Research and quality control in natural family planning with relational database systems.

Research and quality control in natural family planning (NFP) is based on continuous data collection in prospective studies. The quality of the data is determined by the reliability of collection, input, management, and retrieval. During a period of ten years, different relational databases were programmed to manage the large number of very different data in NFP studies. Recently, all experience with different database systems has been summarized by writing and testing a completely new data management system based on MS Access 97: NFPDAT 1.0. This new software is used for data collection, evaluation and administration in NFP Study Groups. Over 200 internal formulae guarantee maximum data consistency while 30,000 cycles from 1477 patients were stored. Easy data evaluation for research and administration is possible with the help of a new report generator even without prior knowledge of SQL (System Query Language) or Visual Basic for MS Access 97. Using this method, interim results for research and quality control can be obtained at any time. NFPDAT can be used by all Natural Family Planning Study Groups using the symptothermal method for research and administration. With the help of NFPDAT, various prospective studies of Natural Family Planning were conducted.

Results of an efficacy-finding study (EFS) with the computer-thermometer Cyclotest 2 plus containing 207 cycles.

Prospectively collected cycles of 207 women were used to find out the efficacy of the Cyclotest 2 plus algorithm in detecting the fertile time in a woman's cycle. The results of the device were compared with the beginning and the end of the fertile time identified by the symptothermal method (STM) of natural family planning (NFP). It was found that the algorithm led to dangerous reduction of the fertile time (FT) in only 2 out of 207 woman cycles (0.96%). However, at the end of fertile time (FE) the device requested more abstinence than was necessary in about 12% of the cycles. We feel that more research should be performed on detecting the end of the fertile time.

The CUE Fertility Monitor compared to ultrasound and LH peak measurements for fertile time ovulation detection.

A prospective study of the reliability of the CUE Fertility Monitor to identify the fertile time of the menstrual cycle was conducted. The device provides a digital measurement of the electrical resistance of saliva (SER) and vaginal secretions (VL). The readings of the device were compared with the fertile time detected by ultrasonography of the growing follicle and estimation of the LH surge to detect ovulation. Thirteen women participated in the study. Sixteen cycles contained both signals (SER, VL) for the beginning and the end of the fertile period. In 2 cycles a CUE signal could not be found by the device. Using a computerized algorithm for evaluation of the CUE signals, the beginning of the fertile period was accurately detected in 14 cycles; in 2 cycles the signal was found less than five days prior to ovulation. The last day of fertility was identified correctly by the CUE Fertility Monitor in 10 cycles; in 6 it was incorrectly identified during the time when the woman was still fertile. This suggests that the CUE Fertility Monitor utilizing the algorithm on which it currently is based cannot be recommended for natural family planning. However, we think that the algorithm for evaluation should be improved as useful signals in the menstrual cycle are detected.

[How do self-observed cycle symptoms correlate with ovulation?]. / Wie korrelieren selbstbeobachtete Zyklussymptome mit der Ovulation?

The symptoms of self-observation of the menstrual cycle (basal body temperature, mucus symptom, autopalpation of the cervix) are often regarded as not reliable for ovulation detection. In a prospective study 87 NFP cycles are monitored additionally with ultrasound and LH tests to calculate the correlation of the ovulation-time with the symptoms of self-observation. Our results show that the symptoms of self-observation allow a reliable detection of the time of ovulation. Only a short introduction into the method of self-observation is a necessary precondition. The reliable detection of ovulation gives the opportunity of cycle analysis of large groups especially in long time investigations. In this way a large set of valuable and reliable data on normal and disturbed menstrual cycles will be available.

Effectiveness and acceptibility of the symptothermal method of natural family planning in Germany.

Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.

[Has family planning behavior in West Germany changed since 1985?]. / Hat sich das Familienplanungsverhalten in der BRD seit 1985 verändert?

A survey on the family planning behaviour in the Federal Republic of Germany was conducted by interviewers of the EMNID institute in 1985 (n = 1267) and 1989 (n = 950). The survey was carried out with women of 15 to 45 years of age. It was the aim of the 1989 study, to look into changes of the last four years generally and with regard to the increasing knowledge about AIDS. As the use of a combination of family planning methods has significantly increased in 1989, the overall percentage went very much beyond 100% (1985: 106.1% vs 1989: 138.5%). Hence, for comparison of the figures, we omitted any sociodemographic weighting. For each method, the percentage of the users is reported independently of any additional method used. The figures (%) for use of reversible methods of contraception 1985 vs 1989 were as follows: the pill (52.2/61.9), condom (10.0/24.8), IUD (14.1/10.8), withdrawal (5.8/6.6), mini-pill (1.7/6.5), NFP (8.8/6.0), locally applied chemical device (2.6/5.2), vaginal diaphragm (3.0/3.0). The frequency of sterilisation was 6.9 vs 5.7%; the frequency of unwanted pregnancies 26.6 vs 20.9%. 12.3% of the women aged 18-45 years stated, that family planning behaviour has changed in the last two years. 1/3 of these declared, that AIDS has played an important part in their decision. Answers to other questions are compared 1985 vs 1989, like "reasons for selecting a particular method", "need for use of contraceptives", "frequency of unwanted pregnancies" and "importance of natural methods".

[A rheumatic disease register in clinical use]. / Ein Rheumaregister in der klinischen Anwendung.

A registry for the documentation of rheumatic diseases has been developed at the University of Düsseldorf. For 3 years more than 450 parameters for each patient have been documented, checked, and stored in a data bank. The registry has made a definite improvement in the diagnosis and long-term follow-up of rheumatic diseases. The use of special statistical procedures to study the frequency of various parameters in different diseases has allowed independent diagnostic criteria to be established.