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Your search found 19 Results

  1. 1
    377411
    Peer Reviewed

    Severe injection site reactions after subcutaneous administration of Sayana(c).

    Jodicke AM; Dahmke H; Damke B; Schaublin M; Kullak-Ublick GA; Weiler S

    Swiss Medical Weekly. 2017 Jun 21; 147:w14432.

    PURPOSE: Sayana(R) was introduced as the first depot medroxyprogesterone acetate-containing contraceptive that is administered via subcutaneous injection. Within 10 months, the Regional Pharmacovigilance Centre (RPVC) Zurich received several anonymous reports of serious local reactions after Sayana(R) administration. In this retrospective study, individual case safety reports (ICSRs) on local adverse drug reactions (ADRs) related to Sayana(R) were analysed from the WHO pharmacovigilance database. METHODS: International, national and regional ICSRs during Sayana(R) administration up to 1 January 2016 were examined. Data on ADRs were retrieved from the WHO Global Database VigiBase. Demographic data, drug administration information, duration of Sayana(R) treatment, latency time of the ADR, and its course, severity and outcomes were analysed. RESULTS: Worldwide, 398 ICSRs after Sayana(R) use were registered in the database. We identified 20 reported terms that were potentially used to describe a persistent lipodystrophy. When only cases containing one or more of these 20 reported terms were selected, 323 (81.2%) international ICSRs remained for analysis. Of those, 91.6% (n = 296) were categorised as serious. The majority of the reactions (n = 193, 54.4%) did not recover. In the 67 Swiss ICSRs, 77 ADRs were reported using 10 different terms including severe or persistent local reactions like lipodystrophy, atrophy or fat necrosis. Thirty-two patients (47.7%) did not recover. All 11 regional cases reported to the RPVC Zurich were categorised as serious ADRs. For the majority of the patients (n = 7, 63.6%) the interval between the application of Sayana(R) and development of the lipodystrophy was between 2 and 4 months. Most of the reactions were irreversible (n = 9, 81.8%). One patient underwent plastic surgery for artificial infill of the dent. CONCLUSIONS: Persistent local injection site reactions such as lipodystrophy, fat tissue necrosis or atrophy occur frequently after subcutaneous Sayana(R) use. These adverse drug reactions were recently integrated in the Swiss product information. Physicians and patients should be informed and advised about these potentially irreversible effects.
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  2. 2
    334433

    Comprehensive sexuality education: The challenges and opportunities of scaling-up.

    DeJong J

    Paris, France, UNESCO, 2014. [92] p.

    This report builds on a program of work on sexuality education for young people initiated in 2008 by UNESCO. It is also informed by several other past and ongoing initiatives related to scaling up sexuality education, as well as drawing on case studies presented at the Bogota international consultation on sexuality education, convened by UNFPA in 2010. The report emphasizes the challenges for scaling-up in terms of integrating comprehensive sexuality education into the formal curricula of schools. It aims to provide conceptual and practical guidance on definitions and strategies of scaling-up; illustrate good practice and pathways for successful scale-up in light of diverse contextual parameters; and provide some principles of scaling up sexuality education that are of relevance internationally.
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  3. 3
    331739

    Monophasic regimens should Be first choice for new pill users.

    Family Health International [FHI]

    [Research Triangle Park, North Carolina], FHI, [2006]. [2] p. (Research Briefs on Hormonal Contraception)

    A new Cochrane review conducted by Leiden University Medical Center in the Netherlands and Family Health International suggests that monophasic regimens should be the first choice over triphasic regimens for new oral contraceptive users.
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  4. 4
    324656
    Peer Reviewed

    What do we know about sexual and reproductive health of adolescents in Europe?

    Avery L; Lazdane G

    European Journal of Contraception and Reproductive Health Care. 2008 Mar; 13(1):58-70.

    Acceptance of sexual and reproductive health as fundamental to the sustainable development of societies has allowed for creation of new reproductive health programmes and policies. WHO sexual and reproductive health (SRH) strategies were developed in the WHO Regional Office for Europe (2001), as well as globally (2004). Adolescent SRH is important in both strategies. Despite these commitments, adolescents remain vulnerable to poor reproductive health. The goal of this paper is to analyse the current status of SRH of adolescents in Europe. Key reproductive health indicators were chosen. Information was obtained from published studies, databases and questionnaires sent to WHO reproductive health counterparts within the health ministries in the Member States of the WHO European Region. Pregnancy rate, age at first sexual intercourse, contraceptive use at first and last intercourse, contraceptive prevalence, HIV knowledge, and STI rates vary widely according to the population considered. Gender difference and lack of information pertaining to SRH of all adolescent populations are other key findings. While the SRH of most European adolescents is good, they remain a vulnerable population. Lack of standardized reproductive indicators and age specific aggregate data make it difficult to accurately assess the situation in individual countries or perform cross country comparison. (author's)
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  5. 5
    283007
    Peer Reviewed

    Preventing infection from reusable medical equipment: a systematic review.

    Sopwith W; Hart T; Garner P

    BMC Infectious Diseases. 2002 Mar 27; 2:[10] p..

    In 2000, the World Health Organization (WHO) had eight sets of conflicting recommendations for decontaminating medical equipment. We conducted a systematic review of observational studies to assist WHO in reconciling the various guidelines. This paper summarises the methods developed and illustrates the results for three procedures – alcohol, bleach and povidone iodine. We developed a Medline search strategy and applied inclusion criteria specifying the decontamination procedures of interest and an outcome of microbial destruction for a set of marker organisms. We developed protocols to assess the quality of studies and categorised them according to the reliability of the methods used. Through an iterative process we identified best practice for the decontamination methods and key additional factors required to ensure their effectiveness. We identified 88 published papers for inclusion, describing 135 separate studies of decontamination. For disinfection with alcohol, best practice was identified from 23 studies as an exposure to 70–80% ethanol or isopropanol for at least 5 minutes. Bleach was effective for sterilization at a concentration of 5000 ppm for 5 minutes and for disinfection at 1000 ppm for 10 minutes (33 studies). Povidone iodine was only partially effective for disinfection at a concentration of 1% for 15 minutes (15 studies). Our findings provide an evidence base for WHO guidelines on decontaminating medical equipment. The results support the recommended use of bleach and show that alcohol could be used more widely than current guidelines suggest, provided best practice is followed. The effectiveness of povidone iodine is uncertain. (author's)
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  6. 6
    190346
    Peer Reviewed

    Adverse events after immunisation with aluminium-containing DTP vaccines: systematic review of the evidence.

    Jefferson T; Rudin M; Di Pietrantonj C

    Lancet Infectious Diseases. 2004 Feb 1; 4(2):84-90.

    We have reviewed evidence of adverse events after exposure to aluminium-containing vaccines against diphtheria, tetanus, and pertussis (DTP), alone or in combination, compared with identical vaccines, either without aluminium or containing aluminium in different concentrations. The study is a systematic review with metaanalysis. We searched the Cochrane Vaccines Field Register, the Cochrane Library, Medline, Embase, Biological Abstracts, Science Citation Index, and the Vaccine Adverse Event Reporting System website for relevant studies. Reference lists of retrieved articles were scanned for further studies. We included randomised and semi-randomised trials and comparative cohort studies if the report gave sufficient information for us to extract aluminium concentration, vaccine composition, and safety outcomes. Two reviewers extracted data in a standard way from all included studies and assessed the methodological quality of the studies. We identified 35 reports of studies and included three randomised trials, four semi-randomised trials, and one cohort study. We did a meta-analysis of data from five studies around two main comparisons (vaccines containing aluminium hydroxide vs no adjuvant in children aged up to 18 months and vaccines containing different types of aluminium vs no adjuvants in children aged 10–16 years). In young children, vaccines with aluminium hydroxide caused significantly more erythema and induration than plain vaccines (odds ratio 1·87 [95% CI 1·57–2·24]) and significantly fewer reactions of all types (0·21 [0·15–0·28]). The frequencies of local reactions of all types, collapse or convulsions, and persistent crying or screaming did not differ between the two cohorts of the trials. In older children, there was no association between exposure to aluminiumcontaining vaccines and onset of (local) induration, swelling, or a raised temperature, but there was an association with local pain lasting up to 14 days (2·05 [1·25–3·38]). We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events. Despite a lack of good-quality evidence we do not recommend that any further research on this topic is undertaken. (excerpt)
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  7. 7
    182281

    HIV-infected women and their families: psychosocial support and related issues. A literature review.

    Lindsey E

    Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2003. vi, 57 p. (Occasional Paper; WHO/RHR/03.07; WHO/HIV/2003.07)

    This review is divided into three sections. Section one provides a synthesis of the reviewed literature on prevention of mother-to-child transmission (PMTCT) of HIV, voluntary HIV testing and counselling (VCT), and other issues that impact on the care, psychosocial support and counselling needs of HIV-infected women and their families in the perinatal period. Section two provides examples from around the world of projects that focus on the care and support of women and families, with a focus on MTCT. The fi nal section contains recommendations on psychosocial support and counselling for HIV-infected women and families. (excerpt)
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  8. 8
    168620

    Contested terrain: Oxfam, gender, and the aftermath of war.

    Williams S

    Gender and Development. 2001 Nov; 9(3):19-28.

    In this paper, the author explores the terrain of the international nongovernmental organization--in this case Oxfam Great Britain (GB)--and some of its difficulties in integrating gender equity goals in the institutional structures and policies which govern its activities in conflict and its aftermath. The author looks at terrain that is divided into areas that are treated very differently. These are, on one hand, the field of humanitarian interventions in the throes of an emergency, and on the other hand, the field of reconstruction and development. Historically, these two fields of activity have been governed by very different ways of thinking and acting, often in conflict with each other. Gender analysis and gender-sensitive programming are central to these differences, and essential tools in the attempts to overcome them. In Oxfam GB at present, the differences in approaches to gender equity in these two territories are acknowledged, if not routinely addressed; but the importance of addressing gender equity in order to overcome some of these differences, is more complicated and controversial. (author's)
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  9. 9
    133153
    Peer Reviewed

    Sexuality education and young people's sexual behavior: a review of studies.

    Grunseit A; Kippax S; Aggleton P; Baldo M; Slutkin G

    JOURNAL OF ADOLESCENT RESEARCH. 1997 Oct; 12(4):421-53.

    Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.
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  10. 10
    116580

    Planning for Health for All: international experience in setting health goals and targets.

    Nutbeam D; Wise M

    HEALTH PROMOTION INTERNATIONAL. 1996 Sep; 11(3):219-26.

    This paper reviews 10 years of experience in using health goals, targets, and objectives as a planning mechanism. The US was the first country to develop national health goals in 1980. In 1985, the World Health Organization (WHO) produced a defined set of "Targets for Health for All." This review includes the experiences in the US, Australia, New Zealand, England and Wales, and the WHO Regional Office for Europe. These countries used different approaches in defining targets and in achieving the defined targets. Each country's approaches are described. The WHO uses goals and targets in order to define differences in health status between populations and to reduce these differences. Better data are now available for improving the understanding of the personal, economic, environmental, social, and health service factors associated with health. Monitoring of defined targets in the US over a 10-year period has resulted in more improvements in targeted areas than nontargeted areas. In 1988 Australia established national targets. Targets in Australia influenced the formulation of its first national health policy. A stronger infrastructure for health promotion was developed. The evidence that links objective setting to health improvement is not readily available. It appears that target setting may result in a focus on a comprehensive health policy, changes in resource allocation, and methods and structures for improving population health. All countries were concerned about greater efficiency in health system investment. Wales is developing less emotional methods for decision making about health services. The US spent more time on data collection than on implementation. Australia was preoccupied with health issues where there were data. A balance between these two approaches is desirable. New Zealand's program priorities and resource allocation changed with changes in politics. Health goals should be used to guide and measure the results of health system investments.
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  11. 11
    113707

    Visions and discussions on genital mutilation of girls: an international survey.

    Smith J

    The Hague, Netherlands, Ministry of Foreign Affairs, Directorate General for International Cooperation, Development Cooperation Information Department, 1995. [6], 216, [1] p.

    The Netherlands Institute of Human Rights conducted an inventory of international, regional, and national documents, legislation, and rules on female genital mutilation (FGM) to generate an overview of existing FGM-related regulations. Chapter 2 of the study's report presents the various forms of FGM and the countries where FGM is practiced. It also examines religion, tradition, culture, and socioeconomic backgrounds. The chapter also presents the views and attitudes of various famous researchers and authors. The legal approach to FGM has been receiving increasing attention, reaching the level of considering FGM as a health issue. Chapter 3 reviews international and regional regulations as they apply to FGM. The views and initiatives of international and regional governmental and nongovernmental organizations, particularly those initiatives aiming to eradicate FGM, are addressed in chapter 4. Chapter 5 discusses the countries of origin (e.g., Somalia), while chapter 6 discusses those of destination (e.g., Canada). Specifically, these chapters cover these countries' national legislation and their government's views on FGM. These chapters also address initiatives and programs of those national nongovernmental organizations involved in the eradication of FGM. The report concludes with a summary of the findings and various conclusions.
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  12. 12
    084889

    International migration in North America, Europe, Central Asia, the Middle East and North Africa: research and research-related activities.

    Russell SS

    Geneva, Switzerland, United Nations, Economic Commission for Europe, 1993. v, 83 p.

    As a joint effort of the World Bank and the Economic Commission for Europe, the aim of this report was to identify international migration research and research-related activities in major political and institutional context, general overviews, and data sources, migration is discussed in terms of demography, international policies, economic and labor market aspects, highly skilled workers, development, integration, migration networks, ethnic relations, refugees and asylum seekers. East-west migration is also treated in a political and institutional context, with general overviews and data sources cited. The development and labor markets as well as ethnicity and return migration are considered. South-north migration is examined in a broad manner, with special emphasis on migration in the Mediterranean Basin and the Middle East. The review is meant to serve as a useful resource and as a stimulus for dialogue. Basic data are missing on east-west migration and labor, migration patterns within the Middle-East, and north-south movements other than from North Africa. Basic institutional sources for data and research on international migration are available from the Council of Europe; the Organization for Economic Cooperation and Development (OECD); the International Labor Organization; the International Organization for Migration; the Office of the UN High Commissioner for Refugees; the Intergovernmental Consultations on Asylum, Refugee, and Migration Policies in Europe, North America, and Australia; and the European Community. 13 major publications are primary sources of data, of which the most extensive is OECD's SOPEMI Report. 9 sources of data pertain to demographic aspects of migration. The 1986 SOPEMI report and updates document national policies and practices of entry control in OECD member countries; the UN Population Division also published a survey of population policies, including migration policies. The Commission of European Communities policies, including migration policies. The Commission of European Communities also publishes a document on noncommunity citizens. Researchers who have analyzed recent trends are identified, and research papers are cited for labor aspects of migration, highly skilled workers and migration, migration and development, integration and ethnic relations, migrant networks, refugees and asylum seekers, security, return migration, clandestine migration and ethical issues.
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  13. 13
    062994

    Present status of contraceptive vaginal rings.

    Jackson R; Hickling D; Assendorp R; Elstein M

    ADVANCES IN CONTRACEPTION. 1990 Sep; 6(3):169-76.

    Clinical trials of vaginal rings containing progestins or ethinyl estradiol and progestins by WHO, the Population Council and private firms are reviewed. Contraceptive steroids can be formulated into Silastic vaginal rings because they are released continuously from this material (zero-order kinetics). Vaginal rings have the advantage of avoiding the 1st pass effect on the liver, as well as self- administration, unrelated to the timing of coitus and regulation of withdrawal bleeding with removal for 7 days per cycle. The shell vaginal ring, with an inert core, a layer of Silastic containing the progestogen, and an outer Silastic layer is designed to regulate release by the thickness of the outer layer. The WHO tested rings releasing 200 mcg norethisterone/day resulting in too many menstrual side effects; and 50 mcg/day with too high a failure rate. A ring releasing 20 mcg levonorgestrel is expected to perform well. The Population Council designed rings releasing 152 mcg ethinyl estradiol and 252 mcg levonorgestrel, and 183 mcg ethinyl estradiol and 293 mcg levonorgestrel. These resulted in pregnancy rates of 2/100 woman years, and continuation rates of 50%, but unacceptably adverse lipid effects. Women discontinued for vaginal symptoms. Compared to a similar combined oral pill, the rings offered no advantage. WHO subsequently introduced a ring releasing 20 mcg levonorgestrel: efficacy was 3.8 and continuation over 50%. A new segmented ring with desogestrel is causing fewer androgenic effects and bleeding complaints. Another ring in current trials gives off 120 mcg desogestrel and 30 mcg ethinyl estradiol with no pregnancies and good acceptability in 100 women to date. Availability of Silastic material and quality control in manufacture are seen as obstacles to overcome for mass production of these vaginal rings.
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  14. 14
    049982

    Breast-feeding and its promotion.

    Kocturk T; Zetterstrom R

    ACTA PAEDIATRICA SCANDINAVICA. 1988 Mar; 77(2):183-90.

    The acceptance of the World Health Organization (WHO) International Code for Marketing of Breastmilk Substitutes has stimulated governments to design programs for the more energetic promotion of breastfeeding, but promotional efforts in developing nations may not be getting through to the mothers or may not be designed to meet their specific needs. In a prospective study in Istanbul, it was observed that all infants, whether delivered in a hospital or at home, received not only mixtures of sugar and water and other mixtures soon after birth and for about 1 week thereafter, but also complementary foods now and then until this became a regular practice. This pattern can be defined as regular complementary feeding or partial breastfeeding. Yet, the mothers described it as exclusive breastfeeding. The early and haphazard introduction of water and food in those environments where contamination is common exposes the infants to concentrated amounts of microorganisms which may overwhelm the immunological protection provided by breastmilk and also reduces the milk supply through insufficient stimulation of the breast. Exclusive breastfeeding should be encouraged, and irregular complementary feedings during the early weeks of life should be strongly discouraged, unless there is a medical indication. When exclusive breastfeeding is no longer sufficient, i.e., at the age of about 5 months, complementary feeding should be promoted. Programs for the promotion of breastfeeding have been criticized for devoting too much attention to the infant and little or no attention to the needs of the mother. In a given society, it may be difficult to promote breastfeeding if women regard it as a means of preventing them from improving their socioeconomic situation. Women who want to breastfeed their children should not be prevented from doing so by their working conditions.
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  15. 15
    268351

    Breastfeeding: growth of exclusively breastfed infants.

    Huffman SL

    Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.

    Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
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  16. 16
    267312

    Report on developments and activities related to population information during the decade since the convening of the World Population Conference, Bucharest, 1974.

    Hankinson R

    New York, United Nations, 1984 Jun. vi, 52 p. (POPIN Bulletin No. 5 ISEA/POPIN/5)

    A summary of developments in the population information field during the decade 1974-84 is presented. Progress has been made in improving population services that are available to world users. "Population Index" and direct access to computerized on-line services and POPLINE printouts are available in the US and 13 other countries through a cooperating network of institutions. POPLINE services are also available free of charge to requestors from developing countries. Regional Bibliographic efforts are DOCPAL for Latin America. PIDSA for Africa, ADOPT and EBIS/PROFILE. Much of the funding and support for population information activities comes from 4 major sources: 1) UN Fund for Population Activities (UNFPA): 2) US Agency for International Development (USAID); 3) International Development Research Centre (IRDC): and 4) the Government of Australia. There are important philosophical distinctions in the support provided by these sources. Duplication of effort is to be avoided. Many agencies need to develop an institutional memory. They are creating computerized data bases on funded projects. The creation of these data bases is a major priority for regional population information services that serve developing countries. Costs of developing these information services are prohibitive; however, it is important to see them in their proper perspective. Many governments are reluctant to commit funds for these activites. Common standards should be adopted for population information. Knowledge and use of available services should be increased. The importance os back-up services is apparent. Hard-copy reproductions of items in data bases should be included. This report is primarily descriptive rather than evaluative. However, given the increase in population distribution and changes in government attitudes over the importance of population matters, the main tasks for the next decade should be to build on these foundations; to insure effective and efficient use of services; to share experience and knowledge through POPIN and other networks; and to demonstrate to governments the valuable role of information programs in developing national population programs.
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  17. 17
    776174

    Low doses of gestagens as fertility regulating agents.

    FOTHERBY K

    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 283-321

    This review of low-dose gestagen contraception emphasizes the variety of findings from different studies. For example, studies of chlormadinone acetate have found pregnancy rates of 1.1-12/100 woman-years. Results of trials of megestrol acetate suggested that a 500-mcg dose level yielded unacceptable pregnancy rates. No significant difference between various doses of norgestrel which have been studied were found (e.g., 50 and 75 mcg daily of dl-norgestrel or 30 mcg daily of the d-isomer). Pregnancy rate reported for most trials with this gestagen and also norethisterone and quingestanol were within an acceptable range. With 1 exception, pregnancy rates reported in trials of lynestrenol were remarkable low. Cumulative results of trials with various gestagens show Pearl Index rates between 2 and 3, except for lynestrenol. Dose level was the critical variable; i.e., it must be sufficiently high to exert antifertility action and low enough to avoid a high incidence of irregular bleeding. Apart from menstrual irregularities, other side effects from the minipill seem minor and in general less severe than those encountered with combined oral contraceptives.
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  18. 18
    776175

    Long-acting systemic contraceptives.

    BENAGIANO G

    In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 323-360

    Long-acting systemic contraceptives inhibit fertility either at a central or peripheral level. In some instances, a mixed reaction is likely to be working: during the 1st portion of the drug's life-span the contraceptive effect is exerted at a hypothalamic central level, whereas later on--when ovulation is restored--the action is on the cervix or uterus. The most important factor holding back utilization of long-acting agents is serious interference with regularity of the menstrual cycle, and delivery systems must be devised with zero-order release rates to improve cycle control and acceptability. Monthly injectables consisting of synthetic progestins alone proved unsuitable for contraception because of frequent and prolonged amenorrhea. Addition of an estrogenic substance helped cycle control, and a dihydroxyprogesterone acetophenide plus estradiol enanthate combination seems most worthy of clinical investigation; so far, 15,000 woman-months of experience have yielded no unwanted pregnancies. Few bleeding pattern irregularities were reported, but premenstrual tension, dysmenorrhea, and libido changes occurred. Reversibility of drug-induced anovulation has been shown by spontaneous ovulation resumption 12-42 weeks after cessation. Tri-monthly injections of Depo Provera resulted in pregnancy rates averaging .5/100 woman-years of use. Biannual injectable and sustained release systems are discussed and data are presented.
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  19. 19
    730256

    Tentative inventory (by country) of commercial sector activity.

    Population Council

    [Unpublished] 1973 Apr. 33 p.

    A tentative inventory of 31 countries' efforts in commercial distribution of contraceptives is presented in outline form. Funding sources for each project are usually listed, as well as a very brief description of the project. Examples range from contraceptive distribution through a coupon system in Costa Rica to the marketing of condoms through barbershop promotion in Korea.
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