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PubMed2000

Occupational and environmental exposure correlates of adverse live-birth outcomes among 1032 US Navy women.

The integration of women into non-traditional military occupations raises questions concerning the impact of such jobs on women's reproductive health. This study examines the extent to which US Navy women in their reproductive years report exposures to potential occupational and environmental hazards, and the degree to which such exposures are associated with self-reported adverse live-birth outcomes. Data from a survey of pregnant Navy women provided both maternal and paternal exposure information on more than 1000 active-duty women. Self-reported exposures to heavy metals, pesticides, petroleum products, and other chemicals were associated with adverse live-birth outcomes at the bivariate level. Only a father's exposure to pesticides at work predicted an adverse live-birth outcome (preterm delivery) in multivariate models. Maternal occupational exposures may exert their influence through maternal health and/or pregnancy complications and may act as mediators of health-reproductive outcome relationships.

Adolescent↗
PubMed2002

Legal termination of pregnancy among teenagers and older women in Soweto, 1999-2001.

BACKGROUND: Legal termination of pregnancy (TOP) was introduced in South Africa in 1996. No data are available to relate the numbers of TOPs to the total number of pregnancies in specific health regions. The level of use of TOPs by women of different age groups is not known. OBJECTIVE: To determine the proportion of pregnancies that end in TOP, with special reference to maternal age, and to measure trends in use from 1999 to 2001. SETTING: Greater Soweto, Orange Farm and Lenasia, a densely populated urban health region served by Chris Hani Baragwanath Hospital and comprehensive primary care reproductive health services. METHODS: Two cross-sectional studies performed in 1999 and 2001, counting all pregnancies managed in state-run health services, including legal terminations, spontaneous miscarriages, ectopic pregnancies and deliveries. RESULTS: There were 5,412 pregnancies in the study period (9 weeks) in 1999, and 5,316 in the study period (8 weeks) in 2001. The TOP rates decreased from 16.1% to 13.6% (P = 0.20). The TOP rates for teenagers decreased from 22.3% to 16.3% (P = 0.006), but were higher than those for older women (15.2% in 1999 and 13.2% in 2001, P = 0.006 and 0.028 respectively). TOP rates for teenagers 13-16 years decreased from 28.0% to 23.0% (P = 0.44), and rates for older teenagers declined from 21.0% to 14.9% (P = 0.008). In 2001, 16.2% of women aged 35 and above underwent TOP, compared with 12.7% of women aged 20-34 years (P = 0.014). CONCLUSION: Use of TOP services was highest in women at the extremes of reproductive age. There was a significant decline in TOP rates among older teenagers between 1999 and 2001. These data, from a comprehensive urban reproductive health service, provide a benchmark for comparison elsewhere and in the future.

Abortion, Legal↗
PubMed2006

Factors associated with the awareness and practice of evidence-based obstetric care in an African setting.

OBJECTIVE: To identify the factors associated with important (> or =50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions. DESIGN: Cross-sectional analysis of data from our Reproductive Health Interventions Study. SETTING: North-west province, Cameroon, Africa. POPULATION: Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. MAIN OUTCOME MEASURES: Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. METHODS: Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions. RESULTS: A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance. CONCLUSIONS: Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.

Adult↗
PubMed2000

Postponing sexual intercourse among urban junior high school students-a randomized controlled evaluation.

PURPOSE: To describe a randomized, controlled evaluation of a school-based intervention to delay sexual intercourse among urban junior high school students. METHODS: Six Washington, D.C., junior high schools were randomly assigned to the intervention or nonintervention control condition for an educational program. During the first school year, seventh graders (n = 582) from the six schools obtained written parental consent to participate. Three health professionals (one per intervention school) implemented the program, which consisted of reproductive health classes, the Postponing Sexual Involvement Curriculum, health risk screening, and "booster" educational activities during the following (eighth grade) school year. Cross-sectional surveys were administered at baseline, the end of the seventh grade, and the beginning and end of the eighth grade. Intervention and control group differences in virginity, attitudes toward delayed sex and childbearing, and sexual knowledge and behavior were assessed at all four time points. RESULTS: At baseline, 44% of the seventh grade males and 81% of the seventh grade females reported being virgins. At the end of the seventh grade (first follow-up), after controlling for baseline study group differences, intervention-group females were more likely to report virginity, self-efficacy to refuse sex with a boyfriend, and the intention to avoid sexual involvement during the following 6 months. At the end of the eighth grade, significantly more intervention- than control-group females reported virginity, birth control use at last intercourse (for nonvirgins), and knowledge of adolescent reproductive health and confidentiality rights. No changes in virginity, self-efficacy to refuse sex, or sexual intent for the next 6 months were observed among male participants at any time during the study. However, on all three follow-up surveys, intervention-group males scored significantly higher than their control-group counterparts in knowledge of birth control method efficacy. No change in attitudes toward abstinence was observed for either gender at any follow-up point. CONCLUSIONS: Gender differences in baseline sexual activity rates and in various study outcomes suggest a possible need for separate, gender-specific intervention activities that can adequately address the social and cognitive needs of both sexes.

Adolescent↗
PubMed2003

Parents' attitudes to adolescent sexual behaviour in Lesotho.

This study investigated the knowledge, attitudes and opinions of parents on various aspects of adolescents' sexual and reproductive health in Lesotho. The study used a qualitative methodology. Findings reveal that parents are aware that male and female adolescents engage in sexual relationships. Some parents believe that adolescents are too young to initiate sexual activities while others said they don't mind older unmarried adolescents having sex. In addition, parents felt that adolescents do not face discrimination in obtaining family planning services. In relation to passing sexual and reproductive health knowledge to adolescents, there seems to be a dilemma on who should take the responsibility. A number of policy implications have emerged from this study. There should be awareness campaign for parents who are not aware that adolescents engage in sexual relationships. Parents should be encouraged to communicate with their adolescent children on sex-related matters. Government should carry on with the dialogue on introducing sex education in schools curriculum.

Adolescent↗
PubMed2005

Elimination of HIV infection in infants in Europe--challenges and demand for response.

Effective interventions for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) infection now exist and where these are fully implemented, MTCT rates of 1-2% are achievable. Virtual elimination of HIV in infants by 2010 has therefore been set as a goal for European region. There are, however, many challenges. The eastern European and central Asian countries are facing the fastest growing HIV epidemic in the world with a dramatic increase in numbers of HIV-positive pregnancies and new HIV infected infants. Nevertheless, the prevalence of HIV among pregnant women is still relatively low and the high coverage with antenatal care provide an opportunity to decrease the number of new HIV cases among infants to minimal level. The challenge is to move national strategies for prevention of HIV infection among infants from a disease-focused vertical approach towards effective preventive interventions integrated into mother-child health (MCH) and reproductive health services. The scaling up of prevention interventions among those most at risk and hard-to-reach women are key priority actions. This goes beyond clinical care and needs to include a range of care and protection issues, both in health institutions and in the community. The WHO Regional Office for Europe, together with other UNAIDS co-sponsors, has developed a regional strategic framework for prevention of HIV infection in infants. The strategic framework promotes a comprehensive approach comprising the four interrelated elements: (1) primary prevention of HIV infection; (2) prevention of unintended pregnancies among HIV-infected women; (3) prevention of HIV transmission from HIV-infected women to their children; (4) provision of care and support to HIV-infected women, their infants and families. Implementation of all four pillars of the strategic framework would help European countries to achieve the goal of virtual elimination of HIV infection in infants.

Anti-Retroviral Agents↗
PubMed2003

Social causation, health-selective mobility, and the reproduction of socioeconomic health inequalities over time: panel study of adult men.

This study examines how socioeconomic inequalities in perceived health were reproduced as a cohort of adult men became 10 years older, and focuses especially on the role of social causation and health-selective mobility. A two-wave panel data set collected by the Nord-Trøndelag Health Study (HUNT), Norway, is used, and the study is based on a sample of 9189 men aged 25-49 at baseline. Systematic socioeconomic inequalities in perceived health were observed both at baseline and 10 years later when the sample was aged 35-59. Measured as age-adjusted percentage differences, inequalities in perceived health widened during the study period, both among those who were continuously employed and between the employed and non-employed. The pattern of health inequalities was transformed as a result of numerous changes in perceived health and considerable social mobility during the study period. Compared to higher white collar, changes in perceived health during the study period were more negative among medium-level and manual occupations, and even more negative among the non-employed. Mobility between occupational classes among those employed at both observation points was not selective for health, but transitions into and out of employment were strongly health-selective. It is argued that the transformation of the health inequality pattern among those continuously employed was solely due to social causation, i.e., to more negative changes in perceived health among medium/manual occupations than among the white collar. The wider difference in perceived health between the employed and non-employed was, however, primarily a result of health-selective mobility into and out of the non-employed category.

Adult↗
PubMed2002

Providers of primary care to homeless women in Los Angeles County.

Little is known about the access barriers homeless women face at the sites where they are most likely to receive primary health care. To investigate this issue, we administered a mail survey to administrators and clinicians at clinic sites that were actual or potential providers of primary health care to homeless women in Los Angeles County in 1997. The response rate was 65%. Ninety percent of the homeless women seen by responding sites were seen at only 34% of those sites (designated as "major providers"). Deficiencies were identified in several structural and process characteristics that enhance access to and quality of care for homeless women, including clinician training in care for homeless persons; formal screening for homeless status and associated risk factors; and on-site provision of comprehensive health services, including mental health, substance abuse, reproductive health, and ancillary services. Some, but not all, deficiencies were less severe at major providers. Our results suggest that, although providers of care to homeless women share challenges faced by many safety net providers, there are several policy interventions that could improve access to and quality of care for homeless women.

Community Health Centers↗
PubMed2004

A study of medical and health queries to web search engines.

This paper reports findings from an analysis of medical or health queries to different web search engines. We report results: (i). comparing samples of 10000 web queries taken randomly from 1.2 million query logs from the AlltheWeb.com and Excite.com commercial web search engines in 2001 for medical or health queries, (ii). comparing the 2001 findings from Excite and AlltheWeb.com users with results from a previous analysis of medical and health related queries from the Excite Web search engine for 1997 and 1999, and (iii). medical or health advice-seeking queries beginning with the word 'should'. Findings suggest: (i). a small percentage of web queries are medical or health related, (ii). the top five categories of medical or health queries were: general health, weight issues, reproductive health and puberty, pregnancy/obstetrics, and human relationships, and (iii). over time, the medical and health queries may have declined as a proportion of all web queries, as the use of specialized medical/health websites and e-commerce-related queries has increased. Findings provide insights into medical and health-related web querying and suggests some implications for the use of the general web search engines when seeking medical/health information.

Europe↗
PubMed2002

Understanding gender differences in condom use self-efficacy among youth in urban Cameroon.

The aim of this study was to understand gender differences in components of condom use self-efficacy to inform the design of effective reproductive health interventions for youth. Data stem from a July to August 2000 reproductive health survey among youth aged 15-24. Gender differentials in self-efficacy are analyzed using logistic regression. Perceived ability to discuss and negotiate condom use is high for both sexes. Women are less likely than men to know correct condom use (58% vs. 80%, p<.01) but are more likely to be shy buying condoms (67% vs. 50%, p<.01). Prior experience buying and using condoms, parental support, and condom promotion affect perceived ability to correctly use condoms and shyness buying condoms. Programs aiming to increase self-efficacy in condom use should focus on increasing confidence in youth's ability to buy condoms and to use them correctly, especially for young women. There is a need for programs that publicize and/or increase access to youth-friendly outlets and increase the acceptability of young women buying condoms.

Adolescent↗
PubMedDate not supplied

Maternal-child health and family planning: user perspectives and service constraints in rural Bangladesh.

This article presents a microanalysis of interactions between female fieldworkers and women in rural Bangladesh, and a discussion of the broader organizational constraints that hamper service delivery. It is argued that the fieldworker, herself a rural woman, is faced with considerable demand for both maternal-child health (MCH) and reproductive health care services, but that operational constraints prevent her from realizing her potential in both of these areas. Qualitative data show that, in the eyes of rural women, contraceptive use and health care are intricately intertwined, and that this association often raises a range of questions that the worker cannot address competently. A number of specific operational barriers--worker densities, staff motivation, supervision, technical competence, supplies--are identified. These barriers reflect a general institutional weakness in the Ministry of Health bureaucracy that prevents it from organizing itself to deliver user-oriented health and family planning services while maintaining adequate and appropriate standards of care.

Bangladesh↗
PubMedDate not supplied

Most countries not meeting financial targets to implement ICPD -- Ms. Ingar Brueggemann.

Ms. Ingar Brueggemann emphasized that human resources, motivation and financial resources were required for action, and that the role of the parliamentarians was most important in influencing governments to give more resources to population and reproductive health, or to take decisions in making use of those resources. Ms. Brueggemann summarized the current resource mobilization context by mentioning that most countries were not meeting the target of 0.7% of their GNP to official development assistance; that global average was about 0.22%; and that general trend was toward declining aid budgets. By 1996, donors had provided only 35% of their share to meet the total requirement of US$17 billion by the year 2000 for the implementation of population package of the ICPD Program of Action. All major population and reproductive health organizations had seen their income decrease since ICPD. The main multilateral agency in population, UNFPA, and one of the largest NGOs, IPPF, received voluntary contribution, uncertain and vulnerable by definition, increasingly earmarked to specific activities or countries, and often managed in decentralized manner. During the ICPD+5 process, the insufficiency of the resources was highlighted as the main obstacle to the implementation of the ICPD Program of Action. Ms. Brueggemann emphasized both the need to increase the availability of resources and to make the most effective use of those resources, in a world where there was increasing competition for limited resources. There was a need for more coordination among those competing for the same resources, based on their comparative advantages.

Behavior↗
PubMed1999

Epilepsy in women: the science of why it is special.

Epilepsy is a common neurological disorder that may be affected by reproductive hormones and may complicate reproductive health. Many women with epilepsy experience changes in seizure frequency and severity with changes in reproductive cycles, including at puberty, over the menstrual cycle, with pregnancy and at menopause. Ovarian steroids alter neuronal excitability at the membrane and in the genome. Altered protein synthesis as a consequence of changes in RNA mediated gene transcription is one mechanism for steroid mediated effects on excitability. These genomic effects are delayed and sustained. In contrast, membrane effects are immediate and short duration. These effects are mediated at both the GABA-A and NMDA receptors. Estrogen also dynamically alters synaptic connectivity. Estrogen enhances excitability and lowers the seizure threshold, whereas progesterone enhances inhibition and increases the seizure threshold. In experimental models of epilepsy, estrogen is proconvulsant and progesterone is anticonvulsant. The net effect of these steroid actions is to alter neuronal excitability over physiological cycles. Some epilepsy syndromes are expressed or worsened at puberty. One third to one half of women with epilepsy have catamenial seizure patterns, with seizures most likely to occur in the perimenstrual period and at ovulation. More research is needed to understand the effects of menopause on epilepsy. Antiepileptic drugs may exacerbate the risk of reproductive endocrine disorders in women with epilepsy. Fertility rates are lower for women with epilepsy. Women with epilepsy are more likely to have anovulatory menstrual cycles, abnormal pituitary LH release and altered ovarian steroid concentrations. Polycystic ovaries are detected more often in women with epilepsy, particularly those on valproate. Treatment of hormone sensitive seizures relies on standard AEDs. Small trials suggest that adjunctive progesterone therapy is sometimes helpful. The newer AEDs, gabapentin and lamotrigine may have some advantages for women with epilepsy. These drugs do not alter levels of steroid hormones and do not interfere with effectiveness of hormonal contraception. Experience in pregnancy is limited. The dynamic effects of hormones on seizure expression and of seizures on reproductive health complicate the management of epilepsy in women. Newer AEDs may offer advantages for women with epilepsy in the reproductive years.

Epilepsy↗
PubMed2003

GP attitudes to male reproductive and sexual health education and promotion. A qualitative study.

BACKGROUND: Despite evidence that men believe the general practitioner is an appropriate person to assist with sexual health issues, few men actually access medical practitioners for such assistance. Raising community awareness of male sexual and reproductive health issues is expected to generate a clinical demand for men's health services. OBJECTIVE: The aim of this study was to determine GP perceptions of their own education needs and those of the community in the area of men's health. DISCUSSION: A total of 27 GPs from four Victorian divisions of general practice (three metropolitan and one rural) participated in three focus groups. Key themes from the data were identified after analysis of the data by three researchers. General practitioners indicated that a clinical demand for men's health services needed to be generated in order for GPs to be interested in professional development. They suggested community education providing general information to men about sexual and reproductive health issues and emphasising the importance of accessing their GP for health checks. However, due to a lack of information for GPs about some areas of male sexual and reproductive health, e.g., androgen deficiency and male infertility, a case based practical approach to GP education was recommended. General practitioners also requested concrete information, current specialist recommendations and details of locally available services working in men's health.

Adolescent↗