Synthesis of Benzocycloalkanone-Based Michael Acceptors and Biological Activities as Antimalarial and Antitrypanosomal Agents.

A series of benzocycloalkanone derivatives have been prepared and evaluated as antimalarial and antitrypanosomal agents. The compounds were obtained by direct coupling of preformed 4-substituted benzaldehyde and indanone or tetralone substitutes through aldol condensation of Claisen-Schmidt using sodium hydroxide as a catalyst in ethanol at room temperature. Although designed to inhibit the formation of ß-hematin in vitro, only three compounds, 10, 11, and 12, showed activities greater than 50% (75.16%, 63.02%, and 56.17%, respectively). The results of the in vivo antimalarial evaluation show that 10, 11, and 12 reduced parasitemia marginally, and an insignificant increase in the days of survival of the mice was observed. As trypanocidals, all compounds showed marginal activity as inhibitors of the proliferation of T. cruzi epimastigotes, except compound 33, with an activity of 51.08 ± 3.4% compared to the activity shown by the reference compound benznidazole 59.99 ± 2.9%. The compounds appear to have little cytotoxic effect against VERO cells in vitro; this new class of Michael acceptor agents clearly warrants further investigation.

Hydroethanolic extract from Endopleura uchi (Huber) Cuatrecasas and its marker bergenin: Toxicological and pharmacokinetic studies in silico and in vivo on zebrafish.

Endopleura uchi, is used for the treatment of inflammatory disease and related to the female reproductive tract. The aim of this study was to evaluate the acute toxicity of the Endopleura uchi stem bark hydroethanolic extract (EEu) in zebrafish, emphasizing the histopathological and biochemical parameters, as well as evaluating the in silico pharmacokinetic and toxicological parameters of the phytochemical/pharmacological marker, bergenin, as their metabolites. The animals were orally treated with EEu at a single dose of 75 mg/kg, 500 mg/kg, 1000 mg/kg and 3000 mg/kg. the oral LD50 of the EEu higher to the dose of 3000 mg/kg. Behavioral, biochemical and histopathological changes were dose dependent. In silico pharmacokinetic predictions for bergenin and its metabolites showed moderate absorption in high human intestinal absorption (HIA) and Caco-2 models, reduced plasma protein binding, by low brain tissue binding and no P-glycoprotein (P-Gp) inhibition. Their metabolism is defined by the CYP450 enzyme, in addition to bergenin inhibition of CYP2C9, CYP3A4 and CYP2C19. In the bergenin and its metabolites in silico toxicity test it have been shown to cause carcinogenicity and a greater involvement of the bergenin with the CYP enzymes in the I and II hepatic and renal metabolism's phases was observed. It is possible to suggest that the histopathological damages are involved with the interaction of this major compound and its metabolites at the level of the cellular-biochemical mechanisms which involve the absorption, metabolization and excretion of these possible prodrug and drug.

Regioselectivity of glycosylation reactions of galactose acceptors: an experimental and theoretical study.

Regioselective glycosylations allow planning simpler strategies for the synthesis of oligosaccharides, and thus reducing the need of using protecting groups. With the idea of gaining further understanding of such regioselectivity, we analyzed the relative reactivity of the OH-3 and OH-4 groups of 2,6-diprotected methyl α- and ß-galactopyranoside derivatives in glycosylation reactions. The glycosyl acceptors were efficiently prepared by simple methodologies, and glycosyl donors with different reactivities were assessed. High regioselectivities were achieved in favor of the 1→3 products due to the equatorial orientation of the OH-3 group. A molecular modeling approach endorsed this general trend of favoring O-3 substitution, although it showed some failures to explain subtler factors governing the difference in regioselectivity between some of the acceptors. However, the Galp-(ß1→3)-Galp linkage could be regioselectively installed by using some of the acceptors assayed herein.

Overcoming Aminoglycoside Enzymatic Resistance: Design of Novel Antibiotics and Inhibitors.

Resistance to aminoglycoside antibiotics has had a profound impact on clinical practice. Despite their powerful bactericidal activity, aminoglycosides were one of the first groups of antibiotics to meet the challenge of resistance. The most prevalent source of clinically relevant resistance against these therapeutics is conferred by the enzymatic modification of the antibiotic. Therefore, a deeper knowledge of the aminoglycoside-modifying enzymes and their interactions with the antibiotics and solvent is of paramount importance in order to facilitate the design of more effective and potent inhibitors and/or novel semisynthetic aminoglycosides that are not susceptible to modifying enzymes.

Metabolic Pathways for Degradation of Aromatic Hydrocarbons by Bacteria.

The aim of this review was to build an updated collection of information focused on the mechanisms and elements involved in metabolic pathways of aromatic hydrocarbons by bacteria. Enzymes as an expression of the genetic load and the type of electron acceptor available, as an environmental factor, were highlighted. In general, the review showed that both aerobic routes and anaerobic routes for the degradation of aromatic hydrocarbons are divided into two pathways. The first, named the upper pathways, entails the route from the original compound to central intermediate compounds still containing the aromatic ring but with the benzene nucleus chemically destabilized. The second, named the lower pathway, begins with ring de-aromatization and subsequent cleavage, resulting in metabolites that can be used by bacteria in the production of biomass. Under anaerobic conditions the five mechanisms of activation of the benzene ring described show the diversity of chemical reactions that can take place. Obtaining carbon and energy from an aromatic hydrocarbon molecule is a process that exhibits the high complexity level of the metabolic apparatus of anaerobic microorganisms. The ability of these bacteria to express enzymes that catalyze reactions, known only in non-biological conditions, using final electron acceptors with a low redox potential, is a most interesting topic. The discovery of phylogenetic and functional characteristics of cultivable and noncultivable hydrocarbon degrading bacteria has been made possible by improvements in molecular research techniques such as SIP (stable isotope probing) tracing the incorporation of (13)C, (15)N and (18)O into nucleic acids and proteins. Since many metabolic pathways in which enzyme and metabolite participants are still unknown, much new research is required. Therefore, it will surely allow enhancing the known and future applications in practice.

Timing of onset of contraceptive effectiveness in Depo-Provera users: Part I. Changes in cervical mucus.

OBJECTIVE: To evaluate the changes in cervical mucus within the first hours or days after depot medroxyprogesterone acetate (MPA) injection so as to estimate the time at which cervical mucus becomes hostile enough to prevent pregnancy. DESIGN: Multicenter, clinical descriptive study. SETTING: Family planning clinic. PATIENT(S): Thirty women who were between days 8 and 13 of their menstrual cycle and who had requested Depo-Provera were enrolled in the study. INTERVENTION(S): Cervical mucus and blood samples were obtained; transvaginal ultrasonography was performed. MAIN OUTCOME MEASURE(S): Cervical mucus scores, sperm penetration distances, ovarian follicular size, and serum levels of progesterone and estradiol. RESULT(S): From 6 to 24 hours after injection, there was a sharp decline in the cervical mucus score for most of the subjects. All subjects exhibited poor mucus on day 3 after injection, and by day 7, all subjects had zero scores, with the exception of two outliers on each day. Sperm penetration, as measured by the vanguard sperm distance, was already poor (< 1 cm) in 7 of the 30 subjects at the time of injection and was reduced progressively up to 24 hours after injection, when only four subjects had a sperm penetration of > 1 cm. A rapid decline in the estimated number of sperm was observed at 12 hours and more so at 24 hours in the majority of subjects. CONCLUSION(S): The data presented in this report confirmed that depot MPA causes profound changes in cervical mucus after injection. Although very little change was seen at 6 hours, alterations were observed subsequently, with 90% of the subjects showing a poor cervical mucus score 24 hours after administration of the progestin. No reliable clinical marker is available to identify in which women depot MPA might exert its effect on cervical mucus within 3 days. Thus, we believe that at present, women should be informed of this uncertainty and should use a backup method of contraception for 7 days when the first injection of depot MPA is provided after the seventh day of the menstrual cycle.

PIP: More accurate knowledge of the time of onset of cervical mucus changes after Depo-Provera injection would enable family planning providers to counsel new acceptors to use a backup method only for the amount of time it is really needed. To obtain such data, 30 women from a family planning clinic in Campinas, Brazil, who requested Depo-Provera in 1995-96 were recruited. At baseline, 11 women had a poor cervical mucus score (0-4), 12 had a fair score (3-8), and 7 scored in the good range (9-12). Between 6 and 24 hours after injection, a sharp decline occurred in the cervical mucus score in all but 3 patients (each of whom had a "good" score at baseline). On day 3, 29 women had "poor" mucus and the remaining woman had a cervical mucus score in the fair range. By day 7, 29 women had zero mucus scores; the score in the last woman was 1. 24 hours after injection, sperm penetration (measured by vanguard sperm distance) had decreased to under 1 cm in all but 4 women. At day 3, 1 of the 2 women with good penetration at 24 hours maintained a vanguard sperm distance of 2.5 cm and an estimated sperm count of 15,363. By day 7, sperm penetration was zero in all but 1 woman (0.5 cm). These findings confirm that depot medroxyprogesterone acetate causes profound changes in cervical mucus after injection. The lack of a more complete hostility to sperm penetration at day 3 was unexpected, however. Given the nonavailability of a reliable clinical marker to verify a contraceptive effect at 3 days, it seems prudent to advise new Depo-Provera acceptors to use a backup method for the first 7 days.

Contraception and culture: the use of yuyos in Paraguay.

The use of herbs (yuyos) as contraception is common practice in Paraguay. This report analyzes data from the 1995-1996 Paraguayan Reproductive Health Survey. The analysis reveals that women are more familiar with yuyos (88%) than any other method of family planning. Modeling the determinants of ever having relied on yuyos as contraception demonstrates that older women (OR = 1.043) and women with more children (OR = 2.283) are significantly more likely to have used yuyos, but an interaction between older women with more children shows they are less likely to have used this method (OR = .982). Women living in rural areas (OR = .664) and those with more education (OR = .883) are less likely to have used the method. These findings show widespread acceptance and use of yuyos for contraception in Paraguay. More research into the chemical properties of yuyos is needed to determine their contraceptive efficacy and to prevent harmful effects from their misuse.

PIP: According to the 1995-96 Paraguayan Reproductive Health Survey of 6465 reproductive-age females, women are more familiar with herbs (yuyos) than any other method of contraception. These herbs are prepared most frequently as teas and drunk every day. 88% of respondents were aware of yuyos. Bivariate analysis indicated that current yuyo users were geographically isolated, older, less educated, poorer, and more likely to speak Guarani in the home than non-users. In the multivariate analysis, ever-use of yuyos was significantly associated with older age (odds ratio (OR), 1.043) and more children (OR, 2.283), while high education (OR, 0.883) and urban residence (0.664) were inversely related to ever-use. Since no protocol exists for yuyo use for contraception, indigenous women rely on word-of-mouth advice and may be at risk of toxic side effects from improper use. Needed, to reduce this risk, are research studies on the use of herbs in other countries for contraceptive purposes and more rigorous testing of the chemical agents found in plants used for fertility control. If efficacy is discovered, additional research is recommended to identify the conditions under which and for how long yuyos should be taken for contraception or menstrual regulation. Any program that builds on yuyo use to promote use of modern contraceptive methods must proceed in a culturally sensitive way.

Sterilization for family planning in a Third World country.

Outpatient laparoscopy procedures have made sterilization possible for millions of women in developing countries. This report describes the experience of a team of doctors, nurses, and support staff that performed 107 laparoscopic tubal sterilizations during on eight-day sojourn in a remote north-central area of Nicaragua. Minimal analgesia (oral ibuprofen) and anesthesia (1% lidocaine) were used since most of the patients walked to and from the hospital-some up to 15 miles. Because the Nicaraguan government's support for birth-control programs is unreliable and because illegal abortion is the leading cause of maternal mortality in Nicaragua, this safe, minimally invasive surgical method is the favored means of birth control.

PIP: During an 8-day visit to Jalapa, Nicaragua, in 1996, a Short-Term Volunteers in Mission team from Minnesota, US, performed 107 outpatient laparoscopic sterilizations and 14 vasectomies in this remote town near the Honduran border. Standard medical procedures were modified to adapt to the inadequate medical facilities and large patient load. The mean age of female sterilization acceptors was 28.92 years; they had an average of 4.4 living children. 75% lived in or near the town and walked a total of 1 hour or less to and from the hospital; another 20% walked an average of 4 hours round trip. Because of the women's need to walk home after the procedure, local anesthesia (1% lidocaine) was administered in conjunction with oral ibuprofen. More than 75% of acceptors experienced mild or no intraoperative pain and were sent home right after the procedure; 20% reported moderate pain and 3% severe pain, but in all cases the pain dissipated within 10-45 minutes. The length of time from admission to discharge averaged 45 minutes (range, 25-75 minutes). Civil war, overpopulation, and severe poverty limit the ability of government-sponsored programs to deliver family planning services consistently. Thus, sterilization is an ideal method of fertility control for appropriate candidates.

Self-administration with UniJect of the once-a-month injectable contraceptive Cyclofem.

The objective of this study was to evaluate women's acceptance of and ability to self-administrate the injectable contraceptive Cyclofem using prefilled UniJect devices. A total of 102 women were invited to participate in the study. Fourteen women (13.7%) refused to participate. Of the remaining 88 women, 32 women (31.4%) consented to participate and were trained using oranges but were still afraid of the procedure and ultimately refused to self-administer the injections. Only 56 women (55%) ultimately self-injected Cyclofem with UniJect. They performed a total of 144 injections, all of them on the ventral side of the thigh. When nurses evaluated women's ability to activate the devices, they found that more than 80% were successful in both the group of women that later self-administered the injections and the group that did not. The evaluation of the self-administered injection technique showed that more than 90% of the women correctly self-administered the contraceptive using UniJect. With respect to the opinion of the women about the self-administration of the contraceptive, more than 50% (32 of 56) of women who self-injected preferred to self-administer the injection and said that they wished to continue with the self-administration, one-third (17) reported that they were afraid, and seven women (12.5%) expressed the opinion that the injection in the thigh was more painful than the administration in the buttocks or arm. In conclusion, our study showed that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to UniJect.

PIP: Women's capability to self-administer the monthly injectable contraceptive, Cyclofem, through use of prefilled UniJect devices was evaluated in 88 volunteers recruited from three Brazilian health clinics. After training in self-injection in which oranges were used for practice, only 56 of these women (55%) elected to continue with the study. They performed a total of 144 injections on the ventral side of the thigh. When nurses evaluated women's ability to activate the UniJect device, they found more than 80% of women trained in the method and 93% of those who actually performed self-injection used the technique correctly in an angle of 90 degrees. 32 (57.1%) of the 56 women who self-injected indicated they preferred this method and wished to continue to self-inject at home, another 17 (30.4%) reported they liked the method but were afraid to perform it on their own, and seven (12.5%) complained of pain associated with injection in the thigh compared with the buttocks or arm. Self-administration of injectable contraception, a popular method in Latin American countries, has the potential to increase contraceptive coverage as well as reduce costs associated with transportation to a source of contraception. If women are to perform self-injection at home rather than at a clinic, they will require reminders about the dates of reinjection and the importance of aseptic procedures and proper disposal of injecting equipment.

Results of a user satisfaction study carried out in women using Uniplant contraceptive implant.

A study of the acceptability of Uniplant, a 12-month single implant of nomegestrol acetate, included 819 women from Africa, Latin America, and China, participating in a clinical trial of Uniplant. A standard, pre-coded questionnaire was specially designed for this purpose and applied at the moment of removal of implant, either at the end of 12 months of use or at the time of discontinuation for whatever reason. The level of satisfaction proved high when users' comparison with their previous contraceptive method, users' recommendation of Uniplant to others, users' intention to use the method in the future, and service satisfaction were taken into consideration. Uniplant was considered easy to use, safe (low risk of pregnancy), and also to cause fewer side effects than other methods. When asked about the least liked feature of Uniplant, almost half the respondents said that there was nothing that they disliked and about one-third mentioned the changes in their menstrual pattern. However, according to the clinical trial, over half of the Uniplant users have bleeding patterns similar to untreated cycles. The majority of respondents did not feel any discomfort during the procedure of insertion and removal of the implant. About 70% of patients in the study stated that they required contraception for more than one year and most of these women said that they did not mind having to change the implant every year.

[Characteristics of Norplant users in Lima, Peru]. / Caracteristicas de las usuarias del Norplant en Lima-Peru.

PIP: The 832 women who accepted Norplant implants at three hospitals in Peru between December 1988 and February 1991 participated in a study of Norplant method acceptability and user characteristics. The women were seen 1, 3, and 6 months after insertion and every 6 months thereafter. They ranged in age from 18 to 40 years and averaged 28. Nearly 78% had completed secondary school or had higher education. The average number of children was 2.1, and 87% had 3 or fewer children. 30.1% of the women had had 1 abortion, 13.0% had had 2, 2.2% had had 3, and 1.1% had had 4 or more. 47.3% of the women had previously used oral contraceptives or IUDs, 13.1% had used rhythm, 11.2% had used condoms or vaginal methods, 4.9% had used injectables, 1.6% had used other methods, and 21.9% had used no method. 47.9% stated they wanted no future pregnancies, 37.4% wanted to wait at least 3 years, and 6.3% were uncertain. Menstrual problems were the major side effect reported. 22 of the 71 removals were motivated by headaches, 18 by menstrual problems and 13 by medical problems. The continuation rate at 12 months was 88.75%. No pregnancies occurred.^ieng

Family planning goes public.

PIP: The Center for Family Orientation (COF), a private family planning agency with clinics in 8 provinces of Bolivia, initiated a bold, scientifically planned, and successful mass media campaign in 1986. As late as 1978 the Bolivian government had been hostile to COF. The Johns Hopkins University/Population Communication Services helped COF determine that the Bolivian public and its leaders were open to more information about family planning. Bolivia, the poorest Latin American country, then had 7 million people, expected to double in 27 years. There are 2 distinct indigenous groups, the Aymara and the Quechua, and Spanish-speaking people, centered in the cities of La Paz, Cochabamba, and Santa Cruz, respectively. Only 4% of couples use modern family planning methods. Initial surveys of 522 opinion leaders, 300 family planning users, focus groups of users, and a population survey of 1300 people in 8 provinces showed that 90% wanted modern family planning services. Radio was chosen to inform potential users about COF's services, to increase clinic attendance, and to involve men. To obtain support from public leaders, 10 conferences were held. The 1st series of radio messages focused on health benefits of family planning and responsible parenthood; the 2nd series gave specific benefits, information on child spacing, breast feeding, and optimal ages for childbearing. Besides 36,800 radio spots broadcast on 17 stations, booklets, posters, calendars, promotional items, and audiotapes to be played in public busses, were all designed, pretested, and revised. New acceptors increased 71% during the 11-month campaign. Success of the project influenced the start of the National Reproductive Health Project and new IEC efforts planned through cooperation of public and private institutions.^ieng

Race, integration and family planning in Trinidad and Tobago.

"The study considered the effect of the integration of the health services on family planning in Trinidad and Tobago. A drop-out study was based on a sample of six clinics, three representing integrated and three clinics that were non-integrated or vertical. Efforts were also made to solicit the views of a sample of drop outs, current acceptors and health-care providers. The study found that there were characteristics of the population from which acceptors were drawn that were more important in explaining utilization than the question of integration or non-integration of the clinics. Many of the problems were organizational and could, with adequate financing, be met by an even higher level of integration."

A comparison of the performance of male and female CBD distributors in Peru.

This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

PIP: The findings of an operations research (OR) project designed to compare the effectiveness of male vs. female contraceptive distributors in Peru are reported. The OR project was conducted by 2 private, nonprofit family planning agencies that have community-based distribution (CBD) programs: PROFAMILIA in Lima and CENPROF in Trujillo. The OR project sought to test 3 hypotheses: 1) male distributors would sell more condoms and female distributors would sell more oral contraceptives; 2) male distributors would serve more male clients and female distributors would serve more female clients; and 3) male distributors would sell less contraceptive protection than female distributors. Between 1987 and January 1988, the 2 agencies recruited new male and female distributors to serve in the project. Both agencies had a more difficult time recruiting male than female distributors. PROFAMILIA recruited 38 men and 171 women, while CENPROF recruited 52 men and 94 women. All but one of the supervisors in both agencies were female. The supervisors generally regarded the male distributors with skepticism, but the study found no significant difference in the reporting compliance of male and female distributors. The project confirmed hypotheses 1 and 2. In both agencies men sold twice as many condoms as did women, and women sold more oral contraceptives; and male distributors were more likely to serve men, while female distributors were more likely to serve women. The 3rd hypothesis, however, was unsupported. Men sold as much or more contraceptive protection than did women and recruited as many or more new acceptors. It is concluded that men can be effective CBD distributors, and that CBD programs can influence method and client mix by recruiting more men as distributors.

Association between contraceptive method accepted and perception of information received: a comparison of Norplant and IUD acceptors.

In the present study Norplant(R) and IUD acceptors who attended the same counseling sessions have been compared on their perception of the information received at the family planning clinic. The study covered 100 acceptors of each method quota matched by parity and years of schooling. Data were obtained through home interviews. The two groups presented no significant differences when selected socio-demographic characteristics were analyzed. Norplant users recalled more information on this method than did IUD acceptors, and the content of what they remembered was different. This included concepts as important as risk of pregnancy, menstrual and health effects, and method of removal. The results suggest that the intrinsic qualities of the new method and the presence of a group of women motivated to use one with its general characteristics, are not sufficient conditions for its acceptance.

PIP: In this study, Norplant (R) and IUD acceptors who attended the same counselling sessions have been compared on their perceptions of the information received at the family planning clinic. The study included 100 acceptors of each method quota matched by parity and years of schooling. Data were obtained through home interviews. The 2 groups presented no significant differences when selected sociodemographic characteristics were analyzed. R users recalled more information on this method than did IUD acceptors, and the content of what they remembered was different. This included concepts as important as risk of pregnancy, menstrual and health effects, and method of removal. Results suggest that the intrinsic qualities of the new method and the presence of a group of women motivated to use 1 with its general characteristics are not sufficient conditions for its acceptance.

Timing of postpartum tubal sterilization using the Filshie clips: an analysis of data from two developing-country centers.

Two-hundred-ninety-seven women at a Panamanian center and 148 women at a Philippine center had their tubal sterilization performed during their postpartum hospital stay after an uncomplicated vaginal delivery of a live birth. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilization varied from two hours to six days after delivery. At each of the two centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures and lengths of hospitalization after sterilization and before discharge. The one-year gross cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the two timing groups at each center. While the data suggest that tubal sterilizations by the Filshie clip performed two to six days following childbirth are as safe and effective as those performed within 48 hours of delivery, further studies are urged.

PIP: 297 women at a Panamanian center and 148 women at a Philippine center had their tubal sterilizations performed during their postpartum hospital stays after uncomplicated vaginal deliveries of livebirths. The sterilizations were all performed with the use of the Filshie clip via minilaparotomy. The timing of the sterilizations varied from 2 hours-6 days after delivery. At each of the 2 centers, women sterilized within 48 hours after delivery were compared with those sterilized at 49 or more hours with respect to surgical difficulties, tubal injuries, complications/complaints, technical failures, and lengths of hospitalization after sterilizations and prior to discharge. The 1 year grossed cumulative pregnancy rates were also compared. No significant differences were detected in any of the above outcome variables between the 2 timing groups at each center. While the data suggest that tubal sterilizations by Filshie clip performed between 2-6 days postpartum are as safe and effective as those performed within 48 hours of delivery, further studies are necessary.

An evaluation of Profamilia's female sterilization program in Colombia.

The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.

PIP: Profamilia is a nonprofit, private family planning organization based in Bogota, Colombia. To improve program performance, the findings of 3 surveys and 3 studies were used by Profamilia to evaluate and improve their female sterilization (FS) program. The surveys measured socio- demographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost- effectiveness analysis. Results of the projects were used by the Profamilia movement to identify areas of program strengths and weaknesses and to implement operational changes. In 1970, Profamilia offered vasectomy; FS was offered in 1972. The vasectomy program was ineffective; however, FS was very successful. Approximately 72% of all procedures performed in Colombia are done by Profamilia. In 1972, 2 Colombian gynecologists, (1 from Colombia) were trained in Colombia to do FSs by doctors from Johns Hopkins Hospital. At present, Profamilia uses about 40 doctors directly, and contracts with others. Program evaluation is done by using cost-effectiveness evaluation to measure financial efficiency, survey analysis to measure general program efficiency and client satisfaction, and collection of service statistics to measure program output. The 1st survey was done in 1976 and 1977 to learn about user characteristics. The 2nd project was a 2-phase (retrospective-prospective) survey carried out in 1978-83. In 1985, Profamilia decided to do a follow-up survey in conjunction with Association for Voluntary Surgical Conception (AVSC). It emphasized factors influencing the decision to be sterilized. Sterilization acceptors were interviewed in 8 clinics in a nonrandom sample. 3 cost- effectiveness studies have been done on Profamilia's FS program. A departmental study determined the cost per couple year of protection offered by the 5 service departments of Profamilia; an accounting study determined the full unit cost per sterilization; and an organization-wide cost study determined how to assign indirect and shared costs of support divisions to service departments like sterilization.

How one postpartum program works.

PIP: The Mexican Institute of Social Security (IMSS) provides a postpartum family planning program offering information and available contraceptive options. 356,000 postpartum women received contraception through this program in 1989. It is estimated that 136,000 of these women would not have received any contraception without the assistance of this postpartum program. 40% of the family planning services in Mexico are currently being provided by IMSS. Contraception is recommended for postpartum women with and without reproductive risk factors. Staff training, prenatal contraceptive counseling, and selection of contraceptive methods are essential in implementing a successful program. IMSS consists of 311,000 employees, 900 outpatient clinics, and 200 hospitals offering obstetrical and gynecological services. Counseling is provided in prenatal care regarding available contraceptive methods and their side-effects. Available methods offered through IMSS postpartum services include IUDs, female sterilization, and progestin-only oral contraceptives. In 1989, 79% of urban contraceptor acceptors chose IUDs, 30% chose sterilization, and 1% chose the mini- pill. IMSS hopes to expand this selection to include injectables, implants, and male sterilization. Future expansion of these new methods is dependent upon physicians accepting and encouraging their use.^ieng

An assessment of contraceptive need in the inner city.

A survey of low-income areas of Los Angeles County indicates that 41 percent of nonsterile women in their childbearing years who had not made a family planning visit in three years were using some means of birth control, 21 percent were not, 25 percent were not sexually active and 13 percent were pregnant or trying to become pregnant. Given that approximately 10 percent of the respondents were using unreliable means of contraception, at least one-third of respondents were in need of effective contraception. This proportion corresponds roughly to the percentage of respondents who expressed a desire to receive family planning care from a doctor or clinic (34 percent). The percentage of women who were at risk of unwanted pregnancy but not using any method of contraception was greatest among those with incomes below poverty level and among black and Hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a family planning visit shows that those who utilized formal family planning services were substantially more likely than those who did not to be married (40 percent vs. 32 percent) and to belong to a health maintenance organization (24 percent vs. 14 percent), whereas nonusers of formal family planning services were slightly older, on average (29.6 years vs. 28.0 years), and more likely to have other types of private health insurance (47 percent vs. 25 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A survey of low-income areas of Los Angeles County indicates that 41% of nonsterile women in their childbearing years who had not made a family planning (FP) visit in 3 years were using some means of births control, 21% were not, 25% were not sexually active and 13% were pregnant or trying to become pregnant. Given than approximately 10% of the respondents were using unreliable means of contraception, at least 1/3 of respondents were in need of effective contraception. This proportion corresponds to the % of respondents who expressed a desire to receive FP care from a doctor or clinic (34%). The % of women who were at risk of unwanted pregnancy, but not using any method of contraception was greatest among those with incomes below poverty level and among black and hispanic women. A comparison of survey respondents to a parallel sample of low-income women who had made a FP visit shows that those who utilized formal FP services were more likely than those who did not to be married (40% vs. 32%) and to belong to a health maintenance organization (24% bs. 14%), whereas, nonusers of formal FP services were slightly older, on average (29.6 vs. 28 years) and more likely to have other types of private health insurance (47% vs. 25%). In addition, 95% of those who were at risk of unintended pregnancy and who had made a FP visit were practicing contraception compared with 67% of women at risk of unintended pregnancy who had not made a visit. (Author's modified).