Biomedical subjects

Charlotte Ellertson

Publications and source records attributed to Charlotte Ellertson.

28 records · Page 2Linked to original sources

PubMed2002

Policy climate, scholarship, and provision of emergency contraception at affiliates of the International Planned Parenthood Federation in Latin America and the Caribbean.

Emergency contraception (EC) has great potential to decrease the incidence and resulting consequences of unwanted pregnancy, including unsafe abortion. We conducted this study to understand EC practices in Latin America and the Caribbean (LAC). We contacted 43 International Planned Parenthood Federation affiliates in LAC to interview them about EC availability. We collected family planning norms and researched registered EC products in LAC. We searched English- and Spanish-language sources to compile EC literature reviews. Thirty-seven affiliates (86%) responded to the survey, and 62% offer EC. Central and South American affiliates are more likely to offer EC than are Caribbean affiliates. Of those offering EC, 96% offer cut-up packets of oral contraceptives, whereas six affiliates offer dedicated products. Of those not offering EC, 79% believe it constitutes abortion. EC availability and support for the method appear to be increasing in LAC, and clearer distinctions between EC and abortion in medical and policy guidelines should increase acceptance further.

Caribbean Region↗

PubMed2002

Could American women use mifepristone-misoprostol pills safely with less medical supervision?

Medical methods of early abortion differ from surgical methods in that women themselves can potentially administer the regimens. As currently researched and offered, however, the main regimen used for medical abortion, mifepristone-misoprostol, is highly medicalized, involving several clinic visits and extensive physician involvement. We re-examined the role of clinical supervision in each step of the abortion process, using data collected during a large clinical trial of mifepristone-misoprostol abortions in the US, fielded during 1994-1995. The trial was carried out in 17 geographically diverse centers, including private, public, and nongovernmental organization clinics, and enrolled 2121 women, aged 18-45 years, seeking early abortion (< or =63 days since last menstrual period). Women received 600 mg oral mifepristone, followed 48 h later by 400 microg oral misoprostol. Evidence suggests that most women can handle most steps of the medical abortion process themselves, effectively and safely. The utility of clinic visits to ingest mifepristone and misoprostol is questionable. For many women, even the follow-up visit could perhaps be replaced by telephone follow-up, combined with home pregnancy tests. Alternatives to the present protocol might allow greater control, comfort, and convenience at lower cost. Where clinician involvement might be useful, mid-level health care providers typically possess the skills necessary to offer the method safely, implying that physicians might be necessary only as complications arise. Future research useful for determining the optimal amount of medical involvement to provide mifepristone-misoprostol safely and effectively should include self-screening tests, label comprehension tests, calendars to aid in calculating gestational age, and the development of special pregnancy tests with telephone follow-up.

Abortion, Induced↗

PubMed2002

Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra, India.

As several important policy questions remain regarding the use of medical abortion in developing countries, we investigated the safety, efficacy, and acceptability of mifepristone-misoprostol abortion in the outpatient family planning departments of two urban hospitals and one rural hospital in India. Nine-hundred women (with gestations of < or =63 days in the urban sites and < or =56 days in the rural site) received 600 mg mifepristone followed 48 h later by 400 microg oral misoprostol in the clinic. Four point four percent or fewer urban women and 1.0% rural women were lost to follow-up. Perfect and typical-use failure rates were low at all sites. While rural women reported fewer side effects at all sites, the vast majority of women were satisfied with their medical abortions. Medical abortion can be offered safely, effectively, and acceptably in the outpatient family planning departments of urban and rural hospitals in India.

Abortifacient Agents↗

PubMed2002

Women's preferences for general or local anesthesia for pain during first trimester surgical abortion in India.

Women in India are rarely given a choice about their pain management methods for first trimester abortions. To investigate women's preferences and perceptions of pain, we allowed 100 women in Mumbai to choose between local and general anesthesia (60% selected general, while 40% elected local anesthesia). Using visual analog scales ranging from 1 to 7, women characterized their pain several times during their abortion visits. Local anesthesia clients reported more pain during (2.3 local vs. 1.0 general) and immediately after (1.9 vs. 1.0) the procedure. By three hours post-procedure, none of the women in either group reported any pain. General anesthesia clients reported that having no pain (95%) or anxiety (38%) were the best features, while local anesthesia clients liked being ambulatory (26%), avoiding side effects (26%), and feeling awake (21%). Though women in both groups were satisfied, local anesthesia clients were more likely to recommend it to friends (95% vs. 85%). Given these advantages, our study suggests that some women willingly accept additional pain incurred by exchanging local for general anesthesia.

Abortion, Induced↗

PubMed2002

Emergency contraception in Mexico City: knowledge, attitudes, and practices among providers and potential clients after a 3-year introduction effort.

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico City, we conducted a pre-intervention/post-intervention research study of one way to introduce EC. Following a baseline survey of family planning providers and clients in 1997, we organized and implemented a three-year program of training for health care providers and a multi-faceted information campaign for the general public, including a national toll-free hotline and website. In 2000, we again surveyed family planning clinic providers and clients, using instruments similar to those employed in the baseline study. EC awareness increased significantly from 13% of clients to 32%, and support jumped from 73% to 83%. Providers at study clinics improved method recognition from 88% to 100%.

Adolescent↗

PubMed2002

Information campaign and advocacy efforts to promote access to emergency contraception in Mexico.

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico we developed a comprehensive model introduction effort that included four components: provider training, public information (through a dedicated hotline and website, free media, paid radio and TV spots, participation in talk shows, and alternative media channels), collaboration with the public sector to include EC in the official family planning norms, and assistance to partner with commercial firms to register a dedicated EC product. Ongoing efforts to combat misperceptions and overcome opposition are crucial to informing the public and ensuring greater access to the method.

Advertising↗

PubMed2002

Knowledge and attitudes about the differences between emergency contraception and medical abortion among middle-class women and men of reproductive age in Mexico City.

Two reproductive technologies--emergency contraception and medical abortion--have the potential to reduce unintended pregnancy significantly in Latin America. Lack of knowledge and negative attitudes about the methods may limit their impact, however. Results from focus group discussions with middle-class men and women of reproductive age residing in Mexico City indicate that knowledge about emergency contraception and medical abortion is low. After being informed about both methods, participants supported emergency contraception but tied their support for medical abortion to its legal status. Participants remained concerned about the methods' efficacy, mechanism of action, and potential to encourage sexual risk-taking. While almost all desired greater dissemination of information about and access to both methods in Mexico, participants cited religious and cultural concerns, as well as barriers in communication with providers and within families, as significant challenges. Participants hoped, however, that both emergency contraception and medical abortion might play important roles in preventing unwanted pregnancy and abortion-related morbidity and mortality in Mexico in the future.

Abortifacient Agents↗

PubMed2002

Prevalence of battering among 1780 outpatients at an internal medicine institution in Mexico.

Violence against women has recently drawn attention in the medical community as a leading cause of preventable morbidity and mortality. Specific algorithms designed to identify women at risk can be applied to create an opportunity for screening, diagnosis and treatment during medical care initiated for common conditions. This study investigated the incidence and history of battering among women seeking general medical care, and looked for potential risk factors and associations with presenting symptoms. We used a self-administered, anonymous survey to question 1780 adult female outpatients visiting a tertiary care internal medicine teaching hospital in Mexico City. We calculated current abuse (physical and/or sexual abuse by a partner within the past year), abuse during pregnancy, childhood abuse, and lifetime abuse. We found levels of violence against women in Mexico comparable to those reported from other countries. 152 women (9%) reported current physical and/or sexual abuse. An identical number also reported abuse during pregnancy. Lifetime prevalence was 41%. Women currently or previously abused reported more physical symptoms in the last six months than did non-abused participants. Pelvic pain, depression, headache and substance abuse were frequent among abused women. Currently abused women also scored higher (p<0.01) on indicators of depression. Current abuse correlated strongly with a childhood history of physical and/or sexual abuse, with low educational level of the victim, with substance abuse by the partner or by the woman herself, and with higher parity.

Adolescent↗

PubMed2002

How safe is emergency contraception?

Emergency contraception is used to prevent pregnancy after unprotected sex but before pregnancy begins. Currently, women can use emergency contraception by taking higher doses of the active ingredients found in ordinary oral contraceptive pills [either combined estrogen-progestogen (progestin) or progestogen-only formulations], or by having providers insert copper-bearing intrauterine devices (IUDs). The antiprogestogen mifepristone also has an excellent efficacy and safety profile as emergency contraception, but it is currently available for this indication only in China. Many studies have documented providers' and women's fears about the individual and public health safety risks of emergency contraception. Some of these concerns include potentially increased risks of cardiovascular events (including arterial and venous disease), worries about possible effects on future fertility, feared teratogenic consequences following method failure or inadvertent use during pregnancy, exaggerated or extreme fears of adverse tolerability, and concerns about drug interactions with other medications. Wider public health questions include feared reductions in the use of ongoing, more effective contraception, possible 'abuse' of emergency contraception through overly frequent use, and potential increases in risky sexual encounters (owing to the existence of a back-up, postcoital method) and therefore in rates of sexually transmitted infections, including HIV/AIDS. These fears can each be generally allayed. Direct and indirect investigations of emergency contraception in the biomedical and social science literature, the extensively documented safety profile of ordinary oral contraceptives, and more than 30 years of clinical experience since hormonal emergency contraception was first described, give strong evidence for its safety. This review confirms declarations by the World Health Organization and the US Food and Drug Administration, and shows that emergency contraception has an excellent safety profile in nearly all women. Finally, emergency contraception allows women a second chance to avoid unwanted pregnancies. Whether pregnancy is carried to term or terminated, the condition has inherent risks that are greater than any posed by emergency contraception.

Congenital Abnormalities↗

PubMed2002

Differences between emergency contraception users in the United States and the United Kingdom.

OBJECTIVES: to characterize emergency contraception (EC) users and clinical trial participants in the United States and the United Kingdom, comparing previous EC use and awareness, contraceptive history, and experience with EC. METHODS: We collected data from all EC seekers (n=5383) at 1 US and 2 UK clinics (9/97-8/98). We also collected detailed information from women (n=2157) enrolling in an EC trial at the first 3 clinics and 2 additional UK sites (9/97-2/00). RESULTS: More US (16%) than UK (4%) women reported additional acts (other than in the last 5 days) of unprotected sex during the cycle in which they sought EC. Fifty-eight percent of UK trial participants had used EC previously compared to 18% in the United States. Most participants in both groups used contraception regularly and reported needing EC because of condom breaks (67% and 56%). More UK than US participants used an ongoing method of contraception (38% v 28%). US women reported more side effects at follow-up than UK women did (76% v 59%), although similar proportions would take EC again or recommend it. CONCLUSIONS: US and UK women in our trial experienced different side effects. Researchers should use caution when presenting aggregate results from international multicenter trials. In addition, readers should be aware that such aggregate results might mask important geographical differences. More research on experience with EC and barriers to contraceptive use in the United States is needed.

Adolescent↗