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PubMed1979

Epidemiologic aspects and factors related to survival in 384 Registry cases of clear cell adenocarcinoma of the vagina and cervix.

Three hundred and eight-four cases of clear cell adenocarcinoma of the vagina and cervix accessioned in the Registry as of December 31, 1978, have been analyzed. The annual incidence of these tumors has been found to correspond closely to the estimated usage of diethylstilbestrol (DES) for pregnancy support in the United States. The annual incidence of the DES-associated cases appears to have dropped in the United States in the past 2 years in comparison to 1973 to 1975. The risk of tumor development appears to be higher in young women exposed to DES early in intrauterine life than in those exposed later. The carcinomas are rare before the age of 14 years and an irregular peak in the age-incidence curve appears between 17 and 21 years followed by a decline. The 5-year survival rate is better for women over the age of 19 years than for younger patients, and a higher frequency oral contraceptive usage did not appear to influence the behavior of the tumor and the improved survival in those using this medication appears to be related to greater medical surveillance.

Adenocarcinoma↗
PubMed2002

Revisiting a pilot survey involving contraception and teenage pregnancy in Ayrshire and Arran.

CONTEXT: How to respond to the challenge of reducing unplanned pregnancy rates in Ayrshire and Arran. OBJECTIVES: (1) To improve understanding of the educational needs of 11-15-year-olds regarding contraception which could be used to inform planning of future sex education in schools in Ayrshire and Arran. (2) To put this in context by reviewing contraceptive usage amongst 14-16-year-old pregnant teenagers. DESIGN: (1) A questionnaire given to 11-15-year-olds during a sex education class. (2) A retrospective study of pregnant 14-16-year-olds. PARTICIPANTS: (1) School pupils aged 11-15 from an area of mixed social background (n = 80). (2) Pregnant 14-16-year-olds presenting at Ayrshire Central Maternity Hospital between September 1997 and March 1998 (n = 74). RESULTS: (1) Ninety-nine percent of the teenagers said they would use contraception. Seventy-three percent of girls, but only 52% of boys, were aware of the services available. Ninety percent of girls knew about emergency contraception, but only 59% of boys. Thirty-three percent thought they received too little sex education at school. Thirty-two percent received no sex education from home, and 10% 'too little'. More information about sexually-related diseases, safe sex and having a baby was requested. (2) The study of pregnant teenagers showed that 69% went ahead with their pregnancies, that 71% were not habitually using contraception and only 4% were using contraception at the time of conception. DISCUSSION: Teenagers said they would use contraception. However, boys were not aware of local services giving advice and help to young people, nor about emergency contraception. Teenagers felt they had no or 'too little' sex education at home. They felt too young to become a parent and be 'tied down'. CONCLUSIONS: (1) Teenagers at school want information about a wider range of sexual issues. (2) There is a gap between learning about contraception and its practical use, including emergency contraception. (3) Discussion and reinforcement of sex education at home may not exist for many teenagers. (4) Teenagers at school felt that they were not ready to be parents as this would restrict their social lives and disrupt their education. (5) It is recognised that young men are less well-informed than young women are, and this could impact on safe sex.

Adolescent↗
PubMedDate not supplied

Contraceptive pricing and prevalence: family planning self-sufficiency in Indonesia.

Imposing or increasing user fees can move family planning programs toward self-sufficiency. But, economic theory predicts that quantities demanded decrease following price increases; and, that the size of the response depends, all else constant, upon the share of income accounted for by spending on the good or service. This article uses survey data collected in conjunction with an Indonesian self-sufficiency program to assess the differential magnitudes of contraceptive usage responses to price differentials between sample-wide and relatively poor households, and for both subsidized and full private-sector prices. We find a much more substantial response among poor households. As prices move up toward full cost-recovery, the effect is magnified.

Contraceptive Agents↗
PubMed2004

Minimizing missed opportunities: an approach to decrease the unmet need for family planning.

OBJECTIVES: The aim of the study was to determine the participants with unmet need and to show that family planning consultancy given to women and men attending the first-level health facilities would increase contraceptive usage and reduce unmet need for family planning. METHODS: All married women aged 15-49 years and men having wives of the same age group attending the health centers for any service other than family planning were included in the study. Among 2021 attendants, a total of 1701 participated in the study (84.2%). Participants were interviewed after they took the services for which they attended. At the end of the inquiries, all willing participants were referred to the family planning unit in the same building. RESULTS: The unmet need (need for any or more effective contraceptive methods) was 43.1%. All participants with unmet need were referred to the family planning unit in the same building and willing participants were given family planning services. Of the participants, 23.9% attended the family planning unit and 17.8% took services immediately at the time of the attendance. CONCLUSIONS: Linking family planning services with other health services can be a cheap and practical way to reduce the unmet need.

Adolescent↗
PubMed2002

Cervico-vaginal fistula from induced abortions causing subsequent spontaneous midtrimester abortions in Nigerians: case report.

A report of three cases of cervico-vaginal fistula (CVF) from induced abortions causing subsequent spontaneous mid-trimester abortions and a literature review is presented. Restrictive abortion laws, low contraceptive usage and increased sexual activity consequent upon adverse socio-economic conditions have led to an increase in the prevalence of illegal abortions in Nigeria over the previous two decades. CVF appears to be an emerging complication of such abortions. Cervical cerclage is preferred to trachelorrhaphy in the management of such cases. However, where vaginally performed cerclage does not succeed, the abdominal route should be used as a last resort. After a previous induced abortion, clinicians managing the subsequent pregnancy need to search carefully for cervico-vaginal fistula, which may compromise that particular pregnancy. Appropriate contraceptive use and safe abortions using modern methods in cases of contraceptive failure will prevent such horrendous complications of induced abortions in Nigeria and other developing countries.

Abortion, Induced↗
PubMed1991

A case-control study of serum folate levels and invasive cervical cancer.

Although small intervention trials have suggested that folate supplementation reduces cervical dysplasia, the association of blood folate concentrations with invasive cervical cancer risk has not been investigated in well-controlled epidemiological studies. A study was conducted with newly diagnosed Stage I and II invasive cervical cancer cases and controls in 4 Latin American countries. Ninety-five% of subjects donated blood samples, resulting in 330 case and 565 control serum samples analyzed for folate concentrations by radioassay. Cases did not differ significantly from controls in mean levels of folate (5.00 and 4.90 ng/ml, respectively). No associations were observed between quartiles of serum folate and risk of cervical cancer after adjustment for other risk factors, and no interactions with established risk factors were observed. Folate levels were also unrelated to risk among women who might have compromised folate status because of recent or extended oral contraceptive usage or multiple pregnancies. Further, mean levels of folate were similar by stage of disease, arguing against an effect of disease progression on serum values. These results do not support a role for serum folate in the etiology of invasive cervical cancer.

Adenocarcinoma↗
PubMed1990

Carcinoma of the cervix uteri and risk factors.

A prospective study included 210 patients and 100 healthy individuals in whom risk factors for the onset of malignant disorders of the cervix uteri were investigated. The following parameters were analyzed: age, profession, religious affiliation, former pregnancies, chronic irritative process on the cervix uteri, socio-economic status, heredity, contraceptive usage, smoking, sexual life and presence of the human papilloma viruses in the injured and healthy cervix. The results of the research emphasized the relevant risk factors for the genesis of the disease. They are presented in an original sheme. The central place in the pathogenesis of the disease is taken by the existing metaplasia on the portio vaginalis uteri and its contact with definite types of human papilloma viruses. The risk factors that contribute to the genesis of metaplasia and cervical infection by human papilloma viruses proved to be of great importance for the appearance of disorder. The adolescent period, the chronic irritative process on the portio vaginalis and the long-term use of hormonal contraceptives influence the genesis of metaplasia. Early sexual life, the changing of sexual partners, the sexual life of male partners, poor sexual hygiene, and the use of nonbarrier contraceptive devices favour the development of human papilloma viral infections of the cervix uteri.

Adult↗
PubMed1980

Thiamin status during pregnancy.

Thiamin status of 20 nonpregnant women and 60 pregnant women was assessed. Of the 60 pregnant women, only 49 and 25 were examined for the biochemical thiamin status in the 3rd trimester and postpartum period respectively. Thirty per cent of nonpregnant women and 28 to 39 per cent of pregnant mothers (in either the 2nd trimester, 3rd trimester, or postpartum phase of pregnancy) had a deficient thiamin status with the thiamin pyrophosphate effect (TPP effect) greater than 20 per cent. None of the pregnant subject were deficient in all the three periods. Follow up of the pregnant subjects in the 2nd trimester, 3rd trimester and postpartum period revealed that the deficiency was not necessarily established in the early pregnancy nor was aggravated with the progress of pregnancy. Thiamine intake was over 2/3 of the recommended in all the pregnant subjects and revealed no significant correlation with the biochemical indices. A history of oral contraceptive usage before conception had no significant effect on the incidence of deficiency in the 2nd or 3rd trimester. The occurrence of deficient thiamin status demonstrated an increase with number of previous pregnancies. No correlation was noted between the vitamin B1 status and anthropometric measurements of neonates.

Adolescent↗
PubMed2002

Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age.

BACKGROUND: Migraine is recognised increasingly as a risk factor for ischaemic stroke in women of childbearing age. Migraine with aura poses a higher risk than migraine without aura. OBJECTIVE: To investigate further the effect of duration, frequency, recency, and type of migraine on the risk of ischaemic stroke. METHODS: Additional analyses of a previously reported multicentre case-control study of the relation between stroke and migraine in women aged 20-44 years. RESULTS: Among 86 cases of ischaemic stroke and 214 controls, the adjusted risk of ischaemic stroke was significantly associated with: (1) migraine of more than 12 years duration, odds ratio (OR) 4.61 (1.27-16.8); (2) initial migraine with aura, OR 8.37 (2.33-30.1); (3) particularly if attacks were more frequent than 12 times per year, OR 10.4 (2.18-49.4). In no case did correction for oral contraception usage significantly alter these odds ratios. Increasing risk of ischaemic stroke was related to a change to increased frequency of headaches (trend p <or= 0.03). CONCLUSIONS: These data support earlier reports of a relation between ischaemic stroke and migraine with aura. The risk seems particularly high in those whose initial migraine type involved aura occurring more than 12 times per year.

Adult↗
PubMed1989

A model for planning local contraceptive services.

Data were collected on abortion referral rates, single young maternity rates and uptake of contraceptive services in order to identify specific areas of unmet need in the Nottingham Health District. Comparisons were made between boroughs and in the City of Nottingham between electoral wards. There was a direct relationship between abortion rate, single young maternity rate and social disadvantage. Analysis of contraceptive usage suggested a more ineffective service in the inner city, which has implications for the more efficient use of resources in the future. Targeting of consumer acceptable services to residents of the inner city and teenagers in general was recommended as a result of the study. For future planning a more useful routine data set was developed to record the activity at family planning clinics.

Adolescent↗
PubMed1997

Familial thrombophilia: genetic risk factors and management.

There are now a number of potential candidates for inherited thrombophilia but a definite causal relationship has been established for only a proportion of these. Accepted causes of familial thrombophilia include the factor V Leiden defect and the prothrombin 20210 G > A variant, as well as deficiencies of antithrombin, protein C and protein S. Together these inherited abnormalities account for 30-50% of individuals presenting with venous thromboembolism. Factor V Leiden, which is present in up to 7% of the European population, is the most common cause of familial thrombophilia. On a worldwide basis its prevalence varies greatly with ethnic origin. In common with other types of familial thrombophilia the frequency of factor V Leiden is highly dependent on the population group studied. Venous thromboembolism, present in approximately 55% of individuals with familial coagulation inhibitor deficiencies, is the predominant clinical manifestation of familial thrombophilia. There are indications that the venous thrombotic risk is somewhat less in those with factor V Leiden. The thrombotic risk is markedly increased in those with combined defects and in those who are homozygous for factor V Leiden. Risk factors for thrombosis include pregnancy, including the puerperium, surgery, oral contraceptive usage and prolonged periods of immobilization. A substantial proportion of venous thrombotic events may occur spontaneously, i.e. without an obvious precipitating event. The management of patients with familial thrombophilia comprises counselling, thromboprophylaxis and thrombosis treatment. Although the immediate treatment of an acute thrombotic event is not significantly different from that of patients without recognised abnormalities, detailed patient management is seriously hampered by a lack of appropriate clinical trials. Prospective clinical studies, designed to ascertain individual thrombotic risk and to evaluate different therapeutic strategies are urgently required.

Acute Disease↗
PubMed1981

Zinc concentration in hair and serum of pregnant women in Belfast.

Serum and hair levels of zinc were estimated in 28 nonpregnant women and 60 pregnant women at 20 to 22 wk of gestation (2nd trimester), 36 to 37 wk of gestation (3rd trimester), and 3 days postpartum. The mean serum zinc concentration was significantly lower in pregnant subjects compared to the nonpregnant and showed a continuous significant decline with increasing duration of pregnancy. Mean hair concentration in the various stages of study of pregnant women and nonpregnant subjects were comparable. However, a progressive decrease in hair zinc concentration was noted with advancing pregnancy; the decline between 2nd and 3rd trimester was statistically significant. Mean serum zinc concentration in umbilical cord blood was approximately twice that in maternal blood. Smoking had no effect on zinc concentration, while the effect of alcohol and parity was inconsistent. Oral contraceptive usage before conception appeared to lower hair zinc concentration and increase serum zinc concentration during pregnancy. Two subjects had spontaneous abortion and these had serum zinc in the lower range and hair zinc values in the higher range. The remaining 58 subjects gave birth to normal neonates weighing 2500 to 4500 g. The study revealed that zinc nutrition of the majority of the expectant mothers was adequate for normal growth and development of fetus. The possible cause and implication of observed changes in zinc metabolism are discussed.

Adolescent↗
PubMedDate not supplied

An examination of factors influencing black fertility decline in the Mississippi Delta, 1880-1930.

Although the fertility decline in the black population in the Mississippi Delta between the late 1870's and early 1930's closely paralleled that of the national black population, it rose much more dramatically in the 1940's and 1950's to almost 1880 levels. Given the especially rural and oppressed conditions of blacks there, the initial decline seems puzzling. Low fertility rates in the 1930's reflected a large proportion of childless females. Investigations of changing contraceptive usage and mate exposure suggest both were minor components at most. Several physiological impairments were investigated including dietary deficiences, malaria, tuberculosis, and sexually transmitted diseases (STD). Evidence suggests STD played the major role, facilitated by nutritional and other health problems. Models relying heavily on those developed by McFalls and McFalls (1984) suggest 50-80 percent of the decline could have been due to the spread of STD. Age-specific birth rates for different periods and post-World-War-II fertility increases seem consistent with this finding.

Adolescent↗
PubMed1999

Economic development and health status among the poor in squatter settlements of Karachi.

OBJECTIVE: Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor. SETTING: Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996. METHODS: A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets. RESULTS: Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p = 0.02) have lower contraceptive usage (CI; 2.11-2.64; p < 0.001) and childhood immunization rates (CI; 2.08-2.40, p < 0.001). No significant association was observed between economic levels and prevalence of diarrhea. The housing, literacy and employment status was consistently better in the higher economic stratum who were more likely to be Pushto-Punjabi speaking as compared to the Sindhi speaking population. CONCLUSION: To have sustainable improvement in the health status of the poor, those who are most vulnerable need to be identified and programs aiming to improve health should also undertake broader development initiatives like raising family income.

Child↗
PubMed1994

General practitioner notes as a source of information for case-control studies in young women. UK National Case-Control Study Group.

STUDY OBJECTIVE: The UK National Case-Control Study was carried out to investigate the relationship between oral contraceptive use and breast cancer risk. This study investigates whether general practitioner notes could be used as the sole data source for epidemiological studies of young women and what the effect would be on non-response and recall bias. DESIGN: Case-control study with data on gynaecological, obstetric, and contraceptive history collected at interview and from general practitioners' notes. Information from these two sources was compared. SETTING: This was a population-based study. PARTICIPANTS: Altogether 755 women with breast cancer aged under 36 years at diagnosis, each with an age-matched control, participated in the study. Response rates at interview were 72% and 89% for cases and controls but GP data were available for 90% of the 1049 case and first-selected control pairs. MAIN RESULTS: There was generally good agreement between the two data sources with respect to obstetric history and gynaecological procedures (hysterectomy, oophorectomy, and tubal ligation). The use of intra-uterine devices, or diaphragm, and partner's vasectomy were not reliably recorded in the GP's notes. The overall results of the UK study would have been qualitatively the same with respect to the relationship between oral contraceptive use and breast cancer risk if GP notes only had been used, in spite of the fact that only about half of all oral contraceptive usage was recorded in the notes. Response rates would have been higher, recall bias eliminated, and the cost of the study halved. CONCLUSIONS: When planning case-control studies in young women, the possibility of using GP notes as the primary data source should be considered. Lack of data on potential confounding factors is a possible drawback to such use. The practice of destroying GP's notes shortly after the death of patients seriously restricts the possibility of using these notes when studying rapidly fatal conditions.

Adult↗
PubMed2006

Risk factors for ectopic pregnancy: a case-control study.

AIM: To identify the risk factors for ectopic pregnancy. METHODS: We conducted a prospective case-control study for the role of several risk factors in the occurrence of ectopic pregnancy in Turkey. A total of 225 cases and 375 controls were compared for sociodemographic characteristics, cigarette smoking, obstetric, gynaecological, surgical histories, the presence or absence of assisted conception and contraceptive usage. RESULTS: The main risk factors for ectopic pregnancy were prior ectopic pregnancy (adjusted odds ratio (AOR): 13.1) and a history of infectious reproductive system (AOR for pelvic inflammatory disease: 6.8). Other risk factors found to be associated with an increased risk for ectopic pregnancy were multisexual partner (AOR: 3.5), history of infertility (AOR: 2.5), induced conception cycle (AOR: 3.4), current intrauterine device usage (AOR: 3.2), prior Caesarean section (AOR: 2.1) and cigarette smoking at the time of conception (AOR=1.7). On the contrary, barrier methods were protective from ectopic pregnancy (AOR: 0.4). CONCLUSIONS: The increased awareness and knowledge of risk factors have enabled an early and accurate diagnosis of ectopic pregnancy. This study has found prior pelvic infection to be a major aetiological factor for ectopic pregnancy. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy, infertility history and induced conception cycle, may be the result of a previous pelvic infection that may cause tubal sequelae. These factors are potential targets for intervention and modification.

Adult↗
PubMed1984

Complications of female sterilization: immediate and delayed.

Surgical sterilization in women has changed dramatically over the past 20 years. The development of laparoscopy and minilaparotomy have made the procedure readily available even in developing countries. In the United States, changing social values and changes in hospital regulations have done as much as technology to account for the tremendous increases in the number of women undergoing sterilization. Improved sterilization procedures have resulted in lower costs for sterilization and lowered morbidity and mortality rates. Hysterectomy for sterilization alone carries unacceptable morbidity and mortality rates. Originally, laparoscopic techniques utilized unipolar cautery. However, bowel burns, a rare but serious complication, were reported, and this led to newer techniques. These techniques, using bands, clips, and bipolar cautery, have gained increasing popularity and have eliminated many of the serious complications of female sterilization. Historically, there has been concern that tubal sterilization by any method produces, in significant numbers of patients, the subsequent gynecologic and psychologic problems called "post-tubal ligation syndrome." A review of earlier literature indicates that many of these studies have serious methodologic problems, including recall bias, inappropriate control groups, failure to elicit prior history of gynecologic or psychologic problems, and failure to account for the use of oral contraceptives or IUDs. More recent large prospective epidemiologic studies that have controlled for prior gynecologic problems and contraceptive usage have failed to show increased incidence of gynecologic sequelae in large numbers of women. However, there are some data to support the concept that in certain individuals, sterilization may result in disruption of ovarian blood or nerve supply, producing gynecologic sequelae. Additional data from these ongoing large-scale studies and others should help to elucidate this problem in the future. Pregnancy after sterilization (even excluding pregnancies present at the time of the procedure) is more common the first year after the procedure with the risk decreasing in subsequent years.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocoagulation↗
PubMedDate not supplied

Liver tumors and oral contraceptives: pathology and pathogenesis.

Since 1973, over 200 cases of liver masses associated with oral contraceptive usage have been reported. Nearly 100 have been liver cell adenomas and 11 have been hepatocellular carcinomas. Focal nodular hyperplasia (FNH) appears only coincidentally associated, but with a particular hemorrhagic tendency. Bile duct proliferation distinguishes FNH from liver cell adenoma. Two typical cases are presented. Right upper quadrant pain with intra-abdominal hemorrhage is the single most common clinical presentation. Mestranol-containing preparations appear more hazardous. Liver enzymes are usually normal or slightly elevated. Most cases are resectable. Lesions have regressed following discontinuation of pill use; however, close observation is required. Although mammalian liver possesses estrogen receptors, these agents have induced few or no liver tumors in numerous animal studies. Mutagenicity tests indicate that estrogenic compounds do not damage DNA. However, diethylstilbestrol can promote the growth of rat hepatomas initiated by a carcinogen. Further experimental studies may better characterize estrogens as hepatoma promoters.

Adenoma↗