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At least 595 records · Page 33Linked to original sources
PubMed2005

Modern embryo transfer catheters and pregnancy outcome: a prospective randomized trial.

OBJECTIVE: Embryo transfer (ET) is the final crucial step in IVF treatment. The type of catheter used can affect the pregnancy rate (PR). In this prospective, randomized trial we compared the clinical PR between the Wallace and the Cook K-Jet embryo transfer catheters. DESIGN: Prospective, randomized clinical trial. SETTING: A National Health Service Assisted Reproduction Unit. PATIENT(S): One hundred fifty women undergoing a fresh ET. Age more than 40 years, a high basal FSH, a previous difficult ET, or more than six previous ETs were the exclusion criteria. INTERVENTION(S): Women undergoing a fresh ET were randomized at the time of ET to either the Cook K-Jet or Wallace embryo transfer catheter. The randomization was stratified according to age and the number of previous ETs. MAIN OUTCOME MEASURE(S): Clinical PR. RESULT(S): There was no significant difference in the clinical PR between the Wallace and the Cook catheters (22/75 [29.3%] and 23/75 [30.6%], relative risk [RR]: 0.96 [95% confidence interval 0.58-1.58]). CONCLUSION(S): There is no significant difference in the PRs achieved by modern, soft, double-lumen ET catheters.

Adult↗
PubMed2004

Observations on reproductive health programs in the Baltic States.

Public attention in Sweden has been drawn to three neighboring states that recently joined the European Union: Estonia, Latvia, and Lithuania. At this historic moment, it seems instructive to look at how the rapidly reformed health sectors of these ex-Soviet republics are responding to the vision of reproductive health articulated in Cairo 10 years ago. Reproductive health and rights have improved in these states in spite of recent reforms often acting to oppose improvement. Reforms such as the introduction of family medicine need continued adjustment, especially regarding antenatal care. One special challenge is the retention of essential mid-level providers, such as midwives, as the mode of HIV transmission becomes increasingly sexual.

Baltic States↗
PubMed2006

Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention.

OBJECTIVE: To examine HIV-positive women's decision making in the context of pregnancy and HIV/AIDS and to explore interventions that may enhance and develop women's decision-making capacity in the sub-Saharan African context. METHODS: The Ottawa Decision-Support Framework was used to assemble evidence of women's decision-making needs. Several electronic databases were searched and an Internet search of the World Wide Web was conducted to search grey literature sources. An evidence-based approach to assessing benefits, harms and current practices was employed. RESULTS: Several gaps in our knowledge about women's decision making in the context of pregnancy and HIV were identified. The availability of evidence varied for each decision; however, significant gaps included: evidence around testing for ones status, advanced directives for self and child, disclosure (specifically, the impact of), others perceptions of antiretroviral use and data on termination of pregnancies. CONCLUSION: Decision making as a concept was generally not addressed in the MTCT literature. Evidence regarding the perceptions of women and others regarding the various decisions was often not available and subsequently an important aspect of MTCT interventions neglected. PRACTICE IMPLICATIONS: Incorporating a multi-disciplinary decision-support framework may prove useful to promote women's autonomy and involvement in MTCT-related decision making.

Africa South of the Sahara↗
PubMed1984

Evaluation, therapy, and outcome in 493 infertile couples.

From 1973 through 1979, 493 infertile couples were evaluated for their infertility problem, allowing for a minimum follow-up of 1 year and a maximum follow-up of 7 years. Accurate records were kept on margin-punched cards for easy review and updating. Ovulation defects; male factor problems, and tubal disease accounted for 60% of the diagnosed causes of infertility. No diagnosis was made in 25% of the patients studied. Therapy began as soon as indicated and continued concurrently as the diagnostic evaluation progressed. Among the 493 infertile couples, 257 (52%) patients had a successful outcome; 90% of this group conceived by 1 year after the initial visit. One hundred thirty-seven patients underwent both hysterosalpingography and laparoscopy during their diagnostic evaluation. The interpretation of the hysterosalpingogram was wrong in about one third of the cases. Of 37 (7.5%) undiagnosed patients who underwent complete evaluation, including visualization of the pelvis by either laparoscopy or laparotomy, only 12 eventually conceived, 11 by the end of 1 year from the initial visit.

Adult↗
PubMed2002

'A practical approach to gender-based violence: a programme guide for health care providers and managers' developed by the UN Population Fund.

Gender-based violence (GBV) is a worldwide problem that can have serious physical and psychological consequences. Women need to be assessed for GBV and a logical place to do so would be where women go for health care, reproductive health facilities. The United Nations Population Fund (UNFPA) has developed 'A Practical Approach to Gender-Based Violence: A Program Guide for Health Care Providers and Managers' to assist reproductive health facilities in integrating GBV into their programs. This article briefly describes the project options and the steps that need to be taken in order to implement such projects.

Domestic Violence↗
PubMed2002

Short-changing reproductive health.

Health sector reformers, particularly the economists among them, are prone to reject calls for more financial support for reproductive health as "special pleading" even when the argument is made that reproductive health is a basic human right. Reproductive health is not alone in this. Up to now, however, the idea that the right to reproductive health care should take precedence over other health rights has not been put on the table. Economists ask how much interventions cost and whether there is enough money to cover all of the interventions being proposed; if not, they ask which interventions will be funded. Basing decisions about spending for health on evidence about the burden of disease is a way of using the principles of economics to improve health systems performance. However, this methodology poses some special problems for reproductive health as pregnancy is not a disease. Further, economic principles are not the only valid criteria for decisions about health care funding. Those who are concerned about reproductive health need to remain vigilant about the impact of these changes and counter with their own evidence on how they may or may not be contributing to improved health system performance and to reproductive health and rights.

Decision Making, Organizational↗
PubMed2002

The politics of priority setting for reproductive health: breast and cervical cancer in Ghana.

Priority setting for reproductive health is affected by health sector reform policies, the often politically charged nature of issues such as abortion, decreasing funding for reproductive health activities and the broad agenda of the ICPD Programme of Action. This paper examines the influence of political and organizational factors on national priority setting for reproductive health and argues that existing priority setting tools such as disability-adjusted life years and cost-effectiveness analysis do not consider the influence of politics on the priority setting process or account for the interpretation of evidence in priority setting. It suggests that priority setting tools can be strengthened by incorporating empirical measures of political and organizational attention to an issue, and through a new measure--policy priority. The paper applied this new measure to a case study of attention to breast and cervical cancer in Ghana from 1990-97, illustrating how traditional priority setting methods cannot explain the priority given to breast cancer in Ghana. It demonstrates how local politics can trump scientific and economic evidence and suggests that the priority setting process can have unforeseen equity and social implications. It concludes by arguing that the policy priority measure provides a more complete picture of reproductive health priorities and is useful for better understanding the implications of the priority setting process for reproductive health.

Breast Neoplasms↗
PubMed2001

Reliability of adolescents' self-reported sexual behavior: a comparison of two diary methodologies.

PURPOSE: To evaluate techniques for measuring high-risk sexual behaviors by comparing the reliability and acceptability of two daily sexual behavior diary modes: a written calendar and an automated telephone interview. METHODS: This randomized controlled study included 105 sexually active female adolescents aged 15-19 years recruited from among teens seeking reproductive health care services at a family planning clinic in the San Francisco Bay Area. Participants completed a standardized sexual behavior questionnaire each day for 4 weeks. Contraceptive use by method type was recorded. Reporting differences between the two diary modes were assessed using generalized estimating equations, concordance of diary and retrospective interview responses was evaluated using kappa statistics, and contingency table analysis and Poisson regression models were constructed to examine mode acceptability. RESULTS: Respondents randomized to the telephone diary cohort reported less frequent use of barrier contraceptive methods, specifically less spermicide use (odds ratio 0.27, 95% confidence interval 0.08, 0.95), and decreasing male condom use over time, whereas reports of male condom use increased for written diary respondents (p = .007). Participant characteristics associated with diary acceptability, defined as the frequency of diary completion, were assessed and teens classified as higher risk provided fewer diary reports (p < .01). Regardless of mode completed, 65% of respondents believed the telephone diary would be preferable to the written diary for most teens. CONCLUSIONS: The automated telephone diary offered an acceptable, even preferred, methodologic alternative to the written diary calendar and elicited more accurate reporting of selected contraceptive behavior.

Adolescent↗