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The Population Council's International Committee on Contraceptive Research has been working on an alternative hormonal contraceptive in the form of a vaginal contraceptive ring. The ring is 58 mm in diameter and consists of a core of Silastic covered by a thin layer of levonorgestrel and estradiol and an overcoat of silicone rubber. The ring is inserted into the vagina on the 5th day of the menstrual cycle and withdrawn 3 weeks later for 1 week. The contraceptive steroids are released from the Silastic at a regular rate and readily absorbed through the vagina. Thus, the blood levels of contraceptive hormones reached during the use of the ring are sufficient to prevent ovulation but do not exhibit the great daily variations commonly observed in women on oral contraceptives (OCs). There are sufficient hormones in the ring to provide 6 months of contraception. Preliminary research on Swedish and other developed country women indicates that the ring is as effective as, and safer than, OCs. The International Development REsearch Center supported a study to determine the ring's acceptability in practice. It was carried out by the National Council on Population and the Family, Santo Domingo, Dominican Republic, and the Centre for Research on Maternal and Child Health, Campinas, Brazil. The ring was offered, along with other methods, in a number of clinics in each country where prescriptions, instruction, and follow-up were the responsibility of paramedical personnel. The study involved an observation period during which 150-200 ring acceptors in each country were to be enrolled and matched with OC users. Findings indicated that ring users were slightly older than OC acceptors and that they and their partners tended to have more education. 10% of ring users complained of difficulty associated with insertion, 20% of difficulty with removal. 43% worried about correct placement. Twice as many ring users reported menstrual problems, but a larger percentage of OC users (26%) than ring users (17%) reported having other problems, such as headaches. Regarding satisfaction with the method, a larger percentage of the ring users (17%) considered their experience "very good," but the general level of satisfaction with both methods was similar. The information obtained from the study provides important data for the final design of the new method and the instructions that will accompany it.
Asian Pac Popul Programme News 1984 Dec
PMID:The hormonal ring: a new contraceptive gains acceptance. 1231 3

In Viet Nam, health workers conducted focus groups with women seeking pregnancy termination at 2 rural district hospitals in Thai Binh Province and at 2 urban district hospitals in Hanoi to learn why contraceptives failed and why some of these women did not use contraceptive. Researchers used information from the focus groups to design questions for a July-September 1991 survey of 2088 women seeking an abortion at all 9 rural district hospitals in Thai Binh Province and at 5 district hospitals in Hanoi. 85.3% of the women were married and lived with their husbands. Most women were eligible for menstrual regulation (53.7% in Hanoi and 64.9% in Thai Binh). 50% of all women (52.8% in Hanoi and 47.4% in Thai Binh) had had at last 1 prior pregnancy termination (1.6 pregnancy terminations/woman), suggesting that induced abortion is being used as a substitute for family planning methods. Effective modern contraceptive use by 50% of these women would have reduced the number of abortions during the 3 months by 25%. 36.8% (54.7% in Hanoi and 19.9% in Thai Binh) used traditional family planning methods. 38.3% (25.7% in Hanoi and 49.9% in Thai Binh) did not use any method. The leading reason for not using oral contraceptives (OCs) were personal health problems, unavailability, and the perception that contraceptives were bad for one's health. For IUDs, they were bleeding, lumbago, headache, loss of energy, and dizziness. For condoms, reasons for nonuse were disliked by one spouse and unavailability. Women's fear and husband's disapproval were key reasons for not choosing sexual sterilization. Reasons for failure of condoms, IUDs, and OCs were irregular use (62.6%) and poor quality (27.9), retained but still missed menstruation (74.3%), and used irregularly (23/28), respectively. The researchers recommended using these findings to develop an IEC campaign and training curricula for health workers.
Asia Pac Popul J 1993 Dec
PMID:Pregnancy termination and contraceptive failure in Viet Nam. 1231 41

This report summarizes the findings of a study designed to identify the reasons for non-use of family planning among Nepalese women who want to space or limit childbirth. The study's initial phase involved focus group sessions of women with unmet need for family planning who were asked their reasons for non-use. Researchers used this information to develop an in-depth questionnaire. Researchers then randomly selected a total sample of 5,152 women. After interviewing the women, researchers concluded that 31.6% the sample had unmet need for family planning. Consequently, researchers administered the questionnaire to the unmet demand population, which was almost equally divided among women who want to either spacing or limit childbirth. The study analyzes both reasons for the general non-use of contraception and reasons for the non-use of specific contraceptive methods (oral contraceptives, laparoscopy, and vasectomy). Although varying among the different contraceptive methods, the most commonly cited reasons were: 1) causes headache, weakness, nausea; 2) causes weight loss; 3) causes heavy bleeding; 4) insufficient money for nutritious foods; 5) causes weakness and cannot work; 6) currently in poor health; 7) husband disapproves; and 8) affects breastfeeding and dries breast-milk. Explaining the benefits of the study, the report indicates that the information can be incorporated into the training curriculum of health workers, and can be used to target information, education, and communication campaigns. Furthermore, evident in the responses that cite lack of nutritious foods and weakness, the study reveals that nutrition and food supplement programs could help increase contraceptive use.
Asia Pac Popul J 1991 Mar
PMID:The KAP-gap in Nepal: reasons for non-use of contraception among couples with an unmet need for family planning. 1234 62

The objective of this study was to identify sociodemographic, work, living arrangement and lifestyle factors associated with morbidity of electronics women workers in selected factories in Selangor, Malaysia. The research design was a cross-sectional questionnaire-based survey. Most of the 401 respondents were young single Malay women. Morbidity was high as 85.5% of the women reported experiencing at least one chronic health problem, and 25.7% said that an illness or injury prevented them from carrying out normal activities within the last two weeks. Major acute illness symptoms were the common cold, backache, and diarrhoea while chronic health problems such as persistent headache, eye problems, menstrual problems, and persistent backache were also reported. After logistic regression, chronic health problems was significantly associated with room sharing; while illness that prevented normal activities within the last two weeks was significantly associated with overtime work and exercise. Further research is recommended to understand the complex inter-relationship between morbidity and working and living conditions.
Asia Pac J Public Health 2002
PMID:Work and lifestyle factors associated with morbidity of electronic women workers in Selangor, Malaysia. 1286 11

During July/August 2005, Palau hosted the VII South Pacific Mini Games. With an expected influx of at least 2000 athletes and visitors, the Palau Ministry of Health (MOH) decided to operate under an Emergency Incident Command Structure for the duration of the event. Surveillance for infectious diseases and injury was carried out under this framework by the Epidemiology/Intelligence team (Epi Team) established for the event. Health providers traveling with visiting teams or working in Koror were requested to complete daily log sheets of encounters using standardized case definitions. These sheets were collected each evening, either from designated "drop-off" points or directly from the team accommodation, and entered into a Microsoft Access database. Reports were generated and reviewed each morning to provide current statistics for the Incident Command meeting and determine further actions as appropriate. 912 games related encounters were recorded. 19.5% (178) of these presentations were at MOH operated facilities or field teams. The remaining 80.5% presented to visiting medical delegations. 689 (75.5%) of the presentations were considered to be "initial" visits, with the remainder recorded as follow-up visits. Of these "initial" visits the most common diagnoses were injury, prevention (massage or strapping), upper respiratory illness, headache, and dehydration. There were no outbreaks of infectious disease detected during the games. Although several issues with the surveillance methodology arose during the games, the event highlighted the importance of good communication and a flexible team approach in carrying out effective surveillance. It is recommended that future events adopt a similar approach, with a strong emphasis given in the planning stages to establishing direct contact between the staff responsible for surveillance and field and visiting health personnel.
Pac Health Dialog 2005 Sep
PMID:Disease surveillance during the VII South Pacific Mini Games, Palau 2005--lessons learnt. 1818 89

Menstrual pain (dysmenorrhea) is one of the main complaints in clinics for women. The pain is often accompanied by other symptoms such as headache, nausea, constipation or diarrhea, urinary frequency, and vomiting which often leave the patients incapacitated for work or school for a few days. Dietary supplementation with polyunsaturated fatty acids (PUFA) has been shown to alleviate the menstrual pain. The purpose of the present study was to compare the effect of dietary supplementation with PUFA (sunflower seed oil, borage oil and fish oil concentrate) for three months on RBC membrane fatty acid composition in healthy and dysmenorrheica young women. Conversion of linoleic acid, via gamma-linolenic acid, to dihomo-gamma-linolenic acid (a precursor of anti-inflammatory prostaglandin E1) in dysmenorrheic subjects as compared to the controls was slower whereas the level of arachidonic acid (a precursor of pro-inflammatory PGE2) was not affected by the supplementation. Since there are no known side-effects associated with supplementation of these nutrients, management of dysmenorrhea through nutrition modulation should be an acceptable alternative to drug treatments.
Asia Pac J Clin Nutr 2008
PMID:Metabolism of omega-6 polyunsaturated fatty acids in women with dysmenorrhea. 1829 41

Myasthenia gravis (MG) is an autoimmune disease. Approximately 15% of patients with MG have thymoma. Approximately 30% to 40% of them are invasive. A 26-year-old man was admitted with cough and difficulty breathing. He had transsternal thymectomy resulting from MG accompanied by thymoma 6 years previously. Thorax computerized tomography (CT) scans showed metastases to the extra-mediastinum. Diagnosis of invasive thymoma was made by CT-guided biopsy. A PAC regimen (cisplatin, doxorubicin, cyclophosphamide) and radiotherapy were added to MG treatment. Ten months later, he presented again with headache, weakness, and difficulty swallowing. We determined that he had intracranial multiple metastases. He was hospitalized. Cerebral multiple metastases were evaluated as inoperable. However, he died of transtentorial herniation after 1 month. This MG case accompanied by invasive thymoma with multiple intracranial metastases is discussed.
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PMID:Myasthenia gravis and invasive thymoma with multiple intracranial metastases. 1907 11

The parasympathetic nervous system is probably involved in migraine pathogenesis. Its activation releases a mixture of signalling molecules including vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP), which subsequently stimulate VPAC(1), VPAC(2) and PAC(1) receptors. The objective of the present study was to investigate the in vivo effect of VIP, PACAP-27, PACAP-38, the selective VPAC(1) agonist ([Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27)) and a PAC(1) agonist, maxadilan on rat middle meningeal artery (MMA) diameter using the closed cranial window model. Selective antagonists were used for further characterization of the responses. Reverse transcriptase-polymerase chain reaction experiments were also conducted to determine expression of mRNA of PACAP receptors in the MMA. The results showed that VIP, PACAP-38, PACAP-27 and the VPAC(1) specific agonist evoked significant dilations with the rank order of potency; VIP = PACAP-38 > PACAP-27 = [Lys15, Arg16, Leu27]-VIP(1-7)-GRF(8-27). Significant inhibition of dilation was only observed for the VPAC(1) antagonist PG97-269 on PACAP-38-induced dilation of MMA. The VPAC(2) antagonist PG99-465 and PAC(1) antagonist PACAP(6-38) did not significantly block VIP- or PACAP-induced dilation. Expression of mRNA of all three receptors was detected in the MMA. In conclusion, the VPAC(1) receptor seems to be predominant in mediating MMA dilation. A selective VPAC(1) antagonist may be a candidate molecule in the treatment of migraine headache.
Cephalalgia 2009 Aug
PMID:The in vivo effect of VIP, PACAP-38 and PACAP-27 and mRNA expression of their receptors in rat middle meningeal artery. 1922 Mar 6

The aim of this descriptive, cross-sectional study was to determine information requirements of patients with typical meningiomas after surgery. The study sample consisted of 20 patients who underwent surgery for brain tumours in neurosurgery clinics of a university hospital. Permission to conduct research was obtained from all patients and from the hospital. Before the surgery, a booklet was given to patients for training. Patients were followed up one, three, six and 12 months later by the phone after the surgery and asked to report their problems. All questions were recorded and answered. Data were collected by the socio-demographic, patient symptom and health status questionnaire. Descriptive data were analyzed using percentage and arithmetic averages. Comparative statistics were evaluated using chi-square. Patients wanted information about diet, physical therapy and rehabilitation, quick thinking difficulties, fasting, headache, irritability, personality change, fatigue, driving, deep vein thrombosis during the follow up. There was a significant difference between their health status and fear of seizures and recurrent tumor, forgetfulness, lack of concentration (p < 0.05). Although they received health education and booklet, patients needed more information during the 12 months after surgery. Therefore it suggested that monitoring the patient's needs is necessary.
Asian Pac J Cancer Prev 2011
PMID:Information needs of patients with meningiomas. 2154 9

Vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating peptide (PACAP) are potent vasodilators in animals and humans. PACAP infusion but not VIP infusion precipitates migraine attacks in migraine patients. The vascular effects of VIP and the two varieties of PACAP (PACAP-27 and PACAP-38) were investigated versus selective antagonists in segments of rat middle cerebral arteries (MCA), basilar arteries (BA) and middle meningeal arteries (MMA) using myographs. The luminal and abluminal effects of VIP were studied using perfusion myograph. mRNA expression of the relevant receptors (VPAC(1), VPAC(2) and PAC(1)) was examined by in situ hybridization. There was no significant difference in relaxant potency of the peptides in the MCA. In BA the relaxant potency was VIP>PACAP-27=PACAP-38. Relaxant responses were either absent or very weak in MMA. VIP was found to be somewhat more potent in BA than in the MCA. Maxadilan, a selective PAC(1)-receptor agonist, showed no relaxant effect in either vessel. The VPAC(2)-antagonist PG 99-465 alone proved ineffective in the MCA, while it had a weak effect on BA. The VPAC(1)-antagonist PG 97-269 inhibited relaxation induced by both VIP and the PACAPs in cerebral vessels. In combination, the two antagonists demonstrated better effect than either alone. VIP applied luminally via perfusion myograph caused no dilatation, indicating lack of endothelial involvement. In situ hybridization demonstrated the presence of mRNA for all three receptors in the smooth muscle cells of the vessels. In conclusion, migraine-like headache induced by PACAP-38 infusion is unlikely to be caused by direct vasodilator action on intracranial vessels.
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PMID:Pharmacological characterization and expression of VIP and PACAP receptors in isolated cranial arteries of the rat. 2191 46


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