Improved Continuation Rate of Depot-Medroxyprogesterone Acetate in Adolescent Mothers

Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy

The osteopetrotic mutation toothless (tl) is a loss-of-function frameshift mutation in the rat Csf1 gene: Evidence of a crucial role for CSF-1 in osteoclastogenesis and endochondral ossification

The toothless (tl) mutation in the rat is a naturally occurring, autosomal recessive mutation resulting in a profound deficiency of bone-resorbing osteoclasts and peritoneal macrophages. The failure to resorb bone produces severe, unrelenting osteopetrosis, with a highly sclerotic skeleton, lack of marrow spaces, failure of tooth eruption, and other pathologies. Injections of CSF-1 improve some, but not all, of these. In this report we have used polymorphism mapping, sequencing, and expression studies to identify the genetic lesion in the tl rat. We found a 10-base insertion near the beginning of the open reading of the Csf1 gene that yields a truncated, nonfunctional protein and an early stop codon, thus rendering the tl rat CSF-1null. All mutants were homozygous for the mutation and all carriers were heterozygous. No CSF-1 transcripts were identified in rat mRNA that would avoid the mutation via alternative splicing. The biology and actions of CSF-1 have been elucidated by many studies that use another naturally occurring mutation, the op mouse, in which a single base insertion also disrupts the reading frame. The op mouse has milder osteoclastopenia and osteopetrosis than the tl rat and recovers spontaneously over the first few months of life. Thus, the tl rat provides a second model in which the functions of CSF-1 can be studied. Understanding the similarities and differences in the phenotypes of these two models will be important to advancing our knowledge of the many actions of CSF-1

Improved Continuation Rate of Depot-Medroxyprogesterone Acetate in Adolescent Mothers

Poor compliance and high discontinuation rates of Depot-Medroxyprogesterone Acetate (DMPA) and other contraceptive methods are major factors in the continuing problem of adolescent pregnancy. In this study we attempted to determine if providing comprehensive health care for teen mothers and their babies would improve continuation rates of DMPA. Patients who started DMPA between 1/1/96 and 1/1/99 were included. Teen mothers and their babies received all their health care in this clinic, supported by State funding. Key elements regarding DMPA in this clinic were continuity of care, phone and mail reminders of appointments, free DMPA for patients without insurance, counseling at each visit and available evening clinic. In the study period a total of 299 (age 13-22 years) patients were started on DMPA. Fifty-one percent were white, 47% black and 2% others. Sixty-three percent were single, 20% married, 3% cohabitating and 14% undetermined (missing data). Seventy-eight percent had one baby and 22% more than one. A total of 189 patients (63.2%) continued to be compliant after one year of use and 101 patients (33.8% of total) continued beyond the second year. The most common side effect reported was bleeding or spotting (32%), However only seven patients (2.3%) discontinued use because of it. It is concluded that continuity of care (same staff and providers on each visit), regular counseling, flexible hours (evening appointments), financial ease (free DMPA and no visit charge for those without insurance), combined Teen-Tot health visits and regular reminders of appointments may help improve compliance and continuation rates in teen mothers leading to better success in preventing repeat teen pregnancy