Chickenpox during pregnancy is very uncommon and is known to cause fatal malformation during the first half of pregnancy. The infection during pregnancy is also associated with maternal morbidity and mortality. Furthermore, there may also be neonatal complications. Thus, any pregnant woman with Varicella infection should be hospitalized and followed-up closely. In this review, we examined the literature on Varicella Zoster during pregnancy with regard to prevalence, prenatal diagnosis, management and prevention. (author’s)
This article discusses the resources, needs, limitations, and funding of neonatal intensive care unit services in Hungary. Recommendations for the improvement of neonatal health services are included.
Effect of BRCA mutations on the length of survival in epithelial ovarian tumors.
This paper aimed to study the role of breast cancer (BRCA) mutations in ovarian cancer survival. Blood samples and specimens of ovarian tumors (whenever blood samples were not available) at the time of the primary surgery were obtained in the course of a nationwide case-control study of women with ovarian cancer in Israel. The three common BRCA mutations in Israel (185delAG, 5382insC, and 6174delT) were analyzed with a multiplex polymerase chain reaction to amplify the exons containing the three mutations using flour-labeled primers in a single reaction. Because each mutation is a small insertion or deletion, they can be detected as length polymorphisms. Patients were followed for up to 5 years (range, 20-64 months). Statistical analysis was performed using the Kaplan-Meier method and the log-rank test. Stepwise Cox regression analysis was used for determination of independent prognostic factors. This report is based on 896 blood or tumor specimens analyzed for the presence of the BRCA mutations. Of these, 234 women (26.1%) were found to be positive. A significant difference in survival pattern was found between BRCA1/BRCA2 carriers and non-carriers among the women with invasive ovarian cancer (median survival, 53.4 months vs. 37.8 months; 3-year survival, 65.8% vs. 51.9%, respectively). These differences were independent of age at diagnosis or stage of the disease. The authors' data indicate that the survival of patients with ovarian cancer is affected by BRCA germ-line mutations, at least in the early years after diagnosis. (author's)
[Antiestrogens: mechanism of action and clinical applications]
Antiestrogens are compounds d1at inhibit estrogen action by competing for iu receptors. Estrogens are involved in the proliferation and differentiation of target cells and are among me main risk factors for breast and uterine cancer. Some antiestrogens, such as Tamoxifen, are used as adjuvant therapy against breast cancer, and have been proposed to be included in prevention programs for women at high risk of cancer. Antiestrogens are classified according to their action mechanisms into Type I or partial (agonistic/antagonistic), and Type II or pure (pure antagonistic). Advancements in the development of new antiestrogens and their clinical importance are reviewed in this paper, as well as their mechanism of action and clinical applications. (author's)
[Adenomyosis: analytical study of 35 cases]
The authors suggest an analytic study of 35 cases of a adenomyosis discovered on operatory pieces of hysterectomy. The incidence over 28%. The pick of frequency is situated between 40 and 50 years old. The history of voluntary interruption of pregnancy and early abortion are found in 60% of cases. 8 patients have scary uterine post Cesarean section or myomectomy. The symptoms and signs are dominated by vaginal bleeding which is found in 71% of cases. Pelvic pain is present in 34% of cases. The adenomyosis is rarely isolated. It is associated to uterine fibroma in 62% of cases. Their symptoms and signs are often the same. Hysterographie can head the diagnosis in 7% of cases. The endovaginal ultrasound and the IRM may help in the diagnosis. (author's)
Objectives: To examine the detection rate of chromosomal abnormalities using nuchal translucency (NT) thickness in a Brazilian population. Methods: This was a prospective study of 2996 singleton pregnancies with a live fetus at 10-14 weeks of gestation attending for routine antenatal care in a teaching hospital in Brazil. Fetal Crown-rump length (CRL) and NT thickness were measured and the risks for trisomy 21 were calculated by a combination of maternal age and fetal NT with the use of software provided by The Fetal Medicine Foundation. Sensitivity and positive predictive values for different risk cut-offs were calculated. Results: Chromosomal defects were diagnosed in 22 cases, including 10 cases of trisomy 21. The estimated risk based on maternal age and fetal NT was 1 in 300 or greater in 222 (7.4%) cases and these included nine of 10 (90.0%) pregnancies with trisomy 21 and nine of 12 (75.0%) pregnancies with other chromosomal defects. The NT was above the 95th centile in 5.8% of cases and this group included 70% of the trisomy 21 cases. Conclusion: A combination of maternal age and fetal NT provides an effective method of screening for chromosomal defects. The performance of the test in a Brazilian population is similar to that in Britain. (author’s)
Endometrial cancer (EC) is estrogen-dependent tumor in the honnonal treatment of which mostly progestins are used. During last 5-7 years feasibility of aromatase inhibitors use in EC is discussed without any special practical move in this direction. To evaluate possible biological response of tumor and patients to such treatment, we conducted a short pilot study involving 10 primary postmenopausal EC patients, mostly stage Ia,b (average age 59) who received letrozole (Femara, Novartis) 2.5 mg/day during 14 days before operation. Clinical, sonographical, morphological, cytological and hormonal-metabolic (blood estradiol, FSH, LH, glucose, lipid fractions by RIA or enzyme-colorimetric methods; tumor progesterone receptors by LBA and aromatase activity by 3H-water release assay) studies were included into the protocol before and after treatment. Tolerability of letrozole was satisfactory in all patients. 2 patients reported decrease of pain and pathological secretions from uterine cavity. In 3 patients, decrease in M-sonographical endometrial signal was registered; average value after treatment was 31.1% lower than before it. Tendency to the decrease in estrogenicity of vaginal smears was revealed. Average decrease in blood estradiol was 37.8% and in progesterone receptor level and aromatase activity 34.4% and 17.5% respectively. Decrease of aromatase activity in tumor tissue was registered mostly in normal weight patients. A more detailed and longer randomized study of aromatase inhibitors in EC performed in neoadjuvant setting deserves consideration. (author's)
[Prospects for using aromatase inhibitors in treating endometrial cancer patients]
Clearly, we should support the view that it is essential to expand efforts to research the possibility of using aromatase inhibitors to treat endometrial cancer, since traditional progestin hormone therapy is not effective in approximately one third of endometrial cancer patients, even those with receptor-positive tumors. The prospects are therefore being examined for further in vitro research assessing the efficacy of current aromatase inhibitors in treating endometrial tumors, and also their use in a combined treatment of endometrial cancer patients, perhaps as a first line of hormone therapy. (excerpt)
Endometriosis in an adolescent population: the severance hospital in Korean experience.
The records of adolescent patients (10-21), who were admitted to the severance hospital between 1990 and 1999, were reviewed retrospectively to evaluate the age distribution, diagnosis, clinical stage, and treatment for endometriosis in adolescents. Thirty-nine patients who had undergone a laparotomy or laparoscopy and were diagnosed with endometriosis were identified. Endometriosis was classified according to the revised American Fertility Society classification (AFS). The chief symptoms leading to the diagnosis clinical stage, age distribution, and treatment modality were reviewed. All patients, whose average age of menarche was 14.2, were diagnosed with endometriosis with an average interval of 5.9 years after menarche. The chief symptoms leading to the diagnosis were chronic pelvic pain (27%), acute pelvic pain (21%), a palpable pelvic mass (21%), and dysmenorrhea (18%). A laparoscopy was performed in 20 (51%). The majority of patients (44%) presented with the revised AFS classification stage II. Four patients (10%) presented with stage I, 11 (28%) with stage III and 7 (18%) with stage IV. Management after surgery included (GnRH) agonists (54.1%), expectant managements (25.7%), (OCPs) (5.1%) and danazol (5.1%). In adolescents with chronic pelvic pain, endometriosis is not rare. Therefore, early referal to a gynecologist to diagnose the etiology of the pelvic pain and initiate appropriate therapy is recommended. (author's)
[The effect of tamoxifen on endometrium]
The objective of this study is to evaluate the effect of tamoxifen on the endometrium. Hysteroscopy and endometrial biopsies were performed in 26 patients with breast cancer receiving tamoxifen and having vaginal bleeding or endometrial thickness detected by ultrasound. In addition 78 women with postmenopausal bleeding without receiving tamoxifen underwent the same examination. Results show that thirteen (50.0%) patients receiving tamoxifen had endometrial or endocervical polyps, whereas 14 cases (17.9%) not receiving tamoxifen developed the polyps (P < 0.05). 9 (34.6%) patients receiving tamoxifen had thyperplasias, which was significantly higher than that of women not receiving tamoxifen (P < 0.05). In conclusion, the incidence of endometria disease in the patient with breast cancer receiving tamoxifen was increased. These patients should be closely monitored by transvaginal sonography and hysteroscopy. (author's)
[Radiotherapy in the treatment of uterine sarcomas]
The objective of this paper is to study radiotherapy in the treatment of uterine sarcoma and response of radiation in primary or recurrent uterine sarcomas. A total of 102 uterine sarcomas treated in the Cancer Hospital from May 1960 to June 1999. A retrospective review of 45 patients receiving surgery alone, 29 patients for postoperative radiotherapy, 4 radiotherapy alone, 24 recurrent sarcomas receiving radiotherapy. The 5-year overall survival for 45 patients treated with surgery alone and 29 patients managed by postoperative radiotherapy were 56.7% and 58.6% respectively (P > 0.05). The addition of radiotherapy significantly reduced the local recurrence rate from 42.2% to 20.7% (P < 0.05). The tumor was disappeared completely by treatment of radiotherapy aloe in 3 patients of primary uterine cervix sarcomas. 1 patient was free of disease at 36 months. Other 2 patients died 9 and 11 months later because of distant metastasis. The complete and partial response rate of radiotherapy was 50.0% for recurrent tumors. The radiotherapetic sensibility of endometrial stromal sarcomas, mixed mesodermal sarcomas and leiomyosarcomas was downward tendency in turn. In conclusion, the postoperation adjuvant radiotherapy reduced the pelvic recurrent significantly. Radiotherapy should be used in the treatment of uterine sacomas as an important part of combination therapy. (author's)
[Application of high frequency radiosurgical knife in the treatment of cervical diseases]
The objective of this study was to investigate the indication, resection scope of loop electrosurgical excision procedure (LEEP) and pathological characteristics. 176 cases with abnormal cytological and colposcopical findings, including cervical intraepithelial neoplasia (CIN) and atypical squamous cells of undermined significance (ASCUS, were studied. Conization of cervix was performed in 63 cases of >or= CIN2, of which 33 cases with LEEP and 30 by traditional electrosurgical knife (TEK) as controls. Cervical biopsy was performed in 113 cases of CIN1 and ASCUS, of which 60 cases by LEEP and 53 by cervical biopsy forceps (CBF) as controls. Three months after conization of cervix, the cytological persistent rate of disease was 6.1% in LEEP group and 6.7% in TEK group (P > 0.05). The operation duration of LEEP is (5.0 +or- 0.5) minutes, and is much shorter than TEK [(15.0 +or- 0.4) minutes]. The bleeding and recovery time of the cervix are also shorter (P < 0.01). Three months after cervical biopsy the cytological persistent rate of diseases was only 1.7% in LEEP group, significantly less than that in CBF group (35.8%). LEEP is indicated to conization of cervix of CIN2-3 and cervical biopsy of CIN1 and ASCUS. It is safe and time-saving. The optimal depth of cervical conization and biopsy was 7 mm and 4 mm respectively in the cervix, and 15 mm and 4 mm respectively in the cervical tube. It can offer intact sample for pathological diagnosis, and has special value for detecting cervical microinvasive carcinoma and local minor carcinoma. (author's)
[Combination chemotherapy of uterine sarcomas]
The objective of this paper is to study the results of combination chemotherapy of uterine sarcoma after operation and recurrent tumor. 174 cases of 3 major pathological subtypes of uterine sarcomas were treated in the Cancer Hospital from 1960 to 1996. Clinical data were analyzed of 51 cases of uterine sarcomas treated with postoperative adjuvant chemotherapy and 38 cases with recurrent tumors received 98 courses of chemotherapy. They were divided into 4 groups according to the adjuvant chemotherapy regimen: single drug, VAC, VAD, and other regimens. Chemotherapy regimens for recurrent tumors were VAD, PA/PAC, and other combination regimens including etoposide, ifosfamide, cisplatin, adriamycin. The 5-year survival rate of stage I-II uterine sarcoma patients was 54.9% receiving adjuvant chemotherapy. It was 72.7% in VAD group which was significantly higher than that in other regimen groups. The survival rate was related to the number of chemotherapy course. The chemo-sensitivity of various pathological types of recurrent uterine sarcomas was not different. In conclusion, the 5-year survival rate does not improve in patients with stage I-II uterine sarcomas given postoperative chemotherapy. VAD is among the best regimens and at least 3 courses should be performed. The results of new treatment regimens such as EPA, 1A, etc., must await further clinical observation. (author's)
State AIDS training steps up a gear.
The Health Department is refocusing its HIV/AIDS education initiatives and setting target dates for training certain health workers this year, including using SAMA's training division, the Foundation for Professional Development. At least 1000 state sector doctors will begin completing the FPD programme this year, according to President of the HIV Clinicians' Society, Dr Des Martin. (excerpt)
Guarding the citadels of AIDS stats.
This paper describes a controversial issue concerning the refusal of the South African government to release the Medical Research Council findings on the extent of the HIV/AIDS epidemic and its mortality.
The value of treating the male partner in vaginal candidiasis [letter]
The paper by Shihadeh and Nawafleh which appeared in the Saudi Medical Journal, Volume 21, Number 11, November 2000, pages 1065-1067, did not differentiate which category of vaginal candidiasis they studied. This unfortunately, has resulted in some gaps in their presentation and conclusion. (excerpt)
By its decision in Roe v. Wade, the Supreme Court, without textual or historical support, reached out and struck down the abortion laws of all fifty states. The Court thereby established as a constitutional right what had long been viewed in English and American law as a serious crime - the intentional destruction of unborn human life. The Constitution does not deprive the people of their rightful authority, acting through their state legislatures, to protect human life through restrictions on the practice of abortion. That authority should be restored to its legitimate source - the American people. Roe. v. Wade should be overruled. (excerpt)
The aim of the work was to perform a comparative analysis of medical files of 125 neonates with necrotising enterocolitis (NEC) treated between 1990 and 1995 in two regional centres: Glasgow (Scotland) and Western Pomerania (Poland), and to search for factors constituting an indication for surgery in NEC. The following data contained in the medical documentation of NEC cases have been analysed: maternal risk factors, perinatal abnormalities, neonatal risk factors, procedures performed in the neonate, feeding practices, clinical and radiological signs, time of onset of the disease, clinical staging of NEC according to Bell (modified by Walsh and Kliegman), methods of treatment, postoperative course and outcome. The analysis was performed in the whole material and in the subgroup of newborns weighing < 1500 g (low/extremely low birth weight babies). Glasgow neonates with NEC had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower leukocyte count and shorter time of onset of the disease. In the subgroup of newborns weighing less than 1500 g, Glasgow neonates had significantly lower birth weight, gestational age, platelet count, and sodium level when compared to Pomeranian newborns, while the latter had significantly lower 1 minute Apgar score, pH and base excess (BE) values. Glasgow clinical NEC stage was significantly more severe (IIB - IIIB) when compared to Pomeranian neonates. A higher proportion of full-term neonates in the present study - 31.2% - was diagnosed with NEC than in the literature. Hyponatremia with severe acidosis and low platelet count (especially below 100 x 109/L) may constitute an easily available laboratory finding serving as an indicator for surgical intervention in NEC. Statistical analysis revealed that the selection of treatment was influenced in the Glasgow group by birth weight and in the Pomeranian group by the clinical stage of NEC. Overall mortality was 32.8% in the whole group of 125 neonates, 34.4% in the Glasgow and 31.2% in the Pomeranian group. However, Glasgow neonates had significantly lower birth weight and gestational age and were more severely ill. The mortality in the subgroup of Scottish neonates with primary peritoneal drainage was 55.5%, the majority presenting with significantly lower birth weight and stage IIIB of necrotising enterocolitis. In conservatively treated neonates, mortality was 13% in the whole group, 9% in the Glasgow group and 15% in the Pomeranian group. Overall mortality in neonates treated surgically was 46.6%. In the Glasgow group it was 23% without and 42% with primary peritoneal drainage, respectively. Surgical mortality in the Pomeranian group was 42%. Overall mortality was 5.6% in full-term newborns, 3.2% in the Glasgow group and 7.8% in the Pomeranian group. Primary peritoneal drainage is a valuable, mildly invasive method of initial, and in some cases final, treatment in severely ill NEC babies, especially with low birth weight. This method was not used in the Pomeranian group. (author's)
Profile of familial breast cancer in Alexandria, Egypt.
Nearly two thirds of the cancers which will appear in the next 25 years will occur due to unawareness of the public. In a population genetic study in Alexandria, Egypt, we found that the parents of 20% of the population are first degree cousins. Out of 9587 female cancer cases registered in the last 10 years by the Alexandria Cancer Registry, 3250 (33%) were breast cancer. Twelve percent of breast cancer patients had a positive first-degree relative family history of cancer. Familial breast cancer (FBC) occurred at a younger age, ranging from 23-74 years, with a median equal to 46.5 years compared to 35-76 years, with a median of 54.5 years, in non-familial cases. The aim of this work was to show how familial cancer registries can produce useful data, helping to develop a data base of familial cancer, for the primary care program to control the morbidity of breast cancer in females by identification of those with a positive family history of cancer who are at a high risk of developing breast cancer. (author's)
Prevalence of home deliveries and antenatal care coverage in some selected villages.
A cross sectional study was conducted in 14 selected villages of Gazipur Thana with the aim to find the prevalence of home deliveries and ante natal care coverage. All those females who delivered in the recent past (within last three months) from the selected villages were the study population Data were collected by two trained interviewers with a semi-structured interview schedule. Study result shows that 83% of the respondents received antenatal check-up throughout their last pregnancy. Most of this group (88.5%) received this care from Health Assistant or Family Welfare visitors while only 3.1% received care from graduate doctors. Out of 505 respondents 91% of the respondents was found to have delivered at home while only 8.7% at institutions. Study findings also suggested that there was association of place of delivery with level of education and family income of the respondents. Also there was associations of utilisation of antenatal care with level of education and family income of the respondents. (author’s)
Body mass index (BMI) has been employed as an epidemiologic predictor of fetal growth. But most of the studies are focused on BMI values for non pregnancy women, while 8MI varies according to gestational age. On the other hand, adolescence has been considered as a risk factor for intrauterine growth retardation (IUGR:birthweight for gestational age < 10th. centile). The aims of this study were: 1) to identify the distribution for weight, height and BMI in adolescent and adult pregnancies. 2) to measure the association between maternal BMI and fetal growth and 3) to evaluate the relative risk to have an intrauterine growth retardation (IUGR) according to maternal BMI. 2409 pregnancies and their newborns were studied. Maternal height and weight were measured and BMI by gestational age was calculated by trimesters of gestation . Birthweight. recumbent length, cefalic perimeter, BMI and weight by gestational age were determinied in the newborns. Z score by gestational age were calculated in each pregnant woman taken into account the cutt of point of BMI of -1 standard deviation. There were highly statistically significant differences in both body size and body composition between adolescent and adult mothers and in their newborns. The newborns from mothers with BMI under -1 standard deviation were smaller and the relative risk to have an IUGR was double for newborns whose mothers had BMI under -1 standard deviation. Conclusions: 1) Both body sire and composition values differs between newborns from mothers under or above the cut off point of -1SD of BMI and 2) The risk to have an IUGR was double in pregnancies under –1 SD of BMI independently to the age of the mother. (author’s)
A coordinated response requires agencies that serve youth to acknowledge commercial sexual exploitation of children (CSEC) and to confront the secrecy around the sex trade as well as cultural beliefs that continue to rationalize the sexual abuse of children. Ending CSEC also requires persistent and forceful advocacy, insisting that decision makers at the local, state, national, regional, and international levels take the steps necessary to prevent CSEC, to monitor and control the sex trade, and to support comprehensive services for the children who are involved. (excerpt)
Combination of docetaxel and doxorubicin as first-line chemotherapy in metastatic breast cancer.
Docetaxel (Taxoteree) and doxorubicin have previously demonstrated a significant antitumor activity in patients with metastatic breast cancer. Furthermore, a lack of cross resistance and overlapping toxicities between the two agents have been reported. In a prospective study, docetaxel (80 mg/m2, 1-hr iv infusion) and doxorubicin (60 mg/m2, 1-hr iv infusion) were administered as first-line chemotherapy in metastatic breast cancer patients to evaluate the clinical efficacy and toxicity of the combination. Forty-three patients were enrolled in the study. The median age was 47 years (range, 30-69). The docetaxel-doxorubicin combination was applied with 3-week intervals until progression. Complete response was achieved in 9 (21.4%) of 42 assessable patients and partial response in 24 (57.2%) patients, for an overall response rate of 78.6%. Median response duration was 8 months (3-18 months). Nausea and vomiting (76%), alopecia (64%), neutropenia (35.7%) and mucositis (33%) were the major side effects of the combination. There was one case of cardiac toxicity. In conclusion, the docetaxel-doxorubicin protocol can be considered as an active regimen for the treatment of patients with metastatic breast cancer with acceptable toxicity and a fairly high response rate. (author’s)
The objective of this study was to assess if a simple evaluation, adherence to antiretroviral therapy, would correlate to clinical and laboratory outcomes. We followed an open cohort of patients from a public teaching hospital AIDS outpatient clinic. Patients were categorized according to adherence as: regular (Reg), optimal, all doses all days, tolerating only irregular timing (62 hours) of intake; quasi-regular (qReg), those missing up to four doses or 1 full day during a month; irregular (Irreg), all other irregular regimens, and ignored (Ign), those without information. The results from a simple questionnaire were compared to CD41 cell counts and human immunodeficiency virus type 1 (HIV-1) RNA plasma viremia. One hundred eighty-two HIV-1–infected patients (126 males, 69%; 56 females, 31%) were analyzed. Information on adherence was available for 168 (90%). Reg adherence was reported by 75 (41%) patients, qReg adherence by 35 (19%), and Irreg by 53 (29%) of patients. The main reasons for nonadherence were forgetfulness, intolerance, use of alcohol, and misunderstanding of prescription. A significant increase of CD4+ T-cell counts and absolute gain were only observed among Reg and qReg users (p<0.001). The median viral RNA load log10 decreases were 21.68, 21.45, 20.9 log, respectively, for Reg, qReg, and Irreg patients (p=0.043, Kruskal-Wallis). Development of and death from AIDS occurred almost exclusively among those with Ign or Irreg adherence. Previous use of antiretroviral therapy may have had an impact in treatment response. Individuals who were treatment-naive were more likely to be Reg users (41%). Although more refined methods to assess adherence should be implemented when available, the inability to do so should not prevent simple, albeit subjective measurements that also correlate with favorable outcome. Mechanisms to improve adherence should be considered an integral part of antiretroviral therapy. (author’s)
Human immunodeficiency virus (HIV) causes a chronic infection beginning in most individuals with an acute syndrome followed by an asymptomatic stage and progresses in untreated adults over a median of 10 years to the late stage called AIDS. The virus rapidly and enormously replicates from the initiation of infection. The principal immunodeficiency caused by HIV is depletion in the subset of T lymphocytes referred to as helper T cells. New anti-HIV drugs given in potent combination regimens have demonstrated impressive efficacy by both clinical and laboratory measures, and have provided evidence that drugs can suppress HIV replication and disease manifestations HIV/AIDS is still uncommon in Croatia. In the period from 1986 to 2000, 171 patients with AIDS have been reported of whom 101 (59%) died. The incidence of AIDS in 2000 was about 4 cases per million inhabitants. Recent testing of injection drug users at a needle exchange program revealed an HIV incidence of about 1%. (author's)
Widespread, inadequate and inappropriate treatment of gonococcal infections are facilitating antibiotic resistance in Jos Nigeria. We present an antimicrobial susceptibility pattern of Neisseria gonorrhoeae swains in this study. Thirtv-one strains of Neisseria gonorrhoeae were isolated by inoculating swabs onto prewarmed heated blood a gar and Thayer Martins medium and incubated overnight at 35 to 3 7 degree celsius. The isolates were then screened for antimicrobial susceptibilitv by the disk diffusion method. About 93.6% were susceptible to azithromycin, 90.3% to ciprofloxacin, 87.1% to ceftriaxone, 80. 7% and 64.3% to erythromycin and ofloxacin respectively. Less than half were each susceptible to spectinomycin (38.7%) and gentamicin (32.8%), while 12.9% and 4.6% were susceptible to tetracycline and penicillin respectively. These findings suggest that gentamicinenvironment for treating gonococcal infections. Azithromycin, ciprofloxacin and ceftriaxone are the suggested alternatives. Prompt diagnosis, treatment and indeed continued surveillance are hereby recommended for an effective management of gonoccal infections. (author's)
The object of our study has been to assess Chlamydia trachomatis prevalence among symptomatic women in Abidjan and to identify issues relate to the use of cell culture methods in tropical laboratory. 1522 women with vaginal discharge were enrolled in a cross sectional study. One endocervical swab was taken per woman and inoculated into cycloheximide treated Mac Coy cells. Elementary bodies were detected by direct fluorescent anitbody (DFA). The isolate rate of chlamydia trachomatis by cell culture was estimated to 86%. The prevalence of chlamydial infection among symptomatic women was 10.8%. Culture was influenced by presence of blood or cervical mucus in the sample. 206 samples gave no results because of blood or cervical mucus. During this study repeated contaminations of cells with facultative bacteria were noted and disposing of a sufficient number of cells was not easy. (author's)
Seroprevalence of HIV in Manipal.
A total of 32406 persons were screened for HIV 1 and 2 antibodies between 1991 to 1999 by Enzyme Linked Immuno Sorbent Assay at Dept. of Microbiology, KMC, Manipal which is a rural teaching hospital. There was steady increase in seropositivity from 0.38% (1991) to 9.31% (1995) and thereafter there is decrease in the seropositivity rate to 4.15% (1999); but the number of cases screened increased from 1995 onwards. The HIV seropositivity is more in males 7.49% than in females (2.52%). The male to female positivity ratio is 2.72:1, inspite of the total number of samples screened of either sexes being equal. The prevalence of HIV among STD Clinic attendants vs 8.22%. The foci of infection can be traced to cities such as Mumbai and the main mode of transmission is through unprotected heterosexual contact. The decrease in the seropositivity rate from 1996 onwards could be due to the AIDS awareness among public due to the control programmes. (excerpt)
[Syphilis and AIDS: a historical comparison]
The present work displays the analogies and differences among Syphilis and AIDS concerning appearance, evolution, symptoms, treatment, prophylaxis, spreading as well as their names' origin. A comparative analysis among both diseases in terms of causes, clinical evolution and therapeutic essays is established. The Venezuelan health institution effectiveness in fighting these diseases is evaluated. (author's)
HIV in Nepal: is it rare or the tip of an iceberg?
Acquired immunodeficiency syndrome (AIDS) has reached alarming proportions in SE Asia. The magnitude of the epidemic is projected to exceed that of sub-Saharan Africa as we enter the 21st century. Nepal has much in common with India geopolitically and socially and the prevalence of HIV is expected to be no different from the rest of SE Asia. However, evidence thus far paints different picture altogether - a very low prevalence of HIV even in high-risk population groups. This is surprising, particularly since high-risk behaviour is evidenced by a high rate of drug abuse. In addition, other communicable diseases commonly associated with HIV infection, such as tuberculosis and HBV/HCV infection, are common in Nepal and yet still the prevalence of HIV infection in these patients and in the general population is reported to be low. This paper identifies some of these anomalies and attempts to analyse the reasons for this discrepancy. We emphasize the need for extended survey and strict surveillance to avoid an explosion of this dreaded infection. (author's)
[A level of social support and intensity of anxiety in patients with AIDS]
The article is devoted to psychological aspects of functioning of patients with AIDS. The issue may be analysed from different perspectives. The article focuses on two of them. The first, a point of view of the person directly affected by the new illness and the second, a perspective of social phenomena accompanying AIDS. The empirical research have been carried out on the basis of a synthesis of the above mentioned areas and they have made it possible to describe relations between them. The inquiries have concerned mainly the connection between the social support given to the ills and the anxiety experienced by them, resulting from emotional uneasiness. The independent variable, which was social support, has been formulated in a qualitative way by referring to such subjective measures like: feeling of support, its perceived availability and adequacy. The survey pattern has been prepared on the basis of the claim of existence of the so- called main effect i.e., direct relationship between social support and individual's psychophysical comfort. The investigated variables have been measured using the following research tools: The Inventory for Measuring Anxiety as a State and as a Feature, elaborated by C.D. Spielberger and The Scale of Social Support Deficit by K.Kmiecik-Baran. The achieved results have clearly shown the dependence between a level of social support and intensity of the anxiety experienced by the ills with AIDS. Apart from a cognitive value of the fact, it is worth to pay attention to a possibility of its practical application. (author’s)
This study describes growth in a cohort of black South African children born to HIV-1-infected women in Durban. Children born to HIV-1-seropositive women were followed up from birth to early childhood. At birth and at each visit, growth parameters were measured. Mean Z-scores were calculated for weight-for-length, weight-for-age and length-for-age and, if they were low, the children were regarded as wasted, malnourished or stunted, respectively. At the end of the study, there were 48 infected and 93 uninfected children. There were no significant differences between the two groups at birth. Thereafter, the infected group was found to have early and sustained low mean Z-scores for length-for-age and weight-forage but not for weight-for-length. The means reached significance at ages 3, 6 and 12 months for length and at 3, 6 and 9 months for weight. Infected children who died early had more severe stunting, wasting and malnutrition than infected children who survived. Infected children born to HIV-positive women have early and sustained stunting and are malnourished but not wasted. Children with rapidly progressive disease have both stunting and wasting and are more severely affected. Early nutritional intervention might help prevent early progression or death in HIV-infected children, particularly in developing countries without access to anti-retroviral therapy in state hospitals. (author’s)
Does antiretroviral therapy have a role to play in the control of tuberculosis in South Africa?
In this study, 378 patients on antiretroviral therapy attending a University of Cape Town HIV clinic from 1996 to 2001 were compared with 562 similar control patients not on ART and attending the same clinic from 1992 to 1996. The patients had advanced disease. Those treated had median baseline CD4 T-cell counts of 244 and median log viral loads of 5.4, and 40% of patients were at World Health Organisation clinical stages 3 or 4. Adherence to ART in this group was remarkably high--92% at 48 weeks. Using a strict case definition of tuberculosis, TB incidence was 9.9/100 per year in the untreated control group and decreased to 2.1/100 per year in the triple therapy group, despite similar background TB rates in the population over both periods. With Cox proportional hazards modelling adjusting for age, clinical stage, baseline CD4 level and ethnicity, the adjusted RR for dual (some patients had been on two antiretroviral agents only) and triple therapy was 0.28 and 0.11 respectively, which was highly significant (Fig.3). Predictive variables in the triple therapy arm were baseline CD4+ T-cell count of less than 200 (adjusted RR 2.6) and clinical stages 3 and 4 (adjusted RR 2.7), while for each log increase in baseline viral load the adjusted RR increased by 3.1. Reduced adherence to antiretroviral therapy (<90% of tablets taken over the study period) was strongly associated with development of tuberculosis in these patients (adjusted RR 122). These data show that antiretroviral therapy significantly decreases the incidence rate of tuberculosis, even in a setting where TB rates are among the highest in the world, and may be a powerful strategy for the control of HIV-associated tuberculosis even when programmes and health services are swamped with the huge increases in TB rates that come with the HIV epidemic. (excerpt)
Trends of gonorrhoea and early syphilis in Belgrade, 1985-99.
The purpose of this study was to report trends of gonorrhea and early syphilis in the Belgrade population (about two million inhabitants) during the period 1985-99, and to discuss the data in the light of changes in gonorrhea and syphilis rates in other countries of eastern Europe. (excerpt)
Lymphatic filariasis in children: adenopathy and its evolution in two young girls.
Lymphatic filariasis is a widespread infectious disease of children in endemic areas, but little is known about the early lymphatic damage in children and its evolution, either with or without treatment. Two girls (ages 6 and 12 years) from a Wuchereria bancrofti endemic region of Brazil presented with chronic inguinal adenopathy. Neither had microfilaremia. By ultrasound both were shown to have living adult worms in their enlarged inguinal nodes and had occult local lymphatic damage (lymphangiectasis). One girl spontaneously developed acute adenitis in the affected node prior to any intervention; this adenitis resolved within 10 days and was associated with the progressive disappearance over 45-90 days of a1lloca1 abnormalities detectable by ultrasound. In the other child, after treatment with a single dose of diethylcarbamazine (DEC), the same clinical picture of transient adenitis and resolving abnormalities (detectable by ultrasound) occurred. These findings demonstrated filariasis as the cause of adenopathy in children, and also both spontaneous and treatment-induced worm-death, with subsequent reversal of lymphatic abnormalities. (author's)
Objectives: This article examines trends in teenage pregnancy in Canada, focusing on induced abortions, live births and fetal loss among women aged 15 to 19 in 1997. Data sources: The data come from the Hospital Morbidity Data Base at Statistics Canada, and the annual Therapeutic Abortion Survey, conducted by the Canadian Institute for Health Information. Data on abortions performed on Canadian residents in the United States are from an annual survey of selected states. International data are from the Alan Guttmacher Institute. Analytical techniques: Pregnancy rates, abortion rates, live birth rates and fetal loss rates are calculated using population counts of women in the age groups 15 to 17, 18 to 19, and 15 to 19. The percentages of pregnancies that ended in the three outcomes are also calculated for these years. Main results: The teenage pregnancy rate declined from 1994 to 1997, reflecting lower teenage birth and fetal loss ratios. Through this period the abortion rate remained stable, with the result that slightly more than half of all teenage pregnancies ended in abortion by 1997. Younger teens are more likely to have an abortion than to give birth. The majority of pregnancies among older teens end in a live birth, although the number of live births is decreasing. (author's)
Natural family planning: the various components.
In 1968, Pope Paul VI concluded his landmark encyclical, Humanae Vitae, by encouraging married couples to teach Natural Family Planning to other couples. He also encouraged doctors and medical personnel to learn Natural Family Planning (NFP) "so as to be able to give to those married persons who consult them wise counsel and healthy direction, such as they have a right to expect". Since that time, much progress has been made, but there is still much to be done. Some information about NFP has become fairly well known, but other facts remain less known or have been forgotten. The purpose of this article is to review the basic components of Natural Family Planning so that the physician will have a well-balanced understanding of these components and thus be able to give that wise counsel that his patients have a right to expect. (excerpt)
Requests for vasectomy: counselling and consent [letter]
Mr. Harris and Mr. Holmes (October 2001 JRSM, pp.510-511) are correct in stating that an unwanted pregnancy following a vasectomy failure due to late recanalization “can have devastating social and financial consequences”. But their advice that it is sufficient to warn the patient that the (average) risk of such failure is “about 1 in 2000 cases” is, I believe, flawed in two respects. First, it leaves unanswered what sensible advice can be given to a patient who asks what can be done to reduce this risk. Secondly, the term “vasectomy” includes a range of procedures--from the removal of several centimetres of vas (with wide separation of the ends) through division of the vas and separation of the ends by tissue interposition to diathermy of the intact vas resulting in an obstructed segment less than 2 mm in length. (excerpt)
RU-486: Is it hot, or is it not? [editorial]
Despite the tremendous press and promotional maneuvering surrounding the introduction of RU-486, so far, one gets the distinct impression that the primary care medical community, at large, has not rushed to embrace the pill. (excerpt)
Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk.
Little is known about the background of commercial sex workers in Africa. This study investigated how women in a trading town on the trans-Africa highway in southwest Uganda become involved in commercial sex work, which factors contribute to their economic success or lack of success, and what effect life trajectories and economic success have on negotiating power and risk behaviour. Over the course of two years detailed life histories of 34 women were collected through recording open, in-depth interviews, the collection of sexual and income and expenditure diaries, visits to the women's native villages, and participant observation. The women share similar disadvantaged backgrounds and this has played a role in their move into commercial sex. They have divergent experiences, however, in their utilisation of opportunities and in the level of success they achieve. They have developed different life styles and a variety of ways of dealing with sexual relationships. Three groups of women were identified: (1) women who work in the back-street bars, have no capital of their own and are almost entirely dependent on selling sex for their livelihood; (2) waitresses in the bars along the main road who engage in a more institutionalised kind of commercial sex, often mediated by middlemen and (3) the more successful entrepreneurs who earn money from their own bars as wen as from commercial sex. The three groups had different risk profiles. Due partly to their financial independence from men, women in the latter group have taken control of sexual relationships and can negotiate good sexual deals for themselves, both financially and in terms of safe sex. The poorer women were more vulnerable and less able to negotiate safer sex. A disadvantaged background and restricted access to economic resources are the major reasons for women gravitating to commercial sex work. Various aspects of personality playa role in utilising income from commercial sex to set up an economic basis that then makes the selling of sex unnecessary. This has implications for interventions, and part of the longer-term solution should lie in improving the economic position of women vis-a-vis men. (author's)
Water-quality changes in Latvia and Riga 1980-2000: possibilities and problems.
Long-term changes in the environmental quality of water in Latvia (chemical composition of inland waters, wastewater treatment, and drinking-water treatment practices and quality) as a response to socioeconomic changes have been studied. Water composition, the major factors influencing water chemistry, and human impacts (wastewater loading) were studied to determine changes that occurred after recent reductions in pollution emissions, particularly nutrient loading, to surface waters. After 1991, (Latvia regained independence in 1991) inland water quality has begun to improve mainly as a result of decreases in nutrient loads from point and nonpoint sources and substantial efforts in the area of environmental protection. The situation differs, however, for drinking-water treatment, where practices have also changed during the whole period from 1980 till 2000. More stringent drinking water-quality standards and novel insights regarding changes in water quality in the distribution network, necessitate further improvements in public water supply, and place this particular water issue among Latvia's main priorities. (author's)
Many countries of the WOI1d Health Organization Eastern Mediterranean Region suffer from severe water shortage, primarily as a result of population growth. The problem will undoubtedly worsen in the future with possibly drastic consequences. This paper outlines the current situation in the Region and the possible impact of water scarcity on health and the environment. Water conservation in agricultural, commercial and domestic areas is discussed from the perspective of water-conscious development and possible strategies are proposed. (author's)
Concentration of heavy metals in drinking water of different localities in district east Karachi.
Background: Several heavy metals are present in drinking water that play important roles in the body provided their level remains within the specified range recommended by WHO. But now due to the industrialization and rapid urbanization, the problems of pollution have surfaced. This study was designed to ascertain the contents of some heavy metals and then their variations if any in drinking water in different localities of district East of Karachi, Pakistan. Methods: Drinking water samples were collected from different sources and localities of district East of Karachi. The concentration of the heavy metals i.e. Lead, Arsenic, Copper, Iron, Mercury, Chromium, Manganese, Nickel, Cadmium and Zinc were determined by Atomic Absorption Spectrophotometry. PH was estimated by pH meter. Total dissolved solids (TDS) were calculated by formula. These concentrations of heavy metals, pH and TDS were compared with the standards set by WHO. Results: Concentrations of lead and nickel were found to be significantly elevated as compared to WHO recommended levels in all the three sources of water (Piped water, f-Iand pump water and Tanker water supply). Chromium was found to be raised in hand pump water. Arsenic and Mercury were not detected in any source of water. Copper, iron, manganese, cadmium and zinc were found to be within the safe limits in all the three sources of water. pH was found to be within the range of WHO recommended level in all the three sources of water. TDS was found to be elevated in hand pump water and tanker water. Conclusion: Concentrations of lead and nickel were found to be significantly elevated as compared to WHO recommended levels in all the three sources of water in district East of Karachi. (author's)
Suffering from water: social origins of bodily distress in a Mexican community.
This article is an ethnographic analysis of what it means to "suffer from water." Using a critical medical anthropology approach, the study examines how residents living in a foothill community of the Valley of Mexico experience bodily distress associated with water scarcity. Data for the study come from participant-observation of domestic water use and community drinking water management as well as interviews with local civil and religious officials who monitor the water distribution system. While the community discourse on suffering from water does not correspond to biomedical categories of illness, it does speak to the physical and emotional hardships and the social conditions that limit residents' access to an adequate supply of domestic water. By taking a broad view of water-related suffering, the study reveals some of the efforts made by people to address what they consider to be the social origins of their bodily distress. (author's)
Trends in birth rates: New York City 1970-1995.
Traditional means of assessing the problem of teen pregnancy have relied on national or state statistics. By using large geographic areas, usually comprised of a heterogeneous population, it is impossible to tell which subareas have more of a problem than others. This study focused on trends in teen birth rates at the health district level in New York City over a 25-year period to illustrate variations among ethnic groups. Teen birth rates were calculated based on vital statistics published by the New York City Department of Health. They were calculated as the number of births per 1,000 females in each of three age groups: under age 15, 15–17, and 18–19. Rates were calculated for the entire City, for four boroughs, and for selected health center districts. The decline in the birth rate among New York City teens is most significant in health districts populated by blacks. An exception is the noted increases in birth rates in districts populated predominantly by Hispanics. Data show substantial decreases among older teens compared to younger teens. Birth trends in small areas of New York City mirror trends seen nationwide. As migration changes the ethnic composition of small areas, it is important to monitor trends so that policies and programs can be targeted to those in need. (author's)
Teenage pregnancy: risk factors for adverse perinatal outcome.
Objectives: To assess the perinatal outcome of teenage pregnancy in a large cohort and to determine risk factors for low birth weight (LBW) in teenage pregnancy. Study design: All singleton first deliveries to mothers of age 16-24 years between 1990 and 1997 were included. The deliveries were subdivided into three maternal age groups (16-17 and 18-19 compared to 20-24 years) and parameters of perinatal outcomes were compared. To adjust for potential confounding effects on the association between young maternal age and birth weight, logistic regression analysis was performed for LBW with maternal ethnicity, pregnancy-induced hypertension, lack of prenatal care and malformations of the newborn. Results: Among a total of 11496 patients, 600 (5.2%) were 16-17 years old, 2097 (18.2%) were 18-19 years old and the remaining 8799 (76.6%) were 20-24 years old. Bedouin ethnicity and lack of prenatal care were common in the youngest mothers. Rates of preterm delivery were 14.2%, 9.8% and 8.8% in the three age groups, respectively (p < 0.05). Rates of malformations, small for gestational age, LBW and very LBW were also significantly higher in the youngest mothers. Rates of pregnancy-induced hypertension, operative delivery and Cesarean delivery were not significantly different among the three age groups. A multivariate analysis on LBW was performed to assess the unique contribution of young maternal age, adjusted for potential confounders. Adjusted ORs for LBW were 1.25 (95% CI 1.00-1.56) for maternal age < 18 years, 1.80 (95% CI 1.54-2.03) for Bedouin ethnicity, 2.57 (95% CI 2.14-3.07) for pregnancy-induced hypertension, 1.55 (95% CI 1.30-1.84) for lack of prenatal care and 4.09 (95% CI 3.2-5.2) for malformations. Conclusions: Teenage pregnancy was found to be associated with adverse outcome such as LBW, preterm delivery, small for gestational age and malformations. The risk for LBW was affected mainly by demographic factors (maternal ethnicity, lack of prenatal care) and medical factors (pregnancy-induced hypertension, malformations). (author's)
School-based teen pregnancy prevention programs: a review of the literature.
Teenage pregnancy is a well-documented problem in the United States, with approximately 890,000 teenage pregnancies occurring each year. Although teen pregnancy rates have declined since 1991, rates remain higher than the mid-1970s and are fourfold those of European countries. Substantial morbidity and social problems result from these pregnancies, affecting the mother, her children, other family members, and society. Multiple educational approaches have been used, with few demonstrating significant reductions in teen pregnancy. School-based programs have been diverse and multifaceted. Recently, programs with a comprehensive approach have shown potential for success. In this article, characteristics and elements of promising school-based programs are identified and discussed. It is imperative that school nurses play an active role in developing and implementing prevention programs that incorporate rigorous evaluation. As health educators, school nurses are in a prime position to implement and evaluate the effectiveness of teen pregnancy prevention programs. (author's)
Ecological analysis of teen birth rates: association with community income and income inequality.
Objective: To examine whether per capita income and income inequality are independently associated with teen birth rate in populous U.S. counties. Method: This study used 1990 U.S. Census data and National Center for Health Statistics birth data. Income inequality was measured with the 90:10 ratio, a ratio of percent of cumulative income held by the richest and poorest population deciles. Linear regression and analysis of variance were used to assess associations between county-level average income, income inequality, and teen birth rates among counties with population greater than 100,000. Result: Among teens aged 15-17, income inequality and per capita income were independently associated with birth rate; the mean birth rate was 54 per 1,000 in counties with low income and high income inequality, and 19 per 1,000 in counties with high income and low inequality. Among older teens (aged 18-19) only per capita income was significantly associated with birth rate. Conclusions: Although teen childbearing is the result of individual behaviors, these findings suggest that community-level factors such as income and income inequality may contribute significantly to differences in teen birth rates. (author's)
Population growth and fertility patterns in an Old Order Amish settlement.
Background: Since they are a healthy and well-nourished isolate with strong religious proscriptions against birth control, the fertility patterns of the Old Order Amish have long been studied by demographers, particularly those with an interest in natural fertility. Aim: The present report describes population growth, population structure, and fertility patterns in a little-studied Amish settlement located in northeastern Ohio, USA (Geauga Settlement). Subjects and methods: A directory prepared by the Geauga Settlement provides data on the dates of birth of the mother, father, and all children for 1337 families for the period up to I January 1993. This information was used to assess population size, population structure, fertility rates, age at marriage, age of mothers at first and last birth, and birth intervals. Estimates of total settlement size were also derived from an older directory covering the period up to 1 January 1988 and a recently published directory which covers the period up to 1 January 1998. Results: The settlement consisted of 7546 individuals in 1988, 8345 individuals in 1993, and 9572 individuals in 1998. The completed marital fertility rate was 7.7 (SD 3.6) births per woman. Total fertility rate decreased by about one birth between 1909 and 1967, in association with a change in fertility patterns, with women born in more recent cohorts tending to have more of their offspring at an earlier age, both of which suggest the existence of behaviours to control fertility. On the other hand, the age at the birth of the last child remained fairly constant over this time period. Conclusions: There is some suggestion of fertility control by Amish families. However, this control appears to be independent of parity, suggesting that there is no intention to limit family size. It is therefore reasonable to conclude that the Amish in the Geauga Settlement are a natural fertility population. (author's)
Correlates of the desired family size among Indian communities.
The People of India database of the Anthropological Survey of India documents 631 cultural, ecological and economical traits of the 4635 communities to which the entire Indian population is assigned. Focusing on 1342 communities of South India, we looked for correlates of low (1 or 2 children) and high (4 or more children) desired family size (DFS) reported as the norm for any given community by key informants. We found 10 cultural and 18 economic traits to be significantly correlated to high DFS and 21 cultural and 9 economic traits to low DFS. The economic traits so identified are compatible with high family size being desired by parents who have little capability of investing in quality of offspring, but whose children contribute economically from an early age. In contrast, communities desiring low family size are part of the modern intensive agriculture/organized industry/services sector and invest heavily in educating their children. A composite index based on 27 economic traits (CEI) has a high predictive value with respect to the DFS for the entire set of 4635 Indian communities. The 31 cultural traits highly correlated to high or low DFS constitute 5 clusters that can be identified as characterizing scheduled tribes, scheduled castes, rural and landless lower castes, urban upper castes and Moslems. Whereas economic traits have similar influence on DFS within each of these ethnic categories, Moslems demonstrate a significantly higher DFS for lower values of CEI. (author's)
Mortality during winter smog episodes 1982, 1985, 1987 and 1993 in the Czech Republic.
Objective: Severe air pollution episodes were recorded during the 1980s and early 1990s in the Czech Republic as a result of widespread combustion of brown coal. A population-based retrospective study investigated the relationship between air pollution and daily mortality in six highly polluted areas of the Czech Republic during smog episodes in 1982, 1985, 1987, and 1993. Methods: Total daily mortality, mortality by gender and age, cardiovascular mortality, respiratory mortality, data on weekly incidence of acute respiratory diseases and daily mean concentrations of sulphur dioxide and suspended particulate matter were used in the model. The effects of smog on daily mortality were estimated by multiple linear regression analysis. Results: Significant increases in mortality were observed for the 1982 and 1987 episodes (6% and 9%). In 1982, mortality was significantly associated with mean concentration of sulphur dioxide (SO2) of the current and the preceding days and with the 4-day moving average. In the 1985 episode a significant increase in respiratory mortality in men and in both genders together, lagging by 2 and 3 days, was detected. During the 1987 episode significant associations of total daily mortality, mortality in persons over 65 years of age and mortality from cardiovascular or respiratory diseases with 4-day moving average of both pollutants were found. For the 1993 episode a significant association between mortality in women under 65, lagging by 3 days, and mean concentration of suspended particulate matter (SPM) was observed. Conclusions: Most of the results are consistent with other studies aimed at episodic air pollution during the 19505 and 1960s in Western Europe and the USA, in which outdoor air pollution was shown to be a significant predictor of mortality. However, non-significant or opposite associations between air pollution and mortality indicate that other factors may also play an important role. A stronger effect on men under 65 years of age, suggested by a previous Czech study was not confirmed. (author's)
Accuracy of on-line databases in determining vital status.
Ascertainment of vital status is important for epidemiological and clinical trial research. Two free databases based on the Social Security Administration Death Master File have become available on the Internet. The accuracy of these databases is unknown. A cohort of 124 patients known to be dead and a cohort of 203 patients not known to be dead were identified. The on-line databases were searched with both of these cohorts following a specific search algorithm. The results for both on-line databases were identical. The optimal algorithm had a sensitivity of 0.82 (95% confidence interval 0.74–0.89) for identification of deaths. The sensitivity excluding deaths that occurred during the first year of life ( n = 118) was 0.86 (95% CI 0.79–0.92). The specificity was 1.00. This study found that free and convenient on-line databases based on the Social Security Administration Death Master File can be useful in the accurate ascertainment of vital status. (author's)
[Mortality due to smoking in Tunisia in 1997]
In Tunisia, in spite of the high prevalence of the cigarette smoking among males, there consequences in term of mortality were not until evaluated. These last can be estimated from tobacco consumption data, mortality statistics and estimates of risks observed among populations of smokers in cohort studies. Numbers of deaths by causes have been estimated from WHO for 1998 year. Smoking prevalence have been estimated from a national survey conducted in 1996 by l'lnstitut National de Sante Publique and the National League against the Tuberculosis and the Respiratory Illness. Mortality attributable to tobacco in Tunisia has been estimated 6430 deaths. The effect of smoking are a lot more important at the man (5580 deaths), contributing to 22% of male deaths, that at the woman (850 deaths) contributing at 4% of the female deaths. The present mortality to tobacco is similar to certain developed countries as France or Canada. The consumption of cigarettes even though it recorded a light decrease during these last years, remain even elevated notably at the young. Then it is waited to see an increase of tobacco related deaths during the future decades. It is urgent to conduct an efficient politics against this tobacco epidemic by helping the smoker to stop smoking and preventing teenagers to begin to smoking. (author's)
The economic importance of products extracted from Amazonian flood plain forests.
Rural people in the Peruvian Amazon practice agriculture and extract a wide range of products from natural forest, rivers and lakes. Their diversified livelihood system includes fish, game, and plant products. In 2 flood-plain villages, data for one year have been collected to compare the economy of local agriculture with the economy of extracted forest products for subsistence as well as for commerce. The study includes both fauna (game and fish) and flora (timber as well as nontimber). The results show that extracted forest products for subsistence, especially fish, are main a factor in the local economy. The daily net income from extraction activities exceeds both income from cultivation and the normal daily wages for unskilled workers, emphasizing the need for thorough socioeconomic investigations before any alternative land-use option is implemented. The average value per ha of natural forest used for extraction is in the order of USD 13 yr1, and the average extraction area is 113 ha household. When yield from agriculture is included in the calculations, the total per ha value of current extraction and agricultural activities increases to USD 21 yr1. (author's)
Desertification control in China: possible solutions.
First, as viewed from the industrial point of view, emphasis is placed on the agricultural-product processing industry, especially the processing. On the basis of this, other industries are gradually developed and the internal structure of the industry is dominated by the light-processing industry. Second, as viewed from the agricultural viewpoint, agriculture has a very important position in implementing the strategies. To meet the demands for processing agricultural products the internal structure of agriculture needs to be readjusted so as to develop value-added products. Third, both agriculture and industry, are strengthened, and can develop harmoniously to form an entirety. (excerpt)
Local agenda 21 (LA21) processes have 2 goals (i) On the basis of some of the empirical evidence in this study, the primary goal is to improve democratic (environmental) policy-making processes in such a manner that a larger share of the population will be able to participate in planning and decision making and will also be able to understand the consequences of these decisions. (ii) The LA21 processes seek to improve (at least indirectly) the broadly defined environmental situation locally in a manner that takes into account both the local and the global contexts. The first part of this article discusses the concept and methods of LA21 and sheds light on the different action areas that are central to the Baltic LA21 processes. In addition, the study will describe and display the LA21 situation within one network of cities, the Union of the Baltic Cities (UBC). Networking, including transfer of information, models and ideas, has been among the main tools for the diffusion of LA21 ideas especially into newly democratized societies. Finally, the article will conclude with an overall assessment of the LA21 situation on the Baltic rim. (author's)
Understanding human impact on the Baltic ecosystem: changing views in recent decades.
Grave environmental problems, including contamination of biota by organochlorines and heavy metals, and increasing deep-water oxygen deficiency, were discovered in the Baltic Sea in the late 1960s. Toxic pollutants, including the newly discovered PCB, were initially seen as the main threat to the Baltic ecosystem, and the impaired reproduction found in Baltic seals and white-tailed eagles implied a threat also to human fish eaters. Countermeasures gradually gave results, and today the struggle to limit toxic pollution of the Baltic is an international environmental success story. Calculations showed that Baltic deep-water oxygen consumption must have increased, and that the Baltic nutrient load had grown about fourfold for nitrogen and 8 times for phosphorus. Evidence of increased organic production at all tropic levels in the ecosystem gradually accumulated. Phosphorus was first thought to limit Baltic primary production, but measurements soon showed that nitrogen is generally limiting in the open Baltic proper, except for nitrogen-fixing cyanobacteria. Today, the debate is concerned with whether phosphorous, by limiting nitrogen-fixers, can control open-sea ecosystem production, even where phytoplankton is clearly nitrogen limited. The Baltic lesson teaches us that our views of newly discovered environmental problems undergo repeated changes, and that it may take decades for scientists to agree on their causes. Once society decides on countermeasures, it may take decades for them to become effective, and for nature to recover. Thus, environmental management decisions can hardly wait for scientific certainty. We should therefore view environmental management decisions as experiments, to be monitored, learned from, and then modified as needed. (author's)
United Nations Convention to Combat Desertification.
The Web site's Information for Public and Media page provides links to information such as secretariat press releases, educational information kits for classroom use, books, posters, images, and the Down to Earth newsletter. Many of the materials are available in French, Spanish. Russian, Arabic, Chinese, and/or German. Multilingual fact sheets have been developed on topics including the causes and consequences of desertification, partnership agreements between aid donors and affected states, and how desertificatjon is fought in certain regions. (excerpt)
Management challenges on small-scale gold mining activities in Brazil.
This article presents a focused study of environmental management in small-scale gold mining, called garimpo, at the Tapajos River in the Amazon basin (Brazil). Environmental management is necessary in this very important area not only for Brazil but for the general world welfare. The fact that this is a very dispersed area, with a very low economic and education level, complicates the issues. Added to these factors are legislation, administration, and control processes which are shown in their historical, technical, health, and economic aspects. Using systemic integration, the article describes how the inherent interests of each part directly or indirectly involved may be articulated to result in self-control. The same approach reveals also the potential conflicts. Some existent proposals are analyzed with regard to the extent to which they can work, given the described aspect. (author’s)
Emergency contraception provision: a survey of emergency department practitioners.
Objectives: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called ‘‘opt-out’’ or ‘‘abortion-related conscience clauses’’) with those of practitioners from states without these laws. Methods: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. Results: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with ‘‘abortion-related conscience clauses’’ and those from other states. Conclusions: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. ‘‘Abortion-related conscience clauses’’ did not seem to influence willingness to offer EC. (author’s)
This study aimed to assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually transmitted diseases (STD) in female sex workers in Abidjan, Cote d'Ivoire. It used a multiyear cross-sectional study of first-time attenders in Clinique de Confiance, a confidential STD clinic; bi-annual community-based behavioral surveys. From 1992-98, female sex workers were invited to attend Clinique de Confiance, where they were counseled, interviewed, clinically examined during their first visit and tested for STD and HIV infection. Community-based surveys, conducted in 1991, 1993, 1995, and 1997, interviewed women regarding sociodemographic characteristic and HIV/STD-related knowledge, attitudes and behavior. Among female sex workers in Abidjan, there was a trend toward shorter duration of sex work, higher prices, and more condom use. Among sex workers attending Clinique de Confiance for the first time, significant declines were found in the prevalence of HIV infection (from 89-32%), gonorrhea (from 33-11%), genital ulcers (from 21-4%), and syphilis (from 21-2%). In a logistic regression model that controlled for sociodemographic and behavioral changes, the year of screening remained significantly associated with HIV infection. The increase in condom use and the decline in prevalence of HIV infection and other STD may well have resulted from the prevention campaign for female sex workers, and such campaigns should therefore be continued, strengthened, and expanded. (author's)
The aim of this study was to identify the factors which explain correctional officers’ intention of accepting or refusing to make HIV preventive tools (condoms, bleach, tattooing equipment, and syringes) accessible to inmates. A total of 957 officers completed a questionnaire that took into account determinants from several social-cognitive behavior theories. The results indicated that only 21.4% of officers were favorable toward making accessible all of the preventive tools. The theoretical model explained 87% of the intention variance, p < .0001. Self-efficacy (beta=.35), personal normative belief (beta=.29), social determinants (beta=.21) and the affective dimension of attitude (beta=.19) were significant determinants. Moreover, officers with a high level of intention differed from those with a low level of intention on several points of the theoretical model. In conclusion, the results clearly indicated that several difficulties must be overcome before HIV preventive tools as a whole can be made accessible to inmates. (author’s)
The prevalence of obesity is higher in Black women than in White women (JAMA 1994;272:205–11; Arch Pediatr Adolesc Med 1995;149:1085–91). Although it has been shown that Black women have a lower resting energy expenditure (REE), factors affecting REE remain unclear. This 1996-1997 study in Cincinnati, Ohio, assessed racial differences in REE and their determinants in a biracial cohort of 152 healthy young women aged 18–21 years. Two indirect calorimetric measurements were obtained during two overnight hospital admissions 10–14 days apart. Body composition was measured by using dual-energy x-ray absorptiometry. Mean REE (adjusted for body composition, smoking, and contraceptive medication use) was significantly (p = 0.04) lower by 71 kcal/day in Black women (1,453 (standard error, 21) kcal/day) than in White women (1,524 (standard error, 19) kcal/day). Smoking was associated with a REE that was 68 kcal/day higher for both groups (p = 0.03). A trend (p = 0.07) toward increased REE (by 46 kcal/day) was found with contraceptive medication use. In conclusion, young Black women had a significantly lower REE than did White women. Cigarette smoking significantly increased REE. The apparent presence of a more parsimonious energy metabolism in Black women suggests that maintenance of energy homeostasis requires particular vigilance in this high-risk population. (author’s)
OBJECTIVE: The objective of this study was to identify the dose for a contraceptive patch that provides a predetermined level of ovulation suppression and cycle control and that is well tolerated. STUDY DESIGN: In this randomized study, 610 subjects received 10-, 15-, or 20-cm2 patch dose sizes (20- cm2, Ortho Evra/Evra) (Janssen Pharmaceutica, NV Belgium) or Ortho-Cyclen/Cilest (Janssen Pharmaceutica, NV Belgium) for up to 4 cycles. As with Ortho-Cyclen, patch regimens included 21 dosing days (3 consecutive 7-day patches) followed by 1 dose-free week. RESULTS: The patch regimens demonstrated a dose-response for ovulation suppression and cycle control. Presumed ovulation, determined on the basis of serum progesterone concentrations =3 ng/mL in cycles 1 and 3, occurred in 6.2% (Ortho Evra) and 7.2% (Ortho-Cyclen) of subjects. At cycle 3, breakthrough bleeding/ spotting was reported by 10.5% and 15.0% of subjects, respectively. Compliance with each patch was superior to that with Ortho-Cyclen (all P < .001). All regimens had safety profiles typical of oral contraceptives. CONCLUSION: The 20-cm2 patch (Ortho Evra) provided ovulation suppression, cycle control, and safety similar to that of Ortho-Cyclen, with significantly better compliance. (author’s)
Correctional officers and prevention of HIV transmission among prisoners.
We reprint the executive summary of a study conducted in federal and provincial prisons in Quebec. The goal of the study was to identify the factors influencing prison officers, with respect to whether they would agree or refuse to make accessible the tools needed for the prevention of HIV transmission among inmates (ie, condoms, bleach, tattooing equipment, and needles).Among the factors studied are officers’ perceptions and beliefs as well as their attitudes, perceived social norms, emotions, and perceived barriers with respect to making preventive tools accessible. (author's)
[Osteoporosis and hormonal contraception]
Objective: To analyse the influence of the contraceptive treatment on bone mass. Design: Literary review. Setting: Department of Gynaecology and Obstetrics, 1th Faculty of Medicine, Charles University, Prague, Czech Republic. Method: Informations were collected from full texts which were taken from database Medline. Results and conclusion: The lowering bone turnover under combination oral contraception was shown in all studies. It is favourable for bone mineral density after 30 years when bone loss starts. The positive influence is significantly dependent on the length of treatment. Only gestagen drugs have no positive effect on bone mass. The influence of contraception on mineral density in term of physiological bone density increasing before 20-25 year is not clear. Some of studies informed us about adverse effects of extremely-low dose oral contraception on mineral density in this group. (author's)
Objective: Review the knowledge about changes in hemostatic system in combined oral contraceptives users (focused on studies published between 1997 and 2000). Type of study: Review of literature. Setting: Department of Clinical Hematology, University Hospital Hradec Kralove, Czech Republic. Methods: Summary of the results of substantial studies published on this topic. Studies were identified by Medline database search. Results: Hemostatic changes were described in all subsystems (in both procoagulant and fibrinolytic systems, in natural inhibitors of coagulation) and could be seen also in molecular markes of coagulation and fibrinolysis activity. Substantial differences were not described for ethinylestradiol doses 20-50 microgram and up to 1997 also not for different progestins. More expressed acquired resistance to activated protein C at 3rd generation progestins in comparison with levonorgestrel was described recently as well as greater inhibition of fibrinolysis at desogestrel users. Conclusion: The results of recent studies indicate the differences in hemostatic changes between users of 3rd generation progestins, respective desogestrel, and users of levonogestrel. However, the practical recommendations (aiming at minimalization of VTE risk) are focused on personal and family history and on patient counselling. The choice of progestin could be important but it is not crucial. (author's)
One of the goals of population and reproductive health policy is to ensure safe motherhood and reduce reproductive health system related morbidity and mortality. Eliminating unsafe abortion will make an important contribution to achieve this goal. Providing information to men and women on ways of preventing unwanted pregnancy is another strategy. Increasing access to affordable and acceptable quality contraceptive services goes hand in hand. Emergency contraception should be widely promoted. Despite these strategies there will still be women who wish to terminate unwanted pregnancies. The extremely controversial nature of abortions will not change, given the well entrenched views among those opposed to abortion and those who support a woman's right to have an abortion. Women, especially those less privileged, not only confront the legal system, but also put their lives at risk each time they seek an abortion. Women should not be compelled to continue pregnancies when the fetus is abnormal or following rape and incest. Reforming the ancient and restrictive abortion law in Sri Lanka is not merely a moral or legal issue. Medical and health issues are also important. Withdrawing the amendment to the Penal Code in 1995, the then Minister of Justice and Constitutional Affairs stated "Decriminalising of abortion is a feature of evolving legal systems in many parts of the wood and I do not see any reason why Sri Lanka should be out of step with that general development." (excerpt)
Objective. To investigate the mechanism of prolonged uterine hemorrhage after terminated early pregnancy by mifepristone plus misoprostol. Method: Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6-7 week duration. Fifteen women were treated with mifepristone and 15 were treated with mifepristone plus misoprostol. The remaining served as controls. The tPA and PAI-1 mRNA levels were estimated by reverse transcription polymerase chain reaction. Chromogeneic assay and enzyme-linked immunosorbent assay were used to detect tPA activity and PAI-1 protein level in decidua. Results. The activities of tPA in the mifepristone plus misoprostol group and in the mifepristone group were 46.1 ± 20.74 IU/mg protein and 64.25 ± 35.81 IU/mg protein respectively, lower than those in the normal decidual group (99.76 ± 58.61 IU/mg protein, P <0.05). tPA mRNA levels in the mifepristone plus misoprostol group were the highest (1.43 ± 0.39) among the groups. In the mifepristone group, tPA mRNA level (0.90 ± 0.16) was not significantly different from that in the normal decidua group (0.94 ± 0.17). The protein and mRNA expression levels of PAI-1 were not significantly different among the three groups (P > 0.05). Conclusions: Mifepristone plus misoprostol decreased tPA activity in human early deciduas by post-transcription pathways, which may influence deciduas shedding, endometrial angiogenesis, endometrial remodelling, and cause prolonged uterine hemorrhage after drug abortion. (author's)
Objective: To investigate the action of mifepristone plus misoprostol on decidua at the level of vascular endothelial growth factor (VEGF) messenger ribonucleic acid (mRNA) and its protein expression, as well as the mechanism of prolonged uterine hemorrhage after terminating early pregnancy with these drugs. Methods: Forty-five decidua specimens were obtained from 45 pregnant women with amenorrhea of 6-7 weeks' duration, in which 15 women were treated with mifepristone and 15 were given mifepristone plus misoprostol. Enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect VEGF protein and mRNA levels in decidua. Results: In all three groups, only the VEGF121 amplification product of 452 bp was visualized. The mRNA and protein levels of VEGF showed no significant differences among the three groups (P > 0.05). Conclusion: In humans, early decidua VEGF121 mRNA is the main isoform. The action of mifepristone plus misoprostol on blood vessels in human decidua may be medicated by some factors other than VEGF. (author's)
Urban adolescents and sexual risk taking.
The paper analyzes socio-cultural and psychosocial factors affecting sexual activities and related risk-taking behaviors in Croatian high-school students. It attempts to determine the correlates of sexual activity, early sexual initiation, the number of sexual partners, and the use of contraceptives and condoms. Due to the gender-specific trajectories of sexual socialization and initiation, all the analyses were carried out separately for female and male students. The results point out gender-specific structure of adolescent sexual risk-taking, clustering of risk-taking activities, and the habitual character of sexual risk-taking. These findings should be instrumental for the development of a comprehensive school-based sex education curriculum that Croatia lacks. (author's)
Noncompliance among a group of women using a novel method of contraception.
Objective: To compare the incidence of noncompliance measured objectively by a home use fertility monitor with the traditional self-reported incidence of compliance in a study of a new method of contraception. Design: Prospective cohort study. Setting: A large family planning clinic in Edinburgh. Patient(s): Thirty-two healthy women who took part in a trial assessing the efficacy of a novel method of contraception involving accurately timed administration of a single dose of mifepristone. Intervention(s): Mifepristone was administered orally and a blood sample was collected on the same day. Main Outcome Measure(s): Percentage of missed tests detected by the monitor against the self-reported percentage during the critical period. Result(s): Women failed to perform 24.2% (95% confidence interval, 16.5–31.5) of the tests in the 162 cycles analyzed. They missed tests at an absolutely vital time for contraceptive efficacy in 42% of cycles according to the monitor while admitting to missing tests in 14.8%. Poor compliance was associated with younger women, those who discontinued the study before completion, and cycles in which women were not relying on the contraceptive method. Conclusion(s): The use of microelectronic monitoring systems may improve our understanding of the extent of patient noncompliance, providing objective information that no other monitoring technique can produce. This understanding provides the opportunity to make the optimum use of potentially effective treatments while validating research evidence. (author’s)
BACKGROUND: The TwoDay Algorithm is a simple method for identifying the fertile window. It classifies a day as fertile if cervical secretions are present on that day or were present on the day before. This approach may be an effective alternative to the ovulation and symptothermal methods for populations and programmes that find current natural family planning methods difficult to implement. METHODS: We used data on secretions from a large multinational European fecundability study to assess the relationship between the days predicted to be potentially fertile by the TwoDay Algorithm and the day-specific probabilities of pregnancy based on intercourse patterns in 434 conception cycles from the study. RESULTS: The days around ovulation that had the highest fecundability were the days most likely to be classified as fertile by the TwoDay Algorithm. In addition, intercourse on a particular day in the fertile interval was twice as likely to result in a pregnancy if cervical secretions were present on that day or the day before. CONCLUSIONS: The TwoDay Algorithm is effective, both in identifying the fertile days of the cycle and in predicting days within the fertile interval that have a high pregnancy rate. Our data provide the first direct evidence that cervical secretions are associated with higher fecundability within the fertile window. (author's)
Effect of oral and injectable contraceptives on serum electrolytes, weight and blood pressure.
Since the introduction of oral and injectable contraceptives, many metabolic side effects have been reported. The use of oral contraceptive has been shown to be associated with increased level of serum electrolytes, but decrease in levels of serum electrolytes has been reported in women using injectable contraceptives. This study evaluated serum electrolytes, weight and blood pressure in women taking oral and injectable contraceptives because these changes have adverse effects on the health and economy of the subject. Methods: Serum electrolytes. weight and blood pressure were measured in 50 women taking oral contraceptive (Lofeminal) and 50 women taking injectable contraceptives (Depomedroxy progesterone acetate and Norigest). The same women served as control before starting these contraceptives. Results: There was a significant increase in serum sodium and chloride but significant decrease in serum potassium and bicarbonate level in women taking oral contraceptive. There was non-significant decrease in serum electrolytes in women taking injectable contraceptives. There was significant increase in weight and blood pressure of women taking these contraceptives. (author's)
Suppression of spermatogenesis to azoospermia is the goal of hormonal male contraception based on T combined with gestagens. The combination of the long-acting T, ester testosterone undecanoate (TU), with norethisterone (NET) enanthate (E) showed high efficacy. In the present study, we tested the validity of this approach by varying the NET dose and mode of application. The aim of the study was to achieve high rates of suppression of spermatogenesis as reflected by sperm counts, monitor gonadotropins as well as other hormones, and evaluate any possible side effects. In a phase II clinical trial, groups of normal volunteers received: 1000 mg TU im at wk 2, 6, 12, and 18 combined with 200 mg NETE im at wk 0, 6, 12, and 18 (group I); 1000 mg TU im and 400 mg NETE im at wk 0, 6, 12, and 18 (group II); and 1000 mg TU im at wk 0, 6, 12, and 18 with daily oral NET acetate (NETA) from wk 0 to 24 (group III). In all groups marked suppression of gonadotropins resulted in a significant decrease of spermatogenesis and azoospermia in 13/14, 11/12, and 12/14 men in groups I to III, respectively. The remaining men all had less than 1 million sperm/ml. Reversible side effects included increase in body weight, erythrocytes, hemoglobin, and hematocrit and decrease in high-density lipoprotein cholesterol and alkaline phosphatase in all groups and increase in liver enzymes in the oral NETA group. This study documents the high efficacy of TU in combination with NET and confirms that this dose and mode of application (1000 mg TU im every 6 wk plus 400 mg NETE im every 6 wk or plus 10 mg daily oral NETA) is as effective as the previously reported regimen containing 1000 mg TU + 200 mg NETE im every 6 wk. The contraceptive efficacy of this combination of TU and NETE should be evaluated in further clinical trials. (author's)
This study investigated the effect of transdermal T and oral desogestrel on the reproductive axis of healthy men. Twenty-three men were randomized to 1 of 3 treatment groups and received a daily transdermal T patch plus oral desogestrel at a dose of 75, 150, or 300 mg/d for 24 wk. Baseline blood and semen samples were obtained and then every 4 wk thereafter for 32 wk. The outcome measures were sperm density and plasma levels of FSH, LH, total and free T. The results show a dose-dependent suppression of spermatogenesis and gonadotropins. Seven of the 17 subjects became azoospermic. Desogestrel (300 mg daily) in combination with 5 mg daily transdermal T was the most effective (57% azoospermic), whereas a dose of 75 mg was ineffective (0% azoospermic). Total and free plasma T were reduced by approximately 30%. High density lipoprotein cholesterol was significantly reduced. No serious side-effects were encountered. We conclude that daily self-administered desogestrel with transdermal T is capable of suppressing the male reproductive axis, although the efficacy was less marked and less consistent than injectable regimens. The lower efficacy is likely to be due to failure of the transdermal T system to maintain circulating T levels consistently in the required range. (author's)
Concurrent use of oral contraceptives with antidepressants for premenstrual syndromes [letter]
After 3 months of double-blind treatment, there were no differences between oral contraceptive (OC) users and nonusers in the responses to sertraline, placebo, or desipramine, and the statistical power was sufficient to show a difference between OC use and nonuse, if it existed To our knowledge, this is the only placebo-controlled study to examine the association of concomitant use of OCs with treatment response in subjects with PMS or PMDD. In another study of women taldng fluoxetine for other diagnoses of major depression, obsessive-compulsive disorder and bulimia, there was also no evidence that concomitant use of 0Cs interacted with treatment response. Although other data are conflicting, several studies that examined PMS samples for symptom changes during the menstrual cycle, found no difference between OC users and nonusers before treatment, which is consistent with our results. (excerpt)
Community health nurse practitioners are often the major contraceptive counselors who may use anticipatory guidance to help clients’ use behaviors. Because pregnancy rates during typical use are much higher than during “perfect” use, more effective anticipatory guidance could help improve use behaviors. Principles of cognitive theory were used to explore the implications of specific words and approaches associated with discussing young adults’ contraceptive use. Qualitative results are reported here, and potential implications are made for nurse practitioners’ anticipatory guidance related to contraceptive use. (author's)
Reproduction and health services in Brazil and Mexico: some ethical considerations.
This paper provides an initial overview of the main features of reproductive processes and health programs in two Latin American countries (Brazil and Mexico) and subsequently will explore several human rights issues and ethical problems. (excerpt)
Objectives. The effect of a second and third generation oral contraceptive and of the progestagens used in these pills on lipid metabolism was studied in the absence or presence of the factor V Leiden mutation. Design. A single centre, double blind randomized trial. Setting. University Medical Centre. Subjects. A total of 51 women without and 35 women with the factor V Leiden mutation. Interventions. A second generation (30 mg ethinylestradiol/ 150 mg levonorgestrel) or a third generation (30 mg ethinylestradiol/150 mg desogestrel) oral contraceptive. After two cycles of use and a wash-out period of two cycles, the participants received the corresponding progestagen-only preparation containing 150 mg levonorgestrel or 150 mg desogestrel. Main outcome measures. Mean difference in changes between the treatment groups on total cholesterol, HDL, LDL, triglycerides and total/HDL cholesterol ratio. Results. Compared with levonorgestrel, desogestrelcontaining oral contraceptives caused in women without the factor V Leiden mutation significant changes in HDL (0.43; 95% confidence interval [CI] 0.25±0.61), LDL (±0.55; 95% CI ±0.90 to ±0.20), triglycerides (0.19; 95% CI 0.06±0.32) and total/ HDL cholesterol ratio (±0.87; 95% CI ±1.21 to ±0.53). When the progestagen-only preparations were used, differential changes were found for HDL (0.16; 95% CI 0.03±0.29), LDL (±0.31; 95% CI ± 0.56 to ±0.05) and total/HDL cholesterol ratio (-0.55; 95% CI ±0.84 to ±0.26). Desogestrel-only caused changes opposite to those of desogestrelcontaining oral contraceptives. For cholesterol and triglycerides, this effect was also found for levonorgestrel- only in comparison with levonorgestrelcombined oral contraceptives. Levonorgestrel appeared to induce the effect on HDL. Almost all results were similar for women with the factor V Leiden mutation. Conclusion. It appears that desogestrel counteracts the effects of oestrogens to a lesser extent than levonorgestrel. Desogestrel-containing oral contraceptives have therefore a more favourable influence on cholesterol metabolism in comparison with levonorgestrel-containing oral contraceptives. (author's)
Adolescence is normally a healthy period of life. For some young people it is a period of experimentation with risky behavior. For others, it marks the development of habitual risk behaviors that persist into adulthood. Of special concern is adolescent involvement with sexual behaviors that increase the risk of infection with HIV and other sexually transmitted diseases (STDs). Nurses who work with adolescents are seeing an increase in STDs, including HIV infection occurring disproportionately among African-American adolescents. Although the use of condoms can reduce the risk of these sexually transmitted diseases, most sexually active adolescents do not consistently use condoms. This paper will discuss the scope of the problem of STDs, especially HIV infection among African-American adolescents. It will describe the Theory of Planned Behavior as a framework for designing interventions to reduce the sexual transmission of HIV and other STDs. Finally, it will provide strategies for nurses to intervene by empowering African-American adolescents to reduce their risk for sexually transmitted HIV infection. (author's)
A brief sexual barrier intervention for women living with AIDS: acceptability, use, and ethnicity.
Interventions aimed at reducing sexual transmission of human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) have focused primarily on male condom use among seronegative men and women. However, female-controlled sexual barriers (female condoms and vaginal microbicides) offer women living with acquired immunodeficiency syndrome (AIDS) alternative methods to protect themselves and others from disease transmission. A pilot behavioral intervention was conducted to increase sexual barrier use and enhance and assess factors related to acceptability. Participants (N = 178) were drawn from the Stress Management and Relaxation Training with Expressive Supportive Therapy (SMART/EST) Women's Project, a multisite phase III clinical trial for women living with AIDS (Miami, FL; New York City, NY; Newark, NJ). Intervention participants (n = 89) were matched for age and ethnicity with control condition participants (n = 89). Women were African American (52%), Haitian (15%), Hispanic (19%), Caucasian (10%), and other ethnicities (4%). The intervention condition received barrier products (male and female condoms and spermicides based on nonoxynol-9 in the form of vaginal gel, film, and suppositories) during three sessions held over 3 months. Data on barrier use and acceptability were analyzed at baseline and 3 and 9 months postintervention. Use of N-9 spermicides on a trial basis increased significantly by 3 months in the intervention conditions (22%-51%, P < .05). Cultural differences in acceptability were greatest between Haitian women and women in other ethnic groups. Exposure to this pilot behavioral intervention was associated with increased acceptability and use of chemical barriers without decreased use of male condoms. (author's)
Prescription contraceptives: benefit whose time has come?
Health plans and employers are paying increasing attention to recent administrative and judicial developments relative to contraception coverage. Whether self-funded or insured, plans that offer prescription drug benefits may no longer be able to exclude prescription contraceptive drugs or devices. Thirteen states require insurance policies specifically to cover contraceptive drugs or devices. For individuals covered by group insurance policies in other states or for those who are covered by self-funded, employer-sponsored benefit plans, these developments indicate that limitations on contraceptive benefits may be on the way out, though in most of the country, providing contraceptive coverage is not yet legally required. (excerpt)
Why do women douche? Results from a qualitative study.
The objective of this paper was to explore women's attitudes and practices related to douching. The authors conducted focus groups between July and December 1999 with 34 Black and 27 White women enrolled in a managed care plan in Memphis, Tennessee. Participants were at least 18 years of age and had douched at some time in their lives. Five groups were held with Black women and five with White women. The focus groups identified 13 themes that fell in four broad categories: general perceptions about feminine hygiene, douching behavior, factors perpetuating douching, and health information. Each of these categories is briefly discussed with supporting evidence. First, women have deeply-rooted beliefs about the critical role of douching in making them feel clean. Second, douching generally starts at a young age and is reinforced by family, friends, and the media. Third, douching is a very difficult behavior to change; any efforts to influence this behavior must consider women's belief and the media marketing efforts that promote douching. Finally, simplistic interventions that only provide risk information about douching are not likely to result in behavior change. (author's)
[Contraceptives for epileptics?]
In this article Dr. Otto R. Frey discusses which methods of hormonal contraception are appropriate for epilepsy patients. He examines various forms of contraception including oral contraceptives, diaphragms, injections and implants.
Findings in female offspring of women exposed in utero to diethylstilbestrol.
OBJECTIVE: To examine a group of women (third-generation daughters) whose mothers were exposed in utero to diethylstilbestrol (DES) and compare their findings on pelvic examination with those noted in their mothers. METHODS: Letters were mailed to women documented to have been exposed in utero to DES who had given birth to a female offspring, inviting them to have their daughters come in for a detailed history and pelvic examination. Records of the mothers whose daughters appeared for examination were reviewed, and findings noted at the time of their initial examination were recorded. Detailed pelvic examination of the third-generation daughters included colposcopic examination and iodine staining of the vagina and cervix and Papanicolaou smear. The findings observed in these women were compared with those noted in their mothers at the time of their mothers’ first examination. RESULTS: Twenty-eight third-generation daughters were examined. Three of the daughters were delivered from one mother. Review of the mothers’ records indicated that 16 (61.5%) of the mothers exposed to DES during their pregnancy demonstrated structural changes of the cervix, upper vagina, or vaginal epithelial changes consisting of adenosis, nonstaining vaginal epithelium after application of iodine solution, or white epithelium within the vagina. None of the daughters were found to have changes usually associated with DES exposure. CONCLUSION: The absence of abnormalities in the lower genital tract in third-generation women compared with the high frequency of these abnormalities in their mothers suggests that third-generation carryover effects of in utero DES exposure are unlikely. (author's)
Noncontraceptive health benefits of intrauterine devices: a systematic review.
Most women and their clinicians are unaware that IUDs confer important noncontraceptive health benefits. This review summarizes the evidence from published articles on this topic. We conducted a series of systematic literature searches to identify articles on the noncontraceptive health benefits of IUD use. We reviewed the potentially pertinent ones for content, grouped them according to type of IUD, and evaluated them using the U.S. Preventive Services Task Force rating system. Over 500 titles were identified and several hundred abstracts were reviewed. Use of nonhormonal IUDs (plastic and copper) was associated with a decrease in endometrial cancer. The levonorgestrel intrauterine system can treat a variety of gynecological disorders, including menorrhagia and anemia. The levonorgestrel system has also been used successfully as part of hormone replacement therapy, as adjuvant therapy with tamoxifen, and as an alternative to hysterectomy for women with bleeding problems. Like oral contraceptives, intrauterine contraceptives confer important noncontraceptive health benefits. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the currently marketed IUDs in the U.S., to summarize the current literature about the noncontraceptive benefits of IUD use, and to list the noncontraceptive benefits of IUD use. (author's)
Nonoxynol-9 may increase HIV transmission risk.
Although N-9 did have a limited ability to kill HIV in the laboratory, in human studies N-9 was found to strip away the outer layer of skin inside the vagina and the rectum. HIV that wasn't killed entered the bloodstream more easily, thereby increasing the risk of HIV transmission by as much as 50 percent when compared to using a water-based lubricant without N-9. Because of this, the Centers for Disease Control and Prevention has advised against the use of N-9 as a microbicide. (excerpt)
Predictors of initiation of early sex in Black and White adolescent females.
This study examined the extent to which problem solving, self-image, and other health-related factors predict age at first intercourse among Black and White adolescent females. The volunteer sample was 16 to 19 years old; 52% were Black (n=105), and 48% (n=97) were White. Adolescents were recruited from family planning clinics throughout South Carolina. Stratified analyses identified race as a modifier of the relationship between problem solving and time of first intercourse (early or delayed). Logistic regression revealed three predictors of early age at first intercourse in Black girls, but only one predictor in White girls. There were no race differentials in either age or the proportion of girls initiating early intercourse. However, Black girls who had less problem solving skill than their peers were five times more likely to have early intercourse, three times more likely to practice fewer health-promoting behaviors, and seven times more likely to have 10 or fewer years of education. Early intercourse was significantly associated with unprotected first intercourse. Our findings suggest that interventions may need to be tailored for different risk groups within Black populations of adolescent girls. (author's)
Objective. The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection. Methods. HIV-infected women in one study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use. Results. Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at 12 months. Conclusions. The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention design, and sample characteristics help explain these differences. (author's)
Interviewing young men about sex and procreation: methodological issues.
Because clear instructions for interviewing men about their developing procreative identities do not exist, the authors discuss a variety of methodological issues that surfaced during in-depth interviews with young men about relationships, sex, contraception, pregnancy, and fatherhood. The authors interviewed a diverse sample of 50 single male participants, ages 16 to 30, who had dated at least one woman in the past 3 years (or had been married). The purpose of the reflexive analysis was to sensitize researchers, social service providers, and the authors to the challenges of conducting quantitative interviews with young men. The authors present indices for assessing interview success. (author's)
[Oral hormonal contraceptives, coagulation and thrombosis (editorial)]
The association between the use of oral hormonal contraceptives and venous thromboembolic disease (VTE) was described for the first time at the beginning of the sixties. Starting with the first epidemiological studies at the end of the sixties, it has been demonstrated that oral hormonal contraceptives increase the risk of VTE disease. The thrombotic risk due to the use of oral estrogen-progestin contraceptives is related, in the first place, to the estrogen concentration of the pill, as well as to the amount and androgenic effect of the associated progestin. The risk is additionally influenced by special circumstances like the congenital thrombophilic factor of every woman. (excerpt)
Emergency contraceptives are methods that prevent pregnancy when used shortly after unprotected sex. Three different emergency contraceptive methods are safe, simple, and widely available in the United States. These are: (1) ordinary combined oral contraceptives containing ethinyl estradiol and levonorgestrel taken in a higher dose for a short period of time and started within a few days after unprotected intercourse; (2) levonorgestrel-only tablets used similarly; and (3) copper-bearing intrauterine devices inserted within approximately 1 week after unprotected intercourse. Emergency contraceptive use is best known for women who have been raped, but the methods are also appropriate for women who have experienced condom breaks, women who did not use any method because they were not planning on having sex, or women who had unprotected intercourse for any other reason. Unfortunately, few women know about emergency contraceptives, and few clinicians think to inform their patients routinely about the option. A nationwide toll-free hotline (1-888-NOT-2-LATE) and a website (http://not-2-late.com) can help women learn about these options. Sharing "family planning's best-kept secret" widely with women could prevent as many as a million unwanted pregnancies annually in the United States. (author's)
Contraceptive vaginal rings (CVRs) contain sex steroids that diffuse through a plastic polymer ring at a constant rate and are absorbed directly through the vaginal epithelium into the systemic circulation. This delivery system provides many advantages over oral contraceptives (OCs), including avoidance of the first-pass effect through the liver, constant serum steroid levels, longer duration of use, and greater bioavailability of the hormones. CVRs containing progestin only are designed for continuous use for 3 to 6 months. Those containing progesterone alone are indicated for use in women who are breastfeeding. Large clinical trials of progestin-containing CVRs demonstrated good efficacy and safety of the CVR, with continuation rates similar to that of OCs. CVRs containing a combination of estrogen and progestin are designed to be used for 1 to 12 months in a cyclic manner similar to OCs, with withdrawal bleeding in the fourth week of each cycle. In clinical trials these CVRs have typical use efficacies similar to OCs, with an acceptable pattern of bleeding. (author's)
Background: Little is known about infection rates for human immunodeficiency virus (HIV) and other diseases that can be transmitted sexually in Bangladeshi women who may be at intermediate levels of risk—that is, women who are not commercial sex workers (CSWs) but whose sexual contacts may include men at high risk for STD. This study examines HIV/hepatitis/STD and other genital tract infections in women living near Tejgaon truck stand in Dhaka, Bangladesh. Methods: This population based study was conducted from January to December 1998. A random sample of 384 women provided urine and blood samples and participated in an interview; 261 of them also had a physical examination in which vaginal and cervical specimens were taken. Laboratory tests included PCR on urine and cervical swabs for gonorrhea and chlamydia, culture for trichomoniasis, serology tests for syphilis, herpes simplex 2, hepatitis B, C, D, HIV1, HIV2, and clinical diagnoses of other genital tract infections. Results: None of the participants tested positive for HIV. In the 261 women who had a physical examination, trichomoniasis was detected in 19.5%, chlamydia in 3.4%, gonorrhea in 5.4%, bacterial vaginosis in 37.2%, and candidiasis in 10%. In the full sample of 384 women, with tests of urine and blood, prevalence of infection with chlamydia, gonorrhea, syphilis, and herpes simplex 2 was detected in 0%, 6.3%, 5.7%, and 32% respectively. Almost 50% of the subjects had ever been exposed to hepatitis B, 3.6% were currently infective, 1.6% had hepatitis C, and none had hepatitis D. Conclusion: The high prevalence of certain of these infectious diseases indicates the need to implement prevention interventions with these women and, perhaps more importantly, with their male partners. Qualitative research is needed to provide insights into their sexual behavior and the contexts in which high risk behaviors occur. (author’s)
Competing approaches to analysis of failure times with competing risks.
For the analysis of time to event data in contraceptive studies when individuals are subject to competing causes for discontinuation, some authors have recently advocated the use of the cumulative incidence rate as a more appropriate measure to summarize data than the complement of the Kaplan-Meier estimate of discontinuation. The former method estimates the rate of discontinuation in the presence of competing causes, while the latter is a hypothetical rate that would be observed if discontinuations for the other reasons could not occur. The difference between the two methods of analysis is the continuous time equivalent of a debate that took place in the contraceptive literature in the 1960s, when several authors advocated the use of net (adjusted or single decrement life table rates) rates in preference to crude rates (multiple decrement life table rates). A small simulation study illustrates the interpretation of the two types of estimate - the complement of the Kaplan-Meier estimate corresponds to a hypothetical rate where discontinuations for other reasons did not occur, while the cumulative incidence gives systematically lower estimates. The Kaplan-Meier estimates are more appropriate when estimating the effectiveness of a contraceptive method, but the cumulative incidence estimates are more appropriate when making programmatic decisions regarding contraceptive methods. Other areas of application, such as cancer studies, may prefer to use the cumulative incidence estimates, but their use should be determined according to the application. (author's)
[Tetracycline treatment, oral contraceptives and pregnancy]
For three decades, the alleged reduced contraceptive effect resulting from the interaction between oral contraceptives and broad-spectrum antibiotics has been the object of controversy. Numerous casuistic reports on unwanted pregnancy point to this interaction. The biological rationale is the interruption of the ethinylestradiol enterohepathic circulation. (excerpt)
A one-year longitudinal study was undertaken in Kingston. Jamaica, to examine (i) the experience of side effects among female contraceptive users, (ii) the role of side effects in method continuation, and (iii) counselling regarding side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at the women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, contraceptive history, service factors, experience with method and length of use. Forty-eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side effects were irregular bleeding/no period, headaches, nausea/dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty-seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side effects and make informed choices about contraception. (author's)
Health promoting behaviors among rural southern early adolescents.
A central element in attaining the goals and objectives of Healthy People 2010 is promoting healthy behavior lifestyles. Health promotion continues to be sanctioned as the long term most cost effective approach to a reduction in preventable health problems. Adolescents are presently an age group in jeopardy of making the transition into adulthood with healthy lifestyles. This paper describes the use of the Health Promoting Lifestyle Profile (HPLP) (Walker, Sechrist, and Pender, 1987) as a measure of health promoting behaviors in a group of rural southern early adolescents (1036 seventh and eight graders; 81% were African American). The findings suggest that rural southern adolescents perceive themselves to be engaging in health promoting lifestyle behaviors. However, some HPLP subscales seemed to be especially difficult for adolescents. (author's)
African-American girls are at greater risk of engaging in sexual relations at earlier ages and putting themselves at risk for pregnancy and sexually transmitted disease. It may also lead to more limited successful life trajectory. The purpose of this article is to present an overview of some of the issues affecting African-American girls today as they leave preadolescence and enter early adolescence. Research and health promotion strategies are identified that need to be examined and addressed when providing care to this population. (author's)
A flexible, risk-reduction approach, as compared with a single method approach, may increase sexually transmitted disease (STD)/HIV protection for women attending STD clinics. A brief intervention was tested in an observational study of 292 STD clinic patients in three distinct cohorts. These included subjects counseled on (1) the “women’s safer sex hierarchy of prevention methods” (hierarchy cohort, n = 118), including the female condom (FC), male condom (MC), diaphragm, cervical cap, and spermicides, (2) MC only (n = 62), or (3) FC (n = 112) only. We evaluate method use and level of protection achieved at 6-month follow-up among the women in the hierarchy cohort and compare the level of unprotected sex across the three cohorts, using ordinal logistic regression analyses and an imputation procedure to account for attrition. In the hierarchy cohort, the MC, FC, spermicidal film, foam, suppository, and diaphragm were used with main partners by 80%, 46%, 37%, 28%, 17%, and 5% of women, respectively. Spermicides were used frequently, mainly in conjunction with condoms. As compared with hierarchy subjects, both MC cohort subjects (OR = 2.3, p = 0.01) and FC cohort subjects (OR = 1.6, p = 0.11) were more likely to report 100% unprotected sex. The tendency for subjects to move toward higher levels of protection was observed most strongly in the hierarchy group. Hierarchical-type counseling, compared with single method counseling, leads to increased protection during sex among women at high risk of STD/HIV infection and should be implemented in STD clinics. (author's)
Accurate clinical and laboratory data about sexually transmitted diseases (STD) prevalence in Guinea-Bissau are not available. These data are important, since HIV2 is prevalent in this country, rates of HIV1 are increasing and STDs facilitate HIV transmission. Since DNA amplification methods have demonstrated to accurately diagnose chlamydial infections and gonorrhoea, the Amplicor CT/NG PCR Assay with Internal Control of Amplification (Roche Diagnostic System, Branchburg, NJ, USA) was used to estimate the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis genital infections in STDs and Family Planning Clinic attenders in Bissau, from March to July 1997. Two hundred and two cervical swabs contained inhibitory substances. N. gonorrhoeae was identified in 34/200 (17%) women and in 12/13 (38.7%) men. C. trachomatis was detected in 8/200 (4%) women there were no positive C. trachomatis results among the 31 men with urethritis. One woman presented a mixed infection with both organisms. The prevalence difference between men and women was not statistically significant (P = 0.6) for C. trachomatis infection, but it was significant for N. gonorrhoeae infection (P = 0.01). The prevalence rates of these infections found in this study, support the need for an urgent strategy to control STD in the region. (author's)
A suitable job for a woman: women doctors and birth control to the inception of the NHS.
Women doctors reflected wider changes in attitude over time both within the medical profession and in society as a whole. However, given the general hostility and neglect towards contraception which the profession as a whole demonstrated, it is worth noting how many women doctors were in favour, and prepared to get involved with it. They appear far more ready than contemporary male colleagues to protest against the neglect of birth control in medical education - possibly they found it easier to admit ignorance? - and were more active in birth control provision, both in private practice and in clinics, in numbers disproportionate to their presence in the profession as a whole. However, medical women's failure to change the medical curriculum or inaugurate wider provision of facilities, suggests that, however privileged compared to most women, they largely lacked the individual or collective power to influence policy on the national level. (excerpt)
Childbirth care-seeking behavior in Chiapas.
This study was designed to better understand how women in a developing region choose between the multiple options available to them for birthing. We conducted focused, open-ended ethnographic interviews with 38 nonindigenous, economically marginal women in Chiapas, Mexico. We found that although medical services for birthing were readily available to them, these women most often chose traditional birth attendants (TBAs) for assistance with their births. They expressed a clear preference for TBAs in the case of a normal birth, but viewed medical services as useful for diagnosing and managing problem deliveries and for tubal ligations. They favored TBAs because they valued being able to choose birthing locations and birthing positions and to have relatives present during the birth, all features they must give up for medically attended births in this region. (author’s)
Health education and diarrheal disease [letter]
In the course of our own extensive studies exploring various aspects of diarrheal disease, including the KAPs, we have found that for optimal benefits from health education, mothers need to be augmented every 2-3 months in the first year, every 4-6 months in the second year and every 9-12 months subsequently. Else, the useful impact of the health education begins demonstrating a tendency for withering away. (excerpt)
Reduction of high-risk behaviors among incarcerated youths: a challenge in prevention.
The adolescents in America is at increasing risk for acquiring the human immunodeficiency virus (HIV) that causes AIDS(CDC, 1998; 1996;1994;1993). Although the total number of reported AIDS cases among adolescents 12 to 19 years of age is, thus far, fairly small, the identified caseload in this age group has increased by over 40% during one year alone. In fact, one-fifth of all reported AIDS cases occur among 20 to 29 years of age. Many of these young adults contracted HIV infections as teenagers (CDC, 1996). But the trend is changing. In fact, among younger youths, especially those of African heritage, the infection rates are rapidly increasing. These increases will require focused attention by all health professionals, and public policy officials (Lai, Tsai, Hardy, 1997; Porter, Oakley, Guthrie & Killion, 1999). The purpose of this current study was to describe risk-related behaviors of incarcerated youths that are significant factors when planning community-based programs for HIV/AIDS prevention. Several research questions were generated in this regard and tested. Several significant findings emerged from the data that indicate that African-American youths incarcerated are at greater risk for development of HIV/AIDS than their other ethnic counterparts. (author's)
Using village theatre to increase knowledge about eclampsia in Bangladesh.
Objective: To assess the impact of a theatre based educational initiative on the knowledge and attitudes to eclampsia and its treatment in a rural Bangladeshi village. Methods: An established theatre company, Theatre Centre for Social Development, performed scenarios regarding eclamptic pregnant women to a diverse audience of village observers. Before the performance 15 men and 15 women were randomly selected from the audience and asked a series of questions regarding eclampsia. After the performance the series of questions were repeated to the same people. Results: The plays were enthusiastically received by the villagers. The level of knowledge of the villagers interviewed increased significantly after seeing the two plays. Conclusion: The intervention successfully raised both the awareness of eclampsia and the level of knowledge of effective treatments for eclampsia. Village theatre has shown the potential to be a very effective tool in Bangladeshi rural society. (author's)
A call to action. Acculturation level and family-planning patterns of Hispanic immigrant women.
Purpose: To describe family-planning patterns of Hispanic women and to determine their relationship to acculturation level and to selected maternal demographic, pregnancy, and infant birth indices. Design: Descriptive correlational. Methods: A convenience sample of 376 Hispanic women was drawn from prenatal clinics in a large, public teaming hospital in the Southwest United States. Acculturation status was assessed during the prenatal period using the Acculturation Rating Scale for Mexican Americans II. Maternal data concerning pregnancy, infant birth, postpartum, and family planning were abstracted from the hospital record. Data were analyzed using descriptive, correlational, and multiple regression procedures. Results: Most women were of Mexican origin, first generation in the United States, and oriented toward traditional Mexican cultural beliefs and values. Most were married, had less than an eighth-grade education, and experienced a first or second healthy pregnancy with healthy birth outcomes. Over 66% of the women returned for at least one visit in the first year postbirth; compliance at 1 yr declined to 28%. Five variables were significantly correlated with family-planning visit compliance: number of pregnancies, generation in the United States, acculturation level, trimester of first prenatal visit, number of prenatal visits, and gestational age of newborn. Clinical implications: Nurses are in a pivotal position to educate the Mexican immigrant woman about healthcare for herself and for her family, but need to recognize cultural influences on family-planning behavior. Effective interventions build on existing knowledge, beliefs, and practices of traditional immigrant women. It is important to include the generation in the United States as an indicator of adherence to traditional values and beliefs. (author's)
Making midwives: postmodern conditions and midwifery training in Saint Lucia.
Drawing on material from fieldwork conducted on the island of Saint Lucia, I examine how Saint Lucian nurse-midwives and student midwives negotiate multiple ways of understanding and evaluating their practices and roles in light of contradictory and powerful cultural historical, and political forces. I argue that, although Saint Lucian nurse-midwives may not qualify as "postmodern" according to the criteria proposed by Davis-Floyd and Davis (1996), they are nonetheless struggling with postmodern conditions as they negotiate between competing healing ideologies. I illustrate the significance of these negotiations through analyzing: (1) the ways nurse-midwives understand and articulate the healing ideologies at play in Saint Lucia, (2) historical and ideological aspects of the Saint Ludan nurse-midwifery training program, and (3) a classroom discussion during which student reported on "bush-midwives." (author's)
Childbirth and pragmatic midwifery in rural Ghana.
Conceptual categories such as traditional, modern, and postmodern do not further our understanding of the empirical situation of midwifery in late 2Othcentury rural Ghana. Processes of "modernization," it is argued, have not had much impact on the domain of childbirth. And, despite efforts to "medicalize" birth (by the state and the international movement for safe motherhood and child survival), in Anlo-Ewe cultural contexts in the mid-l990s the lineage still controlled most deliveries, with many babies continuing to be born at home. This article provides an in-depth portrait of one midwife, Sena, who practiced in this rural loca1e - a locale that is marked by increased "professionalization" and competing ideologies of healing and health. Exemplifying what might best be referred to as critical midwifery grounded in pragmatism, Sena mediated, translated, and maneuvered as she involved herself in the imbroglios of birth and as she worked to improve maternal and infant health. (author's)
Knowledge and home management of malaria fever by mothers and care givers of under five children.
This study documents the knowledge and home management practices of 376 mothers and care givers of under five children on malaria fever. Results revealed that both the knowledge and case management practices were poor as only 179 (46.8%) knew how malaria was transmitted. Of those who knew malaria could be prevented, clearing of bushes and gutters was the commonly stated method (78 or 21.8%), followed by the use of traditional herbs, 'Agbo' by 75 (20.9) mothers. The elders and friends were stated to be the major source of knowledge about malaria by 141 (37.5%) mothers. Knowledge scores was significantly higher in older mothers, among the educated, and skilled mothers (P < 0.05). As regards practices, self-medication with modern drugs was common, these drugs had been given in the home by 265 (70.5%) mothers while "Agbo", had been used by 95 (25.5%) mothers before presenting at the clinic. Paracetamol was the modern drug often used (217 or 81.8%). Followed by chloroquine (57 or 21.5%). However, drug treatment practice were often incorrect. Chloroquine was prescribed correctly by 15 (26.3%) mothers, while 109 (50.2%) gave the correct dose of paracetamol. Only 16 (4.3%) of the children received anti-malarial on the day the illness began. There is the need for education programmes on malaria for mothers, especially for young, illiterate and unskilled mothers, including the family elders. (author's)
This paper reviews the nature and explores the context of, and reactions to, reproductive health education in China by both the target population of adolescents at school and the wider public. The debate about reproductive health education and its content is taking place within the context of rapid behavioural and sociological changes in China which, in turn is, generating conflicting demands concerning the need for education by the population and the control of the population by the government. Foucault's theories on sexuality and discipline are found to be useful in exploring the subject of reproductive health education in China. (author's)
Objective: To document the socio-demographic profile presenting symptoms, disease state and treatment modality offered to all women attending Harare and Parirenyatwa Hospitals with a histological diagnosis of invasive cervical cancer in 1998. Design: A cross sectional study. Setting: Parirenyatwa Hospital and Harare Central Hospital. Subjects: All women with a histological diagnosis of cervical cancer admitted between 11 January 1998 and 14 December 1998 were recruited into the study. Results: A total of 196 patients, with a median age of 47 years (range 24 to 80 years) were recruited into the study. A high proportion (63.3%) of the women were from rural areas. The mean age at first pregnancy was 17.9 years (SD 2.8) and 112 (63.3%) first sought treatment at the primary health care centre. Persistent vaginal discharge was the most frequent (69.4%) presenting complaint. One hundred and ninety five patients (99.5%) had histological confirmation of invasive cervical cancer (91.8% squamous cell carcinoma, 7.7% adenocarcinoma). Clinical staging by The International Federation of Gynaecology and Obstetrics (FIGO) classification confirmed that the majority (80.3%) of the cancers had spread from the cervix into the parametrium and beyond (stage 2b and above) at the time of presentation. Radiation therapy was the most commonly used (77.0%) treatment modality. Conclusion: This study demonstrates that the burden of cervical cancer occurs around the peak age of 47 years and that the majority of women present with advanced disease. None of the women had ever been screened for cervical cancer. The planned introduction of a cervical cancer screening programme by visual inspection of the cervix with acetic acid (VIA), together with a health education campaign may result in a shift towards more women presenting with early curable cervical cancer cases. (author's)
Aim. The purpose of this study was to conduct an assessment of reproductive health-seeking behaviours, sources of advice, and access to care issues among a sample of clinic-based homeless adolescent women. Background. Adolescent women are among the most vulnerable and medically underserved subgroups within the homeless population in the United States. Homeless youth are rarely invited to participate in research aimed at improving their access to appropriate health care. Also, the culture in which they live and the personal experience of being homeless are often not addressed. Study method. The research was descriptive, using focus groups and individual interviews with a purposeful sample of 20 female youth, aged 14±23 years. Findings. The women said that they seek health advice from other women, including their mothers even while they are homeless. They reported first trying selfcare interventions, and going to clinics when self-care actions no longer worked. They stated that the main barriers to health care were lack of insurance, confusion over consent, transportation problems, lack of respect (from providers) for their own self-knowledge, and judgementalism from providers. Conclusion. Using the concept of cultural competency, the results provide insights into how to improve communication and health care services for these women. Recommendations. Health care providers need to recognize and appreciate the lifestyle, beliefs, and adaptive attitudes of homeless youth, rather than labelling them as “deviant”. All personnel who interact with and on behalf of homeless youth must be adequately trained in general knowledge regarding the health of homeless youth as well as in an understanding of the role that culture plays in their healthseeking behaviours. (author's)
Determinants of low birth weight among HIV-infected pregnant women in Tanzania.
Low birth weight (LBW) increases the risk of infant death, but little is known about its causes among HIV-infected populations in sub-Saharan Africa. The authors assessed sociodemographic, nutritional, immunologic, parasitic, and infant risk factors for birth weight, LBW, and small-for-gestational-age (SGA) status in a cohort of 822 HIV-positive women enrolled in a clinical trial of vitamin supplementation and pregnancy outcomes in Dar es Salaam, Tanzania. Women were enrolled at prenatal care clinics during their second trimester, at which time blood, stool, urine, and genital specimens were collected, and anthropometric measurements and sociodemographic data were recorded. Birth weight was measured at hospital delivery. The mean (+or- standard deviation) birth weight was 3015 +or- 508 g, 11.1% of newborns weighed <2500 g (LBW), and 11.5% were SGA. In multivariate analyses, maternal weight at enrollment and a low CD8 cell count were inversely associated with LBW. Advanced-stage HIV disease, previous history of preterm birth, Plasmodium falciparum malaria, and any helminthic infection were associated with higher risk of LBW. The intestinal parasites Entamoeba histolytica and Strongloides stercoralis were predictors of LBW despite their low prevalence in the cohort. In a multivariate-adjusted linear regression model, body mass index, mid-upper arm circumference, a CD4 cell count <200,000,000 cells/L (200 cells/cu. mm), primiparity, maternal literacy, and infant HIV infection at birth were significantly associated with birth weight in addition to risk factors included in the LBW model. Determinants of SGA included maternal weight, low serum vitamin E concentration, candidiasis, malaria, and infant HIV infection at birth. Prevention of HIV disease progression and vertical transmission, improved nutritional status, and better management of malaria and intestinal parasitic infections are likely to reduce the incidence of LBW in Tanzania. (author's)
The effects of group intervention for battered women in Korea.
This study developed a group intervention model appropriate for battered women in Korea and tested its effectiveness. The sessions in the group intervention were formatted to stress the following topics: assess trauma, identify major problems, deal with feelings, understand self, identify batterer’s characteristics, improve stress management strategies, develop action plans, and promote empowerment. The major finding was that the trait anxiety scores of the 16 battered women in the experimental group significantly decreased after the intervention. The change in levels of state anxiety, self-esteem, and depression in the experimental group were not significantly different from those of the 17 the subjects in the control group. (author’s)
Objective: To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies. Design: Survey of a national sample of births in France in 1995. Setting: All public and private maternity hospitals in France. Population: 12,432 women who had a singleton live birth during one week. Methods: Data were collected during the women’s postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression. Results: Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1–1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0–1.7 for one previous abortion and OR 1.9; 95% CI 1.2–2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant. Conclusion: This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have had repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored. (author’s)
[Preliminary study of human herpesvirus type 8 infection in pregnant women in Dakar, Senegal]
HHV8 was discovered in 1994 and few studies on this virus have been conducted in Africa. The virus is related to Kaposi sarcoma, an opportunistic affection occurring during HIV infection. No studies have been carried out on this subject in Senegal, a country known for its low KS prevalence even among people living with HIV/AIDS. Thus it will be interesting to explore this field. The aim of our study has been first, to demonstrate the presence of HHV8; second, to evaluate sero-prevalence of the infection in Senegal and third, to determine the specificities of HHV8 infection in our country. We performed our study on 407 pregnant women whose average age was 29.24 years, the majority of whom were Senegalese. HIV serology was done by dot blot for the screening and western blot for the confirmation. For the diagnosis of HHV8 infection, we used the indirect immunofluorescence kit of ABI. HIV infection was low among this study population; 0.5% and no HIV1 infection was mentioned. Among the 407 women, 58 or 14.3% were HHV8 positive and there was no HHV8/HIVco-infection. Regarding marital status, no significant difference was found between HHV8 positive and HHV8 negative among unmarried, monogamous or polygamous women. However, women having had 4 to 5 children were more likely to test positive for HHV8. The difference is significant and a relationship has been established with a p value of 0.02. Regarding pregnancy, HHV8 infection is more closely related to abortion: 17.2% of women who had aborted were HHV8 positive versus 4.9% seronegative. The odds ratio calculation shows a strong correlation with a p value of 0.01. No correlation was found between HHV8 infection of the mother and neonate mortality or Apgar score. However, a relationship did show up between HHV8 infection of the mother and low birth weight. 29.2% of seropositive women had had a child with a birth weight under 2600 g whereas only 16.3% of seronegative women had had babies with low birth weight. We determined that HHV8 is indeed present in Senegal. Further studies should focus on transmission routes as well as the molecular epidemiology of this virus and diseases related to HHV8 infection in Senegal. (author's)
OBJECTIVES: Data on neonatal and maternal thyroid function during labour in a mild iodine deficiency endemic area are lacking. The current study focuses on elucidating the thyroid function during labour, in a group of pregnant women who live in an area of mild iodine deficiency in Sudan compared to that observed in their corresponding newborns. MEASUREMENTS: Serum concentrations of TSH, thyroglobulin (Tg), triiodothyronine (T3) and free thyroxine (FT4) were investigated during labour in a group of mothers and their neonates residing in an area with mild iodine deficiency in Sudan (n = 76 mother-newborn pairs). DESIGN: Maternal blood samples were taken on two occasions: first, during the third trimester of pregnancy (weeks 32-39); and, second, just before delivery. Cord blood samples were obtained by a doctor or a trained midwife during delivery. RESULTS: The median concentrations (and interquartile ranges) of neonatal TSH, Tg, T3 and FT4 were 6.8 (4.7-12.4) mU/l, 61 (40.2-98.2) mcg/l, 0.9 (0.8-1.2) nmol/l and 14.2 (13.4-15.9) pmol/l, respectively. The corresponding levels for the mothers during labour were 2.3 (1.9-3.2) mU/l, 33 (15.0-56.8) mcg/l, 2.6 (2.0-2.9) nmol/l, respectively. The median neonatal serum concentrations of TSH, Tg and FT4 were significantly higher than the corresponding maternal levels (P < 0.0001, P < 0.0001, P < 0.0001, respectively). In contrast, the median maternal serum concentration of T3 was significantly higher than that of the neonates (P < 0.0001). When the different neonatal thyroid parameters were compared with each other, significant correlations were observed between TSH and FT4 (r = 0.4, P = 0.001); Tg and T3 (r = -0.3, P = 0.04) and Tg and FT4 (r = 0.5, P = 0.0001). Women with Tg concentrations above 20 mcg/l showed a higher median FT4 concentration than those with Tg concentrations below 20 mcg/l (P < 0.001, P < 0.001, respectively). Nevertheless, the thyroid function of neonates born of mothers with elevated Tg was similar to that of neonates born of mothers with low Tg levels. No significant changes had occurred in the thyroid function parameters between the third trimester of pregnancy and during the time of labour. The thyroid function indicators of the babies born by vaginal delivery did not differ significantly from those of the babies born by Caesarian section. CONCLUSIONS: The study suggests that, in areas with mild iodine deficiency, neonates may be at the limit of decompensation as evidenced by their enhanced TSH and Tg levels as well as increased T4 compared to their mothers. This finding must not create a false sense of well-being and points rather to the urgency of iodine supplementation of mothers even in areas with mild iodine deficiency, as in this part of Sudan. The mode of delivery, whether by spontaneous vaginal delivery or Caesarian section, did not seem to affect the thyroid function of the newborn. (author's)
Our purpose was to compare the efficacy of 25 microg and 50 microg intravaginally administered misoprostol tablets for cervical ripening and labor induction. Either 25-microg (n=58) or 50-microg (n=56) misoprostol tablets were randomly administered intravaginally to 114 subjects with an unripe cervix for labor induction. The physician was blinded to the medication. Intravaginal misoprostol was given every 4 h until the onset of labor. The mean Bishop score before misoprostol administration was 2.1 +/- 1.6 in the 25-microg group and 2.0 +/- 1.4 in the 50-microg group (p>0.05). With the 25-micorg dose the time until delivery was significantly longer (991.2 +/- 514.4 min vs. 703.12 +/- 432.6 min in the 50-microg group). The use of oxytocin augmentation was significantly higher in the 25-microg group (63.8%) than the 50-microg group (32.1%; p<0.05). The proportions of patients with tachysystoles and hypersystoles were not significantly different between the two groups (19 and 6.9%, respectively, in the 25-microg group and 25 and 17.8%, respectively, in 50-microg group; p>0.05). Overall, in the 25-microg group more women achieved vaginal delivery (79.3 vs. 60.7%; p<0.05). The rate of cesarean sections due to nonreassuring fetal status was higher in the 50-microg misoprostol group (28.6 vs. 10.3%; p <0.05). The number of neonates with a low 1-min Apgar score (<7) was significantly higher in the 50-microg misoprostol group (26.8 vs. 8.6%; p<0.05), but 5-min Apgar scores and umbilical artery blood gas values at the time of delivery were not significantly different between the groups (p>0.05). One patient in the 25-microg group suffered a ruptured uterus. Intravaginal administration of 25 microg of misoprostol is a clinically effective labor induction regimen and has the least adverse effects and complications. (author’s)
Risk factors for breast cancer among pre- or post-menopausal women in Belo Horizonte, Brazil.
Background: Much controversy has been generated about pre- and post-menopausal breast cancer patients and investigators have sought to identify whether risk factors differ between these two groups. In Brazil, breast cancer is an important cause of death among women and there are few analytical studies concerning pre- or post-menopausal comparisons. Methods: A case-control study was carried out at the Federal University Hospital, Belo Horizonte, Brazil, to determine if selected socio-economic and reproductive risk factors for breast cancer differed between pre-menopausal and post-menopausal women. Cases were 300 women with breast carcinoma and controls were 600 women with other benign diseases matched for age and date of diagnosis, admitted to the same hospital during the same period (1978–1987). Univariate and multivariate conditional logistic regression analyses were performed. Results: Multivariate analysis showed no differences in breast cancer risk in pre- and post-menopausal women (risk factors were similar in direction and magnitude). Occupation, irregular menstrual cycles, parity, history of breast cancer in at least one first-degree female relative, and oral contraceptive use had similar associations in both groups. Conclusions: The present study indicates that breast cancer diagnosed before and after menopause has a similar risk profile. (author’s)
How the global informs the local: the Botswana Citizenship Case.
In this article I put forward the following positions. First is that women in Africa have not been involved in the formulation and/or interpretation and or implementation of what are now accepted norms and concepts that inform current notions of human rights, democracy, and good governance. Second, women’s contact with systems that are traditionally viewed as the bedrock of democracy and good governance have been from a position of weakness, in roles of servants, objects, and exceptions to the general rule. Third, women have not been participants, on an equal basis with men, in the negotiation, formulation, development, and implementation of national constitutions. Fourth, many national constitutions fail to guarantee women equal rights with men under the law. Fifth, I suggest that only when women are equal actors in the process can there be a legitimate claim that Africa is on the road to democracy. Finally, the local cannot remain isolated and exclusively self-informing, and, consequently, the global must inform and influence the local. Such influence is legitimate, justified, and necessary if women are to gain their human rights at the local level. I use my case, that is, the case of The Attorney General of the Republic of Botswana v Unity Dow Civil Appeal No. 4/91, often referred to as the Citizenship Case, or the Dow Case, to demonstrate these positions. This is a case in which I successfully challenged the Citizenship Act of 1984 on the grounds that it discriminated against women. (author's)
Epidemiology and detection of human immunodeficiency virus among pregnant women in Hong Kong.
Objective: To determine the epidemiology of human immunodeficiency virus infection among pregnant women and the neonatal outcomes in Hong Kong. Design: Retrospective observation study composed of two parts: record review of pregnant women and unlinked anonymous screening of cord blood for from neonates. Setting: Two human immunodeficiency virus clinics and the Government Virus Units. Participants: Female patients attending the two clinics who became pregnant and neonates who underwent routine metabolic screening by the Government Virus Unit between 1992 and 1999. Main Outcome Measures: The outcomes of neonates born to women who had human immunodeficiency virus infection during pregnancy. Results: Forty-one human immunodeficiency virus-related pregnancies were recorded among 32 infected women. Fifteen pregnancies were terminated, of which 14 were in women who knew their infection status before conception. Twenty-six pregnancies continued to term, resulting in 26 live births. Twelve babies were born to women who know their infection status before delivery. One baby was confirmed to be infected. Six women were given zidovudine for prophylaxis against vertical; transmission and none of the babies ere infected at birth. Of the remaining 14 human immunodeficiency virus-related pregnancies, the mother's status became known only at a late date and nine (64.3% babies were confirmed to be infected the age of 18 months or older. The rate ratio of giving birth to an infected baby was 8.18 from mothers who did not know their status antenatal. Unlinked anonymous screening showed that that seroprevalence rate for human immunodeficiency virus in pregnant women was 0.032% (1/3125) in Hong Kong in 1999. Conclusions: Human immunodeficiency virus-related pregnancy is not rate in Hong Kong and the majority of infected mothers were not identified and treated. Detection of these pregnancies will be invaluable for the prevention of mother-to-child transmission. Universal antenatal screening of human immunodeficiency virus antibody is proposed as an effective strategy. (author's)
The effects of postpartum stress and social support on postpartum women's health status.
Background. Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period. Aim. The purpose of this study was to determine postpartum women's health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic. Method. A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty-six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health Questionnaire were used to obtain information about the women's postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA , and multiple logistic regression. Results. Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41%of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity. Conclusions. Because the postpartum women's self-reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury's conclusion regarding the significance of social support during the Chinese women's postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women's health status. Future studies should compare the level of postpartum stress, social support, and women's health status in both Western and Eastern cultures. (author's)
The nutrition transition is underway in India.
Nutrition research in India has previously focused on the serious problem of undernutrition related to nutrient deficit and high rates of infection. Recent data from the National Family Health Survey 1998199 (NFHS 2), however, identified a significant proportion of Indian women as overweight, coexisting with high rates of malnutrition. This paper examines the emerging nutrition transition for women living in rural and urban communities of Andhra Pradesh, India. NFHS 2 provides nationally representative data on women's weight and height. In this paper, we examine representative data from the state of Andhra Pradesh (n = 4032 women). Logistic regression analyses are applied to the data to identify socioeconomic, regional and demographic determinants of overweight and thinness. The major nutrition problem facing women continues to be undernutrition, with 37% having a low body mass index [(BMI) < 18.5 kg/m2]; 8% of these women are severely malnourished (BMI < 16 kg/m2). However, 12% of the women can be classified as overweight (BMI > 25 kg/m2) and 2% are obese (BMI > 30 kg/m2). Furthermore, in the large cities of the state in which 4% of the sample live, 37% of women are overweight or obese, whereas in the rural areas in which 74% reside, 43% have a low BMI. Women from lower socioeconomic groups are also significantly more likely to have a low BMI. Findings from the logistic regression models reveal socioeconomic status to be a more important predictor of both over- and underweight than location of residence. (author's)
Vitamin D status and bone mineral density of veiled and unveiled Turkish women.
The aim of the study is to compare vitamin D status and bone mineral density (BMD) in veiled and unveiled healthy Turkish women of reproductive age. Thirty young to middle aged volunteer veiled women and 30 age-matched control subjects with western clothing habits were enrolled in the study. The two groups had similar dietary habits, body mass index (BMI) distribution, and gestational history. Physical and laboratory examinations were performed to rule out any disease that could affect bone metabolism. Serum 25-hydroxyvitamin D (25-OHD) levels were measured, and BMD of the spine and hip were investigated by dual energy x-ray absorptiometry (DEXA). The mean age of dressing the veil was 15.7 ± 6.13 years, and 66.7% of the veiled women claimed that they were not ever exposed to direct sunlight, as they were leading an indoor life. Compared with the control group, veiled women were less educated and physically less active (p < 0.001 and p < 0.05, respectively). 25-OHD levels were positively correlated with exposure to sunlight and negatively correlated with the duration of being veiled. None of the veiled women had vitamin D insufficiency, but their mean 25-OHD concentration (33.1 ± 16 ng/ml) was significantly lower than that of controls (53.9 ± 27.3 ng/ml) (p = 0.001), and serum alkaline phosphatase (ALP) levels were higher (p < 0.01). Differences in the absolute BMD values at the spine and hip were not statistically significant, but the mean Z value at the lumbar spine was significantly lower in the veiled subjects (p < 0.05). Veiled women have low 25-OHD status, and vitamin D supplementation should strictly be advised to these women for the prevention of osteomalacia and osteoporosis. (author's)
Changing roles and identities of midwives in rural Costa Rica.
The roles and social identities of rural midwives in Costa Rica reflect the changing history of local birth practices vis à vis pragmatic local needs as well as the changing relation of the nation-state to the production of birth. This article explores how midwifery practices changed over time in relation to Costa Rican state policy and why prenatal massage (an important element of prenatal care historically) retains its importance despite the massive hospitalization of birth. Home birth's history as a heterogeneous, flexible model for care, combined with the pragmatic needs of women, make midwives and prenatal massage central in the production of hospital birth. Costa Rican midwives survive in the interstices of the biomedical model of care, providing interventions demanded by women (although demeaned by biomedicine) and serving as a safety net for pregnancy crises in hinterland communities. While acknowledging the potential for maternal or child death during pregnancy crises in isolated regions, midwives generate acute critiques of the biomedical model of birth and clearly articulate the practical need for (and continuing importance of) their practices in rural areas. This case study illustrates the obstacles to international awareness faced by midwives in so-called Third World countries like Costa Rica-midwives who must overcome not only geographic and socioeconomic marginalization, but also overwhelming opposition from the state and multilatera1 "reproductive development" policies. (author's)
Violence against women: a worldwide problem.
This short overview makes it clear that the problem does exist worldwide. The healthcare community bas not taken a leadership position against this crime. Only slowly is there acknowledgment by the bealthcare community and those in power that a grave problem exists. (excerpt)
Chlamydial infection and unplanned pregnancy in women with ready access to health care.
OBJECTIVE: To apply urine-based ligase chain reaction for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) detection and standard urine-based pregnancy testing for Navy-enlisted women, and to compare the prevalence and epidemiologic correlates of these adverse reproductive outcomes. METHODS: Participants were surveyed and urine was collected for pregnancy testing using standard laboratory methods and detection of C. trachomatis and N. gonorrhoeae infection by ligase chain reaction. Self-administered surveys facilitated collection of demographics, sexual behavior, including contraceptive use, sexual partners, sexually transmitted disease, and pregnancy history. RESULTS: Among 299 of 314 participants, the prevalence of chlamydial infection was 4.7% and of pregnancy was 9.7%, with 48.3% of the pregnancies unplanned. Chlamydia trachomatis infection was univariately associated with having a new sex partner within the last 6 months, more sexual partners, single marital status, condom use, drinking until passing out or vomiting in the past 30 days (alcohol misuse), and current pregnancy. Unplanned pregnancy was univariately associated with young age, single marital status, inconsistent condom use, having a new sex partner within the last 6 months, and more recent sexual partners. Among the pregnant women, four (13.8%) were infected with C. trachomatis. CONCLUSION: The high rates of chlamydial infection and unplanned pregnancy found in this population of employed young women with ready access to health care and health education underscore the challenge of enhancing reproductive health via compliance with effective contraceptive and sexually transmitted disease prevention methods. (author's)
This longitudinal observational study aimed to detennine the rates of initiation, duration and corre1ates of breast-feeding by mothers living in a socioeconomically advantaged urban environment in Turkey. Healthy, term infants born at Ankara University Faculty of Medicine Hospital who would be brought to the well-child clinic regularly for at least 12 months were enrolled. Data on feeding practices were obtained at the lst, 2nd, 3rd, 4th, 5th, 6th, 9th and 12th month well child care visits. Breast-feeding outcome was categorized based on recommendations by the World Health Organization (WHO). The majority of the 295 participating mothers were older than 20 years, high school graduates, and lived in apartment housing, and 54.6% were employed. The rates of breast-feeding were 97.9%, 90.1%, 76.9% and 36.9% at 1, 4, 6 and 12 months, respectively, and rates of exclusive breast-feeding were 89.8%, 59.3% and 2.0% at 1, 4 and 6 months, respectively. At 6 months 69.8% of infants were receiving cow's milk, and by 12 months only 23.4% of the infants had been breast-fed according to WHO recommendations. Neither gender; birth weight of infant; age, education, parity, previous breast-feeding experience of mother; nor the status of living as extended versus nuclear family were related to breast-feeding outcome. Mothers who were working (RR: 3.89,95% CI: 1.42-10.65) and those who had less than 4 months postpartum leave from work (RR: 4.20, 95% CI: 2.16-8.17) were more likely to not breast-feed optimally. The results of this study indicate that even where breast-feeding is normative behavior, it may not be optimally practiced, leading to potentially detrimental nutrition for infants. Promotion of breast-feeding even in advantaged urban populations is needed. (author's)
Introduction: Since 1989, Israel has absorbed over 700,000 Jewish immigrants from the former Soviet Union, among them about 375,000 women. Immigrants are known to have greater and/or different health needs than non-immigrant residents, and to face unique barriers to receiving care. However, research addressing the specific health problems of these immigrant women has been scarce. Objectives: To compare self-reported health status and health care utilization patterns among immigrant and non-immigrant Israeli Jewish women; and to explore ways to overcome existing barriers to their care. Methods: A telephone survey was conducted in September and October 1998 among a random national sample of women age 22 and over, using a standard questionnaire. In all, 849 interviews were completed, with a response rate of 84%. In this article we present comparative data from a sub-set that included 760 immigrant respondents from the former Soviet Union and non-immigrant Jewish respondents. Results: A greater proportion of immigrant versus non-immigrant women reported poor perceived health status (17% vs. 4%), chronic disease (61% vs. 38%), disability (31% vs. 18%) and depressive mood symptoms (52% vs. 38%). Lower rates of immigrant women visited a gynecologist regularly (57% vs. 83%) and were satisfied with their primary care physician. Lower rates of immigrants reported discussing health promotion issues such as smoking, diet, physical activity, HRT, and calcium intake with their physician. The article concludes with a discussion of the implications of the findings for designing services that will effectively promote immigrant women's health, both in Israel and elsewhere. (author's)
[Effects of supplementing of calcium, iron and zinc on women's health during pregnancy]
It was the objective of this study to determine the effects of supplementing biscuits fortified with calcium (Ca) and vitamin D (VD), iron (Fe), vitamin C (VC) and zinc (Zn) to pregnant women from the 5th month of gestation until delivery on their health, and to explore a way to improve their Ca, Fe and Zn nutritional status during pregnancy. A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each women of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 5th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 mcg VD, 400 mg Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient woman was selected from the same hospital as control after one trial subject for each study groups selected. The daily dietary intakes of Ca, Zn and Fe in pregnant women were only 47.7%, 54.7% and 86.7% of the Recommended Dietary Allowances for Chinese. Incidence of anemia for mid-term pregnant women was 35.2%, and Fe-supplementation could significantly improved their hemogloblin level (P < 0.05). Prevalence of anemia in the groups of Ca + Fe + Zn + VD and Ca + Fe + VD was 35.3% and 40.7%, respectively, before Fe supplementation and reduced to zero and 4.0%, respectively after Fe supplementation. Whereas, prevalence of anemia in the other groups without Fe supplementation still kept in a relatively high level. In the groups supplemented with Ca, their plasma Ca level increased, especially with the best results in Ca + VD group. Plasma level of Zn declined with length of gestation, which could be improved by Zn supplementation. Serum level of alkaline phosphatase activity increased a little bit with length of gestation. There was no significant difference in radial and ulnar bone mineral density (BMD) between trial groups and controls two months after delivery. Maternal radial and ulnar BMD correlated significantly with their dietary Ca intakes in Ca + VD group. The best way to improve maternal nutritional status is supplementation of Ca + Fe + Zn + VitD, based on the Recommended Dietary Allowances for Chinese. (author's)
[Evaluation of the risk of abortion abuse resulting from the two-week legal delay in France]
Objective: The period for the voluntary termination of pregnancy in France was recently extended by 2 weeks, from 10 weeks to 12. Advances in echography have made it possible to identify potential malformations during the first trimester of pregnancy. A sonogram can sometimes determine the sex of the fetus at 12 weeks. This report assesses the extent to which the legal extension of the period permitted for the termination of the pregnancy may cause women to terminate the pregnancy simply on the basis of the sonogram. Methodology: The survey was conducted in March 2001 in the GO Department of the Jean Verdier Hospital in Bondy, France. Two questionnaires were prepared by the Medical Ethics Department of the Necker Hospital in Paris and given to 128 women and 24 caregivers. Results: The risk of recourse to voluntary termination would be potentially high in cases of gastroschisis or a missing hand, low in cases of nuchal translucency and almost nonexistent for a fetus of the less-preferred sex, in a population having less than one child per woman on average. Conclusion: A national consensus on fetal abnormalities to be identified (number of fingers, harelip etc.) and potential sexing of the fetus in the 1st trimester is urgently necessary. Clear and non-distressing information must be provided before proceeding to a complete and specific prenatal diagnosis (karyotype, echographic control 2 to 3 weeks later). (author's)
The objective of this study is to identify maternal, perinatal, and fetal risk factors for clavicular fracture in a single institution. We performed a prospective study of all deliveries during a 14-month period to identify confirmed cases of neonatal clavicular fracture. The control group consisted of the deliveries immediately preceding and following the index cases. Fifty-three cases of clavicular fracture were identified among the 4789 deliveries from October 1995 through November 1996 for an incidence of 1.11%. Three neonates in the clavicular fracture group were delivered through cesarean section. Neonates with fracture were significantly heavier at birth than those without (3564 vs. 3283 g, p <0.001), and had a lower mean head-to-abdominal circumference ratio (0.93 vs. 1.08, p <0.001), history of giving birth to a macrosomia (21 vs. 4%, p <0.05). The anterior shoulder was the predominant site of fracture (30/53). Fracture was detected mostly during the first 3 days of neonatal life (46/53). The outcome was benign, with complete recovery in all cases and no associated neurological sequelae. Neonatal clavicular fracture tended to be associated with neonatal somatometric characteristics and difficult deliveries. Considering the benign nature of this birth trauma, more invasive intrapartum management to lower its incidence is not advised. (author’s)
[Cicatrix endometriosis of the abdominal wall]
Endometriosis is a rare entity, related after operation on the uterus or uterine tubes or a laparotomy procedures or other extrapelvic procedures, when seeding of endometrial fragments were shed into the peritoneal cavity. We report the case of a menopaused woman with a subcutaneous incisional scar mass that appeared 22 years after a caesaren section. The diagnosis was made by histological examination. (author's)
BRCA1 germline mutations in Cypriot breast cancer patients from 26 families with family history.
Germline mutations in the BRCA1 gene are causative for a variable number of heredity breast/ovarian cancers. The data presented in this study are based on genetic analysis of the BRCA1 gene in 49 DNA samples from breast cancer patients with a positive family history. A combination of manual direct DNA sequencing and SSCP analysis was used to screen the entire coding region of BRCA1. Overall, 13 variants were detected which included 5 missense mutations, 3 polymorphisms and 5 intronic changes. Further genetic analysis of the 13 variants was carried out using 50 control DNA samples. Our results showed that 12 out of the 13 variants detected in the DNA of the patients group, were also present in the control group. It appears that the Greek Cypriot families studied so far have an unexpectedly low frequency of deleterious mutations in the BRCA1 gene. This is the first report on BRCA1 mutation analysis in Cyprus. (excerpt)
Maternal use of cannabis and pregnancy outcome.
Objective: To document the prevalence of cannabis use in a large sample of British women studied during pregnancy, to determine the association between cannabis use and social and lifestyle factors and assess any independent effects on pregnancy outcome. Design: Self-completed questionnaire on use of cannabis before and during pregnancy. Sample: Over 12,000 women expecting singletons at 18 to 20 weeks of gestation who were enrolled in the Avon Longitudinal Study of Pregnancy and Childhood. Methods: Any association with the use of cannabis before and during pregnancy with pregnancy outcome was examined, taking into account potentially confounding factors including maternal social background and other substance use during pregnancy. Main outcome measures: Late fetal and perinatal death, special care admission of the newborn infant, birthweight, birth length and head circumference. Results: Five percent of mothers reported smoking cannabis before and/or during pregnancy; they were younger, of lower parity, better educated and more likely to use alcohol, cigarettes, coffee, tea and hard drugs. Cannabis use during pregnancy was unrelated to risk of perinatal death or need for special care, but, the babies of women who used cannabis at least once per week before and throughout pregnancy were 216g lighter than those of non-users, had significantly shorter birth lengths and smaller head circumferences. After adjustment for confounding factors, the association between cannabis use and birthweight failed to be statistically significant (P<0.056 ) and was clearly non-linear: the adjusted mean birthweights for babies of women using cannabis at least once per week before and throughout pregnancy were 90g lighter than the offspring of other women. No significant adjusted effects were seen for birth length and head circumference. Conclusions: The results of this study suggest that the use of cannabis during pregnancy was not associated with increased risk of perinatal mortality or morbidity in this sample. However, frequent and regular use of cannabis throughout pregnancy may be associated with small but statistically detectable decrements in birthweight. (author’s)
Health status of Romanies (Gypsies) in the Slovak Republic and in the neighbouring countries.
Romanies belong to Indo-European race. The ethnography and anthropology locate their original home to Central Northern India. The highest concentration of Romanies in Europe is in the Balkan and Carpathian regions and they are the second most numerous minority in the Slovak Republic. The inner structure of Romanies shows clear marks former ancestry creation, which they brought from India. Their natural increase of population is 21-33 per mille, but their reproductive health is worse than in majority of Slovak population. Among Romany children there is generally a higher prevalence of infectious diseases, injuries, poisoning and bums caused by environmental hazards, to which they are often exposed. Total premature mortality in the Romanies are probably three times higher than in the total Slovak population. The main causality of a bad health status consists in long-term bad economical situation, low educational level and incorrect lifestyle of the Romany minority. Western authors and politicians claim that at the beginning of 21th Century it is not conceivable for European governments to ignore health needs of a great number of their citizens. The aim of this review is to react to this notice with an analysis of present situation and with presentation of data of our epidemiological investigation on health status, nutrition and lifestyle of Romanies. (author's)
In order to favour the early diagnosis of breast cancer, the authors used an original method consisting in teaching nurses about breast tumors and cancer, and especially about self-examination of the breasts. Subsequently, 73 patients aged under 24 years were admitted to our survey: 90 percent had an understanding of risk factors and 97 percent were practicing self-examination. In 21 cases, consultation was carried out for mastalgia and in 12 cases for esthetic and/or banal inflammatory lesions: 40 patients presented a lump in the breast. Sonography turned out to be a better method of examination than mammography in those young women presenting breast lesions. Following surgery, histological examination found that in the majority of cases the tumor was benign (fibrocyst or adenofibromas). We were surprised by medullary carcinoma in one case. (author's)
[Risk factors for breast cancer among rural Terena Indian women in Mato Grosso do Sul state, Brazil]
In order to evaluate the distribution of selected risk factors for breast cancer among Terena Indian women in the State of Mato Grosso do Sui, Brazil, two samples were interviewed, respectively, in 1995 (330 women from ten Indian villages) and 1997 (40 women from the Limdo Verde village). Reproductive history, diet characteristics, and family and personal medical history were investigated and body mass index was measured. In the larger sample, mean age at menarche was 12.3 years (30% at 13 years old or later). 86% of women reported one or more pregnancies (42% reporting 5 or more). 71% reported three or more pregnancies, mean age at first pregnancy was 18.9 years (3.8% after 28 years), mean duration of breastfeeding was 84 months, and 70% reported menopause before age 50. Dietary pattern in the smaller sample revealed a high intake of fruits, vegetables, pasta, and tubers and scarce intake of red meat and chicken; 50 of the women (95% CI:34.1-65.9) presented overweight (BMI25-29) and 27% (95% CI: 15.1-44.1) obesity (BMI > 29). (author's)
A population-based case-control study was carried out to identify determinant factors for post-neonatal infant deaths due to diarrhea, pneumonia, and malnutrition in Greater Metropolitan Belo Horizonte, Southeast Brazil. From May 1,1991, to April 3O, 1992,511 post-neonatal deaths due to diarrhea, pneumonia, and malnutrition were selected after investigation of medical records to validate cause of death. Of this total, 396 deaths were compared to a neighborhood control group, matched for age. The study was carried out in a low-income area with a high proportion of families living in shantytowns. The article discusses the methodology and selected socioeconomic factors. Logistic regression analysis indicated that number of household appliances, mother's and father's education, and mother's marital and work. status were significantly associated with risk. of infant death, i.e., they were determinants of infant deaths due to avoidable causes. (author's)
Characteristics, diagnosis and treatment of hepatic metastasis of pure immature ovarian teratoma.
Objective: To analyze the characteristics of hepatic metastasis of pure immature ovarian teratoma and explore its proper diagnosis and treatment. Methods: Eighteen cases of hepatic metastasis of pure immature ovarian teratoma were included in this study. The clinical stage, operation, chemotherapy and histopathology of primary and secondary tumors as well as data from long term follow-up were analyzed retrospectively. Results: All of the hepatic metastatic tumors were located in the surface of the liver. 61.1% (11/18) of them were clinical stage III and 44.4% (8/18) were grade 1 at first operation. The hepatic metastatic rate was 16.7% (3/18) in the standard adjuvant chemotherapy group but increased markedly to 31.2% (15/48) in the irregular chemotherapy group. Auxiliary diagnostic methods could not indicate the correct results. The surgical resection rate of hepatic metastasis of pure immature ovarian teratoma was 94.4% (17/18). There were less complications in the group with tumor diameter less than 15 cm. The follow-up time ranged from 3 to 205 months with a mean of 20.9 months. The 3-year-survival rate was 77.8% (14/18), and mortality rate was 22.2%. The 5- and 10-year-survival rate was 55.6% (10/18) and 38.9% (7/18), respectively. The rate of loss in follow-up was 22.2% (4/18) and 38.9% (7/18), respectively, and one patient has survived for more than 17 years. Conclusions: The hepatic metastatic rate of pure immature ovarian teratoma could be decreased using standard adjuvant chemotherapy. Suitable surgical treatment could reduce complications and improve the prognosis for patients. (author's)
Traditional Chinese customs and practices for the postnatal care of Chinese mothers.
This paper aims to provide the reader with an insight into the cultural customs and practices of the Chinese community in the UK, and in particular postnatal care and management of the mother and baby. The following information is based predominantly on personal experiences, and from interviewing many members of my family and Chinese female friends. (excerpt)
Metastatic retroperitoneal and mediastinal fibrosis as first sign of recurrence of breast cancer.
We present three cases of metastatic fibrosis caused by breast carcinoma without any evidence of other metastatic disease. (excerpt)
The value of MR angiography in predicting the risk of torsion of a pelvic spleen during pregnancy.
A case of an enlarged pelvic spleen, studied with MRI and MR angiography (MRA), is presented in a 32-year-old female wishing to become pregnant. An ectopic located spleen may be complicated by an acute abdomen due to torsion of the splenic vascular pedicle, resulting in splenic infarction. Displacement of the spleen and splenic pedicle during pregnancy may further increase the risk of torsion. Urgent splenectomy during pregnancy is associated with a high fetal and maternal mortality and morbidity. On the other hand, elective splenectomy of a pelvic spleen before pregnancy can result in adhesion formation, compromising the patient's fertility. The abilities of MRI and MRA in predicting the risk of these life-threatening complications during pregnancy are discussed, in order to evaluate the benefit-risk ratio of surgical treatment by splenectomy of splenopexia. (author's)
The incidence of breast cancer has been increasing greatly in Taiwan over the past two decades. Increased exposure to environmental carcinogens and adaptation to Western life styles, such as delivery of the first baby at older ages and using hormone replacement after menopause, are suspected risk factors contributing to this increase. Compared to Western countries, breast cancer patients in Taiwan are generally younger, with more than 50% of patients diagnosed annually being younger than 50 years of age. This unique age profile implies a genetic predisposition. We have conducted a series of studies aiming at understanding the gene-environmental interaction during breast carcinogenesis in Taiwan. (excerpt)
Prevalence of the BRCA2 6174 del T mutation in Israeli uveal melanoma patients.
Substantial differences exist in the incidence rates of uveal melanoma (UM) among Israeli Jewish subpopulations: high in immigrants from North America and Europe (Ashkenazic) and low in immigrants from Africa and Asia (Sepharadic). This trend persists in Israeli-born individuals when stratified by their ancestral place of birth. There have been several anecdotal reports of uveal melanoma occurring in breast cancer families with mutations in the BRCA2 gene as well as one systematic study reporting BRCA2 mutations in UM. A single BRCA2 mutation, 6174 del T, occurs in about 1% of the Ashkenazic population and rarely in non-Ashkenazic. To assess the contribution of this germline mutation to uveal melanoma in Jewish Israeli patients, we tested this relationship through analysis of blood samples from a series of UM patients. A total of 153 cases (84 female, 69 male) were available for study, which represents 30% of all cases of UM diagnosed in Israel during the period 1984–1999 (82% for the period 1992–1999). Of the 143 UM patients for which a result could be obtained (4 due to refusals, 6 due to damage to the blood sample), 4 (2.8%, 95% confidence interval [CI] 0–5.6) carried the 6174 del T mutation. Assuming a population frequency of the mutation of 1% as estimated among Ashkenazic Jews in the United States, the probability of observing 4 or more carriers with the 6174 del T mutation, assuming no relationship between uveal melanoma and BRCA2, is 0.057. Although our study confirms the relationship between uveal melanoma and BRCA2, it is clear that the 6174 del T mutation accounts for only a small fraction of all Israeli UM cases. Therefore, BRCA2 mutations are likely to account for an even smaller proportion in populations with low frequencies of BRCA2 alterations. (author's)
Infections in children under 5 years old and latrine cleanliness.
The aim of this study is to assess the cleanliness of the latrine and its relation to occurrence of disease in children under 5 years old. A stratified random sample of 1327 households was conducted in 11 villages in Upper Egypt. It included a sub-sample of 541 children under 5 years living in households with latrines. The latrine cleanliness was assessed and its relationship to disease occurrence within a period of 2 weeks. Thirty-three percent (33.1%) of children under 5 years old with latrines in their household had infections, compared to 28.3% of those without latrines in the house. Infection with diarrhoea was found most in houses with latrine and water tap. A relation was found between latrine cleanliness score and presence of flies, house building material and maternal education, but none with occurrence of infection in children under 5 years old within a period of 2 weeks. (author's)
Purpose: To evaluate the relationship between acute and late normal tissue reactions in 317 consecutive endometrial cancer patients treated with surgery and adjuvant radiotherapy (RT). Methods: The data of 317 patients (staging according to the International Federation of Gynecology and Obstetrics) treated with postoperative RT were analyzed. Both low-dose-rate brachytherapy and external beam RT were applied in 247 patients (78%); brachytherapy only in 49 (15%) and external beam irradiation only in 21 (7%). The median follow-up was 7.3 years (range 4–21). The European Organization for Research and Treatment of Cancer, Radiation Therapy Oncology Group system with elements of the late effects of normal tissue, subjective, objective, management, analytic (LENT/SOMA) scale was used to score the RT reactions. The correlation between the occurrence and severity of acute and late bowel and bladder toxicity, as well as the relationship between the severity of acute effects and time to occurrence of late reactions, were assessed using linear and logistic regression analyses. Results: Of the 317 patients, 268 (85%) experienced acute RT reactions of any grade. Severe acute bowel reactions were observed in 15 patients (5%), urinary bladder complications in 1 patient (0.5%), cutaneous in 1 patient (0.5%), and vaginal in 1 patient (0.5%). Severe acute hematologic toxicity was seen in 3 patients (1%). A total of 158 patients (51%) experienced late RT reactions of any grade. Severe late bowel reactions were observed in 19 patients (6%), urinary bladder in 5 (2%), vaginal in 3 (1%), and bone in 10 (4%). When all toxic events were considered, there was a highly significant correlation between the acute and late bowel reactions (p <0.001), but the acute and late urinary bladder reactions did not correlate (p = 0.64). The grade of acute toxicity was found to predict the grade of late toxicity for the bowel but not for the bladder (p <0.001 and p = 0.47, respectively). The severity of acute bowel and bladder toxicity did not correlate with the time to occurrence of late toxicity in these locations (p = 0.34 and p = 0.47, respectively). Conclusion: Patients with increased acute bowel toxicity during postoperative RT for endometrial cancer have an increased risk of late bowel injury. A higher grade of acute bowel complications correlated with more severe late events, but was not predictive for its latency time. These findings suggest the possibility of an early indication of patients with an increased risk of late toxicity in whom preventive measures might be attempted. (author's)
Background: Breast cancer is the most common malignancy among women in Israel and throughout the world. Israeli women aged 50-75 years are advised to undergo a mammographic screening examination every 2 years. However, the lack of a structured referral system is reflected in the low utilization rate of mammography. Objectives: To describe an innovative program in which family physicians in an urban clinic developed a model framework for referrals, coordinated with radiologists and surgeons, aimed at increasing compliance among women referred for mammography. Methods: A community-based study was conducted outside of the regular reception hours, in a neighborhood practice with a population of 527 women aged 50-75. A referral system under the supervision of family physicians was designed, and the women received appointments for mammography at specified days and hours. The results of the examination were sent to the physician who used dedicated time to continue the diagnostic and/or therapeutic process, as appropriate. At the physician's instructions a research assistant contacted the women who did not keep their appointments, and scheduled a second appointment. Results: In 1993, the year prior to the study, when women referred themselves for mammography, the utilization rate was 9%. During the study year the utilization rate was 77%. Women born in Europe or America had higher compliance rates than women born in Asia or Africa (81% vs. 72%, respectively). Married women were more compliant than unmarried women (81% vs. 70%, respectively). No correlation was found between compliance and age, family history of cancer in general, or breast cancer in particular. Six new cases of breast cancer were detected. Conclusions: The initiative of family physicians increased the utilization of mammography among women under their care. Family physicians allocated time outside of their regular reception hours for the program. A relatively large number of new malignancies were found, but this impression should be confirmed or negated by a large-scale study using the same methods. (author's)
This study supports the finding that adequate maternal weight gain contributed to the low incidence of premature births: 2 out of 32 infants and the mean birth weights of 3.2 kg to 3.5 kg for infants born to participants in both education groups. Superior birth outcome of adolescents was associated with prenatal weight gains equal to the higher end of the Institute of Medicine's recommendations for underweight, normal weight, and overweight women.
Epidemiological profile of India: historical and contemporary perspectives.
Knowledge and understanding of the epidemiological profile is an essential pre-requisite to assess and address public health needs in the country and to enable efficient programme planning and management. The need for adequate and accurate health information and data to undertake such an exercise cannot be over-emphasized. The present effort is a modest attempt to critically analyse the epidemiological profile of India from the historical and contemporary perspective. In order to assess the successes achieved as well caution against the daunting challenge awaiting the country, parameters such as disease burden and health status indicators are increasingly being used. Changes in the population age structure, improvements in the nation's economic status, altered life, styles of people and duality of disease burden testify to the demographic, development and health transition occurring in the country. Population stabilization, poverty alleviation, lifestyle, modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future. (author's)
Effects of metformin on early pregnancy loss in the polycystic ovary syndrome.
Polycystic ovary syndrome is the most common form of female infertility in the United States. In addition to poor conception rates, pregnancy loss rates are high (30–50%) during the first trimester. We hypothesized that hyperinsulinemic insulin resistance contributes to early pregnancy loss in the syndrome, and that decreasing hyperinsulinemic insulin resistance with metformin during pregnancy would reduce the rate of early pregnancy loss. We conducted a retrospective study of all women with polycystic ovary syndrome who were seen in an academic endocrinology clinic within the past 4.5 yr and who became pregnant during that time. Sixty-five women received metformin during pregnancy (metformin group) and 31women did not (control group). The early pregnancy loss rate in the metformin group was 8.8% (6 of 68 pregnancies), as compared with 41.9% (13 of 31 pregnancies) in the control group (P < 0.001). In the subset of women in each group with a prior history of miscarriage, the early pregnancy loss rate was 11.1% (4 of 36 pregnancies) in the metformin group, as compared with 58.3% (7 of 12 pregnancies) in the control group (P = 0.002). Metformin administration during pregnancy reduces firsttrimester pregnancy loss in women with the polycystic ovary syndrome. (author's)
Factors relating to the aggressive behavior of primary caregiver toward a child.
This study aimed to testify the relationship between specific characteristics of family or the caregiver and the aggressive behavior of the caregiver toward a child. The survey was conducted from 2nd to 30th of December 1996 among grade-six students in schools under the Bangkok Metropolitan Administration (BMA). During the survey, self-administered questionnaires were used to collect data from the target group of 413 students. Among these, 81.8 per cent reported experiencing at least one form of aggressive behavior from their caregiver's or parents. The findings revealed that the family relationship, economic status, and caregiver's educational level reversibly correlated with the number of types of aggressive behavior with statistical significance at p-value < 0.05 and r = -0.7697, -0.2467 and -0.1641, respectively. The family crisis positively correlated with the number of types of aggressive behaviors with r = 0.1249 and p-value <0.05. Furthermore, the results showed that students from nuclear families, living in congested surroundings, having a caregiver with experience of unskilled-work, unemployment or gambling had a higher mean score of the number of types of aggressive behaviors than their counterparts which were statistically significant by t and F tests (p-value < 0.05). Hence, the quality of the parent-and-child relationship should be strengthened and a proactive approach should be conducted for families potentially at risk. (author's)
Mixed blessings: cervical cancer screening in Recife, Brazil.
This study examines the effects of a large-scale cervical cancer prevention campaign in Recife, Brazil between 1994 and 1995. It suggests that while this program effectively motivated women to get pap smears, it reinforced local understanding of the pap smear that ultimately had unintended negative consequences for women's health. It argues that because the campaign connected female sexual activity directly with cervical cancer, the program's message was interpreted by many women to mean that cervical cancer was a sexually transmitted disease and that it would behave like one. Women who were no longer sexually active believed that they did not need to be screened. In addition, women who were sexually active believed that they could use pap smears to diagnose and cure sexually transmitted diseases. (author's)
Ovarian cancer, oral contraceptives, and BRCA mutations [letter]
This article discusses the work of Modan et al. showing how genetic testing can be used in providing clear health directives under defined circumstances. It states that Ashkenazi Jewish women with a founder mutation in their breast cancer (BRCA) 1 or BRAC2 gene should be told that multiparity has a protective effect against ovarian cancer but the use of oral contraceptives does not.
Vitamin B2 deficiency is a very rare disease of infants and young children in Europe. Authors report a case of a 9.5-month-old infant who was exclusively breast-fed by his vegan mother and developed serious vitamin B2 deficiency in form of neurological regression, repetitive vomiting, drowsiness, dysphagia, obstipation, and tremor. A few days after intramuscular vitamin substitution his abnormal signs improved dramatically, hematological restitution was reached in six weeks. Authors describe the hematological and neurological signs, the diagnostic and differential-diagnostic pitfalls, therapy, prognosis, and prevention of this condition. Beside reviewing the literature they emphasize the importance of early recognition and intervention and the need of an appropriate doctor-parent cooperation in this disease. (author's)
[Function of BRCA1 and BRCA2 genes associated with hereditary predisposition to breast cancer]
This articles covers: BRCAI and BRCA1-genes of hereditary breast cancer; expression of BRCAI and BRCAl genes; functional domains in BRCAI and BRCA2 proteins; functional domains in BRCAI protein; RING finger domain in BRCAI protein; central part of BRCAI protein; BRCT domains in carboxy terminal region of BRCAI protein; c-Jun domain and BRC repeats in BRCA2 protein ; function of BRCAI and BRCAl genes; DNA repair; transcription regulation; and cell cycle regulation.
Aim. To find the changes in the proportion of women who declared knowledge about cytological tests and underwent that test in the years 1976, 1986, 1990 and 1998, as well as in the proportion of those who declared showing up at the gynaecologist during the last year. To assess the number of women taking part in the secondary prevention of cervical cancer. To correct health education intervention targeted at women. Methods. The results of four cervical prevention surveys on representative samples of Polish women aged over 18 years were compared. Results. The substantial (58%) increase the proportion of women who declared awareness of cytological tests was shown. As expected, smaller favourable changes were found in the field of women's health related to secondary prevention. The percent of women who declared yearly visits at the gynaecologist increased by 12% and those who declared having cytological tests done during last three years by 7%. The lowest level of awareness and the lowest frequency of using prevention services were declared among women aged over 60, represented the lowest education level and resided in rural areas. Conclusions. It is important to continue educational work and intervention measures concerning cervical cancer prevention, with special attention to the most neglected groups of women. (author's)
Prevalence of pre-cancerous lesions and cervical cancer in South Africa -- a multicentre study.
Objectives: To describe the age-specific prevalence rates of cancer of the cervix in South African women presenting for screening. Design: A multicentre prevalence survey in 10 geographically defined areas following a common core protocol. Services were located in existing service sites, with the exception of KwaZulu-Natal which used a mobile service. Women aged 20 years and above were eligible for inclusion. Outcome measures: Age-specific cervical cytologically diagnosed abnormality rates according to the Bethesda classification. Results: During the study 20 603 women participated. Eighty per cent of sample had never had a Pap smear before and just over 91% had not had a Pap smear in the last 5 years. In this study population 468 women screened (2.42%) were found to have low-grade squamous intra-epithelial lesions (LSIL) and the average age of these women was 33.1 years; 366 (1.8%) had high-grade SIL (HSIL) and these women were statistically significantly older 37.97 years of age; and 92 women (0.47%) were found to have cytologically diagnosed invasive cancer. These women were significantly older, with an average age of 51.3 years. A clear relationship was found between age and LSIL, with younger women having a high rate of LSIL which decreases with increasing age. A similar but inverse relationship between age and invasive cancer is described, with the rate being low in young women and increasing with increasing age. A clear relationship between HSIL and age is not described in these data. The adequacy rate (satisfactory and satisfactory but limited) of the slides was 95%, and just under 92% of the study sample received their results. Not all women were appropriately referred and it was not possible to assess if women referred for treatment received it. Conclusions: These data indicate that cancer of the cervix is a common disease and that, similar to other countries, it is a disease of older women. These data give some positive indicators for future screening--older women will present for screening and the majority of women received their results. However, improvements in health system functioning are needed. A uniform national cytology reporting system is required as well as clear guidelines for providers on what action to take based on cytology reports. Linkage between the site of screening and treatment centre is inadequate and requires urgent attention in order to decrease cervical cancer mortality. (author's)
The taxotere-cisplatin combination is highly effective (overall response rate was 72.5% with 55.1% complete response) as a first line of chemotherapy in cases of advanced ovarian cancer. Febrile neutropenia and neurotoxicity were dose-limiting toxicities, but in no cases did these lead to a termination of treatment. Median survival has not yet been reached, but the average duration of survival is 30.13 +/- 1.6 months (after 39 months of observation). Median time to relapse is 23.3 months. The taxotere and cisplatin combination has good prospects for use as a first line of chemotherapy in the treatment of ovarian cancer and can be recommended for ambulatory treatment. (excerpt)
Vaginitis emphysematosa associated with an abnormal Pap smear.
Vaginitis emphysematosa is an uncommon inflammatory condition that is aetiologically linked to trichomonal or gardnerella infection, and has been associated with immunosuppressive disorders. The disease does not have deleterious sequelae and resolves on treating the underlying infection. We describe a case in which the disease predominantly affected the cervix leading to an abnormal pap smear and colposcopic investigation. (author's)
Objective: To investigate the relationship between clinicopathological features and human papillomavirus types in female lower genital tract carcinoma. Methods: Clinocopathological features of 100 cases of female lower genital tract carcinoma (63 cervical carcinoma and 37 vulva carcinoma) were studied retrospectively. Standard PCR (HPV type 6/11, 16. 18) was applied to formalin fixed, paraffin embedded sections. Results: There were 54 cases of cervical carcinoma and 33 cases of vulvar carcinoma in the 87 cases of target DNA qualified samples. The HPV detection rate in cervical carcinoma was 83.3%. HPV16 (55.6%) adn HPV 18 (24.4%) were the predominant types. In vulvar carcinoma, HPVs mainly HPV 16 (70%, 7/10), were detected in basaloid (83.3%, 5/6) and warty carcinoma (83.3%, 5/6), but none in conventional type of keratinized squamous cell carcinoma (0.0%, 0/21). Three of the 6 women with basaloid carcinoma were associated with cervical squamous neoplasia, and the same HPV type was found in both lesions in 2 of the 3 patients with two primary tumors. Four patients with basaloid carcinoma recurred after simple vulvectomy or local excision, but no lymph node metastasis occurred and all were still alive at last follow-up, with a median follow-up of 6.3 years. In contrast, the majority of the women with keratinized squamous cell carcinoma were over 65 years of age, with histologic extensive keratinization and poorer prognosis. Conclusions. A high detection rate of HPV 16 and 18 was found in cervical carcinoma. However, the sensitivity of HPV in vulvar carcinoma seems to be more related to histologic type. (author's)
Objective: To study transfusion transmitted virus (TTV) infection in pregnant women and their newborns, and the route of transmission. Methods: Serum, breast milk from 150 pregnant women and umbilical venous blood from their newborns were collected. TTV DNA was amplified by semi-nested-polymerase chain reaction, and the positive products were sequenced directly. Results: The positive rate of TTV DNA in pregnancy serum was 11.3% (17/150). Among the 17 serum positive cases, TTV DNA was detected in 11 breast milk samples, and none in all the umbilical blood. The homologous of partial nucleotide sequence of TTV DNA between the 3 serum samples and their breast mild were 97.6%-99.2%. Compared the 5 serum positive samples (A1-A5) with N22 segments of Japanese original isolate, the homologous of partial nucleotide and amino acid sequence were 71.5%-92.8%, 71.5%-92.8%, respectively. Conclusion: There exists TTV infection in pregnancy serum and breast milk. Transmission by breast feeding may be one of the main pathway causing TTV infection. (author's)
[Study on nuclear DNA content and image cytometry in cervical cancer and precursor lesions]
Objective: The aim of this research was to study the biological and clinical features of cervical cancer and precursor lesions. Methods: Nuclear DNA was analyzed by image cytometry (ICM) in 125 embedded tissue 5 mcg sections stained with Feulgen stain. Samples included normal cervical squamous epithelium (n = 11), cervical epithelial neoplasia I (CIN I) (n = 22), CIN II (n = 17) and CIN II (n = 13), cervical neoplasm (n = 62). Results: The mean DNA content, nuclear area increased progressively from normal cervical epithelium, CIN I, CIN II, CIN III to invasive squamous carcinoma. Statistical analysis revealed significant difference (P <0.05, <0.01). Histograms of cellular DNA ploidy distribution showed different pattern, where 9 components (9C) cells were observed in cervical cancer and CIN III. No differences in DNA mean ploidy (DMP), DNA index (DI) and nuclear area were observed between cervical neoplasm. Conclusion: It is increased progressively from normal cervical epithelium to cancer, in which CIN III is turning point. (author's)
Objective: To investigate the incidence of pregnancy induced hypertension (PIH) in Shanghai during 1989-1998. Methods: The data were analyzed retrospectively from three municipal general hospitals and five special hospitals obstetrics and gynecology. Results: There were 158,790 deliveries in ten years. The total numbers of PIH were 8,852 cases. The incidence of PIH was 5.57%. The rate of mild, moderate and severe PIH was 55.83%, 29.39%, and 14.78% respectively. There were 114 cases (1.29%) complicated with eclampsia. The rate of cesarean section was 66.97% in PIH patients. The complications of PIH were as following: abruptio of Placenta 0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.07% hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome 0.03%, maternal death one case. There were 9,197 birth of 8,852 cases of PIH (twin 343 cases, triplets one cases). The perinatal death 66 occurred in cases (7.18%) in which fetal death 48 cases, stillbirth 12 and neonatal death 6. Conclusion: The incidence of PIH and the rate of perinatal infant death can be reduced by strengthen antenatal monitoring, prevention, early diagnosis and treatment of PIH. (author's)
Objective: To evaluate the clinical effectiveness of high dose chemotherapy (HDC) with peripheral-blood stem cells transplantation (PBSCT) in the patients with advanced malignant tumors. Methods: Four patients with advanced or refractory ovarian carcinoma and 1 patient with recurrent fallopian tube carcinoma received the HDC with PBSCT after optimal tumor debulking. Of whom 4 patients were with the recurrent or progressive tumors, 1 patient received HDC as primary chemotherapy. The response and toxicity were assessed after treatment. Results: Among 5 patients, four patients are survival. One case died from the recurrence of juvenile granulosa cell tumor. The average survival periods were 21 months. The tumors were all recurrent among the 4 survival patients. The average periods of recurrence after HDC treatment was 9 months. The main toxicity of HDC was severe marrow suppression. The lowest value of the neutrophil count and platelet count was 0.05-0.2 x 10 9/ L and 7 x 10 9/L - 8 x 109/L respectively. The median time to recover a neutrophil count greater than 0.5 x 10 9/L was 14 days and a platelet count greater than 50 x 10 9/L was 17 days. None of the patients was complicated with severe complications. Conclusions: HDC and PBSCT used for ovarian carcinoma was flexibility and security if the patient was selected strictly though its toxicity was severe. Further study among the chemorefactory recurrent patients need to try in the future. (author's)
[Advances in diagnosis and treatment of ectopic pregnancy during the past ten years]
Objective: To investigate the changes of diagnosis and treatment of ectopic pregnancy (EP) during the past ten years. Methods: Medical records of 1 970 cases with EP seen in our hospital from Jan. 1987 to Dec. 1996 were collected and analyzed retrospectively. Results: (1) The incidence of EP increases from 1.0 per 42.4 labours during 1987-1988 to 1.0 per 6.6 labours in 1995-1996. (2) Diagnosis was confirmed more by television laparascopy, transvaginal ultrasonography and sensitive human chorionic gonadotropin-beta subunit assay rather than laparotomy and with a shorter period, (6.5 + or - 0.7) days in 1987-1988 versus (3.7 + or - 0.2) days in 1995-1996. (3) The choice of treatment was more conservative or through laparoscopic surgery than abdominal salpingectomy. (4) The success rate of conservative surgery expectant management reached 100.0% and medical treatment with a variety of choices around 80.0%. Conclusions: Although the incidence of EP increased, with the improvement of diagnostic approaches, patients were detected at an earlier stage and possible to be treated more conservatively. (author's)
[The effect of progesterone on proliferation and apoptosis in ovarian cancer cell]
Objective: To investigate the regulatory effect of progesterone on proliferation and apoptosis in ovarian cancer cell line HO8910 in vitro. Methods: Ovarian cancer cell line HO8910 originated from human ovarian serous cystadenocarcinoma was cultured in vitro. Two groups were set up: study group (progesterone in different concentrations) and control group without progesterone. Cell proliferation was measured by 3-(4,5-dimethylthiazol-z-yl)-2,5-dipheny tertrazolium blue (MTT) colorimetric assay. Cell cycle and apoptotic percentage were detected by flow cytometry, morphological changes of apoptotic cells were observed by light and electron microscopy, and apoptotic cells were quantitatively determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). In addition, expression of intracellular bel-2 protein was analyzed by flow cytometric indirect immunoflourescent technique. Results: Progesterone of 0.0000001 - 0.00001mol/L inhibited HO8910 cell growth significantly in a dose-dependent manner (P < 0.01). After treatment with progesterone, the enhanced Go/G1 arrest was accompanied with the enhanced apoptotic peak and percentage, as well apoptotic cells were found more than those in control group (P < 0.05). By light and electron microscopy, there were many morphological characteristics of apoptosis including compaction and margination of nuclear chromatin, nuclear fragments, and apoptotic bodies. Analysis on expression of intracellular bcl-2 protein showed that progesterone could down-regulate bcl-2 protein and at concentration of 0.0000 mol/L it could almost block bcl-2 expression. Conclusions: It is suggested in the present study that progesterone can inhibit the proliferation of epithelial ovarian cancer cells in vitro and there is an accordant dose-response relationship. Its anticancer effect seems to be due to induction of apoptosis which maybe a result of down-regulation of the anti-apoptotic protein bcl-2. (author's)
Reagent strip diagnosis of UTI in a high-risk population.
A study was undertaken to determine the accuracy of reagent strip diagnosis of urinary tract infection (UTI) in patients seen in the ED who were subsequently admitted to hospital with this diagnosis. The reagent strip results of 100 patients were recorded and the sensitivity and specificity of various parameters in the diagnosis of UTI were calculated. Our results indicate that even in a group of patients with high clinical probability of UTI and with symptoms severe enough to be hospitalized, reliance on positivity of any single parameter alone gives unacceptably low sensitivity: 89%, 39%, 68%, and 63% for WBC, nitrite, RBC, and protein, respectively. We conclude that dipstick analysis is not sufficiently sensitive for diagnosis of UTI in high risk patients in whom missed diagnosis would have serious consequences. (author's)
Perihepatitis or Fitz-Hugh syndrome, peritonitis located in the right hypochondriasis (RH), is a relatively rare affectation. However, the HIV/AIDS pandemic has brought about the emergence and re-emergence of disease-states either uncommon or formerly on the decline as well as the appearance of opportunistic illness. We report the results of a retrospective study conducted in the National Hospital of Bobo-Dioulasso (Burkina-Faso) between 1 June 1997 and 31 December 1999 in an effort to contribute to a wider vision of diseases associated with HIV/AIDS. We based our study on 130 laparoscopies carried out for unexplained pain linked to RH (with or without fever), as well as abdominal-pelvian or diffuse abdominal pain. Thirteen cases (11 women, 2 men) of perihepatitis were diagnosed. The mean age for women and men was respectively 31.4 and 39.5. HIV serology was systematically carried out for all patients and, in case of perihepatitis, cultures were taken. All patients were infected with HIV and some presented signs of AIDS according to the WHO classification. In clinical terms, a shalking pain for RH was noted for 5 patients, abdominal sensitivity in 8 cases as well as gynaecological anomalies: cul-de-sac moving pain (4 cases), leuchorrea (3 cases) and mucosic vulvovaginitis (1 case). Paraclinical tests revealed a slight hepatic cytolysis for only 3 patients (1.5 N). 6 patients tested positive for Chlamydia trachomatis; the 7 others could not be tested, but this aetiology was assumed for evaluating the efficacy of the treatment under study. The high frequency of perihepatitis in these patients, all of whom were suffering from HIV/AIDS, and its presence in the 2 male cases, suggest that immunodepression is conducive to the appearance of this disease. (author's)
This article discusses the European Communities (EC) allegation that certain provisions in Canada’s Patent Act violate the Agreement on Trade-Related Aspects of Intellectual Property Rights. It presents the EC’s arguments, Canada’s position and the EC’s response, and the World Trade Organizations’ decision.
Revising the Declaration of Helsinki: Ethics vs economics or the fallacy of urgency.
Constant vigilance is required to ensure that the rights of volunteers in clinical trials are protected, particularly in developing countries. In this presentation to the XIII International AIDS Conference (abstract ThOrE651), Dirceu B Greco, of the Federal University of Minas Gerais in Brazil, describes the debate that has raged over the proposed changes to the Declaration of Helsinki, particularly with respect to access to medical care for trial volunteers and to the use of placebos in the control arms of the trials. The presentation argues: (1) that all trial volunteers should have access to the best diagnostic, preventive, and therapeutic methods, regardless of the standard of care in the countries where the trials are taking place; (2) that large efficacy trials of vaccines and drugs should be done first in countries where the best diagnostic, preventive, and therapeutic methods are available; and (3) that the costs of providing care and prevention services should be considered an integral part of the cost of the trials. The presentation explains how a partnership between activists, scientists, ethicists, and medical associations was effective in resisting pressures to lower the ethical standards for clinic trials. The presentation concludes that the gains made by this partnership constitute an important step in the struggle to provide universal access to education and health. (author's)
[The management of HIV patients during surgery and in the delivery ward: anesthetic considerations]
To date a total of more than 50 million individuals worldwide have been infected with HIV and more than 20 million have died from the disease. Two thirds of the known carriers of HIV 36 million worldwide, live in Africa. In Israel, as of December 31, 2000, there are a total of 2,843 reported carriers and 165 persons alive with AIDS. On the basis of future projections of increasing incidence of HIV/AIDS in obstetric patients undergoing anesthesia and surgery, obstetricians and anesthesiologists should be aware of the disease and its impact on anesthetic techniques and possible interactions between anesthetic drugs and HIV therapeutic agents. Surgical staff members should be knowledgeable and updated concerning safety precautions during surgical and anesthetic procedures. (author's)
Radiological evaluation of the urinary tract in children with urinary infection.
Objective: This article is to study the association of structural abnormalities of the urinary tract in children with urinary tract infection (UTI) using ultrasound examination. Method: 262 children with culture proven urinary tract infection were studied. Antibiotics were given as per sensitivity pattern. All children had an ultrasound of the abdomen done of the abdomen done within 3 weeks. A micturating cystourethrogram (MCU) was done in those with abnormalities of the lower urinary tract detected on ultrasound, as well as in those who had recurrence of infection, after a normal ultrasound. IVU and renal isotope scans were done in selected cases. Result: All children were followed up until one year after the study period. Fifty-four patients had an underlying urinary tract anomaly; 42 were picked up by ultrasound and 12 by MCU. 22.9% of males and 15.9% of females had anomaly of the urinary tract. Children less than 2 years had the highest incidence of anomalies. Conclusion: Pelviureteric junction obstruction with hydronephrosis, vesicoureteric reflux and non-refluxing megaureter are the major anomalies picked up. 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. An ultrasound abdomen is recommended in all children after the first UTI. In addition, an MCU is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done. (author's)
Upper respiratory tract infections.
Acute respiratory infections accounts for 20-40% of outpatient and 12-35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis are S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus and S. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10-14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexln), amoxycillin or macrolides. (author's)
Factors predisposing to urinary tract infection after J ureteral stent insertion.
Purpose: We determined the group of patients most likely to have bacterial infection or colonization of J stents inserted to relieve ureteral obstruction. Materials and Methods: Midstream urine from 250 consecutive patients who required indwelling J stent insertion obtained before stent insertion and on the day of stent removal was analyzed by microbiological testing. At stent removal 3 to 5 cm. of the stent tip located inside the bladder was also sent for culture. Patient sex, duration of stent insertion and systemic disease, such as diabetes mellitus, chronic renal failure or diabetic nephropathy, were recorded. Patients without systemic disease were classified as normal. The rates of bacteriuria, stent colonization and symptomatic urinary tract infection were compared in patients with and without systemic disease. Results: Of the 250 patients studied 180 (72%) were men and 70 (28%) were women, while 152 (60.8%) had no systemic disease, 27 (10.8%) had diabetes mellitus, 53 (21.1%) had chronic renal failure and 18 (7.2%) had diabetic nephropathy. The bacteriuria rate was 4.2% for stents removed within 30 days and 34% for stents removed after 90 days (p <0.001). Overall the bacteriuria rate in women was 24.3% compared with 13.9% in men (p <0.06). The rate of bacteriuria in normal patients was significantly lower (3.3%) than in patients with diabetes mellitus, chronic renal failure and diabetic nephropathy (33.3%, 39.6% and 44.4%, respectively, p <0.001). The colonization rate of the tip of the stent was higher in women (64.3%) than in men (34.7%). The stent was removed prematurely in 9 of the 250 patients (3.6%) because of septicemia, including 7 women (77.8%) with systemic disease. Conclusions: l1le risk of bacteriuria and colonization of the J stent tip is significantly enhanced by the duration of stent retention, patient sex and the systemic disease, such as diabetes mellitus, chronic renal failure and diabetic nephropathy. These categories of patients should undergo shorter stent retention, antimicrobial prophylaxis and careful follow-up to minimize infectious complications. (author's)
AIDS control in sub-Saharan Africa -- Are more drugs and money the solution?
The stress on money and drugs for HAART paints an unrealistic picture of the needs of resource-poor sub- Saharan African countries, where HAART could only be one of several control components. There is certainly need for additional resources, but first there has to be the capacity to absorb them. (excerpt)
This article argues for a new approach to use of nevirapine in the prevention of vertical transmission of KJV-I. Existing antenatal surveillance should be strengthened to plan geographical allocation, and subsequent evaluation, of a "nevirapine plus" programme. As the epidemic evolves the programme should also and, ideally, care should be tailored to individual women. Underpinning this approach is evidence that a more virulent viral phenotype appears in many patients with advanced KJV-I infection. This phenotype will become more common at the population level as the epidemic progresses. As efficacy of zidovudine correlates with viral phenotype, and use of the drug may alter phenotype, there is an urgent need for a replacement that is safe to use with nevirapine. (author's)
Our recent visit to HIV/AIDS hospital units in Phnom Penh, Cambodia, sharply delineated the contrasting capacity to respond to HIV/AIDS in First World countries, such as Australia, and resource-poor countries. Common to both settings is the relatively young age of those affected, the close attention of loved ones and the dedication of healthcare workers. The contrasts lie in the enormous gaps in quality of healthcare facilities and access to effective HIV treatments. HIV/AIDS may be only one of several major public health issues for these countries, but, probably more than any other issue, it highlights global resource inequities. (excerpt)
Health trends in Jamaica. Significant progress and a vision for the 21st century.
Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in /900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively, in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyle diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis, congenital syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed 10 support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles. (author's)
Consanguinity and early mortality in the Muslim populations of India and Pakistan.
Empirical information from studies conducted in Pakistan has indicated a high level of offspring mortality that can be attributed to parental consanguinity even when non-biological variables are controlled. However, with the exception of some small and geographically restricted studies, few comparable data are available on the influence of inbreeding in child survival among the Muslim population of India, which numbers between 100 and 120 million. The present study compares deaths during the first 5 years of life among the offspring of first cousin (F = 0.0625) and nonconsanguineous unions (F = 0), using data collected in the 1992-1993 Indian National Family Health Survey (NFHS) and the 1990-1991 Pakistan Demographic and Health Survey (PDHS). The focus was on determinants of mortality in live-born children to age 5 years. In both countries, bivariate analyses indicated that mortality was significantly increased in the offspring of first cousin unions during the neonatal and post-neonatal, total infant, and under-5 year periods. The findings were confirmed by multivariate regression, which incorporated control for a range of biological and demographic factors. (author's)
The objective of this study was to compare general and spinal anesthesia with respect to the short-term outcome of newborns born by elective cesarean deliveries. Pregnant women admitted to the authors' hospital from January 1999 to July 2000, for whom elective repeat cesareans were planned after 37 weeks gestation, were allocated randomly after their informed consent to spinal anesthesia or general anesthesia. Maternal age, gestational age, birth weight, Apgar's score, hospital stay duration, and duration of cesarean section time were all noted. The rate of the neonatal respiratory depression, perinatal asphyxia, and admittance to the neonatal intensive care unit of the infants were documented. The authors also studied arterial samples withdrawn from the cord for the pH; bicarbonate; oxygen pressure, arterial; and carbon dioxide pressure, arterial. The serum levels of creatine kinase with myocardial-specific isoform, aspartate aminotransferase, alanine aminotransferase, and total cortisol levels of the newborns were measured and served in ruling out perinatal stress and in confirming the diagnosis of perinatal asphyxia (and of myocardial damage). Statistical analysis was performed with the use of an unpaired Student's t-test, Chi-square test, and a power calculation was done. Results show that from the randomly selected patients, the authors had 38 (45.2%) infants for general anesthesia and 46 (54.8%) for spinal anesthesia. None of the authors' primary endpoints favored any of the study groups, and the clinical short-term outcome of the infants was similar in the neonates born both by spinal and general anesthesia (P > 0.05). The biochemical assays did not rule out or confirm any differences in the occurrence of perinatal stress (P > 0.05). In conclusion, anesthesia type does not seem to influence the short-term outcome of the newborn infants for the elective cesarean deliveries. The authors believe that both spinal and general anesthesia could be performed in elective term cesarean deliveries without any risk to the newborn infants. (author's)
Regional differences in waiting time to pregnancy among fertile couples from four European cities.
BACKGROUND: A previous European study found a longer time to pregnancy (TTP) among fertile women from Paris compared with women from other Western European countries. A co-ordinated, cross-sectional study of pregnant couples from Denmark (Copenhagen), France (Paris), Scotland (Edinburgh) and Finland (Turku) was therefore undertaken to assess differences in waiting TTP among couples from these cities. METHODS: Pregnant women were invited to participate when they showed up for their first antenatal visit in one of the four centres. Inclusion criteria included that their partner was 20-45 years of age and born in the country in which he was currently living and that the pregnancy was achieved without fertility treatment. Both partners filled in a questionnaire and the man underwent a physical examination and delivered a semen sample (Turku: n = 237. Copenhagen: n = 302. Edinburgh: n= 212. Paris: n = 191). RESULTS: French couples had a decreased probability of conception compared with couples from the other three countries, although only after adjustment for confounders. No significant differences between couples from the three other countries were found. CONCLUSION: The observed geographical differences in TTP remain unexplained and were not due to differences in semen quality, but may be caused by varying exposures to an environmental factors or psychological distress. In addition, selection bias due to the low participation rates cannot be ruled out. Future studies examining the causes of geographical differences in TTP are needed. (author's)
Country estimates of maternal mortality: an alternative model.
Ever since the publication of country level estimates of maternal mortality for WHO and UNICEF, there has been some degree of controversy about these estimates. The recent publication of a 1995 revision based on the modification of the multivariate model used for 1990 has not managed to put this controversy to rest. Countries with national estimates of their own have generally protested against the higher figures resulting from the multivariate modelling approach used by WHO and UNICEF, but some experts have also objected to the model itself. As a result of earlier discussions with the WHO/UNICEF team, some adjustments were incorporated into their model, notably the age standardization of maternal mortality ratios (MMRs) and proportions maternal among deaths of females of reproductive age (PDMF) of demographic and health surveys (DHS) direct sisterhood data, as the use of unstandardized values was shown to cause systematic biases. However, a model feature that continued to be controversial was the use of the PMDF as the dependent variable. As will be shown in this paper, the use of this dependent variable has a number of conceptual and practical disadvantages, such as tits dependence on non-maternal deaths and the need for separate projections of births and deaths of women of reproductive age, in order to convert the estimated PMDF into a more conventional MMR. The latter greatly increases the uncertainty of the resulting MMR estimates, even though this additional variance is ignored in the WHO/UNICEF estimates of confidence intervals. On balance, the MMR, while also subject to some legitimate objections, is still considered preferable as an independent variable. This paper therefore derives alternative country estimates for 1995 based on a multivariate model of the MMR. The model is shown to lead to smaller root mean square relative errors of the MMR estimates. While the overall number of maternal deaths estimated worldwide is very similar to the number reacted by WHO/UNICEF, there are major disagreements with respect to particular countries. Finally, a discussion is included on the appropriate way to incorporate the DHS direct sisterhood data, as this affects the results substantially. (excerpt)
Two generations of abortion providers.
This article will discuss the roots of the present shortage of abortion services and speculate on the prospects of a renewed commitment to abortion practice among contemporary medical students. (excerpt)
Understanding the new politics of abortion: a framework and agenda for research.
A conservative majority on the Supreme Court, recent Supreme Court decisions such as Webster v. Reproductive Health Services and Hodgson v. Minnesota that give states more leeway to set abortion standards, actions by state legislatures and governors to pass new, tougher state antiabortion laws, as well as efforts by the Reagan and Bush administrations to prevent workers at federally funded family planning clinics from discussing with clients the availability of abortion services point to a new political climate surrounding the abortion issue. These recent developments also increase the changes that Rowe v. Wade will be overturned in the future. This essay defines the parameters of a "new" politics of abortion, offers framework for understanding this post-Webster abortion politics, and suggests an agenda for future research. The argument advanced here is that the politics of abortion can best be understood by examining the nature and scope of the conflict over abortion and the institutional context: within which that conflict takes place. (author's)
New reproductive technologies, ethics and legislation in Brazil: a delayed debate.
This paper focuses on the debate about the utilization of new reproductive technologies in Brazil, and the paths taken in the Brazilian National Congress in an attempt to draw up legislation to regulate the clinical practice of human assisted reproduction. British documents, such as the Warnock Report and Human Fertilization and Embriology Authority (HFEA) are used for thorough reference. The analysis of the Law Projects in the National Congress, the Resolution by the Federal Medicine Council Resolution 196/96 and documents by the Ministerio Publico (Public Prosecution Office), supplied the bases for the discussion. The principal question involved is the observation of different technical and moral predicaments that influence the conduct of the issue in the legislative process. It is possible to observe that the main focus of the conficts relates to the rights and interests of the children, to those possibly benefited by the technique and to embryo reduction. Very little attention has been directed to the issues of sexual and reproductive rights and to the health submitted to the new reproductive technologies. (author's)
Definition of abortion is found to vary abroad. Some procedures escape U.S. aid limits.
Officially, Bangladesh prohibits abortion except to save a mother's life. But the government of Bangladesh, an emphatic proponent of birth control and the nongovernment Family Planning Association of Bangladesh, an affiliate of International Planned Parenthood Federation in London, do condone a practice that amounts to the same thing in the first 10 weeks of pregnancy. (excerpt)
Algeria to permit abortions for rape victims.
The decision to permit abortions for the rape victims was not officially announced. The daily newspaper AI Khabar, as well as two government officials, said the abortions were authorized a few days by the Islamic Supreme Council, the highest religious authority in the country, which reflects Government decisions. (excerpt)
The purpose of this study was to further evaluate the effectiveness of this preventive program by comparing the caries prevalence of the participating mothers and their children after six years. In addition, another group of mothers and their five-year-old children participating in the program was included together with a control group with mother-child pairs receiving dental care from other clinics in the same area. (excerpt)
Cultural and personal behavioral factors and women's reproductive tract infections.
The objective here was to review the relationship between personal behavior and cultural factors and reproductive tract infections (RTIs). Methods used were English-language literature search using MEDLINE (1994-1998), Social Science Index (1994-1998), and informal discovery. Any original researchers and reviews related to RTIs epidemiology, behavior and culture were selected. Results indicated RTIs have become a silent epidemic that is devastating women's lives each year. The influencing factors include sexual behavior, health related behavior (preventive health behavior, health-seeking behavior, reproductive behavior etc.) and culture, belief, etc. A holistic point of view should be taken. (author's)
An update on human papillomavirus infection and Papanicolaou smears in adolescents.
Human papillomavirus (HPV) infection is onc of the most common sexually transmittcd infections (STIs) in young women. Infection frequently is asymptomatic but may lead to clinical sequelae such as anogenital condylomata and cervical squamous cell carcinoma. High-risk HPV types, which are associated with the development of abnormal Papanicolaou (Pap) smears and adolescent-specific protocols for cervical cancer screening and for follow-up of abnormal cytology. (author's)
Micronutrients and child health: studies in international nutrition and HIV infection.
Convincing epidemiologic evidence currently exists for an association between physical activity and the prevention of colon and breast cancer. Physical activity may also reduce the risk of cancer at several other sites. With increasing research on this topic, it is apparent that studies of physical activity and cancer have numerous methodological similarities with studies of nutrition and cancer. Lessons learned from nutritional epidemiology that can be applied to studies of physical activity and cancer prevention and recommendations for future research are discussed in this review. (author's)
Microlaparoscopy in gynecology: analysis of 16 cases and review of literature.
Microlaparoscopy represents the development of endoscopic surgery towards a minimally invasive surgical procedure. The advantages include fewer surgical complications, faster return to daily activities, more comfortable postoperative recovery, and satisfactory aesthetic results. The possibility of performing surgery under sedation may result in shorter hospitalization, lower hospital costs, and easier anesthetic procedures. The authors report their preliminary experience with the use of microlaparoscopy, using optics and 2mm instruments, as well as a review of the literature since the introduction of this new technique. The report of these 16 cases demonstrates that microlaparoscopy is a feasible technique with satisfactory results. On the other hand, this new technique requires precise indications and a training period for the development of skills necessary for performing these surgeries. (author's)
Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care.
Context: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. Objective: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. Design: Retrospective analysis. Setting: First class tertiary private hospital, Sao Paulo, Brazil. Participants: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998; including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. Results: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.03 per 1,000) and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age groups (5.71 per 1,000). These facts are strong indications that these women were the ones most frequently submitted to assisted reproductive techniques. The median maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000), probably as a consequence of the residual effect of long term use of oral contraception. Conclusions: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years studied, with the twinning rate for primigravidae over 30 years old in 1998 being twice that observed in 1995. The mean maternal age was also high during this period, but the extremely high increase in twinning rate observed cannot be attributed solely to the variable. Assisted fertilization seem to be the most probable cause of this unusually high twinning rate. (author's)
Knowledge about the morbidity caused by Chlamydia trachomatis in eastern Europe is still insufficient. Reporting systems of sexually transmitted diseases and diagnostic tools, especially for the diagnosis of chlamydial infections, are still suboptimal,1 epidemiological studies are costly, and national resources devoted to STD prevention and control are small. The aim of this study was to investigate the prevalence of C trachomatis infections in Lithuanian women, attending six main health care units in Kaunas, the second biggest Lithuanian town (500 000 inhabitants) and to learn about risk factors related to genital chlamydial infections. used for chlamydia antigen detection. (excerpt)
Beyond our borders. Psychosocial support for breast cancer survivors: supporting women in Ukraine.
When Program for Appropriate Technology in Health (PATH) first discuss the idea of psychosocial support for breast cancer survivors, it was met with official skepticism but a profound expression of need on the part of individual women. Now, 15 groups represent 11 oblasts (provinces), with 10 of these groups officially registered as nongovernmental organizations. In Ukraine, where current economic circumstances are extremely difficult, breast cancer survivors have started to play a valuable role in complementing the efforts of medical providers to meet the psychological needs of breast cancer patients and their need for more information. By being willing to go public about their illness, breast cancer survivors are effective role models for newly diagnosed women, serving as living proof that they not only survived breast cancer but also have gone on to live normal, productive lives. (excerpt)
Parents' functioning in the work and family roles was examined in traditional and modern societies at the transition to parenthood. Participants were 162 dual-earner Israeli-Jewish and Arab families, who were interviewed and observed in dyadic and triadic interactions. Arab parents reported better adaptation to work following the first childbirth, and the triadic family process in Jewish families was more cohesive. Child care arrangements, part-time employment, easier infant temperament, and lower separation anxiety predicted maternal readaptation to work. Traditional sex-role attitudes, career centrality, full-time employment, and marital satisfaction predicted fathers' work adaptation. Parents' family focus, marital satisfaction, and responsive parenting correlated with a cohesive triadic process. Discussion considered the impact of nuclear- and extended-family living arrangements on the emerging work and family roles in young couples. (author's)
Neonatal disorders and obstetricians.
Neonatal disorders mean disturbances of normal state of body, organs and abnormal function of a newborn. Obstetricians play a major role to minimize the number of neonatal disorders. Prematurity, respiratory dysfunction, birth trauma, congenital malformations, neonatal infections and haemolytic disorders of the newborn are some examples of neonatal disorders commonly encountered. Preventive obstetrics is most important in reducing these disorders. Regular antenatal check-up, balanced diet, iron and folic acid tablet, avoiding repeated pregnancies are some measures which can prevent prematurity. Any factors which cause maternal hyposis during pregnancy are responsible for foetal hypoxia. Proper antenal care and avoidance of narcotic drugs in pregnancy are the pillars to combat respiratory dysfunction. Obstetrician play an important part to minimise birth trauma which is single handedly an important example of neonatal disorders. Proper antenatal care to detect any obstetrical anomaly reduces birth trauma to a large scale. In case of congenital anomalies, genetic counselling and early abortion in gross congenital anomaly are important aspects which can be looked after by the obstetricians. Neonatal infections can be minimises by the obstetricians themselves if they take care of any suspicious vaginal discharge in antenatal period. Dirty dressings are to be avoided in delivery time. Proper immunisation to the mother and also counselling of HIV transmission are also important. Haemolytic diseases of the newborn can be confronted by proper Rh and ABO blood groupings in an antenatal period and proper intervention at the time of delivery. (author's)
Impact of traditional birth attendant training in Mozambique: a controlled study.
This study was designed to assess the utility and impact on perinatal mortality of a model traditional birth attendant (TBA) training program in rural Mozambique by comparing birth attendance and outcomes in similar communities with and without trained TBAs. Birth attendants and pregnancy outcomes were compared in I) communities with good access to trained TBAs, 2) randomly selected, comparable communities with no access to trained TBAs, and 3) communities with good access to functioning maternities. Information was collected by interviews with women in randomly selected households. A total of 4,169 women were interviewed who redponded on 3,616 completed pregnancies, which resulted in a birth or fetal death. Among women with good access to trained TBAs, 33% reported giving birth attended by a trained TBA, 43% reported giving birth at a health facility, and 24% responded giving birth attended by an untrained person. Among women without access to trained TBAs, 58% reported giving birth at health facilities, and 42% reported attendance by untrained persons. Among women with access to functioning maternity centers, 77% reported giving birth at a health facility and 22% said their birth was attended by an untrained person. There was no significant difference in perinatal or infant mortality among the groups. This study demonstrated a preference for health facility deliveries among rural Mozambican women with good access to trained TBAs. It also failed to demonstrate a reduction in perinatal or infant mortality associated with TBA training. Women said they preferred to deliver in health facilities because conditions were considered better and interventions could be performed if needed. The preference for health facility birth over home birth with a TBA may have been related to difficulties with TBA neighbors and their families or fear of potential witchcraft. Efforts to promote TBA training should be balanced with support for birthing services based in health facilities. (author's)