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A rise of the serum level of von Willebrand factor occurs before clinical manifestation of the severe form of ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) appears to be caused by increased capillary permeability in the vascular endothelial cells. Such cells secrete excess amounts of von Willebrand factor (vWF), a large adhesive glycoprotein. METHODS: We retrospectively evaluated the circulating levels of vWF and of vascular endothelial growth factor (VEGF) twice, on the days of oocyte retrieval and embryo transfer, in 46 women who developed early-onset OHSS. RESULTS: Nineteen, 14, and 13 women developed mild, moderate, and severe OHSS, respectively. Inconsistent changes were observed in the VEGF during oocyte retrieval and embryo transfer. However, the net increase in serum vWF during that period showed an increase in absolute value at the time of embryo transfer that paralleled an increase in the severity of OHSS. That is, in mild OHSS, the serum vWF increased from 140 +/- 44 to 164 +/- 28%; in moderate OHSS, it increased from 113 +/- 47 to 186 +/- 22%; and in severe OHSS, it increased from 120 +/- 35 to 274 +/- 63%. All 9 women with a vWF level > 230% at embryo transfer developed severe OHSS, while 9 of 13 women with severe OHSS exhibited a vWF > 230% at embryo transfer. CONCLUSION: The results suggest that a rise of the serum level of vWF occurs prior to clinical manifestation of OHSS in patients with severe OHSS but not in patients with mild OHSS.

Adult↗

Environmental economics reality check: a case study of the Abanico Medicinal Plant and Organic Agriculture Microenterprise Project.

This paper presents a case study of the Abanico Medicinal Plant and Organic Agriculture Microenterprise Project in the Arenal Conservation Area, Costa Rica. Microenterprise is the Sustainable Development and the Women in Development model for gender equity and environment of the World Bank, International Monetary Fund and large non-government organizations, like the World Wildlife Fund-Canada. The authors of this paper argue that debt-for-nature investment in microenterprise and ecological economic models are not distinct from neoclassical economic and development models that created the environmental, social and cultural crises in the first place. This case study shows that the world market accommodates only one model of development: unsustainable export-oriented production based on flexible labour markets, low wages, indebtedness and low cost production. Working standards in those micro-enterprises are eroded due to many factors,including indebtedness. What happened at a national level in non-industrial countries with the international debt crisis is now mirrored in individual indebtedness through microenterprise. Is current development policy creating a new form of indentured servitude? Medicinal plants, prior to commodification, were a source of women's power and upon commodification in international development projects, are the source of their exploitation.

Agriculture↗

Audit of negative assessments in a breast-screening programme in women who later develop breast cancer-implications for survival.

The aim of this study was to examine observed short-term survival, to estimate future survival, and to assess the impact on survival of amending procedures to avoid false negatives in women recalled for further assessment due to a suspicious screening mammogram. From the start of screening in the seven centres in the East Anglian region, 1 April 1989 to 31 December 1999, 503493 women from a total population of 2.2 million were screened, 25346 were recalled for an assessment and 3689 were diagnosed with breast cancer. Of the 21657 women given a negative result at these assessments, 193 women were subsequently diagnosed with 194 breast tumours at the site previously assessed. These women were followed up for survival, with survival analysis adjusting for host and tumour attributes. We also predicted long-term survival using the pathological features of the tumours diagnosed. From previous estimates of tumour progression rates, we estimated the reduction in incidence of advanced tumours and the potential saving of lives had unsatisfactory assessments been carried out within guidelines. There were 17 deaths, 15 in women who had unsatisfactory assessments. Five-year survival was estimated at 93% (95% CI: 88-97%) for breast cancer and 91% (95% CI: 86-95%) for all cause deaths. Women with positive nodes and/or larger tumours had significantly worse survival. Twenty years survival for women with unsatisfactory assessments was estimated at 66% (35 deaths) and predicted a potential saving of 7-9 lives (14-18% reduction in expected fatality within this special tumour population) had original assessments been carried out within current guidelines. This retrospective audit of a small and special tumour population shows a potential reduction in breast cancer deaths of 18%, had current guidelines been available for the original assessments. Increased use of percutaneous biopsy in recent years should address the problem.

Breast Neoplasms↗

Silencing the self and feminist identity development.

The present study investigated the relation between Jack's 1991 concept of "silencing the self" and Downing and Roush's 1985 stage model of feminist identity development among college women. Analysis indicated that passively accepting women's oppression and adhering to traditional gender roles in interpersonal relationships (Passive Acceptance) was related to silencing the self. These results have important implications for silencing the self and women's development. Specifically, these findings may encourage many young women to acknowledge women's oppression and question the traditional gender roles that promote submission and thereby decrease the potential risk for self-silencing.

Adult↗

A study of the temporal relationship between plasma high molecular weight angiotensinogen and the development of pregnancy-induced hypertension.

In addition to the normally prevalent low molecular weight angiotensinogen (LMrA), significant quantities of a high molecular weight angiotensinogen (HMrA) are present in the human pregnant state. Previous studies have documented that 47% of women who develop pregnancy-induced hypertension (PIH) have a significantly elevated plasma HMrA/LMrA ratio. The purpose of this study is to establish whether or not the increase in the HMrA/LMrA ratio precedes the development of hypertension. Serial plasma samples were collected from a group of women throughout their pregnancy. High molecular weight angiotensinogen and LMrA levels in the samples from these women were determined. Fifteen of these women developed PIH. Seven women in the PIH group had a significantly elevated plasma HMrA/LMrA ratio. There was no consistent relationship between the elevation of the HMrA/LMrA ratio and the onset of hypertension. Three women had an elevated HMrA/LMrA ratio before the development of hypertension. In one woman the two events occurred simultaneously, and in three women the HMrA/LMrA ratio was elevated only after the development of hypertension. The current study shows that the development of hypertension during pregnancy is not the primary biologic signal for elevation of the plasma HMrA/LMrA ratio. Other parameters associated with fetal distress or abnormal development of placental circulatory systems must be involved in increasing the HMrA/LMrA ratio. It is proposed that the elevation of the HMrA/LMrA ratio is a mechanism by which the placental tissue specific renin-angiotensin system is attenuated.

Angiotensinogen↗

Prevalence of coronary artery calcium among asymptomatic men and women in a developing country: comparison with the USA data.

BACKGROUND: Coronary artery calcium score (CACS) correlates with atherosclerotic burden and predicts cardiac events. Most of the published data have been derived from the USA population. OBJECTIVE: To study the prevalence of coronary calcium in an asymptomatic population from the eastern Mediterranean region and compare it to data obtained from a large population study in the USA. RESULTS: A total of 1154 asymptomatic men and women from Lebanon underwent EBCT screening because of the presence of one or more CAD risk factors. Mean CACS as well as the percentile cut-points increased consistently with increasing age and, except for those above 74 years of age, were higher in men than women in each age stratum. Age, hypercholesterolemia, diabetes and smoking showed significant associations with CACS in men, while only age and hypercholesterolemia were significantly associated with CACS in women. Among men, the 75th and 90th percentile distributions were comparable to what is observed in developed countries such as the USA. CONCLUSION: Findings, from this first study in the region, suggest that despite a higher rate of diabetes and smokers in our study population, the CACS distribution in Lebanon is similar to that observed in the USA.

Adult↗

Technology and women's health in developing countries.

In developing countries is medical technology transfer reaching women? Do women control new technologies or are they only passive recipients? What is the impact of these new technologies on women's health and welfare? To answer these questions this article explores concepts of health, technologies, and women, then gives findings from an extensive literature search on contraception, childbirth, immunization, essential drugs, oral rehydration therapy, water, sanitation, and breast-feeding. The article concludes with recommendations on pre-project planning studies, monitoring, and evaluation.

Developing Countries↗

Cervical cancer: the Indian perspective. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Cancer of the uterine cervix is the commonest gynaecologic cancer in India, with most women presenting with disease extending beyond the cervix. The majority of women belong to the lower socioeconomic status, are rural, aged between 35 and 64 years and highly noncompliant for complete treatment and follow-up. Opportunistic screening with cytology, colposcopy and test for Human Papilloma Virus and appropriate treatment are available on payment at urban private medical centres but are not available at urban and rural government health centres that are accessed by women of the lower socioeconomic status. The Government's investment in health is 0.9% of the GDP. Thus cytology screening as a government health measure is not feasible. The 'social vaccine' of health empowerment along with visual inspection and appropriate referral by the rural and urban health personnel (Department of Health and Family Welfare); with an additional input of health awareness and motivation by Anganwadi Workers (Department of Women and Child Development), elected women representatives in the Panchayats (Department of Rural Development and Panchayati Raj) and non-governmental development agencies could be a collaborative effort towards "downstaging" cervical cancer. This could lay the foundation for the introduction of cytology screening when resources are available.

Adolescent↗

Estimates of metabolic adaptation in women living in developing countries: technical limitations.

The measurement of food intake has long been used to describe 'adaptation' to low energy intakes in certain tropical peoples. However, the methods available to quantify food intake are unlikely to reflect accurately real energy intakes in free living peoples. Alternatively, estimating energy expenditure shows some promise--particularly the measurement of basal metabolic rate (BMR). The BMR may be measured effectively in males, but females show wide intra-individual variation in BMR during their menstrual cycle, which makes BMR measurements more difficult to interpret in the context of adaptation. The use of double-labelled water may be the only method suitable to quantify and define 'adaptation' to low intakes in women.

Adaptation, Physiological↗

Laboratory assessment of feeding behavior in bulimia nervosa and healthy women: methods for developing a human-feeding laboratory.

We have designed a human-feeding laboratory to be used to study feeding behavior in patients with eating disorders. Twenty-one normal-weight bulimic subjects consumed 29.711 +/- 39.940 MJ (range 0.862-178.632 MJ; 7101 +/- 9546 kcal, range 206 to 42,694 kcal) in 24 h. In comparison, 11 healthy volunteer women, when instructed to eat ad lib for 48 h, ate 7.715 +/- 2.590 MJ (1844 +/- 619 kcal) during the first 24 h and 7665 +/- 1828 MJ (1832 +/- 437 kcal) during the second 24 h. Bulimics and control subjects had a similar number of eating intervals (6.6 +/- 2.6 vs 5.0 +/- 1.7); 72% of the bulimic subjects' meals were similar in size to the meals of the controls [167-4100 kJ (40-980 kcal)] but these meals were higher in carbohydrate and lower in fat in bulemic patients. Excessive caloric intake by bulimic subjects was because 28% of their meals were very large [range 4.427-28.150 MJ (1058-6728 kcal)]. Data gathered in a laboratory setting appears to be a reasonable replication of naturalistic feeding and suggest that such a laboratory may prove useful for future studies of feeding behaviors in humans.

Adult↗

Is continuation of a gonadotrophin-releasing hormone agonist (GnRHa) necessary for women at risk of developing the ovarian hyperstimulation syndrome?

A total of 28 women scheduled for in-vitro fertilization used buserelin and human menopausal gonadotrophin (HMG) for ovarian stimulation. One group (I) of 17 women was given human chorionic gonadotrophin (HCG 10,000 IU) to trigger ovulation, but the resulting embryos were electively cryopreserved because of the risk (serum oestradiol greater than or equal to 3500 pg/ml) of developing the ovarian hyperstimulation syndrome (OHSS). Six women continued the buserelin therapy in the luteal phase and eleven did not. In group II (n = 11), the HMG injections were discontinued because of an exaggerated ovarian response and the HCG was omitted. Six of these women continued the buserelin injections until the onset of menses and five did not. In both groups, the ovarian response to induction of ovulation (serum oestradiol concentrations and number of follicles) was similar for those who did or did not continue buserelin therapy. There was no difference in the rate of ovarian quiescence (weekly fall in serum oestradiol concentration following the stimulation) between those women who did or did not continue the buserelin therapy in either group. The serum luteinizing hormone concentrations remained low in all women in both groups. We conclude that the omission of buserelin therapy after discontinuing the HMG in women at risk of developing OHSS does not affect subsequent ovarian quiescence.

Adult↗