The recent increase in contraceptive discontinuation in Egypt.

This study sought to establish whether recent changes in discontinuation of contractive use and switching in Egypt can be considered an important cause of the unexpected increase in overall fertility and slight fall in contraceptive prevalence in the country. The analysis was based on calendar data from the 2008 and 2014 Egyptian DHS. Single/multiple decrement life tables were built to calculate contraceptive discontinuation rates and examine these by reasons for discontinuation focusing on three methods: IUDs, pills and injectables. The unit of the analysis was 'segment of use', defined as a continuous period of use/non-use of a contraceptive method (in months). It was found that over the period 2008-2014 the rise in the 'all method' discontinuation rate was mainly due to the shift away from IUDs to hormonal methods, which have higher discontinuation rates. Segments of use were more likely to be discontinued for 'method/service-related' reasons than for 'reduced need' reasons. This was due to an increase in contraceptive failure and side-effect/health concerns. Also, 'the desire to get pregnant' increased to become the second highest reason-specific discontinuation rate. This has coincided with a recent increase in ideal family size in Egypt. About half of the women who reported discontinuing for reasons related to method/services switched to another method, while the rest became subject to the risk of an unintended pregnancy. The rate of switching, rather than stopping use, increased for IUDs, remained the same for pills and increased slightly for injectables, indicating an improvement in switching behaviour. However, a marked high percentage of switchers moved to less-effective methods. If these issues are not addressed, many women in Egypt have an unmet need for contraception, leading to an increase in unintended pregnancies. Specific interventions that would greatly benefit the family planning programme in Egypt include improvement in counselling at the time of IUD insertion and removal and the reduction in failure rates for hormonal methods.

Sex differences in striatal dopamine release in young adults after oral alcohol challenge: a positron emission tomography imaging study with [¹¹C]raclopride.

BACKGROUND: We used a positron emission tomography paradigm with the D2/3 radiotracer [¹¹C]raclopride and an alcohol challenge to examine the magnitude of alcohol-induced dopamine release and compare it between young men and women. METHODS: Twenty-one nonalcohol-dependent young social drinkers completed two positron emission tomography scans on separate days following ingestion of a juice mix containing either ethanol (.75 mg/kg body water) or trace ethanol only. The extent of dopamine released after alcohol was estimated by the percentage difference in [¹¹C]raclopride binding potential (ΔBP(ND)) between days. RESULTS: Alcohol administration significantly displaced [¹¹C]raclopride in all striatal subregions, indicating dopamine release, with the largest effect observed in the ventral striatum. Linear mixed model analysis across all striatal subregions of regional ΔBP(ND) with region of interest as repeated measure showed a highly significant effect of sex (p < .001). Ventrostriatal dopamine release in men, but not in women, showed a significant positive correlation to alcohol-induced measures of subjective activation. Furthermore, we found a significant negative correlation between the frequency of maximum alcohol consumption per 24 hours and ventrostriatal ΔBP(ND) (r = .739, p = .009) in men. CONCLUSIONS: This study provides definitive evidence that oral alcohol induces dopamine release in nonalcoholic human subjects and shows sex differences in the magnitude of this effect. The ability of alcohol to stimulate dopamine release may contribute to its rewarding effects and, thereby, to its abuse liability in humans. Our report further suggests several biological mechanisms that may mediate the difference in vulnerability for alcoholism between men and women.