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PubMedDate not supplied

In utero exposure to environmental estrogens and male reproductive health: a systematic review of biological and epidemiologic evidence.

In recent years, chemicals with hormone-like properties have become a topic of scientific and public discussion. It has been hypothesized that prenatal exposure of the male fetus to endocrine disruptors may be responsible for a series of outcomes, such as hypospadias and cryptorchidism. The purpose of this study was to review the endocrine disruption hypothesis, to present the relevant supporting evidence, to summarize the current knowledge, to identify gaps and limitations in the interpretation of published data, and to define future directions in research. An update on environmental estrogens was followed by an assessment of the biological plausibility and evidence connecting the environmental chemicalization with adverse reproductive outcomes in males. Subsequently, we carried out a systematic review of human studies attempting to document a direct effect of exogenous estrogens on the male reproductive system. The results do not support with certainty the view that environmental estrogens contribute to an increase in male reproductive disorders, neither do they provide sufficient grounds to reject such a hypothesis.

Cryptorchidism↗
PubMed2000

A reproductive health survey on unintended pregnancy in Yamagata, Japan: feasibility of the survey and test-retest reliability and validity of a questionnaire.

We have designed a survey to investigate factors related to unintended pregnancy using a newly devised questionnaire. This pilot study was conducted to examine the feasibility of the study and the test-retest reliability and the validity of the questionnaire. Samples were 107 cervical and breast cancer screening participants aged 35-49 year-old in 1999 in Yamagata, Japan. The same questionnaires were mailed twice to examine the test-retest reliability. Women's medical records for cancer screening were used to examine the validity of the questionnaire. Ninety-six women agreed to participate in the study and 89.6% of them responded to the first survey. The agreements between two surveys were substantial to perfect for the nominal and ordinal data, and for the continuous data, the standard deviations (SDs) were less than 1 and the correlation coefficients were over 0.6. The comparison between medical record and questionnaire derived data showed perfect agreements for reproductive items except age at last birth (SD: 0.71, correlation coefficient: 0.97), and fair agreements for drinking and smoking habits. Obtaining information on unintended pregnancy by questionnaire is feasible, and the test-retest reliability and the validity of the questionnaire are satisfactory. Currently we are conducting a survey with a larger sample.

Adult↗
PubMed2002

Reproductive health in SLE.

Oral contraceptives containing oestrogens and hormone replacement therapy are generally not prescribed for women with systemic lupus erythematosus (SLE). The concern regarding oestrogens is based on the greater incidence of SLE in women, abnormalities of oestrogen metabolism, murine models of lupus, several anecdotes of patients having disease flares while receiving hormones, and one retrospective study in patients with pre-existing renal disease. For healthy women and those with SLE, there are clinical settings in which exogenous oestrogens provide benefit. For pre-menopausal women, these include provision of safe and effective birth control, protection against bone loss, and the consideration of oral contraceptives to preserve fertility in patients taking cyclophosphamide. For post-menopausal women, these include treatment of hot flushes and vaginal dryness, prevention of osteoporosis and, more controversial, prevention of atherosclerosis. Other exogenous hormones (clomiphene citrate, gonadotropins, gonadotropin-releasing hormones) may be used to elevate levels of endogenous oestrogen and stimulate ovulation in patients with diminished fertility. This chapter focuses on three broad categories: birth control, assisted reproduction and hormone replacement.

Contraceptives, Oral↗
PubMed2004

Plasticizers, infant nutrition and reproductive health.

Since the 1930s, plasticizers have been used to impart flexibility to an otherwise rigid polyvinylchloride (PVC). Di-(2-ethylhexyl)-phthalate (DEHP) is the most widely used plasticizer in PVC formulations. However, DEHP leaks out from PVC items with time and use and consequently it is an ubiquitous environmental contaminant. To date, very little is known about the actual extent of DEHP exposure in infants, who are believed to be the most sensitive population, as they may be exposed to several different sources (breast milk, infant formula, baby food, indoor air, and by dermal and oral exposure via indoor dust containing DEHP) since early in life and since differences in DEHP pharmacokinetics and metabolism between children and adults have been well documented. Little information exists on DEHP dietary exposure, believed to represent a major source and orally administered DEHP is converted more rapidly to MEHP than other routes of exposure. Although DEHP has been shown to induce toxicity in experimental animals, a limited but suggestive human exposure data causes a serious concern that an early in life DEHP exposure may adversely affect male reproductive tract development. Here, we report a review on dietary phthalate exposure in babies.

Adult↗
PubMedDate not supplied

[Study of reproductive health risks in Sicily. Congenital malformations and exposure to EDCs: a case-control study (study methodology)].

INTRODUCTION: The incidence of Congenital Malformations may represent an early biological indicator for human toxicity to environmental and occupational contaminants. SCIENTIFIC OBJECTIVE: We are in the process of exploring the relation between various potential sources of parental periconceptional pregnancy exposures to Endocrine Disrupting Chemicals (EDCs) and selected Congenital Malformations in offspring. MATERIALS AND METHODS: The low incidence of Congenital Malformations leads to an epidemiological "Case-Control" study. The areas of the study are the Ragusa Municipalities and the south-east Siracusa Municipalities. We are conducting personal interviews with parents of about 100 cases with orafacial clefts or male genital malformations and 200 nonmalformed controls. The infants for the study were selected from those born during 1998-2002 in these areas. The more important variables considered are: 1--parental occupation and workplace exposures. 2--relevant confounders and recall bias. The analysis of the data will use the classical approach of case-control study (matching procedure), comparing risk factor frequency between cases and controls. CONCLUSIONS: The results of the study will allow to clarify the relationship between parental exposure to EDCs compounds and human reproduction.

Abnormalities, Drug-Induced↗
PubMed2005

[Sexual and reproductive health--specific problems in adolescence].

The specificity of adolescent gynecology is uncontested and asks for a specific knowledge and approach. Even if the symptoms remain the same, differential diagnostic and therapeutic approach will be different, depending on the state of development (early puberty, late adolescence), during which they occur. The ignorance of specific pathologies (utero-vaginal malformation, ovarian pathologies related to the menstrual cycle) and therefore inadequate or retarded medical treatment might be the source of unnecessary sequellae. There are now many possibilities to acquire or improve one's knowledge and skills in this particular domain of gynecology. The medico-legal situation as well differs in many points from that of the adult.

Adolescent↗
PubMed2005

Transdisciplinary training in reproductive health through online multidisciplinary problem-solving: a proof of concept.

OBJECTIVE: The problem of iatrogenic multiple pregnancies has been addressed through an online multidisciplinary discussion forum with the primary aim of developing a transdisciplinary research and training tool. STUDY DESIGN: The pedagogical approach was divided in three phases, unidisciplinary, multidisciplinary and multi/transdisciplinary. Evaluation of the level of transdisciplinarity reached by each of the students was based on their capacity to translate disciplinary knowledge, to establish a frank dialogue, to cross disciplinary barriers, to detach from their initial opinion, and to develop curiosity for others' perspectives and concerns. RESULTS: Translation of disciplinary knowledge and frank dialogue were easily performed by all. Most students showed curiosity towards the others' point of view and started to be preoccupied with the concerns of other students. CONCLUSION: Online discussion forum is a particularly well-adapted tool for transdisciplinary research and training.

Education, Medical, Graduate↗
PubMed2003

Increasing patient participation in reproductive health consultations: an evaluation of "Smart Patient" coaching in Indonesia.

Paternalistic models of health care, social distance between patients and providers, and cultural norms discourage patients from playing an active role in health consultations. This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers. Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions, expressing concerns, and seeking clarification. An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others. Coaching narrowed differentials in active communication by patient type, age, and assertiveness, but it widened differentials by patient education and socioeconomic class. The discontinuation rate at 8 months was lower in the intervention than the control condition, but the difference was only marginally significant.

Adolescent↗
PubMed1997

Evaluation of nature-nurture impact on reproductive health using half-siblings.

Research in the field of preventive medicine will increasingly focus on the role of genetic susceptibility in disease etiology. Epidemiology plays an important role in identifying which diseases are good candidates for such research activity. Computerized population registries of unstable partner relationships and change in environmental exposure settings may provide new tools for research. We illustrate these tools using facial cleft defects as an example. The design is based upon computerized and stored data from large population samples. Data on change of partner or environment between births are used to learn about the recurrence risks for diseases that were present in their first child. The study focused on a susceptible subgroup of the population who previously had an affected child. Thus, by definition, these couples had a sufficient set of causes to initiate the disease and an increased risk of recurrence if relevant genetic or environmental factors remained unchanged. When considering recurrence risks after changes in possible genetic or nongenetic risk factors, etiologically important clues may emerge. The example confirms that genetic factors play a major role in facial cleft defects.

Cleft Palate↗
PubMed2006

[Medical-social aspects of reproductive health in pregnant women with perinatal pathology].

On the basis of epidemiological research the state of health of pregnant women and perinatal outcomes in some regions of Azerbaijan republic were investigated. The analysis of perinatal death rates with revealing cases potentially preventing losses, the reasons and risk factors perinatal pathology rates in regional conditions were carried out. The examination of 200 pregnant women from the group with a high risk factor (in connection to the extragenital pathology burdened by the obstetric gynaecological anamnesis) and 100 pregnant women with late beginning of the obstetric survey was carried out. The program pregraviditary preparations and preventive maintenance of pregnant women in high risk group, complex inspection of fetus condition and fetal-placental systems from early terms gestation was a reserve in decrease perinatal diseases and death rates. In this group of patients who were regularly surveyed during the pregnancy, more favourable outcomes were noted which manifested themselves in lower parameters of the morbidity and mortality rates.

Adult↗
PubMed2005

Resumption of sexual relations following childbirth: norms, practices and reproductive health issues in Abidjan, Côte d'Ivoire.

Before modern contraceptive methods were available in developing countries, post-partum sexual abstinence formed the backbone of birth spacing. With the changes occurring in African societies, how has post-partum sexual abstinence been affected? We conducted an exploratory study in 2000-2001 in Abidjan, Côte d'Ivoire with 23 women and 19 men who were parents of small children. Breastfeeding remains widespread and prolonged. Resumption of sexual relations after delivery was a mean of 11 months. Post-partum sexual abstinence was only distantly related to the traditional lactation taboo. Women expressed fears that their partner would seek elsewhere if they delayed sexual relations too long, and the risk of early pregnancy. Abstinence remained the main way to space births, given low contraceptive use. Mothers generally decided when to wean a child. Men usually made the first move to resume sexual relations, though most women negotiated timing and some insisted on condom use. Provision of condoms post-partum can play a contraceptive role for married couples and protect against STIs/HIV in extra-marital relationships, which are frequent post-partum. The duration of post-partum abstinence is in fact unclear because irregular sex may happen early and become regular only later. Women need post-partum information and services that address these issues.

Adolescent↗
PubMed1996

Urbanisation, household composition and the reproductive health of women in a South African city.

Post-apartheid South Africa is faced with the effects of a distorted urbanisation process. A coherent response to urbanisation includes the mitigation of the adverse health effects of urbanisation. Women, by virtue of the stringent control of their movements to urban areas under apartheid, have migrated to the urban areas at an increasing rate recently. One consequence has been the transformation of traditional household structures consonant with changing patterns of fertility and infertility in the urban areas. This paper describes the composition of households in Khayelitsha, South Africa, a suburb that has seen an explosive increase in population over a 5-year period, from 5000 to an estimated 250,000 people. A survey of 659 households revealed the woman-headed households increased from 11% in those women who had been in the urban areas for fewer than 5 years, to 35% in those who had been in the urban areas for more than 20 years. This was not a function of widowhood or divorce, but appears to be an adaptive strategy adopted by women in the face of gender oppression in a harsh urban environment. The study also revealed the phenomenon of "alliance" household formation, in which atypical households made up of a variety of non-descript combinations of people provide support for women from remote rural areas, another adaptive strategy. Fertility was related to age, income, education and urbanisation. Women who had been in the urban areas for longer than 10 years had a total fertility rate (TFR) of 2.5, while those who had been in the urban areas for less than 10 years had a TFR of 5.8. Reported infertility was related to marital status, education, gynaecological illness and urbanisation, with recently urbanised women reporting more infertility. This probably reflects the different expectations of rural women and changes the mix of attitudes to fertility in the urban areas substantially. These findings have major implications for population policies in South Africa and an eclectic mix of approaches, including small area-specific approaches, to family spacing is recommended.

Adolescent↗
PubMedDate not supplied

Methodological issues of randomized controlled trials for the evaluation of reproductive health interventions.

Randomized controlled trials proved the most valid basis for comparing alternative treatment modalities. Unfortunately, the quality of many such trials has not been as high as our patients deserve. We offer here methodological and practical insights to key issues related to the design, implementation, and analysis of randomized controlled trials in obstetrics and gynecology, based on our experience in exploring research hypotheses in this field. Specifically, we present randomization as a method for the prevention of confounding; we discuss the process of randomization and the bias that can be introduced to randomized controlled trials by some popular methods of randomization. The strategies for presenting baseline comparisons and evaluating the impact of a treatment or intervention are also reviewed. We hope to contribute to a more rigorous selection of treatments for our clinical and public health armamentarium.

Bias↗