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PubMed1980

Blood coagulation and idiopathic thromboembolism among fertile women.

A case-control study of fibrinolytic activity and antithrombin-III (AT-III) was conducted comparing 16 women within the childbearing ages who had a recent history of idiopathic thromboembolism to 29 age- and race-matched female controls without a history of thromboembolism. All subjects had stopped using oral contraceptives at least 12 months prior to study. No difference in AT-III was evident between cases and controls. The mean fibrinolytic response to venous occlusion in cases was significantly lower; however, baseline fibrinolysis was essentially identical. These data demonstrated a bimodal distribution of fibrinolytic response among controls. By dichotomizing fibrinolytic response between the two modes in the controls, we estimated that the rate of low fibrinolytic response was 6 times as frequent in cases as controls. Thus, low fibrinolytic response may signal a natural predisposition to thromboembolism which could be triggered by use of synthetic estrogens.

Adult↗
PubMed2003

Progesterone receptor isoform B in the human fallopian tube and endometrium following mifepristone.

The distribution of progesterone receptor isoform B may have important clinical significance. The aim of this study was to compare the expression, localization and regulation of progesterone receptor isoform B in the human Fallopian tube and endometrium following mifepristone in a dose effective for contraception. Fertile women were treated with a single dose of 200 mg mifepristone on day luteinizing hormone (LH)+2. Biopsies were obtained from the Fallopian tube on day LH+4 to LH+6 and from the endometrium on day LH+6 to LH+8. Progesterone receptor isoform B expression was analyzed by immunohistochemistry and reverse transcriptase polymerase chain reaction. Treatment with mifepristone increased progesterone receptor isoform B concentration in epithelial and stromal cells in the Fallopian tube and also increased progesterone receptor isoform B concentration in the glandular cells of the endometrium. These results further support the hypothesis that the contraceptive effect of mifepristone when given postovulatory is primarily due to alteration of the peri-implantation milieu influencing endometrial receptivity.

Adult↗
PubMed1984

Acute psychiatric admission related to the menstrual cycle.

A study of menstrual cycle phase on the day of acute admission to a psychiatric hospital for 121 women aged 20-39 showed an unequal distribution of admissions. More admissions than expected took place in the menstrual period, and correspondingly fewer intermenstrually. The difference was significant, and points to a certain degree of cyclicity in female psychiatric disturbance. This cyclicity was not significantly influenced by age, diagnosis, oral contraceptives or tendency for premenstrual symptoms. In the age group 20-39 one and a half times as many men as women are admitted to Danish psychiatric departments. Thus, in view of a common baseline, the most conspicuous feature is, that remarkably few women were admitted intermenstrually.

Acute Disease↗
PubMed2000

[Papillomavirus infection in healthy women from St.Petersburg].

The study was aimed to evaluate the features of human papillomavirus (HPV) infection in healthy female inhabitants of St. Petersburg. 309 attendants of gynecological clinics were recruited for the screening. All participants were of reproductive age and were lacking the clinical or morphological symptoms of HPV-related diseases. PCR revealed HPV-specific sequences in 90 (29%) women. HPV type distribution was similar to the one in USA and Europe. HPV-positivity did not correlate with age of females, age at sexual debut, or total life-long duration of sexual activity. However, HPV were overrepresented among women reporting excessive number of contraceptive abortions. The data imply that an establishment of large-scale HPV-testing in Russia could be a desirable component of preventive anti-cancer programs.

Adult↗
PubMed1978

Erythrokeratodermia variabilis. A family study.

Erythrokeratodermia variabilis is a rare genodermatosis; American authors have reported only four previous cases. It had been a problem to obtain a large pedigree for clinical investigation. We studied a family with 12 involved members in five generations. Symmetrically distributed migratory patches and scaling plaques are characteristic and were found to involute with a combination of keratolytic agents and topical steroids. Exacerbations of these patches and plaques were noted in our female patients during such high estrogen states as pregnancy or oral contraceptive usage.

Adult↗
PubMed2003

Hindrances to family planning program: findings from Banke, Nepal.

Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.

Journal Article↗
PubMed1978

Noncirrhotic nodulation of the liver.

Nodular hyperplasia of the liver is characterized by small, uniformly distributed nodules that are delineated by marginal condensations of reticulin. There is no cholestasis and the liver is of normal size and shape. The cause is unknown, but it is not a precursor of cirrhosis, is not preneoplastic, and is not associated with contraceptive use. It is easily distinguished from adenoma, hamartoma, focal nodular hyperplasia, and partial nodular transformation, all of which are focal lesions. Disorder in the terminology that now exists will be minimized by suggesting a new term only when a specific cause is identified or a morphologic feature is distinct.

Chemical and Drug Induced Liver Injury↗
PubMed1987

[Progestagens in contraception].

The different spectrum of biological actions of the various synthetic progestogens is compared on the basis of their chemical structure, pharmacokinetics and interaction with the multiple receptors. In detail, the mechanism of action of the progesterone derivatives (medroxyprogesterone acetate, chlormadinone acetate and cyproterone acetate), the norethisterone-related (norethisterone, ethynodiol diacetate, lynestrenol and norethynodrel) and the norgestrel-related progestogens (levonorgestrel, desogestrel, gestodene and norgestimate), and a possible influence of some metabolites upon the biological profile are discussed. With regard to the progestogenic activity, the time-course of the serum concentrations of the steroids after the application (pharmacokinetics) which is dependent upon absorption, metabolization in the gastro-intestinal tract and liver (first-pass effect), distribution and storage in fat and other tissues, binding to serum proteins, inactivation, and conjugation, is of particular importance. The various side-effects of the progestogens are mainly based on their influence upon hepatic metabolism (lipids, lipoproteins, serum proteins) and upon other organs which is dependent on their different estrogenic, antiestrogenic, androgenic, antiandrogenic, glucocorticoid and antimineralocorticoid actions.

Contraceptives, Oral, Synthetic↗
PubMed1979

An analysis of the influences of maternal age, gestational age, contraceptive method, and the mode of primary treatment of patients with hydatidiform moles on the incidence of subsequent chemotherapy.

In relation to the total number of births in the United Kingdom there was an excess of hydatidiform moles arising in women over 34 years of age and possibly also under 15. The incidence of trophoblastic tumour requiring chemotherapy after hydatidiform mole was greatest in the 30 to 34 years age group and it was also high in the 20 to 24 years age group. This distribution appears to be influenced by the morphology of the moles, the mode of their removal and the use of oestrogens and progestogens in the post-evacuation period. The need for chemotherapy for trophoblastic tumour after evacuation of a hydatidiform mole was found to be two- to three-fold greater in patients who had undergone a medical induction, hysterectomy or hysterotomy compared with those whose hydatidiform moles had been evacuated by vacuum or surgical curettage, or who had aborted spontaneously. The increased risk of chemotherapy was most marked in the earlier weeks of gestation.

Adolescent↗
PubMed2005

"Not that sort of practice": the views and behaviour of primary care practitioners in a study of advance provision of emergency contraception.

BACKGROUND: Advance supplies of emergency contraception (EC) were made available to women aged 16-29 through general practice and family planning services in Lothian, Scotland. Although this intervention was not associated with an overall reduction in abortion rates in Lothian, it was hypothesized that some general practices may have been more successful than others in promoting and delivering the intervention. OBJECTIVE: To investigate, using comparative case studies, whether, and why, some general practices were more successful in promoting and delivering advance supplies of EC than others. METHODS: Eleven purposively sampled general practices from the 97 participating in the intervention were studied. The number of packs of advance supplies distributed was recorded and distribution rates per 100 eligible women per practice calculated. 44 semi-structured interviews with staff were used to describe the mechanisms through which advance supplies were distributed and health professionals' views of the intervention. RESULTS: Distribution rates varied from 0.9 to 32.0 per 100 eligible women. Respondents described three mechanisms through which advance supplies were distributed: passive, reactive and proactive. Views about EC, and the suitability of their patient population for advance supplies, varied and configured specific practice contexts that facilitated or hindered the delivery of advance supplies. Favourable views and pro-active mechanisms were associated with higher distribution rates, less favourable or ambivalent views and passive delivery mechanisms with lower distribution rates. CONCLUSION: If primary care professionals are to actively engage with a sexual health promotion agenda they need to develop appropriate interpersonal skills and address their values, attitudes and cultural competences.

Adolescent↗
PubMed2006

Pre-malignant and malignant cervical pathologies among inert and copper-bearing intrauterine contraceptive device users: a 10-year follow-up study.

OBJECTIVES: The aim of the study was to compare the incidence of pre-malignant and malignant cervical conditions during a period of 10 years of use of inert (Szontagh) and copper-bearing IUCDs. METHODS: Candidates were parous women requesting intrauterine contraception regardless of the previous IUCD use and having no contraindications. Follow-ups were scheduled at 1, 6, and 12 months after insertion, and annually thereafter. Colposcopy and cytological evaluation were performed at insertion and at yearly follow-ups. For comparison of the two groups and the different follow-up periods (at the end of each ordinal year), net and gross cumulative lifetable rates were calculated. Statistical differences were measured by chi-squared test, and were regarded as significant at P <or= 0.05. RESULTS: The total number of insertions was 3536 and 13,518 for inert and copper devices, respectively, and the maximum cumulative woman months of use (CWMU) at 10 years for the two groups were 163,567 and 492,836, respectively. There were no statistically significant differences in the life table rates of terminations for suspected cervical pre-malignant and malignant conditions between the groups at the end of each ordinal year. CONCLUSION: The copper-bearing intrauterine contraceptive devices are not associated with a significantly higher risk of cervical cancer compared to the inert IUCDs.

Adult↗
PubMed1992

Menstrual history in altitude chamber trainees.

Previous studies have determined a higher rate of altitude-induced decompression sickness (DCS) in women than in men. Women are reportedly at higher risk for developing DCS during menses. A study of menstrual history in women completing altitude chamber training without developing DCS has never been accomplished. The purpose of this study was to collect and analyze menstrual history in these women. Thirteen U.S. Air Force Aerospace Physiology Units participated in a USAF-approved survey for 1 year. After completing altitude chamber flights, data on age, day of menstrual cycle (DMC), birth control pill use (BCP), and mean durations of menstrual cycle and menses were collected. There were 508 responses analyzed. There was no differences between mean duration of menstrual cycle and menses in the Yes (Y) and No (N) BCP groups. Y and N BCP groups were equally distributed across the menstrual cycle. Women completing altitude chamber training without developing DCS appear to be evenly distributed across their menstrual cycle, with use of BCPs not affecting their susceptibility to DCS.

Adolescent↗
PubMed1997

[Hospitalization of young women after selected cardiovascular and thromboembolic incidents in Austria 1993 and 1994].

The aim of this study is to describe the hospitalization and regional distribution of selected cardiovascular and thrombo-embolic events (cardiac infarction, cerebral strokes, deep vein thromboses, pulmonary embolism) of young women in Austria in the years 1993 and 1994, and to collect basic epidemiologic data for the study of the side effects of oral contraceptives. The calculated hospitalization rates are based on the Austrian hospitals' discharge records of 1993 and 1994. The persons concerned are women aged between 15 and 44 who live in Austria. The results of the study reveal that--in 1993--of the above mentioned group 51 out of 100,000 inhabitants were hospitalized because of the selected cardiovascular and thromboembolic events: 4/100,000 had a cardiac infarction, 5/100,000 had a stroke, 17/100,000 had a pulmonary embolism, and 27/100,000 suffered a deep vein thrombosis. In 1994 the counted cases per 100,000 inhabitants were 48, out of which 4/100,000 where cardiac infarcts, 5/100,000 strokes, 16/100,000 pulmonary embolism, and 25/100,000 deep vein thromboses.

Adolescent↗
PubMed1995

Adolescents and Norplant: preliminary findings of side effects.

PURPOSE: The purpose of this study was to investigate side effects such as menstrual irregularities, weight gain, and blood pressure changes among adolescent females who had been implanted with Norplant eight or more months. METHOD: A retrospective chart review was completed on adolescents who received care through an outpatient adolescent gynecology service. Subjects (n = 110) with an average age of 17.2 years were implanted with Norplant between March 1991 and February 1992. The mean length of time since implantation was 12.7 months and 64% were African-American. Data collected included: dates of all medical visits; presence of acne, mood changes, and menstrual patterns following implantation. Measurements of blood pressure and weight were taken at implantation and at all subsequent visits. RESULTS: Weights for Caucasian females at the last visit were significantly higher than at baseline (P < .02). With regard to the African-American females' weight, significant differences were found between baseline weight and each follow-up visit. Although we could not determine the bleeding patterns in 22% of our study sample, almost 40% of the adolescent females followed reported their bleeding to be light as well as regular and cyclic. CONCLUSION: Weight gain was the most frequently observed side-effect of Norplant in adolescents in this study.

Adolescent↗
PubMed1998

Increase in incidence of gastroschisis in the south west of England in 1995.

OBJECTIVE: To describe the incidence of gastroschisis and to identify possible aetiological factors. DESIGN: A retrospective case review study. SETTING: The South West Region of England. POPULATION: All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery, databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995. RESULTS: In the first eight years the incidence was 1.6/10,000 but in 1995 a highly statistically significant rise to 4.4/10,000 was found (P = 0.0009). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty-seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%. CONCLUSIONS: The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.

Abdominal Muscles↗
PubMed1992

Safe sex and women.

OBJECTIVE: Sexual behaviour, condom use, HIV knowledge and anxiety for women were examined to understand the range of sexual behaviours, predictors of safer sex and the extent of relapse. DESIGN: A cross sectional sample of women STD clinic attenders completed interviews and questionnaires. SETTING: Central London STD Clinic. SUBJECTS: 153 women drawn from consecutive attenders at a sexually transmitted disease (STD) clinic in inner London. RESULTS: A quarter of the sample had never responded to safe sex and a further 14% had been unable to maintain it over time. Anxiety and knowledge did not differ between safe and relapsed groups, but self efficacy and cognitive variables did. Those who maintained safe sex had significantly less sex. Ten percent of the sample had unprotected anal intercourse. Most women saw themselves in longer term relationships, yet a quarter had sex outside of the relationship and a fifth stated that their partners also did. HIV information gathering was passive and 74% felt they could not protect themselves against infection. High concern over HIV was monitored. Condom uptake was low and non-existent for anal intercourse. 25% had undergone HIV testing. These women did not differ significantly in terms of their behaviour from the untested women. CONCLUSIONS: HIV risks for women are a source of anxiety and tailored intervention is needed to reduce risk and promote dialogue and negotiation.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Epidemiology of liver cancer in Europe.

Liver cancer (LC) ranks fifth in frequency in the world, with an estimated 437,000 new cases in 1990. The estimates are different when LC frequency is analyzed by sex and geographical areas. In developed areas, the estimates are 53,879 among men and 26,939 among women. In developing areas, the estimates are 262,043 in men and 93, 961 in women. Areas of highest rates include Eastern and South Eastern Asia, Japan, Africa and the Pacific Islands (LC age-adjusted incidence rates [AAIRs] ranging from 17.6 to 34.8). Intermediate rates (LC AAIRs from 4.7 to 8.9 among men) are found in Southern, Eastern and Western Europe, Central America, Western Asia and Northern Africa. Low rates are found among men in Northern Europe, America, Canada, South Central Asia, Australia and New Zealand (LC AAIRs range from 2.7 to 3.2). In Europe, an excess of LC incidence among men compared with women is observed, and the age peak of the male excess is around 60 to 70 years of age. Significant variations in LC incidence among different countries have been described and suggest differences in exposure to risk factors. Chronic infection with the hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of LC is well established. In Europe, 28% of LC cases have been attributed to chronic HBV infection and 21% to HCV infection. Other risk factors such as alcohol consumption, cigarette smoking and oral contraceptives may explain the residual variation within countries. Interactions among these risk factors have been postulated. New laboratory techniques and biological markers such as polymerase chain reaction detection of HBV DNA and HCV RNA, as well as specific mutations related to LC, may help to provide quantitative estimates of the risk related to each these factors.

Adolescent↗