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[Hormonal contraception].
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Hepatic cavernous haemangioma: a 10 year review.
Between January 1981 and July 1991, 61 patients with hepatic haemangiomata were examined at Westmead Hospital. There were 14 males (22%) and 47 females (78%). The age range was 26-85 years with a median of 49 years. Forty-one had abdominal symptoms but these could be attributed to a haemangioma in only seven cases. There was at least one subcapsular lesion in 17 (28%). Six of the seven symptomatic lesions were subcapsular and five of these were giant haemangiomata (i.e. more than 4 cm in greatest diameter). One large symptomatic lesion was intrahepatic. No association was observed between hepatic haemangiomata and other hepatic or extrahepatic diseases. Haemangiomata were resected from six patients, four of whom were symptomatic. Symptoms improved in all four but did not resolve completely in any. Follow-up ranged from nil in five patients to 108 months in one. The median follow-up was 12 months after initial diagnosis. Ten patients showed evidence of change in their lesions or symptoms while under observation. Only three had worsening symptoms or suspected change in size of a haemangioma. This study highlights the benign, static nature of most hepatic haemangiomata. When this lesion is suspected, the diagnosis should be confirmed with ultrasound (US) and labelled red blood cell scanning (RBCS). Referral for evaluation by a specialist hepatobiliary surgery unit is necessary when symptoms are intolerable, increasing size is definitely demonstrated or the diagnosis is uncertain and cannot be established without specialized investigations. Bleeding into or from these lesions is rare.
The role of behavioral variables and fat patterning in explaining ethnic differences in serum lipids and lipoproteins.
Mexican Americans have been previously reported to have greater adiposity, higher triglyceride levels, and lower high density lipoprotein (HDL) cholesterol levels than Anglos. This study investigated the relationship between behavioral variables (caloric balance, cigarette and alcohol consumption, exercise, postmenopausal estrogen or oral contraceptive use) and fat patterning (central vs. peripheral distribution of adiposity) in the San Antonio Heart Study (1979-1982) (n = 2,102) to explain the ethnic difference in lipids and lipoproteins. Adjustment for caloric balance (as reflected by body mass index) narrowed the ethnic difference in triglyceride and HDL levels for both sexes, while adjustment for smoking widened the ethnic difference. For females, the ethnic difference was also decreased by adjustment for alcohol and estrogen use. However, adjustment for these behavioral variables did not completely eliminate the ethnic difference in lipids and lipoproteins in either sex. Increased central adiposity, more characteristic of Mexican Americans than Anglos, was positively associated with triglycerides and negatively associated with HDL levels, especially in females. Fat patterning made a more important contribution to the prediction of triglyceride and HDL levels than did the other behavioral variables (except for caloric balance) and, in general, eliminated ethnic differences in lipids and lipoproteins. Epidemiologists should consider the use of a centrality index to distinguish different types of adiposity since it is easy and inexpensive to measure.
Serum copper levels in users of multiload intra-uterine contraceptive devices.
The systemic absorption of copper incorporated into multiload intra-uterine contraceptive devices (IUDs), as indicated by serum copper levels in users of such devices, was assessed in a prospective longitudinal study. One hundred and ten healthy Nigerian women using either multiload copper 250 (MLCU 250) or multiload copper 375 (MLCU 375) IUDs participated in the study. Their serum copper levels were estimated serially during 12 months of continuous use of the devices. The mean (+/- s.e.m.) pre-insertion serum copper levels of our subjects using MLCU 250 (17.0 +/- 3 mumol/l) and MLCU 375 (16.7 +/- 0.5 mumol/l) were found to be lower than those reported in Americans (22.2 mumol/l) and in Germans (20.2 mumol/l), although similar to levels in Indians (17.0 mumol/l). There was no significant difference in the mean serum copper levels estimated before and after 1 month of continuous use of the device. Serial estimations of the serum copper levels in users showed that there was no alteration in these levels after a period of 12 months of continuous IUD use. We therefore conclude that the copper incorporated into multiload IUDs appears not to influence the concentration of serum copper of users.
Role of abortion in control of global population growth.
No nation desirous of reducing its growth rate to 1% or less can expect to do so without the widespread use of abortion. This observational study, based on the experience of 116 of the world's largest countries, supports the contention that abortion is essential to any national population growth control effort. The principal findings are: Except for a few countries with ageing populations and very high contraceptive prevalence rates, developed countries will need to maintain abortion rates generally in the range of 201-500 abortions per 1000 live births if they are to maintain growth rates at levels below 1%. The current rate in the USA is 426 abortions per 1000 live births. Developing countries, on the other hand, are faced with a different and more difficult set of circumstances that require even greater reliance on abortion. No developing nation wanting to reduce its growth to less than 1% can expect to do so without the widespread use of abortion, generally at a rate greater than 500 abortions per 1000 live births. Widespread availability of abortion is a necessary but not sufficient condition to achieve growth rates below 1%. A high contraceptive prevalence is essential as well in order to achieve growth rates below 1%. A high contraceptive prevalence is a necessary but not sufficient condition to achieve population growth rates below 1%. A high rate of abortion (generally 201-500 or more abortions per 1000 live births in the developed and greater than 500 abortions per 1000 live births in the developing countries) is essential to achieve growth rates below 1%. The different and more difficult set of circumstances faced by developing countries that will necessitate even higher abortion rates than developed countries includes a young population with resultant rapidly growing numbers of young fertile women, poor contraceptive use-effectiveness, low prevalence of contraception, and poor or non-existent systems for providing contraceptives. These data show that high death rates of infants and children can moderate population growth rates--a most undesirable solution. The data in this report suggest that actual alternatives are high death rates of infants and children or widespread use of contraception and abortion. African nations tend to have the very lowest abortion rates and the very highest infant and child death rates. To avoid a world with deteriorating social, economic and political stability, with the concomitant loss of personal and national security, we must ensure that safe abortion is made available to all who wish to use this service.
Obstacles to condom use: the combination of other forms of birth control and short-term monogamy.
Two hundred thirty-seven college students involved in heterosexual relationships were surveyed to determine the effects of relationship type and use of forms of contraception other than condoms on condom use. Findings indicated that in the context of a short-term, monogamous relationship, the use of another form of birth control was associated with decreased condom use. In addition, 20% of the participants reported that they had wanted to use a condom for disease prevention on at least one occasion but had decided not to do so because they were using another form of contraception. Implications for preventive health are discussed.
Differentiation in contraceptive behavior of the female population in Thrace, Greece.
OBJECTIVE: To investigate the factors influencing the contraceptive practice of the female population in the rural area of Thrace, Greece. METHODS: We conducted a retrospective sociopsychological study on representatives of the two major religious subgroups in Thrace: 127 Orthodox Christians and 120 Muslims. The women were reasonably representative in terms of age, education, marital status and professional life. Interviews covered sexual history and contraceptive use in detail. RESULTS: We observed a significant preference of Christians for condoms, and of Muslims for coitus interruptus. The use of the male condom was significantly higher in younger, compared to older, Christians (p < 0.001). Muslim women aged 30-39 years showed a significant preference for coitus interruptus and intrauterine devices, as compared with Christians. Highly educated women of both subgroups did not present statistically significant differences concerning contraception. It was found that, the more intense the sexual activity, the more common the use of the condom for Christians and the more popular the choice of interrupted intercourse for Muslims. Muslims with a permanent sexual relationship preferred interrupted intercourse, while all Muslims with multiple sexual partners used the male condom. CONCLUSIONS: There is an urgent need to promote information concerning the variety of modern contraceptive options in order to improve the prevalence of contraceptive use and reproductive health in the region of Thrace.
Knowledge and attitudes about emergency contraception in a military population.
OBJECTIVE: To assess knowledge and attitudes about reproductive issues and emergency contraception among active duty military members. METHODS: A survey was distributed to 302 active duty members of the United States Air Force. Descriptive and Pearson chi(2) statistical analyses were used to evaluate findings. RESULTS: There was a general lack of knowledge about reproductive issues and the Yuzpe emergency contraception method. Eighty-five percent of respondents were sexually active, but only 62% used birth control. Only 40% knew when pregnancy was most likely to occur. Sixty-four percent had heard of emergency contraception, but only 15% were aware of the correct time to take it. Fifty-five percent said they would use emergency contraception if needed, with younger or unmarried individuals most willing. CONCLUSION: Knowledge deficits must be addressed to keep women deployable. Educational materials and emergency contraception kits should be standard issue items. That might prevent unwanted pregnancies and produce significant savings in reproductive health and emotional costs.
Four years of a comparative study with Nova T and Copper T 200 IUDS.
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Blood-lipid fractions: the side-effects and continuation of Norplant use.
OBJECTIVES: Norplant has been widely used in Indonesia, though a previous study conducted in Jakarta indicates that there is a significantly high cholesterol level in acceptors. Other international studies indicate different results. Accordingly, a study on the fraction of blood lipids of Norplant acceptors was considered necessary. MATERIAL AND PROCEDURES: A prospective cohort comparative study was conducted in the Dr Kariadi General Hospital and Primary Health Center at Gunungpati. Clinical and laboratory observations were done by means of pre-post test design. Norplant acceptors were treated as the case group while IUD acceptors were the control group. Cholesterol level, triglyceride, HDL, LDL, and ratio of cholesterol:HDL, side-effects and continuation of use were evaluated. RESULTS: The subjects were 91 Norplant and 89 IUD acceptors. Norplant acceptors showed the following study results: Total cholesterol showed a slight decrease (165.06-132.80 mg/dl), triglycerides were slightly increased (76.23-81.87), HDL showed a decrease (45.55-38.85), and so did LDL (105.75-78.55); the ratio of cholesterol:HDL remained constant (3.75-3.78) and all fraction levels of blood lipids were within the limit of tolerance and did not exceed the critical value. Normal menstrual blood flow remained constant, but heavy menstrual blood flow decreased. The cycle of normal menstruation was reduced and the inter-menstrual bleeding and the 2-3 month menstrual cycle were increased. Complaints of dizziness/headache, leucorrhea, and pain at insertion were all relatively few. There was no change of body weight and blood pressure. Continuation of use was 100%. CONCLUSIONS: The fraction of blood lipids found indicates varied results though blood lipids are still below critical values; it can be concluded that there is no risk of coronary heart disease. The continuation rate of Norplant use was high, due probably to side-effects counseling, and the social and cultural circumstances of acceptors.
The effect of China's one-child family policy after 25 years.
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Relation of cholesterol to apolipoprotein B in low density lipoproteins of children. The Bogalusa Heart Study.
Cholesterol and apolipoprotein (apo) B contents and their relationship within serum low density lipoprotein (LDL) were examined in 2018 children, ages 8 to 17 years, from a biracial community. The levels of LDL cholesterol and LDL apo B showed significant race-related differences (blacks greater than whites) in both boys and girls and gender-related differences (girls greater than boys) in white children. These LDL measures associated inversely and significantly with both age and Tanner stage, more so in boys than in girls. The black-white differences in LDL measures persisted after adjusting for the covariates (sexual maturation, age, adiposity, oral contraceptive use, cigarette smoking, and alcohol use). The distribution of LDL cholesterol for a given range of LDL apo B varied considerably, despite a strong correlation (r = 0.91) between these variables, indicating that measuring LDL cholesterol alone does not accurately reflect LDL concentration. The ratio of cholesterol to apo B in LDL ranged from 1.01 (5th percentile) to 1.42 (95th percentile) among the four race-gender groups, suggesting marked interindividual variation in composition. That this ratio was significantly elevated in black children indicates the occurrence of relatively larger, less dense, and cholesterol-enriched LDL particles in blacks. Significant independent associations were noted between LDL cholesterol/apo B ratios and the levels of serum total cholesterol (positive) and triglycerides (negative), suggesting the influence of pool size of different lipoproteins on LDL composition. These observations may help identify a subgroup of children with apo B-enriched LDL particles who are potentially at risk for coronary artery disease.
Sexual behavior among employed male rural migrants in Shanghai, China.
A study of sexual behavior in migrant men was conducted in construction sites, markets, and factories in Shanghai, the largest city in China. An anonymous, self-administered questionnaire was completed by the migrants. Among 986 sexually active men, 14% had had more than one sexual partner in their lifetime, 31% premarital sex, 3.3% oral sex, and 11.5% commercial sex. Seventy-eight percent never used condoms. Risk-taking was similar in different working venues but increased with decreasing age. Younger men initiated sexual intercourse earlier and had more premarital sex and sexual partners as well as more frequent sexual encounters. Risk-factors that correlate with having multiple sex partners included having seen pornography, early age at initiating sexual intercourse, premarital sex, and a desire for legalization of commercial sex. Sexually transmitted diseases and HIV are likely to increase among migrants, particularly those who are young. Intervention strategies should target younger migrants, and must accommodate a low literacy level.
[Risk factors associated with systemic lupus erythematosis in a Mexican population].
OBJECTIVE: To assess risk factors associated with systemic lupus erythematosus (SLE) in the Mexican population. MATERIAL AND METHODS: A case-control study was conducted on June 1996, at the Reumathology Clinic of Hospital de Especialidades del Centro Médico Nacional Siglo XXI (HE CMN), Instituto Mexicano del Seguro Social, in Mexico City. Cases were one hundred thirty subjects with four or more SLE criteria and disease evolution of +/- 5 years. Controls were hospitalized patients with acute diseases but without autoimmune diseases. Cases and controls were matched 1:1 by age and gender; both groups were evaluated by direct interview through a structured questionnaire. The following risk factors were assessed: genetic family history of SLE and connective tissue disease; socioedemographic (ethnicity, geographic distribution, education, monthly income); hormonal (use of oral contraceptives, replacement therapy and gynecoobstetric background); environmental (use of hair products, living with dogs, bacterial/viral infections, and allergies). Statistical analysis consisted of odd ratios (OR) with 95% confidence intervals (CI) and multivariate analysis using logistic regression. RESULTS: The multivariate model showed association with family history of SLE (OR 4.2, CI 95% 1.17-15.2), family history of connective tissue disorder (OR 2.6, CI 95% 1.15-4.5), use of oral contraceptives for more than one year (OR 2.1, CI 95% 1.13-4.3), repetitive pharyngitis (OR 2.1, CI 95% 1.18-3.6), and use of medications (OR 5.0 IC 95% 1.62-21.6). No association was found with socieconomic status, hair dye products, asthma, or allergies. CONCLUSIONS: Genetic factors, such as family history of SLE and connective tissue disease in first-degree relatives, persist as important factors in the development of SLE. Other factors, such as use of some drugs, oral contraceptives, and repetitive pharyngitis, may also favor the onset of disease in genetically susceptible hosts. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
[A strategy for birth control based on population trends].
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Recent trends and conditions of fertility.
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'Condom gap' examined in Bangladesh survey.
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