Developing multipurpose reproductive health technologies: an integrated strategy.

WOMEN WORLDWIDE CONFRONT TWO FREQUENTLY CONCURRENT REPRODUCTIVE HEALTH CHALLENGES: the need for contraception and for protection from sexually transmitted infections, importantly HIV/AIDS. While conception and infection share the same anatomical site and mode of transmission, there are no reproductive health technologies to date that simultaneously address that reality. Relevant available technologies are either contraceptive or anti-infective, are limited in number, and require different modes of administration and management. These "single-indication" technologies do not therefore fully respond to what is a substantial reproductive health need intimately linked to pivotal events in many women's lives. This paper reviews an integrated attempt to develop multipurpose prevention technologies-"MPTs"-products explicitly designed to simultaneously address the need for both contraception and protection from sexually transmitted infections. It describes an innovative and iterative MPT product development strategy with the following components: identifying different needs for such technologies and global variations in reproductive health priorities, defining "Target Product Profiles" as the framework for a research and development "roadmap," collating an integrated MPT pipeline and characterizing significant pipeline gaps, exploring anticipated regulatory requirements, prioritizing candidates for problem-solving and resource investments, and implementing an ancillary advocacy agenda to support this breadth of effort.

Couples becoming parents: something special after IVF?

The majority of catamnestic studies on successful IVF treatment deal with the development of the children and the parent-child-relationship. Far fewer studies pay attention to the changes within the relationship of couples that become parents. This particular study focused on the transition from partnership to parenthood with assessments at different measuring points (T1: the last trimester of pregnancy; T2: 3 months after birth; and T3: 12 months after birth) and compared 47 IVF couples with 45 couples that conceived naturally. The couples were observed with psychodynamic couple interviews and standardized as well as non-standardized questionnaires. The most striking result of our study was the inconspicuousness of IVF couples and their parent-child-relationship. Partnerships featured a high degree of satisfaction among the couples; the progress of pregnancy was described as very satisfying and free of complaints. Surprisingly these descriptions were given despite more frequent and longer hospital stays by the IVF women during their pregnancy. However, IVF couples acted less openly in the interviews and expressed their own feelings less often, especially the more negative ones. In the partnerships we found that IVF women displayed more avoiding tendencies in their relationships 1 year after the birth of their child/children.

[Lymphangiomatosis as the cause of therapy refractory chylothorax and ascites]. / Lymphangiomyomatose als Ursache eines therapierefraktären Chylothorax und Aszites.

After five weeks of progressing dyspnoea and pain in the lower abdomen a 44-year old woman was admitted in our hospital unit. A massive chylothorax was identified as the cause of the dyspnoea. Clinical and pathological findings were consistent with the diagnosis of lymphangiomyomatosis. The ligature of the thoracic duct as well as pleurodesis and the application of medroxyprogesterone were without any significant effect. Severe complications made further treatment in the intensive-care unit imperative. Symptomatic treatment led only to a short remission. Five months after the outbreak of the disease the patient died from multiple organ failure.

Clinical experience with a new recombinant hepatitis-B vaccine in previous non-responders with chronic renal insufficiency.

Patients with renal insufficiency have an increased risk of hepatitis B infection and a high probability to develop a chronic course of this disease. After hepatitis B vaccination they are known to show a low rate of seroconversion. In the present study we assessed the efficacy of a new recombinant pre-S1 and pre-S2 containing hepatitis B vaccine in 17 non-responders (anti-HBs titer 0) and 4 low-responders (anti-HBs titer < or = 5 IU/ml) with chronic renal insufficiency (16 on chronic hemodialysis therapy and 5 without hemodialysis treatment). Seroconversion rate was 65% after the third and 71% after the fourth vaccination. Only minor side effects were seen. These results encourage to use the new vaccine in a larger number of patients with renal insufficiency.

Hepatitis B vaccination of immunosuppressed heart transplant recipients with the vaccine Hepa Gene 3 containing pre-S1, pre-S2, and S gene products.

The antibody response of immunosuppressed heart transplant recipients to vaccination with the hepatitis B (HB) virus vaccine Hepa Gene 3 (HG-3), containing HB virus pre-S1, pre-S2, and S gene products, was examined. Three heart transplant recipients who had been vaccinated preoperatively against HB responded well to the vaccination. Five of 38 patients (13.2%) vaccinated postoperatively before HG-3 vaccination with the second-generation vaccine Gen-H-B-Vax-D (37 without and 1 with detectable anti-HBs response) and 3 of 24 (12.5%) without previous HB vaccination developed protective anti-HBs titers (greater than 10 U/l) after immunization with the HG-3 vaccine. The low response rate (8/62, 12.9%) found for postoperatively vaccinated patients indicates that heart transplant recipients should be vaccinated against HB before immunosuppressive medication.