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PubMed2005

[Analysis on the relative factors of trichomonal vaginitis in married childbearing age women in rural impoverished area].

OBJECTIVE: To investigate the status and relative factors of trichomonal vaginitis among married childbearing age women in rural impoverished area of the northwestern part of China and hence identify the risk factors and provide a basis for the prevention and treatment of trichomonal vaginitis. METHODS: Questionnaire investigation, gynecological and laboratory examination were carried out in 480 women who had been selected by multi-stage cluster sampling in rural impoverished area of Bao Ji in ShannXi province. A case-control study was conducted to analyze the relative factors of trichomonal vaginitis and other reproductive tract infection (RTI) complications. RESULTS: The prevalence rate of trichomonal vaginitis was 12.9%, and 64.5% of the cases were complicated with chronic cervicitis, 17.7% were complicated with adnexitis. Uni-variated and multi-variated logistic regression analyses revealed that lack of reproductive health knowledge, bath with polluted water, washing vulva or penis with polluted water before sexual intercourse, having intercourse during menstrual period, having past history of trichomonal vaginitis, as well as no-income woman's and husband's negative attitude towards wife's RTIs were risk factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis. And lack of reproductive health knowledge, bath with polluted water, washing penis with polluted water before sexual intercourse, past history of trichomonal vaginitis, husband's negative attitude to wife's RTIs were relative factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis revealed by the binary logistic regression analysis. The less score of reproductive health knowledge, the more risk of suffering from trichomonal vaginitis complicating chronic cervicitis. CONCLUSION: Compositive and successive prevention and treatment scheme should be used to control trichomonal vaginitis and other RTI complications in rural impoverished area of northwestern China. The scheme should be focused on four ways, including improving sanitation behaviors in couples, insisting on normative treatment, generalizing reproductive health knowledge and mobilizing husbands to pay attention.

Adult↗

PubMed1997

Health care access and utilization among pregnant adolescents.

PURPOSE: To assess access to and use of health care by adolescents prior to their becoming pregnant. METHODS: An interviewer-administered questionnaire was completed by all pregnant adolescents (n = 65) entering the Rochester Adolescent Maternity Program (RAMP) between January and June 1994. Questions addressed access and utilization issues including routine care and other services used, and existence of a regular source of care prior to pregnancy. RESULTS: Sixty-one adolescents (94%) completed questionnaires. Almost all (93%) had made a doctor or clinic visit, and 77% had had a checkup in the prior year. Most had Medicaid (85%) or private insurance (13%). The median number of visits to a regular source of care was 2.0 (range 0-10). Most frequently reported sources of regular care were hospital clinics (43%), community health centers (26%), and private physician offices (15%). Two-thirds (66%) reported having used multiple sources of care. Of those who used other sources in addition to a primary care source, 40% used reproductive health clinics. Adolescents whose primary care source was a traditional physician's office were more likely to also use reproductive health clinics than those who reported using more comprehensive primary care sources. CONCLUSIONS: Most pregnant adolescents in this sample had previously used routine primary care, usually in hospital clinics or health centers. Many of those adolescents also use multiple sources of care, most often for reproductive services. Access to reproductive health services does not seem to have been a problem for these adolescents prior to their pregnancies.

Adolescent↗

PubMed1995

Factors associated with use of prostaglandins in reproductive herd health programs for dairy cows.

Use of prostaglandin F2 alpha products (PG) in dairy cows was studied by use of computerized reproductive herd health data compiled from 29 dairy herds in Minnesota and Wisconsin during 1983 through 1988. Treatment with PG was recorded in 1,856 of 7,139 (26.0%) complete lactations. More than 1 treatment with PG was administered in 534 of the 1,856 (28.8%) lactations in which PG were used. The proportion of lactations in which treatment was used varied among herds and years, and was associated with the proportion of cows in which natural breeding was attempted and, to a lesser extent, with estrus detection index and conception rates; these associations were potentially modified by time between veterinary herd health visits. Calving-to-treatment intervals (mean +/- SD) were 100.4 +/- 55.1 days for first treatments only, and 116.2 +/- 66.1 days for all treatments. These values varied considerably among herds and years and among reasons for treatment. Much of the variation in proportions of lactations in which treatment was used and in the time of treatment within lactations could not be accounted for with the variables included in this study, and was probably related to individual considerations for each cow.

Animals↗

PubMedDate not supplied

[Sexual behaviour of adolescents].

INTRODUCTION: Numerous studies have shown that sexual behaviour increases among adolescents. Disharmony between biological and psychosocial maturity among young people may cause risky behavior, and endanger psychophysical and reproductive health of young persons. MATERIAL AND METHODS: A questionnaire on sexual behaviour was completed by 169 adolescents, 1st and 4th year high school students. RESULTS: Every 6th first grade and every 2nd fourth grade adolescent is sexually active. Male adolescents begin sexual activities significantly earlier (at the age of 15.6) than female adolescents (16.5). Also, young men have significantly more partners (3.6) than girls (1.3), and more parallel sexual relations than girls. Only 1/3 of sexually active adolescents always use some kind of contraception, more frequently boys (41.9%) than girls (26.7%). DISCUSSION: Early commencement of sexual activity results with longer active period before realization of the reproductive function, which increases risk for reproductive health disorders. Unprotected sexual intercourse and large number of partners also present significant risk factors. CONCLUSION: Sexual life of adolescents begins at the age of 16, on average, and only every third always uses contraceptive protection, which points to a need for better education on reproductive health by using contemporary methods. It is also necessary to increase availability of contraceptives (condoms) at all places where adolescents spend time (in schools, bars, cinemas, disco clubs etc.) in order to achieve responsible sexual behavior and protection of reproductive health among youth.

Adolescent↗

PubMed2006

Use of private gynaecologist does not relate to better prevention outcomes - an ecological analysis from Finland.

BACKGROUND: Control of reproduction and prevention of reproductive health problems are important reasons for women to use health services, but the proper organisational level of service provision is not clear. The purpose of this study was to investigate whether visits to private gynaecologists correlate with better health outcomes and worse participation in organised screening for cancer programs. METHODS: This is an ecological analysis using municipalities and groups of women at 5-year age intervals within municipalities as study units. First, the Finnish municipalities (n = 452) were classified into three groups by the age-adjusted level of use of private gynaecologists. Secondly, each age group within municipalities was classified into tertiles by the level of private gynaecologist use. The outcomes were participation in cervical and organised breast cancer screening for cancer programmes, stage of gynaecological and breast cancers at diagnosis, and abortion rates and ratios. All data were obtained from national registers by groups at 5-year age intervals and by municipality. Raw and adjusted (age groups, and in some analyses, municipality social class index) odds ratios, total and by urbanity, were calculated. RESULTS: The proportions of women participating in cervical cancer and organised breast cancer screening for cancer were somewhat higher in the groups having a low use of private gynaecologists. The proportions of local cancers of all cervical, uterine, ovarian and breast cancers were similar in the three groups, even though the first analysis method suggested somewhat better results for the low-use group in case of cervical cancer and for the high-use group in case of uterine and breast cancer. The rates of induced abortion were higher in municipalities having a high use of private gynaecologists than in those having lower use. CONCLUSION: This ecological analysis suggests that frequent use of private gynaecologists relates somewhat to lower organised screening for cancer participation, and is not better in preventing abortions or in detecting cancer earlier. Our results suggest that a planned system relying mainly on general practitioners and public health nurses as the first line care providers is equally good for women's reproductive health as that in which specialists are used.

Adult↗

PubMedDate not supplied

Azoospermia and oligospermia among a large cohort of DBCP applicators in 12 countries.

Azoospermia and oligospermia have been well demonstrated among workers exposed to 1,2-dibromo-3-chloropropane (DBCP) in manufacturing and formulation of this pesticide. After DBCP was banned in the United States in the late 1970s, two American companies continued to export it to many less developed countries. In the early to mid-1990s, attorneys assembled a cohort of approximately 26,400 male plaintiffs who, as workers on banana and pineapple plantations in 12 of these countries, had been exposed to DBCP, primarily during its application. These attorneys, for the purpose of a lawsuit against the two American companies, developed from interrogatories a database on these men that included information about stated periods of occupational DBCP exposure. Seminal fluid analysis results were also entered into the database. Analyzing information in this database, the authors found that, after a median exposure to DBCP of three years, 64.3% of these men overall, and 90.1% of men studied from the Philippines, had azoospermia or oligospermia. The mean number of children reported by the men was 2.5 overall. The percentage of men with no children was 28.5% overall. This report represents the largest cohort of DBCP-exposed workers in which adverse reproductive health effects have been described, and the first report of the adverse effects on the reproductive health of workers exposed to DBCP primarily through its application in a cohort of this size. This serious and extensive occurrence of adverse reproductive health effects due to the export of a hazardous pesticide before and after its ban in the United States illustrates a number of needs for monitoring, research, education, and policy development.

Adolescent↗

PubMedDate not supplied

Making women and men matter: the Philippine POPCOM experience.

To reorient population policies and programs and make population workers more gender-responsive was the challenge faced by the Philippine Population Commission (POPCOM), the government's central policymaking and coordinating body for population concerns. This paper traces the history of population policies in the Philippines and describes the factors that helped create a climate conducive to a rethinking of POPCOM's policies. POPCOM first conducted an institutional assessment to determine the levels of awareness of its population officers about gender, reproductive health, and population and development issues. A gender-responsive population policy framework with a reproductive health perspective was then developed to guide training programs, information management strategies, and pilot community-based action research programs. Problems anticipated in integrating a gender and reproductive health perspective include the Catholic Church, different priorities of government, and a reluctant Congress. Suggested strategies are (a) formation of a critical mass of various groups to demand policy shifts; (b) for women, development, and environment nongovernmental organizations to identify allies in government and international organizations; (c) regular dialogues between donors and the government's central planning agency; and (d) working through the media.

Catholicism↗

PubMedDate not supplied

[Medical aspects of adolescent sexuality].

The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. The sexual and reproductive behaviour, attitudes toward sexuality and contraception, as well as the prevalence rates of unintended pregnancy and Chlamydia trachomatis genital infections were analyzed in 300 sexually active adolescent females, aged 19 years. The first sexual intercourse was in 16.9 years, in average. Less than one-third of the total number (31.3%) of these persons had contraceptive protection at the first intercourse; condom was most frequently used (28.3%). Motives for the initiation of sexual activity were: love (45.7%), curiosity (35.7%), physical attraction and passion (8.3%), peer pressure (5.0%), on the boyfriend's insistence (4.7%), need for love (0.3%) and without answer (0.3%). Two-thirds of adolescent females (63.7%) reported more than one partner, 21.7% more than three and 10.2% more than five sexual partners. Almost half of girls (40.7%) experienced sexual intercourse in casual acquaintance, and 10.3% with a 10 or more years older partner. Use of contraceptive methods during each sexual encounter was inconsistent and sporadic. More than half of adolescent females (54.3%) relied on traditional forms of contraception, like withdrawal of the phallus. Condom was the method of contraceptive choice in one-third (34.3%) of girls, "birth-control pill" in 10.7% and spermicides in 0.7% of subjects. With a new sexual partner condom was used regularly by 55.6% of adolescents; and the remaining percentage of girls used condom irregularly (24.7%), or never (19.7%). The time interval between the initiation of sexual activity and the first gynaecological examination was more than 6 months in 56.7% of cases, and from one to three years in 31.0% of tested adolescent females. The reasons for the first gynaecological visit were as follows: fear of getting pregnant (22.0%), suspicion of contracting a sexually transmitted disease (22.0%) and symptoms indicating a pelvic inflammatory disease (18.3%). Only one-third of girls (37.7%) had their first gynaecological examination as a regular control examination or to get some contraceptive advice. During the adolescence unwanted pregnancy was noted in 16.0% of examined girls. One legal abortion had 14.4% of girls, two 1.3% and three 0.3% of adolescent females. Chlamydia trachomatis genital infection was found in 30.3% of girls. In the girls' opinion the improved knowledge about sexuality, reproduction and contraception is the best way of popularizing contraception among youth. This could be done by introduction of sexual education in school programmes (51.0%) or through mass media (33.3%). A successful health care service for young people should include: a gynaecologist who will have enough time and patience for an adolescent patient (91.3%); a female gynaecologist (36.7%); and a kind other health care workers (21.3%). In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.

Adolescent↗

PubMed2002

The effect of left displacement of abomasum corrected by toggle-pin suture on lactation, reproduction, and health of Holstein dairy cows.

Our objectives were to evaluate the effect of left displacement of abomasum (LDA) after correction by toggle-pin suture (TPS) on lactation performance, reproduction and health in Holstein dairy cows in a commercial dairy farm. Cows diagnosed with LDA and corrected by the TPS procedure (188 cows) during the first 70 d postpartum were matched with control herd-mates (186 controls) according to lactation number, calving date, and previous lactation 305-d mature equivalent milk yield. Cows were grouped according to parity and days in milk and fed the same total mixed ration throughout a 321-d lactation. Data collected included yields of milk and 3.5% fat-corrected milk (FCM), concentration and yields of milk fat, somatic cell count, incidence of mastitis, abortion, death and culling, in addition to reproductive measures. Cows affected with LDA corrected by the TPS procedure produced less milk and tended to produce less 3.5% FCM than control cows, but the decrease in production occurred only during the first 4 mo of lactation. Left displacement of abomasum did not affect the interval from calving to conception and conception rates, but it extended the period from calving to first postpartum artificial insemination. Incidences of abortions and mastitis were not influenced by LDA. Cows affected with LDA remained in the study for a shorter period than their control herdmates, and higher proportions of cows with LDA were sold or died. Death and culling were more pronounced immediately after the diagnosis of LDA and the TPS procedure.

Abomasum↗

PubMed2004

[Fertility, maternal mortality and survival of the children in the medical district of Kolda (Senegal)].

Maternal mortality and lethality in childhood constitute a major problem in Senegal. These two rates are often hight in areas off hight birth rate. In the medical district of Kolda (Senegal) no reliable data on reproductive health exists. We report the results of a preliminary investigation of a community based reproductive project. We've used the sisterhood methods reproductive health's indicators. This cross-sectional study was carried out in a sample of 1287 women in age of procreating. An "aggregative" fertility index of 6.59 was found in the "intervention" area as compare to 5,53 in the control area. The maternal death rate was estimated at 1285 per 100.000 alive births [998-1576]. The infant mortality rate was 83 per 1000. These results justify impremantation of a "vigorous" reproductive health policy in this area.

Adolescent↗

PubMed1995

African women carry the message. World Conference on Women.

The African Women's Network (AWN), organized by CEDPA alumnae at the Cairo population conference, has expanded its ranks and is bringing the Cairo consensus on women's empowerment to hundreds of NGOs throughout the continent. In November, AWN participants at the African NGO Regional Forum in Dakar helped to draft the Plan of Action for the World Conference on Women in Beijing, ensuring that key Cairo issues--including reproductive health care, sustainable development and poverty alleviation, the impact of AIDS on women, and gender equity--were addressed. With support from the UNFPA, the AWN and CEDPA organized a "Population Tent" at the forum, which highlighted family planning and reproductive health projects in Africa. AWN collaborated with the Senegal women's organization Yewwu Yewwi, the African Population Advisory Committee (APAC), and FEMNET, which is organizing African NGO participation for Beijing. Further expanding awareness of Cairo issues, CEDPA alumnae and staff members Khadijat L. Mojidi, Belkis Giorgis, and Andrea Okwesa conducted workshops on advocacy, gender and development, community-based family planning, and adolescent reproductive health programs.

Africa↗

PubMed1999

Improving service quality: experience from the Tanzania Family Health Project.

OBJECTIVE: To improve the quality and uptake of reproductive health service in rural communities in Tanzania. DESIGN: Descriptive study of operational research. SETTING: One and a half million people living in urban and rural communities in the Mbeya Region of Tanzania. METHOD: Design and implementation of a range of service quality improvement measures. INTERVENTIONS: Management systems strengthening; clinical skills training; orientation of health staff to service quality; introduction of quality assurance systems; improvement to supervision systems; community involvement in monitoring health service delivery. OUTCOME MEASURES: Health service utilization rates; client perceptions of health service quality; situation analysis of health service provision. RESULTS: Uptake of reproductive health services increased; improved client perceptions of service quality; improved health infrastructure; increased community participation in health service management. CONCLUSIONS: Health service quality in sub-Saharan Africa can be improved substantially through a process of identifying and addressing the constraints which militate against effective service provision. The cost of such improvement is modest compared with current health expenditure. Health planners and managers involved in sectoral reform programmes should give due attention to quality assurance mechanisms in addition to structural elements of the reform process.

Family Practice↗

PubMed2003

[The status quo of perimenopausal and postmenopausal women in Chengdu: report of a population-based cross-sectional study].

OBJECTIVE: To investigate the situation of reproductive health of perimenopausal and postmenopausal women in Chengdu and provide a basis for planning reproductive health care for these women. METHODS: We conducted a population-based cross-sectional study in women who were over 45 years old in the central city and the nearby county of Chengdu. RESULTS: The mean age of menopause was 48.1 years. There were sixty percent of women who had dysfunctional uterine bleeding before menopause. About half of the postmenopausal women had experienced perimenopausal symptoms. There were 460 women who ever used or currently use estrogen therapy. But only half of them visited doctors and sought medical therapy. And the main problems were hot flash, night sweats, dyssomnia, and urinary infection. Most of them took medicine for a short period (< 1 year). CONCLUSION: We found that middle-aged and older women have many symptoms related to menopause. It is necessary for us to provide reproductive health care for them.

Aged↗

PubMed1997

Women's health in maternal and child health: time for a new tradition?

OBJECTIVES: The status quo in maternal and child health (MCH) focuses on obstetric health. An emerging alternative is to broaden the notion to reproductive health. An inclusive perspective encompasses women's health issues in MCH. The purpose of this paper is to further the debate on the relationship of women's health to MCH. Specific aims are (1) to describe activities promoting women's health in MCH and (2) to examine consequences of alternative perspectives for MCH research, services, and training. METHOD: To achieve the first objective, I discuss developments in a state health agency and pertinent documents from the MCH Section of the American Public Health Association. To address the second aim, I follow the Bush Policy Analysis Model of weighing the three paradigms against the following evaluative criteria: equity, efficiency, satisfaction, stigma, indirect effects, feasibility, sensitivity to class and race, and social responsibility. RESULTS: The obstetric approach meets most criteria in a positive fashion; reproductive health satisfies criteria more positively and less equivocally. A women's health perspective bears the most potential for improving reproductive outcomes at this time, since no area of women's general health has been definitively shown to be irrelevant to reproduction (or vice versa). CONCLUSIONS: This analysis suggests that women's health should be incorporated more fully into the MCH field, as well as other areas of public health and medicine. Once research deficits have been addressed and the scope of reproductive health delineated more clearly, the alignment of women's health with MCH may be reevaluated.

Child↗

PubMed1995

Maternal health care focus in Bolivian campaign.

Maternal health care is one of the focuses of Bolivia's new reproductive health campaign. The campaign, which uses television, radio and print media to get its message across, has the slogan "Your health is in your hands." Prenatal and postnatal care, as well as safe delivery, form one of the campaign's target areas. Others are family planning, breast-feeding, and the prevention of illegal abortions. The Bolivian campaign, which has a logo showing a child's tiny hand grasping a parent's finger, is supported by the Population Communication Services project of the Johns Hopkins School of Public Health, Baltimore, US. Bolivia has the highest maternal mortality in the western hemisphere. "The need to create an awareness of reproductive health is vital, with the risk of a Bolivian woman dying during pregnancy or childbirth 60 times that for a woman in Europe or the US," according to Dr. Phyllis Piotrow, director of Johns Hopkins' Center for Communication Programs. Further, Bolivia has the second highest infant mortality rate in the western hemisphere after Haiti.

Advertising↗

PubMed2006

Cultural aspects related to the health of Andean women in Latin America: a key issue for progress toward the attainment of the Millennium Development Goals.

International declarations have affirmed that health is a universal right. In order for people to exercise their right to health, their social and cultural contexts need to be acknowledged. However, due to a number of barriers encountered at different levels of society and geographically this right is not yet fully exercised by a considerable number of women in Latin America. During the last decade progress has been made in the development of public health policies and programs that integrate and recognize the differences in culture that should be considered when addressing indigenous women's health issues. However, a biomedical health model, which discounts cultural influences, prevails globally over a more integrated approach. This leads to a lack of access and use of quality reproductive health services and care among indigenous people and is one of several important factors contributing to high levels of maternal mortality and poor reproductive health among indigenous women. It is important to ensure that an intercultural approach is included in health policies, programs and services. An intercultural strategy fosters dialogue and respect among women, men, and decision-makers and can contribute to the realization of reproductive health rights and improvement of health outcomes. The debate continues on how to accelerate progress in public policies, health programs and health services. An intercultural approach to assure the health of indigenous women should be a key part of this discussion. Specific efforts are critical for obtaining better health outcomes for indigenous women and other vulnerable populations, if not progress will stagnate in the middle of the 21st century, jeopardizing the attainment of the Millennium Development Goal (MDGs).

Attitude to Health↗

PubMed1996

Patterns of ICD-9 diagnoses among adolescents using school-based clinics: diagnostic categories by school level and gender.

PURPOSE: Understanding utilization patterns in school clinics is important in discerning potential health outcomes among adolescents. This study reports on high-middle school and gender differences in ICD-9 diagnostic codes for students using Baltimore school clinics in the academic year 1989-90. METHODS: 12,953 visits resulted in 17,241 individual diagnoses. Data were grouped into 17 major diagnostic categories, subcategories for reproductive health and mental health, and 20 sentinel diagnoses. RESULTS: Reproductive health diagnoses were most common for high school clinics (28% of all diagnoses). Mental health (psychosocial) diagnoses were most common for middle school clinics (30%). Adolescent women were much more likely to use clinics for reproductive health care needs than adolescent men. Adolescent men and women used the clinics with equal frequency for mental health, although specific diagnoses varied considerably by gender. CONCLUSIONS: This overview of diagnostic patterns among adolescents using Baltimore's school-based clinics provides a unique view of differences in health care needs between younger and older teens and between male and female teens. These data have meaningful implications for clinic staffing and enhanced outreach efforts.

Adolescent↗

PubMed1991

Occupational health: how work environments can affect reproductive capacity and outcome.

This article presents a compilation of descriptive data on how work environments can affect reproductive capacity and outcome. A thorough background in issues relevant to reproductive health provides a basis for understanding the effects of work on pregnancy and the effects of pregnancy on work performance. The physical changes of pregnancy and the sequential events by trimester are discussed in relation to work demands and risks. A review of specific job-related risks is also presented, including various chemicals, infections and environmental agents. A third section focuses on the clinical application of taking occupational and reproductive histories, and on guidelines for preconception and pregnancy counseling.

Confounding Factors, Epidemiologic↗