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Obstetrics and Gynecology. 2008 Sep; 112(3):572-8.OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1993; 71(5):535-48.An evaluation was made of the home-based maternal record (HBMR) as an impetus to improved continuity of care and to improved education of women about their health status. The study involved Egypt, India, Pakistan, Philippines, Senegal, Sri Lanka, Democratic Yemen, and Zambia. THe HBMR is a system for recording risk factors and early signs of complications, referrals, and treatment of the mother and infant. Data entry comes from a variety of sources, including the mother and other health personnel. Previous experience with home-based recording systems was reviewed. The WHO record was developed in 1982 and a set of guidelines was developed to evaluate the objectives and explore the functions. The evaluation was conducted between 1984 and 1988 in the 13 countries previously indicated with pre- and post-intervention designs and with controls, where possible. HBMRs were given to mothers during the second through the eight month of pregnancy, and those identified at risk were referred for appropriate care. Study populations ranged from 14,000 to 250,000 and female literacy ranged from 15% to 91%. Sample populations ranged from 75 to 819. Evaluation and results were provided for each of 6 objectives: 1) to encourage continuity of care from pregnancy through interpregnancy periods; 2) to encourage early identification of at-risk women and newborns; 3) to promote referral suitable to women and encouraging self-care; 4) to promote initiation of appropriate care suitable to needs; 5) to provide a useful and practical record of care; and 6) to provide a focus for health education about risk and health care during pregnancy and the interpregnancy period, and for the neonatal period. The findings revealed that HBMR was an important asset in increasing the quality and quantity of prenatal, postnatal, and interpregnancy care of mothers. There was also improved neonatal health care. Mother's knowledge about helpful practices was improved. Other improvements were evident in early identification of risk factors both before and after pregnancy, referrals of at-risk persons, initiation of care, registration of mothers and infants at health centers, vaccination with tetanus toxoid, and provision of useful health information. Continuity of care was improved when compared with baseline and control data. The HBMR was found to be suitable for use with all women regardless of childbearing age.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1987; 40(3):267-78.The primary cause of death in women in the world is cancer. In most developing countries cancer of the cervix is the most prevalent cancer. Breast cancer has this distinction in Latin America and the developed countries of North America, Europe, Australia, and New Zealand. It is also the most prevalent cancer worldwide. The most common cancer in Japan and the Soviet Union is stomach cancer. Effective early detection programs can reduce both breast and cervical cancer mortality and also the degree and duration of treatment required. In Iceland, cervical cancer mortality declined 60% between the periods of 1959-1970 and 1975-1978. Programs consist of mammography, physician breast and self examination, and Pap smear. The sophisticated early detection equipment and techniques are expensive and largely located in urban areas, however, and not accessible to urban poor women and rural women, especially in developing countries. Tobacco smoking attributes to 80-90% of all lung cancer deaths worldwide and 30% of all cancer deaths. Passive smoking increases the risk of lung cancer to 25-35% in nonsmokers who breathe in tobacco smoke. Since smoking rates of women are skyrocketing, health specialists fear that lung cancer will replace cervical and breast cancers as the most common cancer in women worldwide in 20-30 years. Tobacco use also contributes to the high incidence of oral cancer in Southern and South Eastern Asia. For example, in India, incidence of oral cancer in women is 3-7 times higher than in developed countries with the smoking and chewing of tobacco in betel quid contributing. Techniques already exist to prevent 1/3 of all cancers. If cases can be discovered early enough and adequate treatment applied, another 1/3 of the cases can be cured. In those cases where the cancer cannot be cured, drugs can relieve 80-90% of the pain.