Some methodological considerations of a progestin-only oral contraceptive study from a programmatic perspective.

Among the limited number of reports on progestin-oral contraceptives (POCs), noncomparative studies conducted at family planning clinics have been the most often reported. This research trend will probably continue. Generally, noncomparative studies address a number of practical issues on POC use, and such studies have made important contributions to the understanding of this contraceptive modality.

What we have learned from recent IUD studies: a researcher's perspective.

Many studies published on intrauterine devices (IUDs) during the last six years have consistently reported findings in favor of IUD use. Notable among these findings are: IUDs are not abortifacients; newly developed IUDs are highly effective and the efficacy is long-lasting; IUDs can be safely used by most lactating women, with lower removal rates attributable to bleeding and/or pain; and immediate postplacental IUD insertion reduces the risk of expulsion usually associated with postpartum insertion. Most importantly, in apparent contrast to results often reported in the late 1960s through the early 1980s, recent findings show that IUDs per se, especially the medicated ones, are not associated with an increased risk of pelvic inflammatory disease (PID), nor are they associated with an increased risk of ectopic pregnancy or subsequent infertility.

The TCu-380A (AG), MLCu375, and Nova-T IUDs and the IUD daily releasing 20 micrograms levonorgestrel--four pillars of IUD contraception for the nineties and beyond?

With recent studies repeatedly showing results clearing the IUDs from their formerly suspected role in causing pelvic inflammatory disease (PID), very likely IUD use will further increase worldwide. While most previous IUDs have been withdrawn from the US market during the 1980s, newer and more effective IUDs have subsequently been developed; and some, marketed. Four of these devices will probably become the pillars for future IUD contraception worldwide.

The safety and efficacy issues of progestin-only oral contraceptives--an epidemiologic perspective.

Progestogen-only oral contraceptives (POCs) are generally considered a good contraceptive choice for brestfeeding women and for women who want to use an oral form of contraception, but are not suited for, or cannot tolerate the side effects of, estrogen-containing preparations. However, a number of POCs' safety, efficacy and other related issues remain to be addressed. This paper reviews recent literature and evaluates these issues from an epidemiologic perspective.

Postpartum tubal sterilisation: an international perspective on some programmatic issues.

The demand for postpartum sterilisation (performed within 42 days after delivery), is increasing both in developed and developing countries. The incidence of regret after postpartum sterilisation is important, but it could be minimised by carefully screening risk factors. Using trained paramedical personnel to perform postpartum sterilisation via minilaparotomy where physicians are in short supply appears to be safe and acceptable, under close medical supervision.

Immediate postpartum intrauterine device insertion--a report on the Chinese experience.

Immediate postplacental insertion (IPPI) of the intrauterine device (IUD) has been practiced in China for at least 17 years. This presentation reviews and integrates the clinical experiences of IPPIs at five Chinese centers. The stainless-steel ring IUD was the most commonly used device for this procedure.

Risk factors for copper T IUD expulsion: an epidemiologic analysis.

Little is known of the factors associated with expulsion of intrauterine devices (IUD). We conducted a nested case-control study to examine the risk factors for copper T IUD expulsion using data from a multicenter international clinical trial. We included 70 cases with expulsion and 1,536 controls, and we examined a variety of characteristics of the IUD wearers.

The multiload IUD--a U.S. researcher's evaluation of a European device.

This evaluative review focused on the performance and safety of the Dutch-made Multiload copper IUD, primarily the Multiload-375 (MLCu-375) model which has a longer life expectancy (5 or more years) than the Multiload-250 (MLCu-250) model, usually cited for a life expectancy for three years. This copper-medicated IUD differs from the copper-T IUDs in shape and insertion technique. The review shows that (a) the MLCu-375 IUD seems to be slightly less effective in preventing pregnancies than TCu-380A IUD.

Conducting a hospital-based case-control study of the relationship between vasectomy and cardiovascular disease in Korea--an experience in an Asian setting.

An increasing number of case-control studies are being performed in the developing world. This paper describes the difficulties and advantages the author has experienced in conducting a hospital-based case-control study in the Republic of Korea testing the hypothesis of whether vasectomy is associated with subsequent cardiovascular disease. This experience should provide a useful reference for researchers planning studies using a similar approach in an Asian setting.

The progestin-only oral contraceptive--its place in postpartum contraception.

The progestin-only oral contraceptive (POC) is not a widely-used method of contraception, possibly due to competition from other contemporary contraceptive methods or misunderstanding and prejudices among clients and/or service providers. Because of its underuse, the POC, as a contraceptive method, is under-studied. This article evaluates the general merits of the POC and its disadvantages relative to combined oral contraceptives (COCs) and other contraceptive methods, specifically during the postpartum period and particularly for breastfeeding women.

Performing tubal sterilizations during women's postpartum hospitalization: a review of the United States and international experiences.

A considerable number of tubal sterilizations have been performed while women are still in hospital after delivery in the United States as well as in other countries. There are few review papers exclusively on this sterilization modality. This paper provides a comprehensive review of results reported from recent studies of this approach, and answers the pertinent medical and related questions such as: To achieve maximum safety, what is the best time to perform the procedure during the women's postpartum hospitalization? Specifically, is it advisable for the procedure to be performed while the woman is still on the delivery table? What surgical approach and tubal occlusion technique are preferred? What are the risks that the women undergoing sterilization immediately or soon after delivery may incur the short- and long-term medical sequelae, and to conceive accidental pregnancy? What effect does sterilization have on lactation? And how should the women be screened and counseled to prevent poststerilization regret, generally thought to be more likely to occur in women after postpartum sterilization? Newly-developed mechanical tubal occlusion techniques have been included for consideration.

Norms and alcohol consumption: Japanese in Japan, Hawaii and California.

The study compared age/sex norms and alcohol consumption of a sample of Japanese from Japan and Japanese Americans in Hawaii and California. Age norms included acceptable drinking levels for the following age groups: 16, 21, 40 and 60, both male and female. There were significant differences in norms across the sites with the Japanese in Japan holding the most tolerant views of heavier drinking for men, followed by California and Hawaii.

An evaluation of the levonorgestrel-releasing IUD: its advantages and disadvantages when compared to the copper-releasing IUDs.

The levonorgestrel-releasing IUD (LNG-IUD-20), providing a daily dose of 20 ug, has recently been approved for marketing in Finland. The IUD's high efficacy in preventing accidental pregnancy and other numerous positive features make it a promising contraceptive device for worldwide use, just like the currently available T-shaped copper-releasing (TCu) IUDs. This paper reviews published reports comparing the LNG-IUD-20 and the currently used TCu IUDs.

The Nova-T IUD--a review of the literature.

The Nova-T IUD is being widely used in Western Europe, Canada, and some parts of Asia; numerous studies based on comparative trials with other types of IUDs have been reported. The results were consistent among most studies, but conflicting among others. This review paper revealed that, in general, the Nova-T IUD is a safe, effective, and acceptable device for contraception.

Cognitive impairment and hospital use.

Background: An increasing number of older people are at higher risk of developing Alzheimer's Disease or another dementias. The resultant cognitive impairment has been well identified as one of the risk factors for nursing home placement but it has not been well studied as a risk for hospitalization.

Methods: To study the association between cognitive impairment and hospital use, this study examined data from a randomly selected cohort of community dwelling California elderly (California Senior Survey).

Immediate postpartum IUD insertions in a Chinese hospital--a two year follow-up.

A data set consisting of 199 immediate postpartum IUD insertions performed at the Xuan Wu Hospital, Beijing, China was analysed in terms of insertion route, category of inserting personnel and device type. IUD expulsion and continuation of use were the outcome events of interest in this study. Based on our findings, the following hypotheses were derived for future confirmative studies: lower expulsion rates and hence, higher continuation rates of immediate postpartum IUD insertions are associated with (1) insertions through the abdominal incision wound for women who had a cesarean delivery as compared to immediate (less than 10 min) vaginal insertions in women with vaginal delivery; (2) obstetrician insertions, as compared to midwife insertions, and (3) use of the Delta T, as compared to that of the Delta Loop.

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.

Dietary calcium intake and other risk factors: study of the fractured patients in Hong Kong.

Osteoporosis has become a major health problem among the elderly in Hong Kong. This study compares the level of dietary calcium intake and the differences in various risk factors among elderly fracture patients and elderly without fractures. Furthermore, this study identifies the relationship between the risk factors and the amount of calcium intake; and classifies the fracture patients and the low calcium intake group.

Vasectomy and cardiovascular deaths in Korean men: a community-based case-control study.

This community-based case-control study was carried out in four cities in South Korea to examine whether vasectomy is associated with a long-term increased risk of cardiovascular death in Korean men. Our results coincide with those from epidemiological studies conducted in Western countries as well as the one study conducted in China and do not support the vasectomy--atherosclerosis hypothesis originating from animal research.

Is the copper T 380A device associated with an increased risk of removal due to bleeding and/or pain? An analysis.

Previous studies have consistently shown that the family of the Copper T 380 devices is more effective in preventing accidental pregnancies than the inert, as well as most other, if not all, copper devices. However, a number of these studies also reported a higher removal rate due to bleeding and/or pain for the TCu 380A than for other devices. The programmatical importance of these findings prompted us to analyze the international multi-center randomized clinical trial datasets to examine this question on the new TCu 380A (ParaGard) recently marketed in the U.

Do retroverted uteri adversely affect insertions and performance of IUDs?

A large international multi-center IUD data set (N = 5520) coordinated by Family Health International was analysed to determine if the uterine position of a woman (anteverted, mid-positioned or retroverted) affects the ease of IUD insertion and if knowledge of uterine position would diminish insertion-related problems and improve IUD performance. Findings showed that insertion-related events were rare irrespective of uterine position. Women with retroverted uteri were not associated with higher termination rates for accidental pregnancy, expulsion or removal for bleeding and/or pain after 12 months of IUD use, as compared to the other two uterine position groups.

Vasectomy and non-fatal acute myocardial infarction: a hospital-based case-control study in Seoul, Korea.

One hundred and sixty-three Korean men aged 35-64 who were admitted to a university-affiliated hospital diagnosed for the first time with acute myocardial infarction (AMI) were compared with 326 matched non-AMI patients hospitalized with a diagnosis considered unrelated to vasectomy. When other potentially confounding variables were controlled for, vasectomized men were found to be 2.6 times (adjusted odds ratio) more likely to have had an AMI as compared to the non-vasectomized men (95% CL: 1.

Tubal ligation at cesarean delivery in five Asian centers: a comparison with tubal ligation soon after vaginal delivery.

Increasingly more tubal sterilizations are being performed at the time of cesarean section in the United States and probably also in developing countries. This descriptive study provides us with hitherto unavailable information on the impact of this combined procedure on the women undergoing it. Five Asian centers were included for study.

Postpartum IUD contraception--a review of an international experience.

Postpartum insertion of intrauterine contraceptive devices (IUDs) performed while women are still in hospital has a number of advantages. Earlier reports, however, generally associated this procedure with high expulsion rates. Recent studies, on the other hand, have shown that if IUDs are inserted immediately (within 10 minutes) after placental delivery, it is safe and effective.