In the last decade, important advances were made in the struggle for reproductive rights in Mexic... more In the last decade, important advances were made in the struggle for reproductive rights in Mexico. The goal of this study was to discover the opinions of decision-makers about the grounds for legal abortion as well as to explore their perceptions about further liberalization of abortion laws countrywide. In-depth interviews were conducted with eight prominent decision-makers working in governmental health, law and social institutions as well as representatives of political parties. Six decision-makers favored a further liberalization of abortion laws. They proposed several strategies to move forward with liberalization. Two decision-makers were against abortion under all circumstances. Three factors seem to play a key role in the liberalization of abortion: a liberal party governing at the state level, a favorable public opinion and the pressure of NGOs promoting reproductive rights. A state-by-state approach seems more effective for generating changes in abortion laws.
Emergency contraception (EC) has the potential to improve women's reproductive health significant... more Emergency contraception (EC) has the potential to improve women's reproductive health significantly. In Honduras, where nearly one-fourth of pregnancies are unplanned, the need for EC is substantial. To increase awareness of this option, nongovernmental organizations launched countrywide EC outreach activities in 2001-03. We conducted pre-and postintervention cross-sectional surveys among a total of 2,693 family planning clinic clients to assess EC knowledge, attitudes, and practice at baseline and at two years postintroduction. EC awareness increased over time, but remained at just 20 percent at follow-up. Respondents generally demonstrated a positive attitude and low rates of concern about EC. Awareness of and willingness to use EC were strongly associated with age, educational status, and city of residence. Public-sector acceptance of the method is essential to increase awareness of and access to EC. This study is intended to fill an information gap regarding EC in Latin America and the Caribbean and to be useful in determining educational messages and target audiences for future awareness campaigns in Honduras.
Background: In Mexico, abortion is not penalized when a woman gets pregnant as a result of rape, ... more Background: In Mexico, abortion is not penalized when a woman gets pregnant as a result of rape, yet access to abortion services is limited. Understanding physicians' opinions about abortion is critical to creating strategies that will broaden women's access to services. Study Design: Multivariate logistic regression was performed using data collected from a sample of 1206 physicians in Mexico. The influence of independent variables on two outcomes was analyzed: physicians' agreement with abortion being legal in the case of pregnancy caused by rape and willingness to provide abortion services in such cases. Results: Physicians who had performed legal abortions, knew about existing abortion legislation and practiced general or family medicine were significantly more likely to agree that abortion should be legal when pregnancy is caused by rape and were more likely to be willing to provide abortion in the case of rape. Physicians who held a negative attitude towards women who seek abortion and those with greater church attendance were less likely to agree with the legality of abortion. Conclusions: Physicians are among the most important gatekeepers to women's access to safe abortion services. A majority of Mexican physicians agree that abortion should not be legally penalized under certain circumstances. Yet, many also hold negative attitudes towards women who seek abortion. Physicians' support for women's access to safe abortion services is key to ensuring that such services will exist in Mexico.
Objective: To assess Mexican physicians' knowledge about the human papillomavirus (HPV) and cervi... more Objective: To assess Mexican physicians' knowledge about the human papillomavirus (HPV) and cervical cancer and their opinions and practices related to screening, managing, and counselling women on these topics. Methodology: In August 2002 we surveyed 1206 general practitioners (GPs) and obstetriciansgynaecologists (Ob-Gyns) working in a nationally representative sample of public and private facilities in urban Mexico. Eligible physicians completed a self administered questionnaire. We conducted a weighted analysis and used x 2 tests to compare GPs and Ob-Gyns on outcome variables. Results: 76% of recruited physicians responded to the survey. 43% of Ob-Gyns had performed a hysterectomy in the last year to treat a case of CIN I or II. With respect to HPV, while 80% of respondents identified the virus as the principal cause of cervical cancer, many lacked detailed knowledge about this association. Ob-Gyns were more likely than GPs to have heard about specific oncogenic strains of HPV (p,0.001). Nearly all respondents thought that women should be informed that HPV causes cervical cancer; nevertheless, physicians believed that positioning cervical cancer as a sexually transmitted infection (STI) could cause problems in partner relationships (60%), confusion (40%), and unnecessary anxiety among women (32%). Conclusions: Mexican physicians support patient education on the HPV-cervical cancer link. However, findings suggest the need to present clear messages to women (emphasising, for example, that only certain types of HPV are oncogenic), to consider the conflicts such information might create for couples, and to further educate physicians about this topic and about overall cervical cancer screening and treatment protocols. C ervical cancer is the second most common cancer in women, with an estimated 500 000 new cases and 231 000 deaths annually worldwide. 1 2 Latin America has among the highest incidence rates in the world, and unlike the United States and Canada, most of the region has seen little improvement in the past 30 years. In Mexico, cervical cancer remains a leading cause of death among women of reproductive age with a stable mortality rate of around 17/100 000 despite a national screening programme since 1974. 3 Several factors contribute to cervical cancer rates in Mexico, including low coverage of Papanicolaou (Pap) smears especially among high risk women such as those in rural areas with limited contact with the health system, poor quality of cytology services, and lack of follow up for women with abnormal Pap results. One study found that only 64% of women aged 15-49 in Mexico City and 30% in the state of Oaxaca had ever had a Pap test in their lifetime. Since the mid-1990s, clinical evidence has established the human papillomavirus (HPV) as a necessary cause of cervical cancer. 5 Knowledge of this association has spurred research on HPV based strategies for cervical cancer prevention, including primary prevention of HPV, HPV vaccines, and the use of HPV testing for follow up of women with abnormal Pap results and post-treatment for severe lesions or microinvasive cancer. These clinical advances imply the need for appropriate education among both providers and the public. Physicians must remain up to date with research on HPV and cervical cancer diagnostic and treatment technologies. Clear and appropriate information must also be relayed to women in a way that encourages healthy sexual practices and healthcare seeking behaviour. While the United States has launched large scale HPV education programmes aimed at women and the general public, 6 7 information campaigns in Mexico seldom mention HPV. In fact, general knowledge about HPV is very low; in one study with 880 women between 18 and 49 years of age, 2% knew that the virus was a main risk factor for cervical cancer. Designing effective educational messages is not straightforward: firstly, most HPV infections regress without treatment and are undetectable within 6 months to 2 years. 9 10 Of the over 100 HPV strains, only certain types are oncogenic. In the rare case that these strains progress to cancer, the process can take between 5 and 30 years. 11 Furthermore, since HPV is transmitted through skin to skin contact, traditional barrier methods are unreliable in preventing transmission. Despite the role that physicians have in cervical cancer prevention and education, limited research on these topics has been conducted with Mexican providers to date. Findings from a 1998 study with 520 healthcare professionals in the state of Morelos showed poor knowledge about cervical cancer aetiology, diagnosis, and treatment, with 40% of obstetricians-gynaecologists (Ob-Gyns) unaware of the association between HPV and cervical cancer. 13 Since this study, the Ministry of Health has published a programme of action on cervical cancer for 2001-6, outlining national strategies for improving screening, treatment, education, service monitoring, and research. Mexico's official cervical cancer norms were also updated in March 1998. In this context, the present
The authors used the random response technique (RRT) to measure fre-quency of induced abortion in... more The authors used the random response technique (RRT) to measure fre-quency of induced abortion in Mexico, where its practice is illegal under most circumstances. They applied RRT to a national, multistage probabilis-tic sample of 1,792 women ages 15 to 55. The ...
Cationic steroid antibiotics (CSAs), or ceragenins, are amphiphilic compounds consisting of choli... more Cationic steroid antibiotics (CSAs), or ceragenins, are amphiphilic compounds consisting of cholic acid backbone that is attached to several cationic amines. In this study, we tested the hypothesis that CSAs possess anti-parasitic activities with minimal to no effects on mammalian cells, and thus could be used as potential therapeutic agents against pathogenic trypanosomatids. To investigate this, we synthesized CSAs and determined their trypanocidal and leishmanicidal activities in vitro. The 3 ceragenins, i.e., CSA-8, CSA-13, and CSA-54, assayed showed several degrees of parasiticidal activity. CSA-13 was the most effective compound against Leishmania major promastigotes and Trypanosoma cruzi trypomastigotes, LD 50 4.9 and 9 μM, respectively. The trypanocidal activities of these ceragenins were also assessed by infectivity experiments. We found CSA-8 was more effective on T. cruzi intracellular amastigotes, when the infected host cells were treated during 24 hr (LD 50 6.7 μM). Macrophages and LLC-MK 2 (treated for 72 hr) showed relative low susceptibility to these compounds. Our results suggest that ceragenins are indeed promising chemotherapeutic agents against trypanosomatids, but require further investigation.
In the last decade, important advances were made in the struggle for reproductive rights in Mexic... more In the last decade, important advances were made in the struggle for reproductive rights in Mexico. The goal of this study was to discover the opinions of decision-makers about the grounds for legal abortion as well as to explore their perceptions about further liberalization of abortion laws countrywide. In-depth interviews were conducted with eight prominent decision-makers working in governmental health, law and social institutions as well as representatives of political parties. Six decision-makers favored a further liberalization of abortion laws. They proposed several strategies to move forward with liberalization. Two decision-makers were against abortion under all circumstances. Three factors seem to play a key role in the liberalization of abortion: a liberal party governing at the state level, a favorable public opinion and the pressure of NGOs promoting reproductive rights. A state-by-state approach seems more effective for generating changes in abortion laws.
Emergency contraception (EC) has the potential to improve women's reproductive health significant... more Emergency contraception (EC) has the potential to improve women's reproductive health significantly. In Honduras, where nearly one-fourth of pregnancies are unplanned, the need for EC is substantial. To increase awareness of this option, nongovernmental organizations launched countrywide EC outreach activities in 2001-03. We conducted pre-and postintervention cross-sectional surveys among a total of 2,693 family planning clinic clients to assess EC knowledge, attitudes, and practice at baseline and at two years postintroduction. EC awareness increased over time, but remained at just 20 percent at follow-up. Respondents generally demonstrated a positive attitude and low rates of concern about EC. Awareness of and willingness to use EC were strongly associated with age, educational status, and city of residence. Public-sector acceptance of the method is essential to increase awareness of and access to EC. This study is intended to fill an information gap regarding EC in Latin America and the Caribbean and to be useful in determining educational messages and target audiences for future awareness campaigns in Honduras.
Background: In Mexico, abortion is not penalized when a woman gets pregnant as a result of rape, ... more Background: In Mexico, abortion is not penalized when a woman gets pregnant as a result of rape, yet access to abortion services is limited. Understanding physicians' opinions about abortion is critical to creating strategies that will broaden women's access to services. Study Design: Multivariate logistic regression was performed using data collected from a sample of 1206 physicians in Mexico. The influence of independent variables on two outcomes was analyzed: physicians' agreement with abortion being legal in the case of pregnancy caused by rape and willingness to provide abortion services in such cases. Results: Physicians who had performed legal abortions, knew about existing abortion legislation and practiced general or family medicine were significantly more likely to agree that abortion should be legal when pregnancy is caused by rape and were more likely to be willing to provide abortion in the case of rape. Physicians who held a negative attitude towards women who seek abortion and those with greater church attendance were less likely to agree with the legality of abortion. Conclusions: Physicians are among the most important gatekeepers to women's access to safe abortion services. A majority of Mexican physicians agree that abortion should not be legally penalized under certain circumstances. Yet, many also hold negative attitudes towards women who seek abortion. Physicians' support for women's access to safe abortion services is key to ensuring that such services will exist in Mexico.
Objective: To assess Mexican physicians' knowledge about the human papillomavirus (HPV) and cervi... more Objective: To assess Mexican physicians' knowledge about the human papillomavirus (HPV) and cervical cancer and their opinions and practices related to screening, managing, and counselling women on these topics. Methodology: In August 2002 we surveyed 1206 general practitioners (GPs) and obstetriciansgynaecologists (Ob-Gyns) working in a nationally representative sample of public and private facilities in urban Mexico. Eligible physicians completed a self administered questionnaire. We conducted a weighted analysis and used x 2 tests to compare GPs and Ob-Gyns on outcome variables. Results: 76% of recruited physicians responded to the survey. 43% of Ob-Gyns had performed a hysterectomy in the last year to treat a case of CIN I or II. With respect to HPV, while 80% of respondents identified the virus as the principal cause of cervical cancer, many lacked detailed knowledge about this association. Ob-Gyns were more likely than GPs to have heard about specific oncogenic strains of HPV (p,0.001). Nearly all respondents thought that women should be informed that HPV causes cervical cancer; nevertheless, physicians believed that positioning cervical cancer as a sexually transmitted infection (STI) could cause problems in partner relationships (60%), confusion (40%), and unnecessary anxiety among women (32%). Conclusions: Mexican physicians support patient education on the HPV-cervical cancer link. However, findings suggest the need to present clear messages to women (emphasising, for example, that only certain types of HPV are oncogenic), to consider the conflicts such information might create for couples, and to further educate physicians about this topic and about overall cervical cancer screening and treatment protocols. C ervical cancer is the second most common cancer in women, with an estimated 500 000 new cases and 231 000 deaths annually worldwide. 1 2 Latin America has among the highest incidence rates in the world, and unlike the United States and Canada, most of the region has seen little improvement in the past 30 years. In Mexico, cervical cancer remains a leading cause of death among women of reproductive age with a stable mortality rate of around 17/100 000 despite a national screening programme since 1974. 3 Several factors contribute to cervical cancer rates in Mexico, including low coverage of Papanicolaou (Pap) smears especially among high risk women such as those in rural areas with limited contact with the health system, poor quality of cytology services, and lack of follow up for women with abnormal Pap results. One study found that only 64% of women aged 15-49 in Mexico City and 30% in the state of Oaxaca had ever had a Pap test in their lifetime. Since the mid-1990s, clinical evidence has established the human papillomavirus (HPV) as a necessary cause of cervical cancer. 5 Knowledge of this association has spurred research on HPV based strategies for cervical cancer prevention, including primary prevention of HPV, HPV vaccines, and the use of HPV testing for follow up of women with abnormal Pap results and post-treatment for severe lesions or microinvasive cancer. These clinical advances imply the need for appropriate education among both providers and the public. Physicians must remain up to date with research on HPV and cervical cancer diagnostic and treatment technologies. Clear and appropriate information must also be relayed to women in a way that encourages healthy sexual practices and healthcare seeking behaviour. While the United States has launched large scale HPV education programmes aimed at women and the general public, 6 7 information campaigns in Mexico seldom mention HPV. In fact, general knowledge about HPV is very low; in one study with 880 women between 18 and 49 years of age, 2% knew that the virus was a main risk factor for cervical cancer. Designing effective educational messages is not straightforward: firstly, most HPV infections regress without treatment and are undetectable within 6 months to 2 years. 9 10 Of the over 100 HPV strains, only certain types are oncogenic. In the rare case that these strains progress to cancer, the process can take between 5 and 30 years. 11 Furthermore, since HPV is transmitted through skin to skin contact, traditional barrier methods are unreliable in preventing transmission. Despite the role that physicians have in cervical cancer prevention and education, limited research on these topics has been conducted with Mexican providers to date. Findings from a 1998 study with 520 healthcare professionals in the state of Morelos showed poor knowledge about cervical cancer aetiology, diagnosis, and treatment, with 40% of obstetricians-gynaecologists (Ob-Gyns) unaware of the association between HPV and cervical cancer. 13 Since this study, the Ministry of Health has published a programme of action on cervical cancer for 2001-6, outlining national strategies for improving screening, treatment, education, service monitoring, and research. Mexico's official cervical cancer norms were also updated in March 1998. In this context, the present
The authors used the random response technique (RRT) to measure fre-quency of induced abortion in... more The authors used the random response technique (RRT) to measure fre-quency of induced abortion in Mexico, where its practice is illegal under most circumstances. They applied RRT to a national, multistage probabilis-tic sample of 1,792 women ages 15 to 55. The ...
Cationic steroid antibiotics (CSAs), or ceragenins, are amphiphilic compounds consisting of choli... more Cationic steroid antibiotics (CSAs), or ceragenins, are amphiphilic compounds consisting of cholic acid backbone that is attached to several cationic amines. In this study, we tested the hypothesis that CSAs possess anti-parasitic activities with minimal to no effects on mammalian cells, and thus could be used as potential therapeutic agents against pathogenic trypanosomatids. To investigate this, we synthesized CSAs and determined their trypanocidal and leishmanicidal activities in vitro. The 3 ceragenins, i.e., CSA-8, CSA-13, and CSA-54, assayed showed several degrees of parasiticidal activity. CSA-13 was the most effective compound against Leishmania major promastigotes and Trypanosoma cruzi trypomastigotes, LD 50 4.9 and 9 μM, respectively. The trypanocidal activities of these ceragenins were also assessed by infectivity experiments. We found CSA-8 was more effective on T. cruzi intracellular amastigotes, when the infected host cells were treated during 24 hr (LD 50 6.7 μM). Macrophages and LLC-MK 2 (treated for 72 hr) showed relative low susceptibility to these compounds. Our results suggest that ceragenins are indeed promising chemotherapeutic agents against trypanosomatids, but require further investigation.
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Papers by Diana Lara