VARIATIONS ON A THEME BY YUZPE
While the Yuzpe regimen of emergency contraception--calling for two doses of oral contraceptives containing ethinyl estradiol and le-vonorgestrel--remains the standard, different formulations and ways of taking pills after unprotected sex may be equally effective in preventing pregnancy. In a study involving almost 2,000 women attending clinics in the United States and the United Kingdom, those who took two doses of pills containing the progestin norethindrone instead of levonorgestrel and those who took just one dose of the standard Yuzpe regimen had no higher pregnancy rate than those who followed the standard two-dose protocol.1 Women taking a single dose of pills reported less vomiting than others; otherwise, side effects were similar in all three groups. In a related study conducted in the same clinics, pregnancy rates among 111 women who began the two-dose Yuzpe regimen 4-5 days after having unprotected intercourse were statistically indistinguishable from those among 675 women who initiated treatment within the standard 72 hours.2 Together, according to the investigators, the studies suggest that when pills containing levonorgestrel are not available, other preparations should be offered, and that the 72-hour cutoff for beginning treatment may be needlessly restrictive.
1. Ellertson C et al., Modifying the Yuzpe regimen of emergency contraception: a multicenter randomized controlled trial, Obstetrics & Gynecology, 2003, 101(6):1160-1167.
2. Ellertson C et al., Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours, Obstetrics & Gynecology, 2003, 101(6):1168-1171.
HOW TO MAKE A QUICK EURO
Starting January 1, 2004, every French woman who has a child will receive a government award of 800 euros.1 The bonus, announced in May, is one of several measures the government has taken to promote larger families in France, where completed fertility averages 1.8 children per woman, life expectancy at birth is increasing and the ratio of active workers to retirees is falling. Other recently adopted measures intended to encourage couples to have more children are the provision of monthly cash payments to families with at least one child younger than three and, for three years, to families in which one parent stops working; partial reimbursement for at-home child care; and incentives for the development of private nurseries. France spends more on families than any other member of the European Union except the Scandinavian countries.
1. Dorozynski A, France offers E800 reward for each new baby, British Medical Journal, 2003, 326(7397):1002.
HIV PROGRAMS FOR TEENAGERS WORK
Teenagers who have participated in educational, psychosocial or behavioral interventions aimed at preventing HIV infection are at reduced risk for acquiring the virus, according to results of a meta-analysis examining data from 44 controlled studies.1 The studies demonstrate that participants in such programs are considerably better than nonparticipants at communicating with their sex partners, negotiating condom use and using condoms (odds ratios, 1.6-2.5); these young people also are somewhat more likely than their peers who have not taken part in an intervention to reduce the frequency with which they have sex and to use condoms (1.1 for each outcome). Interventions are most successful in improving condom use when they are carried out among noninstitutionalized youth and when they provide condoms and training in condom negotiation skills to participants. The meta-analysis revealed no evidence that participation in these types of interventions is associated with increased levels of risky behavior.
1. Johnson BT et al., Interventions to reduce sexual risk for the human immunodeficiency virus in adolescents, 1985-2000, Archives of Pediatrics and Adolescent Medicine, 2003, 157(4):381-388.
ANSWERING THE CALL
Antiabortion groups are beginning to take advantage of a fairly new fund-raising tool: a phone company that donates all profits to organizations whose members sign up for its services.1 Last year, about 1,000 of the Christian Coalition's two million members were enrolled, and the organization netted a few thousand dollars; the group is now promoting the company aggressively to its membership, and it could bring in tens of millions of dollars if even a quarter of its members sign up. National Right to Life, Concerned Women for America and Heartbeat International are among the other antiabortion groups that benefit when their members' fingers do the walking. The phone company is five years old and has raised money for conservative groups with other agendas and for conservative politicians. Its founder refers to it as a "ministry... based on a direct calling from [the] Lord." Pun intended?
1. Associated Press, Anti-abortion phone company raises funds, New York Times, Mar. 27, 2003, <http://www.nytimes.com/aponline/national/AP-Christian-Calling.html>, accessed Mar. 27, 2003.
WOULDN'T IT BE NICE?
Twenty percent of U.S. men and women believe that an HIV vaccine exists but is being kept secret, according to preliminary findings from a nationwide survey of 3,500 people.1 This misperception is more common than average among Hispanics (28%) and blacks (48%), the ethnic and racial groups who have been most affected by HIV and AIDS. Support for research into an HIV vaccine is high--84% of the public overall and virtually all Hispanics and blacks consider it extremely or very important--but is surrounded by misperceptions. Only three-fifths of Americans understand that before a vaccine can be approved for use, it must be tested on thousands of people, and one-third think that participants in clinical trials can acquire HIV from the products being tested. More than 12,000 men and women worldwide have volunteered to take part in HIV vaccine research, including thousands at about 60 research centers in the United States.
1. National Institute of Allergy and Infectious Diseases, Many Americans think an HIV/AIDS vaccine already exists, news release, May 15, 2003, <http://www.niaid.nih.gov/newsroom/releases/may15_03.htm>, accessed June 11, 2003.
The number of new HIV infections is rising each year in Britain, but a parliamentary committee reports that the incidence of "older" sexually transmitted diseases is particularly worrisome.1 Over the last six years, the incidence of gonorrhea has doubled, and the rate for syphilis has risen by 500%; between 2000 and 2001 alone, the number of new syphilis diagnoses more than doubled. When final data are in for 2002, analysts are expecting to see that the number of HIV diagnoses increased by 26% over the previous year's total. The government committee pointed to a number of problems contributing to what it characterized as the nation's sexual health "crisis": the state health service's failure to recognize that sexually transmitted diseases other than HIV are a serious problem, a longtime lack of political leadership in this area and a consequent lack of resources and direction. The committee called for the inclusion of sex and relationship education in the nationwide school curriculum, and for the development of guidelines for the provision of sexual health care.
1. Reuters, Britain facing sexual disease crisis, say MPs, June 11, 2003, <http://story.news.yahoo.com/news?tmpl=story&ncid=1413&e=2&u=/nm/20030611/sc_nm/health_britain_sex_dc&sid=95832301>, accessed June 11, 2003.
WHAT WOULD FORD THINK?
Americans manage to get quite a lot done while riding in their cars or other motor vehicles: They drink coffee, talk on the phone, apply makeup and, with surprising frequency, give birth. According to a phone survey conducted by Jiffy Lube and a market research firm, one in 300 births occur in a motor vehicle.1 Granted, while those other activities probably were planned to take place on the road, most deliveries that occur while the woman is in transit happen where they do because of traffic, inclement weather or bad timing. Jiffy Lube cites statistics from state health departments suggesting that women living in large metropolitan areas are the most likely to give birth in a motor vehicle; in addition, low-income women may be more likely than those who are better off to deliver on the way to a hospital because they often wait until they are in labor to seek transportation or call an ambulance. Fifteen percent of women surveyed had driven themselves to a hospital or birth center while in labor, a practice that is not recommended. Jiffy Lube's Web site includes a women's page, which provides tips on how to prepare for an emergency birth in a car.
1. The Henry J. Kaiser Family Foundation, One in 300 births occurs in motor vehicle, survey says, May 29, 2003, <http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=1796>, accessed May 29, 2003.
PRACTICE, PRACTICE, PRACTICE
The abortion training that obstetrician-gynecologists receive during residency is an important predictor of whether they will provide the procedure once they are in practice.1 In a survey of 161 physicians who graduated from five residency programs in obstetrics and gynecology between 1989 and 1998, 58% said they had ever provided an abortion since completing training; in the last year, 47% had performed first-trimester abortions and 26% second-trimester procedures. Compared with physicians who had performed 1-24 procedures as residents, those who had done more than 25 had higher odds of providing abortions after training (odds ratios from logistic regression analysis, 2.8 for first-trimester and 5.7 for second-trimester procedures); the odds of providing second-trimester abortions were reduced among those whose residency had taken place outside a main teaching hospital (0.2). Other predictors of abortion provision were practice group restrictions (0.1 for first-trimester procedures) and working in an urban setting (6.4 for second-trimester abortions). The researchers urge obstetrics and gynecology training programs to include "routine, hospital-based training in both first- and second-trimester procedures with sufficient numbers to ensure competence."
1. Steinauer JE, The effect of training on the provision of elective abortion: a survey of five residency programs, American Journal of Obstetrics and Gynecology, 2003, 188(5):1161-1163.
REDUCING RISK AMONG MEN WHO HAVE SEX WITH MEN
Nearly half of men who enrolled in a randomized trial of an HIV prevention intervention for men who have sex with men reported having had unprotected receptive anal sex within the previous six months, and slightly more than half said they had had insertive anal sex without using a condom.1 All 4,295 men were HIV-negative, and 99% had had sex with a male partner in the six months before entering the study. Nearly one in five were in a primary relationship with a man who was infected with HIV or whose serostatus they did not know; 78% had had at least one partner of unknown HIV status in the last six months, and 28% had had at least one partner with HIV infection. The proportions engaging in risky behavior were highest among those with HIV-negative partners, but even among those who had had sex with an infected man, levels of risky behavior were substantial; for example, 21% had had unprotected receptive anal sex, and 37% unprotected insertive anal sex. Regardless of the HIV status of men's partners, risky behavior was more common among users of various substances than among nonusers. The researchers note that their data "emphasize the continued need for effective behavioral strategies designed to prevent HIV infection among [men who have sex with men]."
1. Koblin BA et al., High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE study, American Journal of Public Health, 2003, 93(6):926-932.