Emergency contraception in a country with restricted access to contraceptives and termination of pregnancy, a prospective follow-up study.

OBJECTIVE: Poland has a restrictive abortion law. Emergency contraception (EC) is expensive and available only on prescription, which is not easily obtainable in public health care. We aimed to identify the main reasons for EC requests, observed failure rates and the type and incidence of adverse effects. DESIGN: Prospective single-center observational study. POPULATION: A cohort of women living in Warsaw, who requested EC. METHODS: Data were collected via a questionnaire completed by healthcare providers prescribing EC, and included age, date of the request, previous EC use, time from intercourse to clinic visit and day of menstrual cycle on which intercourse took place. MAIN OUTCOME MEASURES: Reason for EC request, time lapse between unprotected intercourse and EC use, age of women requesting EC, reported cases of pregnancy. RESULTS: A total of 4655 women requested EC. Of these 62.9% (n = 2928) were ≤25 years old. During follow up, 0.75% (31 individuals) became pregnant. Adverse effects of hormonal EC were rare and mild. The main reason for requesting EC was problems associated with condoms (63.2%, n = 2609). The mean interval between unprotected intercourse and EC use was 21.2 h, but 26.7 h when EC failed (n.s.). Considering intake within and after 24 h, the difference was significant (p < 0.05). CONCLUSIONS: Women living in Warsaw seeking EC used the EC product very soon after unprotected intercourse, and this was probably one of the most important reasons for the low pregnancy rates in the studied population.

Risk of cancer development in relation to oral contraception.

Combined oral contraceptives (COCs) are among the most widely used effective and reversible means of family planning. Their beneficial effects are well documented, but many questions are still raised concerning a possible association between the use of COCs and the development of cancer. The authors provide a broad and up-to-date review of the literature regarding the relation between COC use and carcinogenesis in different organs. Studies have not unequivocally confirmed that such a relation exists with regard to breast cancer. Much research focused on the influence COC use could have on the incidence of cervical cancer; most of it was analyzed by J. Smith and co-workers. These authors confirmed the existence of a weak relation between COC use and the development of cervical carcinoma, especially in women using COCs for longer periods. Ovarian carcinoma has the worst prognosis of all cancers of reproductive organs in women. The risk of developing ovarian cancer in women using COCs is at least 40% smaller than in other women; the degree of protection given by COCs is directly proportional to the duration of use of this form of contraception. Reliable scientific data prove convincingly that the risk of endometrial cancer is smaller in women who used COCs than in women who never took them.

[The diagnosis of hyperprolactinemia in clinical practice]. / Diagnostyka hiperprolaktynemii w praktyce klinicznej.

Prolactin is a pituitary hormone that plays pivotal role in a variety of reproductive functions. Hyperprolactinemia is a common condition that can result from a number of causes; including use of medications and hypothyroidism, as well as pituitary disorders. Depending on the cause and consequences of hyperprolactinemia, selected patients require specific treatment. The underlying cause of hyperprolactinemia, sex, age and reproductive status must be considered. Management of this condition depends heavily on the cause and on the effects it has on the patient. The definition of the hyperprolactinemia is not uniformed, and in various clinical settings various criteria of this status are used. In the identification of hyperprolactinemia not only simple measurements of the prolactin serum level are used, the dynamic tests with the use of dopamine antagonists have a special role as well. Neither the measurement of the serum prolactin level, nor dynamic tests with dopamine antagonists are able to determine the presence of macroprolactin molecules in the serum, and this can lead clinicians to establish the false diagnosis of hyperprolactinemia.

[The effectiveness and acceptability of oral contraceptives (Logest), containing 20 micrograms ethinylestradiol and 75 micrograms gestodene]. / Badanie skutecznosci i akceptacji stosowania pigulek antykoncepcyjnych Logest, zawierajacych 20 g etynyloestradiolu i 75 g gestodenu.

OBJECTIVES: The aim of the study was to evaluate the efficacy and acceptability of the use of oral contraceptives Logest, containing 20 micrograms ethinylestradiol and 75 micrograms gestodene (in one tablet). DESIGN: Observational study (during the period of six months) on the healthy women visiting gynecological clinics and asking for establishment of contraception with the use of oral contraceptives. MATERIALS AND METHODS: The observation was carried out on 800 patients who were included (with use including/excluding criteria) to the study. The study was carried out during the period of October 1999-March 2001. Patients were asked to use the Logest intermittently during the period of 6 months (21 days of administration followed by 7 days break, and than again 21 days of administration etc). The administration of Logest was followed up. Basic examination and qualification for the use of oral contraceptive was taken during the first visit. Re-examinations were taken after 3 and 6 month of usage of the study drug. RESULTS: High efficacy, good tolerance and acceptability of Logest administration was observed. Neither cases of non effectiveness, nor serious adverse events, during the Logest administration were reported. CONCLUSIONS: 95.7% of the patients which completed the study, declared that the oral contraception with use of Logest was "very well accepted" or "well accepted".

[Identification of risk factors of obesity in premenopausal women]. / Identyfikacja czynników ryzyka wystapienia otylosci u kobiet przed menopauza.

UNLABELLED: Obesity is a chronic disease conditioned by genetic, endocrine and environmental factors. The aim of study was to determine the risk factors affecting the body mass in women. MATERIAL AND METHODS: The questionnaire investigations involved 363 female volunteers aged 18-49. The questionnaire contained items referring to the environmental factors which might affect body mass (e.g. age, increase in body mass after the age of 18, number of child-births, body mass increase after child-birth, use of oral contraceptives, obesity in childhood, obesity in family, smoking and concomitant diseases). Statistica for Windows was used for analysis, with statistically significant differences at p<0.05. Logistic regression was used for multivariate analysis. RESULTS: Rapid body mass increments occurred in the young women who were overweight already in childhood. Another high risk group was constituted by women who reported considerable body mass increments during the first pregnancy. 39.9% of the examined women took contraceptive pills, however the application of oral contraception had no significant influence on the body mass increase. The body mass gain after the age of 18 was observed to positively correlate with age. CONCLUSION: Overweight in childhood or excessive body mass increment during pregnancy are risk factors of obesity in the later period of life.

Non-effective partner notification system: a missed opportunity for the reduction of sexually transmitted infections in sub-Saharan Africa.

UNLABELLED: It is well know that common sexually transmitted infections (STI) promote HIV/AIDS infections in the community. Partner notification is one of the recommended strategies used for STI control. Antenatal syphilis screening, treatment of syphilis-positive pregnant women and their partner (partners) treatment may decrease the number of new syphilis cases, cases of congenital syphilis and diminish maternal morbidity and mortality. OBJECTIVE: The aim of the study was to assess the adequacy and effectiveness of partner notification and treatment system of rapid plasma reagin (RPR) positive patients of antenatal clinics (ANC) in Swaziland as an example of a country in sub-Saharan Africa. MATERIAL AND METHODS: It was a prospective study of the incidence of syphilis in the group of pregnant women attending antenatal clinics (ANC), and a study of the results of their partners' notification. The data for this study were collected prospectively from routine records of ANC attendees. RESULTS: The positive Rapid Plasma Reagin (RPR) test was established in 19% (n = 2034) screened patients. 38% out of all RPR-positive patients were not informed of their RPR status. The typical syphilis treatment was given in 42% of all RPR-positive pregnant women. Only 5% of partners of the RPR-positive pregnant women were traced, checked and correctly treated. CONCLUSIONS: The usual way of syphilis screening and partner notification in a country like Swaziland is not effective, and there is a need to develop other, African-specific methods of syphilis screening and partners' notification. Most probably without the effective STI management in Africa the battle against HIV/AIDS epidemic will be extremely difficult if not impossible.

[Depot medroxyprogesterone acetate (DMPA) injectable contraception--safe, effective but neglected method of family planning in Poland]. / Octan medroksyprogesteronu podawany domiesniowo--skuteczna ale rzadka forma antykoncepcji.

As it is known from demographical prognosis for Poland, in the nearest years significant increase of the number of women in the childbearing age is expected (reflecting high, postwar, demographical wave). In spite of that, the prognosis of the number of live births is low, and does not exceed 450 thousands. The reason for this phenomenon is the change of life style among young people. They postpone delivery of the first baby, and use modern contraceptives. It is also expected that the number of women using modern contraceptives (especially combined oral contraceptives: estrogen + progestin) should significantly rise. It is well known, that with the age of a woman, there is an increasing number of contraindications for the estrogen use. It is the sufficient reason to think about alternate methods of contraception. DMPA (DEPO-PROVERA-150) is the very effective and safe method of family planning. It is used in many countries all over the world, since the sixties, but it is almost unknown in Poland. The use of DMPA is not reserved only for special cases. After many years of experience, it is possible to select the best candidates for this injectable contraception (patients with contraindications for estrogens, lactating women, smokers--especially over 35 years of age etc). DMPA appears to be acceptable method of fertility regulation. Clinical evidence after more than 30 years of use shows no additional adverse effects and possibly fewer than in the case of other hormonal methods of contraception. The particular advantages of DMPA, as a highly effective, long-lasting and reversible contraceptive, make it important option for Polish women, desiring a modern method of fertility regulation.

Effects of low-dose OCs on weight in women with Central European nutritional habits and lifestyle.

The aim of the study was to evaluate the acceptance and tolerance of combined low-dose oral contraceptives (OCs) (containing 20 micro g ethinylestradiol and 75 micro g gestodene) in a cohort of Polish women, and to present a relationship between the use of combined OCs and changes in body weight. Changes in body weight with combined low-dose OC have not been demonstrated in placebo-controlled trials, nor were such trials performed in a population whose nutritional/dietary habits and lifestyle resemble that of the population of Poland. We performed the clinical study on a group of 800 patients living in several regions of Poland. Patients used the low-dose OC for a period of 6 months. They were assessed every third cycle of OC use (initial examination and examinations after three and six cycles of OC use). On the basis of this investigation, a relationship between OC use and weight gain was not found.

Survey on maternal mortality in Swaziland using the sisterhood method.

Monitoring and evaluating maternal mortality in African countries is impossible without specific and reliable data and indicators. This study of maternal mortality using the 'Sisterhood Method' was undertaken in Swaziland. The crude data on 'sisterhood mortality' were obtained from the 1993-94 Multi-Purpose Household Survey carried out by the Central Statistics Office and Ministry of Health of Swaziland. A total fertility rate of 6.36, as given in the 1986 Swaziland census, was used in estimating these indicators. Prior to this study, the maternal mortality rate (MMR) in Swaziland (based only on health facility data) was considered to lie within the range of 107-125 maternal deaths per 100 000 live births. Use of the 'Sisterhood Method' allowed a more precise estimate of maternal mortality for the general population of Swaziland. The study revealed the estimated MMR to be 229 and the life-time risk of maternal death to be 1 in 69. These values were most probably stable throughout the 6- to 7-year period before the survey.

[Evaluation of patients' satisfaction in relation to private or public health care providers]. / Ocena poziomu satysfakcji pacjentów z uslug swiadczonych w publicznych i niepublicznych zakladach opieki zdrowotnej.

The aim of the study was to evaluate of patients satisfaction in relation to private or public health care provider in the Warsaw's (capital of Poland) region. The authors have used original (partially psychometric test) tool named "Skala AB". 590 adult patients were randomly chosen from 20 private and public owned clinics and hospitals. Main outcome of the study was that patients of private owned clinics (but working on contract with general health insurance system) are much more satisfied from the services provided by these clinics than patients treated by local government-owned clinics. In general patients treated in hospitals were more satisfied than patients treated in clinics. Comparison of more detailed determinants of satisfaction, has shown that all health service facilities in study region, in their practices do not consider the "concentration on real needs of patients" as a serious matter and this is the reason of patients dissatisfaction. Level of satisfaction from the services provided by health care facilities did not correlate with gender or age of the respondents. In opposite, the (higher) level of education and place of living (in a big city) have negatively correlated with patients satisfaction. The tool ("Skala AB") used in this survey was found very convenient for evaluation of the patients satisfaction of services provided by health care facilities.