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PubMed1994

Oral contraceptive use and the prognosis of breast cancer.

In 471 breast cancer patients the influence of a positive history of oral contraceptive (OC) use on survival was investigated. 297 (63%) patients used OCs during any period of their life and 92 (20%) used them still at the time of diagnosis. Sixty months after diagnosis OC users had a significantly increased overall survival (p = 0.037). Survival rates amounted to 79.5% and 70.3% for OC users and non-users, respectively. The effect persisted after adjustment for other prognostic factors and was mainly attributed to women who had taken OCs four years or longer (p = 0.025). Comparing the survival after a 56 months median follow-up dependent on duration of OC use (never, 1-48 months, > or = 49 months) in subgroups of prognostic factors, the most significant influence on survival was observed among long-term users with tumors more than 2 cm in diameter (p = 0.005), with axillary node-positive tumors (1-3 nodes, p = 0.055/ > or = 4 nodes, p = 0.019), and with tumors of low estrogen receptor (p = 0.015) or progesterone receptor content (p = 0.04). The difference in survival between OC users and non-users cannot be explained by the distribution of prognostic factors investigated (histological type, histological grade, tumor size, lymph node involvement, hormonal receptor content). OC users had an even higher percentage of poorly differentiated tumors (p = 0.003). These results suggest an effect of OC use on tumor biology during the preclinical phase of the disease.

Adult↗
PubMed2006

Body size and risk of epithelial ovarian cancer (United States).

OBJECTIVE: We conducted a population-based case-control study of epithelial ovarian cancer in relation to measures of body size and adult weight change. In particular, we sought to characterize the independent relation of body weight at particular ages with risk. METHODS: In-person interviews were sought with 35-54 year-old female residents of metropolitan Atlanta, Seattle or Detroit diagnosed with ovarian cancer during 1994-1998, and with controls sampled from these populations. Information provided by 355 cases and 1,637 controls was analyzed using unconditional logistic regression. RESULTS: The risk among women in the top tenth, relative to women in the lowest fourth, of the distribution of body weight at age 18 years was 1.5 (95% confidence interval, 1.0-2.2); at age 30, 1.9 (1.2-2.9); and 5 years before the reference date, it was 2.1 (1.4-3.3). While our results did not substantiate risk elevations reported in previous studies among subsets of women (e.g., with particular histologic tumor subtypes or according to past oral contraceptive use), we noted a particularly increased risk among women who reported 10 or more pounds gained during their first year of oral contraceptive use. CONCLUSIONS: Our findings suggest that risk of epithelial ovarian cancer may be most closely linked with body weight in the relatively recent past (but before the time in which the disease may manifest as weight loss) among women who develop this disease during the years before or shortly after menopause.

Adult↗
PubMed1995

Contraceptive implant use among inner city teens.

PURPOSES: This study develops a clinical profile of urban teens who selected Norplant for contraception; determines which variables identify the subjects most likely to be compliant with the method; and determines the most common reasons for early termination of use. METHODS: Demographic and health history data and reasons for termination of use were collected prospectively for 122 inner city teens who received Norplant. Life table analysis and the Mantel-Haenszel procedure were used to investigate differences between Norplant retainers and terminators. RESULTS: The sample consisted of black and Hispanic teens between the ages of 13-19 years, the majority of whom had one or more children and were in school. One and two year retention rates were 71% and 62%. The highest removal rates occurred during the 3-6 month interval after insertion. A significant finding was that teens who have experienced induced abortion were more likely to retain Norplant. Common reasons for termination of use included general and social concerns, including pregnancy desire. CONCLUSIONS: Norplant retention rates for this teen sample were greater than the compliance rates reported for other conventional methods. Similar to noncompliance with oral contraceptives, discontinuance of the method was most likely to occur in the first 6 months of use. A history of induced abortion identifies those teens most likely to retain Norplant, suggesting that these teens might evaluate contraceptive risks and benefits differently than those with no abortion history. Pregnancy desire was a common reason for terminating Norplant use.

Adolescent↗
PubMed1990

Effects of outreach intervention on risk reduction among intravenous drug users.

Considerable voluntary risk reduction has occurred among IVDUs in New York City. The purpose of the AIDS Outreach Project was to improve upon the existing level of risk reduction by providing information and anonymous HIV testing to street-recruited IVDUs. Intake and follow-up interviews were conducted with 121 subjects (44% of 276 at intake), with a mean of 4.5 months between interviews. Significant risk reduction occurred in many drug and sexual risk behaviors, although not in bleach use, and more than half of the subjects continued to engage in high-risk sexual behavior. An analysis of differences in risk reduction between early and later intake groups indicated that external trends were not sufficient to account for observed risk reduction. Among subjects engaged in high-risk behavior at intake, those who injected less or were enrolled in drug abuse treatment were more likely to stop high-risk drug injecting. Subjects who (at intake) engaged in less frequent unprotected sex, or who had had sex with someone with AIDS, were more likely to stop high-risk sexual behavior. The majority of subjects at low risk at intake maintained low-risk behavior. Informational interventions appear to be most successful among those IVDUs already engaging in lower levels of risk behavior. More effective methods are needed for those whose level of risk behavior is greater. These might include peer pressure and distributing bleach (as opposed to only providing information about bleach).

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Artificial abortion in Europe].

The authors of the article review the state in various European nations and the possibilities for performance of induced interruption of pregnancy. In connection with this they describe the existing various forms of legislation. There are countries, in which induced abortions are absolutely band (Ireland). Legislation of socialistic countries is far more democratic in this respect. There are many factors, on which depend whether to legalize or not induced interruption of pregnancy. In Roman-catholic countries the religious motives are determinant, but in some other countries--the demographic policy of the government, ect. The practice however prove that induced abortions are widely distributes in Europe. The number of registered abortions is quite large in the socialistic countries. The data show that Bulgaria occupies one the first places (61.9% of women). Furthermore there are a series of problems in connection with the formation of high sexual culture of the population. Attention is paid to family planning all over the world. The question about contraception is an important and pressing problem. Good knowledge of current drugs and methods for prevention of unwanted pregnancy and their correct usage leads to a substantial reduction in the number of induced abortions and their unfavourable consequences.

Abortion, Legal↗
PubMed1990

[Abortion after the 12th completed pregnancy week. Report of experience of a specialist commission].

In the GDR abruptio after 12th completed week of gestation is only allowed in cases of severe threat of health or danger for life. The decision is made by a group of specialists. Analysing the years 1972-1986 all the 135 cases worked up by the commission of the district hospital of Gera were evaluated. Reasons for delayed diagnosis of pregnancy and arguments for wanted abruptio were most interesting. To determine possible trends, the results were subdivided in two periods, 1972-1979 and 1980-1986. In the second period an unfavourable development was detected regarding number of cases, distribution of age, number of preceded pregnancies, and gestational age. A special problem was the group of juvenile pregnant women. Social arguments were dominating, especially problems regarding the partners. Associated with them, indecision on bearing to maturity was a predominant reason for delayed diagnosis of pregnancy followed by disorders of menstruation. Social arguments may be reduced about 80% by consequent contraception methods. Proper and consequent application of oral contraceptives could avoid 70% of the late diagnoses. Teenager should be brought to contraception by more confidence in their families.

Abortion, Legal↗
PubMed1993

Decline and unevenness of infant mortality in Salvador, Brazil, 1980-1988.

Data relating to infant mortality in Salvador, Brazil, were analyzed in order to determine how infant mortality evolved in various parts of the city during the period 1980-1988. This analysis showed sharp drops in the numbers of infant deaths, proportional infant mortality (infant deaths as a percentage of total deaths), and the infant mortality coefficient (infant deaths per thousand live births) during the study period despite deteriorating economic conditions. It also suggested that while these declines occurred throughout the city, the overall distribution of infant mortality in different reporting zones remained uneven. Among other things, these findings call attention to a need for further investigation of the roles played by various health measures (including immunization, control of respiratory and diarrheal diseases, encouragement of breast-feeding, and monitoring of growth and development) and of reduced fertility (resulting from birth spacing, use of contraceptives, and female sterilization) in bringing about declines in infant mortality during hard economic times.

Brazil↗
PubMed1995

[Epidemiology and pathogenesis of Crohn's disease].

The onset of Crohn's disease (CD) is more frequent between 15 and 30 years and also has a second peak over 60 years. It female sex it is slightly more prevalent among female. Incidence rates vary in different geographic areas, ranging from 2 to 4 new cases/100,000 inhabitants/year. Prevalence data range from 1.2 to 200,000/100,000. Ethnic differences are beginning to disappear, underlining the role of environmental factors in the genesis of the disease. At the moment the most reliable hypothesis is that CD has a multifactorial pathogenesis: antigenic and environmental factors acting in genetically predisposed patients. According to this hypothesis, first degree relatives of CD patients have a relative risk of disease ranging from 2 to 4. Many infective agents have been associated with its onset and relapse; the most reliable observations are those related to the measles virus. There is an activation of the immunosystem which is shown by abnormal T-cell activation, by the increase of some cytokines and by the expression of adhesion molecules. The role of oral contraceptives and diet as risk factors is controversial. Smoking is the only risk factor positively associated with the onset of CD and its clinical course; this association is specific and dose-related.

Age Distribution↗