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N Job-Spira

Publications and source records attributed to N Job-Spira.

51 records · Page 3Linked to original sources
PubMed1991

Prevention of sexually transmitted diseases: a randomised community trial.

STUDY OBJECTIVE: The aim was to evaluate the effectiveness of a programme for the prevention of sexually transmitted diseases which affect fertility. DESIGN OF THE PREVENTION PROGRAMME: The programme took place in six French geographical departments. Three of these, randomly selected, served as experimental departments while the other three were matched with the first three and served as controls. DESIGN OF THE EVALUATION: Genital discharge was used as the indicator of a sexually transmitted disease. In each department, about 40 voluntarily participating general practitioners (263 in total) gathered information on the frequency of infected patients and on their characteristics, both before and after the campaign. PATIENTS: Before and after the programme respectively, 412 and 288 women and 117 and 94 men with a genital discharge were described. MEASUREMENTS AND MAIN RESULTS: After the programme, tests for chlamydia trachomatis were prescribed more often to both women and men with a discharge in the experimental departments. The characteristics of women having consulted a general practitioner with a discharge differed according to the department group studied. In the experimental departments, the women were younger than those in the control departments and had fewer sexual partners. In contrast to the results obtained for women, no behavioural changes were observed among men with a discharge. CONCLUSIONS: The results may indicate a decreased risk in spread of infection. Methodological problems associated with such a design are discussed. There is a need to develop specific messages aimed at changing male sexual behaviour. The study design has implications for the best strategy in delivering prevention messages to the general population which are relevant to the present AIDS epidemic.

Adolescent↗
PubMed1991

Increased risk of ectopic pregnancy with maternal cigarette smoking.

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of cigarette smoking. Maternal cigarette smoking at the time of conception was associated with an increased risk of ectopic pregnancy with a dose-response relationship (adjusted odds ratios: 1.30 to 2.49). On the other hand, partner's smoking was not associated with ectopic pregnancy. The study provides a supplementary argument towards a causal effect of smoking in the development of ectopic pregnancy.

Adolescent↗
PubMed1991

Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy.

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of controlled ovarian hyperstimulation in a population with no previous history of ectopic pregnancy. Ovulation induction alone was associated with an increased risk of ectopic pregnancy (adjusted odds ratio = 3.98; 95% confidence interval 1.10-14.30). In contrast, ovulation induction for in vitro fertilization did not increase the risk further (adjusted odds ratio = 2.45; 95% confidence interval 0.54-11.13). These results suggest that hormonal factors may be involved in the development of ectopic pregnancy.

Adult↗
PubMed1991

[Risk factors of ectopic pregnancy. A case-control study at 7 maternity units in the Paris area].

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in ectopic pregnancy (EP). A total of 279 cases and 307 controls were compared for sociodemographic characteristics, cigarette smoking, sexual reproductive and surgical histories and for the conditions under which conception occurred. Many factors were found to be associated with an increased risk of EP: cigarette smoking related to the number smoked at the time of conception (Odds Radio (OR) 1.26 to 2.72), appendicectomy (OR 1.25, 95% CI = 1.02-1.56), prior tubal surgery (OR = 2.42, 95% CI = 1.37-4.22), prior use of intrauterine devices (OR = 1.34, 95% CI = 1.02-1.80), induced ovulation cycle (OR = 1.66, 95% CI = 1.01-2.74) and prior EP (OR = 3.90, 95% CI = 2.27-6.75). Chlamydia trachomatis seropositivity was associated with an increased risk of EP (OR = 1.50, 95% CI = 1.04-2.13), but clinically reported pelvic inflammatory disease was not. Maternal age, parity, previous induced abortion and previous spontaneous abortion were not associated with EP. Use of an intrauterine device, progestagen micro-pill or the combined oestrogen/progestagen pill at the time of conception were associated with a lower risk of intrauterine pregnancy than of EP. These findings confirm the importance of several of the previously reported risk factors for EP; STD's, previous EP and cigarette smoking. They also identify new risk factors: appendicectomy, induced ovulation cycle, and showed that the combined oestrogen/progestagen pill does not prevent ectopic pregnancy as effectively as it prevents intrauterine pregnancy.

Case-Control Studies↗
PubMed1991

[Implementation and evaluation of a program of prevention against abuse in at risk infants].

Teams of pediatricians and psychiatrists led a joint action-research in public health institutions for infants which intended to evaluate original modes of prevention of abuse concerning infants with medico-psychosocial high risk factors. The framework of this study was a randomized controlled trial on the modes of prevention. The sample, consisting of children selected according to risk indicators appearing on their health certificate of the 8th day, was divided into two groups: the treated group who benefited from specific prevention interventions and a control group who benefited from classic surveillance. The research was longitudinal and was centered on the study of mother-infant interactions at 3 months, 1 year, 2 years and 3 years of age. The dynamics of early interactions was studied very precisely on the occasion of each examination. The first results concern the 161 children (72 in the "intervention" group, 89 in the control group) who were evaluated at 1 year of age. Although a real change in practice could be observed (the treated group profited by a mean number of 7.5 actions, while the control group on the average profited by only 1 action), the efficacy of those actions could not be demonstrated. No significant differences were observed between both groups with respect to height and weight growth and psychomotor development, their somatic status and the quality of early interactions, except with respect to a better quality of interactions in the action mode for the treated group. The difficulties inherent in such a type or research are analysed (children lost to follow-up, contamination of the control group by actions intended only to the treated group, difficulty in disposing of reliable criteria of estimation).

Analysis of Variance↗
PubMed1988

The prevention of sexually transmitted diseases which affect fertility: methodological problems and initial results.

Sexually transmitted diseases and their consequences for fertility are currently a major preoccupation in public health. A joint research project is being carried out in France to develop an STD prevention program and then to implement it experimentally to evaluate its efficiency. It includes 2 phases: a feasibility phase, currently concluded, and an active phase, a community randomized trial. The aim of the feasibility phase was to test the research methods and tools and to act as a basis for the design of the prevention program. It measured the incidence of discharge (men and women) at a one-year interval and patient characteristics. Participating physicians were GPs in a French administrative department near Paris. Between the two measurements, information and sensitization actions were carried out in the same department among health professionals and the general public. The results show that the incidence of discharge (chosen here as indicators of STDs) in daily general medical practice is low, of the order of 6 cases per 1000 consultations. The community randomized trial will now be conducted in 6 French administrative departments, randomly divided into 3 treated departments, benefiting from a prevention campaign, and 3 controls, where no actions will be undertaken, and its results will be used in a national STD prevention campaign.

Adult↗
PubMed1988

[Epidemiologic aspects of extrauterine pregnancy].

Looking over the last twenty years, the increase in the numbers of ectopic pregnancies has become an important health issue. It is necessary to find out the principal causes for the rise if preventive action is to be taken. Different publications have widely different views about the incidence of the condition and how the increase came about. This variation is due to the diversity of the places and of the different populations that have been studied (age, the way the populations were recruited) as well as the frequencies that have been calculated (according to the number of pregnancies, according to the number of deliveries or according to the number of women of reproductive age in a population). All the same, the trend can be noted. These are: the doubling or tripling in the last two decades of the incidence in industrialised countries. The results of certain epidemiological studies undertaken to seek out the risk factors (mainly based on case histories) have to be interpreted carefully because of the differences in methodology and particularly in the choice of control groups (there seems to be some failure to take into account confounding factors). The chief of the risk factors for extra-uterine pregnancy which are now considered important are the increase in sexually transmitted diseases and in particular in Chlamydia trachomatis. The role played by tubal sterilisation and by some contraceptive measures such as intra-uterine contraceptive device and the progestational mini-pill in the causation of extra-uterine pregnancy can be explained by the fact that these methods are better at preventing intra-uterine pregnancy than extra-uterine pregnancy, although they to diminish the risk of these as well. Furthermore, spontaneous abortions, abdominal surgery and, above all, terminations of pregnancy which had been said to be conductive to the causation of extra-uterine pregnancies, seem to do this by the fact that they are associated with pelvic inflammatory disease. Finally, the role of in vitro fertilisation, and of vaginal irrigation, as well as of nicotine, should be sought out when further studies are carried out.

Adolescent↗
PubMed1988

[Action-research on the prevention of abuse in the very young child. Methodology and initial results].

Teams of pediatricians and psychiatrists are leading a joint action-research in public health which intends to develop and evaluate original modes of prevention of abuse and grave neglect concerning infants with medico-psychosocial high risk factors. The framework of this study is a randomized controlled trial on the modes of prevention. The sample, consisting of infants under one year of age and selected from their health certificate of the 8th day and 9th month, is divided into two groups: the treated group who benefited from specific preventive interventions and the control group who benefited from classic surveillance. The research was longitudinal and was centered on the study of mother-infant interactions at 3 months, 1 year, 2 years and 3 years of age. The dynamics in the action-research is illustrated by the evolution of the tool for assessment of early interactions and the refocusing of the research. From the analysis of the data from the phase of feasibleness, which included 114 infants, three main results have come out: definition of a "danger" pointer: dysharmonious mother-infant interactions at 3 months; a new risk factor was brought to light: "disrupted grand-parental family"; father's role in mother-infant interactions. These first results have had a major impact on the method for the active phase which is now in progress and intends to evaluate the new modes of prevention.

Child Abuse↗
PubMed1987

[Sexually transmitted diseases in free sexual practice. Epidemiological aspects].

One of the major public health preoccupations at present is the incidence of sexually transmissible diseases and their consequences for fertility. At present there is a programme of combined research by the National Institute of Health and the Medical Research (INSERM U 292) and the Director-General of Health (DGS) and the French Committee for Education in Health Matters (CFES). The object of the exercise is to produce a programme for preventing sexually transmissible diseases and then to put in into action in order to find out how practical it is. The programme consists of two phases, the first which has already been completed was to assess how practical the exercise is, and the second phase which is the active pursuit of the enquiry in a random attempt to change things, and this started in November 1986. The first phase tried to test the methods and see whether they were useful forms of research, and also to serve as a base for the programme of prevention. This consists in looking twice a year at the incidence of discharges in men and in women and the characteristics of the patients who are affected. The consultants were a representative sample of general practitioners who work in the Hauts-de-Seine Department. They gave the information voluntarily. There were two measures carried out in the same region of France. The first was informing the public and making the professionals aware of the situation.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

[Experience of ectopic pregnancy].

This survey relates to the experience and the management of women who have received a treatment for an ectopic pregnancy. It is based on 31 clinical interviews, conducted a month after the end of surgical or medical treatment. Among these women, 42% had had previous treatment for sterility. The main results show that 16% had never previously heard of ectopic pregnancy, and 29% do not see any reason why they had had one. For the patients, the diagnosis had not been made early enough: 45% feel that the consequences could have been serious if they had not taken the matter seriously themselves. Women clearly express some strong feeling against the health professionals (74%) who were responsible for their medical care, in spite of the attention they received, which reveals the psychological trauma they suffered. Although 55% of women felt depressed, for some of them the ectopic pregnancy seemed to operate as an exorcism from a previous more serious situation. They place their hope in a future pregnancy under close medical supervision. When it appears necessary, psychological support should be offered to these patients.

Adaptation, Psychological↗