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W Cates

Publications and source records attributed to W Cates.

At least 19 recordsLinked to original sources
PubMed1992

Commentary: the quest for women's prophylactic methods--hopes vs science.

The companion article by Rosenberg and Gollub in this issue summarizes data from 10 observational studies and concludes that female-controlled contraceptive methods, under typical conditions, are comparable to condoms in preventing sexually transmitted diseases and should be merchandized as such. While we agree that chemical and mechanical contraceptives provide protection against some sexually transmitted diseases, we think the authors have overstated the scientific case for these methods, especially in comparison with the condom. We think the current data remain inconclusive regarding the absolute protection of spermicides against the human immunodeficiency virus and their level of protection--relative to that of the condom--against other sexually transmitted diseases. Three reasons account for our differences: the limitations in the comparative data; the reported adverse effects of spermicides on vaginal conditions, including genital ulcers; and the relative value of condoms, even under typical conditions, in preventing sexually transmitted diseases. For these reasons, we would currently counsel both women and men who practice high-risk sexual behaviors to use condoms as their first line of defense. If this is unacceptable, the female barriers become a fallback position to protect against bacterial sexually transmitted diseases.

Condoms↗
PubMed1992

Vaginal douching among women of reproductive age in the United States: 1988.

BACKGROUND: Vaginal douching has been associated with pelvic inflammatory disease (PID) in several epidemiologic studies. METHODS: To determine the extent to which douching is practiced and to describe the population subgroups in which it is most prevalent, we analyzed data from the 1988 National Survey of Family Growth, which is based on a nationally representative sample of 8450 United States women between the ages of 15 and 44 years. RESULTS: Thirty-seven percent of the sample reported douching; 18% douched at least once a week. The variable most strongly and consistently associated with douching was race: two thirds of Black women, but only one third of White women, reported douching. The practice was least frequent among 15- to 19-year-olds (31%) and most frequent among 20- to 24-year-olds (41%). Douching was more common among women who lived in poverty (50%) than among those who did not (28%). Seventy percent of Black women living in poverty reported douching. Women with less than a high school education were almost four times more likely to report douching as those with 16 or more years of schooling (56% vs 16%). Women with only 1 partner and those with 10 or more partners were less likely to douche than others. Sixteen percent of women who reported douching, compared with 10% of those who did not, also reported a history of PID. CONCLUSIONS: Douching may be a modifiable risk factor for PID, it should be a high priority for future etiologic research.

Adolescent↗
PubMed1992

The epidemiology and prevention of sexually transmitted diseases.

Each year, approximately 12 million cases of STDs occur in the United States, including an estimated 1.4 million cases of gonorrhea, 130,000 cases of syphilis, 4 million cases of chlamydia, 500,000 to 1 million cases of human papillomavirus, 200,000 to 500,000 cases of genital herpes, and 45,000 cases of AIDS. These numbers should be viewed cautiously, because many STDs are not reported, many are not easily diagnosed, and many are asymptomatic or inapparent. The control of STDs can be achieved only through the continuing efforts of physicians to recognize and treat STDs and to counsel patients routinely in prevention.

Adolescent↗
PubMed1991

Self-reported pelvic inflammatory disease in the United States, 1988.

OBJECTIVE: --To assess any changes in the characteristics of women with self-reported pelvic inflammatory disease (PID) between 1982 and 1988 and to evaluate the role of additional behavioral factors. In 1982, PID was a frequent problem among American women of reproductive age, occurring in one in seven. It was also more common among older (greater than or equal to 30 years) than younger women, more common among blacks than among whites, and more common among formerly married women than among those currently married. DESIGN: --We analyzed data on self-reported PID from the cycle IV National Survey of Family Growth, conducted in 1988. SAMPLE: --The survey was conducted with a multistage probability sample of 8450 women. RESULTS: --The findings from 1982 were all replicated. Additional variables available in 1988 show that PID is more common among women with multiple (two or more) sexual partners (10% to 22%) compared with those with only one lifetime partner (7%) and among women who report a history of sexually transmitted disease (STD) (26%) compared with those with no STD history (10%). Controlling for other variables, age, race, vaginal douching, age at first intercourse, STD history, and number of lifetime partners emerged as independent predictors of self-reported PID among American women of reproductive age. CONCLUSION: --PID is still a widely prevalent condition among American women, PID is associated with a variety of risk factors for STD. Prevention of lower genital tract infection is crucial to avoiding PID and its sequelae.

Adolescent↗
PubMed1991

Preventing pelvic inflammatory disease.

Effective strategies for preventing pelvic inflammatory disease (PID) are crucial to protect women from adverse reproductive consequences and to avoid substantial economic losses. To identify current PID prevention options and assess their efficacy, we conducted a literature search and examined relevant data in published reports. We organized our review by level of participation (ie, individuals, providers, and communities) and prevention (ie, primary, secondary, and tertiary). For individuals, several prevention strategies related to personal protection appear promising, but few have been appropriately evaluated. For providers of health care, five prevention measures are recommended, including such primary prevention activities as counseling and patient education in addition to the usual diagnosis and treatment. Specific evidence supporting the efficacy of these provider practices, however, is limited. For communities, maintaining comprehensive sexually transmitted disease control strategies to prevent lower genital tract chlamydial and gonococcal infection is most important in reducing both symptomatic and asymptomatic PID. We provide specific recommendations for preventing PID and outline research needs.

Contraceptive Devices, Female↗
PubMed1991

Recurrence of ectopic pregnancy: the role of salpingitis.

We evaluated the role of salpingitis on the recurrence of ectopic pregnancy from a historical cohort of 2501 women who had undergone laparoscopic examination for acute salpingitis. We used pregnancy (N = 2899) as the unit of analysis and a modified conditional logistic regression to estimate a pairwise odds ratio as a measure of the recurrence of ectopic pregnancy. Among the second or higher order of pregnancy, the recurrence was 21.7%. For pregnancies with a prior uterine pregnancy, the ectopic pregnancy rate increased with prior salpingitis scores constructed from a combination of prior salpingitis episodes and severity (0 score, 2.7%; 1 to 2 scores, 4.8%; and greater than or equal to 3 scores, 12.1%). For those with a prior ectopic pregnancy, the rate did not increase with prior salpingitis scores (score 0, 20.0%; score 1 or 2, 19.2%; and score greater than or equal to 3, 26.9%). The adjusted pairwise odds ratio was 2.2 and was practically unchanged (2.1) after additional adjustment with prior salpingitis scores. These findings confirm salpingitis as a risk factor for first ectopic pregnancy, but once a woman had an ectopic pregnancy, previous salpingitis might not add any incremental risk.

Adult↗
PubMed1991

Genital chlamydial infections: epidemiology and reproductive sequelae.

Genital chlamydial infection is increasing and is now more common than gonorrhea. A sizable percentage of chlamydial infections of the lower genital tract in women progress to endometritis and salpingitis. Tubal infertility and ectopic pregnancy are important sequelae. Failure to control chlamydial infections reflects the following four factors: (1) Many cases are mild or asymptomatic; (2) diagnostic tests are expensive and technically demanding; (3) at least 7 days of multiple-dose therapy are currently required; and (4) partner notification is not routinely performed. Thus early identification of infected persons and compliance with curative therapy are less likely than with other sexually transmitted bacterial diseases.

Acute Disease↗
PubMed1990

Contraception and ectopic pregnancy risk.

Studies of the association of ectopic pregnancy with contraception have generated a conflicting array of results because of methodologic differences between studies. We estimated the absolute incidence rates of ectopic pregnancy for various contraceptives by multiplying the pregnancy rate by the proportion of pregnancies with ectopic implantation for each method. Our results indicated a more than 500-fold difference in ectopic pregnancy incidence, from a low of 0.005 ectopic pregnancies per 1000 women years of oral contraception or vasectomy to a high of 2.6 per 1000 women years of no contraception. These estimated incidence rates should be useful for clinicians and patients seeking to better understand the risks and benefits of contraceptives.

Adult↗
PubMed1990

Acquired immunodeficiency syndrome, sexually transmitted diseases, and epidemiology. Past lessons, present knowledge, and future opportunities.

During the last decade, the field of sexually transmitted diseases has evolved from one with a primary concentration on gonorrhea and syphilis to one of expanded effort addressing a wide spectrum of organisms and syndromes. The emergence of the human immunodeficiency virus (HIV) has greatly accelerated the growth of public concern about sexually transmitted diseases and has provided momentum to epidemiologic research in the field. More than a year before HIV was accepted as the cause of acquired immunodeficiency syndrome, early epidemiologic studies led to public health actions which reduced viral transmission. Future research opportunities for epidemiologists will involve a greater behavioral emphasis and will evaluate primary prevention approaches within a variety of target populations.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Sexually transmitted diseases. Overview of the situation.

A discussion of the recent changes in the transmission of sexually transmitted diseases is followed with one about the factors that have caused those changes. Brief descriptions of the most common bacterial and viral sexually transmitted diseases are included. Finally, prevention and control strategies are explained, including health promotion, clinical care, detection, treatment, counseling, and partner notification.

Adolescent↗
PubMed1990

A guide to interpreting contraceptive efficacy studies.

Results of trials of various birth control methods and contraceptive products may provide misleading data and engender unrealistic expectations regarding efficacy. An analysis of published efficacy-trials reveals numerous fallacies in their design, performance, and reporting. Consequently, family planning clinicians find it virtually impossible to make valid comparisons among the methods or products. This article reviews the definitions and measures that have been used to assess contraceptive efficacy, describes and illustrates some of the flaws that confound interpretation and comparison of studies, and presents a set of recommendations for future studies. A summary table providing comparative failure rates for all methods of contraception is included.

Confounding Factors, Epidemiologic↗
PubMed1979

Local versus general anesthesia: which is safer for performing suction curettage abortions?

The relative safety of suction curettage abortions performed with either local or general anesthesia has not been clearly established. To compare the safety of these two anesthetic techniques, we studied 36,430 women who received local anesthetics and 17,725 who received general anesthetics for this operation in the United States from 1971 through 1975. The aggregated major complication rates for the two groups were similar, but there were significant differences between local and general anesthesia for specific complications and treatments. Local anesthesia was associated with higher rates of febrile and convulsive morbidity; however, general anesthesia was associated with higher rates of hemorrhage, cervical injury, and uterine perforation. Both anesthetic techniques appear to be safe, with similar degrees of overall safety, although each is associated with a different spectrum of complications.

Abdomen↗