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PubMed1999

Activated protein C resistance: automated detection of the factor V Leiden mutation by mismatch hybridization.

BACKGROUND: A single point mutation in the factor V gene has been demonstrated to be the cause of factor Va resistance to proteolytic cleavage by activated protein C. Knowledge of the patient's genetic disposition is of great importance in situations such as pregnancy, surgery, use of oral contraceptives, and immobilization. METHODS: We have developed a rapid, automated test for the detection of the factor V mutation that makes use of differences in thermal stability between perfect-match and non-perfect-match hybrids. A DNA fragment spanning the mutation is amplified with a biotin-labeled primer. Ruthenium-labeled oligonucleotides, perfectly matching either the biotinylated wild-type strand or the biotinylated mutation strand, are added. Heating to 95 degrees C and subsequent cooling lead to the formation of double-stranded DNA. Under the conditions chosen, ruthenium-labeled oligonucleotides form stable, double-stranded DNA with the biotinylated strand only if both strands perfectly match each other. The ruthenium signal is measured on a modified Elecsys 1010 system (Roche Diagnostics). RESULTS: The ratio between the signals obtained with perfectly matching and non-perfectly matching oligonucleotides reflects the genetic status. Analyzed samples can be divided into three nonoverlapping groups based on these ratios. We confirmed the reliability of the method by analyzing several samples of known genetic status; the results were identical in every single instance. CONCLUSIONS: The test discriminates unambiguously between the heterozygous and the homozygous states. Because of its low costs and easy handling, the assay is suitable for use in routine laboratories of clinical chemistry.

Autoanalysis↗
PubMed2004

Determinants of maternal deaths in induced abortion complications in Ivory Coast.

Persistently high levels of maternal mortality have been reported in Abidjan, the capital of Ivory Coast, with a high prevalence of deaths related to complications of induced abortion. In order to assess the determinants of maternal deaths in induced-abortion complications, this study investigated women admitted to the gynecological departments of four reference hospitals throughout Ivory Coast. Information concerning abortion events was collected by means of a questionnaire during a confidential, face-to-face interview. Medical records were used to collect clinical data and final vital status. In our series, 60% of women declared that they induced abortion themselves at their home; a large majority mentioned "insertion of objects into the vagina" or "ingestion of traditional plants" for this purpose. On the other hand, 40% declared that abortion had been performed by a health worker, mostly at a health facility and by using surgical methods (dilatation and curettage). Less-educated women were more likely to have chosen to induce abortion themselves at home, and more-educated women had undergone abortion through a health professional. Our findings highlight the role of both women and health professionals in responsibility for induced abortion complications.

Abortion, Induced↗
PubMed1999

Reasons for hospitalization due to abortion and pregnancy termination.

The aim of this study was to identify the reasons for hospitalization associated with abortion and pregnancy termination among women attending the Maternity Unit of IMIP, Recife, Brazil. In a case-control study, 230 women who were hospitalized consecutively between August 1994 and June 1995 due to causes related to pregnancy termination or abortion were chosen as cases. Four controls per case were selected randomly out of a total of 920 women who delivered at the same hospital. For each potential cause considered, the odds ratio (OR) and respective 95 per cent confidence interval (CI) were calculated. Multiple logistic regression analysis was then used to control for confounders. Among all potential causes studied, those that showed significant association with pregnancy termination or abortion were: being single, absence of emotional support from partner, being a working woman, literacy up to the fourth year of school, failure of contraceptive method employed, and experience of previous pregnancies, children, and abortions.

Abortion, Induced↗
PubMed1997

Linkage of essential hypertension to the angiotensinogen locus in Mexican Americans.

Essential hypertension has been linked to a highly polymorphic marker at the angiotensinogen locus, and association with a polymorphism in this locus has been found in some populations. We tested the hypothesis that these same polymorphic markers are linked to essential hypertension in Mexican Americans. The data comprised all the affected relative pairs in 46 extended families chosen at random from a low-income barrio in San Antonio. Specifically, we searched for linkage by testing for excessive marker alleles shared identical by descent (IBD) among hypertensive relative pairs. When women taking oral contraceptives or hormones were excluded, the affected relative pairs shared a significant excess of alleles IBD for the highly heterozygous GT repeat polymorphism (P=.038) and were marginally significant for the M235T variant (P=.079), which has a much lower heterozygosity (0.43 versus 0.85 for the GT repeat). We also assayed plasma levels of angiotensinogen and, using likelihood methods, found no significant association (P=.43) between plasma levels of angiotensinogen and M235T genotypes. These results support the linkage of essential hypertension to the angiotensinogen locus but do not indicate a specific role for the M235T variant.

Adult↗
PubMed2005

A qualitative study of women's use of emergency contraception.

BACKGROUND: While the use of emergency contraception (EC) is becoming more widespread in Australia, little is known about the reasons for, and the social context of, this use. METHODS: In order to explore the use of EC from the perspective of users, a qualitative study was conducted with women presenting to one of three health care settings in Melbourne, Australia for EC. RESULTS: Thirty-two women ranging in age from 18 to 45 years were interviewed. While a number of themes were discussed with the women, this paper reports on four 'types of users' of EC identified from the data. 'Controllers' experienced failure of their contraceptive method and were very uncomfortable needing EC. They changed their contraceptive strategy in an attempt to avoid needing EC in the future. 'Thwarted controllers' were similar to controllers except that they could not improve their contraceptive strategy due to medical or social limitations. 'Risk takers' saw the use of EC as a component of their overall contraceptive strategy. They did not rely on EC regularly, but were comfortable to use it occasionally when the need arose. A final group of women were 'caught short' by a sexual experience that was unplanned and therefore they did not manage to use their chosen contraceptive strategy. CONCLUSIONS: The findings from this study challenge the assumptions that are often made about the users of EC and highlight the need to acknowledge the different ways that women make sense of, and make decisions about, contraception.

Adolescent↗
PubMed2003

An AIDS risk reduction program for Dutch drug users: an intervention mapping approach to planning.

This article presents the development of a theory- and evidence-based AIDS prevention program targeting Dutch drug users and aimed at promoting condom use. The emphasis is on the development of the program using a five-step intervention development protocol called intervention mapping (IM). Preceding Step 1 of the IM process, an assessment of the HIV problem among drug users was conducted. The product of IM Step 1 was a series of program objectives specifying what drug users should learn in order to use condoms consistently. In Step 2, theoretical methods for influencing the most important determinants were chosen and translated into practical strategies that fit the program objectives. The main strategy chosen was behavioral journalism. In Step 3, leaflets with role-model stories based on authentic interviews with drug users were developed and pilot tested. Finally, the need for cooperation with program users is discussed in IM Steps 4 and 5.

Acquired Immunodeficiency Syndrome↗
PubMed2004

[Teenage pregnancy and delivery: 276 cases observed at the Brazzaville University Hospital, Congo].

OBJECTIVE: To study sexuality, pregnancy and delivery in female teenagers. MATERIALS AND METHODS: Cross-sectional prospective study from January 1(st), 1997 to May 31(st), 1998 concerning 276 female teenagers. The studied features were compared with a control group of 300 women aged more than 18 years chosen at random. RESULTS: Among 5204 women who delivered during the study period, 5.30% were teenagers. Their mean age was 14 years five months; 84.06% were single; 2.90% were married and 13.04% were concubines. Analysis of social background showed that 41.66% had attended school, 51.10% had dropped out, and 7.24% were illiterate. Mean age at first sexual intercourse was 13 years 9 months. Only 14.13% practised contraception, none used a condom. Mean term of the first prenatal consultation was 26 weeks gestation. Predominant pathological conditions observed during pregnancy were infections, anemia and complications of high blood pressure. Mean term at delivery (generally vaginal) was 38 weeks gestation. The rates of perinatal mortality and referral to the department of neonatology were higher than in the control population. CONCLUSION: Risk remains high for teenage pregnancy. Reduction of complication requires combined medical, psychological and social management.

Adolescent↗
PubMed1993

The estrogenic activity of synthetic progestins used in oral contraceptives.

BACKGROUND: Oral contraceptives (OC) contain an orally active estrogen in combination with an orally active synthetic progestin derived from 19-nortestosterone. OC have had an enormous positive impact on public health for the past three decades, and in the main, there has been a remarkably low incidence of troublesome side effects. Although estrogens are implicated in an increased incidence of breast and endometrial cancer, epidemiologic studies have not provided convincing evidence to support a direct correlation between OC use and an increase in breast cancer incidence. By contrast, OC do cause a decrease in the incidence of endometrial and ovarian carcinoma. During the past decade, several isolated reports have linked an increased incidence of breast cancer with the use of synthetic progestins. No mechanism for the proliferative potential of progestins has been offered. Therefore, the authors investigated this problem to formulate a hypothesis, based on laboratory data, that might be evaluated in populations at risk. METHODS: The synthetic progestins (19-nortestosterone derivatives) chosen for the study were norethynodrel, norethindrone, norgestrel (levonorgestrel), and gestodene. These were compared with the actions of medroxyprogesterone acetate (MPA). To determine whether the progestins produced their effects via the ER, the cells were transfected with a chloramphenicol acetyl transferase (CAT) reporter gene containing an estrogen response element only activated by ER. RESULTS: The 19-nortestosterone derivatives all stimulated the growth of estrogen receptor (ER)-positive but not ER-negative breast cancer cells in culture. Antiestrogens, but not the antiprogestin mifepristone (also known as RU 486), inhibited progestin-stimulated cell proliferation. MPA did not stimulate cell proliferation. All the synthetic progestins that increased replication also activated CAT. Activation was blocked by antiestrogens but not by mifepristone; the synthetic progestin MPA was inactive. CONCLUSIONS: These studies provided direct evidence that some synthetic progestins exert estrogenic effects through the ER. The results demonstrated that progestins can have a dual effect on estrogen target tissues either to stimulate or differentiate cells. The results suggest that some beneficial estrogen-like effects could be produced by synthetic progestins (e.g., bone preservation), but epidemiologic studies of OC use should focus of the "total estrogen" content to establish whether some formulations place some groups of women at greater risk of having breast cancer.

Breast Neoplasms↗
PubMed1991

A pilot study of acceptability of RU486 and ONO 802 in a Chinese population.

RU486 and ONO 802 in combination have been shown to be effective in early termination of pregnancy. Anecdotal information suggests that Chinese women have been using herbs to induce abortion, believing that such medication and means of abortion is less harmful to the body than surgery. Hence, a medical means of abortion using RU486 and ONO 802 may be the method of choice for some Chinese women. A pilot study involving 42 Chinese women in Hong Kong was conducted to explore the reasons for acceptance or refusal of RU486 and ONO 802 as abortifacient agents. It was found that more single women chose the medical method for abortion, the main reasons being fear of trauma to the body due to surgery and the feeling of having undergone menstrual regulation rather than having had an abortion with the medical method. Those who refused the treatment were worried about the efficacy and side effects of the new drugs and the long induction-abortion interval. There were 3 failures in the medical group of 23 women. All these 23 women were gland they had chosen the medical abortion method. Twenty-one out of the 23 women said they would choose the same abortion method again. The practice of the use of Chinese herbs was not more common in this group of women as compared to women who did not choose this method of abortion.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

Body weight gain as the major risk factor of cholelithiasis in women and an important risk factor in man.

PURPOSE: The power of correlation was assessed between chosen risk factors of cholelithiasis in order to establish the ranking of these factors in Podlasie inhabitants. MATERIAL AND METHODS: The study involved 169 patients hospitalized due for cholelithiasis (study group) and 202 patients without cholelithiasis (control group). Previous exposure of patients of both groups to the chosen risk factors of cholelithiasis was evaluated (based on a history questionnaire designed by the authors of the study). Two models of logistic regression were prepared (for men and women) for multivariate analysis. RESULTS: The ranking of the risk factors of cholelithiasis was established by analysing multiple correlation coefficients for the two models of logistic regression and their significance was determined with Wald's test. The significant risk factors for women included: overweight and obesity, age, diabetes, use of contraceptive pills, while for men these were: age, serum triglycerol level, obesity. CONCLUSIONS: The knowledge of risk factors of cholelithiasis in our population is the essence of health promoting actions. Obesity is the major risk factor in women and statistically significant in men. Promotion of appropriate eating habits can result in body mass reduction and may thus indirectly decrease other risk factors of cholelithiasis (incidence of type II diabetes and serum triglycerol level).

Adult↗
PubMed1996

Age of natural menopause among women in Mexico City.

OBJECTIVES: The average age of menopause among women in Mexico City was calculated, considering their reproductive and socio-demographic characteristics. The information was obtained from a population-based control group from a case-controlled study of gynecologic cancer. METHODS: Interviews were carried out with 1005 women resident in Mexico City chosen at random from a sample using the housing sample framework of the Mexico General Directorate of Epidemiology, 472 of whom had undergone a natural menopause. RESULTS: The most important results include an average age for menopause in this population of 46.5 +/- 5 years (95% C.I. 46-48) with a median of 47. Groups of women with an average early menopause were those with no formal education (1.6 years), low socio-economic level (1.3 years, P < 0.05), nulliparas (2.6 years, P < 0.05), those who had never breastfed (2.2 years, P < 0.05) and those who had not used contraceptive hormones (1.7 years, P < 0.05). CONCLUSION: This phenomenon must be documented in Mexico because of its strong links with the morbidity and mortality of the growing number of women who are reaching advanced ages and whose survival is calculated at 30 years after menopause.

Age Factors↗
PubMed2006

A randomised controlled trial of a decision-aid leaflet to facilitate women's choice between pregnancy termination methods.

OBJECTIVE: To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination. DESIGN: A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception. SETTING: An NHS regional centre for pregnancy termination. SAMPLE: All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002. METHODS: Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure. MAIN OUTCOME MEASURES: Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet. RESULTS: Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76-1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type. CONCLUSIONS: Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method.

Abortion, Induced↗
PubMed1991

Factors associated with the acceptance of Norplant or IUD among women with similar socio-demographic characteristics.

The purpose of this study was to identify factors that explain why women who consulted at the same clinic, went through the same counseling procedure and who had no contraindications for using Norplant decided to use another long-acting method, the IUD. Subjects were women who consulted at the Family Planning Clinic, State University of Campinas Hospital. One hundred Norplant acceptors and 100 IUD acceptors were interviewed at home, by trained interviewers who were not related to the clinic. Four out of five Norplant acceptors and all IUD acceptors had learned about the method chosen before attending the clinic. Results suggest that among IUD users there were more women who did not like the idea of taking a hormone or medicine to prevent pregnancy, while Norplant acceptors were more willing to try new experiences. Half the Norplant acceptors had learned about the method through TV, compared to 12% of IUD acceptors. Counseling at the clinic was not a determining factor, though it is important to clarify clients' doubts.

Adult↗
PubMed1990

Oral contraceptives in risk groups: exclusion or monitoring?

Careful consideration of absolute and relative contraindications, including newly appreciated factors such as past pregnancy-related hypertension, is essential to select what is termed the "safer women." A family history of either arterial or venous thrombosis indicates preliminary blood analysis to exclude atherogenic lipid states and thrombophilias. The goal then is to prescribe "safer pills." One should also allow for biologic variation in pharmacokinetics and end-organ responses. This can be done to a limited extent in clinical practice by using bleeding from the uterus as a "threshold bioassay." Namely, by identifying for each woman the lowest dose of a chosen estrogen-progestogen combination that is just sufficient to prevent breakthrough bleeding. Thereafter, monitoring requires attention to the development of new risk factors, regular blood pressure checks, and specific attention to the important side effects of headaches and migraines, especially if there are focal (cerebral ischemic) symptoms.

Cardiovascular Diseases↗
PubMed1999

Perimenopausal symptoms in Sri Lankan women.

OBJECTIVE: To determine the types of perimenopausal symptoms (PMS) associated with the natural menopause and to make a preliminary assessment of the influence of PMS on household work, employment duties and social life, since no published data are available regarding these aspects in Sri Lankan women. DESIGN: A cross-sectional descriptive study of 403 women after natural menopause chosen randomly from four selected groups. METHOD: A pre-tested coded questionnaire administered by trained women medical students to consenting menopausal women. RESULTS: An overwhelming majority of menopausal women (87.1%) had one or more PMS. The principal PMS reported were insomnia (57.8%), joint pains (55.8%), night sweats (55.6%), hot flushes (40.2%), irritability (35.3%) and headaches (33.3%). Of the 171 women employed outside the home, 38% noted some interference with employment duties. PMS causes much morbidity in Sri Lankan perimenopausal women.

Adult↗
PubMed2006

Gender role beliefs at sexual debut: qualitative evidence from two brazilian cities.

CONTEXT: Culturally based beliefs about gender roles influence women's sexual behavior and their ability to protect themselves from unwanted sexual experiences. Studying the beliefs that influence women's behavior at sexual debut helps contextualize unwanted sexual intercourse. METHODS: Twenty-four focus groups on women's beliefs about gender roles at sexual debut were conducted in 2002 with low- and middle-income women aged 18-21 and 30-39 who were recruited from public and private venues in Recife, capital of Pernambuco, and Belo Horizonte, capital of Minas Gerais, Brazil. The data were analyzed for common themes, and quotations were chosen to illustrate those themes. RESULTS: Focus group participants perceived that men have an urgent need for sex. This perception caused women to fear abandonment, anger or violence if they refused to have sex with their partner. The participants believed that women had to act passive the first time they had sex because taking the initiative (for example, by asking their partner to practice contraception) would lead him to accuse them of having previous sexual experience. Also, they believed they had to say no to sex under all circumstances to protect their reputation. CONCLUSION: To decrease the occurrence of unwanted intercourse, interventions must address the social expectations that influence men's and women's sexual behavior.

Adolescent↗
PubMed1996

Risk factors of anemia among women in the child bearing period and preschool children in Alexandria.

This study was carried out to determine the risk of some social and biological maternal factors which may contribute to occurrence of anemia among mothers and preschool children. A community based comparative study was chosen for the conduction of this work. The target population were 400 women in the child bearing period, having at least one preschool child (440). Capillary blood samples were taken by finger prick method and hemoglobin level was estimated by Sahly method. According to the cut off level of hemoglobin, women were classified into anemic and non anemic. In addition to that, 440 preschool children belonging to these women were classified according to the cut off level of their hemoglobin into 165 anemic children and 275 non anemic ones. An interview questionnaire was used to collect the data. Analysis of results showed that age of mother (30 years and above), illiteracy, high parity, history of previous abortion, history of previous perinatal mortality, small inter-birth interval and non use of contraceptives are significant risk factors for mothers. However, mother occupation and state of pregnancy has no role in occurrence of anemia among mothers. In addition to that, high parity, history of previous abortion, history of perinatal mortality, short inter-birth interval, non use of contraceptives and pregnancy are maternal risk factors responsible for anemia among preschool children. While, mother age, education and occupation has no role for occurrence of anemia among preschool children.

Adolescent↗
PubMedDate not supplied

Comparing a public and private sector NFP program: implications for NFP expansion.

This paper synthesizes a six year collaboration between a natural family planning (NFP) non-governmental organization (NGO) and the National Health Service of the Emilia Romagna region in Italy. It also compares the public program experience with NFP services provided in the private sector in the adjacent region of Veneto. Midwives provided NFP services in government family health clinics while in the private sector NFP was taught by non-health laypersons in a church-based facility. The populations served by these two programs were different. Women in the public sector were slightly older and two-thirds were married. Forty percent of the clients had chosen to use NFP to achieve a pregnancy. The private sector client, recruited in part through premarriage counseling programs, was equally divided between married and single women, though the majority came for advice on avoiding or spacing pregnancies. In both regions NFP users were more highly educated than the general population.

Contraception↗