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The Greek National Perinatal Survey. II: Socioeconomic factors and perinatal mortality in Greece.

Information concerning all 10,859 singleton deliveries in Greece in April 1983, were analysed to assess the contribution of socioeconomic factors to the perinatal mortality rate. Statistically significant associations were initially found with parental education, parental ages, duration of marriage, paternal occupation and parity. There was no association with maternal smoking habit, maternal occupation during pregnancy, type of health insurance or housing conditions. Once logistic regression analyses had taken account of the strong parity effect (P less than 0.0001), only a moderate association with maternal age (P less than 0.05) remained statistically significant, together with a marginally significant (P less than 0.05) association with maternal education level. Mothers who were moderately well educated had the lowest risk of loosing their baby. It is concluded that traditional measures of social deprivation appeared to have little effect on perinatal mortality in Greece in 1983.

Birth Rate↗

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗

Fertility rates and abortion rates: simulations of family limitation.

A computerized model that simulates reproductive events during the childbearing years of a cohort of women is used to analyze the impact of contraception and induced abortion on fertility. Four different reproductive regimens are investigated: (2) contraception only, (2) abortion only, (3) abortion as a backstop to contraception, and (4) combinations of abortion and contraception. It is concluded that in historical as well as in modern populations, levels of fertility near replacement are unlikely to be obtained without the use of induced abortion.

Abortion, Induced↗

Catholic perspectives on populations issues II.

This Bulletin discusses the history and current status of the population problem from a Roman Catholic viewpoint. While upholding human rights and admitting the right of couples to control the size of their families, the Catholic Church continues to prohibit the use of artificial methods of contraception as sinful. This position hinders the Church, with its some 750 million adherents, from taking an effective lead in confronting the growing threat of global overpopulation. Rhythm has been permitted since 1930 but Pope Pius 12 in 1958 forbade contraceptive use of the pill. Despite the liberal spirit engendered by Vatican Council 2 and against the recommendation of a papal birth control commission, Pope Paul 6 in his 1968 Encyclical Humanae vitae reaffirmed the ban on artificial contraception, apparently convinced that this was necessary to combat growing sexual immorality, family breakdown, and materialism. This stance has been upheld by Pope John Paul 2 and the 1980 Synod of Bishops. The decision ignores the pleas of a number of responsible churchmen speaking for their people at the Synod and of a growing majority of Catholic theologians and laity, that Church teaching must be updated to take account of the facts of modern life. Surveys reveal that Catholic married couples increasingly find Church-approved natural family planning methods unsatisfactory and feel obliged to turn to artificial methods to regulate their family size. On the world scale, Pope John Paul 2 and the Vatican, while insisting on human rights and the need for a reordering of unjust economic, social, and political structures, seem to be neglecting the threat of civilizational breakdown that looms with the prospect of too many people in too little space with too few resources.

Abortion, Induced↗

Barrier contraception in the teenager: a comparison of four methods in adolescent girls.

The use-effectiveness and continuation rates of 4 methods of contraception were studied during a 2 year follow-up period in a group of 405 teenage girls. Results were compared in 2 groups of adolescents, 1 of highly motivated, high socioeconomic status girls (A) and 1 of poorly motivated, low socioeconomic status adolescent clinic patients (B). The method of contraception was selected by the girls, who were instructed in their proper use. Results showed good rates of continuation among girls of the 1st group as compared to those of the 2nd group. Pregnancy rates after 24 months of use, as calculated by Pearl's formula, was 3.6 and 5.4 respectively with the use of a condom, and 5.8 and 10.8 when the diaphragm was used. When using vaginal foam alone, the rates were 4.2 and 12.3 and with the rhythm method, 8.5 and 13.1. The foam-alone method was unpopular in both groups. No serious side effects or complications were recorded. The study demostrated a reasonable acceptability and use-effectiveness for barrier contraceptives. It is suggested that these harmless and complication-free methods, especially the condom and diaphragm, may be reasonable alternatives for the more modern methods in teens of all socioeconomic strata; an effort must be made to educate and instruct the poorly motivated and encourage them to present themselves for regular follow-up.

Adolescent↗