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PubMed1996

Do young women in tropical regions constitute a recognized social category?

In most tropical regions there is little organized health care for young women, yet their household roles within contexts of worsening socio-economic situations create special health problems. In the area of sexual and reproductive health, the onset of reproductive roles does not entitle the young women to either maternal and child health services or family planning services unless they are married and have children under 5 years. Societal values and norms at macro and micro levels have prevented young women from benefiting from reproductive technology, although they are, at the same time, increasingly expected to spend a great deal of their youth in school and outside marriage. Young women thus live in paradoxical situations as indicated by the increasing levels of early teenage pregnancy, induced abortion and related complications, school drop-out and infection with sexually transmitted diseases including HIV/AIDS. Young women clearly constitute an unrecognized social category, and research focusing on them would be particularly rewarding because of the potential it offers for addressing the gender imbalances and their dynamics in health.

Adolescent↗
PubMed1997

Research design and methods of quantitative synthesis of medical evidence.

OBJECTIVE: To review the scientific principles, strengths, and limitations of research designs and methods of quantitative synthesis of medical evidence. DATA SOURCES: We used MEDLINE to perform a systematic search for literature using the keywords research design, epidemiology, and biometry. Journals searched included six major journals in obstetrics and gynecology and three in general medicine. These sources were supplemented with texts and reviews from the general medical literature. METHODS OF STUDY SELECTION: We reviewed the publications identified by our search and evaluated critically the relevant reports. We summarized objectives and scientific guidelines for the common research methodologies and outlined their advantages and disadvantages. TABULATION, INTEGRATION, AND RESULTS: The standard of clinical research design is the randomized controlled trial (RCT), which, if performed with sufficient methodologic rigor, is least likely to have serious biases. Cohort, case-control, and cross-sectional studies are common observational studies used in reproductive health; such observational studies are more susceptible to biases that can distort the researcher's results and conclusions. Descriptive studies such as case series and case reports are often interesting as clinical vignettes but have limited scientific merit. Methods for quantitative synthesis of medical evidence, including meta-analysis, decision analysis, and cost-effectiveness analysis are being used with increased frequency in the reproductive health literature to summarize medical evidence. CONCLUSION: Various research methods have their own inherent advantages and disadvantages. An understanding of the scientific principles of these methods will enable the clinician to evaluate medical evidence critically.

Biometry↗
PubMed1998

For Better, For Worse.

This article addresses the extent to which provisions within Article 16 of the Universal Declaration of Human Rights have influenced subsequent developments in the field of sexual and reproductive health and rights. In particular, it assesses how the right to marry and to found a family, the requirement of free and full consent of intending spouses, and recognition of the family as the "natural and fundamental group unit of society" have affected service provision in this field. Other human rights instruments, such as the Women's Convention, have amplified these rights, but some issues within reproductive health continue to be limited by conventional interpretations of the family, as identified in the UDHR. While the language within Article 16 was clearly molded by the morality of the 1940s, it has, so far, proven to be flexible enough to encompass both social change and technological innovation.

Journal Article↗
PubMed1995

Associations of the epithelial mucin, PAS-1, with yield, health, and reproductive traits in Holstein dairy cows.

Five polymorphic forms of the epithelial mucin, PAS-1, were identified in milk by SDS-PAGE. The sizes of PAS-1 ranged from 194.5 to 163 kDa. Mature equivalent milk, fat, and protein yields and protein and fat percentages from 139 cows in The Pennsylvania State University herd were analyzed with two models. Both models contained a year and season combination of calving and parent average. In Model [1], yields were regressed on the mean size of PAS-1 either linearly or linearly and quadratically. Model [2] included PAS-2 phenotype as a discrete variable. Lactation mean of somatic cell scores (119 cows), number of times bred (136 cows), and days open (136 cows) were analyzed with the same two models excluding parent average (data not available). Mean size of PAS-1 was not linearly related to the traits evaluated. The effects of PAS-1 phenotypes as a discrete variable were significant for mature equivalent fat and protein yields, fat percentage, number of times bred, number of times bred restricted to 3, and days open restricted to 150 d. Overall, there was little indication of an important linear or quadratic relationship between PAS-1 size and traits measured.

Animals↗
PubMed2003

Radiation protection program for declared pregnant workers at Los Alamos National Laboratory.

This article presents an overview of Los Alamos National Laboratory's (LANL) Fetal Radiation Protection Program (FRP) that satisfies the requirements set forth in 10 CFR 835 and LANL's Radiation Protection Program. At LANL, the FRP is one of three components of the larger Reproductive Health Hazards Program, which also includes Occupational Medicine and Industrial Hygiene. Although pregnant employees usually enter the program through Occupational Medicine, coordination with all three groups is achieved. The most important part of the FRP Program is performance of the workplace evaluation at the pregnant worker's workplace. At the meeting between the health physicist and the pregnant employee, the following topics are reviewed: risks to the embryo/fetus of working around sources of ionizing radiation; LANL's requirements and 10 CFR 835 regulations; her dose history; basic methods of radiation protection; and a detailed discussion of the work assignments/locations that enables the health physicist to complete an evaluation of the level of radiological hazards. Interface with her supervisor and the Operational Health Physics health physicist in charge of her work areas is essential in acquiring additional information. All of these data, including the radiation dose history and recommendations for possible work modifications or reassignment, are summarized in the workplace evaluation memo, which becomes part of the pregnant employee's medical file. Using input from LANL's legal staff, the author developed a document titled "Guidance to the Supervisors Regarding Fetal Radiation Protection and Reproductive Health Hazards," which instructs supervisors regarding the requirements and regulations, contact names for workplace evaluations, and, very importantly, how to avoid discriminatory behavior against pregnant employees.

Confidentiality↗
PubMed2006

Phthalate exposure and male infertility.

Phthalates have been used as additives in industrial products since the 1930s, and are universally considered to be ubiquitous environmental contaminants. The general population is exposed to phthalates through consumer products, as well as diet and medical treatments. Animal studies showing the existence of an association between some phthalates and testicular toxicity have generated public and scientific concern about the potential adverse effects of environmental changes on male reproductive health. In particular, prenatal exposure to phthalates seems to play a relevant role in determining these adverse effects given that human exposure has been demonstrated to begin during the intrauterine life. Unprecedented declines in fertility rates and semen quality of antenatal origin have been reported during the last half of the 20th century in developed countries and increasing interest exists on the potential relationship between exposure to environmental contaminants, including phthalates, and human male reproductive health. Here we review the data that support or discounts the evidence existing to date linking phthalate exposure and the decline of human male fertility, especially in developed countries.

Adult↗
PubMed2002

Sexual risk-taking in the slums of Nairobi, Kenya, 1993-8.

Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in the sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a sub-population uniquely vulnerable to reproductive health problems and to expend more resources in slum settings.

Cross-Sectional Studies↗
PubMed1998

Gonadal function in men with testicular cancer: biological and clinical aspects.

This paper reviews current knowledge about the effect of testicular germ cell cancer (TGCC) on gonadal function and of cancer treatment on spermatogenesis and Leydig cell function. It is well documented that testicular cancer is associated with impaired spermatogenic function and some patients already have impairment of Leydig cell function before orchidectomy. The degree of spermatogenic dysfunction is higher than what can be explained by local tumour effect and by a general cancer effect, since patients with other malignant diseases have normal, or only slightly decreased, semen quality. Furthermore, sperm counts after orchidectomy are further reduced to less than half of the values in healthy men, even in patients cured from the cancer disease after orchidectomy alone. These observations are supported by histological investigations which have shown a high prevalence of abnormalities of spermatogenesis in the contralateral testis in patients with unilateral TGCC. The association between testicular cancer and poor gonadal function is very interesting both from a biological and from a therapeutic point of view. Firstly, the increase in incidence of testicular cancer has been suggested to be associated with a general decline in male reproductive health and it seems likely that the development of TGCC shares common aetiologic factors with development of other types of testicular dysfunction. This suggestion is supported by the observation that men with various types of gonadal dysfunction such as testicular dysgenesis, androgen insensitivity syndrome, and cryptorchidism have increased risk of testicular cancer. Secondly, the general cure rate in patients with testicular cancer exceeds 90% and the quality of life, including fertility aspects, is therefore important in the management of these patients. Spermatogenesis is already so severely impaired before treatment that fertility is lower than in healthy men. Moreover, radiotherapy and chemotherapy both induce dose-dependent impairment of spermatogenesis and recovery of spermatogenesis after treatment may be long lasting even more than five years in some patients. Sufficient androgen production is seen in the majority of the patients, but some patients suffer from testosterone deficiency. The effect of chemotherapy on Leydig cell function also seems to be dose-dependent. In conclusion there is no doubt that testicular cancer is associated with poor gonadal function even before treatment. Furthermore, the treatment of testicular cancer may have a serious impact on the gonadal function in these patients, most of whom are in the reproductive age. Moreover, the epidemiological and clinical data indicate a common aetiology between testicular germ cell cancer and other abnormalities in male reproductive health (such as infertility and cryptorchidism). These observations are in agreement with the suggestions of hormonal involvement in the aetiology of testicular cancer. Generally, men with TGCC need counselling about their reproductive function with respect to semen cryopreservation, chance of recovery of spermatogenesis, fertility, and the possible need for androgen replacement.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

[Adolescents and contraception. What should the pediatrician know? (Part 2)].

Many adolescents are sexually active and reproductive health is an important aspect of adolescent medicine. However, pediatricians are often uncomfortable with the issues of sexuality and contraception, for which they have not been particularly trained. The general purpose of this article is to increase pediatricians' sense of competence with adolescents, particularly when having to deal with or counsel on such a sensitive issue as contraception. This second of two parts addresses confidentiality and prescription of oral contraceptives to minors, how to ask questions about sexual and reproductive life, best initial choice and eventual subsequent switch of contraceptive pill, acne and oral contraception, problems with mental handicap, and finally, what about boys. Pediatricians interested in the care of adolescents are strongly invited to keep developing their expertise in the field of sexuality, contraception and reproductive health.

Acne Vulgaris↗
PubMed1995

Knowledge, attitude and practice of family planning in rural communities in Nigeria.

Maternal and infant mortality rates, coupled with a high population growth rate, are unacceptably high in Nigeria. More recently, the Nigerian government endorsed the promotion of reproductive health, including family planning, through maternal and child health services. The Ohaozara Local Government Area (LGA) introduced a Five-Year Action Plan (FYAP) in 1989. To appraise the Ohaozara Five-Year Action Plan, 600 persons stratified by geographical location and sex were interviewed in three randomly selected autonomous communities in the Ohaozara Local Government Area to determine their knowledge, attitude and practice (KAP). The findings in this study showed a high awareness level with a moderately positive attitude and generally low level of practice. Comprehensive reproductive health education (RHE), budgetary increase, evaluation of FYAP, and program coordination are recommended.

Adult↗
PubMed2000

Sexual and reproductive rights: statements, rhetoric and responsibilities.

The current international movement for the promotion of reproductive health has great potential for improving sexual and reproductive rights. Health professionals should play a major role in applying international human rights instruments at the country level. Being at the front line of service delivery, health professionals have a duty to ensure that those rights are articulated in routine care by empowering individuals, lobbying for legislation, promoting policies and reporting violations of human rights treaties.

Contraception↗
PubMed1996

Motivating women. Bangladesh.

The Integrated Family Development Program (IFDP) in Bangladesh is expanding from the original project areas in Panchdona Union and Dhalian Union into four neighboring unions under the initiative of the Family Planning Association of Bangladesh (FPAB). The JOICFP-executed project entered its second cycle this year as part of the UNFPA-supported regional Capacity Building for Sustainable Community-based Reproductive Health/Family Planning (FP) Project Emphasizing Quality of Care. The community-based project has won wide acceptance from people at the grass roots who have helped fuel its expansion into other villages. In particular, villagers have welcomed the comprehensive approach of the project which integrates a range of components such as reproductive health including FP/maternal and child health (MCH), income-generating activities, skills and literacy education for women and children and primary health care including parasite control. The success of the project also convinced the Japanese Embassy in Bangladesh to extend funding under the Japanese government's Grant Assistance for Grass Roots Cooperation Projects. With the funds, FPAB will establish a Women's Multipurpose Training Center in Panchdona Union. The sum of US$68,157 was officially handed over to FPAB on March 29 by Japanese Ambassador Yoshikazu Kaneko. The center, which is to open within this year, will contribute to improving reproductive health and promoting the empowerment of women. Once completed, it will be used for such activities as training in health care, literacy and skills for income generation for women's empowerment.

Asia↗
PubMed1986

Comparison of fecundability with fresh and frozen semen in therapeutic donor insemination.

A series of 401 therapeutic donor insemination (TDI) cycles was analyzed for determining the effect on fecundability of fresh versus cryopreserved semen, the number of inseminations per cycle, recipient age, and the reproductive health of the TDI recipient. We followed a protocol in which inseminations were performed during the periovulatory period determined by urinary luteinizing hormone surge or ultrasound-timed human chorionic gonadotropin injection. The minimum standard for insemination with fresh or cryopreserved semen was a total of 40 X 10(6) grade 3 sperm. We found no decreased fecundability when using frozen semen, rather than freshly ejaculated specimens. The number of inseminations per cycle did not affect the pregnancy outcome after TDI. The reproductive health of the recipient had a significant effect on the pregnancy rate. Fecundability was 15.6% for healthy women, as compared with 6.7% for women with a diagnosis of moderate, severe, or extensive endometriosis, pelvic adhesions, tubal disease, or ovulatory dysfunction. To avoid transmission of human T-lymphotropic virus type III from sperm donor to TDI recipient, we have recently utilized an exclusively frozen TDI program. With well-timed inseminations of 40 X 10(6) grade 3 motile sperm, we have been able to attain pregnancy rates similar to those previously obtained with fresh samples.

Female↗
PubMed2003

Safe motherhood perspectives and social support for primigravidae women in Lusaka, Zambia.

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care.

Adolescent↗
PubMed2004

Detection of quantitative trait loci affecting milk production, health, and reproductive traits in Holstein cattle.

We report putative quantitative trait loci affecting female fertility and milk production traits using the merged data from two research groups that conducted independent genome scans in Dairy Bull DNA Repository grandsire families to identify quantitative trait loci (QTL) affecting economically important traits. Six families used by both groups had been genotyped for 367 microsatellite markers covering 2713.5 cM of the cattle genome (90%), with an average spacing of 7.4 cM. Phenotypic traits included PTA for pregnancy rate and daughter deviations for milk, protein and fat yields, protein and fat percentages, somatic cell score, and productive life. Analysis of the merged dataset identified putative quantitative trait loci that were not detected in the separate studies, and the pregnancy rate PTA estimates that recently became available allowed detection of pregnancy rate QTL for the first time. Sixty-one putative significant marker effects were identified within families, and 13 were identified across families. Highly significant effects were found on chromosome 3 affecting fat percentage and protein yield, on chromosome 6 affecting protein and fat percentages, on chromosome 14 affecting fat percentage, on chromosome 18 affecting pregnancy rate, and on chromosome 20 affecting protein percentage. Within-family analysis detected putative QTL associated with pregnancy rate on six chromosomes, with the effect on chromosome 18 being the most significant statistically. These findings may help identify the most useful markers available for QTL detection and, eventually, for marker-assisted selection for improvement of these economically important traits.

Animals↗
PubMed2004

Implementing the ICPD Programme of Action: what a difference a decade makes.

The Programme of Action adopted at the International Conference on Population and Development in Cairo in 1994 was conceived as a 20-year programme. Now, at its mid-point in 2004, we have reached a time for assessment and re-commitment to its goals. This paper is a reflection on some of the political and other changes that have taken place during the first ten years of the Programme of Action and their implications for its implementation in the coming decade. Many countries have gone ahead and integrated sexual and reproductive health services into primary health care, whether or not the concept has been supported at the international level, and are doing what they can to accommodate the needs of those requiring information and services. The shape of the "playing field" has changed in the past ten years and the goal posts have moved. Yet many countries are adjusting and adapting. The big question, which has yet to be answered, is whether the international community will help or hinder the efforts at country level to achieve the goal of access for all to sexual and reproductive health by 2015.

Adolescent↗
PubMed1994

The use of urinary hormonal assessments in human studies.

The collection and analysis of urine samples provides a practical method for monitoring female reproductive events in non-laboratory and non-clinic populations. Collection of biologic samples permits objective assessment of reproductive health endpoints in epidemiologic studies and for epidemiologic research purposes can provide validation of information provided by the subjects, especially outcomes which are usually concealed and thus unknown to the participant. Urine sampling has several advantages over the collection of blood samples, such as simplicity, non-invasiveness, and cost efficiency. Several studies have shown that endocrine information similar to that obtained in blood samples can be obtained from assays of daily urine samples. The measurement of human chorionic gonadotropin in daily and selected urine samples has been incorporated into several recent epidemiologic studies focusing on early fetal loss, and ovarian and pituitary hormone metabolites have been measured in daily urine samples to evaluate ovarian function in studies focusing on women's reproductive health. As the strategy of urinary monitoring becomes more accepted as a legitimate research tool, laboratory methods are being modified to improve performance, reduce costs and adapted to sophisticated algorithms using multiple hormonal measurements to identify a number of end-points.

Biomarkers↗
PubMed1988

Maternal mortality surveillance, United States, 1980-1985.

To better define the incidence, causes, and risk factors associated with maternal deaths, the Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC, coordinated a study by the Maternal Mortality Collaborative, a Special Interest Group of the American College of Obstetricians and Gynecologists (ACOG). In 1983, this group established voluntary surveillance of maternal deaths for the years 1980-1985. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 39% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Overall, women over 30 years of age had a higher risk of dying than did younger women. For each age group, women of black and other races who were 30 years and older having the highest risk. The leading causes of maternal deaths were embolism, hypertension in pregnancy, sequelae from ectopic pregnancy, hemorrhage, cerebrovascular accidents, and anesthesia complications. Of the 111 nonmaternal deaths, 90 (82%) were attributed to unintentional or intentional injuries. As a result of the success of this voluntary reporting system, the Division of Reproductive Health initiated National Pregnancy Mortality Surveillance in January 1988.

Adult↗