Role of indigenous medical practitioners (IMPs) in reproductive health in rural India.
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AIM: To describe differences in life style variables according to socioeconomic groupings and to analyse the association between birth weight, stillbirth and congenital malformation according to the socioeconomic grouping for the father as well as the mother. METHOD: Follow-up of 11,888 pregnant women in Odense and Aalborg, Denmark who were consecutively enrolled in the study from April 1984 to April 1987 as part of a community trial. DATA: Information on socioeconomic group and life-style factors were collected by means of self-administered questionnaires in the 36th week of gestation. Data on pregnancy outcomes were collected from birth certificates and medical records according to standardized search routines. RESULTS: Women in the lower socioeconomic groups were younger, smaller, had a higher prepregnancy weight, smoked more and had a higher intake of coffee during pregnancy than women in higher socioeconomic groups. Better off women, on the other hand, had a higher consumption of alcohol, fish, and vegetables. Low birth weight was found to be negatively correlated with socioeconomic grouping. The lowest birth weights were found among babies born to unskilled and unemployed women even after adjustment for smoking habits, prepregnancy height and weight and a number of other potential confounders. Stillbirth and the prevalence of congenital malformations was not associated with socioeconomic grouping, but the amount of information was very limited regarding these outcomes.
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CONTEXT: In Ghana, as in many other Sub-Saharan African countries, the behaviors of the current cohort of adolescents will strongly influence the course of the HIV/AIDS epidemic. This study sought to identify factors associated with elevated risks of pregnancy and sexually transmitted infection among unmarried Ghanaian youth. METHODS: A nationally representative sample of 3,739 unmarried 12-24-year-olds were surveyed. Various regression techniques were used to assess the effects of individual and contextual factors on sexual behavior and condom use. RESULTS: Forty-one percent of female and 36% of male youth reported being sexually experienced. On average, sexually experienced youth had had fewer than two partners; only 4% of these females and 11% of males had had more than one sexual partner in the three months before the survey. Although Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner. A sizable number of contextual factors and attributes of youth themselves were associated with sexual behaviors, while individual characteristics were stronger predictors of condom use. CONCLUSIONS: The findings provide further justification for interventions targeting key contextual factors that influence youth behaviors in addition to providing youth with necessary communication, negotiation and other life skills.
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OBJECTIVES: Cervical cancer is the most common malignancy affecting Colombian women. Pap smear screening is used for its early detection. Early stages of cervical cancer can be expressed by the presence of inflammatory atypia in the Pap smear. The main objective of this study is to evaluate the role of inflammatory atypia in Pap smear as a marker of squamous intraepithelial lesions (SIL), given that it is not clear how to deal with the presence of inflammatory cells in Pap smear. MATERIALS AND METHODS: A cross sectional study was carried out to establish the operative characteristics of the cervical Pap smear in the colposcopy clinic of the Clínica Piloto Profamilia, Bogotá, between January 1999 and December 2003. We compared patients with biopsies reporting SIL and those with a benign report in the pathologic study. We evaluated sensitivity the and the specificity of the Pap smear in different cutting points compared to the pathology report as gold standard. RESULTS: The prevalence found was 48,7 % for low grade - Squamous Intrepithelial Lesions (SIL) and 9,7 % for high grade - SIL. The best performance for the Pap smear test to detect SIL was when the atypical squamous cells of undetermined significance (ASCUS) were considered as abnormal. Severe inflammatory atypia were associated to SIL in a similar way as to ASCUS. CONCLUSIONS: Sensitivity of the Pap smear as a screening test decreases when excluding Pap smears reporting ASCUS as a cutting point. In our environment, we recommend to report inflammatory atypia on the Pap smear test stratified by severity until the role of severe inflammatory atypia for the diagnosis of SIL is defined.
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This study assessed the quality of written information about abortion methods provided by clinics in England and Wales. Forty-four sets of leaflets were collected. The average leaflet was found to provide only half the possible information about benefits, risks and general procedures. Only half of the leaflets were of standard readability and accessible by 83% of the British population. Therefore, it seems unlikely that most women in England and Wales are in a position to make an informed decision about abortion method.
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BACKGROUND: Acupuncture as a therapy, and acupressure as self-treatment, are increasingly widely used for gynaecological conditions, and this study aims to review the scientific literature on their effectiveness. METHOD: A systematic review of controlled trials of acupuncture or acupressure for gynaecological conditions, published in a European language. SYNTHESIS: No studies in mastalgia, menorrhagia, pelvic pain, premenstrual syndrome or vulvodynia met the inclusion criteria. Four studies, two of which were patient-blinded, of acupuncture or acupressure for dysmenorrhoea suggest that it may have an effect. Three studies of acupuncture given at various stages of infertility treatment are promising, but none was patient-blind. Two studies of acupuncture for menopausal symptoms showed no effect during the treatment period when compared with sham acupuncture, and a third study showed no effect on hypertension in postmenopausal women, though some improvement in symptoms was noted. CONCLUSION: In view of the small number of studies and their variable quality, doubt remains about the effectiveness of acupuncture for gynaecological conditions. Acupuncture and acupressure appear promising for dysmenorrhoea, and acupuncture for infertility, and further studies are justified.
In the UK, mifepristone and gemeprost are licensed for medical termination of pregnancy (TOP) in the first trimester up to 63 days' amenorrhoea. Current practice, however, is to use low-dose (200 mg) mifepristone and misoprostol. We report a large cohort study using these drugs for medical TOP in the first trimester after 63 days amenorrhoea. Of 415 patients undergoing the procedure, 392 (95%) aborted completely and 96% required only two doses of misoprostol. We conclude that the regime is effective with few complications, however certain safeguards may be necessary for its widespread introduction
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A 1984 pilot survey of administrators of 35 agencies offering family planning services revealed that all offered counseling/educational services for males, and 89 per cent offered medical/supply services for males. Nevertheless, total utilization of these services is low. Major barriers related to the provision of services to male clients are resource limitations, inadequate training, and negative or ambivalent staff attitudes; these factors may contribute to the discrepancy between service offering and utilization.
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