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Human Reproduction Update. 2003 Jan-Feb; 9(1):49-59.Progestogen-only implantable contraceptives are used by increasing numbers of women worldwide. This review outlines the evidence accumulated on these methods to date. Reviews of toxicological evaluations, clinical trials, endocrinological, epidemiological and social science studies, as well as operations research and economic evaluation were undertaken in preparation for an Expert Consultation convened by the World Health Organization in 2001. At the meeting, these reviews were further evaluated and the research results summarized in this consensus paper. A large body of evidence demonstrates the high contraceptive effectiveness and safety of the 5-year levonorgestrel-releasing implants Norplant and Jadelle. Information on the 3-year etonogestrel-releasing implant Implanon is more limited, but suggests that this implant has a high contraceptive effectiveness and a satisfactory safety pro®le. Information available on levonorgestrel-releasing implants manufactured and approved in China suggests that their clinical performance is satisfactory, but was insufficient to allow their full safety assessment. For all implants, there is insufficient information on their use by women with medical conditions. Provision of contraceptive implants requires good quality family planning services and specific provider training.
International Family Planning Perspectives. 2008 Jun; 34(2):98.Physical and sexual intimate partner violence may have lasting effects on a woman's health, according to a recent multicountry study by the World Health Organization. Compared with women who had never been abused, those who had suffered intimate partner violence had 60% greater odds of being in poor or very poor health, and about twice the odds of having had various health problems, such as memory loss and difficulty walking, in the past four weeks. (excerpt)
One Country. 2005 Oct-Dec; 10-13.This is a new way of thinking for many people in the 'traditional' education for sustainable development community, which has tended to be composed of people in higher education and focused on curriculum development, said Steve Cochran, who currently serves as "Interim Steward" of the United States Partnership for the Decade of Education for Sustainable Development. "The very notion of coming from the personal and intimate level of one's faith and building outward from there," added Mr. Cochran, "is one of the most effective ways to get people engaged." In the Baha'i community, the direction and scope of this effort was recently reflected at a two-day seminar held in December 2005 in this Florida resort city. Titled "Education for Sustainable Development: The Spiritual Dimension," the seminar drew some 50 participants from 10 countries, and featured a number of innovative brainstorming exercises designed to stimulate creative thinking and new approaches. Using innovative group process methodologies such as "World Cafe" and "Open Space Technology," the seminar sought to lead participants through a collective exploration of how Baha'i communities around the world could increase awareness of the need for sustainable development and better incorporate its concepts into their activities. (excerpt)
One Country. 2005 Oct-Dec; 2-3.In the face of urgent global problems like terrorism, HIV/AIDS, and severe poverty in Africa, it is sometimes hard to focus on the long term needs of humanity. But with the launch in 2005 of the United Nations Decade of Education for Sustainable Development, there is an opportunity to rethink the manner in which we approach long range global challenges. There are few issues more important to our collective future than sustainable development, a term which has over the years come to be understood as encompassing a whole range of issues that relate to the on-going success of humanity's stay on this planet. These issues certainly include environmental conservation and the challenge of appropriate development -- the two main planks of "sustainable development." But they also extend to the whole gamut of concerns relating to population and human consumption, human rights, women's advancement, food security, energy, industrial growth, urban planning -- and even issues of peace and security. (excerpt)
Evaluating a model for monitoring the virological efficacy of antiretroviral treatment in resource-limited settings. Authors' reply [letter]
Lancet Infectious Diseases. 2006 Jul; 6(7):387-388.We thank Duncan Smith-Rohrberg and colleagues and Stephen Lawn and co-workers for their comments concerning our algorithm and their pledge for the availability of more viral load testing in resource-limited settings. For the moment, however, we have to confront the reality faced by most countries struggling with antiretroviral treatment scale-up: viral load testing remains expensive, requires a well-equipped laboratory, well-trained personnel, and is not available in most resource-limited settings. For these reasons, WHO is still not recommending viral load tests for regular monitoring of antiretroviral treatment in resource-limited settings. Two randomised trials in Africa--the Centers for Disease Control and Prevention (CDC) study in Tororo, Uganda and the Development of Antiretroviral Therapy in Africa (DART) study in Uganda and Zimbabwe--were initiated in 2004, comparing clinical monitoring only with clinical and routine laboratory monitoring. Both studies are still ongoing, meaning the data safety monitoring boards have not stopped them because patients in the laboratory arm were doing better than patients in the clinical monitoring only arm. However, it is unlikely that these studies will provide a definite answer concerning the value of viral load testing to monitor antiretroviral therapy in resource-limited settings. Indeed, viral load testing is only done in one of the three study arms in the CDC Tororo study. Moreover, the primary outcomes of both studies are the development of an AIDS-defining illness or death and not drug resistance, a marker that may teach us more about the long-term outcome of the antiretroviral therapy. (excerpt)
Geneva, Switzerland, WHO, 2004 May 11.  p.This is a critical moment in the history of HIV/AIDS. There is more money, more political will and more attention being paid to this killer disease than ever before. And yet, more people than ever are dying of AIDS and becoming infected with HIV. By using HIV treatment programs to strengthen existing prevention programs and improve health systems, the international community has a unique opportunity to change the course of history, says The World Health Report 2004 - Changing History. WHO, UNAIDS and partners are implementing a comprehensive HIV/AIDS strategy which links prevention, treatment, care and support for people living with the virus. Until now, treatment has been the most neglected element in most developing countries. Yet among all possible HIV- related interventions, the report says it is treatment that can most effectively boost prevention efforts and in turn drive the strengthening of health systems and enable poor countries to protect people from a wide range of health threats. "At long last, global investment in health - and particularly in the fight against HIV/AIDS - is on the rise. It brings a welcome and long overdue improvement in the prospects for controlling the worst global epidemic in several centuries. The challenge now is to coordinate all our efforts and to ensure that this money benefits the people who need it most," said LEE Jong-wook, Director- General of the World Health Organization (WHO). (excerpt)
Lancet Infectious Diseases. 2004 Aug; 4:478.In order to meet the global need for immunisation against meningitis, India has decided to develop a meningitis vaccine. The Serum Institute of India (SII), a premier Indian organisation that claims to supply 75% of the measles vaccine needed worldwide by the United Nations Children's Fund, has signed an agreement with international Meningitis Vaccine Project (MVP), run globally by WHO and an international charity called Path. According to the agreement, the SII would produce a new conjugate vaccine for meningitis A, by combining the meningitis A polysaccharide with tetanus toxoid, through a new conjugation technology transferred from the Center for Biologics Evaluation and Research (CBER), part of the US Food and Drug Administration (FDA). Carl Frasch, an expert at the FDA, told TLID that, “SII would prepare the vaccine with raw materials coming from two sources: the group A polysaccharide would be produced under contract with SynCo BioPartners, a Dutch enterprise, and the SII itself would produce the tetanus toxoid carrier protein. (excerpt)
[Unpublished] 1991 May 9.  p.Norplant is an effective, long-lasting, reversible contraceptive that provides protection for five years. It consists of six thin, flexible Silastic capsules filled with 36 mg of levonorgestrel, inserted just under the skin of a woman's upper arm in a minor surgical procedure. To date (1991), more than 55,000 women in 46 countries have used it in clinical trials and pharmacological evaluations. The pregnancy rate is 0.2 per 100 continuing users for the first year. The most frequently reported side effect is change in the menstrual bleeding pattern. In addition, headache, nervousness, nausea, dermatitis, acne, weight gain, and some effects on hair as hirsutism and hair loss may be associated with Norplant use. The net continuation rate is over 77% of new acceptors the first year and 35% after five years. Any specially trained physician, nurse, nurse-midwife, or trained health worker can do insertions and removals. To make sure the woman is not pregnant, Norplant should be inserted within seven days after the onset of menstrual bleeding or immediately postabortion. Norplant may be used by almost any woman who is in good health. It is particularly suited for women who want long-term birth spacing or cannot use contraceptives that contain estrogen. It can also be an appropriate method for lactating women starting at least six weeks after childbirth. At present more than half a million women have used Norplant in countries where it has been approved for widespread distribution: Finland (1983); Sweden, Ecuador, Indonesia (1985); Thailand, Dominican Republic, Colombia (1986); Peru, Venezuela, Sri Lanka (1987); Chile (1988); and Kenya, China, Czechoslovakia (1990). Among several other countries, Haiti, Nepal, and Tunisia have also authorized Norplant in their national family planning program. With approval of Norplant by the United States Food and Drug Administration in 1990, the method faces potentially greater demand in the future.
London, England, IPPF, .  p.African and Arab women have developed programs against female genital mutilation (FGM). The International Planned Parenthood Federation supports these women as they train, educate, and inform other women about the harmful effects of FGM. The three types of FGM are sunna (foreskin of the clitoris is cut), excision (removal of the entire clitoris and usually the labia minora), and pharaonic or infibulation (removal of the clitoris, labia minora and majora, and sewing together the two sides of the vulva, leaving a small opening for urine and menstrual blood to pass). In Arab countries, Sub-Saharan Africa, Malaysia, and Indonesia, girls from one week old to adolescence are subject to FGM. Female natives of these countries who have migrated to Europe, Australia, or the US are also subject to FGM. More than 100 million living females have suffered FGM. Reasons for FGM differ and are linked to religion, culture, health, and morality. None of the reasons are based in science, logic, or religion, however. Short term risks of FGM include severe hemorrhage, tetanus and other infections, septicemia, shock, or death. It is often the case that several people hold the girl down with legs apart while an untrained traditional birth attendant or old woman performs FGM under unhygienic conditions, during which they use no anesthesia and unsterile instruments (e.g., broken glass). Chronic pelvic urinary tract infections, difficult intercourse, infertility, pregnancy loss, complications during delivery, and psychological and/or psychosexual problems are common long-term effects. Rapid economic growth, universal education, and global cultural changes have affected attitudes against FGM and efforts to rid the world of FGM. The World Health Organization released a statement condemning the practice of FGM by any health provider. Heads of State of Benin, Burkina Faso, Djibouti, Kenya, Mali, and Senegal have issued statements against FGM.
In: Annual technical report, 1992, [of the] World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Geneva, Switzerland, WHO, 1993. 23-36. (WHO/HRP/ATR/92/93)This 1992 annual report of the Task Force on Long-acting Systemic Agents for Fertility Regulation of the World Health Organization's Special Programme of Research, Development, and Research Training in Human Reproduction states that the main objectives of the Task Force are the development of new compounds and/or delivery systems which are superior to existing methods and which are easily delivered by family planning programs. Projects completed in 1992 include a major Phase III clinical trial comparing the once-a-month injectables (which induce regular monthly estrogen-withdrawal bleeding) Mesigyna and Cyclofem in 12 centers in Egypt, a Phase III clinical trial comparing these agents with the Chinese Injectable No. 1 in China, a multicenter study of the effects of Mesigyna and Cyclofem on lipid metabolism and on coagulation and fibrinolysis, and a study in Mexico of the return of fertility after discontinuation of the injectables. Also completed in 1992 were two studies on the pharmacokinetics of the injectables depot medroxyprogesterone acetate and norethisterone enanthate (NET) and a multicenter Phase II study comparing levonorgestrel butanoate (HRP002) to NET. Because of the favorable results of this last study, pharmacokinetic studies of an improved formulation of HRP002 are ongoing. A Phase III clinical trial of the vaginal rings in the UK revealed that a number of users developed vaginal lesions. This development will be given priority in further tests. Other ongoing and planned activities of the Task Force revolve around attempts to develop hormonal postpartum contraception which prevents exposure of breast-fed infants to synthetic steroids and attempts to deal with the problem of unpredictable endometrial bleeding associated with progestogen-only methods.
[Immunocontraception -- current research status] Immunkontrazeption -- jetziger Stand der Forschung.
GYNAKOLOGE. 1990 Jun; 23(3):178-83.In 1972, WHO advanced the idea of a safe and reversible birth control vaccine lasting 1-2 years. This contraceptive could utilize the connection of sperm antibodies and sterility by active immunization (foreign antigens) and passive immunization (monoclonal antibodies). After long experimentation, a vaccine was introduced in 1984 based on the carboxyl-terminal peptide (CTP) of the beta subunit of human chorionic gonadotropic (HCG) couples with a diphtheria toxoid (DT) and mixed with a muranyldipeptide (MDP) adjuvant called 109-145-CPT-beta- HCG:DT mixed with MDP. When given to baboons, the pregnancy rate fell to 4.6% vs. the 70% rate in untreated animals. Out of 15 women with previous tubal ligations, 14 showed production of specific antibodies: in Group A, 80 ug beta-HCG antigen was injected 4 times 2 weeks apart, while Group B received 240 ug only twice, 1 month apart. Side effects included edema, adnexal pain, DNA-antibody increase, plasmacortisone fluctuations, and liver enzyme changes. Later refinements eliminated blood chemistry changes, and injection 4 times produced specific antibody formation after 500 days. Immunization against follicle stimulating hormone (FSH) produced reversible sterility in rhesus monkeys after 4 and 1/2 years; however, the controversial role of testosterone in spermatogenesis terminated this approach. The inactivation of LDH-C4-lactatedehydrogenase produced only reduction of fertility in rabbits and baboons. However, 25 guinea pigs immunized twice, 1 month apart, with PH 20, a sperm-coating antigen, exhibited 100% infertility compared to the fact that 94% of untreated controls had a litter. Zona-pellucida antigens affected not only the egg cells but also the ovarian follicles. Among embryonal antigens, F-9-oncofetal antigens reduced fertility in mice but produced teratocarcinoma. Passive immunization by mono- and polyclonal antibodies against early- pregnancy factor terminated pregnancy in mice, suggesting another possible avenue for immunocontraception.
Estimates of long-term immigration to the United States: moving U.S. statistics toward United Nations concepts.
DEMOGRAPHY. 1992 Nov; 29(4):613-26.U.S. immigration data are revised to reflect the U.N. demographic concept of long-term immigration. Long-term immigration is measured by the number of new immigrants (permanent resident aliens) arriving in the year, temporary migrant arrivals (nonimmigrants) who subsequently adjust to permanent resident status, arrivals of asylees and refugees, and nonimmigrants who arrive during the year and stay for more than twelve months before departing. The estimates of long-term immigration for 1983 are compared to official INS statistics on alien immigration. Significant differences emerge according to country of origin, age, and state of intended residence. A method of producing current estimates of long-term immigration is illustrated. This is a revised version of a paper originally presented at the 1990 Annual Meeting of the Population Association of America. (EXCERPT)
CONTRACEPTIVE TECHNOLOGY UPDATE. 1992 Jan; 13(1):15-6.A recent World Health Organization (WHO) study found that women using Depo-Provera have only a slight increased risk of breast cancer. WHO examined case-control data from 5 hospitals in Africa, Mexico, and Thailand. The study revealed a 1.21 relative risk of breast cancer among all women in the study who had used Depo-Provera (a relative risk of 1.0 means that there is neither an increased or decreased likelihood to develop the disease in question). A relative risk of 1.21 indicates that there is a 21% increased likelihood of developing the disease, but any relative risk of less than 2.0 is considered slight. The study also found that among the diagnosed breast cancer cases, 12.5% had ever used Depo-Provera, compared to 12.2% among the control patients. Although an increased risk of breast cancer among women--especially women under 35--within the first 4 years of exposure to Depo-Provera was found, the risk did not increase with the duration of use, and it did not increase among women who had used the drug for more than 5 years. WHO explains that the risk of breast cancer among Depo-Provera user is similar to that found among oral contraceptives users, whose relative risk ranges from 1.0-1.42. Based on their findings, WHO investigators estimate that there would be 7-8 new cases of breast cancer per 100,000 Depo-Provera users annually, compared to 5 new cases annually among women who had not used the drug. As a recent commentary by Family Health International (FHI) points out, this increased risk of breast cancer must be weighted against the benefits provided by Depo-Provera. FHI concludes that there is a net gain for women using Depo-Provera, since despite the slight risk of breast cancer, it would result in a higher life expectancy compared to women not using contraception.
INTERNATIONAL MIGRATION REVIEW. 1991 Spring; 25(1):60-92.The United Nations has recommended the measurement of types of international migration using demographic criteria, including length of stay and purpose of travel. Information systems at the U.S. Immigration and Naturalization Service (INS) have the potential to provide a basis for documenting these demographic characteristics, in particular, length of stay of temporary migrants to the United States. This article analyzes these characteristics of selected categories of nonimmigrant aliens. The results of the analysis are used to produce series of estimates of alien immigration that conform more closely to the U.N. recommended definitions and better represent demographic concepts of long-term immigration. A strategy for measuring emigration of aliens from the United States using INS information systems is also described. (EXCERPT)
Breast cancer, cervical cancer, and depot medroxyprogesterone acetate. [WHO Collaborative Study of Neoplasia and Steroid Contraceptives] [letter].
Lancet. 1984 Nov 24; 2(8413):1207-8.This letter presents the preliminary findings of a collaborative, multinational, hospital-based, case-control study being conducted under the auspices of the World Health Organization to assess the influence of depot medroxyprogesterone acetate (DMPA) on risks of mammary, gynecological, and hepatobiliary malignancies. The frequency of ever-use of DMPA was greater in breast cancer cases (15/246, or 6,0%) than in controls (381/4162, or 9.2%). When adjusted for age, center, age of birth of 1st child, and nulliparity, the relative risk in women who had ever used DMPA was 0.7. The lowest risk was noted in women who had used DMPA for 3 or more years, but no decreasing trend in risk with duration of use was evident. The reducton in risk of breast cancer in DMPA users was largely confined to women with 1st exposure after age 30 years. In terms of cervical cancer, a history of DMPA use was reported by slightly more cases (67/469, or 14.3%) than controls (269/2704, or 9.9%). Use of oral contraceptives, number of cervical smears, and number of pregnancies were the variables most strongly related to cervical or having the greatest influence on relative risk estimates for users of DMPA. When controlled for these 4 factors and age and center, the relative risk in DMPA was 1.13. The highest relative risk was found in longterm users, although there was no clear trend of increasing risk with duration of DMPA use. These preliminary findings provide no evidence that DMPA increases the risk of breast cancer. The relative risk for cervical cancer for DMPA users obtained in this study could be due to chance or to incomplete control for the confounding effect of sexual variables. Although the absence of a trend of increasing risk with duration of use tends to rule out a causal connection between DMPA use and cervical cancer, the doubling of risk in women who used DMPA for 5 years or more is of potential concern.