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Biomedical subjects

A Glasier

Publications and source records attributed to A Glasier.

At least 19 recordsLinked to original sources
PubMed2000

Once a month administration of mifepristone improves bleeding patterns in women using subdermal contraceptive implants releasing levonorgestrel.

It has been suggested that the administration of an anti-progesterone might improve bleeding patterns in women with irregular bleeding while using low-dose progestin-only contraception. We report the findings of a double-blind, randomized, placebo-controlled trial of mifepristone 50 mg taken once every 4 weeks in 100 Chinese women (50 subjects and 50 controls) complaining of frequent and irregular bleeding while using a levonorgestrel-releasing subdermal contraceptive implant. In all women, regardless of treatment, the frequency of bleeding decreased significantly over 360 days of observation. Women recorded significantly shorter episodes of bleeding (P: < 0.0002) during mifepristone treatment than during the 90 days before treatment started. In contrast, the duration of bleeding episodes fell more gradually in placebo-treated controls. Women using mifepristone were more likely to find treatment acceptable than women receiving a placebo tablet (P: < 0.01). Despite concern that anti-progestogenic effects may jeopardize contraception, there were no pregnancies. This approach may offer a useful strategy to improve continuation rates by alleviating unwanted side-effects until bleeding patterns improve spontaneously with time.

Adolescent↗
PubMed2000

Emergency contraception.

Knowledge and use of emergency contraception world-wide is extremely limited. Recent research has demonstrated that levonorgestrel alone is at least as effective as the Yuzpe regimen and is much better tolerated. Levonorgestrel is likely to become the method of choice in the early 21st century. Mifepristone is highly effective even at doses which are not abortifacient. Efficacy cannot be calculated precisely, but all presently available methods seem to prevent at least 74% of unwanted pregnancies. The Yuzpe regimen inhibits or delays ovulation, but there is no good evidence that it prevents implantation. There are no data on the mechanism of action of levonorgestrel alone and the mode of action of mifepristone depends on when in the reproductive cycle it is used. Accessibility to emergency contraception is limited by the requirement for it to be prescribed by a doctor. Advanced provision of emergency contraception may prevent a significant number of unwanted pregnancies.

Adolescent↗
PubMed2000

A review of bone mineral density scans referred by a community-based menopause clinic in 1997.

Osteoporosis is a growing public health issue for the UK's ageing population. Many older women want know if they are at risk of osteoporosis and if preventive treatment, particularly in the form of hormone replacement therapy (HRT), would be advisable. This results in many women being referred for bone mineral density (BMD) scanning, whether or not they have recognised risk factors for osteoporosis. We present the results of a review of 228 referrals for BMD scan from a community-based menopause clinic. The results are categorised by the indications for the scan. The implications for the future of BMD investigations are considered in the light of ongoing discussion about population screening.

Absorptiometry, Photon↗
PubMed1999

Interaction between broad-spectrum antibiotics and the combined oral contraceptive pill. A literature review.

There is considerable variation in opinion about the importance of drug interactions between the combined oral contraceptive pill (COCP) and broad-spectrum antibiotics. Clinical practice varies widely, especially between doctors in Europe and those in the US. Rifampicin and griseofulvin induce hepatic enzymes and do appear to have a genuine interaction with the COCP, leading to reduced efficacy. The situation with the broad-spectrum antibiotics is less clear. There are relatively few prospective studies of the pharmacokinetics of concurrent COCP and antibiotic use and few, if any, demonstrate a convincing basis for any reduced contraceptive efficacy. There is evidence, however, that variable contraceptive steroid handling could make some women, at some times, more susceptible to COCP failure. Given the serious consequences of unwanted pregnancy, the cautious approach of using additional or alternative contraception during short courses of broad-spectrum antibiotics and the initial weeks of long-term antibiotic administration may be justified to safeguard the few unidentifiable women who may be at risk. Conflicting opinion and advice is potentially confusing to both professionals and patients, and instructions for additional precautions during and after concurrent COCP and antibiotic use are complicated. Many women are ignorant of, or confused about, the circumstances that can cause OC to fail. Health professionals who prescribe the COCP must continue to strive to educate women about the mode of action and about the times when there is the greatest danger of failure. Professionals who feel that concurrent antibiotic use represents a real threat to contraceptive efficacy of the COCP should be prepared to present the advice for additional contraceptive precautions in a simple and consistent way, backed up with written information and reinforced at regular intervals.

Anti-Bacterial Agents↗
PubMed1999

A feasibility study of adolescent sex education: medical students as peer educators in Edinburgh schools.

OBJECTIVES: To determine the feasibility of medical students being involved in sex education in secondary schools, as lesson leaders in peer group discussions. DESIGN: 1. Questionnaires and interviews to determine pupil and professional opinions about the present sex education provision and the possible involvement of medical students. 2. A pilot scheme in one school involving medical students as peer educators. SETTING: Six central Edinburgh secondary schools; local sex education services; Edinburgh University. SAMPLE: 1. Thirty schoolteachers and 205 pupils returned questionnaires. From this, 18 teachers and 12 pupil groups (six to eight pupils each) were interviewed. 2. Pilot scheme involved three sessions with three groups of six to eight pupils per session. Twenty-nine returns for the evaluative (pupil) questionnaire were received. MAIN OUTCOME MEASURES: Questionnaire analysis; anecdotal evidence from interviews; evaluative questionnaire given to pupils participating in pilot study. RESULTS: Ninety-four percent of teachers and 93% of pupils were in favour of medical student involvement in schools. Teachers identified large class size and lack of resources for small group work as factors limiting the effectiveness of present sex education. Pupils identified teacher embarrassment in certain issues as a barrier to communication, and 89% found communication to be easier with medical students. CONCLUSIONS: Response to the idea of medical student involvement was very favourable from all parties involved, and a continuation of the study has been integrated as an options course into the Edinburgh University undergraduate medical curriculum.

Adolescent↗
PubMed1999

Non-invasive screening of teenagers for Chlamydia trachomatis in a family planning setting.

One hundred women aged 20 or younger attending two family planning clinics specifically targeting teenagers were screened for Chlamydia trachomatis using first void urine specimens. An overall prevalence of 6.2 per cent was found, but there was a marked difference between women attending a city centre site (three per cent) and those attending a clinic in a small rural town.

Adolescent↗
PubMed1998

The effects of self-administering emergency contraception.

BACKGROUND: Emergency postcoital contraception prevents pregnancy, but it must be prescribed by a doctor and taken within 72 hours of intercourse. It has been proposed that emergency contraception be made available without a prescription. We undertook a study to learn how women might behave if given a supply of emergency contraceptive pills to keep at home. METHODS: We assigned 553 women to be given a replaceable supply of hormonal emergency contraceptive pills to take home (the treatment group) and 530 women to use emergency contraception obtained by visiting a doctor (the control group). The frequency of use of emergency contraception, the use of other contraceptives, and the incidence of unwanted pregnancy were determined in both groups of women one year later. RESULTS: The results for 549 women in the treatment group and 522 women in the control group were available for analysis. Three hundred seventy-nine of the women in the treatment group (69 percent) and 326 of the women in the control group (62 percent) contributed detailed information at follow-up. One hundred eighty of the women in the treatment group (47 percent) used emergency contraception at least once. Among those who returned the study questionnaire, 98 percent used emergency contraception correctly. There were no serious adverse effects. Eighty-seven women in the control group (27 percent) used emergency contraception at least once (P<0.001 for the comparison with the treatment group). The women in the treatment group were not more likely to use emergency contraception repeatedly. Their use of other methods of contraception was no different from that of the women in the control group. There were 18 unintended pregnancies in the treatment group and 25 in the control group (relative risk, 0.7; 95 percent confidence interval, 0.4 to 1.2). CONCLUSIONS: Making emergency contraception more easily obtainable does no harm and may reduce the rate of unwanted pregnancies.

Adolescent↗
PubMed1998

Continuation rates of long-acting methods of contraception. A comparative study of Norplant implants and intrauterine devices.

Following adverse widespread publicity in the United Kingdom and the United States, it is commonly believed that discontinuation rates for the contraceptive implants Norplant in the UK are high. We have compared discontinuation rates between new intrauterine device (IUD) users (253 women) and new Norplant implant users (502 women) over 33 months following the introduction of Norplant implants among a population of women attending the same clinic and counseled in the same manner by the same group of providers. Women choosing the IUD were slightly older and were more likely to be changing their contraceptive method because of dissatisfaction with their current method. Nor plant implant users were more likely to have completed their families. Continuation rates for Norplant implants were significantly higher than for IUD at 12, 18, and 24 months after insertion. At 24 months, continuation rates for Norplant implants were 72% compared with rates of 55% for IUD users. Higher continuation rates may be related more to factors associated with the providers than with the users of these two long-acting methods.

Adult↗
PubMed1998

Safety of emergency contraception.

Emergency contraception (EC) prevents pregnancy. Four regimens are available in different parts of the world, a combination of ethinyl estradiol and levonorgestrel, levonorgestrel alone, mifepristone, and emergency insertion of an intrauterine device. All the regimens are also used either as long-term contraception or, in the case of mifepristone, as an abortifacient, and considerable data indicate their safety when used in these ways. Data on safety when the regimens are used as EC are lacking, but theoretically, and from practical experience, all appear to be extremely safe, particularly when compared to the risks of pregnancy. There has been a tendency to over-"medicalize" EC. Prescribing EC is simple. Consideration should be given to making EC available off prescription because it is so safe.

Clinical Protocols↗
PubMed1997

Laparoscopic sterilisation: opinion and practice among gynaecologists in Scotland.

OBJECTIVES: 1. To produce a list of evidence-based criteria for good quality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Scotland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria. DESIGN: 1. Agreement with criteria assessed by questionnaire survey; 2. Overview of current practice obtained by questionnaire survey and by casenote review. SETTING: Scotland. SAMPLE: 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals. RESULTS: The response rate to the questionnaire survey was 94%. A list of 15 evidence-based criteria was produced, covering patient selection, information and counselling, techniques of tubal occlusion and timing of sterilisation. All 15 suggested criteria gained an overall balance of support among responding gynaecologists. Similar impressions of current practice were gained from the questionnaire survey and from the casenote review. Aspects of practice which measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes included clear documentation that women had been counselled regarding failure rate and intended permanency; 88% of sterilisations were performed, or directly supervised by, a gynaecologist of consultant or senior registrar status; and only 2% of sterilisations were undertaken in combination with induced abortion. Aspects of practice which compared poorly with the agreed criteria, and for which recommendations for change have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists indicated that they provide locally produced information leaflets as an adjunct to counselling; four methods of tubal occlusion (including unipolar diathermy) were in use; and there were wide variations among hospitals in the use of day-case care, ranging from 19% to 99%. CONCLUSIONS: A list of criteria for good quality care in relation to sterilisation has been validated by agreement among Scottish gynaecologists. Current practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for change in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.

Adult↗
PubMed1996

Contraception for the older woman.

Contraception presents particular problems for women over the age of 40. Although fertility is declining and the risk of pregnancy may be small, the consequences of an unplanned pregnancy may be socially devastating and medically ill-advised. Menstrual dysfunction and psychosexual difficulties increase with age and may exacerbate the side-effects of some methods of contraception. The long-term risks of combined hormonal contraception, particularly cardiovascular disease, become more pertinent to women whose natural risk of disease increases with age. Patterns of sexual activity and contraceptive use change with age. The advantages and disadvantages of currently available methods of contraception are difficult to quantify, and the choice of method is very much a matter for individual concern. The increasing prevalence of HRT may complicate matters for some women who are unsure for how long to continue using contraception. Contraceptives of the future may be designed to improve the reproductive health of all women, particularly those approaching the menopause.

Adult↗
PubMed1996

The introduction of a new contraceptive; two years experience with Norplant.

OBJECTIVE: To determine the uptake, acceptability and continuation rates of a new contraceptive implant, Norplant. DESIGN: Review of case notes of all acceptors during the two years following the introduction of the implant. SETTING: A large family planning clinic in Edinburgh. SUBJECTS: All women choosing Norplant. RESULTS: 508 women chose Norplant, many as an alternative to sterilisation or because they had experienced problems with other methods of contraception. 9% of women were lost to follow-up. Of the remainder continuation rates were 84% at one year and 80% after 18 months of use. 43% of women gave bleeding problems as the reason for removal. However the combination of weight gain, mood swings, depression and headache was frequently reported as unwanted side effects by women seeking removal. No major problems were experienced with either insertion or removal of Norplant. CONCLUSIONS: Norplant is an effective method of contraception which many women find attractive. The incidence of erratic bleeding is high but many women tolerate this problem because the method is easy to use and lasts five years. Careful counselling is essential for high continuation rates.

Adolescent↗