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Popular perceptions of emerging influences on mortality and longevity in Bangladesh and West Bengal.
New York, New York, Population Council, Policy Research Division, 2004. 21 p. (Policy Research Division Working Papers No. 186)Although new environmental and pathological threats to human survival and longevity have been documented, relatively little is known about how these threats are perceived in the popular imagination. During fieldwork in rural Bangladesh and West Bengal, India, researching the changing costs of and motivations for reproduction, the authors included survey questions on respondents' perceptions of changing mortality. Child-mortality levels were perceived to have fallen drastically in recent times, but for the middle-aged and the elderly, the past was seen as a better time in terms of health and survival. The decline in adult health is attributed to environmental deterioration and lifestyle changes associated with modernization. This paper explores the objective validity of and subjective reasons for this unexpected world view. References to pesticides and chemical fertilizers as causes of death abound, but mention of other emerging health threats including the HIV/AIDS pandemic, dengue, and toxic levels of arsenic in the water table is conspicuously absent. (author's)
International Journal of STD and AIDS. 2004 Jan; 15(1):56-60.One thousand individuals in the age group 18± 69 were selected for a multistage nationwide random sample. Of the interviewees 68.3% were of the opinion that the risk of AIDS, in Portugal, is considerably high and 37.1% stated that they had feared being infected by the HIV; 28.0% established a connection between being afraid and the fact that AIDS is a serious/incurable disease; 31.5% believed that there are risks inherent to the health services; only 7.8% expressed fear of AIDS because of an infected partner. Only 42.6% regarded extra-marital sexual relations as either partially or totally acceptable. Sexual relations between youths were seen as totally acceptable by 11.9% and partially acceptable by 51.1%. Homosexual relations between men were seen as either totally or partially acceptable by 38%. Of the interviewees, 7.8% thought that recent treatments can definitely cure AIDS and 6.5% believed that with recent treatments HIV transmission would no longer be possible. (author's)
Evaluation of a prescription based record-linkage model for epidemiological studies of long-term adverse effects of drugs -- with special regard to combined oral contraceptives.
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY. 1991; 40(5):489-93.The Swedish Department of Drugs of the National Board of Health and Welfare undertook a study of the possibilities of post-marketing surveillance of combined oral contraceptives (COC) and epidemiological studies based on individual cancer, death and demographic registries. In Sweden, there are a Cancer Registry, a Cause of Death Registry, a hospital In-Patient Registry, and registries of prescription drugs purchased through the Swedish National Corporation of Pharmacies, all accessed by individual National Registration Numbers. An agency to link these data in an individual-based exposure register would require long-term staff continuity, and large central computer facilities for data processing. In addition, questionnaires would be needed to obtain exposure before the start of the project. A model employing 258,000 women in each 5-year group, with at least 100 cases in each group, would require up to 13 years for cardiovascular outcomes, or 28 years for cancer outcomes, to include induction time and observation time. Data would have to be gathered to prevent bias due to confounding, selective recall, and diagnostic bias. An important obstacle is public objection to intrusion into personal integrity. Advantages of the study included relative ease of linking data, compared to systems in place in other countries. Major impediments cited were long study periods, high costs, and uncertainty about policies of future COC prescriptions. The study concluded that such a project would not be cost-effective. There is a need to study current low-dose COC on a scale begun by the British Royal College of General Practitioners Study and the Oxford Family Planning Association Study. It is suggested that strategies be implemented to improve retrospective epidemiological studies, for example by validating drug exposure by independent sources.
FAMILY PLANNING WORLD. 1992 Jan-Feb; 2(1):10-1, 31.Despite the wealth of evidence supporting the safety and efficacy of IUDs, fears of health problems associated with use of the device still linger in the US. Over the past 10 years, studies have shown that a new class o IUDs, copper-bearing IUDs, result in fewer pregnancies than oral contraceptives, and are as effective as Norplant, the long-acting hormonal implant. Additionally, the new class of IUDs have significantly lowered the rate of complications associated with use, complications such as bleeding, discomfort, and involuntary expulsion. Some experts say that the IUDs are among the most effective and safest forms of contraception available. And while the popularity of IUDs continues to rise in Europe and Asia, only an estimated 1% of US women use IUDs. Fears over IUD use in the US stem from the Dalkon Shield debacle in the 1980s, when reports about infection and infertility associated with the use of this particular type of IUD began to surface. More than 100,000 women filed a class action suit against Dalkon Shield's manufacturer, A.H. Robbins, and fear of similar liability prompted competing manufacturers to withdraw IUDs from the market. From 1986-88, only one type of IUD could be found in the US market. Experts now say that the safety questions -- especially concerns over the risk of pelvic infections -- about IUDs no longer apply, so long as the devices are properly prescribed and inserted under thoroughly aseptic conditions. Although the number of US women using IUDs is small, the IUD enjoys the highest satisfaction rate of any contraceptive method, 98%. Nonetheless, a comeback in the US for IUDs remains unlikely at this time, since the majority of women still distrust of the method, and physicians remain fearful of liability risks.
In: Hormones and sexual factors in human cancer aetiology, edited by J.P. Wolff, J.S. Scott. Amsterdam, Netherlands, Elsevier Science Publishers, 1984. 183-90. (International Congress Series 650; ECP Symposium 1)In light of news reports linking the pill to cancer, the author discusses the role of the media in reporting possible dangers associated with oral contraceptive (OC) use. On October 22, the Lancet published 2 studies linking breast cancer and cancer of the cervix with OC use. The newspaper also printed an editorial which said that the drive to end unwanted pregnancies often ignores safety concerns over the pill. Despite these reports, the public reacted calmly, and women did not rush to the doctor to seek a new contraceptive method. But in other occasions, notably in 1969, reports of possible harmful side effects of pill did stir anxiety among millions of women. The information, which had been leaked to the press, had not yet reached physicians, and they found themselves besieged by oral contraceptives users. Although noting that not all stories concerning OCs are sensationalist or irresponsible, the author explains such a story is highly prized by news editors for several reasons: it deals with sex; it reveals a hidden danger in something otherwise thought to be safe; and it attributes guilt to someone (in this case, the pharmaceutical industry). Furthermore, as part of their guiding philosophy, journalists seek to bring an issue to the attention of the public, which is supposed to serve as a jury in rendering an opinion. In doing so, the media treats complex scientific issues too simplistically. Yet despite the evidence attesting to the pill's side effects, its use has continued, which suggests that the public has already assessed its risks objectively.
MARHIA. 1990 Jan-Jun; 3(1-2):27-8.The Institute for Social Studies and Action of the Philippines is endeavoring to encourage the public and the Catholic Church to Recognize the differences between contraception (which prevents the union of the sperm and ovum) and abortion (which terminates pregnancy long before the fetus is viable). Nonetheless, widespread opposition to contraceptives, especially the IUD, persists because they are considered abortifacients. In terms of the IUD, there is accumulating research evidence that the device works primarily by preventing fertilization and, less frequently, by interfering with implantation. The injectable contraceptive, Depo-Provera, which is banned in the Philippines, suppresses ovulation, as does the pill. Despite the evidence that the most widely available contraceptives are not abortifacients, debate over this issue obscures a far more central issue--the right of each woman to plan her family size and the interval between births. Screening and counseling provided by well-trained health personnel can enable women to choose the contraceptive method that best suits their needs and protects their health. A lack of access to contraception is in part responsible for the 2000 maternal deaths that occur in the Philippines each year during pregnancy or delivery.