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Breast cancer risk and oral contraceptive use: results from a large case-control study.

The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.

Adult↗

Clinical experience of AIDS in relation to HIV-1 and HIV-2 infection in a rural hospital in Ivory Coast, West Africa.

A dramatic rise in AIDS cases in a rural hospital 60 km west of Abidjan is described. Out of 212 adult cases diagnosed between January and November 1987 as having AIDS, using the World Health Organization (WHO) criteria defined in Bangui, 128 (60%) had antibodies to HIV-1 only, 61 (29%) had antibodies to both HIV-1 and HIV-2, 15 (7%) had antibodies to HIV-2 only and eight (4%) had no detectable antibodies to HIVs. These results, taken together with those of Ouattara et al. showing that both retroviruses have a similar seroprevalence in the general rural and urban populations, suggest that HIV-2 may have a lower physiopathological potential than HIV-1. This suggestion is supported by a 6-month follow-up of 60 AIDS cases, but only longer follow-up of cohorts of patients and healthy subjects with antibodies to one of the two viruses will allow definitive conclusions.

Acquired Immunodeficiency Syndrome↗

When cultural practices are health risks: the dilemma of female circumcision.

The circumcision of young women and girls is widespread in African countries as well as in other parts of the world and clearly places them at risk for serious health consequences. Plans to eradicate the practice must recognize the cultural underpinnings that have maintained it. This article discusses the types of female circumcision and the concomitant short- and long-term health risks. The cultural aspects and origins of the procedure are described and a simple model of risk-taking based on control, information, and time is used to explain the complexity of issues that may be involved in the decision of women to consent to the procedure.

Adolescent↗

HLA matching at a single kidney transplant center.

Over 1000 patients were analyzed in two different time intervals, 1978-1983 and 1984-1989; these corresponded to patient groups not treated with cyclosporine and treated with cyclosporine. Analysis of mismatching showed that there was a significant (P less than 0.05) longterm matching effect in the precyclosporine, era with 0 HLA-DR-mismatched recipients having a 9.5-year half-life compared with a 3-year half-life for the 2 HLA-DR-mismatched transplant recipients. The trend was similar for the cyclosporine-treated groups, but not significant. Risk factors for donor age and race of the recipient (P less than 0.05) were identified in the cyclosporine-treated group. Graft survival in the high-risk patient populations was 70% or better in the 0, 1 HLA-ABDR-mismatched groups as compared with less than 60% graft survival in the high-risk transplant recipients with 2-6 HLA-ABDR mismatches. In the cyclosporine era the HLA-ABDR 0, 1-mismatched patient groups showed a significantly better graft survival than was found in all other categories and at all time intervals analyzed. Matching is a way to ameliorate some of the high risk potential associated with less than optimal donor or recipients.

Age Factors↗

Tubal cyst following tubal sterilization: a delayed complication.

Clinical pictures and histopathological findings in 15 patients of tubal cyst following tubal sterilization were analyzed. The interval between tubal sterilization and occurrence of tubal cyst was 10 years (ranged from 4 to 21 years). Clinically 8 cases (53%) suffered from lower abdominal pain, 5 cases (33%) from hypermenorrhea coexistent with uterine myoma and 2 cases (13%) from irregular menstruation. Five out of 9 patients with ultrasound examination were suspected to have tubal cyst before operation. The size of tubal cyst ranged from 1.5 to 9.0 cm in diameter with mean 3.4 cm. Eleven were unilateral and 4 were bilateral. Histologically they showed flattened mucosal epithelial cells with absence of epithelial plica, compression atrophy of muscular layer, suture stitch or granuloma and intact fimbria with clear serous fluid. Thus, the differential diagnosis of adnexal cyst in patients with a past history of tubal sterilization should include tubal cyst.

Adult↗

Trabecular bone in long-term depot-medroxyprogesterone acetate users.

A cross-sectional study was designed to determine trabecular bone density in 75 long-term depot-medroxyprogesterone acetate (DMPA) users (> 3 yr) matched with non-DMPA users by age, body mass index (18-25), limitation of age (< 45 yr), and body weight (< 60 kg). The long-term DMPA cases were divided into 3 groups according to duration of injectable contraceptive use. Neither cases nor controls had a smoking or chronic alcohol consumption history. Cases and controls were matched by age. Trabecular bone of the femoral neck were assessed by X-ray and interpreted by a single-blinded radiologist. Trabecular bone patterns were graded according to Singh's Index. Blood collection for determination of estradiol, prolactin, calcium, phosphorus, and medroxyprogesterone acetate were performed in cases and controls. Venous blood was taken at twelfth week of injection of DMPA and within 5 days after menstrual bleeding cessation in the controls. Mean trabecular bone in the cases was 5.5 +/- 0.6 (range 4-6). It was not statistically different from that in the controls (mean 5.5 +/- 0.6, range 2-6). No statistically significant difference of serum, calcium, phosphorus, prolactin, and estradiol was seen in the cases when compared to controls at mid follicular phase of normal menstrual cycle. Serum MPA of individual case at twelfth week of injection was 4.1 +/- 1.1 nmol/l. In conclusion, trabecular bone density in long-term DMPA users were not statistically different from normal menstruating women who have not received injectable DMPA.

Adolescent↗

The long-term outcome following "special clearance" after vasectomy.

Between 1980 and 1985, 6067 out-patient vasectomies were performed under local anaesthesia at the Elliot Smith Clinic in Oxford. During this period 151 men (2.5%) were given a "special clearance". This sanctioned the discontinuation of other forms of contraception despite the persistence of scanty (less than 10,000/ml) sperm in 2 consecutively examined semen samples at least 7 months after vasectomy. These men have been reviewed and further specimens of semen requested after a minimum follow-up of 3 years (range 3-8); 50 patients supplied a specimen and all except 1 were azoospermic. No pregnancies attributable to failure of the vasectomy have been identified.

Adult↗

Chronic testicular pain following vasectomy.

The incidence of chronic testicular pain following vasectomy has not been previously assessed. We have carried out a survey by postal questionnaire and telephone interview of 172 patients 4 years after vasectomy to assess the incidence of chronic testicular pain. Significant early post-operative complications occurred in 6 patients (3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular discomfort was present in 56 patients (33%), considered by 26 (15%) to be troublesome but not by the other 30 (17%). Testicular discomfort related to sexual intercourse occurred in 9 cases (5%). Of the 9 patients who had sought further medical help only 2 had had further surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3 patients regretted having had the vasectomy because of chronic pain. On ultrasound examination, epididymal cysts were a common finding on both asymptomatic and symptomatic patients following vasectomy. Prior to vasectomy, all patients should be counselled with regard to the risk of chronic testicular pain.

Adult↗

International migration: some consequences for urban areas in Australia and New Zealand.

"This article provides a broad overview of literature on some of the consequences of international migration for urban and, in particular, metropolitan areas in Australia and New Zealand. The focus therefore is diverse; highlighting similarities in the experiences of each country...;and emphasizing long-term and permanent movements favoured by successive governments on both sides of the Tasman Sea.... The four sets of impacts discussed in this article relate to the population, labour force, residential and settlement patterns and social and cultural factors." (SUMMARY IN FRE AND SPA)

Australia↗

Medical abortion or vacuum aspiration? Two year follow up of a patient preference trial.

OBJECTIVE: To describe and compare health outcomes two years after medical abortion or vacuum aspiration in women recruited into a patient preference trial during 1990 to 1991. DESIGN: Women recruited to the original, partially randomised study were contacted for assessment using a structured interview. SETTING: Grampian region of Scotland, UK. PARTICIPANTS: One hundred and forty women who had participated in a partially randomised study of first trimester abortion two years previously. INTERVENTION: Vacuum aspiration or medical abortion using mifepristone and gemeprost. MAIN OUTCOME MEASURES: Long-term general, reproductive and psychological health; acceptability of procedure; perceived value of choice of method of termination. RESULTS: There were no significant differences between women who had undergone medical abortion or vacuum aspiration two years previously in general, reproductive or psychological health. Almost all women placed a high value on the provision of choice of method of termination. There was a significant difference in perception of long term procedure acceptability among women who had been randomised to a method of termination. CONCLUSIONS: Women should have the opportunity to choose the method of termination. This opportunity will result in high levels of acceptability, particularly at gestations under 50 days of amenorrhoea.

Abortifacient Agents, Nonsteroidal↗

Induced abortion in the first trimester of pregnancy and risk of miscarriage.

OBJECTIVE: To analyse the relation between induced abortion and risk of subsequent miscarriage. DESIGN: Case-control study conducted between February 1990 and May 1995. PARTICIPANTS: Case group included 782 women (median age 32 years, range 14-46) admitted for spontaneous abortion (within the 12th week of gestation) to a network of obstetric departments in the greater Milan area. The control group was recruited among women who gave birth at term (> 37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. A total of 1543 controls (median age 30 years, range 14-45) were interviewed. RESULTS: A total of 102 cases (13%) and 181 controls (12%) reported one or more induced abortions. No clear relation emerged between miscarriage and induced abortions. In comparison with women reporting no induced abortion the odds ratio (OR) for miscarriage were 1.1 (95% CI 0.8-1.4) in women reporting one induced abortion and 0.9 (95% CI 0.4-1.8) in women reporting two or more. Likewise, there was no association between time since last and age at first induced abortion and risk of miscarriage. CONCLUSIONS: This study did not find any strong association between induced and spontaneous abortion.

Abortion, Induced↗

Clinical norms for amplitude of accommodation in Chinese.

Amplitude of accommodation was measured in 121 Hong Kong Chinese subjects between the ages of 11 and 65 years, using the 'push-up' method and the results compared with those previously obtained for Caucasian subjects. The results confirm and quantify clinical experience that Chinese people have lower amplitudes of accommodation than Caucasians. If presbyopia is considered to commence when the amplitude of accommodation declines to less than 5 D, then presbyopia in the Chinese race occurs between the ages of 36 and 40 years. By early in the second decade of life the amplitude of accommodation in the Chinese is already lower than that of Caucasians. This suggests that reduced amplitude of accommodation may be due, at least in part, to factors other than longterm environmental effects.

Accommodation, Ocular↗

Vesicovaginal fistula and its complications due to prolonged use of vaginal diaphragm.

The vaginal diaphragm is currently less popular than other contraceptive methods, such as the pill, IUDs or surgical sterilization. It is however, regarded as one of the safest methods of contraception available and complications of diaphragm use are rare. This report describes a case in which a vesicovaginal fistula and genitourinary tract infections complicated the use of this contraceptive method.

Contraceptive Devices, Female↗

Association of maternal, antenatal and perinatal complications with suicide in adolescence and young adulthood.

The aim of the present study was to investigate whether maternal, antenatal and perinatal complications are associated with adolescent or young adulthood suicide in offspring. Cases consisted of individuals, aged 15-22 years, born in New York City and committing suicide in New York City between 1985 and 1991 (n = 189). Two controls were selected for each case, constituting the hospital birth immediately preceding and following that of the case, matched with the case with regard to sex and ethnicity. Cases were compared with controls using an index that summed a range of maternal, antenatal and perinatal complications and also with regard to the frequency of individual complications. In the total sample, cases and controls did not differ either in the mean number of all complications combined or in the proportions with specific complications. This lack of association between complications and outcome also obtained in separate analyses by sex, ethnicity, socio-economic status and age at suicide. These results fail to replicate the findings of two previous reports implicating maternal, antenatal and perinatal complications in risk of youth suicide. At present, epidemiological evidence that adverse reproductive events increase the risk for suicide in offspring remains inconclusive.

Adolescent↗

[Photodamage and photoaging--prevention and treatment].

The exposure of human skin to environmental and artificial ultraviolet irradiation has increased significantly. This is not only due to an increased solar UV irradiation as a consequence of the stratospheric ozone depletion, but also the result of an inappropriate social behaviour with the use of tanning parlors being very popular. Besides this, leisure activities and living style with travelling to equatorial regions also add to the individual annual UV load. Since the population in industrialised countries shows an increasing total life span, in parallel the cumulative life time dose of solar and artificial UV-irradiation is dramatically augmented. In addition to the common longterm detrimental effects like immunosuppression and skin cancer, the photooxidative damage due to energy absorption of UV photons in an oxygenized environment leads to alterations of cells, subcellular compartments and macromolecules. The clinical manifestations of UV/ROS induced disturbances result in photoaged skin with wrinkle formation, laxity, leathery appearance as well as fragility, impaired wound healing and higher vulnerability. Strategies to prevent or to minimize photoaging and intrinsic aging of the skin necessarily include protection against UV irradiation and antioxidant homoeostasis. New developments of therapeutic interventions including DNA repair enzymes will be discussed.

Adult↗