1.  Title: Maternal and perinatal outcome in teenage pregnancies in Sudan. Author: Adam GK; Elhassan EM; Ahmed AM; Adam I Source: International Journal of Gynaecology and Obstetrics. 2009 May;105(2):170-1. Abstract: Pregnancy and childbirth in teenage women pose special risks for both mother and baby. As well as significant medical, nutritional, social, and economic risks, teenage pregnancy is associated with increased risks for adverse pregnancy outcomes, such as preterm birth, low birth weight, and death in the neonatal or postnatal periods. There is a paucity of literature regarding the maternal and perinatal outcome of teenage pregnancies in Sudan, Africa. The aim of the present study was to assess the risk of anemia, operative delivery, and perinatal complications (mainly low birth weight) among primiparous teenagers with a singleton delivery compared with a similar group of women aged 20-24 years. (excerpt) Language: English Keywords: SUDAN | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANT WOMEN | ADOLESCENT PREGNANCY | PREGNANCY OUTCOMES | ANEMIA | LOW BIRTH WEIGHT | MATERNAL AGE | EDUCATIONAL STATUS | Developing Countries | Africa, North | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Pregnancy | Reproduction | Diseases | Birth Weight | Body Weight | Physiology | Biology | Parental Age | Age Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341382 |
| 2. Peer Reviewed Title: Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. Author: Allen RH; Fitzmaurice G; Lifford KL; Lasic M; Goldberg AB Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):276-83. Abstract: OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I. Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | EVALUATION INDEXES | KAP SURVEYS | PREGNANT WOMEN | ANESTHESIA | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ADMINISTRATION AND DOSAGE | PAIN | SIDE EFFECTS | SATISFACTION | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Drugs | Signs and Symptoms | Diseases | Psychological Factors | Behavior Document Number: 330360 Notification |
| 3. Peer Reviewed Title: Comparison of HIV type 1 sequences from plasma, cell-free breast milk, and cell-associated breast milk viral populations in treated and untreated women in Mozambique. Author: Andreotti M; Galluzzo CM; Guidotti G; Germano P; Altan AD; Pirillo MF; Marazzi MC; Vella S; Palombi L; Giuliano M Source: AIDS Research and Human Retroviruses. 2009 Jul;25(7):707-11. Abstract: We analyzed the sequences of the HIV viral populations obtained from plasma, cell-free breast milk, and breast milk cells of HAART-treated (23) and untreated (30) HIV-infected women to obtain information about the origin of the breast milk virus. Sequence analyses of viruses were performed using the TruGene HIV-1 assay. Direct sequences of the reverse transcriptase (RT) and protease (PR) genes were analyzed using the Phylip 3.68 suite of sequence analysis program and pairwise evolutionary distances were calculated with the Kimura two parameter model for estimation of distances. We found that the genetic distances between the plasma and the cell-free breast milk viruses and between the cell-free and cell-associated breast milk viruses for RT were higher in HAART-receiving women than in untreated women, suggesting viral evolution under selective drug pressure in breast milk. Our data support the hypothesis of the presence of an actively replicating viral population in the breast milk compartment, distinct from that present in plasma. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | HUMAN MILK | HIV | HIV TESTING | LABORATORY PROCEDURES | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Lactation | Maternal Physiology | Physiology | Biology | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342889 |
| 4. Title: Efficacy and acceptability of rapid, point-of-care HIV testing in two clinical settings in Ghana. Author: Appiah LT; Havers F; Gibson J; Kay M; Sarfo F; Chadwick D Source: AIDS Patient Care and STDs. 2009 May;23(5):365-9. Abstract: This study assessed the efficacy and acceptability of two rapid point-of-care HIV assays used in a voluntary counseling and testing (VCT) and a tuberculosis (TB) clinic in Kumasi, Ghana. Over a 4-week period in 2007, 95 individuals attending the VCT clinic and 35 patients with newly diagnosed TB were offered a rapid HIV test. Rates of return for positive results and attendance at the HIV clinic were compared with 471 individuals (395 attending the VCT clinic and 76 patients with TB), tested during an 8-week period 6 months earlier using standard testing procedures. All patients offered a rapid test in each clinic underwent testing, compared to 93% of VCT clients and 40% of TB patients offered a test 6 months earlier. In the rapid testing period, 37%, 60%, and 3% of the VCT clients and 26%, 74% and 0% of the TB patients had positive, negative, or indeterminate serology, respectively. There were no discordant results following retesting of patients with a positive test. All patients attending either the VCT or TB clinics who tested positive for HIV with the point-of-care test returned to the HIV clinic for care, while only 64% and 95%, respectively, of the patients previously testing positive had returned for follow-up. Both clients and staff showed high levels of satisfaction with the rapid testing procedure. In conclusion, rapid point-of-care testing in both of these settings was successful in improving diagnosis of HIV infection and engaging those testing positive in a clinical care program. Language: English Keywords: GHANA | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | HIV TESTING | PROGRAM ACCEPTABILITY | CLINIC ACTIVITIES | VOLUNTARY COUNSELING AND TESTING | TUBERCULOSIS | SATISFACTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Program Evaluation | Infections | Diseases | Psychological Factors | Behavior Document Number: 342184 |
| 5. Title: Combined oral contraceptive pills for treatment of acne. Author: Arowojolu AO; Gallo MF; Lopez LM; Grimes DA; Garner SE Source: Cochrane Database of Systematic Reviews. 2009;(3):CD004425. Abstract: BACKGROUND: Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women. OBJECTIVES: To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies. SEARCH STRATEGY: We searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed. SELECTION CRITERIA: All randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placeboor another active therapy for acne in women were eligible. DATA COLLECTION AND ANALYSIS: We extracted data on total and specific (i.e., open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan. MAIN RESULTS: The search yielded 25 trials: 7 placebo-controlled trials made 4 different comparisons, 17 trials made 13 comparisons between 2 different COC regimens, and 1 additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel, although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found the COC groups were similar. AUTHORS' CONCLUSIONS: The four COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question. Language: English Keywords: GLOBAL | LITERATURE REVIEW | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN | ACNE | TREATMENT | ORAL CONTRACEPTIVES, COMBINED | ADMINISTRATION AND DOSAGE | ANTIBIOTICS | HORMONES | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | Dermatitis | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Drugs | Endocrine System | Physiology | Biology Document Number: 341912 |
| 6. Title: Evaluation of commercial HIV test kits used in Nigeria. Author: Banwat EB; Peter JY; Egah DZ Source: Nigerian Journal of Clinical Practice. 2009 Mar;12(1):11-4. Abstract: BACKGROUND:Accurate and reliable diagnosis of HIV plays a central role in any effective HIV intervention. We decided to evaluate 4 commercial HIV test kits to determine their reliability for use in developing countries. METHODS: Serum samples obtained from clients accessing tertiary health services at the STI clinic, Jos University Teaching Hospital were used to evaluate Sdbioline, Diaspot, Determine and DIALAB Elisa kits. A Western blot was used as the reference kit. RESULTS: DETERMINE kit gave 34 positive and 58 negative reactions and the positive sera were all confirmed by Western blot while DIASPOT kit gave 27 false negative results, which was at variance with the reference kit result. Other kits were SDBIOLINE with 5 false positive and DIALAB Elisa kit, which gave one false positive, and one false negative result. CONCLUSION: We conclude that Determine, SDbioline and DIALAB Elisa kits are reliable for HIV antibody testing in Nigeria and other developing countries. Language: English Keywords: NIGERIA | EVALUATION REPORT | CLIENTS | PROSPECTIVE STUDIES | COMPARATIVE STUDIES | HIV TESTING | EQUIPMENT AND SUPPLIES | RELIABILITY | EXAMINATIONS AND DIAGNOSES | LABORATORY PROCEDURES | SCREENING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Evaluation | Program Activities | Programs | Organization and Administration | Studies | Research Methodology | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement Document Number: 342689 |
| 7. Title: Knowledge and practice of university students in Lebanon regarding contraception. Author: Barbour B; Salameh P Source: Eastern Mediterranean Health Journal. 2009 Mar-Apr;15(2):387-99. Abstract: We evaluated knowledge and practice of Lebanese university students regarding contraception in a cross-sectional, comparative study on students in public and private universities using an Arabic language self-administered questionnaire. We found low levels of knowledge of contraception. The majority of males (73.3%) and a few females (21.8%) declared previous sexual relations: the majority of males had used a condom (86.1%), but females had generally not used contraceptives (75.6%). Language: English Keywords: LEBANON | RESEARCH REPORT | COMPARATIVE STUDIES | STUDENTS | MEN | UNIVERSITIES | KNOWLEDGE | CONTRACEPTION | CONDOM USE | RISK REDUCTION BEHAVIOR | SEX BEHAVIOR | Middle East | Developing Countries | Studies | Research Methodology | Education | Demographic Factors | Population | Schools | Sociocultural Factors | Family Planning | Behavior Document Number: 341713 |
| 8. Title: Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania. Author: Bastien S; Leshabari MT; Klepp KI Source: African Journal of AIDS Research. 2009;8(2):213-222. Abstract: A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1,007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/AIDS information, and they communicated more frequently about the topic than did the out-of-school group. The in-school group gave high credibility ratings to medical doctors, the radio, and parents as sources of information, whereas the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents, and doctors as preferred communicators of sexual and reproductive health information. Language: English Keywords: TANZANIA | RESEARCH REPORT | SAMPLING STUDIES | COMPARATIVE STUDIES | OUT-OF-SCHOOL YOUTHS | STUDENTS | HIV INFECTIONS | INFORMATION SOURCES | INTERPERSONAL COMMUNICATION | INTERVIEWS | KNOWLEDGE | MASS MEDIA | SOCIOECONOMIC STATUS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Educational Status | Socioeconomic Factors | Economic Factors | Education | Viral Diseases | Diseases | Information | Communication | Data Collection | Sociocultural Factors Document Number: 339889 |
| 9. Peer Reviewed Title: The management of failed second-trimester termination of pregnancy. Author: Basu JK; Basu D Source: Contraception. 2009 Aug;80(2):170-3. Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery Document Number: 342391 Notification |
| 10. Peer Reviewed Title: Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study. Author: Battaglia C; Mancini F; Fabbri R; Persico N; Busacchi P; Facchinetti F; Venturoli S Source: Fertility and Sterility. 2009 Jul 8; Abstract: OBJECTIVE: To compare the effects of a pill containing drospirenone with those of a combined contraceptive vaginal ring on the lipid and carbohydrate metabolism and on the surrogate markers of arterial function. SETTING: Bologna University School of Medicine. PATIENT(S): Thirty-seven women with polycystic ovary syndrome (PCOS) were randomly submitted to drospirenone + ethinylestradiol (group I; n = 19) or combined contraceptive vaginal ring (group II; n = 18) therapy. The duration of the study was 6 months. INTERVENTION(S): The effect of treatments was assessed after 6 months of therapy. MAIN OUTCOME MEASURE(S): Utero-ovarian ultrasound analysis and color Doppler evaluation of uterine and stromal ovarian arteries. In addition, analysis of brachial artery flow-mediated vasodilatation and 24-hour ambulatory blood pressure monitoring were performed. Fasting blood samples were drawn for testing biochemical and hormonal parameters and nitrites/nitrates. RESULT(S): Both treatments improved hirsutism, hyperandrogenemia, and ultrasound and color Doppler ovarian parameters. Both drospirenone + ethinylestradiol or contraceptive vaginal ring induced a slight but significant increase of diurnal and 24-hour blood pressure. Although both therapies worsened the lipid profile, the oral pill administration was associated with a more evident increase of circulating triglycerides. The 6-month treatment with the vaginal ring significantly improved the area under the curve for glucose, insulin, and C-peptide, whereas the drospirenone + ethinylestradiol pill induced an increase in the insulinogenic index and homeostatic model assessment estimate for insulin resistance values. CONCLUSION(S): Vaginal hormonal contraception appears to be preferable to oral ethinylestradiol + drospirenone administration in hyperinsulinemic patients with PCOS. Language: English Keywords: ITALY | RESEARCH REPORT | PROSPECTIVE STUDIES | COMPARATIVE STUDIES | CLIENTS | OVARIAN CYSTS | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | LOW-DOSE PROGESTINS | VAGINAL RING | CARDIOVASCULAR EFFECTS | CARBOHYDRATE METABOLIC EFFECTS | LIPID METABOLIC EFFECTS | BLOOD PRESSURE | ULTRASONICS | Developed Countries | Europe, Southern | Europe | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Physiology | Biology | Metabolic Effects | Lipids | Hemic System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342128 |
| 11. Title: Sexual behavior and perceived peer norms: comparing perinatally HIV-infected and HIV-affected youth. Author: Bauermeister JA; Elkington K; Brackis-Cott E; Dolezal C; Mellins CA Source: Journal of Youth and Adolescence. 2009 Sep;38(8):1110-22. Abstract: A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9-16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were "cool" or "popular" were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were "cool" or "popular" varied by age, gender, and HIV status. Furthermore, friends' sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV. Language: English Keywords: UNITED STATES OF AMERICA | NEW YORK | RESEARCH REPORT | COMPARATIVE STUDIES | ETHNIC GROUPS | PERSONS LIVING WITH HIV/AIDS | ADOLESCENTS | PEER GROUPS | VALUE ORIENTATION | HIV INFECTIONS | SEX BEHAVIOR | Developed Countries | North America | Americas | Studies | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Youth | Age Factors | Knowledge Sources | Communication | Psychological Factors | Behavior Document Number: 342389 |
| 12. Title: Sexual practices, drug use behaviors, and prevalence of HIV, syphilis, hepatitis B and C, and HTLV-1/2 in immigrant and non-immigrant female sex workers in Argentina. Author: Bautista CT; Pando MA; Reynaga E; Marone R; Sateren WB; Montano SM; Sanchez JL; Avila MM Source: Journal of Immigrant and Minority Health. 2009 Apr;11(2):99-104. Abstract: OBJECTIVE: To study socio-demographics, sexual practices, drug use behaviors, and prevalences of HIV, syphilis, hepatitis B and C, HTLV-1 and HTLV-2 in immigrant (foreigner) and non-immigrant (local/native) female sex workers (FSW). DESIGN: This was a cross-sectional study in immigrant and non-immigrant FSW living in Buenos Aires, Argentina. Participants were interviewed using a standardized questionnaire. RESULTS: A total of 625 FSW were enrolled, of whom 169 (27%) were immigrant FSW from Paraguay, the Dominican Republic, Brazil, Peru, and Uruguay. The prevalence of syphilis and hepatitis C was significantly higher among Argentinean FSW than among immigrant FSW. However, hepatitis B prevalence was higher among immigrant FSW. Adjusted risk factor analysis comparing immigrant FSW with Argentinean FSW indicated that marital status (single), occupation (none), fee per sex act ( Keywords: ARGENTINA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | COMPARATIVE STUDIES | EPIDEMIOLOGIC METHODS | SEX WORKERS | WOMEN IN DEVELOPMENT | IMMIGRANTS | HEPATITIS | SYPHILIS | PREVALENCE | DRUG USE AND ABUSE | HIV INFECTIONS | SEX BEHAVIOR | South America, Southern | South America | Latin America | Americas | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Behavior | Economic Development | Economic Factors | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Measurement Document Number: 331118 |
| 13. Peer Reviewed Title: Bone mineral density in a cohort of adolescents during use of norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives and after discontinuation of norethisterone enanthate. Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM Source: Contraception. 2009 May;79(5):345-9. Abstract: BACKGROUND: Depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives (COCs) have been shown to have a negative effect on bone mineral density (BMD) in adolescents. The aim of this study was to investigate BMD in 15- to 19-year-old new users of DMPA, NET-EN and COCs. STUDY DESIGN: This 5-year longitudinal study followed up new users of DMPA (n=115), NET-EN (n=115) and COCs (n=116) and 144 nonuser controls. BMD was measured at the distal radius using dual-energy X-ray absorptiometry. RESULTS: BMD increased in all groups (annual percent increase: nonusers, 1.49%; DMPA, 1.39%; NET-EN, 1.03%; COCs, 0.84%) during follow-up (p<.001). There was evidence for lower BMD increases per annum in NET-EN (p=.050) and COC (p=.010) users compared to nonusers but no difference between DMPA and nonusers (p=.76). In 14 NET-EN discontinuers, an overall reduction of 0.61% per year BMD was followed upon cessation by an increase of 0.69% per year (p=.066). CONCLUSION: This study suggests that BMD increases in adolescents may be less in NET-EN and COC users; however, recovery of BMD in NET-EN users was found in the small sample of adolescents followed post-discontinuation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | SKELETAL EFFECTS | CONTRACEPTION TERMINATION | NORETHINDRONE ENANTHATE | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Physiology | Biology | Contraception | Family Planning | Norethindrone | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Medroxyprogesterone Acetate | Oral Contraceptives | Contraceptive Methods | Safety | Public Health | Health Document Number: 330938 |
| 14. Title: The President's Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes. Author: Bendavid E; Bhattacharya J Source: Annals of Internal Medicine. 2009 May 19;150(10):688-95. Abstract: BACKGROUND: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown. OBJECTIVE: To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa. DESIGN: Comparison of trends before and after the initiation of PEPFAR's activities. SETTING: 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations). INTERVENTION: A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003. MEASUREMENTS: HIV-related deaths, the number of people living with HIV, and HIV prevalence. RESULTS: Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis. LIMITATION: The selection of the focus countries was not random, which limits the generalizability of the results. CONCLUSION: After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. Language: English Keywords: AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | CAUSES OF DEATH | HIV INFECTIONS | AIDS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | Developing Countries | Studies | Research Methodology | Measurement | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration Document Number: 341612 |
| 15. Peer Reviewed Title: Provision of abortion by mid-level providers: international policy, practice and perspectives. Author: Berer M Source: Bulletin of the World Health Organization. 2009 Jan;87(1):58-63. Abstract: Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice. Language: English Keywords: DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | RECOMMENDATIONS | COMPARATIVE STUDIES | CLINICAL RESEARCH | HEALTH PERSONNEL | ABORTION | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | TRAINING PROGRAMS | Studies | Research Methodology | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Health Services | Education Document Number: 341127 |
| 16. Title: Patterns and trends in adolescents' contraceptive use and discontinuation in developing countries and comparisons with adult women. Author: Blanc AK; Tsui AO; Croft TN; Trevitt JL Source: International Perspectives On Sexual and Reproductive Health. 2009 Jun;35(2):63-71. Abstract: Demographic and Health Survey data from more than 40 countries were used to examine the proportions of 15- to 19-year-old women who are currently married or are unmarried but sexually active; their rates of contraceptive adoption, current use, discontinuation, method switching and contraceptive failure; trends in these indicators; and comparisons with older women. In many countries, the proportion of adolescent women using contraceptives increased substantially over the last two decades. Prevalence among adolescents increased faster than among older women. Greater proportions of adolescents than of older women discontinued using a contraceptive method within a year or experienced contraceptive failure. The authors conclude that expanded demand for contraceptive supplies, services, and information can be expected to challenge the preparedness, capacity, and resources of existing family planning programs and providers. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | WOMEN | OLDER ADULTS | AGE FACTORS | CONTRACEPTIVE METHOD SWITCHING | CONTRACEPTIVE USAGE | CONTRACEPTIVE EFFECTIVENESS | FAMILY PLANNING PROGRAM EVALUATION | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Studies | Research Methodology | Adolescents | Youth | Population Characteristics | Adults | Contraception | Family Planning | Family Planning Programs Document Number: 342143 |
| 17. Peer Reviewed Title: A longitudinal comparison of body composition changes in adolescent girls receiving hormonal contraception. Author: Bonny AE; Secic M; Cromer BA Source: Journal of Adolescent Health. 2009 Oct;45(4):423-5. Abstract: The objective of this study was to examine body composition changes in adolescent girls initiating depot medroxyprogesterone acetate (DMPA), oral contraceptives, or no hormonal contraceptive method. At 6 months, DMPA resulted in significant increases in adiposity with concomitant decreases in lean body mass. Supplemental estrogen may lessen these DMPA effects. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | LONGITUDINAL STUDIES | CONTROL GROUPS | ADOLESCENTS, FEMALE | DEPO-PROVERA | ORAL CONTRACEPTIVES | BODY WEIGHT | OBESITY | ESTROGENS | Developed Countries | North America | Americas | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Physiology | Biology | Hormones | Endocrine System Document Number: 342847 |
| 18. Peer Reviewed Title: Infidelity, Trust, and Condom Use Among Latino Youth in Dating Relationships. Author: Brady SS; Tschann JM; Ellen JM; Flores E Source: Sexually Transmitted Diseases. 2009 Apr;36(4):227-231. Abstract: BACKGROUND:: Latino youth in the United States are at greater risk for contracting sexually transmitted infections (STIs) in comparison with non-Hispanic white youth. METHODS:: Sexually active heterosexual Latino youth aged 16 to 22 years (N = 647) were recruited for interviews through a large health maintenance organization or community clinics. RESULTS:: Adjusting for gender, age, ethnic heritage, and recruitment method, woman's consistent use of hormonal contraceptives, ambivalence about avoiding pregnancy, longer length of sexual relationship, and greater overall trust in main partner were independently associated with inconsistent condom use and engagement in a greater number of sexual intercourse acts that were unprotected by condom use. Perception that one's main partner had potentially been unfaithful, but not one's own sexual concurrency, was associated with consistent condom use and fewer acts of unprotected sexual intercourse. Sexually concurrent youth who engaged in inconsistent condomuse with other partners were more likely to engage in inconsistent condom use and a greater number of unprotected sexual intercourse acts with main partners. CONCLUSIONS:: Increasing attachment between youth may be a risk factor for the transmission of STIs via normative declines in condom use. Perception that one's partner has potentially been unfaithful may result in greater condom use. However, many Latino adolescents and young adults who engage in sexual concurrency may not take adequate steps to protect their partners from contracting STIs. Some youth may be more focused on the emotional and social repercussions of potentially revealing infidelity by advocating condom use than the physical repercussions of unsafe sex. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | ETHNIC GROUPS | WOMEN | WHITES | YOUTH | HETEROSEXUALS | SEXUALLY TRANSMITTED DISEASES | RISK BEHAVIOR | CONDOM USE | Developed Countries | North America | Americas | Studies | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Age Factors | Sex Behavior | Behavior | Reproductive Tract Infections | Infections | Diseases | Risk Reduction Behavior Document Number: 330495 |
| 19. Peer Reviewed Title: Family composition and remarriage in pre-transitional Italy: a comparative study. Author: Breschi M; Fornasin A; Manfredini M; Zacchigna M Source: European Journal of Population. 2009 Aug;25(3):277-296. Abstract: It is well known that timing and intensity of remarriage were strictly dependent upon dempgraphic, socio-economic, cultural and legislative factors specific to each community. Thus, the aim of this paper is to compare the extent to which such factors may affect the remarriage patterns of three pre-transitional Italian populations that were different in many respects. By using micro-level data of the sharecropping communities of Casalguidi and Madregolo and the Alpine village of Treppo Carnico, we highlighted similarities and differences in the respective remarriage patterns, in particular, the far lower intensity in the mountain community with respect to the sharecropping ones. Our findings show that along with differences in the demographic system, household structure and land tenure, normative elements concerning widows and the dotal system could part explain the differentials we found. Language: English Keywords: ITALY | RESEARCH REPORT | COMPARATIVE STUDIES | HOUSEHOLDS | REMARRIAGE | MICROECONOMIC FACTORS | LAND TENURE | Developed Countries | Europe, Southern | Europe | Studies | Research Methodology | Family and Household | Sociocultural Factors | Marriage Patterns | Marriage | Nuptiality | Demographic Factors | Population | Economic Factors | Socioeconomic Factors Document Number: 339898 |
| 20. Peer Reviewed Title: Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. Author: Brinkhof MW; Boulle A; Weigel R; Messou E; Mathers C; Orrell C; Dabis F; Pascoe M; Egger M Author: International Epidemiological Databases to Evaluate AIDS (IeDEA) Source: PLoS Medicine. 2009 Apr 28;6(4):e1000066. Abstract: BACKGROUND: Mortality in HIV-infected patients who have access to highly active antiretroviral therapy (ART) has declined in sub-Saharan Africa, but it is unclear how mortality compares to the non-HIV-infected population. We compared mortality rates observed in HIV-1-infected patients starting ART with non-HIV-related background mortality in four countries in sub-Saharan Africa. METHODS AND FINDINGS: Patients enrolled in antiretroviral treatment programmes in Cote d'Ivoire, Malawi, South Africa, and Zimbabwe were included. We calculated excess mortality rates and standardised mortality ratios (SMRs) with 95% confidence intervals (CIs). Expected numbers of deaths were obtained using estimates of age-, sex-, and country-specific, HIV-unrelated, mortality rates from the Global Burden of Disease project. Among 13,249 eligible patients 1,177 deaths were recorded during 14,695 person-years of follow-up. The median age was 34 y, 8,831 (67%) patients were female, and 10,811 of 12,720 patients (85%) with information on clinical stage had advanced disease when starting ART. The excess mortality rate was 17.5 (95% CI 14.5-21.1) per 100 person-years SMR in patients who started ART with a CD4 cell count of less than 25 cells/microl and World Health Organization (WHO) stage III/IV, compared to 1.00 (0.55-1.81) per 100 person-years in patients who started with 200 cells/microl or above with WHO stage I/II. The corresponding SMRs were 47.1 (39.1-56.6) and 3.44 (1.91-6.17). Among patients who started ART with 200 cells/microl or above in WHO stage I/II and survived the first year of ART, the excess mortality rate was 0.27 (0.08-0.94) per 100 person-years and the SMR was 1.14 (0.47-2.77). CONCLUSIONS: Mortality of HIV-infected patients treated with combination ART in sub-Saharan Africa continues to be higher than in the general population, but for some patients excess mortality is moderate and reaches that of the general population in the second year of ART. Much of the excess mortality might be prevented by timely initiation of ART. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | DEATH RATE | EXCESS MORTALITY | RISK FACTORS | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Mortality | Population Dynamics | Demographic Factors | Population | Health Document Number: 341677 |
| 21. Peer Reviewed Title: Association between efficacy and body weight or body mass index for two low-dose oral contraceptives. Author: Burkman RT; Fisher AC; Wan GJ; Barnowski CE; LaGuardia KD Source: Contraception. 2009 Jun;79(6):424-7. Abstract: BACKGROUND: This analysis investigated the association of oral contraceptive efficacy with body weight and body mass index (BMI) for hypothesis-generating purposes. STUDY DESIGN: Data were from a randomized, parallel-group trial of 180/215/250 mcg of norgestimate (NGM)/25 mcg of ethinyl estradiol (EE) (given to 1671 women) and 1 mg of norethindrone acetate (NETA)/20 mcg of EE (given to 1139 women). Pregnancies were evaluated across BMI deciles and by BMI and body weight dichotomies. A Pearl index was calculated for each treatment group. The relative risk (RR) of pregnancy was calculated with a Cox proportional hazards model. RESULTS: The Pearl index for women who received NGM/EE was 2.36 [95% confidence interval (CI)=1.33-3.40]; for those who received NETA/EE, the Pearl index was 3.29 (95% CI=1.81-4.77). Consistent, weak positive associations between weight and pregnancy risk were found. Overall, for women with a BMI >or=25 kg/m(2) (compared with women with a BMI <25 kg/m(2)), the RR of pregnancy was 1.84 (95% CI=0.98-3.45); that for women who received NGM/EE was 1.39 (95% CI=0.57-3.40), whereas that for women who received NETA/EE was 2.49 (95% CI=1.01-6.13). For women with a body weight >or=70 kg (compared with women with a body weight <70 kg), the RR was 1.25 (95% CI=0.63-2.46); that for women who received NGM/EE was 1.41 (95% CI=0.56-3.54), whereas that for women who received NETA/EE was 1.12 (95% CI=0.40-3.12). CONCLUSION: Women in the higher body weight or BMI category showed a small increase in the risk of pregnancy with these oral contraceptives, but this increase was not statistically significant overall or for either formulation studied. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN | CONTRACEPTIVE EFFECTIVENESS | BODY WEIGHT | NORGESTIMATE | ETHINYL ESTRADIOL | ORAL CONTRACEPTIVES, COMBINED | NORETHINDRONE ACETATE | ADMINISTRATION AND DOSAGE | Developed Countries | North America | Americas | Research Methodology | Studies | Demographic Factors | Population | Contraception | Family Planning | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Oral Contraceptives | Contraceptive Methods | Norethindrone | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341104 |
| 22. Peer Reviewed Title: Response to zidovudine/didanosine-containing combination antiretroviral therapy among HIV-1 subtype C-infected adults in Botswana: two-year outcomes from a randomized clinical trial. Author: Bussmann H; Wester CW; Thomas A; Novitsky V; Okezie R; Muzenda T; Gaolathe T; Ndwapi N; Mawoko N; Widenfelt E; Moyo S; Musonda R; Mine M; Makhema J; Moffat H; Essex M; Degruttola V; Marlink RG Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):37-46. Abstract: BACKGROUND: Numerous national antiretroviral (ARV) treatment initiatives offering protease inhibitor-sparing combination antiretroviral therapy (cART) have recently commenced in southern Africa, the first of which began in Botswana in January 2002. Evaluation of the efficacy and tolerability of various protease inhibitor-sparing cART regimens requires intensive study in the region, as does investigation of the development of drug resistance and the optimal means of sustaining adherence. The "Tshepo" Study is the first large-scale, randomized, clinical trial that addresses these important issues among HIV-1 subtype C-infected ARV treatment-naive adults in southern Africa. METHODS: The Tshepo Study is a completed, open-labeled, randomized study that enrolled 650 ARV-naive adults between December 2002 and 2004. The study is a 3 x 2 x 2 factorial design comparing the efficacy and tolerability among factors: (1) 3 combinations of nucleoside reverse transcriptase inhibitors (NRTIs): zidovudine (ZDV) + lamivudine (3TC), ZDV + didanosine (ddI), and stavudine (d4T) + 3TC; (2) 2 different nonnucleoside reverse transcriptase inhibitors (NNRTIs): nevirapine and efavirenz; and (3) 2 different adherence strategies: the current national "standard of care" versus an "intensified adherence strategy" incorporating a "community-based directly observed therapy." Study patients were stratified into 2 balanced CD4 T-cell count groups: less than 201 versus 201-350 cells per cubic millimeter with viral load greater than 55,000 copies per milliliter. Following Data Safety Monitoring Board recommendations in April 2006, ZDV/ddI-containing arms were discontinued due to inferiority in primary end point, namely, virologic failure with resistance. We report both overall data and pooled data from patients receiving ZDV/ddI- versus ZDV/3TC- and d4T/3TC-containing cART through April 1, 2006. RESULTS: Four hundred fifty-one females (69.4%) and 199 males with a median age of 33.3 years were enrolled into the study. The median follow-up as of April 1, 2006, was 104 weeks, and loss to follow-up rate at 2 years was 4.1%. The median baseline CD4 T-cell count was 199 cells per cubic millimeter [interquartile ratio (IQR) 136-252], and the median plasma HIV-1 RNA level was 193,500 copies per milliliter (IQR 69-250, 472-500). The proportion of participants with virologic failure and genotypic resistance mutations was 11% in those receiving ZDV/ddI-based cART versus 2% in those receiving either ZDV/3TC- or d4T/3TC-based cART (P = 0.002). The median CD4 T-cell count increase at 1 year was 137 cells per cubic millimeter (IQR 74-223) and 199 cells per cubic millimeter (IQR 112-322) at 2 years with significantly lower gain in the ZDV/ddI arm. At 1 and 2 years, respectively, 92.0% and 88.8% of patients had an undetectable plasma HIV-1 RNA level (< or = 400 copies/mL). Kaplan-Meier survival estimates at 1 and 2 years were 96.6% and 95.4%. One hundred twenty patients (18.2%) had treatment-modifying toxicities, of which the most common were lipodystrophy, anemia, neutropenia, and Stevens-Johnson syndrome. There was a trend toward difference in time to treatment-modifying toxicity by pooled dual-NRTI combination and no difference in death rates. CONCLUSIONS: The preliminary study results show overall excellent efficacy and tolerability of NNRTI-based cART among HIV-1 subtype C-infected adults. ZDV/ddI-containing cART, however, is inferior to the dual NRTIs d4T/3TC or ZDV/3TC when used with an NNRTI for first-line cART. Language: English Keywords: BOTSWANA | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | USER COMPLIANCE | DRUG RESISTANCE | IMMUNOLOGICAL EFFECTS | SIDE EFFECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Studies | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Behavior | Immunity | Immune System | Physiology | Biology Document Number: 342371 |
| 23. Title: Progestogen-only contraceptives and the risk of stroke: a meta-analysis. Author: Chakhtoura Z; Canonico M; Gompel A; Thalabard JC; Scarabin PY; Plu-Bureau G Source: Stroke; A Journal of Cerebral Circulation. 2009 Apr;40(4):1059-62. Abstract: BACKGROUND AND PURPOSE: The association between combined oral contraceptives (OC) use and increased risk of stroke has been reported. While progestogen-only contraceptives (POC) are commonly used worldwide, their impact on cardiovascular disease remains unclear. METHODS: A meta-analysis based on EMBASE and MEDLINE referenced literature corresponding to OCs marketed since 1960 was carried out. Eligible articles assessing the risk of stroke in relation to OC or POC were reviewed, and relevant studies were extracted. All types of POC and routes of administration were taken into account in the meta-analysis. RESULTS: Six case-control studies were identified. The combined odd ratio (OR) showed no increase in the risk of stroke among POC users (OR=0.96; 95% confidence interval: 0.70 to 1.31). This result was similar according to the route of administration (either implant or injectable or oral POC). CONCLUSIONS: Data from observational studies show that POC use is not associated with an increased risk of stroke. However, these results are based on limited data. Further investigations are needed in women with risk factors of stroke. Language: English Keywords: FRANCE | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | COMPARATIVE STUDIES | WOMEN | PREVALENCE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, PROGESTIN | RISK ASSESSMENT | CEREBROVASCULAR EFFECTS | CONTRACEPTIVE IMPLANTS | INJECTABLES | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Measurement | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Evaluation | Physiology | Biology | Contraceptive Methods Document Number: 331085 |
| 24. Title: Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial. Author: Chawdhary R; Rana A; Pradhan N Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):78-85. Abstract: AIM: To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. METHOD: This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy < or =63 days gestation by transvaginal ultrasound, an equal number of women (50) were randomized into (i) group A, women who received 200 mg oral mifepristone (RU 486) on day 1 and vaginal misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. RESULTS: Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). CONCLUSION: Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RU-486 | MISOPROSTOL | ABORTION | VAGINA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Population Dynamics | Contraceptive Agents | Contraception | Pregnancy | Reproduction Document Number: 341125 |
| 25. Peer Reviewed Title: Effect of previous live birth and prior route of delivery on the outcome of early medical abortion. Author: Chien LW; Liu WM; Tzeng CR; Au HK Source: Obstetrics and Gynecology. 2009 Mar;113(3):669-74. Abstract: OBJECTIVE: To determine the association between type of previous delivery (vaginal compared with cesarean) on the success of medical abortion with mifepristone-misoprostol in early pregnancy. METHODS: The records of 879 women with intrauterine pregnancies at or before 56 days of gestation who underwent medical abortions were reviewed. Medical treatment consisted of 600 mg mifepristone orally followed 48 hours later with oral misoprostol. An ultrasound examination was performed 14-21 days after treatment, and a successful medical abortion was defined as an empty uterus without surgical intervention. Univariable and multivariable logistic regressions were used to determine risk factors for failure of medical abortion. RESULTS: A total of 797 (90.7%) women had successful medical abortions; 82 (9.3%) had failed medical abortions. Multivariable logistic regression indicated that women with gestational ages greater than 42 days (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.55-4.05) had higher odds of failed abortion compared with a gestational age less than 43 days. Parous women (OR> or =3.94, 95% CI 1.83-8.53) and those with prior cesarean delivery (OR 9.59, 95% CI 4.30-21.39) were more likely to have failed abortions compared with nulliparous women. Among 523 parous women (68 had failed abortion), those with gestational ages greater than 42 days (OR 2.07, 95% CI 1.22-3.50) and prior cesarean delivery (OR 3.33, 95% CI 1.95-5.69) were more likely to have failed abortions compared with those with gestational ages less than 43 days or with prior vaginal delivery. CONCLUSION: Parous women are at increased risk for failed medical abortion in comparison with nulliparous women. Prior cesarean delivery is significantly associated with failed medical abortion. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | CHILDBIRTH | ABORTION | CESAREAN SECTION | RU-486 | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins Document Number: 331067 Notification |
| 26. Peer Reviewed Title: One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens. Author: Chin-Quee D; Otterness C; Wedderburn M; McDonald O; Janowitz B Source: Contraception. 2009 May;79(5):369-74. Abstract: BACKGROUND: Despite World Health Organization and International Planned Parenthood Federation recommendations to provide multiple pill cycles to new users, many programs in developing countries still give only one pill cycle to new acceptors. STUDY DESIGN: To compare provision of a single versus multiple packs of pills, new pill users in 20 matched public sector clinics in Jamaica were assigned to one of two pill regimens in which they received either one (then subsequently three) or four pill cycles at method initiation. The primary outcome was the proportion of women who used pills beyond 4 months. RESULTS: Among 655 women, those receiving one cycle of pills at initiation, followed by counseling and a three-pack resupply, were no more likely to be using pills after 4 months than women who received four packs at initiation (odds ratio=1.33; 95% confidence interval=0.88-2.0). In both pill regimen groups, returning late to the clinic for resupply was a problem. However, more women in the 1+3-pack regimen group returned late to study clinics to obtain their fifth cycle of pills than their counterparts in the 4-pack regimen group (53% vs. 28%). CONCLUSION: Our findings support the recommendation that pill users should be given more than one cycle to start, because an extra visit for resupply contributes to clinic and provider costs. Moreover, providing more pill cycles at initiation would decrease the likelihood that women experience a gap in pill use between cycles. Language: English Keywords: JAMAICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | CONTRACEPTIVE DISTRIBUTION | PACKAGING | ORAL CONTRACEPTIVES | TIME FACTORS | COUNSELING | USER COMPLIANCE | CONTRACEPTIVE PREVALENCE | CONTRACEPTION CONTINUATION | Caribbean | Americas | Developing Countries | Family Planning Surveys | Family Planning | Studies | Research Methodology | Economic Development | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Marketing | Contraceptive Methods | Contraception | Population Dynamics | Demographic Factors | Population | Clinic Activities | Behavior | Contraceptive Usage Document Number: 330940 |
| 27. Title: Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. Author: Chowdhury JR; Chaudhuri S; Bhattacharyya N; Biswas PK; Panpalia M Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):119-125. Abstract: Objectives: Our objective was to compare intramuscular (i.m.) magnesium sulfate with a low dose intravenous (i.v.) magnesium sulfate regimen in prevention of convulsion recurrence and maternal deaths in women with eclampsia. Methods: This prospective trial was conducted in Nilratan Sircar Medical College, India from January 2001 to December 2005. All women with a clinical diagnosis of eclampsia were included in the trial. Magnesium sulfate (4 gm) was given as an i.v. loading dose, followed by either i.m. injections as recommended by Pritchard or low dose i.v. infusions (0.6 gm/h). Primary measures of outcome were recurrence of convulsions and maternal death. Secondary measures of outcome were potentially life threatening events, events related to labor and delivery as well as perinatal mortality and morbidity. Results: Of the 630 women participating in the trial, 480 women received i.m. magnesium sulphate according to the Pritchard regimen and 150 women were subjected to a low dose i.v. regimen ofmagnesium sulphate. There was no significant difference in recurrence of convulsion (3.3% in the i.m. and 2% in the i.v. groups P = 0.586). Maternal deaths were not significantly lower in the i.v. group than the i.m. group (5% in the i.m. and 3.3% in the i.v. groups, P = 0.506) There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality. Conclusion: Low dose i.v. magnesium sulfate regimen is equally effective in prevention of convulsion recurrence and maternal deaths in eclamptic women when compared with an i.m. magnesium sulfate regimen. Language: English Keywords: INDIA | RESEARCH REPORT | COMPARATIVE STUDIES | PREECLAMPSIA | PREGNANCY COMPLICATIONS | DRUGS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 340214 |
| 28. Peer Reviewed Title: Comparison of laboratory methods for analysis of non-nucleoside reverse transcriptase inhibitor resistance in Ugandan infants. Author: Church JD; Huang W; Parkin N; Marlowe N; Guay LA; Omer SB; Musoke P; Jackson JB; Eshleman SH Source: AIDS Research and Human Retroviruses. 2009 Jul;25(7):657-63. Abstract: Detailed comparisons of HIV drug resistance assays are needed to identify the most useful assays for research studies, and to facilitate comparison of results from studies that use different methods. We analyzed nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance in 40 HIV-infected Ugandan infants who had received nevirapine (NVP)-based prophylaxis using the following assays: an FDA-cleared HIV genotyping assay (the ViroSeq HIV-1 Genotyping System v2.0), a commercially available HIV genotyping assay (GeneSeq HIV), a commercially available HIV phenotyping assay (PhenoSense HIV), and a sensitive point mutation assay (LigAmp). ViroSeq and GeneSeq HIV results (NVP resistance yes/no) were similar for 38 (95%) of 40 samples. In 6 (15%) of 40 samples, GeneSeq HIV detected mutations in minor subpopulations that were not detected by ViroSeq, which identified two additional infants with NVP resistance. LigAmp detected low-level mutations in 12 samples that were not detected by ViroSeq; however, LigAmp testing identified only one additional infant with NVP resistance. GeneSeq HIV and PhenoSense HIV determinations of susceptibility differed for specific NNRTIs in 12 (31%) of the 39 samples containing mixtures at relevant mutation positions. PhenoSense HIV did not detect any infants with NVP resistance who were not identified with GeneSeq HIV testing. In this setting, population sequencing-based methods (ViroSeq and GeneSeq HIV) were the most informative and had concordant results for 95% of the samples. LigAmp was useful for the detection and quantification of minority variants. PhenoSense HIV provided a direct and quantitative measure of NNRTI susceptibility. Language: English Keywords: UGANDA | RESEARCH REPORT | DATA ANALYSIS | COMPARATIVE STUDIES | RESEARCH METHODOLOGY | INFANT | PERSONS LIVING WITH HIV/AIDS | HIV | POPULATION GENETICS | LABORATORY PROCEDURES | HIV TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Genetics | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342880 |
| 29. Peer Reviewed Title: Rate of pregnancy after using drospirenone and other progestin-containing oral contraceptives. Author: Cronin M; Schellschmidt I; Dinger J Source: Obstetrics and Gynecology. 2009 Sep;114(3):616-22. Abstract: OBJECTIVES:: To determine whether prior oral-contraceptive use has a negative effect on the ability of women to conceive in both the short-term and long-term. METHODS:: The European Active Surveillance Study on Oral Contraceptives (EURAS-OC) was a controlled, prospective, noninterventional cohort study of 59,510 users of oral contraceptives containing drospirenone or other progestins in clinical practice in seven European countries. In a planned secondary analysis, pregnancy outcomes were investigated in 2,064 participants in EURAS-OC who stopped oral-contraceptive use after study entry because of planned pregnancy. The influence of age, parity, progestin type, ethinylestradiol dose, duration of oral-contraceptive use, and smoking status on the rate of pregnancy was assessed. RESULTS:: Overall, 21.1% (95% confidence interval [CI] 19.4-23.0%) of the past oral-contraceptive users were pregnant one cycle after oral-contraceptive cessation. This rate increased to 79.4% (95% CI 77.6-81.1%) at 1 year (13 cycles). Progestin type, ethinylestradiol dose, duration of oral-contraceptive use, and parity had no major influence on the rate of pregnancy after oral-contraceptive cessation. Up to age 35 years, age had only a minor influence on the rate of pregnancy. Rates of pregnancy were reduced in women older than 35 years and in current smokers. CONCLUSION:: Previous oral-contraceptive use does not negatively affect initial and 1-year rates of pregnancy after oral-contraceptive cessation. A comparison of these data with data external to this study indicates that the negative effect of aging on fecundity is not amplified by oral-contraceptive use. LEVEL OF EVIDENCE:: II. Language: English Keywords: EUROPE | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANCY | PREGNANCY OUTCOMES | ORAL CONTRACEPTIVES | LOW-DOSE PROGESTINS | CONTRACEPTION TERMINATION | PREGNANCY RATE | Developed Countries | Studies | Research Methodology | Reproduction | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 342570 |
| 30. Peer Reviewed Title: Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger. Author: Dale NM; Grais RF; Minetti A; Miettola J; Barengo NC Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):126-30. Abstract: OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs. Language: English Keywords: NIGER | UNITED STATES OF AMERICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CLASSIFICATION | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | EVALUATION INDEXES | CHILDREN | GROWTH | MALNUTRITION | STANDARDS | HEALTH STATUS INDEXES | WHO | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Youth | Age Factors | |