Age at effective marriage and fertility: an analysis of data for North Kanara.
From time to time, Indian demographers have advocated that the age at marriage of girls be raised so as to reduce the reproductive span of women, and thereby, bring down the birth rate. Some researchers have estimated a 10-20 percent reduction in the birth rate if the age at marriage of girls is increased to 18-20 years while others estimate it to be less than 10 percent. Despite variations in estimates, and depending on the assumptions made by the researchers, it may be concluded that delaying the marriage of girls would lead to some reduction in the birth rate. A recent review of the literature shows that scant attention has been paid by researchers to the question of whether an increase in the age at marriage of girls does in fact result in controlling fertility or whether it is merely one aspect of social change which, in addition, involves changes in the roles of women and economic structures and fertility reduction. Further, the review suggests that late marriage may not automatically lead to lower fertility. Srinivas and others belong to the school of thought which considers increased age at marriage as one aspect of social change and plays no more than a supporting and secondary role in controlling fertility. This view is further strengthened by the findings of several other researchers. According to Zachariah and Talwar, only about 30 percent of the overall fertility decline in Kerala between 1965 and 1980 can be attributed to an increase in the age at which women married. Coale attributes the decline in marital fertility in late-marrying populations to not only the longstanding social conditions that accounted for the tradition of late marriage in Western Europe, but the favourable attitude for early adoption of contraceptives. (excerpt)
Fertility patterns and family planning acceptance among slum dwellers in Kanpur.
During the last two decades, a large number of studies have been published on slums. The studies have usually been conducted by various agencies as a part of successive population censuses, or as a part of general physical and socioeconomic surveys. Yet, very few have concentrated on the fertility of slum populations. Conceptually, most of the slum studies have treated the slum as a unit of analysis. They have explained slum life in the context of dual economy assuming that slums are inhabited by poor rural-urban migrants of recent origin who are employed in the formal sector. The slums have often been projected as places of despair, and their life as being disorganized. This conceptualization has emerged largely from studies conducted in the slums of some of the largest tan cities of the country. However, on has been paid to fertility differentials within slums and to alternative concepts of slums; slums in one city have been compared to slums in other cities or with the city outside them. That slums are internally differentiated and fertility patterns in slums may vary considerably among various groups that comprise its population has been largely ignored. The present study then was conducted with the purpose of examining the differentials in fertility patterns and family planning acceptance among two distinct categories of respondents living in slums, namely those working in the formal sector and those working in the informal sector. (excerpt)
Women's health is an outcome of their social existence. The Indian women, though they had participated overwhelmingly in the National Freedom Movement, suffered since various aspects of their lives including health were under the control of the patriarchal social norms. The discourses on women's health revolved around biological reproduction; and successful biological reproduction meant a son by a 'pure' mother. This was the fulfillment of any man's existence and the ideological justification of man's control over women. Similarly, in the history of health services in Independent India, the health of women has been perceived by the planners primarily in the context of 'motherhood'. In the economic production processes, women specially those who had to migrate to the place of their work, were socially discriminated against and were not favoured. At that time, the International lobby for women's health offered the Indian working class women, 'maternity benefit and leave' only. The burdens of malnutrition and hard factory labour on women were recognized only in the context of motherhood, while they continued to suffer from problems of low wages and imminent unemployment. Women started expressing their struggles, voice their resistance and protests against the adverse physical and social conditions, through their writings. Some of them formed the left-wing Progressive Writers' Association with men during the Freedom Movement in the 1930sE But with independence and the gain of a secular state with constitutional guarantee of equal rights of women and men in political and economic life, the wave of women's movement had temporarily settled down. The movement, however, got intensified since the seventies with wider understanding of and deeper insights into women's lives. Over time on various occasions / accounts, it has brought out the limitations of the narrow perception of 'motherhood' in health planning and in capturing the realities of women's health problems in Indian society. The implications of this for women's health is serious both ideologically and empirically. (excerpt)
I just returned from Sao Pedro, Sao Paulo, Brazil having attended the very stimulating 15th International Congress on Women’s Health Issues (ICOWHI) where more than 600 participants engaged in discussions of research and clinical experience. Most of the presentations were about pregnancy, infertility, and birth control, but all stages of the life cycle were included as was the impact of women’s work on their health. While the level of scholarship was excellent, I personally learned the most from the informal dialogues that emerged when women of disparate disciplines discussed what matters most to them in addition to their work. When the formal sessions had ended for the day, we spoke of our family, friends, and our students in terms of hopes and dreams for the future. At that time, despite our ethnic differences, it was clear we had much in common. All of us wished to improve the status of women, regardless of which health issue was being discussed. While the theme of the conference was “women’s health, culture, and society” all recognized that in a healthy society, women’s work must receive social and economic recognition by men. In an inspirational lecture, Maria Conceicao Maia de Oliveira, recipient of the ICOWHI Taylor and Francis Award, discussed the work of a group of Amazon midwives. (excerpt)
A longitudinal study on the food and nutrient intake of pregnant women.
The extensive changes that occur in women during pregnancy influence the need for different nutrients and the efficiency with which the body uses them. Brown has indicated that the diet of a pregnant women should provide the vast majority of her nutrient need in required amounts. Unfortunately findings of the research reports of several groups of workers have indicated that the diet of pregnant women is inadequate both in quality and quantity. Inadequate diets have been related to clinical problems during the course of pregnancy as well in the outcome of pregnancy. Considerable data is available regarding the food and nutrient intake of women during pregnancy from cross-sectional studies conducted in different parts of India, whereas such data from longitudinal studies are meagre. But data from cross-sectional studies may not give reliable and exact information because of the multifactorial interplay and their influence on the nutritional status. Hence, the longitudinal study which is superior to cross-sectional studies in assessing the food intake of women during pregnancy was chosen for the present investigation. (excerpt)
Breast feeding -- what every mother must know.
Breast-feeding is the proud privilege of every mother. It gives her an opportunity to fondle her little one with tender care and looks forward to his growth and development with high expectations. Since breast-feeding is the only source of nourishment for the child in early months of life, she is prepared to make any sacrifice to provide all that the child needs. To do so properly, it is necessary for her to know all the nutritional requirements of the growing child. Following information may be considerable help for every mother who is breast-feeding the child. (excerpt)
Attitudes toward male fertility control: results of a multinational survey on four continents.
Following extensive research activity to develop an effective agent to control male fertility, such a product may be available for use within ~5 years. However, little is known concerning contraceptive knowledge, desires and attitudes of men in different countries, and their acceptance of male fertility control (MFC). A survey of >9000 males aged 18–50 years was performed in nine countries on four continents in 2002. The objective was to compare, on a cross-cultural basis, the knowledge, attitudes and acceptability of MFC among men and assess their willingness to use such a method. Between 50 and 83% of the male respondents currently use contraceptive methods, and 55–81.5% reported that both partners participate in selecting the method of contraception employed. Overall acceptance of hormonal MFC was high (>55%), with 28.5–71.4% of survey participants of various nationalities expressing the willingness to use such a method. While MFC appears to be well accepted overall, the willingness to use this type of contraception varies widely between differing population groups. The specific characteristics and profile of any MFC product will have to be carefully evaluated to accurately assess its acceptance, both by men and their female partners. (author's)
Births by day of week: a historical perspective.
Our objective was to describe the historical pattern of the decline in weekend births. Data on 906,100 health maintenance organization enrollees’ birthdates were analyzed to show patterns of birth by day of week from 1910 to 1999. The decline in Sunday births dates to the 1930s, and the decline in Saturday births dates to the 1950s, far earlier than previously demonstrated in the literature. The expected natural birth process has been significantly modified. By examining a much longer time series than in other literature, it is also possible to see that the trend is not abating and may be increasing. (author's)
This trial was conducted to compare cycle control with vaginal ring a combined contraceptive vaginal ring, and a combined oral contraceptive (COC) delivering 30µg ethinylestradiol (EE) and 150µg levonorgestrel. This open-label, randomized, multi-centre, Phase III study involved adult women from 11 countries. Subjects were treated with either vaginal ring or a COC for 13 cycles (12 months). A total of 1030 subjects (vaginal ring, n = 512; COC, n = 518) comprised the intention-to-treat (ITT) population. The percentage of women in the ITT population who completed the trial was 70.9% for vaginal ring and 71.2% for the COC group. The incidence of breakthrough bleeding and spotting over cycles 2–13, the primary efficacy parameter, was lower with vaginal ring (range 2.0–6.4%) than the COC (range 3.5–12.6%), and for cycles 2 and 9 the lower incidence with vaginal ring was confirmed as statistically significant (P = 0.003 and P = 0.002 respectively). The incidence of intended bleeding was significantly higher over all cycles with vaginal ring (58.8–72.8%) than with the COC (43.4–57.9%). Cycle control with vaginal ring was excellent and superior to that of a COC containing 30µg EE. (author's)
Transmission of malaria in resort areas -- Dominican Republic, 2004.
Malaria is caused by any of four Plasmodium parasites carried by Anopheles mosquitoes and usually is transmitted by the bite of an infective female Anopheles. In rural areas of the Dominican Republic, P. falciparum malaria is endemic, with the highest risk in the far western region of the country, and prophylactic medication with chloroquine is recommended for incoming travelers. Conversely, urban and resort areas in the Dominican Republic have been considered nonmalarious, and prophylactic medication has not been recommended for persons traveling to these areas (1). However, since November 2004, CDC has received reports of three malaria cases in U.S. travelers returning from areas in La Altagracia and Duarte provinces previously considered nonmalarious. An additional 14 cases of malaria in La Altagracia Province, in the far eastern region of the country, have been reported in European and Canadian travelers. This report describes three of these 17 malaria cases and summarizes the overall investigation, which led to expansion of CDC recommendations for chloroquine prophylaxis to include all of La Altagracia and Duarte provinces. (excerpt)
In this paper, we investigate the ways in which migrant households in rural Oaxaca, Mexico, use remittances. We use data from a survey and ethnographic research in 12 rural communities in the central valleys of the state to examine three investment strategies: those made in the local (village) commercial economy, those made in the agricultural/dairy sector, and those made in Oaxaca’s tourism industry. In our discussion, we examine the challenges that surround such local efforts and ask whether such patterns increase dependency, or create opportunities. Finally, we ask, can the investment of remittances mitigate future migration? (author's)
Gender, caste, and economic inequalities and marital violence in rural South India.
We conducted a survey to examine the relationships among gender, caste, and economic inequalities and marital violence among women in rural South India. Thirty-four percent of 397 women reported having ever been hit, forced to have sex by their husbands, or both. Women belonging to lower caste, poorer households, having greater economic autonomy, and whose husbands consumed alcohol were more likely to report violence. In multivariate analyses, indicators of women’s economic autonomy and husbands’ alcohol consumption were significantly associated with violence, independent of caste and economic status, which highlights the need to address the links between gender inequalities and marital violence. (author's)
Retroperitoneal perforation of the colon caused by colonic tuberculosis: report of a case.
We present a 25-year-old, HIV-negative patient from Kosovo, with no significant past medical history, who was admitted to a local hospital for nonspecific upper abdominal discomfort. He was transferred to us after a retroperitoneal mass with contact to the right colonic flexure had been found during workup. Colonoscopy demonstrated an edemateous area with a central fistula in the right flexure, and histology showed caseous necrosis. Although neither bacteriology nor histology could detect any germs, gastrointestinal tuberculosis seemed to be very probable. Laparotomy with a segmental resection of the colon was performed to remove the fistula-bearing segment, and histologic examination of the resected specimen confirmed the intraoperative suspect of a retroperitoneal colonic perforation. Again, all cultures from the specimen were negative for tuberculosis, but polymerase chain reaction of a regional lymph node revealed acid-fast bacilli of the Mycobacterium tuberculosis/ bovis species. Although the patient had no other sites of tuberculosis infection like pulmonary or urinary, he received adjuvant standard tuberculosis treatment for six months. At control examination one year after the operation, the patient was free of recurrence and in very good general condition. We report this extremely rare presentation of gastrointestinal tuberculosis to sensitize physicians to tuberculosis again, because incidence rates are increasing and this disease will certainly play a more important role in the future. (author's)
New low- and high-tech calendar methods of family planning.
Calendar-based methods are not usually considered effective or useful methods of family planning among health professionals. However, new “high-” and “low”-tech calendar methods have been developed, which are easy to teach, to use, and may be useful in helping couples avoid pregnancy. The low-tech models are based on a fixed-day calendar system. The high-tech models are based on monitoring urinary metabolites of female reproductive hormones. Both systems have high levels of satisfaction. This article describes these new models of family planning and the research on their effectiveness. The author proposes a new algorithm for determining the fertile phase of the menstrual cycle for either achieving or avoiding pregnancy. (author's)
Donkey work: women, religion, and HIV / AIDS in Malawi.
Addressed in this article are the familial, cultural and religious influences on Malawi women that contribute to HIV/AIDS. Thirty-nine adult Malawi women representing voluntary assistance groups, religious groups, and university women participated in 3 focus groups in Malawi. Interview data were taped, transcribed, and analyzed using qualitative descriptive analysis. Findings revealed that multiple burdens in the lives of Malawi women resulting from poverty and responsibility for family members are made more onerous by religious institutions, sexual practices, and cultural beliefs. In conclusion, women’s “donkey work” may result in at-risk sexual behavior as a means of survival, thus increasing the incidence of HIV/AIDS. Alleviating the burdens involves efforts from religious groups and restructuring of belief systems. (author's)
Buddhism, the status of women and the spread of HIV / AIDS in Thailand.
The common-sense construction of Buddhism is that of a general power for good; the less positive aspects of Buddhism’s power, especially when reinforced by folklore and ancient superstition, is infrequently recognised. In this article we make explicit Buddhism’s less positive power, particularly as it relates to the status of women and, by implication, its role in the human immunodeficiency (HIV)/acquired immune deficiency syndrome (AIDS) epidemic in Thailand. The Buddhist, folklore, and superstitious bases of Thai misogyny are explored, together with its expression in the differential gender roles of women and men. In addition, the attitudes of both women and men to commercial sex workers (CSWs) and condom use is discussed. The implications of these attitudinal analyses to the epidemiology of HIV/AIDS in Thailand is outlined. We argue that the current spread of HIV/AIDS in Thailand is primarily a function of the inferior status of women, which, in turn, is a function of Buddhism and Thai cultural beliefs. In light of this, some realistic strategies to address the problem also are discussed. (author's)
Temporary versus permanent youth brain drain: economic implications.
Existing high levels of temporary migration between Central and Eastern Europe and the European Union (EU) have highlighted a number of concerns relating to the eastern enlargement of the Union. While much of the debate has focused on the destinations, we use Slovakia as a case study to explore economic implications for the countries of origin of highly skilled migrants. First, the paper examines estimates of the scale of "youth brain migration", comparing survey-based and expert-opinion estimates with our own estimate based on reconciling labour market and educational data. This identifies a substantial loss of graduate workers from the labour force through migration, accounting for a potentially significant proportion of Gross Domestic Product (GDP) growth. Second, we consider whether such migration will constitute "brain drain-over-flow" or "brain circulation": in other words will it be temporary or permanent? In some ways, however, this is a false dichotomy, for there are strong links between initial temporary migration and intended permanent migration, explored here through a survey of the motivations and social networks of returned migrants. Third, we address the ability of national states to intervene to mediate such losses. We generally concur with other commentators on the need for a multiscalar and multi-functional approach, focusing especially on economic development. However, we are pessimistic about the likely speed of economic convergence and, moreover, argue that initial temporary migration (with implications for permanent migration) will continue to be driven by non-economic goals. (author's)
The cost of HIV treatment and care. A global review.
This review of published studies on the costs of HIV treatment and care describes some of the recent developments that have influenced these costs in industrialised and industrialising countries, especially within the context of changing drug treatments. Some of the different approaches to estimating the economic impact of HIV infection are briefly presented. The methods used to review the literature are described, particularly the criteria of a scoring system that was specifically developed to systematically screen some of the studies identified. The mean review score for studies dealing with direct hospital costs increased significantly (p = 0.003) over the 3 periods analysed (before 1987, 1987 to 1995, and 1996 and beyond), indicating that the overall 'quality' of studies increased over time. All cost estimates, other than those from non-industrialised regions, were converted to 1996 US dollars using country-specific total health expenditure inflaters and country-specific Gross Domestic Product Purchasing Power Parity converters. A summary of hospital cost estimates over time and by region demonstrated that the costs of treating asymptomatic individuals and people with symptomatic non-AIDS increased over the period, but that the costs of treating individuals with AIDS appears to have stabilised since the late 1980s. As fewer studies could be identified on the costs of community and informal care, indirect productivity costs and population cost estimates, and costs of care for children with HIV infection, all of these studies were reviewed without the use of the scoring system. Finally, the discussion explores the evidence on the global costs of HIV in non-industrialised economies and the affordability of HIV treatment and care. Some suggestions for the direction of future HIV costing studies are also presented. A need remains for good quality cost data. Adequate research effort should be directed to improving the scope and quality of information on costs of HIV service provision around the world. (author's)
The origins and demise of the concept of race.
To MODERN EYES, especially American ones, the reality of race is self-evident. Peoples whose ancestors originated from Africa, Asia, and Europe typically have different appearances in terms of skin color, hair texture, and other superficial features. Although racial differences may be only skin deep, it is widely assumed that races have been a primordial source of identity and intergroup antagonism from the earliest societies to the present, with ancient hatreds, exploitation, and discrimination among the most common patterns. Even in modern societies, which have exposed the myth of racism, race remains a widely used term for socially defined groups in popular discourse- and, in some countries, also in scholarly research, and public policy. A basic problem with this perspective is that it is increasingly difficult to define and measure race as a social category. Are Jews a race? What about Muslims in Europe or Koreans in Japan? If Filipinos and Samoans are official races listed in the US census form, why can't Arab Americans or Middle Easterners be included? And how might the golfer Tiger Woods respond to the standard question about his racial identity? (excerpt)
"New dawn" for Botswana. Offering free HIV treatment -- and hope.
Although the prevalence of HIV/AIDS in Botswana is one of the highest in the world, with infection estimates of about 37.4% of adults, a public- private partnership for addressing the epidemic has brought new hope to the country. One critical component of the African Comprehensive HIV/AIDS Partnerships (a collaboration between Botswana's government, the Bill & Melinda Gates Foundation, and the Merck Foundation/Merck & Co Inc) is Masa (a Setswana word meaning "new dawn"), an ambitious program involving offering free antiretroviral drugs to all Botswana citizens who require treatment (http://www.achap.org/MASA.htm). Overseeing Masa's efforts is Ernest Darkoh, MD, MPH, an American-born son of Ghanian parents, who grew up in Africa and later received his medical and public health degrees from Harvard University and an MBA from Oxford University. JAMA recently spoke with him about how the program is progressing. (excerpt)
Placing emergency contraception in the hands of women [editorial]
For more than 50 years, since the successful synthesis of estrogens and progestins, safe and effective pregnancy prevention has been possible. Nonetheless, in the United States an estimated 3.5 million unwanted pregnancies occur annually, one third of which involve teenagers.' Among the many possible explanations for this paradox, barriers to health care figure prominently. For instance, lack of health insurance, an issue for more than 44 million Americans, creates a formidable barrier to access. Religious beliefs, concerns about contraceptive safety, and psychological barriers also contribute. Contraception may not be sought, especially by teens and other women for whom a physician visit and discussion of sexual behavior may prove embarrassing. (excerpt)
Etiology of pruritic papular eruption with HIV infection in Uganda.
Context A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. Objective To determine the etiology of PPE occurring in HIV-infected individuals. Design, Setting, and Patients Cross- sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. Main Outcome Measures Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. Results Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/µl) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eight-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/µl; P=.02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/µl; P=.07) than those without histological evidence of arthropod bites. Conclusions Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients. (author's)
Blocking malaria transmission.
Japanese researchers have identified a protein essential for the malarial parasite to essential for the malarial parasite to develop in mosquitoes to a stage when it can be transmitted to humans, a discovery that might point to a possible strategy for controlling the disease. The investigators reported their findings on November 1 in the online edition of the Proceedings of the National Academy of Sciences of the United States of America. In earlier work, the authors discovered that Plasmodium, the malarial parasite, uses a membrane-disrupting protein to invade the livers of vertebrate hosts. Suspecting that the parasite may require a similar protein to infiltrate epithelial cells of the mosquito's midgut the parasite continues its development before moving into the mosquito salivary glands), the researchers screened the parasite's genome and found a protein they named membrane-attack ookinete protein (MAOP). Genetically altered Plasmodium with a defective MAOP gene were unable to rupture the midgut cell membrane and invade the mosquito's gut. (excerpt)
This paper examines the displacement and vulnerability associated with the migration of unaccompanied illegal Romanian minors who came as economic migrants to Western Europe, found no legal opportunities for work or education, and were forced into criminal activity on the streets of French cities such as Paris, Lyon, and Nice. Beginning in 1997 growing numbers of unaccompanied Romanians, mostly boys, some as young as age ten, many younger than age 15, were subject to systematic prosecution rather than protection in Paris, the site of the largest and most influential juvenile court in the nation. They were arrested, detained, indicted, released pending trial, judged, and sentenced in absentia, multiple times with different identities. The Romanian minors were caught without legal papers or visas, claimed to be squatters living in abandoned buildings, trailers, or camps outside Paris, and gave little reliable information about their families or lives. Initially arrested for the destruction of city property and the theft of the proceeds from city parking meters, they gradually turned to begging, shoplifting, and prostitution when the city switched from coin to card payment. Deeply concerned by the penalization of a vulnerable population, the president of the Paris juvenile court created a special court to deal more humanely with unaccompanied minors in general, and Romanian children in particular, by establishing their identities and reconnecting them with their families. This article explores the contradictions that emerged between the representation of Romanian children in the media, the legal establishment, nongovernmental organizations (NGOs), and the Government, on the one hand, and their treatment in the juvenile justice system, on the other. It examines the discourse and the context of judging as well as the interactions between court personnel and Romanian minors from in-take interviews in jail and indictment hearings in chambers to judgment in absentia in the formal court. It compares and contrasts cases heard before and after the creation of the special court and centres on the gaps between official rhetoric, legal norms, and judicial practice. It concludes that the creation of the special court may be having the unintended effect of reinforcing and institutionalizing the very judicial practice it was designed to prevent, namely the penalization of marginality. (author's)
Context It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible an used. Objective To evaluate the effect of direct access to EC through pharmacies and advance provision on reproductive health outcomes. Design, Setting, and Participants A randomized, single-blind, controlled trial (July 2001-June 2003) of 2117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. Intervention Participants were assigned to 1 of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control). Main Outcome Measures Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assessed at 6 months; secondary outcomes were changes in contraceptive and condom use and sexual behavior. Results Women in the pharmacy access group were no more likely to use EC (24.2%) than controls (21.0%) (P=.25). Women in the advance provision group (37.4) were almost twice as likely to use EC than controls (21.0%) (P<.001) even though the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P=.46). Only half (46.7%) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12% acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group; adjusted odds ratio [OR], 0.98; 95% Confidence interval [CI], 0.58-1.64; P=.93; advance provision group: OR, 1.10;95% CI, 0.66-1.84, P=.71) or increase in STIs (pharmacy access group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P=.73; advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P=.79). There were no differences in patterns on contraceptive or condom use or sexual behaviors by study group. Conclusions While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics. (author's)
Exercising exit, voice and loyalty: a gender perspective on transnationalism in Haiti.
This article explores gendered patterns of migration and transnationalism in Haiti. A combination of factors has prompted extensive rural-urban migration and emigration over the last three decades: violence, repression, economic collapse and the implementation of neo-liberal reforms have left many Haitians with few options other than to seek a new life elsewhere. Although many Haitians abroad naturalize and take citizenship in host countries, emigration does not mean that ties to their homeland are severed. Indeed, a substantial number of Haitians remain intimately connected to Haiti, visiting, sending remittances and gifts, investing in land and exercising political voice in Haiti and in their country of residence. This article focuses on the gender dimension of Haitian migration and transnationalism drawing on Hirschman's typology of exit, voice and loyalty. These options are uniquely gendered. Although most analyses of transnational citizenship focus on men, women and women's movements in Haiti have also benefited from transnational organizing and the transnational links forged over the past three decades. Through migration, women have participated in changing the financial architecture and political landscape of Haiti. Expressions of voice and loyalty by women are challenging traditional gender roles in Haiti and contributing to an emerging transnationalism that has profound effects on Haitians and their communities at home and abroad. (excerpt)
In order to better understand both the global and local contours and impact of transnationalism as a political and cultural force, this article suggests the need for an exploration of shifting gender roles and expectations as they are becoming manifest in situated arenas. The awkwardness of transposing an international rights discourse into local communities and settings deeply infused with tradition, or onto grassroots nationalist movements that work to resist foreign impositions is a widely recognized concern. At the same time, the influence of diaspora populations is seen to leaven and situate global discourse for local movements in a sending country and translates more local interests into global concerns in important and effective ways. Transnational feminist discourse now often concerns itself with the different strategies employed by diasporas, the strategic uses of global discourse, and the meaningful efforts to resist it. Through illustrations drawn from a study of women refugees in El Salvador, the Haitian democracy movement, and a rural Brazilian women's organization, this article links the experience of transmigration to women's mobilizing efforts and the proliferation of rights discourses. (author's)
Resettlement, rights to development and the Ilisu Dam, Turkey.
A cursory attempt to measure the extent of displacement over the past two decades indicates significant increases in conflict-induced displacement and displacement resulting from development projects. At the same time a growing opposition to the latter form of displacement has raised questions over its legitimacy through a variety of media, including public campaigns and protests. This article focuses on some of the challenges that this presents to the displacement and resettlement discourse. In particular it considers the influences of the rights to development agenda on the spatial context of displacement and its associated economic and political changes. There appears to be a disjuncture between the practices of mainstream development, which tend to interpret development policy as it is defined and applied by a nation state and to assess inequalities within clear geographical definitions, and the universality of a rights based approach to development. This article examines these tensions in the context of displacement and resettlement management, drawing on evidence from a case study of the Ilisu dam in South East Anatolia, Turkey. (author's)
Organizing the unorganizable: unions, NGOs, and Indonesian migrant labour.
There has been little engagement between the organized labour and labour migration literatures. Studies of organized labour movements in Asia have traditionally focused on trade unions that organize workers in factories, in offices, and on the plantations of the countries in which those unions are based, or on international cooperation between such unions. Studies of migrant labour, on the other hand, have tended to emphasize the demographic features of labour migration flows, or the experiences of migrant workers in either their country of origin or their host society. Yet, with the help of local and international non-governmental organizations (NGOs), migrant workers from countries such as the Philippines and Indonesia are beginning to organize both at home and abroad. This article examines the emergence and operation of both migrant labour NGOs and migrant labour associations from a labour movement perspective. It focuses on the schism between the literature on labour migration, in which descriptions of migrant labour NGOs most often appear, and the literature on organized labour, which has generally ignored both the incrcasing significance of temporary overseas labour migration and the role of non-union bodies in the organization of labour. Exanlples from Indonesia and Hong Kong Special Administrative Region of China (herinafter Hong Kong) are used to argue that the experiences of migrant labour NGOs and migrant labour associations should be taken more seriously by trade unions and by the scholars who study them. (author's)
Rights of foreign workers and the politics of migration in South-East and East Asia.
The issue of cross-border migration in South-East and East Asia is linked to the integration of regional, if not global, labour markets. The types of labour that arc currently in demand have changed substantially since the 1990s in terms of (1) overall magnitude, (2) gender composition, and (3) increased diversification. This paper, however, focuses upon those workers classified as unskilled as they constitute numerically the largest and most vulnerable group. The challenges to provide adequate protection from, and prevention of, exploitative and abusive practices that seriously minimize the socio-economic benefits for these workers are linked to migration policies and the issue of rights in the origin and destination countries. This paper's objective is to provide a broad outline of the emerging trends and issues revolving around contemporary cross-border labour migration and the politics of migrants' rights in South-East and East Asia, illustrated by the difficulties experienced with the ratification of the 1990 United Nations Convention on the Rights of All Migrants and their Families (ICMR). The data this paper is based upon were collected for a report commissioned by the United Nations Educational, Scientific and Cultural Organization (UNESCO) with fieldwork carried out in seven countries located in the Asia Pacific region. It is argued that ratification of the ICMR is obstructed by politics and by a lack of political will. A rights-based approach to the protection of migrant labour is thus related to a number of macro and micro level issues, revolving around development and practices of "good governance" in addition to interstate relations. This means that the promotion of migrants' lights requires a holistic approach addressing national and transnational issues in an era of increasing mobility across border (author's)
The trafficking of migrant workers: what are the links between labour trafficking and corruption?
Trafficking in human beings, including the trafficking of persons for migrant labour exploitation is a violation of human rights. Yet what is often neglected in deliberations on the situation of trafficked migrant workers is the existence of the overarching discourse of universal human rights protecting all workers, regardless of situation, exploitation, or legal status. International human rights standards do offer protection to migrant workers that ought to be more widely applied. Yet there remains reluctance by states to offer trafficked migrant workers little more than scant protection for fundamental rights. Attempting to locate and describe the subject of labour trafficking is currently conducted at the peril of simplifying the issues to a few basic and inadequate descriptions. While it is speculated that the worker subjected to labour trafficking is multifaceted, distinct features are largely unknown. The limitations in drawing conclusions are primarily due to a lack of data on the number and circumstances of trafficked migrant workers. This paper will also analyse how and where corruption oils the wheels of trafficking networks. It is suggested that a symbiotic relationship between corruption and trafficking exists, a relationship that both increases risks for migrant workers and facilitates the processes of trafficking of people for labour exploitation. Consequently it should be crucial that any analysis of labour trafficking allocates significant resources to identifying the particulars of a possible relationship between trafficking and corruption. However, to the detriment of holistic strategies to understand and combat labour trafficking, corruption is yet to be named and targeted in most antitrafficking statistical research or policy studies. This paper concludes with a summary of three sets of recommendations on approaches to address labour trafficking, and in part address the corruption that intersects with labour trafficking. (author's)
The AIDS epidemic and migrants in South Asia and South-East Asia.
Migrant vulnerability to AIDS is an important public health care issue. After having listed some characteristics of the epidemic in Asia and their link with migration, the article describes some of the disease's consequences on economic sectors that employ migrants and lists preventive measures (regulatory, sectoral, microeconomic) that have been taken to counter the spread. (author's)
Nationality matters: SARS and foreign domestic workers' rights in Taiwan Province of China.
Taiwan suffered the third largest national outbreak of Severe Acute Respiratory Syndrome (SARS) during the first half of 2003. A crisis often illuminates issues of power and control, and the SARS crisis highlighted important patterns in Taiwan's utilization of foreign labour in general and foreign domestic labour in particular. Firstly, inequalities between Taiwanese citizens and non-Taiwanese migrant domestic workers were both magnified and illuminated at the level of nation and at the level of household in terms of confinement. Secondly, the generalization and intensification of existing patterns of abuse resulted in this abuse coming to light in the public arena. Notably, these issues only became known when they were brought to the attention of both the public and the state, and this occurred largely through the actions of Filipina domestic workers via the media and non-governmental organizations (NGOs). The reason that such issues could be brought into the open for public debate was a matter of nationality. Importantly, the epidemic served to articulate the issue of the differential access of migrant domestic workers to information about their rights and the range of factors that facilitate or impede such access. This paper explores the centrality of issues of nationality to understanding the migration experiences of Indonesian and Filipina domestic workers in Taiwan by considering how SARS played out for them in terms of their occupational location, their national background, their access to support and information networks regarding rights, and their official representation. The paper seeks to expand our understanding of the experiences of migrant domestic workers in Taiwan by means of my research on Indonesian domestic workers. However, I would argue that this case study is not just an empirical curiosity but that it is instructive in a broader theoretical sense. Understanding the nationality issue stands at the core of understanding the diversity of experiences of migrant domestic workers in any given geographic and temporal location. If we combine this factor together with the key variables of the relationship to the state and the relationship to the employer, as Bridget Anderson (2000) suggests, we move closer to a more incisive and less reductionist understanding of the factors which shape the living and working conditions of migrant domestic workers. (author's)
An outbreak of malaria in US Army Rangers returning from Afghanistan.
Context With numerous US military personnel currently deployed throughout the world, military and civilian health care professionals may encounter imported malaria from this population. Objective To identify malaria in US Army personnel deployed to a combat zone. Design, Setting, and Patients Case series in the US Army health care system. A total of 38 cases of malaria were identified in a 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002. Main Outcome Measures Identification of malaria cases and soldiers' self-report of compliance with antimalarial measures. Results A total of 38 patients were infected with Plasmodium vivax, yielding an attack rate of 52.4 cases per 1000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia. One case was complicated with acute respiratory distress syndrome during the patient's primary attack and a spontaneous pneumothorax during relapse. This care accounted for 1 of 2 relapse cases in the study population. From an anonymous postdeployment survey of 72% (521/725) of the task force, the self-reported compliance rate was 52% for weekly chemoprophylaxis, 41% for terminal (postdeployment) chemoprophylaxis, 31% for both weekly and terminal chemoprophylaxis, 82% for treating uniforms with permethrin, and 29% for application of insect repellent. Conclusions Delayed clinical presentation can occur with P vivax. Symptoms are often vague, but malaria should be included in the differential diagnosis for soldiers returning from an endemic region. Suboptimal compliance with preventive measures can result in a malaria outbreak. (author's)
Lymphadenopathy, pneumonia, and HIV-a common trio, an uncommon outcome.
In August, 2002, a 4-year-old African child presented with neck swelling. He had large, tender cervical lymph nodes, generalised lymphadenopathy an left lower lobe bronchopneumonia. A Mantoux test was negative. Consent for HIV testing was declined by his mother and he was lost to follow up after a course of antibiotics. In January, 2003, he presented with cough, weight loss, and diarrhoea. His mother was being treated for pulmonary tuberculosis (TB). He had oral thrush, generalised lymphadenopathy, 3 cm hepatomegaly, right lower lobe consolidation, and a positive (13 mm) Mantoux test. His haemoglobin was 7.0 g/dL and he was HIV-1 seropositive. Gastric washings were negative for acid fast bacilli. In the setting of generalised lymphadenopathy, a positive Mantoux, and a tuberculous contact, he was started on anti-TB drugs an augmentin. (excerpt)
Context Legislation has been proposed that would mandate parental notification for adolescents younger than 18 years (minors) obtaining prescription contraception from federally funded family planning clinics. Objective To determine the extent to which parents are currently aware that their teenage daughters are accessing reproductive health services and how minors would react in the face of mandated parental involvement laws for prescription birth control. Design, Setting, and Participants A total of 1526 female adolescents younger than 18 years seeking reproductive health services at a national sample of 79 family planning clinics were surveyed between May 2003 and February 2004. Main Outcome Measures Proportions of minor females who reported that a parent or guardian was aware that they were at the family planning clinic and, under conditions of mandated parental involvement, proportions of minors who would access prescription contraceptives at family planning clinics or engage in unsafe sex. Results Sixty percent of minors reported that a parent or guardian knew they were accessing sexual health services at the clinic. Fifty-nine percent of all adolescents would use the clinic for prescription contraception even if parental notification were mandated. This response was less common (29.5%) among adolescents whose parents were unaware of their clinic visits and more common (79%) among those whose parents were aware. Many adolescents gave more than 1 response to mandated parental involvement. Forty-six percent would use an over-the-counter method, and 18% would go to a private physician. Seven percent said that they would stop having sex as one response, but only 1% indicated this would be their only reaction. One in 5 adolescents would use no contraception or rely on withdrawal as one response to mandated notification. Conclusions Most minor adolescent females seeking family planning services report that their parents are aware of their use of services. Most would continue to use clinic services if parental notification were mandated. However, mandated parental notification laws would likely increase risky or unsafe sexual behavior and, in turn, the incidence of adolescent pregnancy and sexually transmitted diseases. (author's)
Women shoulder growing HIV / AIDS burden.
The rapidly changing face of HIV/AIDS reflects a collection of diverse epidemics throughout the world that increasingly affects women and populations in Asia and Eastern Europe. In a recent report, released days before World AIDS Day on December 1, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization warned that the pandemic cannot be tamed without expanded prevention programs and changes in social norms that currently deprive women of basic rights in many developing countries. "In every single region, the percentage of women among people living with HIV is going up," said Peter Piot, MD, PhD, executive director of UNAIDS. "We have to put women at the heart of the response to AIDS if we want to stop this epidemic." (excerpt)
Introduction of routine HIV testing in prenatal care -- Botswana, 2004.
In 2003, approximately 37% of pregnant women in Botswana (2001 population: 1.7 million; approximately 40,000 births per year) were infected with human immunodeficiency virus (HIV). Since 2001, all prenatal clinics in Botswana have offered HIV screening and interventions for prevention of mother- to-child transmission of HIV (PMTCT), which can decrease vertical transmission of HIV from 35%-40% to 5%-10%. Historically, HIV testing in Botswana has been performed after individual pretest counseling, with patients actively choosing whether to be tested (i.e., an "opt-in" approach). In 2003, 52% of pregnant women receiving prenatal care nationwide learned their HIV status. In 2004, to increase use of free national PMTCT and antiretroviral treatment (ARV) programs, Botswana began routine, noncompulsory (i.e., "opt-out") HIV screening in prenatal and other health-care settings. Concerns have been raised that routine testing in Africa might deter women from seeking prenatal care and might result in fewer women returning for their test results and HIV care after testing. (excerpt)
Background Raised HIV viral load in blood has been associated with accelerated disease progression and increased transmission of infection. To assess the effect of Plasmodium falciparum malaria on concentration of HIV in blood, we did a prospective cohort study in Malawi. Methods We recruited 367 HIV-1-infected adults. Among 334 people aparasitaemic at baseline, 148 had at least one malaria episode during follow-up and received antimalarial treatment. Of these, 77 had HIV-1-RNA measurements at baseline, during malaria, and post- malaria. We used linear regression with generalised estimating equations to assess effect of four definitions of malaria (any parasitaemia, parasite density =2000/µl, febrile parasitaemia, and febrile parasitaemia with parasite density =2000/µl) on changes in log HIV-1 RNA, overall and by baseline CD4 count. Finding With malaria defined as any parasitaemia, HIV-1-RNA concentration almost doubled between baseline (median 96 215 copies per mL) and malaria (168 901 copies per mL), a 0.25 (95% CI 0.11-0.39) log increase in mean RNA concentration. HIV-1-RNA concentration fell to median 82 058 copies per mL by about 8-9 weeks post-malaria. Increases in HIV-1-RNA were greatest for people with fever, parasite density 2000/µL or greater, and CD4 count more than 300 cells per µL, in whom concentrations rose from median 38 483 copies per mL at baseline to 196 098 copies per mL during malaria, a mean log increase of 0.82 (95% CI 0.55-1.10, p<0.0001), and fell to median 75 331 copies per mL post- malaria. People who remained aparisitaemic showed no changes in HIV-1-RNA concentration. Interpretation HIV-infected individuals with malaria have a significantly increased viral load, which might enhance HIV transmission and accelerate disease progression. (author's)
Mammographic breast density associated with postmenopausal hormone replacement therapy.
Objective: To study the mammographic density changes associated with three different regime of hormonal replacement therapy (HRT): either estrogen alone or estrogen in cyclic or continuous combination with progestogens in a patch rout. Subject and methods: Base line mammographic density was recorded for 100 postmenopausal women and after 1 year of administration of HRT. HRT therapy was in form of estrogen compound only (n = 25), estrogen in cyclic (n = 30) or continuous (n = 45) combination with progesterone. Mammographic density was quantified according to the Wolfe classification (1976). Results: An increase in mammographic density was more common among women receiving continuous combined HRT (57.8%) compared to cyclic (33.3%) and estradiol only (8%) treatment with significant difference between the three groups. Breast discomfort was more frequent (20%) among women using continuous combined regimen compared to (13.3%) and (8%) in cyclic combined and in estrogen only regimen respectively. Conclusion: Regime of HRT had different effect on mammographic density. The most density increase was associated with estrogen in continuous combination with progesterone. The least impact on mammographic density was with estrogen alone treatment. (author's)
Minimal wound closure at cesarean section.
Background: During the last years, the rate of cesarean deliveries is increased in most of countries, a lot of efforts were directed towards simplification of the operative technique of cesarean section to reduce the total costs and to keep it as safe as the traditional technique. Aim: To evaluate whether an alternative method in wound closure (minimal wound closure) at cesarean delivery would be more advantageous especially regarding operating time, postoperative morbidity and hospital stay. Patients and methods: A prospective randomized trial including 218 women undergoing lower segment cesarean section through a Pfannenstiel incision in Ain Shams University Maternity Hospital (approximately 10000 deliveries annually). All women were randomly allocated to two groups, Group I (control group, n = 110) underwent a standard operative technique in wound closure, Group II (study group, n = 108) underwent minimal wound closure with a modification in the operative technique where the transverse uterine incision was closed with a continuous, locking one layer closure, and both layers of the peritoneum (visceral and parietal) were left unsutured. Results: The mean operating time was 28 minutes in the study group comparing with 40 minutes in the control group (P < 0.001). There were significant difference regarding postoperative pain and needs to analgesia with advantage to minimal wound closure group (P = 0.002). Postoperative febrile morbidity were significantly reduced in minimal wound closure group (P = 0.04). There were a highly significant different in postoperative mobilization and resuming intestinal function (P < 0.001). Postoperative hospital stay was about one day less in minimal wound closure group (P < 0.001). The incidence of wound infection and intraoperative blood loss showed non significant statistical difference between the two groups. Conclusion: Minimal wound closure at cesarean section is considered to be as safe as the traditional closure but simpler to perform, beneficial to the obstetricians, patients and is associated with less costs. (author's)
Involuntary unemployment and mortality in Taiwan.
Background and Purpose: Unemployment is known to be associated with increased mortality, but little data is available from Taiwan, where dramatic structural changes in the economy have increased unemployment in recent years. The aim of this study was to investigate the effect of unemployment on mortality in Taiwan. Methods: The study design was a cohort study with a control group. The unemployed group included 92,563 involuntarily unemployed individuals in 2001. Those in the control group (n = 92,599) were randomly selected from 1,230,000 employees, and matched with those in the unemployed group, by age, gender, income, firm size and urbanization, using a frequency matching mechanism. All subjects were followed during the period from January 2001 to December 2002. The adjusted hazard ratio was estimated using the Cox proportional hazards model. Results: After adjusting for other factors, unemployment was associated with a higher risk of mortality (hazard ratio, 1.99; 95% confidence interval [CI], 1.60-2.48). The gender-specific adjusted hazard ratios for unemployment were 2.07 (95% CI, 1.59-2.70) for men and 1.82 (95% CI, 1.22-2.69) for women. Unemployed men had a significantly higher mortality risk for cardiovascular disease, digestive system diseases, all other diseases (except for cancer, digestive system and cardiovascular diseases), and other external causes (not including suicide) than men who were employed. In contrast, unemployed women had a significantly higher mortality risk only for other diseases, compared women who were employed. Conclusion: Unemployment is an important risk factor for mortality in Taiwan. The long-term impact of unemployment on mortality in Taiwan remains to be explored. (author's)
Peritoneal non-closure at cesarean section.
Background: It has been suggested that peritoneal closure can be omitted while performing cesarean section, without adverse effects. Objectives: The objective of this study was to assess the direct effects of nonclosure as an alternative to closure of the peritoneum in our institute, on intraoperative and immediate post operative outcomes. Study Design: The setting was at Menofiya University hospitals, starting May 1999 to September 2000. A single blind randomized controlled study was performed on 200 women undergoing cesarean section for different reasons. One hundred of them were allocated as the control group with peritoneal closure, and the other hundred patients were the study open group. The main outcome measures were the operative time, postoperative pain and infection. The postoperative management was made without reference to the treatment group. Statistical analysis compared the intraoperative and the postoperative out come between the compared groups. Results: None closure of the peritoneum saved the operating time and anesthesia time. There were no significant differences in postoperative morbidity, analgesic requirements or the length of hospital stay. (author's)
Efficacy and safety of glyceryl trinitrate versus ritodrine for preterm labor.
Objective: To compare the efficacy of tocolysis with glyceryl trinitrate (GTN) patch and intravenous ritodrine hydrochloride with respect to maternal side effects and neonatal outcome. Subjects and Methods: 57 singleton pregnancy with preterm labor and intact membrane between 28 and 34 weeks gestation were assigned randomly to receive either GTN patch (n = 27) or ritodrine hydrochloride infusion (n = 30). The principal outcomes assessed were prolongation of pregnancy for 48 hours, 7 days and until 34 weeks of pregnancy & maternal side effects and neonatal outcome. Results: Both GTN and ritodrine treated women were comparable in entery variable including age, parity, gestational age, contraction frequency and cervical dilatation & effacement. Delivery of women was delayed for 48 h, 7 days and until 34 weeks gestation in 77.8%, 59.2% and 44.4% of women respectively treated with GTN compared with 73.3%, 56.7% and 43.3% respectively among women received ritodrine (no significant difference). Average number of the side effects per patient was significantly (P <0.01) lower with GTN treatment than ritodine therapy. The neonatal outcome was similar in the two treatment regimens. Conclusion: GTN was as effective as ritodrine in suppressing preterm labor. Its use was associated with less frequent side effects. (author's)
Tracheoesophageal fistula is an uncommon complication usually associated with chronic usage of ventilator and pressure necrosis of the tracheoesophageal wall. A 56-year-old female patient with severe acute respiratory syndrome (SARS) with tracheoesophageal fistula is reported. She was intubated for ventilatory support 3 days after admission because of progressive respiratory distress. Methylprednisolone pulse therapy followed by a maintenance dosage was given due to persistence of bilateral pulmonary fibrosis. Thirty three days after admission, she underwent tracheostomy because of difficult in weaning from the ventilator. Ten days after tracheostomy, she developed tracheoesophageal fistula, which was confirmed by bronchoscopy and panendoscopy. Tracheal resection and primary repair for the esophageal defect was performed via a cervical incision combined with partial sternotomy. She was weaned from the ventilator soon after the surgery and discharged 34 days after the operation. In SARS patients with persistent pulmonary fibrosis and under prolonged corticosteroid treatment, special care should be given to avoid intubation-related tracheal injury during the period of ventilatory support. The tracheoesophageal fistula, once developed, can be repaired in a single stage after improvement of the nutritional status. (author's)
Assessment of the factors that influence the effectiveness of intrauterine insemination.
Objective: To determine the factors influence the outcome of intrauterine insemination. Study Design: A prospective study of the outcome of 1120 consecutive intrauterine insemination cycles. Total of 224 women participated in this study over a period from March 1997 to September 1999. They were recruited from the infertility outpatient clinic, department of obstetrics and gynecology, Ain Shams University. Women were alternatively assigned to receive intrauterine insemination or super-ovulation plus intrauterine insemination. Results: The use of controlled ovarian hyper-stimulation and IUI yielded higher pregnancy outcome then IUI in non-stimulated cycles (p < 0.0001). The pregnant cycles occurred when the woman was younger (p < 0.01), when the ovaries showed at least 2 follicles in response to the stimulation protocol (p < 0.05). Conclusion: The main factors that influence the results of intrauterine insemination protocols are patient age, the number of follicles at the time of intrauterine insemination, and sperm motility in the inseminate. (author's)
Perinatal outcome in relation to the duration of the second stage of labor.
The second stage of labor has been thought of as a time of particular asphyxial risk for the fetus. The perceived risk has been invoked to justify arbitrary time limits and high rates of operative vaginal delivery. The aim of this study was to determine whether perinatal outcome worsened as the second stage of labor lengthened. Over 1 year period, 300 nulliparous women reached the second stage of labor with a live singleton cephalic fetus with birth weight ň22500 gm. The perinatal morbidity and mortality was related to the duration of the second stage of labor. The second stage lasted > 2 hours in 3.33% of nulliparous women and > 2.5 hours in 0.66%. There was no significant relationship between second stage duration and low 5-minutes Apgar score, neonatal seizures, or admission to the neonatal intensive care unit. The present study reached a conclusion that operative intervention in the second stage of labor is not warranted merely because some set number of hours has elapsed. (author's)
A new antibiotic shows promise for treating tuberculosis (TB) more swiftly than current anti-TB drugs, according to research by scientists in Belgium, France, Sweden, and the United States. The study was published on December 9 in an online edition of Science (http://www.sciencemag.org). The drug, called R207910, belongs to a newly discovered family of compounds called diarylquinolines and appears to have a mechanism of action that differs from that of other antibiotics used to treat TB or other infections, impeding the cell's ability to produce energy in the form of adenosine triphosphate. Cell culture studies found that R207910 potently inhibits both drug-sensitive and drug-resistant TB bacteria, the researchers reported. (excerpt)
China's infamous one-child policy.
Your Sept 11 Editorial (p 909) refers to China's "infamous one-child policy", without acknowledging that without it conditions of life for the country's 1-3 billion people would have been much worse. In theory, one-child families should only be necessary in certain circumstances. These are: (a) that a community has outgrown the carrying capacity of its ecosystem or is about to do so, and (b) that there is nowhere for people to migrate to, and (c) that a country has too few exports to exchange for food and other essentials. Known as demographic entrapment, these circumstances invariably result in severe poverty, starvation, and violence; the only response is for a community to limit its fertility radically. As such, China's one-child policy saved 200-400 million people, and was the only rational solution to what the country perceived as its "grain problem" in the face of its rapidly increasing population. (excerpt)
Pesticides posing hazards to wildlife reproduction.
Many pesticides possess the ability to disrupt the reproductive hormones, and thereby pose a hazard to wildlife. This paper reviews a number of these pesticides and their modes of action. In some cases, the effects in laboratory animals are outlined in order to highlight the possible effects in the wild, but for some pesticides, effects in wildlife are noted. (author's)
Smoking during pregnancy: an association with low birth weight infants.
Objective: To evaluate the association between smoking during pregnancy and preterm birth and birth weight deficits. Study Design: In this study, two hundred women in spontaneous labor were randomly selected Tobacco exposure was assessed from maternal serum samples and from umbilical serum samples obtained at delivery, by measuring the concentration of nicotine metabolite, cotinine. The main outcome measures were gestational age and birth weight. Results: cotinine (>6 µgL/l was detected in either maternal or umbilical serum in 49 pregnancies, and these mothers and newborns were classified as exposed. Tobacco exposure was associated with shorter gestational age and reduced birth weight of the newborns. After correction for parity, gender, and gestational age, the exposed newborns were on average 188 grams (95% confidence interval ((CI) 123- 253 grams) lighter than the nonexposed newborns. Conclusions: Smoking increases the risk of preterm birth and birth weight deficits. There is a quantitative dose and effect relation between tobacco exposure and a decrease in the gestational age and weight at birth. (author's)
Chlamydial infection in cases complaining of idiopathic infertility in Port Said.
The role played by asymptomatic chlamydial infection in the etiology of unexplained infertility was the subject of this study which was conducted on 200 cases divided into two groups and selected from those attending the outpatient clinic and family planning clinic of El-Nasr General Hospital, in Port-Said governorate. An endocervical swab was taken with the brush technique during the post-menstrual phase of the cycle. Swabs were immediately fixed and examined for chlamydial inclusion bodies in the endocervical cells using the immuno- flourescent technique. The results of this study showed that asymptomatic chlamydial infection was encountered in 21% of cases of the control population. The difference between the two groups was statistically significant. (author's)
Objective: To determine between intrauterine (IUI) or Intraperitoneal insemination (IPI) combined with superovulation, as a better therapy for treating unexplained infertility before approaching more sophisticated assisted reproduction techniques. Design: A prospective randomised study of ninety-three couples with unexplained infertility. Setting: El-Galaa Maternity Teaching Hospital and a private clinic. Subjects: Ninety-three partners with unexplained infertility were divided at random into two groups. Group (A; n=60) and group (b; n=33) were treated by IPI and (IUI) respectively following controlled ovarian hyperstimulation. A total of 200 treatment cycles in both groups were studied. Outcome measures: Pregnancy rates (PR) per cycle and per couple, pregnancy outcome and complications of treatment. Results: 26 pregnancies occurred with 128 cycles of IPI and 7 pregnancies with 72 cycles of IUI, giving an overall PR of 35.4%. Pregnancy rates with IPI were 20.3% per cycle and 43.3% per couple compared to 9.7% per cycle and 21.2% per couple with IUI giving a significant statistical difference (P=0.0214). There were no significant statistical differences between the IPI and IUI groups with regard to abortion (26.9% and 28.6%), ectopic pregnancy (3.8% and 0%) and multiple pregnancy rates (15.4% and 14.3%; all twins) respectively. One patient only in the IPI group developed mild ovarian hyperstimulation syndrome and none in both groups had pelvic infection. Conclusion: This study shows that in the treatment of couples with unexplained infertility, IPI is more successful than IUI. It is safe, relatively inexpensive and can be performed as an office-procedure. We advise that it should be attempted before resorting to the costly, invasive and complicated assisted reproductive techniques such as GIFT, IVF and ICSI. (author's)
Aim of the Study: The purpose of the study is to determine the value of use of level of vaginal pH in diagnosis of bacterial vaginosis, menopausal Status and in monitoring the effect of hormone replacement therapy in menopausal women. Study design: Vaginal pH levels were determined in 250 patients from the attendants of outpatient clinic El Minia university hospital using the phenophthazine (Nitrazine paper. All the patients were exposed for speculum examination and were not pregnant. Vaginal cultures were done for 50 premenopausal women under aerobic conditions. Determination of the level of estradiol and FSH in serum of 25 premenopausal and 25 of menopausal women was done for correlation with vaginal pH levels in absence of vaginal complaints. Ten menopausal women were exposed for determination of the vaginal pH value before and after starting a course of hormone replacement therapy in the form of prempack/c (conjugated estrogen and norgestrel) for two months. Statistical analysis using the chi-square, the mean value, the P value and the standard deviation was setting in El Minia university hospital. Results: Vaginal pH was elevated in all patients with bacterial vaginosis and the pH varied from 5.0- 5.9. Serum estradiol levels showed an inverse relationship with vaginal pH while serum FSH showed a direct relationship with the level of vaginal pH in absence of bacterial vaginosis. In the presence of hormone replacement therapy, vaginal pH showed a marked decrease after previous elevation in menopausal women. This decrease was statistically significant. Conclusion: Measurement of vaginal pH is an easy, effective and nearly costless method for diagnosis of bacterial diagnosis and the occurrence of menopausal status in absence of bacterial vaginosis or vaginitis. A vaginal pH of 4.5 is consistent with a premenopausal serum estradiol level and the absence of bacterial vaginal pathogens. An elevated vaginal pH in the range of 5 - 6.9 suggests the diagnosis of vaginal pathogens in premenopausal women. A level of vaginal pH of 5 - 6.5 in absence of bacterial vaginosis suggests decreased level of estradiol, elevated level of FSH and occurrence of the menopause. Vaginal pH can be used as a method of monitoring the effect of hormone replacement therapy in menopausal women. (author's)
Ethics in family health [editorial]
The World Health Organization defined "reproductive health" as a condition in which the reproductive process is achieved in a state of complete physical, mental and social well-being and that it is not simply the absence of disease. Later, the term "Women's Health" was introduced to emphasize another concept namely that reproductive health should not be limited to mothers or to women in the child-bearing age, but should extent to include the different phases of women's life: infancy, adolescence, the reproductive age as well as the postmenopausal life. Now we speak about "family health" to highlight the fact that women's health cannot exist in isolution from that of her children, and also to acknowledge that men -too- have reproductive health needs that should be fulfilled so as to achieve reproductive health. (excerpt)
Objective: The study was conducted to evaluate the value of transvaginal color Doppler ultrasonography of the uteroplacental circulation in predicting pregnancy outcome in women with threatened abortion during the first trimester of pregnancy. Design: Prospective study. Setting: Cairo University hospital. Subjects and Methods: 48 patients with threatened abortion of 7 to 11 weeks were prospectively evaluated. Transvaginal color Doppler ultrasonography was used to locate the retrochorionic arteries and to visualize blood flow within the intervillous space. Doppler shift spectra from the retrochorionic arteries were recorded and the resistive index (RI) of the retrochorionic vessels was calculated. If active blood flow was seen within the intervillous space it was located and recorded. Results: Abnormal color Doppler findings were associated with a significantly higher prevalence of abortion. The resistive index (RI) of the retrochorionic vessels was significantly higher in pregnancies ending in abortion. Also the presence of intervillous blood flow was significantly increased in gestational sac that end in miscarriage. Conclusion: Transvaginal color Doppler ultrasonography is an appropriate, non-invasive diagnostic method to evaluate the integrity of the uteroplacental circulation during early pregnancy. Abnormal color Doppler signals can be used to predict the outcome of first trimester gestations in women with threatened abortion. (author's)
Screening for postnatal depression by antenatal questionnaire.
Objective: Whether antenatal psychosocial assessment of childbearing women would identify those at risk for postpartum depression. Methods: 400 Pregnant women were included in this study starting from early pregnancies (8 weeks). During routine antenatal care visits the women asked to repeat the general health questionnaire (GHQ) at 10 weeks, 20 weeks, and 34 weeks gestation. After 3 days of the delivery, the women were interviewed again and asked to repeat GHQ and Edinburgh postnatal depression scale (EPDS). The women were assessed at 6 weeks postpartum. Results: Screening for liability to postpartum depression identify: 1. Postnatal mental illness affects 10% of all mothers. 2. Mother's mood with 3 days of delivery was the best predictor of later postnatal depression. 3. More than 50% of the cases of the first onset major depression are associated with earlier presence of minor depression during pregnancy. 4. Other women develop the illness for the first time postpartum. Conclusions: Attention to emotional and mental health must be an important aspect of antenatal care. The obstetrician must be aware of the patient's psychiatric condition. The indication for psychiatric consultation must be familiar to any obstetrician. (author's)
Objective: To evaluate the predictive value of Doppler ultrasound studies of the uterine arteries in pregnancy, in identifying pregnant women at risk of subsequently developing pre-eclampsia, or the delivery of a small for gestational age infant. Design: Prospective cohort study. Population: 53 women with singleton pregnancy at high risk for developing pre-eclampsia. Methods: Measurements included S/D ratio, resistance index and timed averaged mean velocity starting at 24 weeks gestation and monthly thereafter. Main outcome measures: Pre-eclampsia and birth weight. Results: 25 women developed pre- eclampsia. There was no significant relation for resistance index between both groups. The S/D ratio showed just a significant relation at 28 weeks gestation, and tendency to significance at 36 weeks gestation between the two groups. There was a limited significant relation for A. vel at 32 weeks gestation (P<0.05). There was no significant relation regarding birth weight, Apgar score at one hand and five minutes between both groups. Conclusion: Uterine artery Doppler velocimetry waveform analysis does not qualify as a reliable screening test for pre-eclampsia or low birth weight for gestation. Measurement of S/D ratio at 28 weeks might improve the predictive value of the test. (author's)
Prepregnancy health status and the risk of preterm delivery.
Background: Despite extensive evaluation, our understanding of risk factors for premature delivery is incomplete. Objective: To examine whether a woman's health status and risk factors before pregnancy are associated with a woman's risk of preterm delivery, independent of risk factors that occur during pregnancy. Design, Setting, and Participants: Prospective cohort of pregnant women in the San Francisco Bay area who delivered a singleton infant (n = 1619). Main Outcome Measure: Preterm delivery (<37 weeks' gestational age). Results: Sociodemographic characteristics alone explained 13.0% of the risk of preterm delivery, whereas risk factors that occurred before pregnancy explained 39.8% and risk factors that occurred during pregnancy explained 47.1%. After we adjusted for sociodemographic characteristics, prepregnancy risk factors, and pregnancy risk factors, women who reported poor physical function during the month before conception were nearly twice as likely to experience a preterm delivery (odds ratio, 1.97; 95% confidence interval, 1.18-3.30) as women with better physical function. Conclusion: A broader focus on the health of women prior to pregnancy may improve rates of preterm delivery. (author's)
This study examines child-bearing, new sexual partnerships, disclosure of HIV status prior to coitus, and negotiations on condom use among HIV infected, uninfected and unaware persons as the basis for ascertaining the group at high risk of HIV infection/re-infection. HIV infected (86 females and 58 males), HIV uninfected (25 females and 21 males) and HIV unaware (59 males and 40 females) persons were drawn from one parish of Kampala, Iganga, Soroti, Lira, Masaka, Mbarara and Kabale districts. A pre-tested questionnaire which yielded a content validity index (CVI) of .79 was used to measure childbearing, new sexual partnerships, disclosure of HIV status prior to coitus, negotiations on condom use for the three groups. Focus group discussions were also carried out with each group to establish the etiological basis of these behaviours. HIV infected persons (86%) reported higher levels of childbearing compared to the uninfected (66%) and unaware (57%) persons. Of the HIV infected persons who learned of their HIV status through a test, about 61% went ahead to bear children. Also, more HIV infected (44%) and uninfected persons (44%) tend to disclose to partners their HIV status prior to coitus than the HIV unaware persons (35%). However, HIV unaware and uninfected persons reported higher levels of initiation and coitus negotiations on the form of coitus (condom use) than the HIV infected (69%) and with new partners during the past year from the time this study was undertaken than the HIV infected persons. Childbearing and non-negotiation with partners on condom use turned out as the factors that increase HIV re-infection among PHAs. (author's)
The role of reproductive health providers in preventing HIV.
Reproductive health providers serve millions of women in developing countries now at the center of the global HIV pandemic and are increasingly reaching out to young people and to men. As such, they are poised to play an important role in reducing the incidence of new HIV infections over the coming years. Policymakers, donors, researchers and activists should recognize the benefits of supporting the filler integration of HIV prevention efforts with reproductive health services. (excerpt)
HIV / AIDS toolkit. Building political commitment.
This component of the Building Political Commitment for Effective HIV/ADS Policies and Programs Toolkit describes the content and importance of political commitment to effective HIV/AIDS programs. It describes political commitment as a willingness on the part of leaders to use their positions, insofar as possible, to support effective action to limit the spread of HIV and mitigate the impacts of the epidemic. This action needs to be based on a solid understanding of the nature of the epidemic and its impact on African development. National leaders include not only political and government leaders but also civil, community, private sector and business, religious, education, military, nongovernmental organization, and many other leaders. This discussion notes the important leadership role that ranking political leaders can play in combating the epidemic and the special role of government. It then gives some examples of what actions different types of leaders can take now to combat the epidemic. (excerpt)
Regional HIV / AIDS strategy for East, Central and Southern Africa, 2002-2006.
The response to the epidemic by member countries has evolved over time; however, it has not been commensurate with the magnitude of the problem. The responses thus far have been country specific as member states developed national HIV strategies and medium-term plans based on identified priorities. Though the implementation of these plans and strategies is at different stages in the various countries, the need is evident and urgent for a collective regional approach to addressing the HIV/AIDS scourge. This strategy document is the product of several regional consultations involving member states, regional organizations and international partners. It highlights the prevailing situation with regard to HIV/AIDS in the region and the context within which the problem must be addressed. The strategy analyses the strengths, weaknesses, opportunities and challenges involved. A strategic framework outlining the outputs, activities, indicators, timeframes, monitoring and evaluation is presented. In addition, the financial implications and the estimated cost of scaling up regional HIV/AIDS activities are set. (excerpt)
HIV / AIDS toolkit for local government. Revised.
The Toolkit was developed to assist Local Government in South Africa to define their role in the Partnership Against AIDS and to initiate their responses to the epidemic. The Toolkit was developed following interviews with key stakeholders from business, unions, NGOs and with Local and Provincial Government officials in KwaZulu-Natal. The interviews focused on the role of Local Government in general and in the context of the HIV/AIDS epidemic; and what Local Government would need in terms of resources, partnerships and technical assistance to mount effective responses to HIV/AIDS. (excerpt)
Ghana HIV / AIDS strategic framework, 2001-2005.
The National HIV/AIDS Strategic Framework for Ghana has been formulated in recognition of the developmental relevance of the disease. It is an issue that requires a holistic, multi-sectoral and multi-disciplinary response to confront it and bring it under control. Ghana, by this document and the bold initiatives therein outlined, has joined the global community in a united effort to combat the epidemic. Over the years, the incidence of HIV/AIDS has increased steadily and has almost reached epidemic proportions in the country. The very fact that victims of HIV are mainly in the productive ages of 25-49 years, poses a major challenge to Ghanais developmental efforts. We, therefore, have to take urgent and pragmatic steps to confront the epidemic. This- Framework provides broad guidelines for sector Ministries, Departments, Agencies, District Assemblies, the Private Sector, Non-Governmental Organisations and civil society at large, to evolve such specific HIV/AIDS strategic plans and activities as may be determined by their peculiar needs and circumstances. (excerpt)
The general goal of the AACC HIV/AIDS programme was to facilitate ways the churches in Africa especially the leadership can be better informed to enable them respond more positively to the HIV/AIDS pandemic. The specific objectives: By the end of the two Consultations it was hoped that participants should be able to: Create means/fora for sharing of accurate information on HIV/AIDS; Facilitate means/ways of sharing best practices; Identify the root causes of HIV/AIDS and suggest the ways of responding to the crisis more effectively; Develop ways/means to break the silence on HIV/AIDS; Commit themselves to practical ways of responding to the pandemic; Share the message of HIV/AIDS in Africa and among churches and partners outside of Africa. (excerpt)
HIV / AIDS in Nigeria: overview of the epidemic.
Based on population estimates and the HIV prevalence rates we estimate the size of the infected population in Nigeria. In 1990 around half a million were infected with HIV. By 2000 this had increased to 3.26 million and by 2005 it is estimated that over 4 million Nigerians will be HIV positive. The epidemic has reached the point now, where it is estimated that one person dies of AIDS every 2 mins (i.e. 800 Nigerians/day). By the end of 2002 it is estimated that more than 1.3 million Nigerians will have died of AIDS since the start of the epidemic and by 2005 an additional 1 million will die if nothing is done. (excerpt)
Regional HIV / AIDS strategy and resource mobilization plan.
At the 30th Regional Health Ministers' Conference (RHMC) held in Seychelles in October 1999, the Ministers were concerned about the gravity of the HIV epidemic and its negative socio economic consequences in the region. Accordingly, they recommended that CRHCS should work with member states in mounting an effective response to the pandemic and consider the development of a regional strategy to reduce the threat of HIV/AIDS and to bring this pandemic under control. This strategy is a response to the resolutions of the Conference of Health Ministers. This strategy document begins by summarizing the current status of the disease and its socioeconomic impact in the region. Twelve of the world's fifteen countries most heavily affected by HIV/AIDS are part of this regional health community and. In 10 out of the fifteen countries; over 10% of adults are HIV positive. (excerpt)
The Kenya National HIV / AIDS Strategic Plan, 2000-2005. Popular version.
The launch of the Kenya National HIV/AIDS Strategic Plan in December 2000 was the advent of a new phase of total war against the HIV/AIDS disaster. Since that launch, the Government has received a substantial amount of goodwill and support from all Kenyans and development partners including NGOs, the private sector and donors. The Government intends to translate this goodwill into action, to prompt a collective national response at all levels. In developing this popular version of the Strategic Plan, the Government intends to facilitate broader understanding and increased usability of the plan by implementing agencies. This summarised version of the plan provides illustrations and is laid out in a user-friendly manner. The Policy environment and the HIV/AIDS situations are highlighted with the institutional response so far mounted in various sectors and opportunities, interventions and the potential threats. The priority areas of the plan are presented graphically to enable implements to see the logical flow of objectives, strategies and activities. The roles and responsibilities of implementers are clearly spelt out with linkages and interface between and within the institutional framework brought about by the establishment of the National AIDS Control Council [NACC]. (excerpt)
Estimating national HIV prevalence in Malawi from sentinel surveillance data: technical report.
A technical working group organized by the National AIDS Commission has used the latest sentinel surveillance results for 2003 to estimate national HIV prevalence in Malawi. This report describes the methodology, assumptions and results of that work. The analysis indicates that levels of HIV infection in the adult population of Malawi have remained constant for the last seven years at 12-17 percent. The level of HIV infection among adults in urban areas is over 20 percent. HIV prevalence is about twice as high in the South as in the North and Centre. The stable prevalence at 12-17 percent does not mean the HIV/AIDS problem has gone away. Every year as many as 80,000 people are dying from AIDS and as many as 100,000 new infections occur, at least half among young people 15-24. There are some hopeful signs. The infection level among young women (1 5-24) attending antenatal clinics people in Lilongwe has declined from about 26 percent in 1996 to 16 percent today. For all adults (15-49) in Lilongwe the level of infection has declined from 26 percent in 1998 to 17 percent today. (excerpt)
In the late 1990s, reproductive health (RH) agencies began exploring alternative information communication technology (ICT) initiatives to ensure that RH information materials are transmitted in an efficient and acceptable manner. The tangible benefit of this technology is the connectivity that enhances the link between the individual requesting for information and the counselor that provides the response. Such link reduces isolation and improves knowledge sharing as information is provided, strategies discussed and experiences shared in efforts to build support for particular issues. The cell phone and message texting are deemed exciting, attractive and effective modes of information transmission. They are appropriate for inquiries since they are non-threatening and do not impose any sequence or order. It depends on the users to follow thru their own interests at their own pace. Hot lines and message texting are effective ways to reach a large audience at relatively low cost. They provide individuals with convenient, confidential, interactive and compassionate access to information, counseling and referrals and can provide a deeper understanding of the unique sexual and reproductive health needs of vulnerable groups. In addition, the ability to communicate quickly and directly by text messaging improves information and referral systems. It is more tailored to specific target audiences, more responsive to the queries of the clientele and more issue/problem oriented. While factual information is provided, it also enables the inquirer to examine his/her values, improve communication skills and help in goal-setting and decision-making. (excerpt)
Draft National HIV / AIDS and STI Policy document.
I am pleased to introduce this very important and far-reaching National HIV/AIDS and STIs Policy document on Ghana. Essentially, the Policy will address the very serious health and developmental challenges that have received the attention of governments and the world's health and scientific community. The Government of Ghana is committed to improving the health and social well-being of all of its citizens and residents. Government is also aware of the obvious threat that the Acquired Immune Deficiency Syndrome (AIDS) poses to the achievement of our national development pals enshrined in the VISION 2020 document. (author's)
Female labor force participation in the developing countries has been slow relative to that of industrialized countries were there have been significant upward trends of female labor force participation. Some developing countries have even experienced substantial declines during the past few decades. Research concerning Women and Third World Development widely support Boserup's proposition that women's economic activities are hampered in the course of economic growth, since the traditionally female dominant industries decline faster than the creation of modern industries in which men are preferred. However, this approach ignores the effects of the new international division of labor (Froebel et al., 1980) on female labor force participation in developing countries. As industrial activities increasingly become globalized, manufacturing exports became more an important source of economic development among many developing countries. Some studies (Sen, 1981; Ward, 1985) suggest that such export-led industrialization largely utilize female labor, while industrialization based on import substitution is less responsive to economic opportunities for women. This paper is intended to improve our understanding of the influence that trade strategies have on the trends in female labor force participation in 40 developing countries. We will address the basic question: Do Trade Strategies Affect Changes in Female Labor Force Participation in Developing Countries? (excerpt)
The port and harbor areas of Ghana present a challenging working environment where the risk of HIV infection is anticipated to be high. For this reason, GSMF International obtained funding from the Royal Netherlands Embassy to implement an HIV/AIDS workplace program for the port and harbor workers. The goal of the program is to reduce HIV transmission in these areas by increasing awareness about, and prevention of HIV/AIDS. Prior to implementing the project, GSMF asked CMS to conduct an assessment of the port and harbor workers and the informal sector around the port and harbor. The purpose of the assessment was to explore behavioral factors associated with the risk of HIV infection among port and harbor workers and the neighboring communities. Findings from this study will be used to guide a strategy for implementation of an HIV/AIDS work place program among the Ghana port and harbor workers. (excerpt)
The purpose of this Feasibility Study (FS) was to assess the viability of a full-scale outcome evaluation of the NIH-supported AIDS International Training and Research Program (AITRP). Our specific objectives were: to explore relevant topics and formulate follow-up in-depth questions surrounding strategic planning, program management, partnerships, and results-related issues surrounding AITRP; to examine existing data - about the grantees, trainees, and other stakeholders - to determine its sufficiency and integrity; to assess if an outcome evaluation is appropriate; to explore conventional and emerging methods that may be especially appropriate to a full-scale outcome evaluation; and, in the event a full-scale outcome evaluation is warranted, to propose a study plan and data collection approaches. The study involved a small level-of-effort - about 1,000 person-hours over a 6 month period. (excerpt)
The regular receipt of child support: a multi-step process.
In this paper, we examine factors that predict how much child support income a custodial parent receives.' Among these are characteristics of the. custodial parent, such as her race, marital status, and education; her current economic well-being, as measured by income, AFDC status, and poverty status; and information about custody arrangements and how an agreement, if any, was reached. The question of what factors determine how much child support is received encompasses several subquestions, as previous researchers have argued. Hardly anyone receives support without a support agreement -- whether reached voluntarily or through a court proceeding (Robins and Dickinson, 1984). Therefore the first question is: what factors determine whether there has been a child support award? Because the amount actually paid is highly dependent on the amount mandated by the award, the next question is: what factors determine the amount of the award? Then, given an award of a certain size: how much if any is actually received? However, the distribution of amounts paid is bimodal. A large proportion of mothers receive no payments at all; the rest receive amounts that are distributed around the award amounts, though skewed downward. Therefore we separately examine the factors that determine whether a woman receives any support and, among women receiving some support, those that determine how much is received. We also examine what factors determine how regularly child support is received among women who receive child support. (excerpt)
Fertility differentials by age and parity, European immigrant groups in the U.S. in 1905-09.
This paper examines the marital fertility of major immigrant groups in the U.S. in 1910. By focusing on how marital fertility varied by both age and parity, we demonstrate that different ethnic groups not only had different levels of fertility, they also had different patterns of control. We go beyond previous analyses of immigrant fertility in several ways. First, although previous censuses included information on country of origin, the 1910 census added information on mother tongue. Using this information permits us to define ethnic groups that reflect more accurately the cultural boundaries of 19th century Europe. Second, we are able to use number of years since immigration to confine our analysis to children born in the U.S. rather than the total children-ever-born, which includes children born in the old country as well as those born after arrival. (excerpt)
Among the many innovations and modifications in the structure of family life, the growing incidence of cohabitation without marriage is one of the most intriguing. Why would a couple choose cohabitation instead of marriage? Which couples are more likely to choose cohabitation? What evidence is there that bears on the frequency of that choice and its repercussions? These are the questions we begin to address in this paper. (excerpt)
On the occasion of the 10th anniversary of the historic International Conference on Population and Development, or ICPD, held in Cairo in 1994, the Population Institute and Population 2005 jointly hosted the Global Population Forum 2004 in Washington D.C., from 13 to 14 May 2004, with policymakers, parliamentarians, NGO and media representatives from 42 countries in attendance. The main objectives of the forum were to celebrate the successes of Cairo; recognize the continued relevance of the ICPD's forward-looking Program of Action; share the experiences of different countries and regions in program implementation, and formulate a clearer vision of directions, objectives and actions required to ensure that the goals of the Cairo will be met. While recognizing that the Cairo Conference dealt with a wide range of issues, each extremely important in its own right, the forum limited its focus to four areas: reproductive health, HIV/AIDS, migration and aging. After deliberating the priority issues specific to these four areas, the forum adopted the following Declaration. (excerpt)
Traditional protocols for depo medroxyprogesterone acetate (DMPA) initiation mandate that women start the method during the first 5–7 days of the menstrual cycle. Women who do not have their initial clinic visit during this time period are generally instructed to return to clinic during menses to begin DMPA, which often leaves them insufficiently protected from pregnancy. An alternative approach is to give women the injection immediately during the clinic visit, regardless of menstrual cycle day. In this prospective study, we evaluated a protocol for immediate DMPA initiation among 149 women who presented on cycle day 8 or later. Ninety-two percent (n =137) of subjects returned for a follow-up pregnancy test, but half of all subjects required multiple reminders to return for the visit. There were three pregnancies. Forty-seven percent (n =70) continued to a second DMPA injection or another contraceptive method within 14 weeks of their initial clinic visit. Factors associated with returning for repeat injection included satisfaction with DMPA, older age and finding it easy to return for the follow-up pregnancy test visit. (author's)
Objectives: Comparison of male condom (MC) vs. female condom (FC) with respect to self-reported mechanical and acceptability problems and semen exposure using prostate-specific antigen (PSA) as an objective biological marker and evaluation of the effect of an educational intervention on self-reported problems and semen exposure, by condom type. Design: Randomized crossover trial. Methods: Four hundred women attending a family planning clinic in Brazil were randomized and either received in-clinic instruction or were encouraged to read the condom package insert; all used two FCs and two MCs. We measured the rates of self-reported user problems with MC and FC use and the rates of semen exposure during use (assessed by testing vaginal fluid for PSA). Results: The educational intervention group reported fewer problems with either condom as compared with the control group (p=.0004, stratified by condom type). In both groups, self-reported problems were more frequent with FC use than with MC use (p<.0001, stratified by intervention). The educational intervention did not significantly reduce semen exposure. Overall, semen exposure occurred more frequently with FC use (postcoital PSA, >1 ng/mL; 22%) than with MC use (15%); the difference, however, was small and nonsignificant for high PSA levels (ň150 ng/mL; 5.1% for FC vs. 3.6% for MC). Conclusions: In this study, the FC was less effective than the MC in preventing semen exposure during use and led more frequently to self-reported user problems. Both devices were highly protective against "high-level" semen exposure, as measured by postcoital PSA levels in vaginal fluid. In-clinic education may reduce user problems and increase acceptability and use of both devices. (author's)
Fertility, women's employment and childrearing over the life cycle in Ghana.
In this paper we examine the relationship between fertility, employment, and childrearing in Ghana, a country where high rates of cash employment for women are known to co-exist with high fertility. Our framework emphasizes the ways in which women make choices regarding these three critical elements of their lives over their reproductive years. While women of childbearing age in Ghana are clearly confronted with a variety of choices regarding fertility, employment, and childrearing, they are constrained as well by many factors beyond their control, including poverty, gender roles, labor market opportunities, by the specific family to which they belong, by the lack of family planning services, and by social norms relating to childbearing and rearing. The specific choices available as well as those actually chosen will vary over the life cycle. We examine occupational characteristics, variations in work patterns, household composition, fertility, and childcare arrangements among women over the course of their reproductive years. We view these elements as interacting with one another to form patterns which reflect a balancing of roles as women respond to shifting responsibilities over the life cycle. Because child fosterage is a flexible social institution designed to meet the needs of children and their parents at various phases of their development, we explore its determinants in some depth in the second part of the paper. We conclude with a discussion of the implications of our findings for changes in fertility and women’s employment, and the relationship between them. Further, we identify possible avenues through which the burden of childcare may be shifting in Ghana and the likely consequences for women over the life cycle. (excerpt)
The study evaluated the effects of the long-term use of a combined oral hormonal contraceptive containing 30 µg ethinyl estradiol and 75 µg gestodene in adolescents. Thirty-three volunteers, aged from 14 to 19 years, who used the oral contraceptive for three consecutive years, were studied. Evaluation of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides was made before use and after 1, 2 and 3 years. During the 3-year study period, total cholesterol, HDL-C, LDL-C and triglyceride levels were significantly higher than previous measurements, but average values did not exceed the normal range. Compared to the first year, the second- and third-year cholesterol, HDL-C, LDL-C and triglyceride levels were not significantly different. (author's)
Intergenerational ties, Guanxi and mate choice in China.
This paper will examine intergenerational relationships in China through the window of marriage decisions. By examining change in the role of parents in mate choice within the specific context of current Chinese society, we find both an explanation for parental involvement in marriage and evidence of a unique kind of resource exchange among family members. Many scholars, writing about a variety of cultures, have discussed changes in the family that have come with certain kinds of economic and social change. These include the nuclearization of the family, a rise in companionate marriage, lower fertility and a decrease in the power of elder kin. There is an underlying assumption in many of these studies that modern developing societies will follow a path similar to that of the west. (excerpt)
Mifepristone medical abortion was introduced in 2002 into the University of New Mexico Medical Center clinic system through a joint effort of the departments of Family Medicine and Obstetrics and Gynecology. A stepwise approach to the integration of medical abortion, manual vacuum uterine aspiration, and first trimester obstetric ultrasound was successful in overcoming a series of educational, political, economic and logistical challenges. The integration of medical abortion care into resident training in FM and Ob/Gyn may expand access to reproductive services in primary care settings. (author's)
Steroid hormones for contraception in men: systematic review of randomized controlled trials.
Male hormonal contraception has been an elusive goal. Administration of sex steroids to men can shut off sperm production through effects on the pituitary and hypothalamus. However, this approach also decreases production of testosterone, so an “add-back” therapy is needed. We conducted a systematic review of all randomized controlled trials of male hormonal contraception and azoospermia. Few significant differences emerged from these trials. Levonorgestrel implants combined with injectable testosterone enanthate (100 mg im) were significantly more effective than was levonorgestrel 125 µg po daily combined with testosterone patches [10 mg/d; odds ratio (OR) for azoospermia with the oral levonorgestrel regimen, 0.03; 95% CI, 0.00–0.29]. The addition of levonorgestrel 500 µg po daily improved the effectiveness of testosterone enanthate 100 mg im weekly by itself (OR for azoospermia with the combined regimen, 4.0; 95% CI, 1.00– 15.99). Several regimens, including testosterone alone and gonadotropin-releasing hormone agonists and antagonists, had disappointing results. In conclusion, no male hormonal contraceptive is ready for clinical use. All trials published to date have been small exploratory studies. As a result, their power to detect important differences has been limited and their results have been imprecise. In addition, the definition of oligospermia has been imprecise or inconsistent in many reports. To avoid bias, future trials need to pay more attention on the methodological requirements for randomized controlled trials. Trials with adequate power would also be helpful. (author's)
Fertility and ethnicity in less developed countries.
We examine the nature and extent of the impact of ethnic group membership on fertility in less developed countries, using data from the World Fertility Survey (WFS). The way in which ethnicity is woven into the fabric of social life undoubtedly varies over time within countries, and also varies across countries at a given point in time. In recent years, ethnicity has assumed a prominent role in the politics of both more and less developed countries. Among social scientists, this has led to a greater concern for understanding both the strength of ethnicity and the consequences of ethnic awareness and group membership for other aspects of society. In social demography, researchers have shown heightened awareness of the potential impact of ethnic group membership on the fundamental demographic entities--births, deaths, and mobility. (excerpt)
The effect of nonoxynol-9 on human endometrium.
Contraceptive microbicides formulated as vaginal gels offer the possibility of women-controlled contraception and prevention of HIV infection. However, the effects of these gels on the upper reproductive tract is largely unknown. The purpose of this study was to determine the effects of nonoxynol-9 (N-9) on human endometrium. Human endometrial biopsies were cultured and incubated with various dosages of N-9 for 6 or 24 h. Endometrial histology was assessed by light microscopy using hematoxylin and eosin. Inflammatory response was determined by analyzing proinflammatory cytokines with enzyme-linked immunosorbent assay. Endometrial mucin was assessed by immunohistochemistry and real-time polymerase chain reaction. Histological changes consistent with focal coagulative necrosis were seen after 6 and 24 h of culture. All cytokines (interleukin 1ß, tumor necrosis factor a and interleukin 8) decreased at all concentrations of N-9 after 24 h of incubation. The expression of Mucin1 (MUC-1) was inhibited in a dose-dependent manner at both the protein and messenger RNA levels. These results demonstrate for the first time that N-9 has multiple, potential deleterious effects on the human endometrium characterized by necrosis, alteration of proinflammatory cytokines and inhibition of MUC-1 expression. Taken together, these in vitro findings suggest that N-9 can interrupt the functional barrier provided by the endometrium and, thus, facilitate infection with HIV and other pathogens. (author's)
The expanding role of genetics in contraception and women's health [editorial]
Perhaps the most dramatic and important change in the practice of medicine over the past decade has been the integration of genetics into diagnostic protocols and therapeutic approaches. The Human Genome Project rightfully assumes considerable credit for this advancement; by marrying the resources of the United States government and private industry, incredible discoveries were made on an almost regular basis. From the publication of the sequence of the human genome to the delineation of numerous mutations responsible for disease to a better understanding of the genetic mechanisms responsible for a variety of normal and abnormal physiologic functions, our understanding of biology, disease and genetic mechanisms have undergone a considerable change in the past decade. For many in science and medicine, these advances herald a new approach to the science and practice of medicine. (excerpt)
Contraceptive vaginal rings releasing Nestorone and ethinylestradiol: a 1-year dose-finding trial.
In a multicenter 1-year trial of contraceptive vaginal rings (rings) involving 150 women, three dose combinations of the progestin Nestorone (NES) and ethinylestradiol (EE) were compared with respect to effectiveness, safety and acceptability. Mean in vitro drug release rates for the three doses were 150 and 15, 150 and 20 and 200 and 15 µg/day of NES and EE, respectively. Each ring remained in situ for 21 days, removed for 7 days and then reinserted for a total of 13 cycles of use. We studied ring performance with respect to pregnancy and other termination events, adverse events, the extent of ovulation inhibition, serum drug levels and bleeding control. We also assessed the rings' effects on the vagina using a standardized colposcopy procedure. Seventy-two percent of the women completed the 1-year (=350 days) study. In studied cycles, luteal activity (progesterone =10 nmol/L) was noted in 17%, 7% and 12% of subjects with monitored cycles at the 150/15, 150/20 and 200/15 doses, respectively (p=.34). Two pregnancies occurred, both in subjects using the 200/15 µg/day ring. Breakthrough bleeding during ring use averaged about 2 days/year and breakthrough bleeding and spotting averaged about 7 days/year. In the entire trial, only two women discontinued because of bleeding problems. Medical conditions, chiefly vaginal problems, personal reasons and device loss or repeated expulsion were the principal reasons given for study discontinuation. Vaginal and cervical colposcopy, conducted with standardized techniques and standardized interpretations, revealed no elevated event incidence attributable to ring use. Clinical performance and adverse event profiles indicate that each of these 1-year NES/EE rings, used on a 21-day-in and 7-day-out regimen, provided women effective, acceptable and safe long-acting contraception under their own control. (author's)
Objective: To assess the risk of colorectal cancer among women who have used oral contraception or hormone replacement therapy (HRT), especially those exposed to both classes of exogenous hormones. Design: Nested case-control study using prospectively collected data from the Royal College of General Practitioners' Oral Contraception Study (OCS). The 146 cases were women with a diagnosis of colorectal cancer recorded on the OCS database by March 2003. Each case was matched with three controls who were free of the disease at the time of the case's diagnosis, of similar age and with similar length of follow-up in the OCS. Results: Compared with never use, current use of oral contraception was associated with a reduced risk of colorectal cancer: adjusted odds ratio (OR) 0.38 [95% confidence interval (CI) 0.11-1.32]; former use 0.89 (95% CI 0.59- 1.33); ever use 0.84 (95% CI 0.56-1.24). Similar comparisons for HRT were: current use 0.34 (95% CI 0.13-0.91); former use 0.59 (95% CI 0.30-1.14); ever user 0.49 (95% CI 0.27-0.87). The OR among women who had used both classes of hormones was 0.34 (95% CI 0.15-0.79) compared with those who have used neither. Conclusions: Ever users of oral contraceptives do not benefit from a long-term reduction in colorectal cancer, although current and recent use may confer some protection. Women who have ever used HRT appear to have important reductions in their risk of colorectal cancer, especially while using these hormones. Further study is needed in order to determine how long any benefits last and whether these are stronger in women exposed to both classes of exogenous hormones. (author's)
Objectives: To evaluate the impact on lipid and carbohydrate variables of a combined one-third ethinyl estradiol (EE)/levonorgestrel (LNG) dose reduction in oral contraceptives. Methods: In an open-label, randomized study, a dose-reduced oral contraceptive containing 20 µg EE and 100 µg LNG (20 EE/100 LNG) was compared with a reference preparation containing 30 µg EE and 150 µg LNG (30 EE/150 LNG). One-year data from 48 volunteers were obtained. Results: We found a decrease of HDL2 cholesterol and increases of low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol and total triglycerides in both treatment groups from baseline to the 13th treatment cycle. Although for four of six variables, the changes in the 20 EE group were lower compared with the 30 EE group, none of the differences between the two treatments were statistically significant. The median values for the fasting levels of insulin, C-peptide and free fatty acids slightly increased or remained unchanged while the fasting glucose levels slightly decreased after 13 treatment cycles. While the glucose area under the curve (AUC) (0-3 h) was similar in both groups during the OGTT, the insulin AUC(0-3 h) was less increased in the 20 EE/100 LNG group compared with the 30 EE/150 LNG group. None of the differences between the treatment groups for any of the carbohydrate metabolism variables were statistically significant at any time point. Both study treatments were safe and well tolerated by the volunteers. Conclusion: Similar effects on the lipid and carbohydrate profiles were found for both preparations. The balanced one-third EE dose reduction in this new oral contraceptive caused slightly lower, but insignificant, changes in the lipid and carbohydrate variables compared with the reference treatment. (