High-risk sexual behaviors while on depot medroxyprogesterone acetate as compared to oral contraception

Background

Depot medroxyprogesterone acetate (DMPA) contraceptive use is associated with an increased risk for Chlamydia infection. However, prior studies inadequately account for potential differences in sexual behavior between users of DMPA and users of other contraceptive methods. In this study we compare sexual risk-taking behavior in women using DMPA to women using oral contraceptive pills (OCP) to assess risk of Chlamydia trachomatis infection.

Methods

In this cross-sectional study of 630 reproductive-aged women seeking routine gynecologic care (449 OCP and 181 DMPA users) sexual risk-taking was evaluated by use of the Safe Sex Behavior Questionnaire, a validated measure of sexual behaviors and attitudes. All women were screened for Chlamydia. Logistic regression estimated the association of contraceptive choice, sexual behaviors, and Chlamydia infection.

Results

Oral contraceptive pill users differed from DMPA users in age, race, marital status, education level, and pregnancy history (p-values all <0.05). Oral contraceptive pill users had used their method of contraception for longer average duration (p < 0.01) and reported greater frequency of condom use (p < 0.01). Eleven (2.5%) OCP and 2 (1.1%) DMPA users had Chlamydia (p = NS).

Conclusions

Oral contraceptive pill and DMPA users differed with respect to both demographic factors and frequency of condom use. Odds of current Chlamydia infection did not differ between OCP and DMPA users when controlling for sexual risk-taking or demographic factors, though due to low Chlamydia rates in our population, this study was underpowered to detect this difference.

Can Computerized Decision Support Help Patients Make Complex Treatment Decisions? A Randomized Controlled Trial of an Individualized Menopause Decision Aid

Purpose. To compare the effectiveness of an individualized decision aid (DA) with standard educational materials on decisions about menopausal treatments and to assess the feasibility of integrating this DA into clinical practice, with and without coaching. Methods. We conducted a 3-armed randomized controlled trial in 3 clinics, enrolling menopausal women between the ages of 45 and 65 years with primary care appointments. Of the 145 women included, 99 completed a 2-week follow-up. The control group received generic educational materials, 1 intervention group received an individualized computer-generated DA mailed to patients and their clinicians before clinic appointment, and the 2nd intervention group received the same DA along with coached care before clinic appointment (DA + CC). Decisional conflict, satisfaction, and knowledge were measured 2 weeks after clinic appointment. Results. Participants' mean age was 52 years, and 97% were white. Most women (98%) read all or most of the documents. Decisional conflict was significantly lower in both intervention groups but not in the control group. DA reduced decisional conflict from preintervention to postintervention (pre—post change) by 0.70 (SD = 0.56) points (on a 1—5 scale), compared to reductions of 0.51 (SD = 0.51) and 0.09 (SD = 0.44) for the DA + CC group and the control group, respectively. Satisfaction with the decision made was significantly higher at 2 weeks in the DA v. control group. Self-reported knowledge significantly improved in DA + CC compared to controls. Conclusion. Our decision aid lowered decisional conflict and improved patient satisfaction; adding coaching provided little additional benefit.

Impact of a personalized decision support aid on menopausal women - results from a randomized controlled trial

To improve menopausal counseling, we developed a computer-generated personalized menopause decision support aid (DSA) and measured its impact in a randomized, controlled trial. Results suggest that this DSA may help women make informed decisions about menopausal therapy, change their risk perceptions, and motivate behavioral change.

Survival impact of tamoxifen use for breast cancer risk reduction: projections from a patient-specific Markov model

The authors estimate tamoxifen's impact on life expectancy among healthy women. A Markov model compared the effects of 5 years of tamoxifen on survival among 50-year-old postmenopausal women. Scenarios were explored using alternative assumptions with regard to tamoxifen's long-term effects on breast and endometrial cancer. Postmenopausal women without a uterus had substantial life expectancy gains from tamoxifen (1 to 4 months), whereas women with a uterus had such gains only if they were at a very high breast cancer risk. If tamoxifen's impact on endometrial cancer persists after treatment is discontinued, women at high risk for endometrial cancer have life expectancy losses from tamoxifen unless they are at a very high risk for breast cancer. The authors conclude that tamoxifen use among postmenopausal women is associated with substantial life expectancy gains. However, this benefit is modulated in women at increased endometrial cancer risk and depends on assumptions concerning tamoxifen's lingering effects on breast and endometrial cancer.

Identifying patient preferences for communicating risk estimates: a descriptive pilot study

BACKGROUND

Patients increasingly seek more active involvement in health care decisions, but little is known about how to communicate complex risk information to patients. The objective of this study was to elicit patient preferences for the presentation and framing of complex risk information.

METHOD

To accomplish this, eight focus group discussions and 15 one-on-one interviews were conducted, where women were presented with risk data in a variety of different graphical formats, metrics, and time horizons. Risk data were based on a hypothetical woman's risk for coronary heart disease, hip fracture, and breast cancer, with and without hormone replacement therapy. Participants' preferences were assessed using likert scales, ranking, and abstractions of focus group discussions.

RESULTS

Forty peri- and postmenopausal women were recruited through hospital fliers (n = 25) and a community health fair (n = 15). Mean age was 51 years, 50% were non-Caucasian, and all had completed high school. Bar graphs were preferred by 83% of participants over line graphs, thermometer graphs, 100 representative faces, and survival curves. Lifetime risk estimates were preferred over 10 or 20-year horizons, and absolute risks were preferred over relative risks and number needed to treat.

CONCLUSION

Although there are many different formats for presenting and framing risk information, simple bar charts depicting absolute lifetime risk were rated and ranked highest overall for patient preferences for format.

[Games of chance and gambling in adolescents and in adolescents-at-risk]

A number of studies have established that adolescents are attracted to games of chance and gambling, and have confirmed that excessive gambling is not a phenomenon of adulthood alone. In Quebec, the proportion of high school students who are struggling with gambling problems is estimated at 2.6% (Ladouceur, Boudreault, Jacques, & Vitaro, 1999). So far, few researchers have studied adolescent populations that are at greater risk of developing gambling problems. The present study was carried out among 104 adolescents in difficulty, ranging in age from 12 to 19 and served by the Centre jeunesse de Québec. It assesses the prevalence of excessive gambling and the problems associated with it. The results indicate that 92.3% of adolescents had bet at least once during the previous year and 40.4% bet every week. The prevalence of excessive gambling was established at 7.7%. Girls were found to gamble as frequently as boys and to experience as many gambling problems. In addition, habitual gambling was found to be associated with the consumption of psychotropic substances, delinquent behaviour and school absenteeism. The discussion puts the results obtained in perspective and emphasizes the need for establishing gambling prevention programs among at-risk youth.