Patient education pamphlet and book literature, August 1975.
An international bibliography on patient education pamphlets and books on sterilization compiled in August 1975 by The International Project of the Association for Voluntary Sterilization is presented. 85 references are included from the following counries: Colombia, El Salvador, Great Britain, Guatemala, Indonesia, Korea, Mexico, Pakistan, Philippines, Taiwan, Thailand, Trinidad and Tobago, and the U.S.
Female sterilization by colpotomy, August, 1975.
An international bibliography of 30 published articles and 5 conference proceedings on the subject of female sterilization by colpotomy is supplied. The various entries address the following aspects: 1) tubal sterilization, general, with an emphasis on colpotomy (1 selection); 2) colpotomy, general or technical (29); 3) comparisons with abdominal tubal ligations (2); 4) comparison with culdoscopy (1); and 5) colpotomy case studies (2). 31 entries are in English, and 2 each are in Japanese and French.
Hysterectomy for sterilization, August, 1975.
An international bibliography of 22 published articles on the subject of hysterectomies for sterilization is supplied. The various entries address the following aspects: 1) hysterectomies for sterilization, general (8 selections); 2) vaginal hysterectomies (9); 3) cesarean section by hysterectomy (1); 4) comparisons with tubal ligation (2); and 5) psychological and physical reactions (2). 21 entries are in English, and 1 is in German.
Culdoscopic female sterilization: a selected bibliography, August, 1975.
An international bibliography of 45 published articles, 10 conference proceedings, and 2 monographs on the subject of culdoscopic female sterilization is supplied. The various entries address the following aspects: 1) culdoscopic tubal ligation, general or technical (40 selections); 2) kidney injury (1); 3) comparisons with laparoscopy (6); 4) culdoscopy case studies (3); 5) peridural anesthesia (1); 6) comparison with colpotomy (2); 7) computer technology (1); 8) research and development regarding outpatient sterilization (1); and 9) public acceptance (1). 47 entries are in English, 4 in French, 3 in German, 2 in Spanish, and 1 in Portuguese.
Female sterilization by mini-laparotomy, August, 1975.
An international bibliography of 14 published articles and 7 conference proceedings on the subject of female sterilization by minilaparotomy is supplied. The various entries address the following aspects: 1) minilaparotomies, general or technical (19 selections); 2) experiences and 3) characteristics and recovery times of acceptors (1). 20 entries are in English, and 1 is in Spanish.
Laboratory studies and clinical trials of a vaginal contraceptive Conceptrol Cream investigated the hypothesis that the standard Food and Drug Administration (FDA) approved, nonprescription agent can protect against sexually transmitted diseases. The currently marketed FDA-approved products were tested in vitro against N. gonorrhoea, T. vaginalis, C. albumins, and T. pallidum. Conceptrol Cream, Nonoxynol 9, a single dose packet of Delfen Cream was selected Laboratory studies included: 1) the chemical susceptibility of N. gonorrhoeae in continuous passage in the presence of the cream; 2) the survival and recovery of N. gonorrhoeae under different environmental conditions, 3) virucidal effect of chemical contraceptives in Herpes simplex virus type 2, and 4) the effect of vaginal lubricants on N. gonorrhoeae. Clinical trials involved 37 treated patients and 50 controls for a 1-year period. The cream preparation was antibacterial in nature. Vaginal lubricants also proved to be antibacterial. Changes in resistance of other growth characteristics were absent after continuous passage. A variety of contraceptive creams tested against Herpes virus showed some inactivation. The first 6 months of contraceptive use showed a statistically significant lowering of the incidence of gonorrhea. The second 6 months showed insignificant differences. Conceptrol cream can offer the female an over-the-counter contraceptive that can also aid in the control of venereal disease.
Food, Drug, and Cosmetic Act Amendments of 1975. Report to accompany S.963.
The Committee on Labor and Public Welfare, to which the bill S.963 was referred, reports favorably to amend the Food, Drug and Cosmetic Act to prohibit the administration of diethylstilbestrol (DES) to any animal to be used as food or for other purposes. The Committee report on DES includes the history of the regulation of DES -as an animal feed supplement and as a morning-after contraceptive. 3 hearings were held by this Committee exploring these 2 areas of use. The need for legislation of DES use based on its cancer-causing potential is encouraged, including support for basic, clinical, and epidemiological investigation. The 2nd part of the report includes Title 2, which seeks to improve national health law by providing for a statutory Food and Drug Administration (FDA) within the Dept. of Health, Education and Welfare, prescribing its powers and strengthening its responsibility for consumer safety. Ongoing research on DES is abstracted in the appendix. A section-by-section analysis of S.963 includes propoosed directions for the use of DES, labeling, use of informed consent forms, physicians report of prescription of the drug, and pharmacist's reports. The power and functions of the Commissioner of the FDA are outlined. Prohibited acts and penalties are described.
Diethylstilbestrol as a "morning after" pill.
Diethylstilbestrol (DES) has been used to prevent pregnancy following unprotected intercourse. Effectiveness of this treatment decreases after 72 hours have elapsed since intercourse. Treatment usually involves taking 25 mg DES twice a day for 5 days. Taking DES for 5 days is equivalent to taking birth control pills for several decades. Nausea and vomiting are common side effects. Long-term effects of DES are unknown although immediate risks of blood clots are present. DES carries a potential risk of being harmful to a female fetus; it should not be taken if pregnancy has been affirmed; voluntary termination of the pregnancy should be considered. Since DES fails to protect against pregnancy, an effective method of contraception should be used during coitus.
This is an update of the original factbook prepared by the Family Planning Council of New York City 1973. It was hoped that the book would help in planning, evaluating, and improving family planning services in the City. 25 tables plot the data and an introduction summarizes the accumulated data. There was a need to review the family planning situation because of changes in the population and changes in the abortion law in recent years. The percentage of whites declined and that of blacks and Puerto Ricans increased substantially in the years between 1940 and 1973. The number of high parity births has declined in recent years, due largely to increased use of family planning services. The general fertility rate in New York City declined from 81.5 per 1000 eligible females in 1970 to 59.5 in 1973. By 1973 there were almost 8 abortions performed for every 10 babies born in the City. Infant mortality rates were down. The family planning program in the City largely serves the indigent, the ones who need it most. Nearly 1/2 the births in the City took place in subsidized hospitalizations, 27% were o ut-of-wedlock, and 26% of the women giving birth had late or no prenatal care. Family planning information is now being provided in city schools.
Law and fertility in Bulgaria.
Bulgaria's birthrate has fallen from 40/1000 in 1900 to 14.9 in 1966 , followed by a short rise to 16.9 in 1968, then down to 13.4 in 1972. The rise around 1968 is partly the result of family allowances, tighter abortion regulations, and government attempts to raise the birthrate, and partly the result of the incrased numbers of adult women maturing from the large birth cohorts immediately following World War 2. The present birthrate is below the level of modest increase and is a cause of official concern. This seems to be the result of the housing crisis, the lack of infant care facilities, and the lack of educational attainment among women. The difference in fertility between towns and villages has decreased to only 19%. This is the result of rapid urbanization, resulting in a decline in the number of young women in the countryside. There has been a significant decline in infant mortality from over 100 to 25/1000 live births in the last 25 years. There has also been significant decline in higher order births and births to women over age 30. Contraceptive supplies are sold at pharmacies and active educational campaigns and carried out to help couples plan the number of children wanted. Abortion is not allowed for a 1st pregnancy unless medical evidence indicates considerable risk. Women's groups actively warn against aborting a 1st pregnancy because of secondary sterility. Abortion is available on request for later pregnancies and no obstacles are encountered if the woman is over 45 or has 3 or more children. Afte r 12 weeks abortion is allowed only if there is grave risk to the mother or known serious toxic condition affecting the fetus. Under law illegitimate births have the same rights as children born in marriage and the mother is entitled to all benefits. The government is attempting to increase the number of 3rd order births in the family. This seems necessary to fight the decline resulting from the decreasing number of marriages, from primary and secondary sterility, and from women choosing to end their reproductive lives at early ages.
Hysteroscopic sterilization. August 1975.
An international bibliography on hysteroscopic sterilization compiled by The International Project of the Association for Voluntary Sterilization, August 1975, is presented. There are 34 referenes included.
A bibliography of the literature on laparoscopic sterilization is presented. 223 publications are cited.
Vasectomy (1973-1975). August, 1975.
An international bibliography compiled by the IPAVS, listing 197 entries of titles of works related to vasectomy between 1973-1975, is presented.
Psychological effects of vasectomy, August, 1975.
This international bibliography concentrates on the behavioral and emotional aspects of vasectomy. It contains several follow-up studies from various counries as well as theoretical articles and case histories.
Psychological effects of female sterilization, August, 1975.
Articles in several languages pertaining to the emotional aspects of female surgical sterilization are listed. Included are case studies, long-term follow-up studies, and comparisons of the psychological aftermaths of different techniques.
Spontaneous reanastomosis of the vas deferens after vasectomy, August 1975.
An international bibliography compiled by the IPAVS listing 28 entries related to spontaneous reanastomis of the vas deferens following vasectomy is presented.
Audio-visual materials (on sterilization). August 1975.
This listing of films, filmstrips, slides, video tapes, and audio-cassettes inclues 2 types of material: 1) technical presentations for physicians and surgeons and 2) materials for lay audiences. Many of the lay materials also include general contraceptive information or a discussion of the problems of overpopulation. A list of names and addresses of distributors is included.
The biomedical effects of vasectomy: a selected bibliography, August 1975.
Articles in English, French, and German on the biomedical effects of vasectomy are listed. They cover operative techniques, complications, repair, treatment for complications, and results of follow-up studies. Several deal with the problems of antibodies, autoimmunity, and hormonal changes.
Attitudes towards voluntary sterilization, August 1975.
This series of journal articles, articles from popular magazines and newspapers, and conference reports is categorized by major regions of the world and by countries. 39 countries are specifically represented in addition to general articles covering Europe, Asia, the Middle East, North America, and Central and South America.
The association of pelvic inflammatory disease (PID) with contraceptive use was investigated in 1583 undergoing interval sterilization. Women using an IUD had a much higher incidence of PID, while those taking oral contraceptives had a much lower incidence than those using other contraceptive methods. The risk of PID appeared to be greater among women who had been using the IUD for a short period of time. There did not appear to be a direct correlation between factors such as age, parity, socioeconomic status, number of marriages, history of abortion, and previous abdominal and gynecological surgery and the occurrence of PID. The increased risk of PID to IUD acceptors and the possible protective effect of OCs are discussed.
Law and population in the Philippines.
The effect on fertility of Philippine laws concerning sterilization, contraception, abortion, the minimum age of marriage, laws regarding annulment and divorce, and the concept that a child can be given gifts or inherit by will while still in the womb is summarized. The status of women is a strange mixture of Spanish, American, and Philippine law. The new constitution tries to abolish discrimination against women, but some provisions still exist which prohibit a daughter aged 20-23 from leaving home without her father's consent, a wife's accepting presents except from specified relatives, a husband's control over his wife's business activities, and his administration of the family property. Criminal law treatment of sexual activities and laws concerning public welfare, public health, education, property and economic factors, and taxes are also covered. An appendix presents a draft population law which would make family planning the right of every couple, exempt contraceptives from import duties, give right of sterilization to any consenting adult with 3 or more children, raise minimum age of marriage to 18 for both men and women, and would bring family planning procedures under a national health care program. The Presidential Decree No. 79 of 1971 setting forth the current Philippine population policy is also reprinted. This is the decree which sets up POPCOM. In each section the effect of a law upon fertility either directly or indirectly is analyzed and suggestions are made where changes in legal structure might help population policy. In general, law cannot effect change without social attitude behind it but law can obstruct change. The greatest need is for promotion of employment, maximum economic growth feasible, more equitable income distribution, greater education for the masses, and greater social development. Without these factors, attempts to limi t population growth will lag.
An exploratory and descriptive research effort focusing on a socioeconomic cross-section of the Monterrey population was conducted by the Faculty of the Universidad Autonoma de Nuevo Leon in Mexico. A questionnaire was developed to evaluate the socioeconomic status of the sample and another questionnaire was designed to register the necessary information to evaluate attitudes, knowledge, and practice of contraception. Preliminary applications of the questionnaires was made to 50 patients and refinements and corrections were incorporated before a sampling of 400 interviews took place. The average age of the women and their spouses was 33 years old. More than 83% of the women were married and the majority had not completed primary schooly Almost all of the sample of men and women were Catholics. 45% of the women interviewed had from 1 to 3 children. It was learned that the principal motive for not using contraception was ignorance of the subject and of its sexual aspects. 81.4% of interviewees reported not knowing about the process of menstruation and 73.2% did not know how pregnancy originated. 68.6% had not used contraception. Of those who had, 1/3 used the oral contraceptive, 28.4% used coitus interruptus, and 20.3% practiced abstention. It was found that religion did not influence nor impede contraceptive practice. The rhythm method was almost unknown. 65% of the group indicated that they didn't want any more children, and 85.1% wanted to space their children in order to give more attention to the living children. 58.2% regarded 3 to 4 children as ideal and 2/3 of the group felt that family planning should begin before the 1st child.
The purpose of this abortion surveillance is to document the number and characteristics of women obtaining abortion in the U.S. and to eliminate preventable mortality and morbidity related to abortion. The most current data available to the Center for Disease Control for the years 1969-1974 are used. Provided are: 1) demographic and epidemiologic data on legal abortions in 1974; 2) trends in the practice of legal abortion from 1972 to 1974; 3) abortion related mortality data for the 3-year period 1972-1974, including types of procedures, death to case rates, and causes of death; and 4) rates of abortion morbidity derived from the Center's 4 year multicenter study of abortion complications. Additionally, 2 important abortion studies are summarized. It was learned that in 1974 the 50 states and the District of Columbia reported 763,476 legal abortions to the Center, a 24% increase over the 1973 figure. There was nearly 1 legal abortion for every 4 live births in 1974, and the national abortion rate increased from 14 to to 17 abortions per 1000 women aged 15-44. 1974 was the 1st year in which all 50 states and the District of Columbia reported that abortion services had been performed within their boundaries. 87% of women undergoing abortions in 1974 did so in their own state in contrast to 75% in 1973 and 56% in 1972. Women obtaining legal abortion in 1974 tended to be young, white, unmarried, of low parity, and early in pregnancy at the time of the abortion. Suction curretage was used in 77% of all procedures performed in 1974. Deaths related to abortion continued to decline in 1974 although at a slower rate. Preliminary analysis of morbidity from 80,437 abortions performed in 32 institutions from 1971 through 1975 revealed that major complication rates had decreased since the 1st multicenter study was conducted during 1970 and 1971.
Fertility rates for 3 study areas of this benchmark survey are unavailable because of inadequate vital statistics, but use of the child-women ratio from the 1970 census showed ratios of 429 and 277 respectively in Changsung and Dongduchun areas (compared with 711 for the national average of rural areas) and 32 in Sanggye-dong (compared with national urban ratio of 476). Average age of marriage was about 21 in all 3 areas and the duration was 10-14 years. There was an average of 4.3 and 4.5 pregnancies up to time of survey in Changsung and Sanggye-dong while Dongduchun reported 5.2. 90% of the women in Changsung replied they could become pregnant, 70% in Dongduchun, and 75% in Sanggye-dong. Average number of children for women under 30 was about 3.5 in all areas. However among women aged 40-44 Changsung had 4.75, Dongduchun had 3.60, and Sanggye-dong had 4.15. Incidence of induced abortion was higher than the estimated national average: 30% in Changsung, 55.4% in Dongduchun, and 47.6% in Sanggye-dong. Spontaneous abortions were 13.8-17%. Stillbirths ranged from 1.7% in Sanggye-dong to 3.1% in Dongduchun.
Attitude toward family planning.
5 variables were studied to determine attitudes toward family planning: 1) Ideal number of children: This was 2.60 in the urban area of Sanggye-dong, 3.01 and 2.75 in the rural areas of Changsung and Dongduchun. This shows a decrease compared with that of the nation in 1973. Women with high educational attainment wanted fewer sons and nearly 1/2 of all women wanted at least 1 daughter. Younger women wanted fewer children than older. 2) Ideal period of spacing: Most advocated 3 years, followed by those advocating 4 years. 3) Ideal age at completed childbearing: 71% of Sanggye-dong women considered 25-30 years ideal whereas 50% of Changsung and 67% of Dongduchun stated 25-30 was ideal. 36.9% in Changsung thought 30-34 was best, compared with 20% in the other 2 areas. 4) 85% of Changsung women and 90-95% of the others stated unwanted pregnancies will result in induced abortion. 5) 98-99% of the women in all areas approved of family planning regardless of education, job status, or age.
Seminar/workshop recommendations. (Family planning services)
Participants urged that each member Family Planning Association endeavor to: integrate community-based distribution of family planning services into its program; undertake motivational and educational activities; initiate education of family planning personnel to help them understand the changing pattern in family planning services; recruit and train members of the community to be motivators; investigate using commercial expertise and resources for wider distribution of contraceptives and improved evaluation; evolve supervisory medical services to support community-based projects; work for relaxation of legal constraints; and cooperate with governments and other nongovernmental organizations to ensure coordination of all activities.
Objectives of seminar/workshop. (Family planning services)
This seminar was held to understand the changing pattern in the delivery of family planning services due to: increased government involvement, the need to expand to the widely scattered rural population, limited resources, and the need for broad-base community support. Efforts will be made to find out how commercial resources can improve services, to fit the clinical aspect of FPA into the total government-based health program, and to study the medical, legal, and social implications of community-based family planning services. The object is the necessary reorientation of FPA programs and defining new roles for physicians and other health and auxiliary personnel in CBFPS.
This proposal covers recruitment of family planning educators, curriculum development, training of trainers, training of field educators, and integration of family planning into other field services. It is suggested that before any recruitment is done, a survey be made to find out what type of worker would have the greatest credibility in family planning. During the 1st year of the proposed program, 10 weeks would be allocated for this survey. At the same time an advisory committee would be appointed for curriculum development and training staff recruited. Recruitment of trainees should take 8 weeks; training of staff, 3 weeks; Phase 1 training of the 1st group of workers, 4 weeks; fieldwork, 8 weeks; then other training courses for new groups. Follow-up and evaluation is also provided. Suggested budgets are included.
Intra-uterine devices: physiological and clinical aspects.
Physiological and clinical aspects of IUDs are reviewed. Over 3 million IUDs had been distributed in the U.S. by the end of 1967. The history and design of IUDs, the antifertility effects in some species, their systemic effects, and effects on the ovary, fallopian tube, and uterus are reviewed along with tissue reactions of the ovary, fallopian tubes, endometrium, myometrium, uterine fluid, cervix, and the vagina to the presence of an IUD. There is no demonstrated carcinogenic effect of IUDs. Sources of clinical data on IUDs and statistical methods and clinical protocol for evaluating IUDs are discussed. Pregnancy rates tend to be higher with smaller sized devices than the larger sized IUDs. Side effects associated with IUDs include abnormal bleeding, pain and pelvic discomfort, vaginal discharge, pelvic infection, uterine perforation, and pregnancy with an IUD in situ. Expulsion rates vary widely among the various devices. Smaller sized devices tend to be expelled more easily, though factors such as thickness, elasticity, and stiffness also contribute to variations in the incidence of expulsion. Expulsion rates are highest when insertions are performed in the immediate postpartum and lowest when performed 3 months or more after childbirth. Abnormal bleeding and pelvic pain are the most common reasons for removal of an IUD. Removals are most responsible for discontinuation of all types of IUD. Continuation rates for the various IUDs are rather similar, averaging 75% at the end of the 1st year, 65% at the end of the 2nd year, and 50% at the end of the 5th year. Contraindications of IUDs include active pelvic inflammatory disease, congenital malformations of the uterus or the presence of fibroids of sufficient size to deform the uterine cavity, and pregnancy. Nulliparas do not tolerate an IUD as well as parous women. Preinsertion examination, the use of paramedical personnel in insertions and removals, the insertion technique, follow-up care and long-term safety of IUDs are briefly discussed. Basic research needs and further clinical and epidemiological studies of IUDs are outlined.
A series of in-depth interviews with 33 men and 34 women to determine effectiveness of a series of family planning films shown with other short features in a typical rural film show in India is described. The 7 films tested were shown 1 at a time as part of a weekly film show; the interviews were conducted informally the next morning. The problems of getting interviewees is detailed. Most of the women, especially, were very shy and suspicious. The original objective, to get 50 men and 50 women matched for caste and religion, proved impossible in the village setting. Instead, a series of profile interviews are presented to help determine most effective film approaches. An abstract film called ''Hands'' had the lowest retention and was the least liked. A film which delivered the family planning message in a song sung over and over was enjoyed for entertainment value but the message was totally missed. Both men and women felt films which showed the benefits to children of smaller families were more credible. The men were also responsive to arguments about division of land and economic matters; these made little impression on the women. The women were responsive to poor health from bearing too many children, a subject which the men reacted to by saying they knew lots of women with many children who were healthy. The biggest finding was that the films were seen as purely diversion and the women, especially, tended to ignore the narration. However, they found dialogue interesting and listened to it. The films had little impact on perception of family planning, or at least the interviewers could find little. In general the vasectomy scenes were reacted to negatively, mainly due to the situation in the district. The family planning personnel on the screen were viewed as being only interested in quotas and were not an effective source of advice. Complex film-making techniques such as flash-forwards or flash-backs confused the respondents. A slowly-paced story featuring a couple in the same age bracket (wife 15-25 years of age) with narration had the best retention.
The good of every individual and of society as a whole is bound up in the stability of the family. The family must remain free to determine its own destiny if its well-being is to be ensured. The Church and State must play supportive roles fostering conditions which will help the family achieve the fullness of its mission, i.e., bringing humans into being and maturity by making responsible, generous decisions regarding family size. Freedom is undermined when persons or agencies outside the family unit, particularly those who control welfare benefits or represent public authority, presume to influence the decision of a couple regarding family size. Government promotion with tax dollars of family planning programs may easily result in the decision to reduce efforts to foster economic, social, and moral reforms needed to build an enlightened society. Freedom is more than the right to choose among birth control methods; birth control is not a universal obligation. The government is, it seems, rapidly abandoning its neutral policy regarding birth control and is seeking to persuade and even coerce the underprivleged to practice. This trend in policy is currently being exercised overseas as well. This is overreach and violates the right of human privacy.
Project in family planning communication for rural young married couples:
The project aimed at designing an effective media strategy to inform and educate young couples (wives ages 25-25 years) to adopt 1 or a combination of contraceptive methods. It was carried out in Saharanpur District of Uttar Pradesh and functioned at the microlevel of block and village. Media materials were to be of local origin and were to be community specific in the hope they would thus be effective and relevant. The 1st phase involved a baseline survey of target couples and an examination of the role and function of family planning workers. Spectator response to family planning films was also measured and the content of 2 films analyzed. It was found that motivational films were too remote and that the family planning film show had no social context in the community. Films could be effective if designed to suit audience expectations. Family planning workers were found to have lost their faith in the target-oriented program. They lacked adequate leadership and knowlege of birth control methods. Attitudes of young couples were disapproving of contraception and very negative toward sterilization. Most had never been approached by a doctor or family planning worker suggesting an appallingly low level of communication between the community and fmaily planning personnel. Interviewing and data gathering proved difficult and quite often family planning clinic records were inaccurate. It is concluded that in order to be effective, family planning communication could not be separated from clinical services and the general socioeconomic development of the community. Positive experiences with portable video equipment suggested it could be more effective at diffusing information because of its immediacy than films had been.
[The Statistical Yearbook of the Czechoslovak Socialist Republic 1972]
This statistical report deals with the population of Czechoslovakia. The portion cited above contains statistical tables dealing with population levels from 1945 to 1971, social structure, births, reproductive measures, reported abortions, deaths by causes, and migrations.
[Opinion survey on family planning in rural areas]
A knowledge, attitude, and practice survey of rural Morocco was conducted in September-October 1967, 1 year after the start of the government Family Planning Program. The survey included 1423 women under 50, 266 women over 50, and 656 men. 1428 households were selected from Zones 1 and 2 after dividing the country into 3 zones by accessibility of villages to roads. The population surveyed was 96% married, with low income, relatively isolated from modern education (5% of the men only attended primary school), and communication (25% of the men listened to radio). 41% of the women under 50 wanted no more children, a number which varied with number of living children and of sons. 2/3 were aware of decreasing infant mortality, high in comparison with an urban survey. 40% said they could not raise mortality, high in comparison with an urban survey. 40% said they could not raise any more children. The ideal numbers of children expressed were 4.1 by men and 4.6 by women, compared with 3.1 and 3.3 by urban men and women. Only 10% of men had heard of the family planning program, usually from friends rather than the media 13% of women replied yes to an open question about knowledge of modern contraception, and 60% to closed questions on specific methods (including withdrawal, rhythm, condoms). 25 and 43% affirmed knowledge of traditional methods (e.g., herbs and talismans) in open and closed questions. 1/2 of the women approved of family planning, citing unemployment or health as reasons; 1/2 disapproved citing religion or tradition. 5% claimed past use of contraception, 1/2 of these successfully; 15% of women said they would use contraception. Ideal age for marriage was about 16 for women and 21 for men. These results showed a greater interest in family planning than expected for rural Moroccans, similar to urban attitudes, but rare and vague knowledge and negligible practice of contraception.
This study on the increase of population in Egypt and its impact on development tackles the question of the population growth from its various aspects as well as the economic factors of the problems of overpopulation. It covers the present-day and future problems of the population increase in Egypt and the world, the demographic statistics of the population problem, the economic factors and socioeconomic development in relation to population growth in Egypt. The analysis of the demographic elements presents statistics on the age and sex composition of the population, marital relations, fertility trends, mortality levels and trends, and the population movement and internal migration. Economic factors are analyzed according to population and natural resources, characteristics of the labor force, education in national development, consumption patterns and trends, and investment and saving. Methods and aims of development in relation to socioeconomic development, the effect of the growth of population on economic development, and the effect of economic development on population growth in the future are discussed and analyzed. Analytical studies on this information for Egypt and many other countries are included in an appendix to the appropriate subject.
Depo-Provera. (FDA approval history)
A history of Food and Drug Administration (FDA) action concerning Depo-Provera for injection is presented. The original approval occurred in November 1960. Depo-Provera was originally proposed for use in habitual and threatened abortion, endometriosis, and suppression of ovulation. Provera is 24-48 times more effective when administered subcutaneously. Provera is 20-30 times more effective than progesterone in suppressing ovulation. Original contraindications included cases of dysmenorrhea and functional uterine bleeding. Injection of the drug causes little or no local pain and no bad systemic effects. Patients receiving Depo-Provera should be watched for signs of adrenocorticoid action. Large doses in animals have produced masculinization in females. From 1963 onward, the RDA added items which should be mentioned in the Depo-Provera packaging, including various precautions, contraindications, and side effects. In October 1973 Depo-Provera was removed as a possible drug for use in pregnancy-related indications, i.e., threatened and habitual abortion and endometriosis. This action was taken due to discovery of a possible connection between administration of progestins in early pregnancy and congenital heart defects in the offspring.
[The population of Ecuador. Characteristics and growth; 1950,1960, 1974]
In an effort to avoid the sometimes artificial nature of demographic data gathered according to political or administrative divisions, the population is analyzed by conglomerations categorized as follows: localities of 100,000 or more, population centers with 10,000-99,000 inhabitants, those of 2000-9999, and those of less than 2000. Data for analysis were taken from the 1950 and 1960 censuses and from provisional findings of the 1974 census. The study is divided into 2 parts: population dynamics both on a national and regional level and an analysis of the demographic characteristics, educational level, and economic activity of the population. The analysis reveals, in the opinion of the authors, geniune socioeconomic and demographic differences among the 4 levels which, when related to information in the 1974 census can be used to identify possible factors that determine change in population size, and to project the size of the population in the future.
[Population policies and problems in economically advanced countries]
The purpose of the report is to disseminate the findings of the Ditchley Conference of 1972 on what shape population plicy ought to take in developed countries. Discussed are population tendencies, future perspectives, population policy, optimal population size, general problems with population policy, consequences of migration, urbanization, family planning, developed country responsibility in the world, and the role of the U.N. 2 basic questions were addressed: Are the population declines in progress in developing countries sufficient or should a deliberate policy to stimulate further reductions be adopted? and How could such a policy be effected in a democratic society without restricting personal freedoms? Major findings include: 1) in most economically advanced countries the population has decreased in recent years mostly due to a drop in birthrates; 2) the decrease is seen to have more advantages than disadvantages and is encouraged by individuals and governments; 3) when the population exceeds its optimal level it is largely due to unwanted births or to the failure of parents to completely face up to the social costs of childbearing; 4) measures that affect the population growth rate should be based on and reinforced by social measures like availability of family planning services and opportunities for employment for women; 5) family planning including sterilization and abortion should be available to everyone; and 6) the developed countries have the responsibility of aiding the developing countries with population control, but only after the former have addressed their own population problems.
"Where do Babies Come From?" and "Growing Up": two radiovision sex education aids.
2 filmstrips originally designed to be used with a radio broadcast are described. Most teachers, however, taped the radio broadcast or read the script to achieve flexibility in presentation. By the end of July 1970, 1 year after introduction, 2847 schools had bought ''Where Do Babies Come From?'' and 2673 had bought ''Growing Up.'' 2/3 had either used them or had plans for integrating them into an upcoming curriculum. Of the remaining 1/3, 15% gave extraneous reasons for nonuse, 12% preferred another series, 12% reported staff objection to sex education, and 14% gave miscellaneous objections. Most schools required parental permission for student participation. Reaction after showing was generally quite favorable.
Health aspects of family planning.
Family planning worldwise encompasses the following activities: birth control, infertility counseling, parenthood and sexuality education. Family planning has an impact on national health through prevention of unwanted pregnancies and unnecessary abortions, through a declining birth rate, and in the spacing and timing of pregnancies. The types of side effects, either serious or minor, experienced by users of various methods of contraception are mentioned. Objectives, methods, and sources of data for studies on the health impact of family planning are suggested. Different ways of integrating family planning services into other aspects of the health care system are discussed. Various necessary family planning personnel are described. Family planning activities can be carried out in different situations. Different means of evaluating the health aspects of family planning are mentioned. Problems in carrying out such studies are pointed out. Improved quality and broadened geographical coverage of studies in this area are needed. The report also includes a list of specific topics for further research.
Fortieth report and accounts, 1971-1972.
Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
The Thailand project in functional literacy and family life planning.
The entire ongoing functional literacy program as well as the philosphy on which it was based has been revised in Thailand. The primary components of the present model of functional literacy are geared to identifying and eliminating obstacles to social and economic development in the learners' environment. Emphasis is now placed on teaching initially conceptual material that will be relevant to the student. The belief is that this approach will significantly reduce the high attrition rate of previous adult education programs. Priorities are determined on the basis of the broad needs of the entire family unit; the concept thus emerges as that of family life planning. Program implementation began with a survey of 5 villages in the provinces of northern Thailand. The initial baseline data was collected to formulate the curriculum and subsequently used for evaluation purposes. The syllabus that was constructed took into account the express objective of the ministries of agriculture, health and economic affairs. After determining the syllabus, a working group from the division of Adult Education was established to write the materials. This was followed by the selection and training of teachers for the 20 pilot classes. The eventual sucess of this pilot program led to the expansion phase of the project now underway in northern and southern Thailand.(Author's, modified)
The results of discussions held and recommendations made on methods of planning and evaluation in applied nutrition programs at a joint FAO/WHO technical meeting in Rome in January 1965 are summarized. This conference was envisaged as an initial step toward systematizing methods of planning and evaluation in applied nutrition programs through review of existing techniques being used in programs jointly assisted by FAO and WHO. Chapters are included on basic concepts and working definitions for future planning and evaluation, participation of program personnel in planning and evaluation, and involvement of local communities in the planning and evaluation of applied nutrition programs. A primary chapter contains a detailed analysis of the place of program planning and evaluation within various phases of actual program operations. Main conclusions are summarized in a concluding chapter. Appendices contain criteria or indicators for evaluating horticultural and poultry production aspects of applied nutrition programs, for nutrition programs for protecting mothers and young children from malnutrition, and for the evaluation of educational efforts in applied nutrition programs.
Final report of the twenty-third American Assembly.
Participants at the 23rd American Assembly agreed that the accelerating rate of world population growth threatens worldwide welfare and security. Rapid population growth injures personal development and family life, hinders national economic development, and creates social unrest and political instability. Assembly participants recommended that the U.N. expand its population-related activities, provide financial aid to national family planning programs, encourage basic reproductive research, and increase world awareness of the population problem. The U.S. should give added attention to its national population problems and similar problems in the world. Specific areas of action for the U.S. are pointed out.
This statistical report summarizes population growth and density in Japan, the trends in general, maternal, and infant mortality, and examines the changes in fertility patterns since World War 2. Population is expected to increase from the estimated 103,356,000 in 1970 to 140,619,000 by 2025. This population will be older, highly urbanized, and closely packed into the major metropolitan areas. The problem will be 1 of balance between economic development and social development. Figures show that the proportion of children will decline, the number of aged dependents will increase, the number of children per household will decline, and more women will reenter the labor force after age 35. Japan's problems are closely bound up in the fate of other Asian nations, which are experiencing high population growth. For Japan to prosper it must trade with other nations. Greater prosperity in Asia will mean greater trade for Japan. It is therefore important for Japan to share its experience in curbing population growth with its Asian neighbors.
Developments in fertility control.
A WHO scientific Group on developments in Fertility Control was held in November 1968 to review current work in fertility control; hormonal steroids, oral gestogens, and periodic abstinence were not discussed and IUDs were only considered as means of introducing chemicals into the female genital tract. Male and female human reproductive physiology are described. To increase effectiveness and reduce undesirable side effects, inhibition of male fertility is best effected on mature sperm prior to ejaculation. Both chemical and immunological male fertility control research are being conducted with laboratory animals now. The female reproductive process can be regulated at all the following stages: 1) ovulation; 2) capacitation, fertilization and tubal passage; 3) blastocyst formation and implantation; and 4) early embryonic development. Current chemical approaches to female fertility control are discussed. Immunological methods are not practical at this time. Adaptation of animal research to human application is discussed. Guidelines for human experimentation are laid down. Safety of the user and well-being of the offspring in cases of contraceptive failure must be considered. Basic research is needed.
Report of Southeast Asia ministerial conference on family and population planning.
A Southeast Asian Ministerial Conference on family and population planning was held in Kuala Lumpur in October 1970 to explore areas of cooperation in the region. Representatives from various international organizations and ministers from Laos, Indonesia, Cambodia, Nepal, Philippines, Singapore, Thailand, Vietnam, and Malaysia attended the conference. Each delegate spoke about the population situation in his/her own country. Working papers were presented on aspects of the population problem in Southeast Asia and objectives, activities, and priorities on regional cooperative effort. A chart of demographic indicators accompanies the report.
Application of serum alpha feto-protein assay in mass survey of primary carcinoma of liver.
Results, from the Kiang-su province and Shanghai, of alpha fetoprotein (AFP) screening by double-diffusion and counterimmunoelectrophoresis in 343,999 persons for mass survey of primary liver cancer showed that AFP had some significance in early detection of the disease. Of 147 AFP positive cases detected by screening, 129 (88.4%) were finally diagnosed as primary liver carcinoma by physical examination, other diagnostic procedures and tests, laparotomy, pathological examination, or 2-10 months of clinical follow-up. Of 21 histological specimens examined, 20 were primary hepatocellular carcinoma, and 1 was choangiocellular carcinoma. However, in 18 AFP positive cases followed for 3-10 months, no obvious clinical features of primary liver cancer occurred. Of 53 liver cancer patients, only 20 had obvious clinical signs of the disease while AFP screening was positive, and the other 33 showed signs 1-10 months later than AFP positive detection. Apparently, AFP screening was detecting primary liver cancer before appearance of clinical signs (liver enlarged, hard, and nodular). In 26 AFP positive cases, at the time AFP was positive by screening, results of other examinations (clinical or histological) were largely negative, showing that AFP screening can give positive results earlier than other examinations. In endemic areas of primary liver cancer, repeated AFP screenings are recommended.
In order to assess the nature and extent of the problem of the adult use of tobacco, surveys were conducted in 1964 and 1966. This third survey, conducted in the spring of 1970, focused on 3 major areas of study: 1) demographic data on smokers and nonsmokers and prevalence rates on the use of tobacco; 2) attitudes toward smoking and smokers and beliefs about smoking as a health hazard; and 3) behavior and changes in behavior, as related to cigarettes and other forms of tobacco. The data for the 1970 study were collected from a probability sample of households in the contiguous U.S. Approximately 5200 individuals were surveyed; 91% of them were interviewed by telephone and 9% were interviewed face-to-face. Each person interviewed identified him or herself as either a current cigarette smoker, a former smoker, or a never smoker. The following were included among the survey results: 1) the prevalance of cigarette smoking was dramatically reduced between 1964 and 1970 among both men and women and was most marked for men; 2) the smoking rate among women increased slightly between 1964 and 1966; 3) the proportion of former smokers in the population has increased among both men and women; 4) 87% of the respondents agree that smoking is harmful to health, and 76% agree that it often causes disease and death; 5) belief in the positive aspects of smoking has declined; 6) approximately 74% of all 1970 respondents agree that federal government money should be used to determine why cigarettes are harmful; and 7) 9 out of 10 believe that cigarette advertising should carry a warning statement to the effect that smoking may be harmful to health, and 60% say that cigarette advertising should be stopped completely.
Tobacco smoking and cancer of the lung.
It is claimed that an increasingly potent environmental factor is involved in the rapidly increasing incidence of lung cancer in industrialized countries. This environmental factor is tobacco smoking and air pollution, industrial hazards, and other factors play only a minor role. Epidemiological surveys, both retrospective case control studies, conducted in many industrialized countries, and longitudinal prospective studies, undertaken in the U.S. and Great Britain, demonstrate a strong association between lung cancer and smoking. Furthermore, mortality rises as the amount an individual smokes increases. Laboratory studies, confirming the presence of small amounts of known carcinogens in tobacco smoke, add support to the smoking hypothesis by demonstrating a cause and effect relationship. This hypothesis has withstood critical examination and it is unlikely that the observed relationship between lung cancer and smoking is a spurious one. There is some evidence in support of the pollution hypothesis. Deaths from lung cancer are higher in urban areas and it has been established that death rates for non-smokers are higher in urban areas than in rural areas. However the evidence in support of the air pollution hypothesis is neither as extensive nor as consistent as the evidence in support of the smoking hypothesis.
The Report comprises: 1) opening ceremony; 2) working sessions; a) procedural arrangements; b) consideration of project and program agreed to at the 1st Meeting of Intergovernmental Coordinating Committee; c) presentation and consideration of new proposals for cooperation; d) date and venue of next meeting; e) adoption of meeting and press release; 3) text of address statements, documents, and press release; a) text of welcome address; b) agenda; c) notes on agenda; d) working papers; and 4) members of the Coordinating Committee, observers, Interim Secretariat, and Conference Staff.
Toward balanced growth: quantity with quality.
This book aims to define questions, issues and alternative sets of consequences on matters of immediate concern to the growth of the American nation. In the light of the rapidly deteriorating environment caused by industrial and technological progress, there is a need to develop guidance mechanisms in order to balance the growth of the Nation. As the President of the US stated in January '70: "In the next 10 years we shall increase our wealth by 50%...-does this mean we will be 50% richer in a real sense, 50% better off, 50% happier? Or does it mean that in the year 1980 the President...will look back on a decade in which 70% of our people lived in...areas choked by traffic, suffocated by smog, poisoned by water, deafened by noise and terrorized by crime?" The same type of questioning applies to the issues discussed in this book. The 1st chapter presents the different issues that are currently affecting society; it also discusses the role of citizens in shaping the destiny of their nation. The subsequent chapters deal with the issues in greater detail and the final chapter analyzes the lessons of the debates or issues and policy implications for balanced growth.
(Iran) Summary of contraceptive supplies.
This is an analysis of the family planning and contraceptive supply situation in Iran. A general treatment of the socioeconomic background of the country precedes the discussion. The governmental health care program and family planning services described. Legal requirements and regulations regarding contraceptive import, manufacture, advertising, export, and distribution are described. Companies, percentage of the market, contraceptive cycles, and costs involved are tabulated. Commercial distribution of contraceptives supplements the governmentally-sponsored program. Contraceptive usage concentrates on the pill, followed by condoms; spermicide use is not significant. Commercial market potential is assessed. All data is tabulated.
(Jamaica) Summary of contraceptive supplies.
This is an analysis of the family planning and contraceptive supply situation in Jamaica. A general treatment of the socioeconomic background of the country precedes the discussion. The governmental health care program and family planning services, as well as services offered in the private sector, are described. Legal requirements and regulations regarding contraceptive import, manufacture, advertising, export, and distribution are described. Companies, contraceptive cycles, and pricing costs involved are tabulated. Private and commercial sector distribution of contraceptives supplement the governmentally-sponsored program. Commercial market potential is assessed. All data is tabulated. During the year 1971, almost 20% of the nearly 300,000 potential customers used some contraceptive product. Almost 60% of them were supplied by public sector agencies; the rest purchased contraceptives through the private sector. Pills, condoms, spermicides, and injections are used in that order of importance.
In 1971 more than 3 million cycles of oral contraceptives were distributed in the Philippines. Over 70% were distributed through public sector channels. Almost all 22,640 gross of condoms were distributed in the commercial sector; also 177,200 tubes/packets of spermicide. Of the estimated 4.3 million potential consumers, 8.7% used spermicide; and 21.6% used the IUD. High birth rates, 45/1000, and low mortality rates, 11/1000, produce a young median age, 17.1 years. The female population aged 15-44 is 7.8 million. The average household size is 6.8 children. 75% of the population is literate; 84% is Roman Catholic. Each couple is considered a potential consumer. 13 cycles of contraceptives, 120 condoms, and 10 tubes or packets of spermicide are the projected quantities per couple, per year.
Cause of death, non-smokers and cigarette smokers.
Death by cause is the focus of part 6 in "A Canadian Study of Smoking and Health." The death rates are based on total numbers of persons at risk although it is recognized that competing risks must be considered when studying the relationship between smoking and cause of death and that there is a selectivity process of survivors occurring in each age bracket. Generally, overall mortality ratios are less for those who have stopped smoking with the exception of death by bronchitis and emphysema which has increased 12 times indicating a strong cause/effect relationship. The differential death rates are greatest between smokers and nonsmokers in the 50-69 age group indicating this age is most susceptable to effects of smoking. More specifically, respiratory diseases have the highest mortality ratios while deaths from heart and circulatory disease are 50 times greater among smokers than nonsmokers. Also, excess cancer deaths account for one third of all excess deaths in this age group. Smokers of less than 10 cigarettes/day in the 30-49 age bracket have approximately the same death rate as nonsmokers. However, the rate (particularly coronary and circulatory disease rates) increases for those who smoke 10 to 20 and 20 plus cigarettes/day. Selective survival in the age group 70 plus is evidenced by the low mortality ratios. Data show that coronary circulatory disease, other heart and circulatory disease and lung cancer account for the greatest number of excess deaths along with an increase in their mortality ratios as the quantity of cigarettes smoked also increases. The cause of death pattern for the average Canadian male is shown by standardizing the death ratios in the study to the 1961 population distribution of 100,000 males age 30 plus.
During 1971, 1.7 million cycles of oral contraceptives (OCs) and 90,000 gross of condoms were distributed in Venezuela. The private sector accounted for 66% of the cycles distributed and nearly all of the condoms. A small number of spermicides were also distributed in Venezuela, with the majority sold through commercial channels. In 1971, the public sector alloted 396,000 OCs and the private sector 775,000; 312 gross of condoms were distributed by the public sector and 90,277 by the private; the public sector was responsible for 3600 12-packs of spermicides and the private distributed 21,000. The number of OC cycles sold doubled since 1966, but distribution was limited. In 1966, there was a potential eligible population of 1.8 million couples, 86% of whom were not using contraception; in 1971, of the potential population of 2.1 million couples, 90.4% were not using contraception, despite the large volume of free samples made available. The intermediate years also represented a decline vs. 1966 figures. Of the 201,245 consumers in 1971, 54% used condoms, 45% used OCs, and less than 1% used spermicides. Information on communication services and delivery systems available in Venezuela is also provided.
This is an analysis of the family planning and contraceptive supply situation in Turkey. A general treatment of the socioeconomic background of the country precedes the discussion. The health delivery system and family planning services programs are described. Legal requirements and regulations regarding contraceptive import, manufacture, advertising, export, and distribution are described. Companies, contraceptive cycles, and pricing costs involved are tabulated. Private and commercial sector distribution of contraceptives supplement the governmentally-sponsored program. Commercial market potential is assessed. All data are tabulated. During 1971, only 7% of the potential couples were practicing contraception--IUD, pills, condoms, spermicides in that order. The private sector accounted for most of this distribution. Among clinic patrons, the IUD is most favored among the general population, the condom and withdrawal are favorites.
The WCP (Westinghouse Population Center), under contract to the USAID, surveyed contraceptive distribution patterns in 8 selected developing countries including Venezuela, Panama, Jamaica, Iran, Turkey, Korea, Philippines, and Thailand. A summary of contraceptive supplies was covered for all countries as well as information on social and economic background; family planning programs; the commercial market including legalities, imports/exports, distribution, price, and market; and the potential of the commercial market including the attitudes of the importer/distributors, and the consumer. In addition, further study was done in Venezuela, Panama, Philippines, and Thailand on media advertising and estimates of radio-TV penetration. Surveys were also extended in Iran and the Philippines to cover pharmacies, street vendors, and organizations with clinics reporting family planning acceptors.
The WPC (Westinghouse Population Center), under contract to the USAID, is surveying Jamaica, Panama, Venezuela, Philippines, Thailand, South Korea, Iran, and Turkey to identify and evaluate the contraceptive market, contraceptive distribution, and the potential for increasing the contraceptive market. The study will: 1) present data on importation, production, manufacturing, distribution, sales, and use; 2) provide cross-country/cross-regional data analysis for market limitations and potential; 3) recommend plans for future market development; and 4) recommend formal marketing programs for at least 2 countries. Background reports on each country's population dynamics were prepared and submitted to USAID and personal interviews were used to collect relevant data. Jamaica was used as a host country for conducting a retail outlet and consumer use survey. Information was collected by interviewing importers, distributors, and wholesalers of contraceptives as well as companies distributing mass consumer items to determine the cost of using alternate distribution systems. Advertising firms were also interviewed to assess available media coverage and possible commercial advertising programs.
Effects of cigarette smoking: females.
The Canadian Dept. of National Health and Welfare conducted an epidemiological study into the long-term effects of cigarette smoking on women. 10,416 nonsmokers and 3810 smokers were included in the study. During the study period, July 1956 to June 1962, the overall mortality ratio for cigarette smokers to nonsmokers was 1.17. The mortality ratio for those women who had stopped smoking, most due to ill health or doctors' orders, was nearly as high as that of current smokers. Overall mortality ratios increased with smoking intensity. Smoking duration of less than 10 years did not affect mortality; duration above 10 years was significantly associated with elevated mortality ratios. Cigarette smoking was particularly associated with mortality from cardiac or circulatory diseases.
The references cited in this bibliography cover the mandates of the United Nations and its specialized agencies in the field of human reproduction, population dynamics and family planning, and other related documents as well as World Health Organization publications dealing with family planning and related subjects.
The physician and population change: a strategy for action.
In a world of rapid population growth and its grave socioeconomic consequences, the physician has important roles to play in effo ts to influence population change. This "Strategy for Action" outlines how the physician can most effectively contribute to resolving the problems associated with population change in his own time and place, as is his profession's right and responsibility. The physician's role in fertility regulating services is one of making these available to all who want or need them, and as a practitioner and family counselor he can provide to all advice concerning the means of regulating fertility. As a teacher and educator, it is the physician's responsibility to be concerned with health aspects of population change, human reproduction and sexuality, development of community health and fertility regulating programs, and education of medical students. The physician as a research scientist can make important contributions to improving health, reducing morbidity and mortality, and regulating fertility. Finally, as a leader, the physician's role may be viewed in 3 broad categories: 1) opportunities in community leadership; 2) leadership in the health team; and 3) leadership in organized health services and agencies.
Estimation of Thailand's contraceptive market potential in the light of the country's socioeconomic background; family planning efforts; commercial market for contraceptives and attitudes of manufacturers and consumers indicate that government regulations regarding Thai import, trade and pharmaceutical activities are generally not very restrictive compared with those of other developing countries. Problems encountered by pill manufacturers are the low retail prices of pills (the Schering Company plans to increase retail prices through local production of the pills) and the possibility of a massive free contraceptive distribution through government family planning programs. Overall, trade prospects for the pills are seen by all concerned as bleak. In the private sector, no major cultural factors are expected to hamper contraceptive sales. There is in fact a high level of interest and motivation among Thai women to practice contraception due to family tradition and their participation in the labor force (in 1966, it was estimated that 42% of the female population was actively employed). Problems in marketing the condom include the "illicit sex" image associated with its use and the widespread belief regarding the inferiority of local products to improted products. Empirical evidence indicate tht Thailand's potential market for condoms consist of about 1,500,000 males and a corresponding annual market of 180 million condoms, or 10 times that of the current market. However, in the light of the limited purchasing power of the Thais and a free government family planning program, more realistic estimtes would be an annual sales potential of 86 million pieces, or a 400% increase over the current market.
The meeting of Experts Between Family Planning Administrators and Commercial Marketing Executives has established that the application of commercial resources can be relevant and pertinent to the specific needs and constraints of family planning programs. Discussions were concerned mainly with the marketing of contraceptives, while the marketing of the idea of family planning, or social marketing, was regarded as a possible approach within the curriculum of the Information/Education/Communication (I/E/C) division component of the total family planning program. An attempt was made to identify some of the basic existing constraints, country experiences, and innovations in a hypothetical operation of marketing contraceptives by family planning administrators, focusing particularly on the distribution system and production promotion. The pill and condom are cases used to illustrate the extreme contrast of these countraints and proposed solutions, the former representing a list of drug-oriented contraceptives, and the latter representing a list of nondrug-oriented contraceptives. The consensus was that social marketing techniques could be effectively injected into the I/E/C program, making it extensively commercial and nonclinic-based. Discussions also revealed the potentiality of utilizing commercial resources to accelerate the pace of existing family planning programs. Specific country requests are considered for Singapore, Thailand, Indonesia, Nepal, Malaysia, the Republic of Vietnam, Laos, and Indonesia.
Technology in retrospect and critical events in science Vol. 2.
The project purpose was to involve the retrospective tracing of key events which led to several major technological innovations in the hope that such tracing would offer the basis for better insight into the process and the need for its various components -- nonmission research, mission-oriented research, and development. In the fall of 1967 the Naitonal Science Foundation initiated a contract with the IIT Research Institute for a systematic study of the contributions of various types of research and development activity to innovations of economic and social importance. The analysis, findings, and summaries of the 5 innovations studied -- magnetic ferrites, video tape recorder, the oral contraceptive (OC) pill, the electron microscope, and matrix isolation -- were presented in the 1st volume of this report. This 2nd volume consists of working papers for the 5 retrospective case studies of innovations. Focus in the case study concerning the OC is on the history of its development, endocrine control of ovulation in human species, and some social and economic implications of OCs. The direct economic effects of OCs are evident. The most obvious effect is the growth of a $100 million business within the ethical drug industry in a decade. The less evident effects are the possible indirect economic effects of OCs on such concerns as decreased family size, increased disposable family incomes, decreased public welfare costs, and more productive animal husbandry. OCs are pertinent to some of the leading social concerns of these times.
Demographic techniques for manpower planning in developing countries.
The purpose of this handbook on demographic techniques for manpower planning in developing countries is to explain some of the major demographic techniques with particular attention to their application to the developing countries. The handbook is devised primarily for field analysts with limited mathematical and statistical background. Alternative methods of estimating and projecting population and the labor force in totals and by major demographic characteristics is provided. The choice of method among the provided alternatives should be determined after due consideraiton is given to the following: 1) the availability and reliability of the basic data used in the different methods; 2) the time involved in undertaking the different computations; 3) the mathematical and statistical skill of the investigator; and 4) the level of reliability prescribed by the purpose of the estimate. The handbooks 5 parts deal with the following: 1) estimating and projecting total population (estimating total population by empirical methods, between 2 given dates by interpolation, and for sub-national regions, and projecting total population to future dates by extrapolation); 2) estimating and projecting components of population change (components of population change, measuring the growth components of population change between 2 censuses, use of the component method for population projection, short-cut method for projecting population by age and sex, estimating and projecting the number of persons reaching a given age annually, and methods for developing or adjusting basic data); 3) estimating and projecting the labor force from population data; 4) a case study - the Fiji Islands; and 5) a bibliogrpahy on selected topics.
From September 19-23, 1960 the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel met in Geneva to discuss the training and utilization of auxiliary personnel in medicine, nursing, midwifery and sanitation. For the purpose of the record and to avoid misunderstanding, the following definitions were adopted: 1) a professional worker is a health worker trained to the generally accepted level for that discipline in a particular country; and 2) an auxiliary worker is a technical worker in a particular field with less than full professional qualifications. The Committee focused on the need for auxiliaries in relation to public health programs, the use of auxiliaries, the training of auxiliaries, the training of teachers of auxiliaries, orientation of professional groups in the use of auxiliaries, supervision and follow-up of auxiliaries at work after training, and international cooperation. The Committee determined that of particular importance is assistance provided directly in the form of: 1) substantial information as to the ways in which auxiliary training is organized to meet the varying situations in different countries; 2) advice and assistance in establishing training institutions; 3) assignment of teachers; and 4) provision of fellowships for the strengthening of teaching schools and services.
Participants representing all 9 Inter-Governmental Coordinating Committee (IGCC) countries (Indonesia, Khmer Republic, Laos, Malaysia, Nepal, Philippines, Singapore, Thailand, and the Republic of Vietnam) attended the expert meeting of family planning administrators and commercial marketing executives held in Malaysia during September 1974. The meeting consisted of an opening ceremony session, 3 plenary sessions, 2 multinational group sessions, and 2 national group sessions. 15 background papers are included; they served as reference documents for discussion. The discussions of the following topics are summarized: marketing and product promotiof, constraints existing within family planning programs, and application of commercial resources to family planning programs. The discussions revealed the potentiality of using commercial resources to accelerate the pace of existing family planning programs. To facilitate effective follow-ups within the IGCC region, the proceedings proposed the establishment of a "regional corps of commercial sector experts" by the IGCC Secretariat. This type of scheme could be made up of leading commercial experts in the region who could organize a regional capacity for assistance. The success of this proposition would depend on the following: 1) a good working relationship between the family planning administrators and the corp of experts; 2) the availability of funds from the annual budgets of family planning programs allocated for such services; 3) the cost or rates imposed by the corps of experts for their services; 4) the possibility of outside funding by donor agencies; and 5) the ability of the corps of experts to design programs (related to specific country requests) pertinent to the existing needs and constraints faced by the family planning administrators.
Neuroendocrinology and reproduction in the human.
This WHO technical report focuses on the 1) psychosomatic factors in human reproduction; 2) hypothalamo-hypophyseal system; 3) mechanism of sexual rhythm; 4) nervous influences on the hypothalamus; 5) hormonal influences on the hypothalamus; 6) neuroendocrine aspects of sexual behavior; and 7) effects of drugs on reproduction. After summarizing current research status on the above-mentioned topics, the following research needs are suggested: 1) assays of individual human endogenous gonadotropins, suitable for clinical application; 2) autoradiography, fluorescent-antibody, spectrophometric interference and histochemical and biochemical techniques for studying cells that supply axons to the primary capillary plexus of the hypophyseal portal system and for studying effects of different hormonal status on hypothalmic structure and function; 3) computer techniques for evaluating electrophysiological data; 4) improved lesioning techniques; 5) comparative studies of reproductive activity patterns, exteroceptive factors, neuroendocrine factors in sexual and related social behavior, and long-term or delayed effects of drugs administered during gestation on subsequent sexual development; 6) studies of synaptic connections of hypothalamic neurones; 7) studies of endogenous gonadal and gonadotropin production in prepuberal animals; 8) functional significance of regional distribution of hypophyseal portal system; 9) mechanisms involved in selective uptake of labeled hormones; 10) hypothalamic lesions in species with spontaneous ovulation and active luteal function; 11) direct effect of gonadal hormones on single hypothalamic neurones studied with combination of microinjection and unit recording devices; 12) studies of the possibility of a direct feedback of gonadotropic hormones on the hypothalamus; 13) studies of the receptor mechanisms involved in neuroendocrine reflexes; 14) wider exploration of brain structures, with regard to feedback action of gonadal hormones; 15) studies of pineal function; 16) further investigation of a possible role of the peripheral autonomic pathways in reproductive processes; and 17) research on the application of tissue culture techniques for studying problems of the origin and metabolic effects of neurohormonal mediators and the biochemcial and morphological changes induced by sex hormones.
Reproductive function in the human male.
After summarizing current WHO research directed at the control of male fertility focusing on 1) gametogenesis and ultrastructure of the testis; 2) cytogenetic aspects; 3) hormonal regulation; 4) epididymal function (the maturation and preservation of spermatozoa); 5) vas deferens; and 6) semen analysis; recommendations for further research in the area are made. Studies are required on the following aspects of reproductive function in the male: 1) structural and cytochemical organization of the various classes of germ cells in humans and nonhuman primates; 2) interstitial tissues and the components of the blood-testis barrier and their role in the regulation of gametogenic function of the testis; 3) structural and functional state of the testis during growth and development, during aging, and in most histopathological conditions leading to partial or complete sterility; 4) the role of meiotic chromosome aberration in degeneration of germ cells; 5) role of abnormal chromosomes as an etiological factor in male infertility; 6) binding and metabolism of androgens and their effects on the seminiferous tubule; 7) role of gonadotropins, particularly follicle stimulating hormone (FSH), in regulation of spermatogenesis; 8) identification of tubular factors involved in regulation of FSH secretion; 9) elucidation of epididymal function in a number of species; 10) characteristics of sperm surface; 11) nature of epididymal plasma and the factors that control it; 12) anatomy, physiology, and functional role of human vas deferens, with emphasis on blood supply; 13) effect of vasectomy on male reproductive function and possible immunological sequelae of this operation; 14) relationship between fertility and such characteristics of sperm as number, motility, and morphology; 15) biochemical characteristics of the nucleus, acrosome, and midpiece of sperm, and their relationship to sperm motility and fertility; 16) chemical nature of substances secreted specifically in different accessory sex organs; 17) the possible relationship between autoimmune phenomenoa and testicular disease; and 18) immunological sequelae of vasectomy. In addition, studies on the cryobiology of human and animal sperm are expected to yield information on the biology of sperm.
Stilbestrol and adenocarcinoma of the vagina.
The Australian Drug Association Committee wants to draw attention to the reported association between exposure to stilbestrol in utero and the development of adenocarcinoma of the vagina in adolescence and young adult life. A controlled retrospective study revealed a highly significant correlation between the treatment of mothers with diethylstilbestrol during pregnancy and the subsequent development of adenocarcinoma of the vagina in their daughters. Other factors of significance were maternal bleeding during the pregnancy under study and prior unsuccessful pregnancy, which may reflect the characteristics of the patients selected for estrogen therapy. All 13 patients were born between 1946 and 1953, when estrogens were being widely used in America and elsewhere for the treatment of repeated or threatened abortion. As far as can be ascertained, stilbestrol has not been used to any extent in Australia for the management of threatened abortion but was recommended in diabetic pregnancies in the late 1940s. Exposure to residuals in meat is another issue. Abnormal vaginal bleeding in young girls should be investigated fully; a functional disorder cannot be assumed even if the vaginal cytology is normal. Stilbestrol should also be avoided as a postcoital contraceptive.
A training program for supervisory workers in local family planning programs.
A training program is presented for administrative and supervisory family planning personnel in private and government agencies with the following 3 objectives: 1) to present technical, programmatic, and sociocultural knowledge concerning family planning (including contraceptive methods; means for establishing the unmet need for family planning services; organization and structure of family planning clinics; and aspects of the community which motivate and constrain people from using family planning services); 2) instruction of supervisory personnel in methods of ascertaining the particular socioecultural factors that may operate in their communities; and 3) to acquaint supervisors with methods of selecting, training, and using nonprofessional aides in local family planning programs. The training program is presented in 4 main parts. The 1st section concentrates on the need for family planning as seen from the family or individual point of view, and covers the health, financial, and family consequences of unwanted conceptions. The 2nd section is concerned with the family planning service delivery system and touches on nonprofessional aides; the patient referral system; clinic organization; and methods of contraception. The 3rd section covers program planning and evaluation and considers population and social statistics; methods of estimating unmet needs for family planning services; record-keeping; and program evaluation methods. The 4th section consists of a 4-week training schedule together with recommended teaching techniques. The emphasis is not on lectures, but on role-playing; statistical projects; field visits; and discussion. The objective is for trainees to learn by discovery and doing a teaching method effective in past family planning programs.
Announcing an oral contraceptive...(Ovrette). (Advertisement)
The marketing of a nonestrogenic oral contraceptive, Ovrette (norgestrel) is announced. Ovrette is slightly less effective that oral contraceptives containing both estrogen and progestogen. 1950 patients taking Ovrette for 20,833 months of therapy reported 37 pregnancies for a pregnancy rate of 1.1/100 woman-years and a use-effectiveness rate of 2.3/100 woman-years. The dropout rate is, however, much higher than for combination products. Bleeding patterns can be irregular with this product. In 68.2% bleeding intervals were between 21-45 days. In 25.9% they were less than 21 days and in 5.9% there were greater than 45 days. Ovrette is administered continuously rather than cyclically. Prescribing information is also included. Because Ovrette differs markedly from estrogen/progestogen oral contraceptives, attention is directed to the sections "Important Note," "Contraindications," "Warnings," "Precautions," "Adverse Reactions," and "Dosage and Administration."
The question of the recognition of conscientious objection to abortion was discussed at the meeting on January 15, 1974, of the Joint Consultants Committee. At a previous meeting the question had been raised and the following recommendations were made by a special working party: 1) the 4th Schedule of the National Health Service shall be amended to provide that no question is asked of a candidate about his beliefs in relation to the undertaking of abortion; 2) it shall be determined before advertising a consultant post in an obstetric and gynecological unit whether it is essential that the candidate undertake abortions; 3) an appropriate description shall be included in job description; 4) no reference shall be included in the advertisement for the post; and 5) generally, any question as to a candidate's religious or personal beliefs is irrelevant. The recommendations were adopted by the committee.
A review of the literature concerning the clinical distinctions among progestagens, their contraceptive effects, and use in other indications is presented. The current status of progestational agents is discussed. Areas of special interest include: 1) the clinical assessment of potency of progestagens; and 2) the clinical use of progestagens (oral contraceptives, injectables and implants, the "precoital" or "weekend" pill, control of abnormal uterine bleeding ,luteal deficiency, and abortion, and progestagen treatment of carcinoma and endometriosis. An annotated bibliography of 100 articles about pregstagens is included. The bibliography is divided into topic sections: 1) progestagens and their effects; 2) survey of combination oral contraceptives; 3) new contraceptive methods, including "microdose" and injectable therapy; 4) progestagen therapy in other indications; 5) side actions during therapy; 6) reversibility of contraception; and 7) social factors in contraception. Indexes are by subject and author.
The Kathmandu Seminar on abortion, initiated by Nepal, was attended by representatives from India, Indonesia, Iran, Israel, Republic of Korea, Malaysia, Philippines, Singapore, and Thailand, each of which made a country report. Representatives from Switzerland, the U.S., the UN, WHO, and Canada also participated. The liberalization of abortion laws were being discussed in Nepal as part of the King's interest in family planning. The purpose of the seminar was to review the status of induced abortion and related research in the region, consider advances in psychosocial research, and develop plans for future research. The work sessions were organized around 2 major themes: 1) studies of opinions of leaders regarding abortion, and 2) studies of individual choicebehavior in seeking abortion. A model of the decision making process was conceptualized on the basis of 4 variables: 1) environmental level (age, education, working conditions); 2) perception of choices; 3) marital stability; 4) communication process.
The agenda for the seminar included the following primary considerations: 1) the status of women as a factor influencing fertility; 2) implications for the status of women of current trends in population growth; 3) the importance of family planning for women as individuals and its impact on their roles in society; 4) programs and services relating to family planning; and 5) conclusions and recommendations concerning the relationship of the status of women and family planning and future action required as a matter of priority at the national, regional, and international levels. It was concluded that the exercise of the right of women to decide freely and responsibly on the number and spacing of children is closely related to the extent to which they are integrated into the social, economic, cultural and political life of the societies in which they live. Recommendations emphasized the following: 1) endorsement of family planning as a basic human right; 2) the concept of family planning as enhancing the enjoyment of human rights and improvement of living conditions; 3) inclusion of information and education programs as an integral part of family planning programs at all levels of society; 4) the need for further research on the interrelationship of the status of women, population factors, and total development; 5) concern about the health risks of improperly performed abortions; 6) inclusion of women in agencies concerned with health and family planning; 7) family planning as an important means of promoting the advancement of women; 8) coordination of a program of action for the advancement of women by the UN and national governments; 9) review of legislation affecting the status of women and fmaily planning; 10) training programs for rural women; 11) studies on the status of women in education and employment; and 12) publicizing the work of the UN Commission on the Status of Women.
Community sex education project: report on the experimental period ending 30 November 1974.
The goal of the Grapevine community sex education project was the creation of a model which could be adapted to other areas of the United Kingdom; this report describes and evaluates progress to date in meeting the sex information needs of young people. A prime objective of the project was to develop an experimental action research project to discover ways to make sex and health education available to those youth who do not seek information from traditional sources. Additional objectives included identifying, testing, and coordinating ways of involving young people in the work, and reporting on results with recommendations for future adaptations. Methods used in the project were continuous recruitment of young volunteers to serve as peer counselors, visits by these volunteers to contact places, involvement of volunteers in decision-making, liaison by Grapevine professional workers with other agencies, telephone information service, continuous monitoring of results with relevant modification of procedures, and promotion of Grapevine ideas in the mass media. Conclusions concern satisfaction with the volunteers, effectiveness of personal contact with target groups, indications for future research, comparison with other groups, extension to other regions, and recommendations for expansion and funding.
In 1971, 4 million oral contraceptive (OC) cycles were distributed in both the public and private sectors of the Korean market, one of the biggest contraceptive markets among the developing nations. Analyses of contraceptive market potential in the light of the country's socioeconomic background; family planning efforts; legal requirements and regulations; manufacturing and trading aspects of contraceptives; and, distribution and marketing systems suggest that generally, pill manufacturers support the Korean government's effort to control population growth. They conceded that people, especially those from rural areas, have to be enlightened on the benefits of contraception. Significant problems encountered by pill manufacturers are the high cost of the pills (Korea has a generally low standard of living) and the controversial side effects of the pill. Dong Kuk, a condom manufacturer, is aware of a potential market for condoms; to increase sales, it recommends setting up of vending machines in restaurants and other public places and having raw materials for condom production exempt from duties to lower prices of condoms. An estimate of potential consumers for contraceptives in the light of the population's familiarity with contraceptives and of increases in the young female population shows that there is a big market for contraceptives. In 1970, the 10-19 age group of young Korean females was 50.5% or 3,671,000 more than the 20-29 age group. A 1966 KAP survey indicated that 88% of the population from both urban and rural areas said they were aware of family planning, with 72% stating they knew at least 1 method. Of these, 60% mentioned the IUD; 56% the condoms; 40% the foams and vasectomy; 18% the pills, and 13% the jel lies and rhythm methods.
In 1970, there were about 300,000 women between 15-44 years of age in Panama. Only 12% of these were estimted to be contraceptive consumers. 80% purchased oral contraceptives, 8.9% condoms, 7.6% spermicides, and 3.3% injections. The private sector accounted for 81.8% of the sales, with the public sector and various agencies accounting for the remainder. Estimation of contraceptive market potential in Panama is difficult due to lack of inventory record control systems among many Panamanian importers, coupled with personnel turnover. Analysis of Panama's socioeconomic background, family planning efforts, contraceptive market and attitudes of importers/distributors and consumers indicate that most distributors have a positive attitude towards family planning programs, more as a concern for population growth rather than for business profits. Importers feel that high prices and lack of access to information impede market expansion, particularly in the rural areas. Government distribution of free products is seen by many as unfair competition, though some believe that government distribution helps tap remote market areas not easily accessible to commercial distributors. Condoms are not very popular as a family planning method because of their association with disease prevention and illicit sex. A 1965 KAP study in Panama City suggest that education is not a critical factor in achieving ideal family size, which ranged between 3.37 and 3.65 children. The data also suggest that contraceptives are not being used effectively, and that religion does not affect birthrates.
Provera-Provest bibliography, 1964.
This is a series of bibliographies on the literature dealing with Provera injectable and Provest oral contraceptives. The series, put out by Upjohn Technical Library, was started in September 1964 and continues through March 1973 with periodic updates. The bibliography lists the items in alphabetical order by author, arranged in the order of publication date. Worldwide journals are included, but all titles are listed in English. There is no annotation. A computer printout lists each of the bibliographic items arranged alphabetically by title.
Summary on nutrition and fertility.
Malnutrition and uncontrolled fertility are closely interrelated, fo r unless fertility can be modified there is little that can be done to i mprove nutrition for the marginal family. When pregnancy occurs within a state of chronic malnutrition, pregnancy wastage and child losses are high and lactation periods and birth intervals thereby shortened. Nutritional programs tend to have more of an impact on marginal families than do fertility control programs, and as nutrition improves so will infant survivorship and length of birth interval, which eventually will produce a state in which family planning will seem reasonable and acceptable. Nutrition and fertility, however, constitute only a part of a complex problem albeit an important part. Policy development should focus on: 1) the sharp decrease in breast-feeding, 2) increases in adolescent and postadolescent pregnancy with all its attendant risks, 3) integrating fertility control and nutrition programs, and 4) problems associated with rapid urbanization. In program development, the multipurpose survey approach should be stressed, more use should be made of less highly trained auxiliary personnel, an intermediate supervisory echelon between the administrative and fieldworker levels should be developed, and evaluations should be carefully done and considered. Research needs include: comparative studies between birth intervals and pregnancy wastage, child loss and growth, and physical and mental develo pment under defined conditions of nutritional and socioeconomic status; studies of the effects of different degrees of nutritional deprivation on ovulation; side effects from the use of steroids and other contraceptives among nutritionally deprived populations; and study of cultural, economic, and demographic factors that impinge on nutritional status and fertility rates.
The situation of developing countries with respect to the theory of demographic transition is a complex one. Many have already arrived at the 2nd phase, or that of a large absolute population, and are under pressure to minimize the interval before arriving at improved socioeconomic standards and slowed population growth, and to bolster available resources during the interim by expanding education, promoting and improving health and nutrition, and reducing fertility. Any society should enable an individual to have the options of a wholesome diet and controlled fertility; at issue is whether the 2 options can be made more accessible and attractive by an integrated approach. The consensus of workshop participants was that joint action is logical and could well re sult in increased operating efficiency and program effectiveness. When integrated action is not feasible each of the 2 goals should be pursued as rapidly as possible. It must be recognized however, that in certain situations the immediate effect of nutrition programs will be to increase reproductive performance.
The results of implementing the directives of Chairman Mao and the Party's Central Committee on family planning in Communist China are discussed. The Communist revolution involves radical rupture with traditional ideas, and promoting late marriages and birth control helps erase outmoded concepts about marriage annd childbirth. In 1974 there were 2300 meetings to discuss political theory, over 1600 meetings to repudiate old ideology, and 300 meetings to "recall past suffering and consider today's happiness." The major topics discussed were: 1) the old concept that men are superior to women and the new ideology that men and women are equal, 2) the archaic Confucian-Mencian teaching that many sons mean much happiness, and 3) the reactionary theory of "heavenly mandate." The County Party Committee took the lead in linking birth control with the movement "In agriculture, learn from Tachai." Women were freed from burdens of child care to participate in agricultural production. Barefoot doctors have been organized to study Chairman Mao's directive on the question of theory. Mobile teams sent to the countryside by health and medical units perform sterilization operations. 85% of the barefoot doctors can place and remove contraceptive rings, and 15% can perform ligation surgery. Each brigade has a cooperative medical service and 3 or more barefoot doctors. Secretaries of the Party organization at the county attend to family planning personally. Several discussions are held yearly on solving the problems in family planning. Several organizations include family planning in their work. Trade departments supply contraceptives, and stores and supply-coooeratives send them to homes. The state provides them free of charge.
Clinical considerations (of nutrition and fertility).
It is necessary in even a simple analysis of the relationships between nutrition and fertility to consider both the effects of nutrition on fertility and the effects of fertility on nutrition. Consideration of fertility as related to the woman can be divided into the following components: 1) number of pregnancies and births experienced; 2) age at each pregnancy and birth; 3) duration of the intervals between conceptions; 4) lactation; and 5) health/nutrition services available to meet the needs of pregnancy, delivery, and postpartum care. Nutritional considerations involve the mother and the child, for both are immediately affected by the mother's fertility behaviors. These considerations are 1) dietary intake, 2) incidence of disease, 3) duration of breast-feeding of each infant and the frequency of lactation periods, 4) family size and pregnancy intervals, and 5) health/nutrition services. In all nations it is important to give special attention to the nutritional status of adolescent girls, and effective ways of delaying the age of 1st pregnancy need to be devised. As advanced age and pregnancy are considered hazardous, there is no question that the health and nutrition of mothers in less developed countries and at the upper end of the childbearing years or of parity order need special protection as long as complete avoidance of pregnancy is not assured. Infant mortality shortens lactation, vitiates cultural pressures for abstinence, and places women in a continuous state of reproductive effort. In this situation, the concept of protecting the pregnancy-free interval tends to disappear. Certain physiologic elements of this situation as well as their nutritional implications will be considered in more detail at a later time.
Sequential birth control pills discontinued.
All 3 U.S. companies manugacturing sequential birth control pills have voluntarily taken their products off the market because: they are somewhat less effective than combination pills, they are associated with higher risk of blood clotting, and they seem to have higher potential for risk of cancer of the uterus. Products withdrawn are: Oracon, made by Mead-Johnson and Company; Ortho-Novum SQ, Ortho Pharmaceuticals; and Norquens, Syntex Laboratories. Existing stock was not recalled because only a 2-month supply was on the market. 5-10% of the 10 million U.S. women taking oral contraceptives are taking sequentials.
Implications for future action.
As part of this committee's actions, the following recommendations were made concerning policy development: 1) a world program to sponsor education on human lactation and to provide nutritional and social support that will enable more women to successfully breast-feed their babies should be established; 2) policies should be supported that promote better nutrition among preadolescent and adolescent females, aim to postpone the age of marriage and of 1st pregnancy, and identify pregnancies among very young women and offer special health supervision to them; 3) policies should be devised to promote intervention programs that offer integrated or parallel services of nutrition promotion and fertility modification; and 4) more attention needs to be given to the implication of rapid urbanization in less developed countries with emphasis on special types of programs for nutrition promotion, fertility modification, and other social services among recent migrants to the cities. After appropriate policies are established, they need to be implemented through program development. Most programs should have immediate objectives, and integrated nutrition/ fertility programs should be started where there are not yet programs of either kind. Additionally, emphasis, particularly in rural areas, should be placed on the critical life points for protection of nutrition and human reproduction. Additional recommencations are made concerning information needs, surveys, administration, personnel development, and training, evaluation, research needs.
Implications for program intervention.
When findings and trends are simulated in different hypothetical communities, the need for a combined approach to achieve the objectives of improved nutrition and modified fertility become clear. These relationships in 4 types of communities are presented in table form. Community 0 is a deprived population. Mothers are on inadequate diets and their fertility is uncontrolled. Since maternal nutrition is poor, these mothers will be more vulnerable to unfavorable pregnancy outcomes and interrupted pregnancies. These mothers will experience high infant losses that shorten the interbirth interval and, eventually, higher parity will result. The combined cyclic interactions adversely affection pregnancy wastage, maternal nutrition, chances of infant survival, child growth and development, and maternal longevity will continue. In Community A, diets have been modified. As a result, maternal nutritional status should improve somewhat, and pregnancy out comes should be more favorable. However, if fertility is not controlled, mothers for parts of their childbearing years remain in risk categories that aggravate pregnancy wastage and infant loss. A secondary result would be birth intervals that were shorter than desired, high overall parity, and possibly reduced maternal longevity. In Community B, fertility modification has been introduced, but if only the fertility factor is controlled, maternal nutrition and its sequelae would not be corrected and pregnancy wastage would remain high. Community AB has an effective combined diet and fertility modification program, and it is only with this approach that these interrelated cyclic phenomena are broken and positive results can be achieved in all the categories listed.
Suggested opportunities for program integration.
It appears that program integration is most promising at points where activities tend to either overlap or interact. There are 7 components to program integration--hospital, clinic services, distribution of commodities, education, surveys, program evaluation, and strategies of evaluation. Hospital clinical services may include initiation of family planning services postpartum, provision of an effective method of contraception immediately following an abortion, contraceptive advice and treatment given when a woman is in treatment for a nutritional or another health problem, and family planning assistance provided at the time children are brought in for pediatric care. Regarding the clinical services of health centers and clinics, it needs to be recognized that a woman should be provided with both nutritional and contraceptive assistance. In fact, the nutrition program could probably play an increased role than it now does in selection of contraceptive methods and amelioration of secondary symptoms. In that the customary daily distribution of supplemental foods usually does not coincide with the distribution of contraceptives which is done once during a 3-month period, an easy merging of these 2 programs does not appear possible. However, as the procedures for setting up a distribution program vary little, distribution should be regarded as an ancillary rather than a main issue when integration between nutrition and family planning services is under consideration. When information on nutrition and fertility relationships is disseminated in order to inform and to increase general awareness and interest, it needs to be remembered that all information should be presented in a simplified and understandable form. As the procedures for both nutritional and fertility surveys are similar, it is not difficult to envision a single survey that serves to meet both ends. As long as it is 1st known how to evaluate each component separately, it appears possible to approach evaluation in such a way as to evaluate nutrition promotion and fertility modification programs either separately or together.
Program considerations (of nutrition and fertility).
Integrated family planning and nutrition programs are intrinsically valuable and often persuasive in the political struggle for funding and in the competition for limited resources. Family planning programs are frequently more likely to be found acceptable if they indicate concern for the health and well being of mothers and children rather than focusing totally on limiting family size. However, there are certain aspects of family planning and nutrition that do not fit easily together and, consequently, cannot be integrated, such as development of new crop varieties or new contraceptive methods. There may also be situations where integrated services are not the most effective approach, where disadvantages outweigh programmatic convenience and economy. Sometimes problems arise from the way things are done, especially by distortion of objectives. An additional problem may develop when services of a substantially different type are ''piggybacked'' onto a successful program. For example, it has been common to add family planning services to successful malaria control programs, thinking that a successful program could release staff to work on other duties. Similarly, incentives should not favor 1 type of activity over another. Even where activities are closely related in almost every way, experience has shown that a broader scope of duties means a greater volume of work. Although integration of nutrition and family planning programs provides many theoretical advantages that can become realities with sound planning and administration, integration is not always desirable. Inappropriate combinations and unacceptable exploitation of program resources can do more harm than good.
Intravaginal collagen sponge contraceptive device: status, December, 1976.
A new device for female contraception invented by Milos Chvapil has progressed to Phase 3 (use-effectiveness) testing under Dr. Wayne Heine at the University of Arizona Medical Center in Tucson. A mechanical barrier of collagen sponge, it is inserted by the user and may remain in the vagina for up to 28 days without irritation, discomfort, or infection developing. The rounded disk has the ability to absorb and retain over 40 times its weight in fluid, resulting in the rapid immobilization of sperm upon ejaculation. The device is removed 8-24 hours postcoitally, washed with warm water and reinserted, as 30% of sexually active women report an objectionable odor after 3-4 days of continuous wearing. No adverse effects or reactions were reported in 700 woman-days of use. At the 1st day of menstruaiton, it is removed and disposed of in any sewage system where it will biodegrade. Testing in 30 women, using the Sims-Huhner methods, showed that it prevents sufficient sperm for fertilization from reaching the uterus. Additional studies are planned using the sponge for the prophylaxis of certain sexually transmitted diseases. Phase 3 testing will have 2000 women participating worldwide to establish the actual use-effectiveness of this device.
Current status of use of contraceptives by type of contraceptives.
A benchmark survey in 3 districts in Korea showed that 46.2 percent of married eligible women in Sanggye-dong, 36.6 percent in Changsung, and 50 percent in Dongduchun practiced contraception. Practice of the loop varied from 22 to 33 percent. Of ever-users 66-72 percent have discontinued and only 2-8 percent of respondents who had heard about it but never used it, wish to use it. Between 26-33 percent have used condoms with 52-69 percent discontinuing. Only 1.2-1.9 percent of respondents who had never used them selected them as a preferred contraceptive. As age increased, percentage using condoms increased. 40-49 percent had used oral pills and 70-76 percent had discontinued. Respondents who had heard about them but not tried them and would like to use them ranged from 1.5-11.5 percent with Sanggye-dong having the highest percentage wanting to try them. The proportion of young women who had used oral pills was highest in Changsung and Dongduchun. In all 3 areas more educated women were more likely to use the pills. Vasectomy was most popular in Sanggye-dong with 11 percent of husbands vasectomized and 6.2 percent wishing their husbands would be vasectomized. Changsung and Dongduchun both had 2.7 percent who wanted husbands vasectomized but only Dongduch had more than 3 husbands vasectomized. Tubal ligation use ranged from 2.7-2.8 percent in Changsung and Sanggye-dong to 6.9 percent in Dongduchun. 3.8-7.3 percent wanted to use this. Rhythm was used by 11-16 percent with 31-50 percent indicating they would like to use it. Withdrawal was least popular; 10 percent had ever used it and 55-73 percent stopped. Of the 46.8 percent using at least 1 method, 13 percent in Sanggye-dong, 12 percent in Dongduchun, and 28 percent in Changsung are dissatisfied. The relatively high dissatisfaction rate in Changsung needs further exploration.
Ovulation induction by human FSH - the results of the Australian programme.
The Human Pituitary Advisory Committee was formed in 1967 to set up a central collecting and processing system to distribute follicle stimulating hromone (FSH) to patients throughout Asutralia. The FSH Sub-Committee drew up guidelines for the selection and treatment of patients, and initiated use of a computer file which represents complete information of this program over 5 years of national use. 202 pregnancies occurred in 390 treatment series of 179 women. The incidence of pregnancy was lower in women who had previous abortions, hirsutism, and galactorrhea. Single pregnancies resulted in 65.5% of patients and miltiple pregnancies in 18.3% or 21.8% of pregnancies not ending in abortion. Spontaneous abortions occurred in 16.1% of pregnancies. This nationwide project has achieved excellent management of cases due to the voluntary referral of suitable patients to the specialized clinical units in main centers of population, and close collaboration of workers in the different centers.
Thrombosis - perspective on a major side effect of oral contraceptives.
The added risk to oral contraceptive users incurred by major surgical procedures is emphasized. The risk of postoperative thrombosis has been estimated to be 4 times higher if oral contraceptives are used immediately before a major surgical procedure. Women in the premenopausal group, those who smoke, and those who undergo surgery during the winter have been shown to have a higher risk than others. The dose of estrogen in the oral contraceptive is also important. It is advisable to discontinue using oral contraceptives containing estrogen for 6 weeks before elective surgery. A change to occlusive contraceptive methods has been recommended but has not been popular. A temporary change to a progestogen-only pill, such as lynestrenol or norethisterone, is advised although poor cycle control is associated with their use. The patient should be so advised. A review of the literature regarding thrombosis and of the clotting mechanism is included.
Survival of humankind: the Philippine experiment.
Executive summaries of the International Conference on the Survival of Humankind: the Philippine Experiment, held September 6-10, 1976, are given. These summaries concentrate on population control, population distribution, food, health, nutrition, housing and urban development, energy, education, technology, science transfer and utilization, environmental protection, natural disaster prediction and control, and planning management and decision-making. In the field of population control and distribution it was recommended that effective rural outreach and improved continuation rates could be achieved by using personnel recruited from villages and trained in situ. Research was recommended to find ways to increase motivation and bring back dropouts. Already the program administration has been decentralized to bring family planning closer to the people. To improve population distribution, rural development programs must be started which increase economic opportunity in all parts of the country. Population maldistribution is a reflection of maldistribution of opportunity. To improve the food supply it was recommended that emphasis be placed on tropical plants such as mungbeans (mungo) and peanuts, which have a high protein content and can be planted as 2nd crops. Other native plants should be used as cattle fodder and for other purposes. In the past too much reliance has been placed on temperate zone plants whose potential has never been realized in tropical countries. Self-help programs, scientific farming of the sea. use of new technologies to generate energy thermally, and greater attention to disaster prediction (particularly tropical storms) are among the other recommendations.
Family planning and fertility decline in Colombia, 1964-1975.
Colombia has had a successful, functioning family planning campaign since 1965. Since the 1964 census, the country has experienced an unprecedented fertility decline. A committee of family planning directors and researchers was set up at the end of 1975 to evaluate the impact of family planning programs on the fertility rate. All available evidence was analyzed by 2 different computer simulating models. Findings from these 2 models are tabulated. Both find that the family planning program can be attributed with some measure of the fertility decline.
Effects of cigarette-smoking on the fetus and child.
Cigarette-smoking by the mother during pregnancy can affect the fetus, and smoking by either parent in the presence of the child may affect his or her health. If the mother smokes during pregnancy, the birthweight of the infant is reduced an average of about 200 gm. When women in the 32nd to 38th week of uncomplicated pregnancies smoked 2 cigarettes in succession, fetal breathing was diminished. Early studies were about equally divided among those which did and those which did not show increased fetal wastage when the mother smoked during pregnancy. In the last few years, however, the trend had been toward those which did show an effect. In the aggregate, studies of the teratogenic effects of cigarette-smoking in humans have been inconclusive. The subtle manifestations recently described for the fetal alcohol syndrome and the fetal hydantoin syndrome suggest that careful study of neonate whose mothers smoked heavily during pregnancy may reveal previously undetected abnormalities. A Jerusalem study showed that infants of mothers who smoked had significantly more admissions to the hospital for bronchitis or pneumonia during the 1st year of life than did children whose mothers did not smoke. In a study of long-term effects of maternal smoking on physical growth and intellectual development through the 1st 7 years of life, no effect could be demonstrated. Cigarette-smoking is more frequent and begins earlier among children of smokers than among children of non-smokers. The range of indisputable effects of smoking runs from depression of breathing movements during fetal life to cancer, respiratory disorders, and heart disease in later years.
A detailed demographic survey of Jordan (the East Bank) was conducted to determine the implications for health care planning. Many of the statistics are tabulated on a regional basis and show changes through time. Total population was estimated at approximately 2 million in 1976. this rate, if continued, would result in a doubling of the population in 22 years. Due to continuing high fertility, the Jordanian population is young, with 51% under 15 years of age. This implies heavy maternal and child health care demands. With 30% of the total national population concentrated in Amman, health care has also been concentrated in that city causing a shortage of health services in smaller towns and rural areas. The young-age dependency ratio makes large demands on social and economic services as well as on health services. High infant and early childhood mortality rates indicate a strong need for protective and preventive maternal and child health care. The Jordanian pattern of early marriage and prolonged childbearing provides unfavorable conditions for child survival.
Population profile of the United States: 1975.
The 1975 birth rate was 14.9/1000, as in 1974, but the fertility rate fell from 1857 in 1974 to an all-time low of 1800/1000 in 1975, representing a 27% decline since 1970. A 2120 rate is required for net replacement of the population, but the present age structure postpones attainment of zero population growth. The 1975 net civilian immigration rate was 2.3/1000, largely due to the influx of Vietnamese refugees. Ever-married women age 40-44 in 1975 have had an average of 3.3 children and will finish their childbearing years with the highest fertility rates of any cohort since the 1880s, while married women under age 25 are expected to show all-time low rates, intending to have 2.2 children on the average. The dependency ratio (population under 18 and 65 and over/100 population 18-64) dropped from 78.2 in 1970 to 71 in 1975 as the number of children declined. The annual number of divorces passed 1 million in 1975 for the 1st time in history. There is a trend toward marriage postponement, with 60% of men and 40% of women ages 20-24 having never been married. Female-headed households increased by 30% between 1970-1975. About 25% of those 25-34 have completed 4 or more years of college. Metropolitan areas are now growing less rapidly than nonmetropolitan ones, and fewer blacks are leaving the South. Women's labor force participation rate rose from 37.7% in 1960 to 46.3% in 1975. The number unemployed increased 54.3% between 1974 and 1975, with the rate highest for teenagers. Average family income (in constant dollars) declined 4% in 1974. 1974 median income was $13,360 for white families, $7810 for black families, and $9560 for those of Spanish origin. The lowest income category was families headed by a female ($4465/year). Blacks and Spanish-origin persons comprised 11% and 5%, respectively, of the population in 1975.
Labor induction: January 1973 through December 1975 (478 citations).
This National Library of Medicine Literature Search is on the subject of labor induction (limited to humans) and includes citations to premature labor and labor inhibition or onset for the period January 1973 through December 1975. The National Library of Medicine Literature Searches are computer-generated bibliographies produced by the Library's Medical Literature Analysis and Retrieval System (MEDLARS). Each citation is listed along with the major and minor descriptors selected from the National Library of Medicine's list of Medical Subject Headings (MeSH) under which the article was indexed.
Diethylstilbestrol and gynecologic neoplasma: January 1970 through December 1974 (80 citations).
A Literature Search by the NLM (National Library of Medicine) produced selected computer-generated bibliographies on the general subjects of Diethylstilbestrol and gynecologic neoplasms. A short descriptive title with qualifying subtitle or brief introductory paragraph indicating the specific point of view of the literature is prepared. Important subject headings that appear in the literature search include adenocarcinoma, vaginal neoplasms, and mesonephric carcinoma of the vagina and cervix. NLM literature searches are announced monthly in Index Medicus, Monthly Bibliography of Medical Reviews, Journal of the American Medical Association (Book Forum), Drug Research Reports, Journal of American Dental Association, and Public Health Reports. Complete lists of literature search titles may be obtained by writing: Literature Search Program, Reference Section, Reference Services Division, National Library of Medicine, 8600 Rockville Pike, Bethesda, Maryland 20014.
Contraception in males: January 1973 through November 1975. (142 citations))
This National Library of Medicine (NLM) Literature Search on contraception in males is a bibliography of citations of articles on methods of male fertility control in use and under investigation, the condom, and vasectomy. NLM Literature Searches are computer-generated bibliographies produced by the Library's Medical Literature Analysis and Retrieval System (MEDLARS). Each citation is listed together with the major and minor descriptors selected from NLM's list of medical subject headings under which the article was indexed. Descriptors of most significance in an article are identified with an asterisk. The article cited will be found in Index Medicus only under a major descriptor that has been assigned an asterisk. Index Medicus may be searched under major descriptors for additional or related citations.
This National Library of Medicine (NLM) Literature Search on hypertension and smoking related to heart diseases is a bibliography of 261 citations which are listed together with the descriptors selected from NLM's list of medical subject headings under which the article was indexed. Subject headings of major importance in an article are identified with an asterisk, and the article cited will be found in Index Medicus under those headings. Some nonrelevant citations may appear and some relevant ones may be absent, but this is to be expected for machine-generated searches.
Surgistat solid-state electrosurgery. Complete instruction manual.
This complete, but preliminary, instruction manual for the Surgistat line of generators for electrosurgery claims that the generator is appropriate for every procedure except transurethral resections. A section of the manual is a short primer on electricity and electronics for the electrical layman along with a glossary of terms. The remainder of the manual focuses on information applicable to the supervisory personnel rather than surgery personnel.
Model SSE3 solid-state electrosurgery. Complete instruction manual.
This complete, but preliminary, instruction manual for the Model SSE3 electrosurigical generator focuses on the generator's versatility, design features, and reliability. This Manual goes beyond electrical specifications to a more complete description of the equipment's usefulness in new situations and its potential for hazards. Section 1, generator capabilities, is slanted for the surgeon and contains the basic surgical capabilities and limitations of the generator. Section 2 is a short primer on electricity and electronics for the layman, and Section 9 is a glossary of terms. The remainder of the Manual convers technical topics of less concern to the surgeon, but of great concern to the hospital engineer, circulating nurse, or supervisor.
Abstracts of papers presented at the symposium on male fertility and the community held in New South Wales (Sydney, Australia) during July of 1974 are provided. The following are the subject areas: 1) sexual differentiation; 2) semen composition and accessory gland secretion; 3) seminal antigens; 4) spermatozoa - morphology, transport and biochemical relationships; 5) developments in testicular structure and physiology; 6) pubertal development in the male; 7) spermiostatis; 8) vasectomy techniques and demand in Australia; 8) hormonal effects of vasectomy; 9) the relationship between the ability of spermatozoa to penetrate cervical mucus, and the endocrinological profile of the patient; 10) infertility in the male - clinical investigation; 11) treatment of the infertile male; 12) psychological aspects of male infertility; 13) artificial insemination; and 14) sperm auto-antibodies and seminal prostaglandin levels in infertile males.
Reducing fertility through beyond family planning measures.
The objectives of the Inter-Governmental Coordinating Committee (IGCC) Workshop on Reducing Fertility through Beyond Family Planning Measures, held in Malaysia during January 1976, were to assess the "State of Art" and the stimulation of further research and pilot experimentation on the determinants of fmaily planning and beyond family planning measures which may encourage further fertility reductions by promoting the attractiveness of a small family to parents. Focus was upon the relationship of beyond family planning measures to aspects of development and socioeconomic planning which had been identified as areas for potential fertility lowering policies - land development, education and employment, housing, social security and health, taxation and other economic incentives. In addition to the country papers presented for the participating IGCC countries of Nepal, Malaysia, Indonesia, Philippines, Singapore, and Thailand, papers on the following subjects were part of the Workshop proceedings: 1) workshop on reducing fertility through "beyond family planning measures"; 2) some determinants of fertility: implications for public policy; 3) socioeconomic policies to encourage smaller families; 4) human rights aspects of "beyond family planning measures;" 5) land development - a 'beyond family planning' measure; 6) the role of communication in programs that extend beyond family planning; 7) housing; 8) comprehensive approach to a population program in the plantations of southern India; 9) program for the integration of family planning and parasite control; 10) management issues in "beyond family planning" policies; 11) considerations when designing a "beyond family planning" project; and 12) stimulating demand for family planning - a proposal. Among the number of beyond family planning measures discussed by the participants, employment, education, health, and housing seemed to be the most promising areas where incentive and disincentive policies may be instituted in order to ensure reduction in fertility and encourage small family size norm.
17 participants from 6 Inter-Governmental Coordinating Committee (IGCC) member countries (Indonesia, Malaysia, Nepal, Philippines, Singapore, and Thailand) took part in the IGCC Regional Workshop/Seminar on the Financial Management of Population and Family Planning Programs held in the Philippines in March 1976. In addition to the country papers, papers were presented on the following topics: 1) an operational framework for management of family planning programs; 2) planning, programming, budgeting system; 3) planning, programming, and budgeting in brief; 4) acounting and auditing concepts, tools and techniques; 5) accounting and auditing; 6) cost benefit and cost-effectiveness analysis in family planning programs; 7) cost-effectiveness and cost-benefit from the Philippine family planning program; 8) financial resources and management of the International Planned Parenthood Federation; and 9) the innovative role of United Nations Fund for Population Activities within the United Nations system. Gerardo P. Sicat in a keynote address spoke of the need for cost effective analysis and the finance managers' role in such analysis. He urged finance managers of population programs to assist in effectively mobilizing scarce financial resource to promote the success of the population program.
Selected annotated bibliography of population studies in the Netherlands. 1975.
This is a selected bibliography of population studies in the Netherlands. It continues a series started in 1970. Most of the entries were originally in Dutch with the title translated into English. Each entry is annotated in English. Entries are arranged in the following categories: 1) general population studies and theory; 2) regional population studies; 3) spatial distribution; 4) trends in population size; 5) mortality; 6) fertility and natural increase; 7) marriage, divorce, and the family; 8) international migration; 9) internal migration; 10) characteristics; 11) demographic and economic interrelations; 12) demographic and noneconomic interrelations; 13) policies; 14) methods of research and analysis; 15) production of population statistics; 16) professional meetings; 17) bibliographies; 18) new periodicals; and 19) official statistical publications. An author index is included.
A general model of a distribution system.
A basic commercial distribution flowchart is applied to family planning services delivery. Unit 1 produces goods (pills, condoms; device or agent) and sells them to the distributor for a price. Unit 2 is the general marketing department, Units 3 and 4 are the wholesale and retail sections. The price paid by the consumer must pay for all tasks up the line. The price paid is a sensitive item of information and a mechanism of control. If the management unit can help the wholesale unit improve procedures the margin of profit increases. Family planning is usually organized into a national program with direct responsibility over Units 2, 3, and 4. The important difference is that family planning programs tend to be subsidized by the public sector, therefore the price paid for product is not designed to pay for all tasks up the line. The flowback line is absent or weakly represented. Additional responsibility falls on the information unit and its flowback lines.
Library automation: the orient and South Pacific.
The Library Automation, Research and Communications Association (LARC) delegates for the People-to-People mission to the Orient and South Pacific met with counterparts in Japan, Hong Kong, Singapore, Australia, and New Zealand for the common purposes of encouraging the deployment of the world's scientific resources related to library automation developments and establishing communications liasons between LARC and the various national library communities. The report of the meetings include: 1) Japan; 2) Japan Documentation Society: its history and activities; 3) Computer applications in libraries of Japan; 4) The present situation of computer processing at the library attached to Gunma University; 5) The processing system of Japanese bibliographic data of the National Diet Library; 6) The National Diet Library; 7) Library automation serial control system at the University of Tokyo Medical Library; 8) Mechanization of library procedures at the Kyoto Sangyo University; 9) Southeast Asia; 10) Possibilities in employing computer and other information technologies to further library and information services in Southeast Asia; 11) The Chinese University of Hong Kong; 12) Library committee report on computerization of library procedures; 13) University of Hong Kong Library reserved book collection computerization project objectives; 14) Hong Kong Polytechnic Library; 15) Australia; 16) Monash University Library--EDP Section: notes on organization and objectives; 17) Automated systems at the University of Sydney; 18) The IBM circulation system at the University of New South Wales; 19) Automated serial system at the Library of New South Wales; 20) Computer-based cataloging system at the New South Wales Institute of Technology; 21) Library Automated System Information Exchange (LASIE); 22) New Zealand; Data processing activities in New Zealand libraries; and 23) Report on the University of Canterbury acquisitions system.
The doctors role: selected articles on family planning and population by Dr. D. Malcolm Potts.
The role of the medical profession in the task of controlling human fertility is 3-fold: 1) to show leadership; 2) to use the physician's powers of motivation; and 3) to provide specialist skills. The great majority of physicians will never be directly involved in family planning. The role of this group is to recognize the social and health importance of family planning, to recommend contraception, to refer couples for advice, to use their prestige within society to reinforce couples motivation to begin or continue using contraception, to maintain an informed perspective about the social and demographic need for family planning and physiological consequences of systemic contraceptives, and to appreciate the roles of reversible methods, sterilization, and abortion in the overall pattern of family planning. 4 subjects are discussed in detail: medical provision of family welfare planning; coitus interruptus (history, contemporary extent of use, side effects, effectiveness, role in the evaluation of family planning); condoms (evolution and present use, what really is a male method of contraception); and the sociology of population control (ideology and population control, the pressure for population policies, contemporary family planning programs, cultural barriers to birth control services, the People's Republic of China).
The health consequences of smoking: a reference edition.
This reference report contains selected chapters of previous reports to Congress of summations of known health hazards from smoking, i.e., cardiovascular disease, cancer, and respiratory disease. An overview of the 1975 report is followed by chapters on cardiovascular disease; chronic obstructive bronchopulmonary disease; cancer; pregnancy; peptic ulcer disease; involuntary smoking; allergy; tobacco amblyopia; pipes and cigars; exercise performance; and harmful constituents of cigarette smoke. The consensus of scientific evidence is that risk of disease is dose-related and reduction of tars and nicotine intake reduces harmful effects. Nicotine increases heart rate, stroke volume, and blood pressure.
New trends and approaches in the delivery of maternal and child care in health services.
Approximately 125 million infants were born in 1975 and approximately 10-12 million died before their first birthday. The WHO Expert Committee on Maternal and Child Health met in Geneva December 9-15, 1975 to consider new approaches and trends in delivering maternal and child care health services. The Committee decided to redefine health problems and adapt delivery of services in light of social and environmental changes. The effect of careful and informed mothering on the health of the entire family and the relation of family health to community health are important factors in individual, national, and community development. The roles of environmental and socioeconomic factors in mortality, morbidity, and growth and development have been further clarified during the last decade. In countries where data was not previously available, the mmultiple causation of the main health problems of mothers and children has been better documented. The priority health problems are related to the synergistic effects of malnutrition, infection, and unregulated fertility, together with poor socioeconomic conditions and scarcity of health services.
Price list: electrosurgical products.
The 1976 prices are given for the following electrosurgical products: 1) generators; 2) cords (permanent and disposables) and adapters for LectroSwitch; 3) Electrodes (reusables, electrode extensions, and sterile disposables); 4) chuckhandles (expandables, reusables, and sterile disposables); 5) test equipment (electrosurgical analyzer and LectroSwitch tester); 6) forceps (including bipolar forceps); 7) conductive gel; 8) footswitches; 9) patient return electrodes (reusables and disposables); 10) mounting fixtures; and 11) manuals. The manufacturer offers a free presentation on electrosurgical theory and technique for operating room staff which includes the basic principles, uses, and precautions involved in electrosurgery.
Provided here is a description, a photograph, and a price list for the following pieces of endoscope equipment: fiber optic light sources, light transmission cables, accessories cold light projectors, cystoscope 3420, cysto-urethroscope 3220, special accessories for cysto-urethroscopy 3220, rigid forceps, optical urethrotome, resectoscope 3100, resectoscope with continuous irrigation, special accessories for resectoscope, cystoscopic rongeur and biopsy forceps, flexible instruments, urological accessories, accessories for irrigation, nephroscope 2310, rectoscope-proctoscope, rectoscope with annular cold light illumination, accessories for rectoscopy, operating laparoscope, small laparoscope, pneumoperitoneum set, cold-light amnioscope, operating hysteroscope, hysteroflator for hysteroscopy, culdoscope, arthroscope, cleaning accessories, and teaching attachment.
Organization of mental health services in developing countries.
Studies indicate that seriously debilitating mental illness is likely to affect at least 1% of any population at any one time and at least 10% at some time in their life. Since about half the population in many developing countries is under age 15 there is a high quantity of child and adolescent disorders. The prevalence of organic brain damage will diminish with the introduction of public health services, but the same measures are liable to increase the number of surviving children with brain damage. The World Health Organization recommends the pooling of mental health experts to aid the developing countries lacking personnel and resources to cope with mental disorders. Pilot programs in mental care are also recommended to create awareness in communities that mental illness exists and can be treated.
A case study of induced abortion in rural villages of Cavite, Philippines.
A KAP survey of induced abortion was conducted in 5 barrios with an estimated total population of 5000. At the end of 1975 all married women aged 15-49 were visited in their homes by a trained interviewer. The questionnaire was designed to detect the incidences and trend of induced abortion in a rural community, to determine who had abortions and how and by whom the abortions were performed, and to understand public attitudes toward the moral and legal aspects. Because of the difficulties involved in questioning women about such a sensitive subject, the topic was approached indirectly and the survey instrument carefully designed to elicit information in more than 1 way. 705 eligible women were identified, 676 (96%) were actually interviewed. 115 women (17%) reported having had an abortion; 87 had had 1, 23 had 2; 4 reported 3; and 1 reported 4. Of the 3179 pregnancies experienced by all respondents, 4.7% were terminated by induced abortion, 3.8% through fetal wastage such as miscarriage and stillbirth. Most abortions were obtained by women aged 25-29 years. There seems to be no increase or decrease in abortion rate. In general women with less than primary education resorted to abortion more than women with more education. 32% were performed by the transitional midwife, the hilot, who did abdominal massage, prescribed herbs, or gave tablets or injections; 29% were performed by the women themselves with tablets purchased from drugstores; 28% were performed by medical doctors who gave tablets and did a few dilatation and currettages; 8% took herbs by themselves; 3% received oral tablets from professionally trained midwives or nurses. 12% of these abortions involved hospitalization. 82.4% were performed to space children rather than limit childbearing. 24 of the women had 0-1 child at the time, 54 had 2-3, and 36 had 4-5. About 21% of the total respondent group knew how an abortion could be performed. 77% of those with abortion experience and 57% of the total group responded that abortion was legal. At time of survey abortion was illegal in the Philippines. The problems associated with this type of survey are discussed.
An estimate of the direct impact of family planning programs on the birth rate of Colombia.
The interrelationship between the very successful family planning campaign conducted in the developing country of Colombia over the 1965-1975 decade and the decline in fertility experienced over this same period are examined. A working committee, consisting of directors and research technicians representing all of the organizations in Colombia that have been involved in family planning and the demographic research, was formed to undertake a study of this interrelationship. All evidence used by the committee is included, and the analysis is outlined in detail. A model, able to account for all of the relevant facts and capable of stimulating further research and of focusing the research on key issues, is presented. The committee concludes that the organized family planning programs of Colombia accomplished the following during the 1965-1975 decade: 1) assisted the commercial sector in reducing the use of unreliable contraceptive methods; 2) blunted an epidemic increase in abortion; 3) positively affected public opinion and knowledge so that commercial and private medical sectors gained as many new clients as they might have lost to the organized programs; 4) brought family planning services to lower socioeconomic strata and to outlying and other populations which were without services; and 5) as a result of the above accomplishments, provided an unduplicated margin of additional contraception that has accounted for 100% of the estimated decline in fertility.
Herbal Medicine: January 1974 through May 1976 (121 citations).
The literature search, a computer-generated bibliography produced by the National Library of Medicine's Medical Literature Analysis and Retrieval System (MEDLARS) includes isolation of pharmacologically active substances from plants as well as medicinal uses of herbs and selected other plants. Each citation is listed with the major and minor descriptors selected from the subject headings under which the article was indexed.
Medicine and health in China: January 1973 through December 1975. (279 citations))
This bibliography contains selected citations from articles regarding medicine and health in China, with major and minor descriptors selected from the National Library of Medicine's list of Medical Subject Headings (MeSH). The article cited will be located in the Index Medicus under a major descriptor with an asterisk. A complete list of current National Library of Medicine Literature Searches can be found in Index Medicus, Abridged Index Medicus and Monthly Bibliography of Medical Reviews. Further information can be obtained by writing: Literature Search Program, Reference Section, Reference Services Division, National Library of Medicine, 8600 Rockville Pike, Bethesda, Maryland 20014.
Contents include: Summary and recommendations of Expert Meeting on Comparative Fertility Research, Sterilization and Post-Conceptive Regulation, Kuala Lumpur, January 12-13, 1976, by T.H. Lean, Singapore; Review of the Proceedings of the Expert Meeting on Comparative Fertility Research and Post-Conceptive Regulation held in Kathmandu, Nepal, March 7-9, 1976, by T.H. Lean, Singapore; Progress report of the IFRP studies in each country: Indonesia, Malaysia, Philippines, Singapore, Thailand; Protocol for IGCC anesthesia studies, laparoscopic sterilization with electrocautery, spring-loaded clips, and silastic bands: technical problems and early complications, by William Brenner; A comparison of laparoscopic tubal occlusion by cautery, spring-loaded clip and tubal ring, by Elton Kessel; Tubal ring equipment sterilization procedures and maintenance, laparoscopic sterilization using a needle-puncture technique, by Pouru P. Bhiwandiwala; Menstrual regulation: Singapore experience, by D. Vengadasalam; The current status of prostaglandins as abortifacients, by William E. Brenner; the current use of prostaglandins and its future potential areas of research, by Prof. S.S. Ratnam; Testing for pregnancy, by H. Lorrin Lau; A proposal for an acceptability study of female sterilization methods in camps, by Kanti Giri; Fourth Expert Meeting on Comparative Fertility Research, Sterilization and Post-Conceptive Regulation, in Kuala Lumpur, January 12-13, 1976, list of participants.
Advances in methods of fertility regulation.
The World Health Organization (WHO) Scientific Group on Advances in Methods of Fertility Regulation, meeting in Geneva December 9-13, 1974, focused on the special problems that have not been extensively reviewed in the past, such as the low-estrogen combination oral contraceptive (OC) and the effects of hormonal contraceptives on vitamin metabolism, or in which significant advances have been made in the 2 years since the last meeting on the subject. Attention at the meeting was focused on the following areas of concern: 1) steroidal combination OCs with less than 50 mg ethinyl estrogen content (rationale for use, potency, efficacy in clinical trials, assessment of contraceptive effectiveness, and side effects); 2) effects of estrogen-progestogen combined OCs on vitamin metabolism (Vitamin A, B2, B6, C, B12 and folic acid); 3) postcoital estrogens (efficacy, dosage, side effects, safety, and parenteral administration); 4) low-dose progestogen oral contraceptives (rationale for use, efficacy, mechanism of action, clinical side effects, metabolic effects, and incidence of tubal pregnancy during use); 5) return of fertility after discontinuation of contraceptive steroids (estrogen-progestogen OCs, progestogen-only OCs, and injectable contraceptives); and 6) prostaglandins in fertility control (for contraception, for termination of pregnancy, comparison of hypertonic saline and prostaglandins for termination of pregnancy). Included among the recommendations made were the following: 1) a need exists for standardizing definitions of menstrual cycle phenomena; 2) further studes are required concerning lactating women using all types of hormonal contraception; 3) the effects of hormonal contraceptives on the outcome of pregnancy should be investigated; 4) properly designed comparative studies should be conducted on continuation rates with different methods of fertility regulation in different parts of the world; and 5) the current status of sustained release contraceptives requires critical review.
Oral contraceptives and estrogens for postmenopausal use, 1976. Hearings, January 21, 1976.
The increasing use of estrogens, both as a means of contraception and as a treatment for the effects of menopause has aroused great controversey, and while scientists argue about what may happen in the future, millions of Americans continue their daily exposure to these products. They remain at risk and have a right both to understand the potential dangers they face, and to be protected. The Joint Hearing examines the role of oral contraceptives and estrogens in order that the public may be informed about any actual or potential danger involved in their use. Included in the proceedings are statements by various expert witnesses, and additional information in the form of articles and publications on the side effects of oral contraceptives, specifically endometrial cancer, and the effect of estrogen use by women in menopause.
LectroHesive. (Promotional material)
This is a piece of promotional material for PREP, patient return electrode procedure. The piece of surgical equipment being advertised is an electrosurgical preparatory pad which combines the dispersive gel pad and an adhesive to hold the pad tightly to the skin as close to the site of surgery as possible. The advertisement includes pictures of the pad and pictures of possible uses for it. Technical specifications are included.
Model "K" SSE2 solid-state electrosurgery Service manual.
This service manual contains information regarding installation and basic operating instructions for an electrosurgical generator piece of equipment. Monopolar and bipolar electrosurgical configurations and accessories are covered. The manual contains sections on technical specifications, circuit descriptions, the testing and troubleshooting of the generator, and maintenance. Block diagrams and pictures show the machine, electrical current curves, resistor circuitry, and waveform charts. A schematic diagram is presented for the circuitry of the entire machine.
Status report: collatex collagen contraceptive device, January 1977.
A report is presented of a new contraceptive device, the Collatex collegen contraceptive, a mechanical barrier method of contraception using a collagen sponge made from bovine hide and tendon. The biocompatibility of the collagen enables the contraceptive device to remain in the vagina for up to 28 days without removal or irritation. The material adapts to the vagina during intercourse and orgasm and can absorb 40 times its weight in fluid resulting in rapid immobilization of sperm. The device is wetted prior to insertion and loaded into an inserter. It is typically removed 8-24 hours postcoital, washed, and either reinserted or stored. Clinical trials have been designed in 3 phases: 1) establishing the safety and suitability of the collagen material for intravaginal use, 2) evaluation of the contraceptive's ability to prevent sperm penetration, and 3) evaluation for use-effectiveness. The 3rd phase is being conducted by the International Fertility Research Program at various centers worldwide. The device will be tested in the U.S. for the addition of zinc to reduce odors from semen. Additional studies using the device for the prophylaxis of sexually transmitted diseases and treatment of others are in the planning stages.
A demographic profile based on data from the U.S. Bureau of the Census, the 1966 Special Demographic Survey, the 1970 and 1975 population censuses, the 1971 National Fertility Survey, and the 1973-74 Korean National Fertility Surveys, delineates the population dynamics of the Republic of Korea, population 37,835,000. The fertility rate, 3.65 in 1975, was projected to 3.42 in 1976. In 1971, the fertility rate was 4.35. Life expectancy at birth increased from 63.1 to 64.1 years for males and 69.3 to 69.6 for females from 1975 to 1976. A net emigration of 34,100 occurred between 1975-76. Infant deaths decreased from 68/1000 in 1961 to 47/1000 in 1970. The projected number of women aged 15-49 (childbearing years) is 90,082 in 1975 and 116,920 in 1985. 37.5% of all married women used contraceptives in 1977. From 1968 to 1975 the number of new acceptors increased from 4880 to 6860. 87.6% of those over 15 are literate. The daily newspaper circulation is 136/1000. 59% of agricultural workers are women.
Rural child health care in Kwangtung Province.
Child health care services in the rural areas of the People's Republic of China have steadily developed. Party committees at all levels of the provincial government attach great significance to rural child health care services. A team of full- and part-time mother and child health care workers is assigned at the provincial, regional, county, people's commune, production brigade and production team levels to be responsible for providing the service. Some of the main activities of the rural child health care service include dissemination of health knowledge for better environmental sanitation, proper management of the newborn, instructions on infant feeding, prophylaxis against children's infectious diseases, use of combined methods of traditional Chinese and western mention in the prevention and treatment of common diseases of children, and operation of nurseries and kindergartens in a way that ensures the sound mental and physical development of children. Improvement in the health of children and reduction of acute infectious diseases among the children demonstrates the success of the rural health services.
Gynaecological laparoscopy: [summary to the report of the Working Party].
The Royal College of Obstetricians and Gynecologists in England sponsored a confidential inquiry regarding laparoscopy techniques and its immediate complications. Fellows and members of the College, their assistants and anesthetists completed questionnaires regarding sterilization and diagnostic operations (20,586 completed questionnaires regarding diagnostic operations and 29,661 regarding sterilization). Some of the complications detailed in the reports (Table 1) included 4 deaths (rate of 8/100,000 operations), tubal hemorrhage (134), and bowel trauma (90). Among sterilizations, complication rates associated with termination of pregnancy were 38.5/1000 cases and 39.8/1000 when done electively. The overall complication rates were 29.1/1000 for diagnostic procedures and 40.6/1000 for sterilization. Technical recommendations made by the Working Party included aspects relating to induction of the pneumoperitoneum, volume and pressure of insufflated gas, use of various sterilizing methods, and anesthesia. A more extensive teaching procedure for training gynecologists was also recommended.
From observations that oral contraceptive users have an increased risk of 1/5000/year of dying from cardiovascular disease, with the risk concentrated in women over 35 years of age especially among those who smoke cigarettes and have used oral contraceptives continuously for 5 years or more, it is recommended that 1) women under 30 who use oral contraceptives stop smoking; 2) women aged 30-35 who smoke and have used oral contraceptives continually for 5 years or more reconsider their decision and not continue oral contraceptives unless they stop smoking; and 3) women 35 or over reconsider their method of contraception, especially those who smoke and/or have used oral contraceptives for 5 years of more. Oral contraceptives should not be discontinued, however, until an alternate method of contraception is found which is acceptable. No determination is possible at this time as to whether low doses of estrogen are advantageous.
PCBs (polychlorinated biphenyls) in breast milk.
Publicity has raised concern about the presence of polychlorinated biphenyls (PCBs) in breast milk. There are no known effects in children at levels found in people in the U.S. In Kyushu, Japan, pregnant women who ingested cooking oil that was heavily contaminated with PCBs and other chemicals had small-for-gestational-age infants who had transient darkening of the skin. PCBs are stored in body fat and are not readily excreted, except in the fat of breast milk. In the past, PCBs have entered the body through a variety of foods. More recently, contaminated game fish and occupational exposures have been the main sources. The only women in the U.S. who may have been heavily exposed are those who worked with PCBs or who have eaten large amounts of sports fish from PCB-contaminated waters such as the Saint Lawrence Seaway. Unless women have a history of exposure to PCBs, they should be encouraged to breast-feed their infants as usual. When a well-documented history of exposure to PCBs is obtained and the mother wants to breast-feed her infant, the mother's PCB level could be measured in about 3 weeks' time. The advice of state health department officials should be sought in the rare instances when a high PCB level is found.(FULL TEXT)
Before focusing on the experience of Thailand in incorporating family planning with general health services, focus is on the issue of integrating family planning programs into general health services. This integration is essential in developing countries because of the scarcity of resources and trained personnel. Constraints to the implementation of integrated health delivery systems fall into the categories of policy development, organizational development, personnel development, and evaluation. Evaluation of an integrated health service may focus on process evaluation, effectiveness evaluation, and impact evaluation, and an evaluation scheme is summarized in chart form. Since the inception of Thailand's National Family Planning Program in 1968, family planning interventions have been a part of maternal and child health services, services already incorporated into basic health services. The National Family Planning Program used existing personnel, almost entirely, to motivate and then provide services to those in need of contraception. Various types of unipurpose local field workers for family planning services have also been tried, but they have failed. A volunteer system, now in the process of being developed, will provide community inputs in terms of facilitating accessible and acceptable points of entry for health services customers. The major constraints in the integration of more and more new services into the basic health services network has been the creation of a complicated health organization, lacking appropriate management practices for effective and efficient program planning, implementation and evaluation.
A selected international bibliography on voluntary sterilization: audio-visual materials.
This bibliography is a listing of current audiovisual materials, with emphasis on surgical techniques and patient education, for use by the international health community. Prices of the materials and distributors' addresses are given with each entry. Films, filmstrips, slides and video tapes cover a wide variety of general subjects regarding contraception and family planning, female and male sterilization techniques.
A selected international bibliography on voluntary sterilization: medical/scientific and general.
This bibliography is a compilation of selected literature relating to international voluntary sterilization activities and programs. Subjects covered are colpotomy, culdoscopy, laparoscopy, and minilaparotomy; vasectomy; reversibility of male and female sterilization; psychological aspects of contraceptive sterilization (general attitudes toward contraceptive sterilization); patient education pamphlet and literature, and sterilization programs. IPAVS regrets that copies of specific works cannot be supplied to biography users; the local library, or publishers of the literature may, however, be contacted.
Sterilization reversal: January 1974 through September 1978 (125 citations).
References on sterilization reversal for the period January 1974 through September 1978 selected from some 3000 English and foreign language biomedical journals and a limited number of monographs are included in this bibliography. Articles from these journals and monographs are indexed for inclusion in Index Medicus and other bibliographies produced by the National Library of Medicine. The references included in this literature search were retired from the National Library of Medicine's MEDLINE data base.
"Rural Penetration and Diffusion of Contraceptive Technology" is the challenge of the 5th Expert Meeting of the Inter-Governmental Coordination Committee (IGCC). The Thai experience in minilaparotomy has demonstrated that female sterilization services can be effectively provided to the rural population in a simple way. The instruments are simple, inexpensive and available almost everywhere, and the operation can be performed by trained paramedics. A progress report of the International Fertility Research Program (IFRP) is presented for the countries of Indonesia, Malaysia, Nepal, Philippines, Singapore, and Thailand. Also included in the proceedings are presentations covering the following: 1) update on camp approach to female sterilization; 2) use of an injectable in delivery of family planning services to some rural communities of Northern Thailand; 3) provision of IUD services; 4) outreach service for specific target population; 5) community-based distribution of contraceptives -- the spectrum of approaches and strategies; 6) training for health centers -- Ramathibodi's experience; 7) computer charts by IFRP on female sterilization surveillance study, hospital abortion record, and maternity record; 8) household distribution of contraceptives survey; 9) the family planning clinic record; and 10) current advances in family planning technology.
Strategies for coordinating programs.
The present compilation of abstracts includes a selection of recent and pertinent publications on the study of problems and development of programs for out-of-school population education projects. Abstracts are classified into: 1) books and other published reports; 2) periodical articles; and 3) unpublished materials. Each entry includes the following information: author; title; place of publication; publisher; date; series note; number of pages; the symbol "ED" and the number of a particular microfiche if it is an Educational resources Information Center document; and location of the material abstracted. The abstract, a summary and description of the content and purpose of the material, is provided after each entry, while further description of the scope and subject of each title is indicated through use of descriptor terms or descriptors.
The Tokyo International Symposium reviewed the progress made since 1974 in integrating population policies with socioeconomic development, with additional focus on needs of rural areas. It was discovered that even countries experiencing economic growth have still failed to provide basic human needs - health, nutrition, housing, education, and employment - and that in densely populated rural areas, and marginal districts of cities, fertility decline has been slow or nonexistant. New evidence presented at the symposium suggested that now a new stage of population history is approaching, characterized by falling birth rates and slackening of world population growth; nevertheless, rapid population growth in developing countries has not ended because 1) of the high proportion of young people in many countries and 2) the fertility rates of the poorest half of the population are 50% higher than the national averages. While projections of world population are being revised downward, world population is still likely to grow from its present 4 billion to 6 billion by the turn of the century. All agencies, official or private, need to emphasize development of cost-effective methods which the government may adopt after a successful pilot study that take into account the social values, religious beliefs, and customs in each country. The symposium urges that additional resources be made available for a broad range of new initiatives in the following areas: 1) to make the fullest range of family planning services available in rural areas and marginal districts of cities; 2) to expand the social and economic roles of women and to improve their status in other fields; 3) to educate adolescents and young adults about their reproductive behavior and to underscore the impact that premature parenthood would have on themselves, their families, and communities; 4) to integrate family planning with development activities; and 5) to encourage program design by affected populations.
Instruments for the use of the Valtchev's uterine mobilizer.
To use the Valtchev's uterine mobilizer, the uterine cavity must be sounded and measured to ensure that the proper interuterine obturator is selected. The instrument consists of 5 interuterine obturators; 2 are for postpartum and postabortal uterus, 2 are for the nonpregnant uterus, and 1, a Cannula 14, is for injection of dye or X-ray medium contrast as well as for uterine mobilization. The proper interuterine obturator is then locked into place and inserted into the uterine cavity. The finger rings, used to mobilize the interuterine obturator, must be kept at or above the level of symphysis to avoid bringing the uterus or surrounding structures too close to the abdominal wall and thus damaging them. The laparoscope is then introduced into the peritoneal cavity so that the uterus may beflexed and/or rotated under direct visual control. Only under direct visualization through the laparoscope should the uterine mobilizer be rotated along its longitudinal axis either to the left or right to allow visualization of either adnexa. The uterine mobilizer should be used cautiously; excessive force should not be used to correct abnormal positions of the uterus.
The Interamerican Training Center in Communication for Population organized a course to enhance the communication skills of 24 Haitian health professionals involved in maternal and child health and family planning programs from April 3-28, 1978 during which time the participants spent 58 hours in the classroom, 54 hours in group discussion, and 32 hours in fieldwork. During the 1st 2 course units, the participants became familiar with the policy and objectives of the maternal and child health and family planning programs and acquired a basic knowledge of the theory of communication and an understanding of the barriers to effective communication. The 3rd unit dealt with basic techniques of participatory communication and involved fieldwork. The participants conducted a series of nonstructured interviews among the inhabitants of a rural community in order to ascertain the felt needs of the community members. After analyzing the results of these interviews, the participants staged a group meeting with the villagers. The emphasis in this group meeting was on motivating the community members to express their needs, define their problems, and develop solutions relevant to the community. The remaining 3 course units dealt with mass media communications. The participants were instructed in the function, design, and production of mass media messages and learned how to tailor media strategy to a particular audience. Participants were pleased with the course; 79% evaluated the course as excellent and the remaining 21% as very good. Tables present the course evaluation results and a summary of the workplan for the course.
Evaluating the safety and efficacy of placental antigen vaccines for fertility regulation.
Since guidelines for safety evaluation of antifertility vaccines do not exist, this WHO report attempts to define the parameters to be examined and the methodology which might be used for such a safety assessment. In principle, antifertility vaccines may: 1) prevent sperm transport and/or fertilization; 2) prevent or disrupt implantation; and 3) prevent blastocyst development. Potential advantages of this immunological approach to fertility regulation include: 1) possibility of infrequent administration, possibly by paramedicals; 2) use of antigens or antigen frangments that are not pharmacologically active; and 3) the possibility of large-scale synthesis and manufacture of vaccine at relatively low cost in the case of antigens of known chemical structure. To evaluate the efficacy and safety of placental antigen vaccines, placental antigens used should not possess significant immunological similarity with tissue other than placenta. Carriers or haptens may require structural remodifications of placental molecules to overcome natural immunological tolerance. Adjuvants may be needed to enhance the immune response required. Quality-control procedures for vaccine component production include tests for: 1) purity; 2) toxicity; 3) sterility; and 4) shelf-life. Acute, subacute, and chronic toxicity testing in animals is described for it must be performed separately for the haptenated antigen or conjugate and adjuvant. Such tests would include hematological parameters, blood chemistry, urinanaylsis, gross pathological and organ weight analysis, and ophthalmological tests. Animal models are suggested. Means of monitoring the immune reponse and potential hazards of immunization (e.g., allergy or autoimmune disease) are discussed. The rationale and protocol for safety and efficacy studies of human chorionic gonadotropin-peptide vaccine receive similar attention, with emphasis on tests to be performed before human clinical trials can start.
Gynecological laparoscopy instruments. Instruction manual.
This is a sales catalogue/instruction manual from a gynecological laparoscopy instruments manufacturer. Gynecological laparoscopy is being used in various diagnostic and operative procedures, e.g., tubal dilatation, biopsy, and cautery, these days. Laparoscopy must be performed by trained personnel in adequate facilities. All equipment necessary for the procedure are described, diagrammed, and pictured in the manual. Instructions include a section on sterilizing and cleaning the equipment. Categories of instruments are: 1) standard fiber illuminated laparoscopes; 2) unipolar instruments; 3) Kleppinger bipolar forceps; and 4) electrosurgical units.
Adverse effects of oral contraceptives: July 1974 through December 1977. (659 citations))
This is a bibliography of references to recent articles discussing the adverse effects of oral contraceptives. Postcoital and hormonal agents, primarily estrogenic and progestational steroids, are included. Side effects include cardiovascular, hematologic, metabolic, neoplastic, psychological, and systemic disorders and conditions. Articles on therapeutic use of oral contraceptives and adverse effects of these substances on fetuses, neonates, and children are excluded. Citations are limited to English language articles. 3000 English and foreign language biomedical journals and selected monographs were searched for the bibliography. The search was made through Index Medicus, produced by the National Library of Medicine. Citations are listed alphabetically by author along with descriptor words and terms from the National Library of Medicine's Medical Subject Headings (MeSH). Descriptors of most significance are marked with an asterisk.
The history of IUDs dates back to the time of Hippocrates when he first inserted medication or pessaries into human uteri by means of a hollow lead tube or sound. In the early part of the 20th century, various IUDs were developed, only to be abandoned by the medical profession because of serious complications sometimes resulting in death. Major IUD advances came during the '60's when improved IUDs were found to be medically acceptable as a contraceptive. In Australia, currently available IUDs are the Graefenberg rings; Lippes Loop; Saf-T-Coil; copper IUDs? Progestasert; and Anderson Latex Leaf. Half of the estimated 15 million IUDs currently in use are from women from developing countries and the other half from developed countries. Highest frequency of use is observed among the 35-39 age group. The IUD mode of action is not well known, and various hypotheses have been suggested. Mortality risks are much lower than those associated with pills. Rare deaths associated with IUDs are attributed to infected spontaneous abortion or undiagnosed ectopic pregnancy. Morbidity risks, however, are higher for IUDs than for pills. Nevertheless, in the light of medical and social risks of unwanted pregnancies, IUD risks of mortality and morbidity are very small. Absolute and relative contraindications to IUD insertion include pregnancy; pelvic inflammatory disease; uterine and cervical abnormalities; menstruation disorders and others. Preinsertion counseling and post insertion follow up are musts for better patient tolerance and long term use of IUDs. Clinical management of IUDs is also discussed.
Second report on intrauterine contraceptive devices.
This report is an update of the 1968 Report on Intrauterine Contraceptive Devices. It provides information on new technological developments and regulatory changes which have affected IUDs over the years. The 1st chapter presents a history of IUDs dating back to Hippocrates. The 2nd chapter deals with the controversial issues and theories surrounding the IUD's mechanism of action, both earlier, and current, and other aspects of its biologic action. The 3rd chapter evaluates the utilization and effectiveness of IUDs. Included in the chapter are discussions of the characteristics of IUD users and many of the factors which influence the safety and effectiveness of the IUDs. Among these are size; shape; flexibility; bleeding; and bioactivity. Adverse reactions are the subject of the next chapter, those such as perforation; expulsion; cramping; bleeding; ectopic pregnancy; pelvic inflammatory disease; and some possible long-term effects. Chapter 5 discusses the clinical management of the IUD acceptor, involving such concerns as IUD contraindications; other special considerations; timing of IUD insertions; management of major complications; and IUD removal. The final chapter presents a summary of Food and Drug Administration Regulatory Policy. Each chapter is followed by a list of special references which served as resource material and at the end of the report is contained a comprehensive bibliography of further references on the IUD.
The objective of the symposium was to promote exchange of information and experiences between participating countries (Indonesia, Malaysia, Nepal, Philippines, Singapore, Thailand, Bangladesh, Korea, and Sri Lanka) with respect to the evaluation systems used in national family planning programs. Generally, each country has its own built-in evaluation systems which assess contraceptive prevalence and program impact, in addition to research being conducted on socioeconomic and cultural factors affecting fertility. Evaluation is an integral part of family planning programs which can be used effectively to stimulate political and social support. Because family planning can no longer be divorced from socioeconomic development, fertility control efforts should be considered within the broader context of the total development process. Similarly, it is necessary to consider the evaluation aspect of family planning programs relative to the total development process. Through the cooperation of regional evaluation experts and thru financial support from international agencies, it is possible to develop a simple, effective and inexpensive evaluation methodology. The following proposals may be worthwhile to consider: make an inventory of human resources from which experts in different areas can be drawn (management, service delivery; training; research and evaluation; logistics); invite experts in the region to assess the other countries' programs; encourage the development of more junior research personnel thru organized training programs within the region; and standardize family planning terms, concepts and procedures, health and vital statistics.
In 1978, the Bureau of Drugs, on grounds of 6 safety concerns, refused to approve the Upjohn Company's supplemental NDA for Depo-Provera as an injectable contraceptive. However, the Upjohn Company, in the light of Depo-Provera's safety record in more than 60 countries, is convinced that American women should not be denied access to Depo-Provera as a contraceptive method. This report attempts to refute the "substantial risks" or "potentially high risks" attached to Depo-Provera by presenting an objective review of old and new information and by comparing Depo-Provera with other contraceptive methods. For some patients, Depo-Provera is an acceptable, safe contraceptive; for some, it is the best contraceptive method available. The new data supports the original safety observations in the NDA and subsequent reports to the FDA. The report also focuses on the Bureau of Drug's 6 legitimate concern for safety of the drug but refutes the rationale behind the Bureau's disapproval of the drug. It is divided into 6 parts: breast cancer in beagles; patient needs and comparative risks; supplemental estrogen; birth defects; postmarketing study; and probable use.
Over the past several years diagnostic laparoscopy and sterilization through the laparoscope has become very popular. The procedure, although successful, has been accompanied by bowel burns, abdominal wall burns, electric shock to operating personnel, and obliteration of the blood supply to the ovary which may result in menstrual dysfunction following sterilization. In an effort to eliminate these complications and to provide an improved method of sterilization, Waters Instruments introduces the Model 138 Cautery. The special features of the Model 138 Cautery are safety (electric current does not pass through the body tissues), convenience (the system is small, compact and portable), and power supply (the Cautery is self powered). The operating procedure is described.
Model 138 Fallopian tube cautery system. (Instruction manual)
This is an instruction manual which indicates use of the Waters 138 Fallopian Tube Cautery System manufactured by Waters Instruments, Inc. This piece of equipment is said to be ideal for use in Fallopian tube coagulation and transection. This piece of equipment was designed to minimize complications associated with other laparoscopic sterilizing equipment. Safety features are listed. The instrument panels are pictured. Operating procedure is explained and photographed.
The objectives of the Project Identification Meeting: Lactation and Fertility, held in Kuala Lumpur on February 23-24, 1978, were to review the role of lactation in pregnancy spacing and identify studies to explore ways of linking family planning services to breast feeding women with advice and assistance on weaning and infant care and nutrition. The session began with an overview of the pattern and trend of breast feeding in the community, the role of lactation, sociological attitudes and perception towards breast feeding, infant nutrition and relationship between lactation and use of contraceptives. In the last session Indonesia, Malaysia, Nepal, Philippines, Singapore, and Thailand presented country papers concerning research to be conducted. Country reports by participants gave evidence that breast feeding is common in rural areas but less in towns and still declining in incidence. Breast feeding was reported to be advantageous for infants, particularly in low income groups where artificial feeding and its hygienic application is difficult. Breast feeding continues to help space pregnancies for many couples and contributes to fertility regulation at a national level, but problems remain about predicting when fertility will return for individual breast feeding women and additional contraceptive precautions should be available. It was noted that higher dose oral contraceptives could have an adverse effect on lactation but research was being conducted to confirm or refute the hope that 30-35 mg pills had no effect on the quantity and quality of milk. Participants felt that although a reduction in the duration of breast feeding was an inevitable consequence of socioeconomic development, aggressive advertising of artificial milk should be resisted.
26 men and 28 women who had been voluntarily sterilized in Mexico City volunteered to submit themselves to a psychological interview. General characteristics of the sample are presented along with opinions about the period before sterilization, the operation itself, and feelings and some changes respondents experienced after sterilization. 92.6% of the sterilized men and women were married; 64.8% of the candidates were under age 40; and there was a predominance of higher level of education among the men who were sterilized. 81.5% of the interviewees presently have 4 or less children. About 60% of the people who were sterilized answered that the operation was simple, and 83.3% reported that the sterilization was either without pain or almost without pain. 80% of the sample reported no complications after the operation. Complications that were experienced had to do mostly with bleeding and infection problems. All the women answered that they felt satisfied with their decision to be sterilized and that 86% of their companions were also satisfied. 96% of the sterilized men reported to be satisfied with their decision and that 100% of their companions were also satisfied. 94% of the sterilized men and women would recommend sterilization to their friends or relatives.
The Inter-Governmental Cooperation and Coordination (IGCC) Workshop on an Integrated Approach at Grassroots Level towards Family Planning and Health Programs with particular Emphasis on Parasite Control and Nutrition was held at Genting Highlands and Kuala Lumpur, Malaysia from March 23-25, 1977. The workshop objectives were to collect and exchange information on the experiences of IGCC countries in their family planning and health programs, with particular focus on nutrition and parasite control; and to study the feasibility of integrating family planning with nutrition and parasite control programs and the potential of such an approach in generating community participation and community activities. The Workshop was attended by country delegates of the IGCC member countries (Indonesia, Malaysia, Nepal, Philippines, Singapore, and Thailand). In addition to the country papers, papers were presented on the following topics: 1) parasite control, nutrition and family planning in relation to each other and in the health context; 2) fertility related development needs; 3) implications of an integrated approach; 4) constraints and evaluation; 5) administration constraints and evaluation; 6) partnership of the integration program; 7) a guideline for the integrated family planning program; 8) new horizons for integrated health services and primary health care in Thailand, the Lampang health development project; 9) the place of family planning in health and national development in Thailand; 10) International Planned Parenthood Federation's view on integration; 11) first 6 months results of the 2nd year integration program in Nantou country, Taiwan; 12) interrelationships between fertility nutrition and parasitic diseases; and 13) needs as perceived by the community.
National health planning in Jordan: phase two: health policy strategy.
This report analyzes the current health care delivery system in Jordan and proposes a health care strategy which would primarily consist of curative and preventive activities, particularly in the area of maternal and child health. The current health care delivery system in Jordan is hospital-oriented, with a major portion of the country's total health care budget being spent within hospitals. This creates problems and inefficiencies in 2 areas: the health clinics or centers, and the field of planning, management, administration and statistics. A detailed health manpower plan is proposed, one which is auxiliary-based, rather than physician-based as the current system. One of the advantages of an auxiliary based system is that auxiliaries are not internationally recognized, thus providing a disincentive for leaving the country in search of jobs elsewhere. A precondition to the manpower proposal is the need for a coordinated policy for health services and health manpower, coupled with an effective and efficient management and evaluation systems. Other recommendations deal with the need to provide adequate health care to the underserved segment of the population, in particular, the infants, young children and fertile-aged women.
Health conditions in the Americas 1973-1976.
This report is a collection of national vital statistics and health information of the regions of the Americas, broadly divided into 2 categories, North and Latin Americas. North America comprises Canada, the United States, and the islands of Bermuda, St. Pierre and Miquelon. Latin America consists of 4 subregions: the Caribbean; Continental Middle America; Tropical South America; and, Temperate South America. Sources of data are the annual questionnaires sent by the WHO and the PAHO to different countries, and official publications and documents of the countries and of the UN and its specialized agencies. Subjects covered include population; vital statistics; communicable diseases; health services; hospital services; environmental health; and, human resources. Charts are included to illustrate graphically the health conditions of the country in question. For continuity of series and for long-term analysis, Annex tables are also provided. In spite of availability of reliable data, PAHO still feels the need to strengthen national statistics and health information systems for an even more reliable data base.
Combination Lap Unit, Light-Projector Unit and Bi-polar generator. (Instruction manual)
This is an instruction manual for the Wolf Corp. laparoscope and light projector. The manual cautions that only qualified and experienced surgeons should use this equipment. It is important to give the equipment proper care and maintenance. Careful inspection upon receipt and prior to each use is urged. The equipment is pictured and its use is outlined in detail.
In preparation for the Vancouver Conference on Human Settlements June 1976 the UN Centre for Housing, Building, and Planning assembled a global review of human settlements conditions, drawing on a wide array of available data. Volume I is a quantitative overview and discussion of the demographic and economic aspects of the urbanization process and the consequences of this process for patterns of land use, housing, and the settlement infrastructure. Volume II is a statistical annex of detailed country-specific tables. Some principal observations are that: The world is rapidly approaching the point where half the total population will be urban. In developed regions, rural populations are generally undergoing absolute declines; in the developing regions, urban populations tend to grow two to three times more rapidly than rural populations. About half of all urban growth is due to natural increase, and half to net in-migration. Urban populations everywhere are characterized by comparatively fewer children and more persons in the working ages than there are in rural populations. There is a fairly strong, positive correlation between levels of urbanization and per capita gross national product; however, the relation between the rate of urban growth and the rate of increase in per capita GNP is very weak. Urban densities of population range from an average of 100 per hectare in Asia to 45 in Europe and about 15 in North America. The trend is toward still higher densities in developing countries but toward lower densities in the urban areas of the developed countries. In most developing countries more than half the existing stock of dwellings lack piped water, one-third of the urban dwellings have neither toilet nor pit privy, electricity is available in substantially less than half of all dwellings. It is estimated that in order to accommodate population increase plus make essential replacements to existing stocks, some 323 million dwelling units will have to be built during the next decade--an average ratio of construction of about 8 units per thousand population annually. (FULL TEXT)
Contraceptive retail sales program: Jamaica.
In July 1974, Westinghouse Health Systems began the process of establishing a contraceptive retail sales program (CRS) to market condoms and oral contraceptives in Jamaica. The program, designed to utilize existing retail distribution systems, had as its major focus the development of indigenous resources to augment the existing clinic activities of the Jamaica National Family Planning Board, and centered on 5 major areas: 1) advertising and promotion; 2) product pricing and packaging; 3) distribution; 4) consumer and retailer education; and 5) program evaluation and monitoring. Initial research was aimed at educating the public, distributors, and retailers in the availability, usage, and potential side effects of oral contraceptives. A major advertising campaign involving radio, television and the press was directed at promoting the 2 contraceptive brands - Perle oral contraceptives and Panther condoms. In September, 3 years after implementation, management of the program was turned over to the Jamaican National Family Planning Board. Annual program sales had reached 184,000 cycles of pills, and 880,000 condoms through 267 Perle outlets and 1108 Panther outlets, nearly doubling and tripling pill and condom sales. Introduction of the new brands has had no effect on sales of competitive brands, nor has there been a negative impact on distribution of condoms and oral contraceptives through the public clinic sector. In addition, the cost per acceptor has been less when compared to costs per acceptor in the public sector clinics. By 1979, the projected costs per acceptor will be $262 in the CRS program versus $32.73 in the public sector program.
The survey of fertility in Thailand. Country report. Vol. 2.
This report presents the results of 4 separate surveys on fertility: the Household Survey and Husband's Survey conducted by the National Statistics Office, and the Fertility Survey and Community Survey conducted by the Institute of Population Studies, Chulalongkorn University (IPS). The 1st volume of this report details the main findings of the surveys, and provides information on questionnaires used. Volume 2 presents basic statistical tables divided into 7 major categories: Group 0 presents the de facto population recorded on schedules used in the Fertility Survey for the selection of eligible women for the fertility interview, while Groups 1 through 5 present questionnaire information on selected background variables (nuptiality and exposure to childbearing; fertility; preferences for number and sex of children; knowledge and use of contraception; use of contraception as related to fertility preferences) taken from household and husband's questionnaires. Group 6 tabulates additional information from husband's questionnaire.
Model D5008U fiber light projector. (Instructional manual)
Step-by-step operating instructions for the Model D5008U fiber light projector are presented along with power requirements and warnings of explosion and electrical shock hazard. The circuit components are depicted figuratively.
Model D4002U fiber light projector. (Instruction manual)
Step-by-step operating instructions for the Model D4002U fiber light projector are presented along with power requirements, leakage current, and warnings of its explosive hazard.
Included in this profile of the population of India are tables of selected demographic information, including size of population, and estimates of fertility and mortality. Specifically, annual estimates of total population are shown beginning in 1950. An adjusted distribution of the population are shown beginning in 1950. An adjusted distribution of the population by age and sex is given for the latest census year and for 1978. Projections of the number of women of childbearing age are shown for each year to 1985. Fertility measures shown in the profile include crude birthrates, age specific fertility rates, and gross and net reproduction rates. Mortality is shown in terms of crude death rates, life expectancy at birth, infant mortality rates, and selected life table values by age and sex. Also presented in summary form is information on family planning, urban population, marital status, and some data from which past migration can be inferred. The data reveal that both mortality and fertility have been declining slowly for many years in India. Both fertility and mortality are expected to continue to decline in the future. An increasing number of persons were using contraceptive methods and adopting sterilization through 1976. For example, the number of new sterilizations more than tripled to over 8 million from 1975 to 1976.
This equipment catalogue meant for obstetrical and gynecological practices gives instructions for use of electrocautery equipment advertized and provides a price list covering all available items, including: 1) unipolar instruments for coagulation; 2) bipolar coagulation instruments; 3) trocar sleeves (single puncture) and their selection; 4) trocars and sleeves for operating laparoscopes; 5) Palmer-Jacobs fiber light operating scopes; 6) operating scope with 3-mm channel and one with 5-mm channel; 7) double puncture trocar sleeves and advice on selection; 8) double puncture trocar sleeves for standard laparoscopes; (9 standard fiber light laparoscopes; 10) 3- and 5-mm instruments for 2nd puncture; 11) Kleppinger bipolar forceps; 12) bipolar unit accessories; 13) instruments to manipulate the uterus; 14) Verres needle and laparoscopy accessories; 15) C02 insufflator and accessories; 16) mobile utility cart; 17) comb ination laparoscopy unit; '18) combination electrosurgical unit and fiber light projector; <19) electrosurgical accessories; &20) Hulka clip applicator 21) Lay loop applicator; ,22) amnioscopes; 023) vaginoscopes; *24) hysteroscopes; -25) hysteroscopy insufflator 2020; 426) Lindemann-Semm hysterscope Type 8999; 827) porto-pneumo hysteroscope type 4995; %28) porto-operating hysteroscope Type 4998; :29) culdoscope; >30) female air urethroscope (Robertson type); B31) accesories; @and 32) cleaning instruments and spare parts. CPictures and praise of all are provided by the manufacturer who hopes you will use the price list provided.
Tubal ligation with hemoclips by culdoscopy/vasectomy with hemoclips. (Price list)
The 1977 prices listed for instruments for tubal ligation with hemoclips by culdoscopy ranged from $18.00 to $450.00. Prices for fiber optic light source, cable for culdoscope, cable for speculum, vaginal speculum, Weck culdoscope, hemoclip applier, box of 150 large hemoclips, and hemoclip cartridge base were induced. The prices listed for instruments for vasectomy with hemoclips ranged from $8.75 to $47.50. Prices for 6.2 inch hemoclip applying forcep, box of 200 medium hemoclips, hemoclip cartridge base, 5.5 inch curved Metzenbaum Scissor, and 5.5 inch dressing forcep were included.
Valleylab's SSE3 electrocauterizer features a monopolar output current monitor and reduces its output if an imbalance occurs in the system. The 6 operating modes make the device suitable for laparoscopy, urology, cardiovascular, and/or neurosurgery. The SSE3 has separate monopolar and bipolar output capabilities which can be used simultaneously. The bipolar output provides a true dessication effect (no sparking). Pure cut, blended cut, or coagulation mode selection can be used with either bipolar or monpolar outputs. With a Coag Crest factor of 10.0, the SSE3 supplies twice the hemostasis of conventional solid state generators and rivals the hemostasis of console-type, spark-gap systems.
Tubal ligation by culdoscopy. (Promotional material)
The Guitierrez-Najar Sterilization set allows for ligation with Hemo clips. The set includes culdoscope with trocars; hemoclip applying forceps; and a vaginal speculum set. The Hemoclips prevent tissue resection because they are made of tantalum. Hemoclip technique makes a bilateral occlusion possible in less than 10 minutes and the cost to the patient is reduced.
Model 126 Carboflator. (Instruction manual)
A description is given of a carboflator which controls the inflation of the peritoneal cavity during laparoscopy, keeping the pressure in the abdomen within safe limits. The main components of this instrument are 1) a pressure reducing valve; 2) a flow control orifice; 3) a pressure control valve; 4) a pressure relief valve; 5) a main pressure gauge; 6) a tank pressure gauge; and 7) a main shut-off valve. The carboflator is fail-safe in design, indicates when the inflation needle is in the peritoneal cavity, and requires no attention during the procedure. The full guarantee of the instrument includes air express replacement if any malfunction occurs. Instructions are given for mounting the carboflator on a gas cylinder, and the 10-step operating sequence is described.
This catalog provides illustrations and prices for obstetrical, gynecological equipment. The Universal Purtubation Apparatus for insufflation, hysterosalpinegography, hydropertubation, colpotonography for cervix adapter, cervical balloon-catheter and balloon-clamp is featured. Other insufflators and insufflator systems; tube testers; endoscopy units; intercontainers for salpinography; abdominal retraktors; vaginal specula; suction-curets; gyn-suction biopsers; CO2 fittings; mobile strands; crystometers; vagino-tonographs; coagulators; pelviscopies; coeliotonometers, and laparoscopes are depicted with brief descriptions along with a full line of accessories. The price list is effective March 1, 1977.
Endoscopes. (Equipment catalog)
This is a catalogue of endoscopic equipment manufactured by the Richard Wolf Medical Instruments Corp. of West Germany for gynecological purposes. The catalogue includes diagnostic light sources, endophoto equipment, operating instruments for use with fiber light sources, unipolar and bipolar instruments for coagulation, laparoscopes, puncture instruments, culdoscopes, and instruments for establishing the pneumoperitoneum. The catalogue includes drawings, descriptions, and prices for each piece of equipment.
Laparoscopy. (Equipment catalog)
The Wolf catalog for 1978 advertises the following laparoscopy equipment: Palmer-Jacobs fiber light operating laparoscope; 6mm instruments for a 2nd puncture; laparoscopy accessories; instruments for establishing the pneumoperitoneum; laparoscopy utility cart; combination "lap" unit; electrosurgical fiber optic light projector; fiber light cables; heavy-duty fiber light projector; and laparoscopy spare parts. Included in loose-leaf are: 1) price list for laparoscopy--June 1, 1973; 2) Lindemann-Semm's hysteroscope price list; and 3) important instruments for gynecological laparoscopy.
The annual meeting of the Colombo Plan Consultative Committee provides the opportunity for the Colombo Plan member countries from both within and outside the region to review progress, exchange views, and share ideas in the field of cooperative economic and technological development. A distinctive aspect of these meetings is the frank analysis and discussion of problems affecting South and Southeast Asian countries. The primary meeting objectives are as follows: 1) to review the progress of member countries in implementing their programs for economic development during the period under review; 2) to discuss how the available resources, as channelled and applied through foreign aid and regional government expenditures, can best be used for development; 3) to exchange views on the conduct of development programs and how their administration can be improved; 4) to provide a forum for an exchange of views on current specific development problems; 5) to review the activities of the Colombo Plan Council, the Colombo Plan Bureau and the Colombo Plan Staff College for Technician Education; and 6) to take decisions about the organization of the Consultative Committee proceedings and other questions relating to the Colombo Plan. In the 1st part of this annual meeting report focus is on a review of economic progress, the tasks ahead, technical cooperation, and problems relating to the transfer and adaptation of technology to and among member countries. Country chapter reports are included for Afghanistan, Bangladesh, Bhutan, Burma, India, Indonesia, Iran, Korea, Malaysia, Maldives, Nepal, Pakistan, Papua New Guinea, Philippines, Singapore, Sri Lanka, and Thailand. Contribution chapters are included for Australia, Burma, Canada, India, Korea, New Zealand, Pakistan, Philippines, Singapore, Thailand, United Kingdom, and the United States.
The survey of fertility in Thailand: country report. Vol. 1.
Preliminary assessment is made of the findings of the Survey of Fertility in Thailand (SOFT), which had the following objectives: 1) to obtain data on fertility levels and information concerning fertility behavior as a basis for formulating more effective policies with regard to population, economic and social development planning; 2) to promote the further development of demographic survey methodology, population research, and the scientific study of fertility and related variables; 3) to provide accurate and timely data on fertility and mortality patterns and levels, as well as information on factors affecting fertility; 4) to provide the information necessary for evaluating the effect of family planning programs on fertility; and 5) to provide internationally comparable data on fertility patterns and levels. SOFT utilized 4 questionnaires to collect the basic data through Household, Husbands, Fertility, and Community Surveys. Findings are presented under the following headings: 1) characteristics of the survey population; 2) comparison of responses of hsubands and wives; 3) nuptiality and exposure to childbearing; 4) fertility; 5) preferences for number and sex of children; 6) attitudes on advantages and disadvantages of children; 7) knowledge and use of contraception; and 8) contraceptive practice related to fertility preferences. A summary of the major findings indicates that: 1) the trend in recent decades of a gradual rise in age at marriage is confirmed; 3) the views of husbands and wives on the number of children wanted tended to balance, and the mean number wanted by husbands was 3.9, compared with 3.7 desired by wives; 4) awareness of contraception is widespread, and there appears to have been a significant though recent increase in contraceptive use; and 5) there are marked regional differences in fertility, family size preference, and contraceptive use.
The association of induced abortion with adverse outcome in the subsequent pregnancy.
The results of a collaborative effort of the World Health Organization Task Force on the Sequelae of Induced Abortion concentrated in 9 cities in 8 countries - Denmark, Finland, Hungary, Korea, Poland, Sweden, United Kingdom, and Yugoslavia - to determine if induced abortion increases the risk of an adverse outcome in the subsequent pregnancy, is presented. Subjects were recruited at the time of 1st prenatal contact and designated into 1 of 4 groups: 1) induced abortion, 2) spontaneous abortion or stillbirth, 3) live birth group, and 4) never previously pregnant. Cases in Groups 3 and 4 were matched to those in 1 and 2 on the basis of age, social class, and parity. Subjects were contacted a 2nd time at 7 months of pregnancy. Records of deliveries and complications were reviewed as were records of women having had induced abortions. There were 11 confounding variables including uncertainty of last menstrual period, induction of labor, and accurate reporting. Analysis was done by multiple regression, testing outcome variables individually as dichotomous variables against the independent, and a life table analysis. Data were handled separately for each center. Preliminary review of the data shows marked differences between Asian and European women in the study. There is a correlation between outcome of pregnancy and age, social class, education, smoking, and height. Smoking is associated with shorter gestations and significantly lower birthweights in all groups. There is also an association of increased risk of adverse pregnancy outcome when the abortion to current conception interval is short. It is hypothesized that it will be possible to demonstrate the effect of induced abortion on future pregnancy outcome by continuing to follow this protocol.
Hemoglobin levels, blood pressure, body weight, and the subjects' impression of changes in various conditions were recorded in a multicentered double-blind study of levonorgestrel (1g) and norgestrienone (ng) subdermal implants in 900 women evenly divided among Brazilian, Chilean, Jamaican, Dominican Republican, and Scandinavian centers. 492 subjects received 1g and 498 received ng, and 100 acceptors of Copper T devices served as controls. In this 1-year study, a major reason for termination of 1g implants was disturbance of menstrual patterns. Substantially larger proportions of subjects using 1g noted changes in menstrual flow, duration of menses, and intermenstrual bleeding and spotting than users of ng. Relative to users of implants, Copper T users reported increased dysmenorrhea and an increase in amount and duration of menstrual flow. But despite these recorded increases, women using subdermal implants showed an increase in blood hemoglobin levels during the 1-year course, whereas IUD users had no change in mean hemoglobin levels. Neither systolic nor diastolic blood pressure of steroid users was affected. A small net increase in body weight among steroid users was not evident in IUD users. Increases in acne and other skin conditions were perceived by the same percentages of IUD users as steroid users. A greater proportion of IUD acceptors noted increased nervousness and depression than was felt by steroid users.
Abortion surveillance--United States, 1976.
U.S. abortion surveillance data from 1976 reveal that 988,267 legal abortions were obtained, a 16% increase over 1975. The nationwide abortion ratio increased by 15% from 272/1000 live births in 1975 to 312 in 1976. 65% of women obtaining legal abortions were under 25, 67% were white, 75% were unmarried, and 48% had no living children. 90% of the abortions were obtained in the woman's home state, and the redistribution of legal abortions into states which had restrictive laws before 1973 continued. 47% of abortions performed were at less than or equal to 8 weeks gestation and 89% were within the 1st 12 weeks. The suction curettage method accounted for 83% of all procedures. 25 abortion-related deaths were reported: 10 from legal procedures, 3 from illegal operations, 11 following spontaneous abortions, and 1 cause unknown. Analysis of suction curettage abortions performed at less than or equal to 12 weeks gestation indicates that the rate of major complications was similar for local and general anesthesia (3 and 3.5/1000 procedures, respectively). However, local anesthesia was associated with higher rates of febrile (p < .001) and convulsive (p < 0.05) morbidity, while general anesthesia was accompanied by higher rates of hemorrhage (p < .001), cervical injury (p < .001), and uterine perforation (p < .05).
Results of a review of current knowledge of the epidemiology of induced abortion, the safety and efficacy of techniques, and the organization of abortion services are presented. While induced abortion makes a relatively large initial contribution to birth rate decline, it is overtaken by contraception with a few decades. A higher incidence of repeat abortion is found in settings where contraceptive services are not offered to women undergoing abortion or voluntary sterilization is not available. A computer model based on data from developed countries suggests that use of 1 of the barrier methods with first trimester legal abortion as a backup measure is safer than all other fertility regulating procedures. Although some studies have indicated that legal abortion is followed in subsequent pregnancies by a greater risk of spontaneous abortion, short gestation, and low birthweight, other factors (e.g., smoking, prenatal care) may be involved. Techniques used in early pregnancy (4-6 weeks) termination include menstrual regulation, curettage, or administration of prostaglandins. Vacuum aspiration and dilatation and curettage are the methods of choice when the pregnancy is 7-12 weeks. Early second trimester data are inconclusive but indicate that dilatation and evacuation should be used only by skilled operators, while the saline method is less risky. Data are insufficient to allow determination of a method of choice from among the various 2-stage methods used in pregnancies 16 weeks or over. Complication and mortality rates increase if sterilization is concurrent with abortion; however, IUD insertion at the time of a first trimester abortion seems to be safe and to have an expulsion rate comparable to that following postmenstrual insertion. For maximal safety and efficiency, abortion services should facilitate legal induction early in pregnancy by skilled operators. Constraints jeopardizing this goal include stipulations of the social and legal systems, attitudes of women as consumers of the service, and policies of the health services. Abortion services should constitute an integral part of maternity and family health services and not be organized as an independent system. This facilitates health education and contraceptive provision. Further research is needed in defined areas relating to the epidemiology of abortion, its medical aspects, and services provided.
Gossypol: a new antifertility agent for males.
Gossypol, a yellowish, phenolic compound isolated from the cotton plant, has been clinically tested in laboratory animals and 4000 humans and seems capable of inhibiting fertility in males. In animal studies, gossypol 1st damaged spermatids; spermatocytes became damaged with increased dose and duration in male rats. The epididymis contained exfoliated spermatids and spermatocytes with numerous dead sperm, many of which had separated heads and tails. Electron microscope studies revealed changes in acrosomes and mitochondrial spiral sheath; interstitial cells of the testis seemed unaffected. Serum luteinizing hormone and response of the pituitary to gonadotropin releasing hormone of gossypol-treated rats did not differ significantly from controls. Libido of the rats seemed unaffected. Radioactive absorption studies in animals showed that the testis is the only organ damaged at low doses and that the concentration of gossypol in testis is lower than that in many other organs (peak concentration: liver, 1192; heart, 398; spleen, 718; kidney, 708; testis, 372), indicating that the selective action of gossypol on the testis is not due to selective concentration but to a higher vulnerability of that organ to the drug. Gossypol had no obvious toxic effect at antifertility doses (rats: 75 mg/kg/day for a year; humans: 20 mg daily up to 4 years). 4000 men have used gossypol for 6 months with antifertility efficacy of 99.89%, and few incidences of mild side effects were reported. Reversibility was complete within 3 months of cessation.
Serial im injections of 15-methyl-prostaglandin F2 alpha (PGF2a) were used to abort 515 women 10-20 weeks' pregnant in a multicenter, multinational trial. Their mean age was 25, weight 55.3 kg, parity 1.4, and gravidity 2.7. The dosage of 15-methyl-PGF2a was 200 mcg, then 300 mcg every 3 hours for up to 30 hours. 79.3% successfully aborted within 24 hours, 35% were incomplete, and 4 received additional treatment. Mean abortion times were 13.7 hours in multigravidae and 15.7 hours in primigravidae. Side effects included vomiting (2.9 episodes each), diarrhea (2.8 episodes despite routine Lomotil medication), flushing in 14.2%, and cervical laceration in 3 (.6%). It is concluded that this method would best serve to supplement another abortion method that had failed.
Multinational midtrimester abortion trials were conducted with 2.5 mg 15-methyl-prostaglandin f2 alpha (PGF2a) given intraamniotically in 311 women, 2.5 mg 15-methyl-PGF2a compared with 40 mg PGF2a in 251 women, and 2.5 mg 15-methyl-PGF2a compared with 50 mg PGF2a in 684 women. Success rates within 48 hours were 95.2, 95.6, and 92.8% in the 3 15-methyl-PGF2a groups, 81.7% in women given 40 mg PGF2a, and 86.6% in women given 50 mg. There were 109 failures, the majority in PGF2a groups. 35 women were given supplementary treatment. Incidence of complete abortion ranged from 49 to 55% in the 5 groups, usually higher at longer gestation. Frequency of heavy bleeding was higher in PGF2a groups. Both vomiting and diarrhea occurred more frequently in the 15-methyl-PGF2a groups. Cervical rupture of up to 2 cm occurred overall in 4.4% of primigravidae and 1% of multigravidae, and 1 serious cervical rupture occurred.
15-methyl-prostaglandin F2 alpha (PGF2a) was injected extraamniotically .92 mg in 5.5 ml Hyskon (dextran 70, 32%) in 660 women 10-20 weeks' pregnant for abortion. 72.6% aborted within 36 hours and 80.3% within 36 hours, but only 32.2% had complete abortions. Mean abortion intervals were 13.1 hours in multigravidae and 16.2 in primigravidae. Infrequent complaints included flushing, nausea, dyspnea, chest pain, headache, and shivering. 1 cervical laceration was reported. 6 woemn required readmission for bleeding or infection of the 53% attending for follow-up. It is concluded that this method is safe and effective for abortion.
Steroid contraception and the risk of neoplasia.
Studies on steroid contraception (SC) and risk of neoplasia are reviewed. Methodological issues in neoplasia etiology studies include: 1) possibility of a latent period between exposure to cause and disease development; 2) cumulative effects of prolonged or repeated SC exposure; 3) discontinued drugs or dosage schedules; 4) time of exposure (adolescence or prenatal, e.g.); 5) isolation of specific causes among multiple risks; and 6) variations in neoplasma diagnoses. The 4 epidemiological approaches to SC-associated neoplasia studies have inherent shortcomings, but cohorts yield significant associations. Relative risk (ratio of disease incidence among exposed vs. nonexposed persons) is an index of association only, not evidence of cause and effect. Benign breast neoplasia risk was reduced by current SC use of >2 years, and weak evidence points to a residual protective effect, apparently associated with progestogen dose. Aggregated breast cancer data show no clear adverse or beneficial effect of SC use; however, evidence suggests SCs may increase breast cancer risk in population subgroups (e.g., young women). Only short-term evidence is available; hence, no inference of long-term SC breast cancer effects is possible. No beneficial effect of SCs on uterine fibroids is evident, but sequential SCs, no longer marketed, may have increased risk to endometrial carcinoma. Inconclusive data suggest SCs may decrease ovarian cancer risk. Increased risk of cervical dysplasia and carcinoma in situ is associated with SC use, especially long-term use by women with predisposing factors. Risk of hepatocellular adenoma of the liver increases with prolonged SC exposure, especially high dose. Relevance of existing data from more developed countries to disease risk in less developed ones is discussed, and recommendations made.
The association of induced abortion with adverse outcome in the subsequent pregnancy.
The WHO Task Force on the Sequelae of Induced Abortion undertook a collaborative study of the effect of induced abortion on subsequent pregnancy; 9 cities (Copenhagen, Helsinki, Debrecen, Seoul, Warsaw, Stockholm, Newcastle and Ljubljana) in 8 countries (Denmark, Finland, Hungary, Korea, Poland, Sweden, United Kingdom and Yugoslavia) were involved in the study. The research design consisted of grouping the women, based on antenatal records and direct questioning, according to induced abortion, spontaneous abortion or still birth, live birth, never previously pregnant; and of validating history of women without prior induced abortion. The study design involved data collection at initial recruitment and at 7 months of pregnancy, and a matching procedure to limit the number of women to be followed up. Differences between groups were tested based on descriptive and confounding variables, which were in turn tested against selected diagnosis of outcome: prematurity or spontaneous abortion. Based on the preliminary findings of this study, it was postulated that the adverse effect of induced abortion on subsequent pregnancy could be attributed to D and C, particularly with dilatation greater than 12 mm, interval since previous abortion, cigarette smoking and other confounding variables. Some of these factors may have a contributory effect, while others may be synergistic; prevalence of these factors vary in frequency among women who have had induced abortion and who have not. The final results of this study (analysis is still in progress) should be illuminating.
Herbal medicine: June 1976 through June 1978 (222 citations).
This bibliography is a compilation of selected citations from some 3000 English and foreign language biomedical journals and monographs dealing with medicinal herbs and plants; it also presents information on traditional remedies in both folk and modern societies, toxic and beneficial effects of herbal drugs, and pharmacologically active substances extracted from medicinal plants. Full details of elements in each citation and a complete list of current National Library of Medicine Literature Searches are included in Index Medicus, Abridged Index Medicus and Monthly Bibliography of Medical Reviews. Current list of Literature Search titles can be obtained by writing: Literature Search Program, MEDLARS Management Section, National Library of Medicine, 8600 Rockville Pike, Bethesda, Maryland 20014. Please type name and address on gummed labels.
Traditional methods of birth control.
This report includes a history of traditional methods of birth control and individual sections on coitus interruptus; breast feeding and fertility; abortion; cervical barriers; condoms; and natural family planning. A survey and evaluation of natural fmaily planning service and methods in Australia found the two most widely used and taught methods were the Ovulation Method and the Temperature Method. 63 clinics and centers were surveyed. 85% of the couples using natural methods were Catholic and middle-class. Data suggests low acceptance rates, 1/500, in clinics which generally teach only one method of natural contraception and teach it very conservatively. Using the Pearl formula rate, the Temperature Method has an associated failure rate of 15.9 pregnancies/100 woman years, while the Ovulation Method failure rate is 27.58/100. A profile of 567 attendants of family planning clinics is also included in this report. 29.3% used behavioral and traditional family planning methods.
Instruments, according to Semm, for sterilization, sterility diagnosis and therapy, and abortion and techniques for using the instruments are described. Instruments include 1) univeral insufflation apparatus model T and accessories, a complete unit for diagnosis and treatment of sterility; 2) CO 2 Pneu Insufflator for laparoscopy, culdoscopy, pelviscopy, and cystoscopy; 3) cervical adaptor for insufflation which permits tight closure of the cervical canal without pain; 4) cervical adapter for menstrual blood collection allowing for the collection of blood 1-2 cm above the external cervical aperature and thus reducing the risk of contamination; 5) cervical adapter for insemination; 6) cervical balloon catheter for insufflation during sterility operations; 7) vacuum intrauterine sound; 8) tubal balloon clamp;9) vaginal speculum for routine clinical purposes which allows for simple manipulation and for the insertion of cervical adapter; 10) suction curet for evacuation of uterus; 11) needle for insufflation; 12) coagulator and accessories; 13) sterilization unit for low current tubal occlusion; 14) respiratory and suction apparatus for newborns; and 15) adjustable abdominal retractor composed of an oval frame with 6 retractor attachments.
SurgiStat. (Promotional material)
This is a piece of promotional material for SurgiStat, an office electrosurgery instrument. The piece of surgical equipment being advertised provides moderate, consistent electrical current for either bipolar or monpolar procedures. Pictures of the equipment in use plus an explanation of various procedures for which SurgiStat could be used are included in the advertisement. Technical specifications are listed.
Methodology of the national regional and state life tables for the United States: 1959-1961.
Western Samoa, county paper: demographic situation in Western Samoa.
Fifteenth Annual Report, The Barbados Family Planning Association.
Glossary of evaluative terms in public health.
Study of fertility change in developing countries through analyses of open birth intervals.
The continuous motivation system for delivery of family planning services.
Knowledge, attitudes and practice of family planning in Los Rios and Northern Guayas, Ecuador, 1973.
Review and assessment of major policies and programmes in family planning in the ECAFE Region.
Periodicals in the ECAFE Region with special interest in population information.
Perceptions and attitudes towards fertility regulating methods and services.
Family planning programmes and fertility in the countries of the ECAFE region.