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The role of the expanded function nurse in fertility preservation.

The women's health care nurse practitioner has a unique opportunity to provide care to women in all stages of the reproductive life span. The care and guidance provided can affect general gynecologic health and the patient's ability to conceive. Crucial decisions about contraception and life-style choices have a far-reaching impact on reproductive potential. Women must be made aware of the issues surrounding these topics so they can make appropriate choices. The nurse practitioner, in the role of primary care provider, can assist women in this decision making process.

Adolescent↗

The quality of family planning services in rural China.

This article provides a preliminary analysis of three aspects of service quality in four rural counties in China--the availability of contraceptive methods, information given to users, and provider knowledge about methods. Contraceptive choice and characteristics of contraceptive use by women in the study areas are also examined. The data are derived from a survey carried out by the authors during 1987, under the auspices of China's State Family Planning Commission. The survey was conducted in four rural counties located in Fujian and Heilongjiang provinces. A total of 318 married women of reproductive age were randomly selected and interviewed. All family planning service sites serving the women were visited and a sample of service providers was interviewed. No shortage of contraceptives existed in any of the counties, but variations in community wealth and local procurement practices have resulted in the acquisition of an IUD with high failure rates. Although providers believe they inform women about method choices and side effects, women were poorly informed about the methods they selected. Not all providers who insert IUDs and distribute pills were knowledgeable about contraindications and side effects of the methods. Ever-use of contraception was nearly 100 percent, but most women, especially in Heilongjiang, have only used one method: the IUD or sterilization. Improvements in quality, especially in method mix, providers' level of knowledge, and the quality and quantity of information provided to users will likely improve contraceptive continuation, client satisfaction, and women's health.

China↗

Medical aspects of contraception.

It is evident that choice of contraceptive has important medical implications, whether a mechanical or a hormonal method is elected. Each technology has unique benefits and risks, constraints, applicability, and inconvenience. Wise advice in a medical context must be based on thorough familiarity with the options available to each woman.

Adult↗

Influence of menstrual cycle, parity and oral contraceptive use on steroid hormone receptors in normal breast.

Steroid receptor was assessed immunohistochemically in 158 samples of normal breast for variation through the menstrual cycle. Patterns and intensity of reaction were used in a semi-quantitative scoring system to examine the influence of cycle phase, cycle type, parity and age. The changes in oestrogen receptor for natural cycle and oral contraceptive (OC) cycles indicated down-regulation by progestins. Progesterone receptor did not vary significantly in natural cycles, but increased steadily through OC cycles. This study provides strong evidence that both oestrogen and progesterone influence breast epithelium, but dissimilarities from the endometrium are apparent. The interval since pregnancy had a significant negative effect on frequency and score of oestrogen receptor and score of progesterone receptor. Multivariate analysis established the phase of cycle and OC use as independent significant influences on oestrogen receptor. The interval since pregnancy was an independent significant factor for both oestrogen and progesterone receptor presence.

Age Factors↗

Factors affecting desired family size among preliterate New Guinea mothers.

A random sample of 331 Enga mothers in Papua New Guinea perceived that an average of 5.96 live births (S.D. = 1.88) were needed to achieve their mean desired completed family size (DFS) of 4.65 children (S.D. = 1.32). The mean of the personal child mortality rates projected by the individual mothers. 194/1000, is very close to the rate of 198/1000 (224 deaths among 1134 live births) experienced by the women as a group and the 177/1000 documented in a 1972 prospective study in the area. This suggests that as a group preliterate women may possess an accurate estimate of prevailing child mortality rates. Considerable interest in family planning was shown. However for cultural or linguistic reasons, the majority (except in the case of the pill and tubal ligation) expressed no opinions about their readiness to use specific modern methods. The mean parity of 43 women seeking tubal ligation was 5.98 (S.D. = 1.81). An integrated maternal health and family planning program focusing on the health benefits to mother and child of the current 3-4-year birth interval seems indicated.

Adult↗

Results of establishing medical guidelines for selecting oral contraceptive types in family planning agencies.

Family planning agencies are attempting to increase their efficiency and cost-effectiveness in delivering services, as federal funding is diminishing. We have examined the effects of establishing guidelines in a family planning agency, outlining the types of OCs to be routinely prescribed. We found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.

Contraceptives, Oral↗

Determinants of current contraceptive use among Ghanaian women at the highest risk of pregnancy.

This study uses data from the Ghana Demographic and Health Survey (GDHS) of 1988 to examine factors determining the continued low levels of contraceptive use in Ghana. The women currently using efficient contraception are those who have sexual intercourse regularly, who discuss family planning with their partner, whose husbands approve of the use of family planning, and who live in the northern sector of the country. The finding that husband's approval is an important determinant of efficient contraceptive use has significant policy implications for Ghana and other African countries, to motivate both husbands and wives to share fertility control responsibilities.

Adolescent↗

Use of contraceptives by women of upper socioeconomic status.

This was a descriptive correlational study of the contraceptive knowledge, methods, and consistency of contraceptive use by women of upper socioeconomic class. Socioeconomic class was determined using Hollingshead's Four-Factor Index of Social Status (1975) and was based on the woman's own educational and occupational status. The mean socioeconomic score for participants in this study (N = 83) was high in the second of five socioeconomic classes. Study participants were found to be consistent users of their contraceptive method and had fewer unplanned pregnancies in their history than the general population. They were more knowledgeable about contraceptives and reproduction than others tested with the same contraceptive knowledge instrument. They used barrier methods predominantly, with the use of less theoretically effective methods correlating significantly with a greater number of contraceptive methods used in the past.

Adult↗

A comparison study of lipid and androgen metabolism with triphasic oral contraceptive formulations containing norgestimate or levonorgestrel.

The effects of norgestimate triphasic (Ortho Tri-Cyclen, Tri-Ciles) and levonorgestrel triphasic (Triphasi) formulations on lipid and androgen metabolism were assessed in a study of 66 healthy women treated through six menstrual cycles. Levels of the following were measured: cholesterol and its subfractions, triglycerides, carrier lipoproteins, estradiol, testosterone, and sex hormone binding globulin (SHBG). Comparison of baseline values with values after 3 and 6 months of treatment indicated that both regimens influenced lipid and androgen metabolism. There was a statistically significant between-regimen difference in levels of high-density lipoprotein, which were favorably increased with norgestimate triphasic but reduced with levonorgestrel triphasic. Related data on SHBG showed that plasma levels of this marker of estrogen/androgen balance were increased significantly more in the norgestimate triphasic group, providing additional evidence of low androgenicity. Both regimens inhibited follicular growth to the same extent, as evidenced by low mean levels of estradiol in all on-therapy cycles; and both decreased free testosterone. Side effects in both groups were minor and characteristic of those observed with low-dose oral contraceptive agents. The results of the study support the reported safety and positive effects of norgestimate on lipid and androgen metabolism, in comparison with a levonorgestrel-containing combined oral contraceptive.

Adolescent↗