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Biomedical subjects

R A Hatcher

Publications and source records attributed to R A Hatcher.

At least 55 records · Page 3Linked to original sources
PubMed1980

The association of depo-medroxyprogesterone acetate and breast cancer.

The use of depo-medroxyprogesterone acetate (DMPA) as an injectable contraceptive for women has continued to be controversial for over 10 years. The U.S. Food and Drug Administration has not approved it for contraceptive use but the World Health Organization has. We undertook a case-control study to clarify the possible association of breast cancer and DMPA use. Subjects were selected from women enrolled in the Grady Memorial Hospital Family Planning Clinic in Atlanta, Georgia, from 1967 to 1979. The risk of breast cancer in DMPA users compared to nonusers is identical. The small number of women with breast cancer, the short average exposure to DMPA, and the lack of detail about the subjects themselves caused us to interpret our results cautiously. However, it seems reasonable to conclude that short-term use of DMPA among black women is not associated with any increased risk of breast cancer.

Adult↗
PubMed1978

Febrile spontaneous abortion and the IUD.

A case-control study was done to determine the risk and pathogenesis of febrile spontaneous abortion for intrauterine device (IUD) wearers compared to non-wearers. Four groups of women coming to a large city hospital between 1970 and 1975 were compared: 1) women presenting with febrile spontaneous abortion, 2) women presenting with afebrile spontaneous abortion, 3) women presenting with afebrile spontaneous abortion which subsequently became febrile, and 4) women delivering a live infant. Pregnant women with an IUD in situ had a 5-fold higher risk of both febrile and afebrile spontaneous abortion compared to pregnant women without an IUD in situ. Women who had a spontaneous abortion that shifted from afebrile to febrile were somewhat more likely to be IUD wearers than the other 2 spontaneous abortion groups. In our study population, the increased risk of febrile spontaneous abortion for IUD wearers appeared primarily due to the increased risk of the spontaneous abortion event itself, rather than a primary IUD-related infection causing febrile spontaneous abortion.

Abortion, Spontaneous↗
PubMed1977

Rh immunoglobulin utlization after spontaneous and induced abortion.

To monitor the utilization of Rh immunoglobulin (RhIG), we reviewed the charts of 389 spontaneous and 1350 induced abortion patients treated in 1975 at a metropolitan hospital. The rate of ascertainment of Rh type was significantly higher for induced (99.6%) than for spontaneous abortion patients (95.1%) (P less than 0.001). Utilization of Rh immunoglobulin (RhIG) also was significantly higher for induced (98.9%) than for spontaneous abortion patients (80.6%) (P less than 0.001). Women at risk who did not receive RhIG after spontaneous abortion were mostly young, of low gravidity, and at gestational ages (mean 14.4 weeks) associated with substantial risks of Rh sensitization. Eradication of Rh hemolytic disease requires improvement in the system of identifying and treating patients who need prophylaxis.

Abortion, Induced↗
PubMed1976

Contraceptive choice and prevalence of cervical dysplasia and carcinoma in situ.

Whether use of oral contraceptives is associated with subsequent development of cervical neoplasia is an important public health question. Before evaluating this issue, we must determine if choosing oral contraceptives identifies a woman who is intrinsically at high risk of developing cervical neoplasia. We have examined the demographic and reproductive characteristics as well as cervical premalignant changes manifest by 15- to 44-year-old black women who enrolled in a public family-planning clinic. When compared to IUD acceptors, oral contraceptive acceptors did not have a disproportionately large number of women with traits which predicted for high risk of developing cervical neoplasia. Oral contraceptive acceptors, compared to IUD acceptors, did not have a higher prevalence rate of carcinoma in situ. Oral contraceptive acceptors with no Pap smears prior to initial choice of contraceptive method did have a 1.4-fold higher prevalence rate of cervical dysplasia than IUD acceptors. These results suggest that the deicision to use oral contraceptives, per se, does not identify a group of women at higher risk to develop cervical carcinoma in situ. Such a decision may, however, identify a group with a small increased propensity for developing cervical dysplasia.

Adolescent↗
PubMed1976

Efficacy information in contraceptive counseling: those little white lies.

Various procedures for estimating the effectiveness of a method of contraception have been devised. These measures, in turn, have been used in populations which differ widely in their propensity to use contraceptives properly. Therefore, a wide array of failure rates is available in the family planning literature. Unfortunately, because of differences in measurement and in choice of population, a random selection of these reported failure rates will not produce a consistent ordinal or cardinal ranking of methods by their effectiveness. Moreover, such a wide variety or reported rates permits the family planning practitioner to choose selectively in order to maximize the attractiveness of his favorite method(s). By surveying family planning personnel in two major cities, we found that they do indeen appear to place the methods they actively dispense in an extremely favorable position. Specifically, they are biased against the traditional contraceptives, foam and the condom. In this paper, we discuss the theoretical underpinnings of the measurement of effectiveness, report the apparent bias in the levels of contraceptive effectiveness reported to the patient, and finally, recommend a procedure for eliminating the jumble of rates in the literature and the consequent confusion among family planning personnel.

Attitude of Health Personnel↗