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In the special section EVERYTHING IS ENLIGHTENED three authors present new developments in the Enlightenment research. In this short introduction we determine the boundaries within which the more than thirty books that are discussed by these authors can be placed, en we observe that historians of the Enlightenment have in recent years explored the limits of what can still be considered Enlightened.

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Summary Background Secondary loss of response to anti-TNF-α therapy is observed in Crohn's disease patients. Aim Serum C-reactive protein (CRP) levels at baseline and after infliximab induction therapy at week 14 were assessed as predictors for maintained response or remission through 54 weeks of treatment in patients with Crohn's disease who responded to induction therapy. Methods ACCENT I was a multicenter, randomised, placebo-controlled study. Patients who received infliximab induction (weeks 0, 2 and 6) and maintenance (5 or 10 mg/kg every 8 weeks beginning at week 14) therapy were considered. Patients in clinical response or remission to induction therapy at week 14 (n = 212 or n = 138 respectively) were analysed. Associations between CRP levels (cut-off points 0.5–3.0 mg/dL), baseline disease variables and maintained clinical response or remission during maintenance therapy were assessed. Results A significant association was observed between baseline CRP levels and maintained remission. Forty-five percent of patients with baseline CRP ≥ 0.7 mg/dL vs. 22.0% with CRP

Objective. To study the influence of counseling on women's contraceptive decisions. Design. A cross-sectional multicenter study. Setting. 70 Swedish family planning clinics. Population. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Methods. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Main Outcome Measures. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. Results. In all, 173 healthcare professionals and 1 944 women participated. The mean (SD) age of the women was 22.6 (6.1) years. After structured counseling, a majority of women (56.0%; n= 1 069; 95% confidence interval [CI] 53.1-58.9) chose the daily pill, 6.2% (n= 118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n= 430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2% vs 2.4% before counseling; p

Timeline of the Sister Republics (1794-1806)[-]The political culture of the Sister republics - Joris Oddens and Mart Rutjes[-]'The political passions of other nations'. National choices and the European order in the writings of Germaine de Sta l - Biancamaria Fontana[-][-]1. THE TRANSFORMATION OF REPUBLICANISM[-]The transformation of republicanism in the Sister Republics - Andrew Jainchill[-]'Republic' and 'democracy' in Dutch late eighteenth-century revolutionary discourse - Wyger R. E. Velema[-]New wine and old wineskins. Republicanism in the Helvetic Republic - Urte Weeber[-][-]2. POLITICAL CONCEPTS AND LANGUAGES[-]Revolutionary concepts and languages in the Sister Republics of the late 1790s - Pasi Ihalainen[-]Useful citizens. Citizenship and democracy in the Batavian Republic, 1795-1801 - Mart Rutjes[-]From rights to citizenship to the Helvetian indig nat. Political integration of citizens under the Helvetic Republic - Silvia Arlettaz[-]The battle over 'democracy' in Italian political thought during the revolutionary triennio, 1796-1799 - Mauro Lenci[-][-]3. THE INVENTION OF DEMOCRATIC PARLIAMENTARY PRACTICES[-]Parliamentary practices in the Sister Republics in the light of the French experience - Malcolm Crook[-]Making the most of national time. Accountability, transparency, and term limits in the f.irst Dutch Parliament (1796-1797) - Joris Oddens[-]The invention of democratic parliamentary practices in the Helvetic Republic. Some remarks - Andr Holenstein[-]The Neapolitan republican experiment of 1799. Legislation, balance of power, and the workings of democracy between theory and practice - Valeria Ferrari[-][-]4. PRESS, POLITICS, AND PUBLIC OPINION[-]Censorship and press liberty in the Sister Republics. Some reflections - Simon Burrows[-]1798: A turning point? Censorship in the Batavian Republic - Erik Jacobs[-]Censorship and public opinion. Press and politics in the Helvetic Republic (1798-1803) - Andreas W rgler[-]Liberty of press and censorship in the f.irst Cisalpine Republic - Katia Visconti[-][-]5. THE SISTER REPUBLICS AND FRANCE[-]Small nation, big sisters - Pierre Serna[-]The national dimension in the Batavian Revolution. Political discussions, institutions, and constitutions - Annie Jourdan[-]The constitutional debate in the Helvetic Republic in 1800-1801. Between French influence and national self-government - Antoine Broussy[-]An unwelcome Sister Republic. Re-reading political relations between the Cisalpine Republic and the French Directory - Antonino De Francesco[-][-]Bibliography[-]List of Contributors[-]Notes[-]Index

Background The multinational CHOICE (Contraceptive Health Research Of Informed Choice Experience) study evaluated the effects of structured counseling on women’s contraceptive decisions, their reasons for making those decisions, and their perceptions of combined hormonal contraceptive (CHC) methods in eleven countries. The aim of this paper to present data from the 1,802 women participating in Israel’s CHOICE program. Methods Women (aged 17–40 years) who consulted their health care providers about contraception and who would consider a CHC method qualified to participate. After indicating their intended CHC method, the women received counseling about the daily pill, weekly patch, and monthly vaginal ring. After counseling, the women completed a questionnaire about their contraceptive decisions. Results Before counseling, 67%, 6%, and 5% of women (mean age 27 years) intended to use the pill, patch, or ring, respectively. Counseling significantly influenced the women’s CHC choice, with 56%, 12%, and 23% of women selecting the pill, patch, or ring (P

User satisfaction and the physical and psychological effects of five commonly used contraceptive methods were investigated in a population survey among 1466 West German women. The focus was on effects attributed by current and past users to these methods, rather than objectively assessed effects, to shed further light on personal experiences that are highly relevant to the user but often remain unknown to prescribers and unreported in the medical literature. Within the overall sample, 1303 women were surveyed concerning their current or past use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices (IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization (respondents completed questions about each method used). It emerged that satisfaction was greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP (43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted pregnancy during use of this method, as compared with one in 20 OC and condom users. The majority of users reported no mood changes during use of the methods studied. The percentages reporting negative mood changes (various items were scored) were up to 16% among OC users, 23% among condom users, and 30% among NFP users. The latter observations suggested that subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the user's sense of confidence in the method concerned (notably, with regard to efficacy and safety). Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas that of condoms was often negative. Whereas OC users often reported less heavy and painful menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent (in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less negative impact on physical and psychological functioning than the other methods studied, in contrast to what the general public often believes.A survey covering sociodemographic characteristics, contraceptive use, and previous use of oral contraceptives (OCs), condoms, IUDs, and natural family planning (NFP) was conducted among 1466 West German women to evaluate their satisfaction with their birth control method. The focus was on the effects attributed to these methods by current and past users to of them rather than on objectively assessed effects. The aim was to gain insight into personal experiences that are very significant to the user but often remain unknown to prescribers and unreported in the medical literature. Results showed that almost 1 in 3 NFP users had had an unwanted pregnancy during the period of use; the figure was 1 in 20 among OC and condom users. A majority of users for each method claimed no mood changes during the use of that method. Negative mood changes were reported among 16% of OC users, 23% of condom users, and 30% of NFP users. The subjective side effects of a contraceptive agent on mood were observed to reflect the user's sense of confidence in the method concerned. OC, IUD and sterilization had a broadly positive impact on sex life, while that of the condom was always negative. OC users reported less heavy and painful menstruation. IUDs were associated with heavier, prolonged and more painful menstruation, as was sterilization to a lesser extent. The satisfaction rate among OC and sterilization users was generally higher than that among those who used other methods. Overall, OC and sterilization had less of a negative physical and psychological impact than did the other methods.

To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling.CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models.The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern.Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.

Background: The European CHOICE study was a cross-sectional survey that evaluated women’s combined hormonal contraceptive choices before and after contraceptive counseling in Austria, Belgium, Czech Republic and Slovakia, the Netherlands, Poland, Sweden, Switzerland, Israel, Russia, and Ukraine. The changes in method selection before and after counseling were reported previously. In this paper we present the reasons given by the 18,787 participating women for selecting their contraceptive method of choice, as well as their perceptions about the contraceptive pill, patch, and ring after counseling. Methods: Women with an interest in a combined hormonal contraceptive method (pill, patch, or ring) were counseled using a standardized counseling leaflet. The women completed questionnaires, which included questions on why they had selected a particular method of contraception, and the extent to which they agreed with statements about the attributes of the pill, patch, and ring. The results for each country were compared with the percentages for all countries combined by using a binomial regression model. Multiple logistic regression models were used to investigate the extent to which the probability of choosing a method was related to prespecified aspects (i.e. perceptions) of each contraceptive method. Results: ‘Easy to use’, ‘convenience’, and ‘regular menstrual bleeding’ were important selection criteria. ‘Nondaily administration’ was one of the main reasons women selected the patch or ring. ‘Daily use’ and ‘will forget to take it’ were the primary reasons for not selecting the pill, while the main reasons for not choosing the patch included ‘not discrete, visible’ and ‘can fall off’. In a small number of instances, the ring was rejected because some women don’t like to use a ‘foreign body’. Women’s perceptions influenced their contraceptive decisions: positive perceptions about a method increased the likelihood that a woman would select it. After counseling, many women associated the pill with forgetfulness, and many still did not know about the patch or ring’s key attributes. Women’s knowledge about a particular method was generally greater if they had chosen it. Conclusions: To support informed contraceptive decision-making, healthcare professionals should realize that a woman’s view of a method’s ease of use is more important than perceived efficacy, tolerability, health benefits, or risks.

In the age of the Dutch Republic, both political authors and the public lacked detailed information on the behaviour of political figures, because decision-making took place on a level to which neither groups had direct access. This often led writers who aimed at a national audi­ence to represent political figures in a stereotypical manner. During the first years of the Bata­vian Republic, the proceedings of the sessions of the National Assembly (the Dagverhaal) granted direct access to the political process. As long as the Dagverhaal was read by a large part of the population, the media and the electorate had the same knowledge of the public acts of their deputies. As a result, political commentators could take an important step towards a multidimensional and individualized representation.

To encourage healthcare professionals to counsel women seeking combined hormonal contraceptives (CHCs) about alternative CHCs and to study the influence of counselling on women's selection of CHCs.Women (15-40 years old) in 11 countries who consulted HCPs about CHCs were counselled about the pill, transdermal patch, and vaginal ring. Both the HCPs and the women completed questionnaires.Of women who were counselled (n = 18,787), 47% selected another CHC method than originally planned. One in four who intended to use the pill chose another method (16% chose the patch; 65% chose the ring). In total, patch use increased from 5% -8% (difference = 3.7% [97.5% CI: 3.3-4.2]; p0.0001). Ring use nearly quadrupled from 8% -30% (difference = 21.7% [97.5% CI: 21.0-22.5]; p0.0001). Nearly all women who were undecided prior to counselling selected a method after counselling. Selection of the pill increased most in Russia (+ 11%) and Sweden (+ 5%); patch selection was greatest in Russia (+ 7%) and Israel (+ 6%); ring use increased most in Ukraine and in the Czech Republic and Slovakia (+ 36%).Counselling increases use of alternative CHCs, such as the patch and the ring. Considerable differences between countries were noted.

In 1795 the old Republic of the Seven United Provinces collapsed, and Dutch revolutionaries founded a new, “Batavian” Republic. This essay reexamines the Batavian appreciation of the example of the American Revolution by focusing on one specific political phenomenon that troubled both the American and the Batavian minds: the problem of faction in republican states. I will show how the Batavians were introduced to the now famous Madisonian theory of faction by the Dutch federalist Gerhard Dumbar, a supporter of the American Constitution who wrote a Dutch anthology of the Federalist Papers. Subsequently, I will trace the Batavian understanding of factionalism as it was displayed in the parliamentary debates of the Dutch National Assembly and in the political weekly De Democraten. In the last section, I will turn to the Dutch revolutionary events of the year 1798 and their relevance for the Batavian answer to the problem of faction, which will lead me to conclude that the American alternative to an understanding of faction was ultimately rejected by all sides in the Dutch revolutionary debate.

To study the influence of counseling on women's contraceptive decisions.A cross-sectional multicenter study.Seventy Swedish family planning clinics.Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method.Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional.Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice.In all, 173 healthcare professionals and 1,944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method.Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.

In the Active Ulcerative Colitis Trial (ACT)-1 and ACT-2, patients with ulcerative colitis treated with infliximab were more likely than those given placebo to have a clinical response, undergo remission, and have mucosal healing. We investigated the association between early improvement (based on endoscopy) and subsequent clinical outcome.Patients underwent endoscopic evaluations at weeks 0, 8, 30, and 54 (ACT-1 only), and were categorized into 4 subgroups by week 8 (Mayo endoscopy subscore, 0-3). The association of week 8 endoscopy subscores, subsequent colectomy risk, symptoms and corticosteroid use outcomes were analyzed. Mucosal healing was defined as a Mayo endoscopy subscore of 0 (normal) or 1 (mild).Infliximab-treated patients with lower week 8 endoscopy subscores were less likely to progress to colectomy through 54 weeks of follow-up evaluation (P=.0004). This trend was not observed among patients given placebo (P=.47). Patients with lower endoscopy subscores achieved better symptomatic and corticosteroid use outcomes at weeks 30 and 54 (P.0001, infliximab; P.01, placebo). Among patients who achieved clinical response at week 8, trends in subsequent clinical outcomes by week 8 endoscopy subscores were generally consistent with that for the overall patient population; no trends were observed among patients who achieved clinical remission.The degree of mucosal healing after 8 weeks of infliximab was correlated with improved clinical outcomes including colectomy. Similar trends were observed for all outcomes except colectomy among the subgroup with clinical response at week 8. The degree of mucosal healing at week 8 among those in clinical remission did not predict subsequent disease course.

To study the extent to which variation in satisfaction with a birth control method is explained by variation in perceived physical and psychological effects.A population survey among 1466 German women was carried out. Within the overall sample, 1303 women had ever used oral contraceptives, 996 had relied on condoms, 342 had ever used intrauterine devices (IUD), 428 had used natural family planning and 139 women were sterilized. For each method a woman had ever used, she answered questions about satisfaction with the method, concerns about getting pregnant or suffering health risks during use, ease of use, changes in sexual relationship, relationship with the partner and mood. Past and current users of oral contraceptives and IUDs and sterilized women additionally reported changes in menstrual bleeding.Variation in satisfaction was, for a large part, explained by variation in health concerns among oral contraceptive users, by variation in perceived changes in the quality of the sexual relationship among condom users, by perceived ease of use among IUD users and sterilized women, and by variation in pregnancy concern among natural family planning users.Counselling about these perceived experiences is most likely to result in greater satisfaction and therefore improved compliance.

Arie Yeshaya,1 Amos Ber,2 Daniel S Seidman,3 Bjorn J Oddens41Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, 2Maccabi Health Services, Tel Aviv, Israel; 3Department of Obstetrics and Gynecology, Sacker School of Medicine, Tel Hashomer, Israel; 4Global Medical Affairs, MSD, Oss, the NetherlandsBackground: The multinational CHOICE (Contraceptive Health Research Of Informed Choice Experience) study evaluated the effects of structured counseling on women's contraceptive decisions, their reasons for making those decisions, and their perceptions of combined hormonal contraceptive (CHC) methods in eleven countries. The aim of this paper to present data from the 1,802 women participating in Israel's CHOICE program.Methods: Women (aged 17–40 years) who consulted their health care providers about contraception and who would consider a CHC method qualified to participate. After indicating their intended CHC method, the women received counseling about the daily pill, weekly patch, and monthly vaginal ring. After counseling, the women completed a questionnaire about their contraceptive decisions.Results: Before counseling, 67%, 6%, and 5% of women (mean age 27 years) intended to use the pill, patch, or ring, respectively. Counseling significantly influenced the women's CHC choice, with 56%, 12%, and 23% of women selecting the pill, patch, or ring (P

Objective: To identify factors associated with long-term hormone replacement therapy (HRT) and reasons for early discontinuation of it. Methods: A cross-sectional study was conducted in four United Kingdom group general practices. Six hundred fifteen past or present HRT users (representing a response rate of 66%) responded to questionnaires on HRT and potential determinants of long-term use. Main outcome measures were long-term HRT use (at least 6 years) as opposed to short-term use (at most 2 years) and self-reported reasons for discontinuation. Odds ratios (ORs) of long-term use were adjusted for age and other variables, in the same groups, calculated by logistic regression and 95% confidence intervals (CIs). Results: Ovariectomy (OR 2.59, 95% CI 1.12, 5.97), hysterectomy (OR 2.28, 95% CI 1.37, 3.79), previous oral contraceptive use (OR 1.76, 95% CI 1.03, 3.01), HRT prescription to prevent osteoporosis (OR 1.81, 95% CI 1.04, 3.13), opinion that HRT prevents health problems (OR 3.22, 95% CI 1.57, 6.63), opinion that HRT is associated with health risks (OR 0.23, 95% CI 0.08, 0.65), and opinion that HRT has cosmetic benefits (OR 2.52, 95% CI 1.45, 4.40) were statistically significantly associated with long-term HRT. Women surveyed most often reported side effects and weight gain (each about 30%) as reasons for discontinuation, followed by possible health risks and dislike of menstrual bleeding or hormones (each about 15%). Conclusion: Ovariectomy, hysterectomy, and opinions about benefits and disadvantages of HRT were the most important determinants of long-term use, whereas women themselves mentioned side effects and weight gain most frequently as reasons for discontinuing it.

This study addresses attitudes towards changes in menstrual bleeding patterns caused by oral contraceptives (OC) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OC or HRT in relation to reproductive age group. Data were collected by means of telephone interviews with 325 women in each of four age groups (15-19, 25-34, 45-49, and 52-57 years). In total, 80.5% of currently menstruating women preferred one or more changes in bleeding pattern such as less painful, shorter, or less heavy periods, or amenorrhea. The majority of the menstruating women in all age groups preferred to have a bleeding frequency of less than once a month or never, whether the bleeding was spontaneous or induced by OC. In the case of HRT, amenorrhea was most preferred. These findings with respect to preferred bleeding frequency and OC may have important implications for health care providers and for future contraception development.This study addresses attitudes toward changes in menstrual bleeding patterns caused by oral contraceptives (OCs) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OCs or HRT in relation to reproductive age group. A survey on 325 Dutch women from each of four age categories (15-19, 25-34, 45-49, and 52-57 years) was conducted through telephone interviews. Results showed that OC users and menstruating women prefer one or more changes in bleeding characteristics such as less painful, shorter, or lighter periods. It was less significant in the non-OC users in all age groups (75.1% vs. 86.3%, p = 0.016, in women aged 15-19 years; 60.0% vs. 72.3%, p = 0.030, in women aged 25-34 years; 50.9% vs. 74.5%, p = 0.002, in women aged 45-49 years). Most women would prefer a bleeding frequency of less than once a month or never. The proportion of women who reported amenorrhea as a positive consequence of OC/HRT use increased with age. These findings provide significant implications for health care providers in future contraception development.

A scenario study was conducted to assess the extent to which the unintended pregnancy rate in Japan, where oral contraceptives (OC) have not been legalized for family planning purposes and couples rely mainly on condoms, might change if more women were to use OC. Because current rates of unintended pregnancy and abortion in Japan are not known, data provided by the 1994 Japanese National Survey on Family Planning were used to construct scenarios for national contraceptive use. Annual failure rates of contraceptive methods and nonuse were applied to the contraceptive use scenarios, to obtain estimates of the annual number of contraceptive failure-related pregnancies. Subsequently, contraceptive practice situations assuming higher OC use rates were defined, and the associated change in the number of contraceptive failure-related pregnancies was estimated for each situation. It emerged that OC use rates of 15% decreased the expected number of unintended pregnancies by 13%-17%, whereas use rates of 25% resulted in decreases of 22%-29% and use rates of 50% in decreases of 45%-58%. The findings were reasonably robust to variation in the assumptions that were made. In conclusion, each theoretical percentage increase in the OC use rate in Japan was found to lead to a roughly equivalent percentage decrease in the number of unintended pregnancies.A scenario study was conducted in Japan, where oral contraceptives (OCs) have not been legalized for family planning purposes, to assess the extent to which more widespread OC use would reduce the unintended pregnancy rate. This approach was necessary because of the lack of national data on current rates of either induced abortion or unintended pregnancy. Scenarios for national contraceptive use were constructed on the basis of data from the 1994 Japanese National Survey on Family Planning. Annual failure rates associated with various contraceptive methods and contraceptive nonuse were applied to the survey data. It was assumed that women in need of contraception who currently used no method or relied on rhythm, basal body temperature, withdrawal, condoms, and spermicides were potential OC users. Estimations suggested that an OC use rate of 15% would decrease the expected number of unintended pregnancies by 13-17%, while use rates of 25% and 50% were associated with decreases of 22-29% and 45-58%, respectively. The percentage changes in the predicted numbers of unintended pregnancies were very robust to the various assumptions made, despite uncertainty about current numbers of unintended pregnancies in Japan and the contraceptive needs of nonusers. In the 1994 survey, 13% of women who knew about OCs said they would use the method if it became available.

Objective: To study the prevalence and determinants of consultation for climacteric complaints and the prescription, commencement, and continuation of hormone replacement therapy (HRT) among women aged 45–65 years. Methods: A cross-sectional national survey was conducted in Denmark in November 1994 among 1459 women. A total of 1015 women (response rate 69.6%) agreed to participate and provided questionnaire data. Results: Of the women who had experienced climacteric complaints, 67.4% (95% confidence interval [CI] 63.3, 71.4%) had consulted a physician. More women consulted if their complaints were severe rather than slight-to-moderate (odds ratio [OR]6.46). Within the total sample, 33.4% of the women had been prescribed HRT at some time, and 94.1% of these women actually had started the treatment. Of the women who started the treatment, 66.3% reported that they still were using HRT at the time of the survey. The current HRT use rate among all respondents was 18.4% (95% CI 16.1, 20.9%). Women with severe or slight-to-moderate climacteric complaints more often reported having had HRT prescribed than women without complaints (OR 23.2 and 5.80, respectively). Furthermore, women who had had a hysterectomy with bilateral oophorectomy more often reported use than women with an intact uterus (OR 10.0). Hormone replacement therapy prescription was associated only weakly with osteoporosis concerns (OR 1.74). Its continuation decreased with age, was higher after hysterectomy and among women who regularly participated in sports or exercised, but was not ( P > .05) related to osteoporosis concerns. Age-specific HRT continuation rates decreased among users who reported withdrawal bleeding ( P P > .05). Conclusion: In this survey, HRT had been used by one in three women at menopause, mainly for the alleviation of climacteric complaints and hardly ever because of osteoporosis concerns. Although it might be expected that HRT users who are concerned about developing osteoporosis in later life would be likely to continue the treatment for longer than other users, the study results did not bear this out. Continuation depended mainly on having had a hysterectomy and participation in sports and was higher among users with an intact uterus if they had had no withdrawal bleeding.

Objective. To investigate current contraceptive practice in Sweden and Swedish women's attitudes towards various contraceptive methods. Methods. In 1994, a random sample of Swedish women (n=2330), aged 15-45 years (stratified according to age and geographic distribution), were invited by telephone to participate in the study. Women (n=1788) who accepted the invitation to participate were sent a postal questionnaire Results. Completed questionnaires were returned by 1422 women (overall response rate: 61.0%). The sample was somewhat skewed towards higher educational level, but in other demographic respects no great deviations from the parent population were observed. The distribution of contraceptive methods in fertile, sexually active women who wished to avoid pregnancy uas as follows. oral contraceptives (OCs) 33%, OC plus barrier method 5%, intrauterine device 21%, barrier methods 23%, sterilization 5% (female 3%; male 2%) and injectable steroids 2%. The overall pattern of contraceptive use in women aged 15-45 years had changed very little compared to results of a similar survey performed in 1987, However, the use of less effective methods (periodic abstinence. coitus interruptus and no method grouped together) was considerably lower among teenagers in 1994 (3%) than in 1987 (18%). The use of these traditional methods was still high in women aged over 35 years (15-17%). A large number of women considered medical methods of contraception to be reliable and easy to use but many were concerned about the safety for health of medical methods. Conclusions. Contraceptive practice changed towards more frequent use of medical, effective methods among young Swedish women, but not in the total female population. The latter was among others related to the relatively high use rates of less effective methods among women aged over 35. Women were concerned about the health safety of medical methods and relatively low percentages of women reported having received advice from health care professionals to use effective methods.

The views of 48 female and 24 male professional singers aged 40-74 years were sought regarding the occurrence of possible voice changes in around the fifth decade of life. The changes actually experienced were investigated to determine whether women's and men's voice changes were different, which might indicate that the menopause had an impact on the female voice. Respondents were approached via personal contacts and completed anonymous questionnaires that were returned by mail. Given the delicate nature of the study topic, no information was obtained on non-responders. Seventy-seven percent of the female singers and 71% of the men were of the opinion that the voice generally underwent changes at around the age of 50. The female singers placed greater emphasis on problems affecting the high registers and voice control than the men. Overall, 29% of the women had actually experienced negative voice changes at around age 50, as compared with 38% of the men. Both sexes reported huskiness, but the women seemed to have more frequent problems with voice emission, voice control and reaching their highest registers. In addition, 27 women reported that they had experienced voice changes during menstruation and five women stated that these had occurred during use of the oral contraceptive pill, which may have reflected the impact of other hormone-related factors. Despite the limitations of this initial investigation (the sample was small and selective), the broad findings indicated that the female voice undergoes specific changes at around the time of the menopause.

EDITOR,--We welcome the recent editorial and papers on research ethics committees,1 2 3 4 which were published at the time when we were revising our ethical and scientific standards. Our organisation deals with questionnaire surveys relating to reproductive health carried out in various European and Asian countries. We are all too familiar with the problems recognised in the articles. In our view, many are related to the fact that, apart from general principles of scientific …

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