Unintended pregnancy: Attitudes toward contraception of women obtaining abortions

Forty-nine percent of pregnancies in the United States are unintended and significant numbers of pregnancies are unintended for women of all ages. One possible reason for the high rate is that while 85% of women at risk for an unintended pregnancy use contraception, negative attitudes about the method used make them poor contraceptors. Negative attitudes may prevent the remaining 15% of women from using any method of birth control. This study examined adult women's attitudes toward contraception and its use to see if attitudes correlate with unintended pregnancy. ^ To obtain a sample of women experiencing unintended pregnancies, women obtaining therapeutic abortions were surveyed since almost all women obtaining therapeutic abortions are experiencing an unintended pregnancy. The study used a cross-sectional survey design and included 312 women obtaining abortions at the Planned Parenthood Surgical Services Clinic in Houston in the latter half of 1999. ^ The responses revealed a lack of knowledge about the safety and effectiveness of contraception, particularly for methods other than oral contraceptives and condoms. Thirty-four percent of the participants were uncomfortable buying contraception. While 71% of the participants said their physician recommended their use of contraception, 17% were unsure and 35% did not talk to their physician about contraception on a regular basis. ^ The attitudes of women using contraception were compared with those not using contraception and many differences were seen. Women not using contraception responded with more ‘unsure’ answers and believed contraception was more difficult to use. They felt planning ahead for the use of contraception interfered with the enjoyment of sex (p-value = 0.06). They were less likely to use contraception if their partner disapproved (p-value = 0.01) and more of them believed their church disapproved of contraception (p-value = 0.02). In comparison, women using contraception had negative attitudes about the safety of the pill (p-values = 0.01–0.08) and the effectiveness of the condom (p-value = 0.04). Therefore, the negative attitudes women using contraception had about contraception may interfere with their effective use of birth control. Those not using contraception were found to hold attitudes that may contribute to their non-use of contraception. ^

Clinical, microbiological, and immunological markers of gingival and periodontal disease induction and progression

The potential impact of periodontal disease, a suspected risk factor for systemic diseases, presents challenges for health promotion and disease prevention strategies. This study examined clinical, microbiological, and immunological factors in a disease model to identify potential biomarkers that may be useful in predicting the onset and severity of both inflammatory and destructive periodontal disease. This project used an historical cohort design based on data obtained from 47 adult, female nonhuman primates followed over a 6-year period for 5 unique projects where the ligature-induced model of periodontitis was utilized. Standardization of protocols for sample collection allowed for comparison over time. Bleeding and pocket depth measures were selected as the dependent variables of relevance to humans based upon the literature and historical observations. Exposure variables included supragingival plaque, attachment level, total bacteria, black-pigmented bacteria, Gram-negative and Gram-positive bacteria, total IgG and IgA in crevicular fluid, specific IgG antibody in both crevicular fluid and serum, and IgG antibody to four select pathogenic microorganisms. Three approaches were used to analyze the data from this study. The first approach tested for differences in the means of the response variables within the group and among longitudinal observations within the group at each time point. The second approach examined the relationship among the clinical, microbiological, and immunological variables using correlation coefficients and stratified analyses. Multivariable models using GEE for repeated measures were produced as a predictive description of the induction and progression of gingivitis and periodontal disease. The multivariable models for bleeding (gingivitis) include supragingival plaque, total bacteria and total IgG while the second also contains supragingival plaque, Gram-positive bacteria, and total IgG. Two multivariable models emerged for periodontal disease. One multivariable model contains plaque, total bacteria, total IgG and attachment level. The second model includes black-pigmented bacteria, total bacteria, antibody to Campylobacter rectus, and attachment level. Utilization of the nonhuman primate model to prospectively examine causal hypotheses can provide a focus for human research on the mechanisms of progression from health to gingivitis to periodontitis. Ultimately, causal theories can guide strategies to prevent disease initiation and reduce disease severity. ^

Use of contraception and contraceptive services among U.S. Hispanic women: 2006--2008

This study investigates the association between race/ethnicity and acculturation variables (language preference and nativity) with use of contraception and contraceptive services among Mexican/Mexican American and “other” Hispanic women aged 15-44 when compared to non- Hispanic white women.^ Data was analyzed from the 2006-2008 National Survey of Family Growth. The sample contained 3357 women aged 15-44. Multivariate logistic regression analysis was used to examine the association between race/ethnicity and acculturation variables and contraceptive-related behaviors adjusted for other known covariates. ^ After multivariate analysis, neither nativity nor language preference were significantly associated with contraception use or contraceptive services. Mexican/Mexican American women did not differ in their contraception-related behaviors when compared to non-Hispanic whites. Other Hispanic women, however, were less likely to obtain contraceptive services than non-Hispanic whites (OR=0.67, 95% CI=0.45-1.00). Women aged 30-39 and 40-44 were less likely to obtain contraception and contraceptive services than those aged 15-19. Single women were less likely to use contraception (OR=0.72, 95% CI=0.56-0.92) and contraceptive services (OR=0.69, 95% CI=0.53-0.89) than married/co-habiting women. Women with healthcare coverage were more likely to use contraception and contraceptive services than uninsured women.^ Among Hispanic women of different origin groups, age, marital status, and healthcare coverage were stronger indicators of contraception-related behavior than race/ethnicity, language preference, and nativity. Reproductive health programs that target increased use of contraception and contraceptive services among Hispanic origin groups should specifically target women who are over 30, single, and uninsured.^

Factors associated with contraception use among postpartum or parenting Latina adolescents: A systematic review

Despite advances in effective and long-acting contraceptive methods and the introduction into health care that an initial unplanned pregnancy allows, repeat unplanned pregnancy continues to affect Hispanic adolescents at a rate higher than that of non-Hispanic whites. The current study was undertaken to identify and categorize factors associated with uptake of long acting contraception (implant or intrauterine devices) or consistent use of highly effective methods (injectable DMPA, ring, patch, or pills), among Hispanic/Latina teens who have previously given birth. ^ I searched Ovid Medline, Pubmed, CINAHL, PsychINFO, POPLINE and Scopus, and reference lists for studies in English, ≥1980, of original data from the United States on factors related to initiation, maintenance, or discontinuation of contraceptive methods in postpartum or parenting adolescent females. I then identified articles that specified the inclusion of Hispanics/Latinas in the study population and either reported findings specific to race/ethnicity or used race/ethnicity as an independent variable in analyses of contributing factors. I then extracted data for each study and categorized independent variables as predisposing, enabling, or reinforcing following the PRECEDE model.1 Factors found to be associated with contraception use or non-use were combined to create a logic model of risk. ^ Of 9 eligible studies, one solely addressed initiation; one, initiation and maintenance; two, initiation and discontinuation; three, maintenance; and two, maintenance and discontinuation. There was some overlap in the studies' assessments of maintenance and discontinuation and the author(s) often did not distinguish between the two. Nearly all (k=7) were prospective observational studies with convenience samples and bivariate analyses (k=6). One study was initially a quasi-experimental design but became a prospective cohort due to extremely high attrition. Sociodemographic characteristics and predisposing factors were studied frequently, as were reinforcing factors; enabling factors were discussed infrequently and only in studies involving focus groups or interviews. Due to a paucity of research, a consensus of factors found consistently to influence the contraception behavior of postpartum Latina teens could not be established for the overall population nor for cultural subgroups. Future research is needed that focuses on postpartum/parenting Latina teens, with subgroup identification and differentiation, to determine the prevalent and pertinent predisposing, enabling, and reinforcing factors related to effective contraception initiation and maintenance.^

IMMUNOLOGICAL MECHANISMS OF EXTRACORPOREAL PHOTOPHERESIS IN CUTANEOUS T CELL LYMPHOMA AND GRAFT VERSUS HOST DISEASE

IMMUNOLOGICAL MECHANISMS OF EXTRACORPOREAL PHOTOPHERESIS IN CUTANEOUS T CELL LYMPHOMA AND GRAFT VERSUS HOST DISEASE Publication No.___________ Lisa Harn-Ging Shiue, B.S. Supervisory Professor: Madeleine Duvic, M.D. Extracorporeal photopheresis (ECP) is an effective, low-risk immunomodulating therapy for leukemic cutaneous T cell lymphoma (L-CTCL) and graft versus host disease (GVHD), but whether the mechanism(s) of action in these two diseases is (are) identical or different is unclear. To determine the effects of ECP in vivo, we studied regulatory T cells (T-regs), cytotoxic T lymphocytes (CTLs), and dendritic cells (DCs) by immunofluorescence flow cytometry in 18 L-CTCL and 11 GVHD patients before and after ECP at Day 2, 1 month, 3 months, and 6 months. In this study, ECP was effective in 12/18 L-CTCL patients with a 66.7% overall response rate (ORR) and 6/11 GVHD patients with a 54.5% ORR. Prior to ECP, the percentages of CD4+Foxp3+ T cells in 9 L-CTCL patients were either lower (L-CTCL-Low, n=2) or higher (L-CTCL-High, n=7) than normal. Five of the 7 GVHD patients had high percentages of CD4+Foxp3+ T cells (GVHD-High). Six of 7 L-CTCL-High patients had >80% CD4+Foxp3+ T cells which were correlated with tumor cells, and were responders. Both L-CTCL-High and GVHD-High patients had decreased percentages of CD4+Foxp3+ and CD4+Foxp3+CD25- T cells after 3 months of treatment. CD4+Foxp3+CD25+ T cells increased in GVHD-High patients but decreased in L-CTCL-High patients after 3 months of ECP. In addition, numbers of CTLs were abnormal. We confirmed that numbers of CTLs were low in L-CTCL patients, but high in GVHD patients prior to ECP. After ECP, CTLs increased after 1 month in 4/6 L-CTCL patients whereas CTLs decreased after 6 months in 3/3 GVHD patients. Myeloid (mDCs) and plasmacytoid DCs (pDCs) were also low at baseline in L-CTCL and GVHD patients confirming the DC defect. After 6 months of ECP, numbers and percentages of mDCs and pDCs increased in L-CTCL and GVHD. MDCs were favorably increased in 8/12 L-CTCL responders whereas pDCs were favorably increased in GVHD patients. These data suggest that ECP is favorably modulating the DC subsets. In L-CTCL patients, the mDCs may orchestrate Th1 cell responses to overcome immune suppression and facilitate disease regression. However, in GVHD patients, ECP is favorably down-regulating the immune system and may be facilitating immune tolerance to auto-or allo-antigens. In both L-CTCL and GVHD patients, DCs are modulated, but the T cell responses orchestrated by the DCs are different, suggesting that ECP modulates depending on the immune milieu. _______________

Advance provision of emergency contraception for pregnancy prevention (Review)

Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Thinking Ethically About Emergency Contraception.

http://www.chausa.org/docs/default-source/health-progress/hp1001l-pdf.pdf?sfvrsn=0

Contraception and induced abortion in the West Indies: a review

ANTECEDENTES: La mayoría de las islas en West Indies no tienen leyes liberales sobre el aborto, ni programas para la prevención del embarazo (contracepción). El presente trabajo presenta los resultados de una revisión de la literatura sobre la actitud de los proveedores del cuidado de la salud y las mujeres hacia la contracepción y el aborto inducido (emergencia), prevalencia, métodos y aspectos jurídicos del aborto inducido y políticas de prevención. MÉTODOS: Se obtuvieron artículos de PubMed, EMBASE, MEDLINE, PsychINFO y SocIndex (1999 a 2010) que usaban como palabras claves contracepción, aborto inducido, terminación de embarazo, aborto médico y West Indies. RESULTADOS: Treinta y siete artículos correspondían al criterio de inclusión: 18 sobre contracepción, 17 sobre aborto inducido y 2 sobre ambos asuntos. Los resultados principales indicaron que los conocimientos de los proveedores de cuidado de la salud acerca de la contracepción de emergencia, eran pobres. Los estudios mostraron un conocimiento pobre de la contracepción, pero las sesiones de counseling aumentaron su efectividad. No se encontraron números exactos sobre la prevalencia del aborto. Se estima que el número total de abortos por año en West Indies es de 300 000. Uno de cada cuatro embarazos termina en aborto. El uso de misoprostol disminuyó las complicaciones de abortos inseguros.La legislación sobre el aborto varía ampliamente en las diferentes islas del Caribe: Cuba, Puerto Rico, Martinica, Guadalupe y San Martín tienen abortos legales. Barbados fue la primera isla angloparlante con legislación liberal para el aborto. Todas las otras islas tienen leyes restrictivas. CONCLUSIÓN: A pesar del alto número de abortos, según se estima, no hay investigaciones sobre la prevalencia del aborto. Los estudios mostraron un pobre conocimiento de la contracepción y un uso bajo entre los adolescentes. La mayoría de las islas del Caribe tienen leyes restrictivas contra el aborto.

Caribbean initiative on abortion and contraception: Acercando el Caribe a América Latina en la lucha por el aborto seguro, Puerto Rico

Describe las actividades realizadas en la visita a la región del caribe Oriental con el propósito de actualizar la situación del aborto, parece ser un momento histórico muy particular en esta región del Caribe Oriental con una clara tendencia hacia la liberalización en lo que toca a la legislación sobre aborto. Dado el contexto particular de ser regiones geográficas pequeñas, donde la intimidad y estigma se ven más vulnerados, la colaboración internacional en lo tocante al tema del aborto es bienvenida y ciertamente podría contribuir a facilitar el diálogo entre los tres sectores más afectados las mujeres, profesionales de salud y el sector gubernamental

Specific therapy regimes could lead to long-term immunological control of HIV

We use mathematical models to study the relationship between HIV and the immune system during the natural course of infection and in the context of different antiviral treatment regimes. The models suggest that an efficient cytotoxic T lymphocyte (CTL) memory response is required to control the virus. We define CTL memory as long-term persistence of CTL precursors in the absence of antigen. Infection and depletion of CD4+ T helper cells interfere with CTL memory generation, resulting in persistent viral replication and disease progression. We find that antiviral drug therapy during primary infection can enable the development of CTL memory. In chronically infected patients, specific treatment schedules, either including deliberate drug holidays or antigenic boosts of the immune system, can lead to a re-establishment of CTL memory. Whether such treatment regimes would lead to long-term immunologic control deserves investigation under carefully controlled conditions.

Cytokine-mediated enhancement of epidermal growth factor receptor expression provides an immunological approach to the therapy of pancreatic cancer

The increased expression of epidermal growth factor receptor induced by tumor necrosis factor α renders pancreatic cancer cells more susceptible to antibody-dependent cellular cytotoxicity by a mAb specific for this receptor. Laboratory studies with athymic mice bearing xenografts of human pancreatic cancer cells demonstrated a cytokine-induced ability of the mAb to cause significant tumor regression. In a phase I/II clinical trial, 26 patients with unresectable pancreatic cancer were enrolled into three cohorts receiving variable amounts of the antibody together with a constant amount of tumor necrosis factor α. With increasing doses of antibody, the growth of the primary tumor was significantly inhibited. This was reflected by a longer median survival, with one complete remission lasting for 3 years obtained with the highest dose of antibody employed. Thus, a combination of the cytokine, tumor necrosis factor α, with a mAb to the epidermal growth factor receptor offers a potentially useful approach for the treatment of pancreatic cancer.

Immune surveillance against a solid tumor fails because of immunological ignorance

Many peripheral solid tumors such as sarcomas and carcinomas express tumor-specific antigens that can serve as targets for immune effector T cells. Nevertheless, overall immune surveillance against such tumors seems relatively inefficient. We studied immune surveillance against a s.c. sarcoma expressing a characterized viral tumor antigen. Surprisingly, the tumor cells were capable of inducing a protective cytotoxic T cell response if transferred as a single-cell suspension. However, if they were transplanted as small tumor pieces, tumors readily grew. Tumor growth correlated strictly with (i) failure of tumor cells to reach the draining lymph nodes and (ii) absence of primed cytotoxic T cells. Cytotoxic T cells were not tolerant or deleted because a tumor antigen-specific cytotoxic T cell response was readily induced in lymphoid tissue by immunization with virus or with tumor cells even in the presence of large tumors. Established tumors were rejected by vaccine-induced effector T cells if effector T cells were maintained by prolonged or repetitive vaccination, but not by single-dose vaccination. Thus, in addition to several other tumor-promoting parameters, some antigenic peripheral sarcomas—and probably carcinomas—may grow not because they anergize or tolerize tumor-specific T cells, but because such tumors are immunologically dealt with as if they were in a so-called immunologically privileged site and are ignored for too long.