Perceptions of long-acting reversible contraception among women receiving medication for opioid use disorder in Vermont

OBJECTIVES

To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder.

STUDY DESIGN

Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont.

RESULTS

A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method.

CONCLUSIONS

Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method.

IMPLICATIONS

Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.

Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes

OBJECTIVE

Chromium picolinate (CrPic) supplementation has been suggested to improve glycemia, but there are conflicting reports on efficacy. We sought to determine the effect of CrPic on insulin sensitivity, glycemic control, and body composition in subjects with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Thirty-seven subjects with type 2 diabetes were evaluated. After baseline, subjects were placed on a sulfonylurea (glipizide gastrointestinal therapeutic system 5 mg/day) with placebo for 3 months. Subjects were then randomized in a double-blind fashion to receive either the sulfonylurea plus placebo (n = 12) or the sulfonylurea plus 1,000 microg Cr as CrPic (n = 17) for 6 months. Body composition, insulin sensitivity, and glycemic control were determined at baseline, end of the 3-month single-blind placebo phase, and end of study.

RESULTS

Subjects randomized to sulfonylurea/placebo, as opposed to those randomized to sulfonylurea/CrPic, had a significant increase in body weight (2.2 kg, P < 0.001 vs. 0.9 kg, P = 0.11), percent body fat (1.17%, P < 0.001 vs. 0.12%, P = 0.7), and total abdominal fat (32.5 cm(2), P < 0.05 vs. 12.2 cm(2), P < 0.10) from baseline. Subjects randomized to sulfonylurea/CrPic had significant improvements in insulin sensitivity corrected for fat-free mass (28.8, P < 0.05 vs. 15.9, P = 0.4), GHb (-1.16%, P < 0.005 vs. -0.4%, P = 0.3), and free fatty acids (-0.2 mmol/l, P < 0.001 vs. -0.12 mmol/l, P < 0.03) as opposed to sulfonylurea/placebo.

CONCLUSIONS

This study demonstrates that CrPic supplementation in subjects with type 2 diabetes who are taking sulfonylurea agents significantly improves insulin sensitivity and glucose control. Further, CrPic supplementation significantly attenuated body weight gain and visceral fat accumulation compared with the placebo group.

[Rapid typing of Escherichia coli K antigens using bacteriophages]

E. coli capsular (K) antigens are important virulence factors contributing to the development of urinary tract infections (UTI). Serotyping of these antigens is laborious and depends on the availability of respective antisera which are difficult to prepare because of the low immunogenicity of these polysaccharide antigens. The application of specific K phages are a big advantage. Two collections of E. coli strains (500 from Rostock, 214 from Erfurt) isolated from patients with UTI have been investigated with a set of ten K specific bacteriophages including phi 1, phi 2, phi 5, phi 7, phi 9, phi 12, phi 13, phi 20, phi 30 and phi 36. The K1 antigen has been found to be the most frequent capsular antigen (16.4% in Rostock; 12.2% in Erfurt) followed by K13/K20 in Erfurt (8.9%) and K5 in Rostock (8%) and Erfurt (7.5%). The collection of phages proved to be suitable for the detection of UTI associated K antigens covering the most common O serogroups found in UTI. The method appears to be simple, non-laborious and applicable for routine use.

[Bacteriologic studies of bicarbonate dialysate and suitable initial solutions]

Dialysates for the haemodialysis are produced unsterile and usually contain bacteria. Own investigations of bicarbonate dialysate and adequate initial solutions comprised sterility tests, determinations of the germ count and germ tolerance experiments. Only the "acid concentrate" was sterile. In the other solutions Corynebacteria, Acinetobacter and Pseudomonas bacteria dominated as typical water germs. In the fresh reverse osmosis water and the bicarbonate dialysate as well as in the recently produced 35-mmolar and 1-molar NaHCO3-solution the germ count was in each case about 10(5)/l and did not change itself essentially at room temperature within 6 hours. The "acid concentrate" and at a lower level also the 1-molar NaHCO3-concentrate have an antibacterial effect. The reverse osmosis water is the main contamination source for the bicarbonate dialysate, the application of which within 6 hours seems worth being used on account of the low germ count.

[Bacteriological examination of subgingival flora in patients with marginal periodontitis]

Before and 4 weeks after a single course of local treatment, the composition of subgingival microflora of 15 patients with marginal periodontitis was determined by cultural and microscopical examination. A significant reduction in the number of gram-negative microorganisms could be achieved by this treatment. Anaerobic sporeless rods like Bacteroides and Fusobacteria but also Spirochetes, Eikenella and Capnocytophaga were involved in the inflammation. The number of Actinomyces in the subgingival flora was also significantly reduced by therapy. After treatment the number of gram-positive bacteria like Streptococci and Corynebacteria was significantly increased. The reduction in the number of these gram-negative bacteria in line with the reduction of periodontal inflammation is a criterion of their significance in the etiology of marginal periodontitis.

[Detection of antibody-coated bacteria and cylinders in urinary sediment from patients with indwelling catheters]

In 34 patients without pre-existing infection of the urinary tract mostly a few days after insertion of an indwelling catheter a bacteriuria with 10(5) germs per ml urine developed. In 24 patients from the moment of the first proof of bacteriuria up to the removal of the catheter 1 to 10 days passed away. During this time in 6 patients a cylindruria, in no case, however, an antibody-coat of the bacteria could be established. In 10 patients who carried the catheter for a longer time, the excretion of antibody-coated germs in the urine began 11 to 18 days after the first proof of bacteriuria. A cylindruria was observed in 9 of these patients. Altogether the proof of cylinders in the early phase of the renal infection was more sensitive than that of antibody-coated bacteria in the urine. The probability of a provable participation of the kidneys in catheter-conditioned infections of the urinary tract consequently increases with increasing period of indwelling of the catheter.

[Mass screening for bacteriuria in students]

From 1973 to 1978 in 2.6% out of 244 female students and in none out of 160 male students a significant persisting bacteriuria was proved. By the slight rate of falsely positive findings could be demonstrated that the midstream technique gives evident results when persons able to cooperate are sufficiently instructed.

[Demonstration of bacteriostatic substances in boric acid preserved urine specimens]

The results of bacterilogical investigations of urine specimens which contain chemotherapeutics or other germ-inhibiting substances are to be used only with limitation. In order to avoid malinterpretations of microbiological findings by unknown natibacterial autoactivity of the investigation material the routine proof of germ-inhibiting substances in the urine by means of a simple agar diffusion test has proved. By preservation of boric acid which is to be recommended for a longer transport of urine specimens which are to be investigated bacteriologically the results of the inhibitor tests is not falsified.

[Problems in the determination of pathogens in prostatovesiculitis]

In patients with prostatovesiculitis the qualitative proof of microorganisms from experiment or ejaculate has only an insignificant diagnostic value on account of the lacking possibility of the recognition of contamination germs, It may be concluded to a prostatitis caused by bacteria, when the number of germs established in the exprimate is unequivocally larger than this one in the middle stream urine. In order to use successfully also the differences of the number of germs of ejaculate and middle stream urine for the differentiation between bacterial contamination and prostatovesiculitis, it must be presumed that bacteria of the physiological flora of the urethra may be cultivated in about the same quantity by investigations of the ejaculate as well as of the middle stream urine. Of 100 males without inflammatory disease in the region of the urogenital tract, therefore, middle stream urine and ejaculate or exprimate-containing urine were examined bacteriologically. Hereby was recognized that the number of germs in the different ejaculte specimens of healthy men considerably varied in comparison to the middle stream urine or the exprimate-containing urine and, consequently, is scarcely taken into consideration as diagnostic criterion for the prostatovesiculitis.