rays).(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1634026&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Estrogen influences auditory brainstem responses during the normal menstrual cycle.

Elkind-Hirsch KE, Stoner WR, Stach BA, Jerger JF.

Department of Otorhinolaryngology, Methodist Hospital, Baylor College of Medicine, Houston, TX 77030.

We evaluated the impact of the menstrual cycle on auditory brainstem response (ABR) latency in nine normally cycling women. Subjects (age 23-40 years) using no hormonal therapy were recruited and underwent ABR testing during four different phases of the same menstrual cycle: early follicular (cycle days 1 to 3); mid-cycle (cycle days 12 to 15); mid-luteal (cycle days 17 to 22), and premenstrual (cycle days 25-27). Cycles were verified by basal body temperature, and serum estrogen (E2), progesterone (P), and gonadotropin levels. A control group of nine women (age 23-40 years) on oral contraceptives (Nordette-28) was also studied four times during a pill cycle. Results show a significant increase in the latency of wave III and wave V peak latencies and in the I-V interpeak interval associated with a high estrogen state at the mid-cycle phase. No statistically significant variations in latency were found in the birth control pill group. These data suggest the existence of brainstem auditory neural pathways that are sensitive to fluctuations in E2 levels during the menstrual cycle.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1639724&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
The vascular history and physical examination.

Nelson JP.

Barry University School of Podiatric Medicine, Miami Shores, Florida.

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1735054&dopt=Abstract birth control pill



birth-control-14.matches:
birth control pill
Retailers in social program strategy: the case of family planning.

Black TR, Farley JU.

PIP: The provision of contraceptive agents and devices through hospitals and clinics is not a cost-efficient procedure, therefore the distribution through retailers in a preexisting network is an attractive prospect. To really distribute contraceptives, e.g., birth control pills, the retailer would have to be trained in a format of questions. Two studies of retail marketing were conducted, one in Jamaica for condoms and one in Kenya where a subsidized marketing program for condoms was started in rural areas. More urban shops, which were larger in size, carried condoms than rural shops. Retailers in both areas were completely oriented to their immediate vicinity. Their concerns were with volume and with aggregate demand both before and after subsidized programs. The distribution system requires the additional support of advertising and marketing, but since the structure is in place it can be used with relatively little capital outlay. Research of retailers' attitudes and perceptions is inexpensive and often indicates customer preference and local market conditions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12261395&dopt=Abstract birth control pill



birth-control-24.matches:
birth control pill
Heterosexual activity and cycle length variability: effect of gynecological maturity.

Burleson MH, Gregory WL, Trevathan WR.

Department of Psychology, Arizona State University, Tempe 85287.

Previous studies linking heterosexual activity to women's menstrual cycle variability have failed to take into account the effects of gynecological maturity. One hundred thirty-two women, all at least seven years postmenarche and not using birth control pills, completed daily records of their cycles and their heterosexual behavior. Data from women classified as sexually celibate or as regularly sexually active (having sex at least once per week in every nonmenstruating week) replicated previous findings while controlling for gynecological maturity: Women classified as celibate had more variable cycles than women who engaged regularly in heterosexual activity. An interaction between gynecological maturity and sexual status was also found, precluding a comparison involving women who were sexually active on an irregular basis. The interaction revealed that increased gynecological maturity is associated with less variable cycles in the sexually sporadic women, but is not associated with cycle variability in either celibate or sexually regular women. Possible biological mechanisms for these findings and their implications are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1775565&dopt=Abstract birth control pill