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Puvogel S, Blanchard K, Casas BS, Miller RL, Garrido-Jara D, Arizabalos S, Rehen SK, Sanhueza M, Palma V. Altered resting-state functional connectivity in hiPSCs-derived neuronal networks from schizophrenia patients. Front Cell Dev Biol 2022; 10:935360. [PMID: 36158199 PMCID: PMC9489842 DOI: 10.3389/fcell.2022.935360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Schizophrenia (SZ) is a severe mental disorder that arises from abnormal neurodevelopment, caused by genetic and environmental factors. SZ often involves distortions in reality perception and it is widely associated with alterations in brain connectivity. In the present work, we used Human Induced Pluripotent Stem Cells (hiPSCs)-derived neuronal cultures to study neural communicational dynamics during early development in SZ. We conducted gene and protein expression profiling, calcium imaging recordings, and applied a mathematical model to quantify the dynamism of functional connectivity (FC) in hiPSCs-derived neuronal networks. Along the neurodifferentiation process, SZ networks displayed altered gene expression of the glutamate receptor-related proteins HOMER1 and GRIN1 compared to healthy control (HC) networks, suggesting a possible tendency to develop hyperexcitability. Resting-state FC in neuronal networks derived from HC and SZ patients emerged as a dynamic phenomenon exhibiting connectivity configurations reoccurring in time (hub states). Compared to HC, SZ networks were less thorough in exploring different FC configurations, changed configurations less often, presented a reduced repertoire of hub states and spent longer uninterrupted time intervals in this less diverse universe of hubs. Our results suggest that alterations in the communicational dynamics of SZ emerging neuronal networks might contribute to the previously described brain FC anomalies in SZ patients, by compromising the ability of their neuronal networks for rapid and efficient reorganization through different activity patterns.
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Affiliation(s)
- Sofía Puvogel
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
- Cell Physiology Laboratory, Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile
| | - Kris Blanchard
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
- Cell Physiology Laboratory, Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile
| | - Bárbara S. Casas
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
| | - Robyn L. Miller
- Department of Computer Science, Georgia State University, Atlanta, GA, United States
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS Center), Atlanta, GA, United States
| | - Delia Garrido-Jara
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
| | - Sebastián Arizabalos
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
| | - Stevens K. Rehen
- Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Magdalena Sanhueza
- Cell Physiology Laboratory, Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile
- *Correspondence: Verónica Palma, ; Magdalena Sanhueza,
| | - Verónica Palma
- Laboratory of Stem Cells and Developmental Biology, Department of Biology, Faculty of Sciences. Universidad de Chile. Santiago, Chile
- *Correspondence: Verónica Palma, ; Magdalena Sanhueza,
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Biggs M, Ehrenreich K, Morris N, Blanchard K, Bustamante C, Choimorrow S, Hauser D, Hernandez Y, Kapp N, Kromenaker T, Moayedi G, Perritt J, Ralph L, Raymond E, Valladares E, White K, Grossman D. Comprehension of an Over-the-counter Drug Facts Label Prototype for a Mifepristone and Misoprostol Medication Abortion Product. Contraception 2022. [DOI: 10.1016/j.contraception.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grindlay K, Key K, Bradford RD, Amato C, Blanchard K, Grossman D. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wollum A, Blanchard K, Teal SB. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Blanchard K, Zorrilla de San Martín J, Marty A, Llano I, Trigo FF. Differentially poised vesicles underlie fast and slow components of release at single synapses. J Gen Physiol 2020; 152:e201912523. [PMID: 32243497 PMCID: PMC7201884 DOI: 10.1085/jgp.201912523] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
In several types of central mammalian synapses, sustained presynaptic stimulation leads to a sequence of two components of synaptic vesicle release, reflecting the consecutive contributions of a fast-releasing pool (FRP) and of a slow-releasing pool (SRP). Previous work has shown that following common depletion by a strong stimulation, FRP and SRP recover with different kinetics. However, it has remained unclear whether any manipulation could lead to a selective enhancement of either FRP or SRP. To address this question, we have performed local presynaptic calcium uncaging in single presynaptic varicosities of cerebellar interneurons. These varicosities typically form "simple synapses" onto postsynaptic interneurons, involving several (one to six) docking/release sites within a single active zone. We find that strong uncaging laser pulses elicit two phases of release with time constants of ∼1 ms (FRP release) and ∼20 ms (SRP release). When uncaging was preceded by action potential-evoked vesicular release, the extent of SRP release was specifically enhanced. We interpret this effect as reflecting an increased likelihood of two-step release (docking then release) following the elimination of docked synaptic vesicles by action potential-evoked release. In contrast, a subthreshold laser-evoked calcium elevation in the presynaptic varicosity resulted in an enhancement of the FRP release. We interpret this latter effect as reflecting an increased probability of occupancy of docking sites following subthreshold calcium increase. In conclusion, both fast and slow components of release can be specifically enhanced by certain presynaptic manipulations. Our results have implications for the mechanism of docking site replenishment and the regulation of synaptic responses, in particular following activation of ionotropic presynaptic receptors.
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Affiliation(s)
- Kris Blanchard
- Université de Paris, SPPIN - Saints-Pères Paris Institute for the Neurosciences, Centre National de la Recherche Scientifique, UMR 8003, Paris, France
| | - Javier Zorrilla de San Martín
- Université de Paris, SPPIN - Saints-Pères Paris Institute for the Neurosciences, Centre National de la Recherche Scientifique, UMR 8003, Paris, France
| | - Alain Marty
- Université de Paris, SPPIN - Saints-Pères Paris Institute for the Neurosciences, Centre National de la Recherche Scientifique, UMR 8003, Paris, France
| | - Isabel Llano
- Université de Paris, SPPIN - Saints-Pères Paris Institute for the Neurosciences, Centre National de la Recherche Scientifique, UMR 8003, Paris, France
| | - Federico F Trigo
- Université de Paris, SPPIN - Saints-Pères Paris Institute for the Neurosciences, Centre National de la Recherche Scientifique, UMR 8003, Paris, France
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Chandrasekaran S, Gerdts C, Robinson Y, Hannum C, Blanchard K, Paul M. Safety and effectiveness of one-day later abortion procedures: A retrospective chart review. Contraception 2020. [DOI: 10.1016/j.contraception.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Acevedo C, Blanchard K, Bacigalupo J, Vergara C. Possible ATP trafficking by ATP-shuttles in the olfactory cilia and glucose transfer across the olfactory mucosa. FEBS Lett 2019; 593:601-610. [PMID: 30801684 DOI: 10.1002/1873-3468.13346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/12/2022]
Abstract
Odor transduction in the cilia of olfactory sensory neurons involves several ATP-requiring enzymes. ATP is generated by glycolysis in the ciliary lumen, using glucose incorporated from surrounding mucus, and by oxidative phosphorylation in the dendrite. During prolonged stimulation, the cilia maintain ATP levels along their length, by unknown means. We used immunochemistry, RT-PCR, and immunoblotting to explore possible underlying mechanisms. We found the ATP-shuttles, adenylate and creatine kinases, capable of equilibrating ATP. We also investigated how glucose delivered by blood vessels in the olfactory mucosa reaches the mucus. We detected, in sustentacular and Bowman's gland cells, the crucial enzyme in glucose secretion glucose-6-phosphatase, implicating both cell types as putative glucose pathways. We propose a model accounting for both processes.
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Affiliation(s)
- Claudia Acevedo
- Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Kris Blanchard
- Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Juan Bacigalupo
- Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Cecilia Vergara
- Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
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Young YY, Cohen D, Thompson TA, Blanchard K. Examining Medicaid reimbursement rates for abortion care. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barraud C, Corbière C, Pottier I, Estace E, Blanchard K, Logie C, Lagadu S, Kéravec V, Pottier D, Dionnet F, Morin J, Préterre D, André V, Monteil C, Sichel F. Impact of after-treatment devices and biofuels on diesel exhausts genotoxicity in A549 cells exposed at air-liquid interface. Toxicol In Vitro 2017; 45:426-433. [DOI: 10.1016/j.tiv.2017.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 04/03/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
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Meadows J, Gutierrez H, Hannum CPS, Douglas-Durham E, Blanchard K, Dennis A. Mixed-methods study of women's experiences with second-trimester abortion care. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lobrano A, Blanchard K, Abell T, Minocha A, Rock W. 111 HYPERCOAGULABILITY IS FOUND IN A REMARKABLY HIGH PERCENTAGE (89%) OF PATIENTS WITH SEVERE GASTROPARESIS. J Investig Med 2015. [DOI: 10.2310/6650.2005.00006.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Blanchard K, Roberts S, Ramjee G, Lince N, Dawad S, Kelvin E, Hoffman S. Contraceptive use and sexual health behaviors among newly-diagnosed HIV-positive South African women and men. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Morse J, Chipato T, Blanchard K, Nhemachena T, Ramjee G, McCulloch C, Blum M, Saleeby E, Harper CC. Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa. BJOG 2013; 120:1386-94. [PMID: 23721413 DOI: 10.1111/1471-0528.12290] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings. DESIGN Nationally representative survey of clinicians. SETTING HIV-prevalent settings in South Africa and Zimbabwe. POPULATION Clinicians in South Africa and Zimbabwe. METHODS Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. MAIN OUTCOME MEASURE Multivariable logistic regression of contraceptive provision and clinician training needs. RESULTS Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians' perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. CONCLUSIONS Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.
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Affiliation(s)
- J Morse
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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Lince N, Blanchard K, Adanu R, Anarfi J, Hill A. W428 “PEOPLE REALLY WORRY ABOUT UNWANTED PREGNANCY”: WOMEN'S DESIRED FAMILY SIZE AND ATTITUDES TOWARDS ABORTION IN ACCRA, GHANA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Grossman D, Grindlay K, Li R, Blanchard K, Trussell J, Potter J. Interest in over-the-counter access to oral contraceptives among a representative sample of US women at risk of unintended pregnancy. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Montgomery ET, van der Pol B, van der Straten A, Ramjee G, de Bruyn G, Chipato T, Blanchard K, Padian NS. Discrepancies in diagnosis of incident HIV infection between antibody- and DNA-based tests in a phase III prevention trial in southern Africa. Int J STD AIDS 2012; 23:649-52. [DOI: 10.1258/ijsa.2009.009124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dried blood spots (DBS) are widely used to test for HIV in a variety of research and service delivery settings; however, uniform guidelines regarding collection, storage and DNA extraction processes have neither been developed nor evaluated. Previously published reports suggested DBS may be stored at room temperature for up to 60 days, and intensive stability tests have shown that DBS can withstand high temperatures, humidity and freeze–thawing. During the implementation of a large randomized controlled trial (RCT) in southern Africa, with HIV acquisition as the primary endpoint, we observed 65 instances when DBS samples collected from the same day as a positive HIV antibody test yielded negative DNA polymerase chain reaction (PCR) results. The source of this discrepancy may have been due to inadequate specimen volume, filter paper or DNA extraction procedures, but were most likely due to storage conditions that have been reported as acceptable in other settings.
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Affiliation(s)
- E T Montgomery
- Women's Global Health Imperative, RTI International, San Francisco Project Office, San Francisco, CA, USA
| | - B van der Pol
- Indiana University School of Medicine, Infectious Disease Laboratory, Indianapolis, IN
| | - A van der Straten
- Women's Global Health Imperative, RTI International, San Francisco Project Office, San Francisco, CA, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - G Ramjee
- Medical Research Council, Kwazulu-Natal
| | - G de Bruyn
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - T Chipato
- University of Zimbabwe-University of California San Francisco Research Collaborative Programme in Women's Health, Harare, Zimbabwe
| | - K Blanchard
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
| | - N S Padian
- Women's Global Health Imperative, RTI International, San Francisco Project Office, San Francisco, CA, USA
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Adanu RM, Seffah J, Anarfi JK, Lince N, Blanchard K. Sexual and reproductive health in Accra, Ghana. Ghana Med J 2012; 46:58-65. [PMID: 22942453 PMCID: PMC3426379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To describe sexual and reproductive health among women in Accra and explore the burden of sexual and reproductive ill health among this urban population. DESIGN Cross-sectional study. METHODS We analysed data from the WHSA-II (n=2814), a cross-sectional household survey on women's health, and supplemental data from an in-depth survey (n=400), focus groups discussions (n=22) and in-depth interviews (n=20) conducted among a sub-sample of women which focused specifically on reproductive health issues. RESULTS Modern contraceptive use was uncommon. More than one third of women reported ever using abstinence; condoms, injectables and the pill were the most commonly reported modern methods ever used. The total fertility rate among this sample of women was just 2.5 births. We found a considerable burden of sexual and reproductive ill health; one in ten women reported menstrual irregularities and almost one quarter of women reported symptoms of a Sexually Transmitted Infection (STI) or Reproductive Tract Infection (RTI) in the past 6 months. Focus group results and in-depth interviews reveal misperceptions about contraception side-effects and a lack of information. CONCLUSION In urban Ghana, modern contraceptive use is low and a significant proportion of women experience reproductive ill health (defined here as menstrual irregularity or RTI, UTI, STI symptoms). Increased access to information, products and services about for preventive care and contraception could improve reproductive health. More research on healthy sexuality and the impact of reproductive ill health on sexual experience is needed.
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Affiliation(s)
- R M Adanu
- Population Family and Reproductive Health Department, School of Public Health, University of Ghana, Legon, Ghana.
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Grossman D, Lince N, Harries J, Constant D, Alblas M, Steyn P, Blanchard K. O529 The efficacy, safety and acceptability of medical and surgical second trimester termination of pregnancy in Cape Town, South Africa. Int J Gynaecol Obstet 2011. [DOI: 10.1016/s0020-7292(09)60902-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dennis A, Blanchard K, Córdova D, Clark J, Wahlin B, McIntosh J, Tsikitas L, Edlund K. Beyond stopping Stupak: emerging challenges to abortion access under health care reform. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Dennis A, Manski R, Blanchard K. Barriers to timely access to abortion: opportunities for immediate improvements while working for systemic change. Contraception 2011. [DOI: 10.1016/j.contraception.2011.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Venkatesh KK, van der Straten A, Cheng H, Montgomery ET, Lurie MN, Chipato T, Ramjee G, Blanchard K, Padian NS, Mayer KH, de Bruyn G. The relative contribution of viral and bacterial sexually transmitted infections on HIV acquisition in southern African women in the Methods for Improving Reproductive Health in Africa study. Int J STD AIDS 2011; 22:218-24. [DOI: 10.1258/ijsa.2010.010385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assess the relative contribution of viral and bacterial sexually transmitted infections (STIs) on HIV acquisition among southern African women in a nested case-control study within the Methods for Improving Reproductive Health in Africa (MIRA) trial. Cases were women with incident HIV infection; controls were HIV-uninfected at the time of case seroconversion selected in a 1 to 3 case to control ratio (risk-set sampling), matched on study site and time of follow-up. Conditional logistic regression models were used to calculate adjusted odds ratios (AORs) and population-attributable fractions (PAF). Among 4948 enrolled women, we analysed 309 cases and 927 controls. The overall HIV incidence rate was 4.0 per 100 women-years. The incidence of HIV infection was markedly higher in women who had prevalent Herpes simplex virus type 2 (HSV-2) (AOR: 2.14; 95% confidence interval [CI]: 1.55–2.96), incident HSV-2 (AOR: 4.43; 95% CI: 1.77–11.05) and incident Neisseria gonorrhoeae (AOR: 6.92; 95% CI: 3.01–15.90). The adjusted PAF of HIV incidence for prevalent HSV-2 was 29.0% (95% CI: 16.8–39.3), for incident HSV-2 2.1% (95% CI: 0.6–3.6) and for incident N. gonorrhoeae 4.1% (95% CI: 2.5–5.8). Women's greatest risk factors for HIV acquisition were incident bacterial and viral STIs. Women-centred interventions aimed at decreasing HIV incidence in young African women need to address these common co-morbid conditions.
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Affiliation(s)
- K K Venkatesh
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - A van der Straten
- Women's Global Health Imperative, RTI International
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - H Cheng
- Women's Global Health Imperative, RTI International
| | | | - M N Lurie
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - T Chipato
- University of Zimbabwe, Harare, Zimbabwe
| | - G Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa
| | | | - N S Padian
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - K H Mayer
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - G de Bruyn
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
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de Bruyn G, Shiboski S, van der Straten A, Blanchard K, Chipato T, Ramjee G, Montgomery E, Padian N. The effect of the vaginal diaphragm and lubricant gel on acquisition of HSV-2. Sex Transm Infect 2011; 87:301-5. [DOI: 10.1136/sti.2010.047142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Dennis A, Blanchard K. “Are we even speaking the same language?”: contested definitions of rape, incest and life endangerment under the Hyde Amendment. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Harper C, Blanchard K, Morar N, McCulloch C, Ramjee G. O131 Provider HIV and pregnancy prevention in South Africa: the female condom. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Blanchard K, Grossman D. O130 Moving oral contraceptives over the counter: safety, effectiveness, potential benefits and the way forward. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Dennis A, Blanchard K, Cordova D, Wahlin B. Impact of mandatory insurance coverage on family planning providers in Massachusetts. Contraception 2009. [DOI: 10.1016/j.contraception.2009.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hu D, Grossman D, Levin C, Blanchard K, Goldie SJ. Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City. BJOG 2009; 116:768-79. [DOI: 10.1111/j.1471-0528.2009.02142.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wilkinson S, Perry R, Blanchard K, Linsell L. Effectiveness of a three-day communication skills course in changing nurses' communication skills with cancer/palliative care patients: a randomised controlled trial. Palliat Med 2008; 22:365-75. [PMID: 18541641 DOI: 10.1177/0269216308090770] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This multi-centre, two-armed parallel-group pragmatic randomised controlled trial (RCT) evaluated the effectiveness of a 3-day communication skills course in changing nurses' communication skills. The primary outcome was the change in the nurses' communication skills score from pre-course to 12 weeks post-course. The main secondary outcome was the change in the nurses' level of confidence in communicating with patients. A total of 172 nurses were randomised to the course or control. The communication skills score for the intervention group increased by 3.4 points post-course but decreased in the control by 0.05 points (between-group difference in change: 3.41, 95% CI: 2.16-4.66, P < 0.001). Confidence scores increased by 18.16 points for the intervention group but decreased 0.7 points in the control (between-group difference in change: 18.86, 95% CI: 13.39-24.34, P < 0.001). This RCT contributes to the evidence base on the effectiveness of communication skills training in cancer and palliative care.
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Affiliation(s)
- S Wilkinson
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK.
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Blanchard K, Cooper D, Dickson K, Cullingworth L, Mavimbela N, von Mollendorf C, van Bogaert LJ, Winikoff B. A comparison of women's, providers' and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa. BJOG 2007; 114:569-75. [PMID: 17439565 DOI: 10.1111/j.1471-0528.2007.01293.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare providers' and women's estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility. DESIGN Cross-sectional study. SETTING Public termination of pregnancy (TOP) services in three provinces. SAMPLE A total of 673 women attending the above services for TOP. METHODS Women participating in a medical abortion feasibility study in South Africa provided estimates of pregnancy duration and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams. We compared estimates using the four methods, calculating the proportion of women in the 'caution zone' (< or = 8 weeks gestation by woman or provider estimate and > 8 weeks by ultrasound). MAIN OUTCOME MEASURES Mean gestational age by each method; difference between provider and LMP estimates and ultrasound estimates; and percentage of women in the 'caution zone'. RESULTS Women's estimates of pregnancy duration were 19 days fewer than ultrasound estimates (95% CI = -27 to 63). Mean provider- and LMP-based estimates were two (95% CI = -30 to 35) and less than one day(s) (95% CI = -46 to 51) fewer than ultrasound estimates. Comparing provider and ultrasound estimates, 15% of women were in the 'caution zone'; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable. CONCLUSIONS Provider estimates of gestational age were sufficiently accurate for determining eligibility for medical abortion. LMP-based estimates were also accurate on average, but included more extreme differences from ultrasound estimates. Medical abortion could be provided in TOP facilities without ultrasound or with ultrasound on referral.
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Affiliation(s)
- K Blanchard
- Ibis Reproductive Health, Cambridge, MA 02138, USA.
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Harper CC, Blanchard K, Grossman D, Henderson JT, Darney PD. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings. Int J Gynaecol Obstet 2007; 98:66-9. [PMID: 17466303 DOI: 10.1016/j.ijgo.2007.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/02/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
Over 99% of deaths due to abortion occur in developing countries. Maternal deaths due to abortion are preventable. Increasing the use of misoprostol for elective abortion could have a notable impact on maternal mortality due to abortion. As a test of this hypothesis, this study estimated the reduction in maternal deaths due to abortion in Africa, Asia and Latin America. The estimates were adjusted to changes in assumptions, yielding different possible scenarios of low and high estimates. This simple modeling exercise demonstrated that increased use of misoprostol, an option for pregnancy termination already available to many women in developing countries, could significantly reduce mortality due to abortion. Empirical testing of the hypothesis with data collected from developing countries could help to inform and improve the use of misoprostol in those settings.
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Affiliation(s)
- C C Harper
- Bixby Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
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Abstract
BACKGROUND Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use. OBJECTIVES To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. SEARCH STRATEGY In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. SELECTION CRITERIA We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy. DATA COLLECTION AND ANALYSIS We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data. MAIN RESULTS Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women. AUTHORS' CONCLUSIONS Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.
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Affiliation(s)
- C B Polis
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Room W4510, 615 N. Wolfe St, Baltimore, Maryland 21205, USA.
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Ridgway D, White SA, Nixon M, Carr S, Blanchard K, Nicholson ML. Primary endoluminal stenting of transplant renal artery stenosis from cadaver and non-heart-beating donor kidneys. Clin Transplant 2006; 20:394-400. [PMID: 16824160 DOI: 10.1111/j.1399-0012.2006.00499.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated the efficacy of primary endovascular stenting in cases of transplant renal artery stenosis (TRAS) from cadaver and non-heart-beating donor kidneys. Patients with TRAS (n = 13) from a single-centre transplant population (n = 476) were treated by primary percutaneous angioplasty and endovascular stenting. The short-term efficacy of this intervention is demonstrated in terms of serum creatinine, glomerular filtration rate (GFR) biochemical, anti-hypertensive medications and mean arterial blood pressure control. Stenting for TRAS was performed in male (n = 10) and female (n = 3) recipients. The median age at transplantation was 55 yr (range 10-67 yr). Stenting occurred at a median duration of 410 d post-transplantation (range 84-5799 d). Mean serum creatinine (pre, 247 micromol/L; post, 214 micromol/L; p = 0.002), GFR (pre, 82.6 mL/min; post, 100.9 mL/min; p < 0.001), arterial blood pressure (pre, 104 mmHg; post, 97 mmHg; p = 0.036) and the number of anti-hypertensive medications required (pre, 3.4; post, 3.0; p = 0.002) showed significant improvement after post-endovascular therapy. There were no serious complications encountered. Primary endovascular stenting of TRAS produces a significant improvement in biochemical parameters of renal graft function and in blood pressure stability, with the benefit of low patient morbidity and single arterial puncture. Primary endoluminal stenting of TRAS is a safe and effective procedure for the treatment of TRAS.
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Affiliation(s)
- D Ridgway
- Department of Surgery, University Hospitals of Leicester, NHS Trust, UK
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Lobrano A, Blanchard K, Abell TL, Minocha A, Boone W, Wyatt-Ashmead J, Fratkin J, Subramony C, Wee A, Di Nardo G, Barbara G, Stanghellini V, De Giorgio R. Postinfectious gastroparesis related to autonomic failure: a case report. Neurogastroenterol Motil 2006; 18:162-7. [PMID: 16420295 DOI: 10.1111/j.1365-2982.2005.00728.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.
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Affiliation(s)
- A Lobrano
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Jain S, Blanchard K, Minocha A. 110 MULTIPLE COLONIC ULCERS IN AN ADULT CYSTIC FIBROSIS PATIENT ON PANCREATIC ENZYME SUPPLEMENTS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Blanchard K, Rock W, Schmieg R, Araghizadeh F, Borman K, Abell TL. 67 PATIENTS WITH SYMPTOMS OF SEVERE GASTROPARESIS HAVE A HIGH INCIDENCE OF BOTH ACQUIRED AND CONGENITAL HYPERCOAGULABLE DISORDERS. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Clark S, Blum J, Blanchard K, Galvão L, Fletcher H, Winikoff B. Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States. Int J Gynaecol Obstet 2002; 76:65-74. [PMID: 11818096 DOI: 10.1016/s0020-7292(01)00567-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate current clinical use of misoprostol for the treatment of a range of reproductive health indications by providers in Brazil, Jamaica, and the United States. METHODS Using a 'snowball' sampling technique, we surveyed 228 gynecologists and obstetricians in Brazil (n=123), Jamaica (n=52), and the United States (n=53). RESULTS Providers use misoprostol for labor induction (46%), postpartum hemorrhage (8%), intra-uterine fetal death (61%), cervical priming (21%), missed abortion (57%), and incomplete abortion (16%) as well as first and second trimester abortion induction (27% and 13%, respectively). CONCLUSIONS There is considerable variation in the regimens used; moreover, the regimens commonly used in clinical practice often differ from those recommended in the medical literature. While misoprostol is an appealing alternative for many reproductive health indications in developing countries, the varied regimens and lack of registration raise critical medical and policy questions.
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Affiliation(s)
- S Clark
- Population Council, New York, NY 10017, USA
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Ellertson C, Ambardekar S, Hedley A, Coyaji K, Trussell J, Blanchard K. Emergency contraception: randomized comparison of advance provision and information only. Obstet Gynecol 2001; 98:570-5. [PMID: 11576569 DOI: 10.1016/s0029-7844(01)01506-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether multiple courses of emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods. METHODS We randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about emergency contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain emergency contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability. RESULTS Women given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken emergency contraception, although numbers were too small to permit statistically significant inferences. No women used emergency contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about emergency contraception useful, and all those receiving only information wished they had received supplies as well. CONCLUSION Multiple emergency contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.
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Tharawan K, Manopaiboon C, Ellertson C, Limpakarnjanarat K, Chaikummao S, Kilmarx PH, Blanchard K, Coggins C, Mastro TD, Elias C. Women's willingness to participate in microbicide trials in Northern Thailand. J Acquir Immune Defic Syndr 2001; 28:180-6. [PMID: 11588513 DOI: 10.1097/00126334-200110010-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To assess women's interests and concerns regarding participation in trials of microbicides in Chiang Rai, Thailand, we administered structured questionnaires. Before answering the questionnaire, women attended an educational session on microbicides and clinical trials. Of 370 participants, 82% correctly answered 8 or more of the 11 overall comprehension questions, indicating an adequate knowledge base among the women from which to answer questions about attitudes toward microbicide trials. The most common motivations for participating in a trial were "getting tested for HIV" and "doing something good for women's health." The greatest barrier to participation was women's fear that if they proposed use of a microbicide, their husbands might feel protected and thereby have more sex partners. Overall, 6.2% said they would be "definitely willing to participate," and 66.8% said they wanted to participate but wanted to think about it. Most women previously unacquainted with the concept of microbicides or clinical trial design displayed adequate knowledge of these subjects after the short educational session. If women's initial reactions are validated by actual willingness, surveys could prove valuable for selecting sites for microbicide trials, estimating enrollment rates, and tailoring trials to make them most acceptable to women.
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Affiliation(s)
- K Tharawan
- The Population Council, Bangkok, Thailand
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Coetzee N, Blanchard K, Ellertson C, Hoosen AA, Friedland B. Acceptability and feasibility of Micralax applicators and of methyl cellulose gel placebo for large-scale clinical trials of vaginal microbicides. AIDS 2001; 15:1837-42. [PMID: 11579246 DOI: 10.1097/00002030-200109280-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) To evaluate the feasibility and acceptability of the Micralax applicator and of methyl cellulose placebo gel for use in vaginal microbicide clinical trials. DESIGN A two-centre prospective study following women for 2 months. SETTING Two primary health care clinics in South Africa. PATIENTS, PARTICIPANTS Female volunteers (n = 28) 18 years or older who were HIV negative and had no clinically detectable genital tract abnormalities or reproductive tract infections. INTERVENTIONS Participants used pre-filled Micralax applicators to apply methyl cellulose gel every other day, as well as up to 1 h before to every episode of vaginal sex. MAIN OUTCOME MEASURE(S) Consistency in the weight of gel dispensed per application; side-effects attributed to applicator or gel use; and acceptability of the applicator and of the gel. RESULTS Over a 2 month follow-up period the 22 women completing the study reported no adverse events related to gel or applicator use. The Micralax applicator proved acceptable. The gel was not too messy and did not reduce sexual frequency or pleasure. On average, the applicator dispensed 4.7 ml per use (close to the 4 ml planned). CONCLUSIONS The Micralax applicator performs well as a delivery system for potential vaginal microbicides; and methyl cellulose is an appropriate placebo for future microbicide trials.
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Affiliation(s)
- N Coetzee
- Department of Public Health, University of Cape Town, Johannesburg, South Africa
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Abstract
Paget's disease of the breast is a rare disorder of the nipple-areola complex that is often associated with an underlying in situ or invasive carcinoma. A change in sensation of the nipple-areola, such as itching and burning, is a common presenting symptom. Objectively, eczematoid changes of the nipple-areola complex are common. The later stages of Paget's disease of the breast are characterized by ulceration and destruction of the nipple-areola complex. Eczematoid changes of the nipple-areola complex and persisting soreness or itching, without obvious reason, is a suspicious symptom for Paget's disease of the breast and calls for thorough evaluation, including mammography. Exfoliative cytology with demonstration of Paget's cells may be useful, but a negative finding does not exclude Paget's disease of the breast. Surgical biopsy is the diagnostic standard and therefore the diagnosis should always be confirmed by open (surgical) biopsy. The histogenesis of Paget's disease of the breast continues to be debated. The epidermotropic theory holds that Paget's cells are ductal carcinoma cells that have migrated from the underlying breast parenchyma to the nipple epidermis. According to the in situ transformation theory, the Paget's cells arise as malignant cells in the nipple epidermis independent from any other pathologic process within the breast parenchyma. This theory has been proposed to explain those cases in which there is no underlying mammary carcinoma or when there is a carcinoma remote from the nipple-areola complex. Each of these theories is plausible; however, treatment approaches differ markedly depending on the theory of histogenesis. Mastectomy has been considered the standard of care in the management of patients with Paget's disease of the breast. Nowadays, however, some patients with Paget's disease of the breast are candidates for breast-conserving therapy. Patients must be selected carefully on an individual basis. Until there is a better understanding of the relationship of Paget's disease of the breast to the underlying cancer the surgeon should understand the natural history and behaviour of this lesion and be aware of both the risks of under- and over-treating patients with Paget's disease of the breast.
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Affiliation(s)
- G H Sakorafas
- Department of Surgery, 251 Hellenic Air Force General Hospital, GR--115 25 Athens, Greece.
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Blanchard K, Hananel A, Rutchik S, Sullivan J. Transurethral resection of the prostate: failure patterns and surgical outcomes in patients with symptoms refractory to alpha-antagonists. South Med J 2000; 93:1192-6. [PMID: 11142455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND alpha-Antagonists (AAs) are ineffective in some men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) may be required. Reasons for AA failure and surgical outcomes in these patients have not been reported. METHODS We retrospectively reviewed cases of TURP for LUTS due to bladder outlet obstruction from 1995 to 1998. The TURP patients in whom AA therapy had failed (group 1) were compared with those who had symptomatic BPH but were not taking AAs (group 2). Comorbid conditions that might influence treatment results were considered, as were sizes of resection and pathologic results. RESULTS No differences occurred between groups 1 (n = 38) and 2 (n = 25) in age, length of postoperative follow-up, or resection size. However, outcomes were poorer in group 1 than in group 2. A trend toward greater comorbidity that might lead to voiding dysfunction, though not statistically significant, was seen in group 1. CONCLUSIONS Postoperative results of TURP may be less successful after AA therapy failure. This may be due to preoperative risk factors that affect voiding function rather than to prostatic size.
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Affiliation(s)
- K Blanchard
- Department of Urology, Ochsner Clinic, New Orleans, LA, USA
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Coggins C, Blanchard K, Alvarez F, Brache V, Weisberg E, Kilmarx PH, Lacarra M, Massai R, Mishell D, Salvatierra A, Witwatwongwana P, Elias C, Ellertson C. Preliminary safety and acceptability of a carrageenan gel for possible use as a vaginal microbicide. Sex Transm Infect 2000; 76:480-3. [PMID: 11221133 PMCID: PMC1744249 DOI: 10.1136/sti.76.6.480] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We sought to determine the safety and acceptability of vaginal gel formulation PC-503 among low risk, abstinent women. The active ingredient was 2% pharmaceutical grade lambda carrageenan, a sulphated polymer that is generally recognised as safe by the US Food and Drug Administration. METHODS 35 women in five sites applied 5 ml of the PC-503 gel vaginally once a day for 7 days while abstaining from sexual intercourse. Visual vaginal examinations were performed on days 1, 4, and 8. STI testing and vaginal pool Gram stain preparations were done on days 1 and 8. Participants were asked about product acceptability. RESULTS 34 of the 35 women enrolled completed 7 days' use. Following product use, five reported mild symptoms including "bladder fullness," "genital warmth," or discomfort, and lower abdominal pain, and one had moderate pale yellow cervical discharge. Using the Nugent criteria, three women had bacterial vaginosis (BV) before and after use; three had BV before but not after, and two had BV after but not before. Most of the women found PC-503 to be pleasant or neutral in feel and smell and considered extra lubrication to be an advantage; however, one third found it to be messy. CONCLUSIONS Vaginal use of PC-503 gel did not cause significant adverse effects in a small number of low risk, sexually abstinent women. Further testing in larger numbers of sexually active women is planned. A smaller volume of gel may be more acceptable to some women.
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Affiliation(s)
- C Coggins
- Population Council, New York 10017, USA
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Blanchard K, Winikoff B, Coyaji K, Nguyen TN. Misoprostol alone--a new method of medical abortion? J Am Med Womens Assoc (1972) 2000; 55:189-90. [PMID: 10846336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Misoprostol shows promise for early termination of pregnancy. The drug is widely available, inexpensive, and easy to administer. Current evidence on the efficacy of potential regimens for early abortion, though, is hard to decipher and often contradictory. Research on a safe, effective, acceptable regimen of misoprostol alone for early abortion is underway. Available data show a wide range in efficacy of various regimens, and additional research is needed to understand this variability. A framework for additional research on misoprostol alone for medical abortion is presented with a focus on the need to evaluate benefits and risks of new regimens in the context of women's options for termination of pregnancy. We discuss the potential usefulness of a regimen with less efficacy than approved medical abortifacients. Research is needed as well on women's ability to self-diagnose incomplete abortion or ongoing pregnancy and the potential for misoprostol to be used as treatment for incomplete abortion in order to evaluate the benefits and risks of misoprostol-alone regimens.
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van de Wijgert J, Elias C, Ellertson C, McGrory E, Blanchard K, Friedland B, Winikoff B, Brown G. Condom promotion in microbicide trials. Am J Public Health 2000; 90:1153-4; author reply 1156. [PMID: 10897199 PMCID: PMC1446295 DOI: 10.2105/ajph.90.7.1153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Vaginal microbicides are being developed in an attempt to expand women's and men's options for protecting themselves against HIV and other sexually transmitted infections. Taking account of men's attitudes during product development and introduction could increase the likelihood that products are acceptable and used. To capture the perspectives of urban and rural men from a range of cultural settings, we conducted focus group discussions with taxi drivers and farmers in Zimbabwe, Mexico and the USA. These explored HIV/STD risk perception and prevention strategies, desirable characteristics of vaginal products and of a microbicide, and attitudes towards use of a potential product. Men were generally supportive of the idea of a microbicide; urban somewhat more than rural men. Most thought microbicides would be preferable to condoms though many raised concerns about potential side effects. The men wanted these products to be as inexpensive and readily available as condoms, and differed as to whether a woman should have permission from her partner to use it. For them to be widely used, the men thought these products must not only be safe and effective, but should also have no negative effect on sexual pleasure. When a product becomes available, introductory messages must explain the limits on its effectiveness and encourage use with condoms. Further research is needed on definitions of pleasurable sex and the ramifications of this for microbicide formulation, and on partner communication around issues of sexuality and prevention of infection.
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47
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Abstract
Many biomedical aspects of emergency contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of emergency contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing emergency contraceptive services. The review also offers ideas for designing new emergency contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.
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Affiliation(s)
- C Ellertson
- Population Council, DF, Col. Villa Coyoacan, Mexico
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48
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Blanchard K. Reaching out to others through simple truths: Ken Blanchard's theory of good managing and fulfilled living. Interview by Val J. Halamandaris. Caring 1999; 18:20-4. [PMID: 10623082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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49
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Abstract
Increased access to medical methods of abortion could significantly reduce maternal mortality, especially in developing countries. In light of the political and commercial difficulties in distributing the abortifacient mifepristone, the widely studied mifepristone-misoprostol regimen may not be sufficiently available in the near future. Thus, researchers have begun to look for alternative regimens, including regimens using misoprostol alone. This article reviews the current available evidence on the potential of a misoprostol-alone regimen for medical abortion. Although the data are varied and difficult to compare, recent studies indicate that a misoprostol-alone regimen could be safe and effective as a method of medical abortion. Misoprostol is widely marketed around the world for its other indications and is inexpensive, stable in tropical climates, easy to transport, and simple to administer. A misoprostol-alone regimen of medical abortion could thus greatly improve the access to safe medical abortion services by women in developing countries.
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Affiliation(s)
- K Blanchard
- Population Council, New York, New York 10017, USA.
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50
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Blanchard K. Improving women's access to emergency contraception: innovative information and service delivery strategies. J Am Med Womens Assoc (1972) 1998; 53:238-41. [PMID: 9859631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Barriers to widespread use of emergency contraception (EC) include lack of knowledge on the part of women and providers, lack of support for the method from providers, and lack of a dedicated product in many countries. This article reviews strategies to improve women's access to EC launched by national or regional health authorities, clinicians, grass-roots health organizations, and women's groups. Information campaigns have targeted women to improve their knowledge of EC and providers to improve their comfort with it. Local groups and individual providers have also provided leaflets or designed innovative service strategies in order to improve women's access to the method. Expanding the scope or number of these programs and introducing them in areas where women do not currently have adequate knowledge of or access to EC will insure that more women will be able to use this method.
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