Your search found 22 Results

  1. 1
    Peer Reviewed

    Putting people first: a primary health care success in rural India.

    Vlassoff C; Tanner M; Weiss M; Rao S

    Indian Journal of Community Medicine. 2010 Apr; 35(2):326-330.

    Background: The World Health Report, 2008, contains a global review of primary health care on the 30th anniversary of the Declaration of Alma-Ata. The period covered by the study reported on here corresponds with that of the Report, allowing for a comparison of achievements and challenges in one primary health care centre vis-a-vis the WHO standards. Materials and Methods: This study uses qualitative and quantitative data from a rural primary care facility in Western Maharashtra, collected over three decades. It analyzes the four groups of reforms defined by WHO in the context of the achievements and challenges of the study facility. Results: According to the WHO Report, health systems in developing countries have not responded adequately to peoples needs. However, our in-depth observations revealed substantial progress in several areas, including in family planning, safe deliveries, immunization and health promotion. Satisfaction with services in the study area was high. Conclusion: Adequate primary health care is possible, even when all recommended WHO reforms are not fully in place.
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  2. 2

    Circumcision and HIV [letter]

    Lazarus J

    South African Medical Journal. 2009 Jan; 99(1):12.

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  3. 3
    Peer Reviewed

    Estimates of maternal mortality worldwide between 1990 and 2005: An assessment of available data.

    Hill K; Thomas K; Zahr CA; Walker N; Say L

    Lancet. 2007 Oct 13; 370(9595):1311-1319.

    Maternal mortality, as a largely avoidable cause of death, is an important focus of international development efforts, and a target for Millennium Development Goal (MDG) 5. However, data weaknesses have made monitoring progress problematic. In 2006, a new maternal mortality working group was established to develop improved estimation methods and make new estimates of maternal mortality for 2005, and to analyse trends in maternal mortality since 1990. We developed and used a range of methods, depending on the type of data available, to produce comparable country, regional, and global estimates of maternal mortality ratios for 2005 and to assess trends between 1990 and 2005. We estimate that there were 535 900 maternal deaths in 2005, corresponding to a maternal mortality ratio of 402 (uncertainty bounds 216-654) deaths per 100 000 livebirths. Most maternal deaths in 2005 were concentrated in sub-Saharan Africa (270 500, 50%) and Asia (240 600, 45%). For all countries with data, there was a decreaseof 2.5% per year in the maternal mortality ratio between 1990 and 2005 (p<0.0001); however, there was no evidence of a significant reduction in maternal mortality ratios in sub-Saharan Africa in the same period. Although some regions have shown some progress since 1990 in reducing maternal deaths, maternal mortality ratios in sub-Saharan Africa have remained very high, with little evidence of improvement in the past 15 years. To achieve MDG5 targets by 2015 will require sustained and urgent emphasis on improved pregnancy and delivery care throughout the developing world. (author's)
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  4. 4

    Brazilian response to the HIV / AIDS epidemic, 2001 -- 2005.

    Bastos FI; Buchalla CM; Ayres JR; da Silva LJ

    Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:1-4.

    The document from the United Nations General Assembly Special Session (UNGASS) on HIV/ AIDS forms a fundamental reference point for everyone working in this field. It encompasses a wide variety of perspectives, from the formulation of public policies within the national, continental and global spheres to the provision of clinical care and implementation of preventive strategies by governments and civil society, and last but not least it relates to continuing dialogue with community leaders and the people who are living with HIV and AIDS. Thanks to an initiative coordinated by the Brazilian Institute of Health, with support from the non-governmental organizations Gestos-PE and Gapa-SP, the Ford Foundation and the National STD/AIDS Program of the Ministry of Health, it was possible to quickly bring together a variety of researchers, activists and managers of public programs for the prevention and treatment of HIV/AIDS, for a meeting on November 21 and 22, 2005, at the State of São Paulo Department of Health, in the city of São Paulo. Given the importance of the topic and the quality of the contributions from the different authors, it was decided to publish the communications presented: not in their original format, which was very preliminary, but fully incorporating the critiques and ideas arising from the discussions that followed the presentation of each text at the time of holding the seminar. It was decided, in our view correctly, to review each contribution in detail, starting by designating editors who would be in charge of three thematic blocks related to their respective fields of activity. (excerpt)
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  5. 5
    Peer Reviewed

    Implementation of the WHO Multicentre Growth Reference Study in Ghana.

    Lartey A; Owusu WB; Sagoe-Moses I; Gomez V; Sagoe-Moses C

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S60-S65.

    The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) African site was Accra, Ghana. Its sample was drawn from 10 affluent residential areas where earlier research had demonstrated the presence of a child subpopulation with unconstrained growth. This subpopulation could be identified on the basis of the father's education and household income. The subjects for the longitudinal study were enrolled from 25 hospitals and delivery facilities that accounted for 80% of the study area's births. The cross-sectional sample was recruited at 117 day-care centers used by more than 80% of the targeted subpopulation. Public relations efforts were mounted to promote the study in the community. The large number of facilities involved in the longitudinal and cross-sectional components, the relatively large geographic area covered by the study, and the difficulties of working in a densely populated urban area presented special challenges. Conversely, the high rates of breastfeeding and general support for this practice greatly facilitated the implementation of the MGRS protocol. (author's)
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  6. 6
    Peer Reviewed

    Implementation of the WHO Multicentre Growth Reference Study in Brazil.

    Araujo CL; Albernaz E; Tomasi E; Victora CG

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S53-S59.

    The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) South American site was Pelotas, Brazil. The sample for the longitudinal component was drawn from three hospitals that account for approximately 90% of the city's deliveries. The cross-sectional sample was drawn from a community survey based on households that participated in the longitudinal sample. One of the criteria for site selection was the availability of a large, community based sample of children whose growth was unconstrained by socioeconomic conditions. Local work done in 1993 demonstrated that children of families with incomes at least six times the minimum wage had a stunting rate of 2.5%. Special public relations and implementation activities were designed to promote the acceptance of the study by the community and its successful completion. Among the major challenges of the site were serving as the MGRS pilot site, low baseline breastfeeding initiation and maintenance rates, and reluctance among pediatricians to acknowledge the relevance of current infant feeding recommendations to higher socioeconomic groups. (author's)
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  7. 7
    Peer Reviewed

    Implementation of the WHO Multicentre Growth Reference Study in India.

    Bhandari N; Taneja S; Rongsen T; Chetia J; Sharma P

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S66-S71.

    The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site. (author's)
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  8. 8
    Peer Reviewed

    Implementation of the WHO Multicentre Growth Reference Study in Oman.

    Prakash NS; Mabry RM; Mohamed AJ; Alasfoor D

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S78-S83.

    The World Health Organization (WHO) Multicentre Growth Study (MGRS) Middle East site was Muscat, Oman. A survey in Muscat found that children in households with monthly incomes of at least 800 Omani Rials and at least four years of maternal education experienced unconstrained growth. The longitudinal study sample was recruited from two hospitals that account for over 90% of the city's births; the cross-sectional sample was drawn from the national Child Health Register. Residents of all districts in Muscat within the catchment area of the two hospitals were included except Quriyat, a remote district of the governorate. Among the particular challenges of the site were relatively high refusal rates, difficulty in securing adherence to the protocol's feeding recommendations, locating children selected for the cross-sectional component of the study, and securing the cooperation of the children's fathers. These and other challenges were overcome through specific team building and public relations activities that permitted the successful implementation of the MGRS protocol. (author's)
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  9. 9
    Peer Reviewed

    The WHO Multicentre Growth Reference Study: Planning, study design, and methodology.

    de Onis M; Garza C; Victora CG; Onyango AW; Frongillo EA

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S15-S26.

    The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development. (author's)
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  10. 10
    Peer Reviewed

    Managing data for a multicountry longitudinal study: Experience from the WHO Multicentre Growth Reference Study.

    Onyango AW; Pinol AJ; de Onis M

    Food and Nutrition Bulletin. 2004; 25 Suppl 1:S46-S52.

    The World Health Organization (WHO) Multicentre Growth Reference (MGRS) data management protocol was designed to create and manage a large data bank of information collected from multiple sites over a period of several years. Data collection and processing instruments were prepared centrally and used in a standardized fashion across sites. The data management system contained internal validation features for timely detection of data errors, and its standard operating procedures stipulated a method of master file updating and correction that maintained a clear trail for data auditing purposes. Each site was responsible for collecting, entering, verifying, and validating data, and for creating site-level master files. Data from the sites were sent to the MGRS Coordinating Centre every month for master file consolidation and more extensive quality control checking. All errors identified at the Coordinating Centre were communicated to the site for correction at source. The protocol imposed transparency on the sites' data management activities but also ensured access to technical help with operation and maintenance of the system. Through the rigorous implementation of what has been a highly demanding protocol, the MGRS has accumulated a large body of very high-quality data. (author's)
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  11. 11
    Peer Reviewed

    Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics / WHO international growth reference: implications for child health programmes.

    de Onis M; Onyango AW; Borghi E; Garza C; Yang H

    Public Health Nutrition. 2006 Oct; 9(7):942-947.

    The objectives were to compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Design: Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Subjects: Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations. (author's)
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  12. 12

    World population ageing: 1950-2050.

    United Nations. Department of Economic and Social Affairs. Population Division

    New York, New York, United Nations, 2001. [48] p. (ST/ESA/SER.A/207)

    The Population Division of the United Nations has a long tradition of studying population ageing, including estimating and projecting older populations, and examining the determinants and consequences of population ageing. From the groundbreaking report on population ageing in 1956, which focused mainly on population ageing in the more developed countries, to the first United Nations wallchart on population ageing issues published in 1999, the Population Division has consistently sought to bring population ageing to the attention of the international community. The present report is intended to provide a solid demographic foundation for the debates and follow-up activities of the Second World Assembly on Ageing. The report considers the process of population ageing for the world as a whole, for more and less developed regions, major areas and regions, and individual countries. Demographic profiles covering the period 1950 to 2050 are provided for each country, highlighting the relevant indicators of population ageing. (excerpt)
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  13. 13

    School-age children: their nutrition and health.

    Drake L; Maier C; Jukes M; Patrikios A; Bundy D

    SCN News. 2002 Dec; (25):4-30.

    This paper addresses the most common nutrition and health problems in turn, assessing the extent of the problem; the impact of the condition on overall development, and what programmatic responses can be taken to remedy the problem through the school sys- tern. The paper also acknowledges that an estimated 113m children of school-age are not in school, the majority of these children living in Sub-Saharan Africa and South-East Asia. Poor health and nutrition that differentially affects this population is also discussed. (excerpt)
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  14. 14
    Peer Reviewed

    Transmission intensity index to monitor filariasis infection pressure in vectors for the evaluation of filariasis elimination programmes.

    Sunish IP; Rajendran R; Mani TR; Munirathinam A; Tewari SC

    Tropical Medicine and International Health. 2003 Sep; 8(9):812-819.

    We conducted longitudinal studies on filariasis control in Villupuram district of Tamil Nadu, south India, between 1995 and 2000. Overall, 23 entomological (yearly) data sets were available from seven villages, on indoor resting collections [per man hour (PMH) density and transmission intensity index (TII)] and landing collections on human volunteers [PMH and annual transmission potential (ATP)]. All four indices decreased or increased hand-in-hand with interventions or withdrawal of inputs and remained at high levels without interventions under varied circumstances of experimental design. The correlation coefficients between parameters [PMH: resting vs. landing (r = 0.77); and TII vs. ATP (r = 0.81)] were highly significant (P < 0.001). The former indices from resting collections stand a chance of replacing the latter from landing collections in the evaluation of global filariasis elimination efforts. The TII would appear to serve the purpose of a parameter that can measure infection pressure per unit time in the immediate household surroundings of human beings and can reflect the success or otherwise of control/elimination efforts along with human infection parameters. Moreover, it will not pose any additional risk of new infection(s) and avoids infringement of human rights concerns by the experimental procedures of investigators, unlike ATP that poses such a risk to volunteers. (author's)
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  15. 15
    Peer Reviewed

    The prognostic value of the World Health Organisation staging system for HIV infection and disease in rural Uganda.

    Malamba SS; Morgan D; Clayton T; Mayanja B; Okongo M

    AIDS. 1999; 13(18):2555-62.

    The objective was to assess whether the WHO staging classification for HIV provides prognostically valuable and applicable information in rural Uganda. Data were obtained from a population-based cohort of 232 HIV-infected individuals. Clinical information was obtained using a detailed questionnaire and ascertained by physical examination. Participants were seen routinely every 3 months and when they were sick. A computer algorithm based on clinical history, examination and laboratory findings was used to stage HIV-positive participants at each routine visit. Kaplan-Meier survival estimates and the Cox proportional hazard model were used to assess the prognostic strength of the clinical and laboratory categories of the system. An attendance rate of 81% and 799 person-years of follow-up were achieved. Survival probability estimates at 6 years from being seen in clinical stages 1, 2, 3, and 4 were 63%, 46%, 24%, and 6%, respectively. When staging was revised to incorporate lymphocyte categories, the survival probabilities were 73%, 62%, 39%, and 6%, respectively. Unexplained prolonged fever and severe bacterial infection had survival probabilities closer to stage 2 conditions, mucocutaneous herpes simplex virus infection for more than 1 month and cryptosporidiosis with diarrhea for more than 1 month closer to stage 3 and oral candidiasis closer to stage 4 conditions. Even without the laboratory markers, the clinical category of the WHO staging system is useful for predicting survival in individuals with HIV disease. This is important for areas with limited access to laboratory markers. A simple rearrangement of a few clinical conditions could improve the prognostic significance of the WHO system. (author's)
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  16. 16
    Peer Reviewed

    The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Methods for the Natural Regulation of Fertility

    FERTILITY AND STERILITY.. 1999 Sep; 72(3):441-7.

    The main purpose of this study was to compare the duration of postpartum lochia among 7 groups of breast-feeding women, and in addition, to investigate whether age, parity, birth weight, or the amount of breast-feeding affects this duration. The participants included 4118 breast-feeding women aged 20-37 years living in China, Guatemala, Australia, India, Nigeria, Chile, or Sweden. The duration of lochia, frequency of an end-of-puerperium bleeding episode, and frequency of post-lochia bleeding episodes within 56 days of delivery were measured. This study revealed that the median duration of lochia was 27 days and varied significantly among the centers (range, 22-34 days). In about 11% of the women, lochia lasted >40 days. An end-of-puerperium bleeding episode around the 40th day postpartum was reported by 20.3% of the women. Bleeding within 56 days of delivery (separated from lochia by at least 14 days) occurred in 11.3% of the women and usually was followed by a confirmatory bleeding episode 21-70 days later. This study was able to quantify the average duration of postpartum lochia at 3-5 weeks, with significant variations by population. Lochia durations of >40 days were not unusual. A separate and distinct end-of-puerperium bleeding episode occurred in 1 out of every 4-5 women, although it is unclear how this phenomenon is clinically, socially, or culturally significant.
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  17. 17
    Peer Reviewed

    The World Health Organization multinational study of breast-feeding and lactational amenorrhea. III. Pregnancy during breast-feeding.

    World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on Methods for the Natural Regulation of Fertility

    FERTILITY AND STERILITY.. 1999 Sep; 72(3):431-40.

    This prospective longitudinal study aimed to determine the risk of pregnancy during lactational amenorrhea relative to infant feeding status. The participants included 4118 breast-feeding mother-infant pairs, with maternal age of 20-37 years, recruited from 7 study centers located in China, Guatemala, Australia, India, Nigeria, Chile, and Sweden. Infant feeding practices, menstrual status, and the number of pregnancies were recorded. The results revealed that in the first 6 months after childbirth, cumulative pregnancy rate during amenorrhea, depending on how the end of amenorrhea was defined, ranged from 0.9% (95% confidential interval (CI) = 0-2%) to 1.2% (95% CI = 0-2.4%) during full breast-feeding, and from 0.7% (95% CI = 0.1-1.3%) to 0.8% (95% CI = 0.2-1.4%) up to the end of partial breast-feeding. At 12 months, the rates ranged from 6.6% (95% CI = 1.9-11.2%) to 7.4% (95% CI = 2.5-12.3%) during full breast-feeding, and from 3.7% (95% CI = 1.9-5.5%) to 5.2% (95% CI = 3.1-7.4%) up to the end of partial breast-feeding. Regardless of the degree of supplementation, the pregnancy rate increased with time from 6th to the 12th month postpartum. Overall, the rate of pregnancy during amenorrhea was unaffected by variations in the return of menses. This large, multicenter study found that the cumulative 6-month rate of pregnancy during lactational amenorrhea was between 0.8% (95% CI = 0-1.4%) and 1.2% (95% CI = 0-2.4%). This is equivalent to the protection provided by many nonpermanent contraceptive methods as they are actually used and upholds the 1988 Bellagio Consensus.
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  18. 18

    Measurement of morbidity and disability with cross-sectional surveys in developing countries. Review of recent evidence on reliability and validity.

    van Ginneken JK

    In: International Population Conference / Congres International de la Population, Montreal 1993, 24 August - 1st September. Volume 1, [compiled by] International Union for the Scientific Study of Population [IUSSP]. Liege, Belgium, IUSSP, 1993. 483-97.

    The measurement of morbidity and disability is reviewed. Information on perceived, self perceived, or subjective morbidity is obtained by 1) rating the state of health in general; 2) questions on signs, symptoms, and diseases; 3) algorithms on diagnosis of diseases; and 4) sets of questions on disability focusing on the behavioral consequences of morbidity. The 3rd and 4th approach have more potential than the 1st and 2nd. Data collection methods for objective morbidity studies comprise cross-sectional, population-based studies; longitudinal, populations based studies; and medical records. Data collection for perceived morbidity studies consists of cross-sectional, population-based studies; longitudinal, population-based studies; and anthropological studies. The existing techniques to check on the quality of data fall into 3 categories; internal consistency checks, reinterviews and comparison with other sources of data. The internal consistency checks validate the length of the recall period or advantages and disadvantages of open or closed questions. Reinterviews and external comparisons facilitate it to draw conclusions on the quality of information of results of health interviews. Aspects of cross-sectional interview surveys with relevance for measurement of morbidity are: incidence, duration, and prevalence; accuracy of information and length of the recall period; phrasing, sequence, and number of questions; open vs. closed questions; self vs. proxy reporting; and training and supervision of interviewers. Health interviews and other sources of data are often compared with medical examinations medical records, mother's definition with standard definition, and 2 cross-sectional surveys. Instruments used in cross sectional surveys are very sensitive to length of the recall period, wording of the question, open vs. closed questions, and self vs. proxy reporting.
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  19. 19

    Why men avoid vasectomies.

    Stein R

    WASHINGTON POST HEALTH. 1993 Jan 12; 11.

    In the United States a total of 490,000 men obtain vasectomies each year compared to more than 600,000 women who sought sterilization in 1992 via tubal ligation. Vasectomy is often permanent, and even monogamous men avoid the procedure, partly because of the misconception that vasectomies reduce sexual prowess, fear of emasculation, and its confusion with castration. Also, there have been suggestions that vasectomy may increase the risk of prostate cancer. The World Health Organization experts in 1991 concluded there was no reason to stop recommending vasectomies. However, 2 large studies at Harvard University in Boston have added to the controversy. The 1st study involved more than 23,000 husbands of women in the Nurses' Health Study and followed the men from 1976 until 1989. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37%. The 2nd study involved more than 51,000 men in the Health Professionals Follow-up Study. Similarly, preliminary analysis indicated that vasectomized men appear to have a 21% increased risk for prostate cancer. These findings cause concern, since 4 million American men have had the procedure. A vasectomy involves severing each vas deferens, which carries sperm from the testicles into the penis. In the new, no-scalpel vasectomy technique the doctor makes 1 tiny puncture, and for the patient there is less swelling and bleeding. 300 US doctors are trained to perform the procedure, which was pioneered in China. Failure usually occurs because the vasa reconnect by themselves. Only a small percentage of men experience complications, most commonly excess bleeding or infections. Microsurgical techniques result in a 98% chance of reconnecting the vasa, if a reversal of the procedure is desired. But only about half of those who undergo a reversal succeed in fathering children, because after a vasectomy the immune system often produces antibodies against sperm.
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  20. 20
    Peer Reviewed

    Mortality and attrition processes in longitudinal studies in Africa: an appraisal of the IFORD surveys.

    Kuate Defo B

    POPULATION STUDIES. 1992 Jul; 46(2):327-48.

    The Institute for Demographic Training and Research (Institute de Formation et de Recherche Demographiques--IFORD) is a UN institution in Yaounde, Cameroon, which has been conducting longitudinal surveys since 1978 in urban areas of Africa to determine levels and characteristics of infant and child mortality. Longitudinal studies, however, lose original participants through attrition. Some critics assert that failing to adjust for this participant dropout may seriously bias study results. This study examines dropout characteristics to assess the degree of validity IFORD surveys hold as alternatives to indirect measurement technics. Employing 1978-81 IFORD survey data, relationships are explored between the initial characteristics of children in maternity units and different statuses of children identified by the IFORD surveys. Study results show no evidence that mortality or observed mortality differentials are biased by attrition. No relation was found between mortality and attrition in the survey, thereby suggesting that dropouts would have mortality experiences similar to those who remained in the study. Ignoring attrition, IFORD surveys may be used instead of indirect techniques to find levels and determinants of mortality in countries where registration systems and vital statistics are inaccurate. There is no need for such countries to wait for censuses or large-scale surveys to begin looking at infant mortality patterns. Specifically for Cameroon, the study revealed substantial mortality differentials by birth weight, ethnicity, place of delivery, and area of residence.
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  21. 21
    Peer Reviewed

    Genital human papillomavirus infections and cancer: memorandum from a WHO Meeting.

    World Health Organization [WHO]


    Cervical cancer ranks as the 2nd most frequent cause of cancer in women. Research demonstrates that infection with the human papilloma virus (HPV) leads to cervical cancer. The clinical HPV lesion in both sexes is the pointed wart like tumor called condyloma acuminatum. Detecting subclinical lesions varies, however, based on the genital organ and on the methods of examination. Several types of HPV infect anogenital epithelia and the resultant disease is partially determined by HPV type. In vitro methods to detect HPV do not exist, so laboratory personnel must depend on biochemical diagnostic procedures--molecular hybridization and serological procedures. HPV lesions, especially HPV- 16 and HPV-18, may turn into carcinomas depending on the activation or inactivation of some unknown genes perhaps influenced by tobacco smoking, oral contraceptives, other genital infections, or other unknown cofactors. Clinicians need to realize the potential gravity of HPV infection including the pathogenesis of lesions and its transmission through sexual contact. They must also be able to perform those diagnostic procedures that can detect HPV infection. Treatment of HPV lesions (e.g., cryosurgery, cautery, etc.) aims to either cure a repulsive, infectious, yet uncomplicated condition or prevent invasive cancer if HPV is connected with intraepithelial neoplasia. The results of the few well controlled studies of treatment of anogenital HPV- induced lesions show that 15-60% of lesions return with 3 months of treatment. Researchers must discover if humoral immunity can protect against HPV infection, and if it can, a vaccine using purified structural proteins should quickly be developed and approved.
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  22. 22
    Peer Reviewed

    Implications of oral contraceptive use on vitamin nutritional status.


    Indian Journal of Medical Research. October 1978; 68(Suppl):80-87.

    Cross-sectional and longitudinal studies were made to assess vitamin nutritional status of women using oral contraceptives (OCs). In the cross-sectional study, data obtained on 20 women, who had used Ovulen 50 for 6-12 months, were compared with data obtained on matched controls who had never used OCs. In the longitudinal study, 23 women were examined initially (before OC use) and again at 1 or more points during the next 6 months of OC use. Changes were found in several parameters of nutrition tested. 1) OC use produced a highly significant rise in plasma vitamin A within 1 month of treatment. 2) Thiamine activity measurements showed a slight fall, but did not affect the TPP effect, suggesting that OCs did not seriously alter thiamine status. 3) Erythrocyte riboflavin concentration showed a fall, revealing a very high incidence (> 80%) of biochemical riboflavin deficiency in women before starting OCs which was further reduced after treatment. 4) There was a marked rise in urinary excretion of xanthuremic and kynurenic acids after a standard tryptophan load, indicating impaired tryptophan metabolism due to pyridoxine deficiency. 5) Erythrocyte folate levels showed a small but significant fall. These observations on Indian women belonging to low income groups show clearly that OC use does affect the vitamin economy of the body adversely. Biochemical evidence presented argues that OCs alter vitamin economy through rise in levels of some proteins which bind vitamins. Vitamin supplements are recommended not only for patient benefit but for program acceptability.
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