1.  Peer Reviewed Title: Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Author: Black V; Brooke S; Chersich MF Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 1):292-9. Abstract: OBJECTIVE:: To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. METHODS:: Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. RESULTS:: During the 5-year period, 106 maternal deaths occurred out of 36,708 births (facility-based maternal mortality ratios 289/100,000 live births, 95% confidence interval [CI] 237-349/100,000). In 72% of cases, HIV status was known (76/106), with the majority being HIV-infected (78%, 59/76). Among HIV-infected women, only two had initiated antiretroviral treatment, and 70% of deaths were HIV-related (41/59), mainly from tuberculosis (21) and pneumonia (12). Direct obstetric causes of death such as hypertension and pregnancy-related sepsis predominated in women who were HIV-negative or of unknown status (48.9%, 23/47). Maternal mortality ratios in HIV-infected women were 776/100,000 (95% CI 591-1,000/100,000), 6.2-fold higher (95% CI 3.6-11.4) than in HIV-negative women (124/100,000, 95% CI 72-199/100,000). Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year (95% CI 1.3-1.4) and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. CONCLUSION:: In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care. LEVEL OF EVIDENCE:: III. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | HYPERTENSION | MATERNAL-CHILD HEALTH SERVICES | HIV INFECTIONS | AIDS | MATERNAL MORTALITY | CAUSES OF DEATH | HIV/FP INTEGRATION | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Vascular Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 342270 |
| 2. Peer Reviewed Title: [Spatial distribution of elderly individuals in a medium-sized city in São Paulo State, Brazil, according to key socio-demographic and morbidity characteristics] Distribuição espacial dos idosos de um município de médio porte do interior paulista segundo algumas características sócio-demográfi cas e de morbidade. Author: Campos FG; Barrozo LV; Ruiz T; Cesar CL; Barros MB; Carandina L; Goldbaum M Source: Cadernos de Saude Publica. 2009 Jan;25(1):77-86. Abstract: Geographic Information Systems serve as important public health tools for analyzing population disease distribution and thus for identifying individuals with chronic non-communicable diseases. The current study performed a spatial analysis of the distribution of the population 60 years and older in the city of Botucatu, São Paulo State, Brazil, studying the socio-demographic profile and the presence of diabetes mellitus and arterial hypertension. Data were analyzed from 468 elderly individuals from a population survey conducted in 2001-2002. Elders with the highest socioeconomic status live in the census tracts with the highest social strata, as proven statistically by spatial analysis techniques for income and schooling. No spatial distribution pattern was found for elderly individuals with hypertension and diabetes, who were located heterogeneously on the map. The study suggests the use of geoprocessing techniques for digital mapping of areas covered by primary health care units, aimed at better monitoring of the distribution of elderly individuals with chronic diseases and their care by health professionals. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGY | GEOGRAPHIC FACTORS | POPULATION DISTRIBUTION | DISEASES | HYPERTENSION | DIABETES | SOCIOECONOMIC STATUS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Public Health | Health | Population | Vascular Diseases | Socioeconomic Factors | Economic Factors Document Number: 341870 |
3.  Title: The growing chronic disease burden: implications for reproductive health. Author: Drake JK Source: Outlook. 2009 Jul;26(1):8 p. Abstract: Approximately 80 percent of deaths from chronic disease occur in low- and middle-income countries, where people tend to develop these diseases at younger ages, suffer longer, and die sooner. A recent analysis found that chronic disease is an "important cause of female death, even during childbearing years, and for women with young families." The newsletter provides background on the growing chronic disease burden in developing countries, and explores current and anticipated impacts of cardiovascular conditions, diabetes, and obesity on reproductive health. Examples include hypertension and diabetes in pregnancy and contraceptive choice and access for women with cardiovascular conditions and risk factors. Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | EPIDEMIOLOGY | DISEASES | REPRODUCTIVE HEALTH | MATERNAL MORTALITY | DEATH RATE | HYPERTENSION | DIABETES | SCREENING | FAMILY PLANNING | TREATMENT | PREVENTION AND CONTROL | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population | Vascular Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 341982 |
| 4. Title: Pharmacotherapeutic options for the treatment of preeclampsia. Author: McCoy S; Baldwin K Source: American Journal of Health System Pharmacy. 2009 Feb 15;66:337-344. Abstract: Purpose. Pharmacotherapeutic options for the treatment of preeclampsia are reviewed. Summary. Risk factors for the development of preeclampsia include microvascular diseases, such as diabetes mellitus; vascular and connective tissue disorders; hypertension; antiphospholipid antibody syndrome; and nephropathy. Several pathophysiological factors contribute to the development of the preeclamptic state, including vasospasm onset, coagulation system activation, increased inflammatory response, and ischemia. The specific agents used for the treatment of preeclampsia are dependent on a number of factors including symptom severity, maternal or fetal compromise, the progression to eclampsia, gestational period, and cervical status. The diagnosis of preeclampsia beyond the gestation period of 38 weeks requires delivery. The presence of maternal compromise or eclampsia at gestation greater than 20 weeks also necessitates delivery. In cases of chronic or mild hypertension, oral methyldopa may be administered on an outpatient basis. Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancies. The most common adverse effect of hydralazine administration is unpredictable hypotension. Labetalol decreases heart rate and may be preferred because of a lack of reflex tachycardia, hypotension, or increased intracranial pressure. However, the drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period is i.v. magnesium sulfate. Therapeutic serum magnesium levels cause cerebral vasodilation, thereby reversing the ischemia produced by cerebral vasospasm during an eclamptic episode. The results of one study indicated that women receiving magnesium sulfate therapy had a 58% lower risk of eclampsia than placebo. Conclusion. Magnesium sulfate remains the drug of choice for the prevention and treatment of preeclampsia. Alternative antihypertensive agents mayprovide additional benefit in the management of hypertension for preeclamptic patients. Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | PREECLAMPSIA | HYPERTENSION | RISK FACTORS | RENAL EFFECTS | SIGNS AND SYMPTOMS | DRUGS | ADMINISTRATION AND DOSAGE | SAFETY | LACTATION | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Pregnancy Complications | Diseases | Vascular Diseases | Health | Urogenital Effects | Urogenital System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Public Health | Maternal Physiology Document Number: 340210 |
| 5. Title: [Effect of combined hormonal contraceptives on the vascular endothelium und new cardiovascular risk parameters] Effekt hormonaler Kontrazeptiva auf das Endothel und neue kardiovaskulare Author: Merki-Feld GS Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):89-92. Abstract: Epidemiological studies indicate an increased cardiovascular risk in users of combined oral contraceptives (COC) but not progestagen-only preparations. A specially high risk was observed in women older than 35 years with additional cardiovascular risk factors like smoking or hypertension. The mechanisms underlying arterial occlusion can not be explained by hormonal effects on the vascular tonus, nor by effects on newer risk parameters like homocysteine or transforming growth factor-beta. However, CRP increases during oral and transdermal COC use, an effect which can not be observed during use of a progestagen-only implant. Studies concerning the effect of COC on the vasotonus, nitric oxide, homocysteine and CRP usually include young healthy women with intact endothelial function. Females with nicotinabusus, hypertension and hypercholesterolemia have a damaged endothelium. The effect of hormonal treatment on the endothelium in these women might include decreased ability to release the strong vasodilator nitric oxid and as a consequence of that impaired vasodilation. Language: German Keywords: RESEARCH REPORT | EPIDEMIOLOGY | ORAL CONTRACEPTIVES, COMBINED | CARDIOVASCULAR EFFECTS | HYPERTENSION | TREATMENT | RISK FACTORS | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Vascular Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 329574 |
| 6. Peer Reviewed Title: Placental Malarial Infection as a Risk Factor for Hypertensive Disorders During Pregnancy in Africa: A Case-Control Study in an Urban Area of Senegal, West Africa. Author: Ndao CT; Dumont A; Fievet N; Doucoure S; Gaye A; Lehesran JY Source: American Journal of Epidemiology. 2009 Aug 13; Abstract: In tropical countries, malaria and hypertension are common diseases of pregnancy. They have physiopathologic similarities such as placental ischemia, endothelial dysfunction, and production of proinflammatory cytokines. Recent findings suggested their possible link. The authors conducted a case-control study to explore the relation between malaria and hypertension at Guediawaye, a hypoendemic malarial setting in Senegal. Cases were pregnant women admitted to the delivery unit for hypertension. Controls were pregnant women admitted for normal delivery, without any history of hypertension or proteinuria during the present pregnancy. Malarial infection was determined by placental tissue examination. From January to December 2002, 77 cases of gestational hypertension, 113 cases of preeclampsia, 59 cases of eclampsia, and 241 controls were enrolled. Placental malarial infection (PMI) was present in 14 cases (6.3%) and in 15 controls (6.2%). The prevalence of PMI was 4.6% for eclampsia, 4.0% for preeclampsia, and 11.6% for gestational hypertension. In multivariate analysis, PMI appeared to be an independent risk factor for gestational hypertension (adjusted odds ratio = 2.7, 95% confidence interval: 1.0, 7.6). The authors found an association between PMI and nonproteinuric hypertension in women living in a malaria-hypoendemic area. The exact significance of such relation should be clarified in further studies in different settings of malarial endemicity. Language: English Keywords: SENEGAL | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | RISK FACTORS | HYPERTENSION | PREGNANCY | MALARIA | PREECLAMPSIA | FETAL MEMBRANES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Vascular Diseases | Diseases | Reproduction | Parasitic Diseases | Pregnancy Complications | Fetus Document Number: 342554 |
| 7. Title: [Contraception in adolescence and perimenopause] Kontrazeption zu Beginn und Ende der fertilen Lebensphase. Author: Neulen J; Thaler C; Birkhauser M; Braendle W; Keller PJ Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):109-15. Abstract: The risk-benefit-ratio of hormonal contraception (OC) is positive in adolescents as well as in women over 40 years of age if some essential rules are respected. In adolescents, the acquirement of a normal peak bone mass has to be guaranteed by the use of the OC. The dosage of the OC has to be adapted individually to the basic hormonal situation. In women over 40, contraindications such as hypertension, obesity, smoking or dyslipidemia have to be actively excluded. In both groupes of age, the risk of a correctly indicated OC is inferior to the risk of an unwanted pregnancy. Language: German Keywords: RESEARCH REPORT | ADOLESCENTS | ORAL CONTRACEPTIVES | HYPERTENSION | OBESITY | TOBACCO USE | PREGNANCY, UNWANTED | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Vascular Diseases | Diseases | Body Weight | Physiology | Biology | Behavior | Reproductive Behavior | Fertility | Population Dynamics Document Number: 329571 |
| 8. Title: Cardiac manifestations of HIV infection: an African perspective. Author: Ntsekhe M; Mayosi BM Source: Nature Clinical Practice. Cardiovascular Medicine. 2009 Feb;6(2):120-7. Abstract: The pericardium, myocardium, coronary arteries and pulmonary arteries are the main targets for cardiac disease in people who are infected with HIV. Geography and access to highly active anti-retroviral therapy (HAART) have a major influence on which of these targets is affected. In sub-Saharan Africa, where tuberculosis is endemic and access to HAART is limited, the dominant forms of HIV-associated heart disease are pericardial tuberculosis and cardiomyopathy. However, in industrialized countries, where tuberculosis is rare and HAART is widely available, coronary artery disease is the main cause of death and disability in these patients. Observational data suggest that HAART, by preserving immune function, reduces the incidence of myopericardial disease and pulmonary hypertension. The result has been that, although optimal strategies to reduce vascular disease in this population continue to be sought and debated in industrialized nations, the focus of prevention and treatment strategies for HIV-related heart disease in developing countries has been to support the active campaigns to get universal access to HAART in the first place. Herein, we review the cardiac manifestations of HIV in sub-Saharan Africa. Language: English Keywords: AFRICA | SUMMARY REPORT | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | CARDIOVASCULAR EFFECTS | HEART DISEASES | HIV INFECTIONS | HYPERTENSION | Developing Countries | Viral Diseases | Diseases | Infections | Physiology | Biology | Vascular Diseases Document Number: 330530 |
| 9. Title: [Contraception and pregnancy after liver transplantation: an update overview] Contracepcao e gravidez apos transplante hepatico--uma visao atual. Author: Parolin MB; Coelho JC; Urbanetz AA; Pampuch M Source: Arquivos De Gastroenterologia. 2009 Apr-Jun;46(2):154-8. Abstract: CONTEXT: Successful liver transplantation not only treats the underlying liver disease but also restores libido and fertility in female recipients. Although reports of successful pregnancy after liver transplantation continue to increase, these pregnancies are considered of high-risk because they are associated with increase maternofetal morbidity. EVIDENCE ACQUISITION: A MEDLINE search (1978-2007) was conducted using the terms 'liver transplantation', 'pregnancy', 'immunosuppressive agents', 'sexual function'. Reviews, retrospective series, long-term clinical follow-up of case series and original articles containing basic scientific observations were included. RESULTS: Although no formal guidelines have been established there are some 'golden rules' to improve the probability of favorable maternal and fetal outcome. Most transplant centers recommend to delay pregnancy for at least 1-year after transplantation. The recipient should be on a stable immunosuppression regimen, with good graft function and no evidence of renal dysfunction or uncontrolled arterial hypertension. Considering the increased incidence of prematurity, low birth weight, hypertension and preeclampsia reported during pregnancy post-LT, these high-risk patients should be managed by a multidisciplinary team, including an obstetrician specialized in high-risk pregnancies. Carefully monitoring of immunosuppressive drugs serum level is prudent to avoid graft rejection episodes and drugs with teratogenic potential should be discontinued. Breastfeeding is usually not recommended. CONCLUSIONS: Successful pregnancies are the rule after liver transplantation. A carefully monitoring by an experience multidisciplinary team increases the chances of favorable maternofetal outcome. Language: Portuguese Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY | SURGERY | LIVER DYSFUNCTION | HYPERTENSION | PREECLAMPSIA | LOW BIRTH WEIGHT | PREGNANCY, HIGH RISK | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Vascular Diseases | Pregnancy Complications | Birth Weight | Body Weight | Physiology | Biology Document Number: 341915 |
| 10. Title: Evidence-based practices to reduce maternal mortality: a systematic review. Author: Piane GM Source: Journal of Public Health. 2009 Mar;31(1):26-31. Abstract: BACKGROUND: To achieve the World Health Organization's Millennium Development Goal of reducing maternal mortality by three-quarters by 2015, a strong global commitment is needed to address this issue in sub-Saharan Africa where the risk to women is greatest. A comprehensive international effort must include both clinical and community-based interventions. In sub-Saharan Africa where the majority of women deliver babies at home without a trained attendant, the national plans must rely predominantly on community-level interventions. METHODS AND RESULTS: This study compiles the Cochrane reviews whose outcome measure is maternal mortality. Nine reviews documented the effectiveness of specific drugs given during pregnancy while six reviews demonstrated that particular drug regimens and procedures actually increase maternal death. Two of the Cochrane reviews found no significant difference in maternal mortality risk due to antioxidant use or in training traditional births attendants. CONCLUSIONS: The dearth of evidence highlights the need for increased focus on clinical and community-based interventions that are feasible in sub-Saharan Africa. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | LITERATURE REVIEW | MATERNAL MORTALITY | RISK FACTORS | INTERVENTIONS | HYPERTENSION | DRUGS | Africa | Developing Countries | Mortality | Population Dynamics | Demographic Factors | Population | Health | Programs | Organization and Administration | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 341639 |
| 11. Peer Reviewed Title: Maternal deaths due to eclampsia and HELLP syndrome. Author: Vigil-De Gracia P Source: International Journal of Gynecology and Obstetrics. 2009;104:90-94. Abstract: Objective: To evaluate maternal deaths associated with eclampsia, HELLP syndrome, and the concurrence of these conditions. Method: A review of Medline studies reporting maternal deaths associated with eclampsia or HELLP syndrome published in English, Spanish, and Portuguese between 1995 and June 2008. Results: A total of 304 deaths were identified: 100 due to eclampsia, 117 due to eclampsia/HELLP, and 87 associated with HELLP syndrome. Of the total deaths, 71.3% of women had seizures and 67.1% developed HELLP syndrome. In high-income countries 3.9% of deaths were due to eclampsia without HELLP syndrome, while in low-income countries this figure was 42.5% (Pb0.0001). The presence of HELLP syndrome in the women who died of eclampsia was 90.6% (29/32) in high-income countries compared with 47.6% (88/185) in low-income countries (Pb0.001). Conclusion: Concurrent eclampsia and HELLP syndrome was diagnosed in 5-6 out of 10 deaths associated with eclampsia or HELLP syndrome in this review. Language: English Keywords: GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | MATERNAL MORTALITY | ECLAMPSIA | PREECLAMPSIA | CAUSES OF DEATH | HYPERTENSION | CEREBROVASCULAR EFFECTS | LIVER DYSFUNCTION | BLOOD PRESSURE | Mortality | Population Dynamics | Demographic Factors | Population | Pregnancy Complications | Diseases | Vascular Diseases | Physiology | Biology | Hemic System Document Number: 340212 |
| 12. Title: 2006 Bangladesh Urban Health Survey (UHS). Volume II. Author: Bangladesh. National Institute of Population Research and Training [NIPORT]; University of North Carolina at Chapel Hill. Carolina Population Center. MEASURE Evaluation; International Centre for Diarrhoeal Disease Research, Bangladesh [ICDDR,B]; Associates for Community and Population Research [ACPR] Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2008 Dec. [310] p. (USAID Contract No. GPO-A-00-03-00003-00TR-08-68b) Abstract: Nearly all of the global population growth in the next three decades will occur in urban areas, primarily as a massive migration occurs from the rural areas of middle and lower-income societies to their cities. Many, if not most of these migrants, who are generally possessed of low human and financial capital on arrival in the city, will settle in slums, the areas of concentrated poverty and environmental vulnerability that are already a dominant feature of much of the urban landscape of the developing world. Bangladesh will be no exception to these trends. The growth in her urban population is set to outstrip by a wide margin that in rural areas. Moreover, the urban growth already experienced in recent decades demonstrates that slums will likely be an increasingly important feature of urban existence in Bangladesh. Anticipating these developments, USAID and the Government of Bangladesh tasked a research team based in Bangladesh and the United States (at the University of North Carolina at Chapel Hill) with conducting a survey designed to obtain a broad health profile of the urban population of Bangladesh. The ultimate fruit of this effort was the 2006 Urban Health Survey (2006 UHS), a rich, microlevel health-interview survey of communities, households, and individuals throughout the City Corporations and a sample of District Municipalities. The principal objectives of the 2006 UHS were: 1) To obtain a profile of health problems and health-care seeking behavior in urban areas of Bangladesh; 2) To identify vulnerable groups and examine their health profile and health-care seeking behavior; and 3) To examine the individual, household, and neighborhood-level factors associated with health outcomes and health behaviors in urban areas. Language: English Keywords: BANGLADESH | SUMMARY REPORT | PREVALENCE | HEALTH STATUS INDEXES | ACCIDENTS AND INJURIES | NUTRITION | HYPERTENSION | TOBACCO USE | DOMESTIC VIOLENCE | FERTILITY | FAMILY PLANNING | REPRODUCTION | INFANT NUTRITION | MENTAL HEALTH | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Health | Vascular Diseases | Diseases | Behavior | Crime | Social Problems | Sociocultural Factors | Population Dynamics | Demographic Factors | Population Document Number: 329543 |
| 13. Title: Maternal mortality in India: a 20-year study from a large referral medical college hospital, West Bengal. Author: Bhattacharyya SK; Majhi AK; Seal SL; Mukhopadhyay S; Kamilya G; Mukherji J Source: Journal of Obstetrics and Gynaecology Research. 2008 Aug;34(4):499-503. Abstract: AIM: The present study was carried out to analyze the maternal death rate and its changing trends over a 20-year period in a large referral/teaching institution in Eastern India. METHODS: A retrospective analysis of maternal deaths was carried out from January 1986 to December 2005 at the Department of Obstetrics and Gynaecology, R. G. Kar Medical College and Hospital, Kolkata, India. Records were divided into four 5-yearly periods: 1986-1990; 1991-1995; 1996-2000; and 2001-2005, for comparison of the trends. The initial interval from 1986 to 1990 was chosen as the reference period. RESULTS: The cumulative maternal mortality ratio (MMR) was 599.3 per 100 000 live births. Comparison between the first 5-year period (1986-1991) and the last (2001-2005) showed a statistical significant downward trend in MMR (683.6 vs 474.3; P < 0.001). Deaths due to direct causes are still the leading cause, accounting for 82.09% of total deaths. Hypertensive disorders (36.14%), hemorrhage (21.91%) and sepsis (19.54%) were still the major causes of direct obstetric deaths throughout the study period. Hypertensive disorders alone showed a substantial decline after the introduction of magnesium sulphate. CONCLUSION: The fall in maternal mortality has been very slow. Language: English Keywords: INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | RETROSPECTIVE STUDIES | WOMEN IN DEVELOPMENT | DEATH RATE | MATERNAL MORTALITY | CAUSES OF DEATH | PREGNANCY COMPLICATIONS | HYPERTENSION | BLEEDING | INFECTIONS | ECLAMPSIA | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Vascular Diseases | Signs and Symptoms Document Number: 329364 |
| 14. Title: [Myocardial infarction and oral contraceptives] Infarctus du myocarde et contraceptifs oraux. Author: Bounhoure JP; Galinier M; Roncalli J; Assoun B; Puel J Source: Bulletin De L'Academie Nationale De Medecine. 2008 Mar;192(3):569-79; discussion 579. Abstract: Shortly after the introduction of oral contraceptives in 1960, myocardial infarction (MI) started to emerge as a major adverse effect. Its mechanism and pathophysiology have remained elusive. Many epidemiological studies identified smoking, hypertension, diabetes and hypercholesterolemia as risk factors for coronary thrombosis in young women using oral contraceptives. The pathogenesis of MI involves two phases: atherosclerotic plaque formation, and thrombotic arterial occlusion. The use of very low doses of estrogen (less than 50 microg of ethinyl estradiol) and new progestagens have minimized the vascular risks. However, the risk remains in women who smoke or have other atherosclerotic risks factors. We report 12 cases of MI in women aged 35 +/- 5 years who were using different types of oral contraceptive. All the women had several risks factors, such as smoking, hypertension, hypercholesterolemia, obesity, and type II diabetes. Coronarography during the acute phase showed either occlusions on severe atherosclerotic stenoses or thrombosis of arteries with non significant atherosclerotic plaque. In two cases coronarography was normal after thrombolysis. Ten women recovered without sequelae, but reversible left ventricular dysfunction occurred in the other two women, who did not have acute-phase revascularization. Recent case-control studies show that the cardiovascular risk is very low with new, third-generation combined contraceptives. But the risk of MI increases with age, smoking, hypertension, dyslipidemia and diabetes. The absolute risks associated with oral contraceptives and smoking are higher in women over 35, because of the steeply rising incidence of atherosclerosis. It is mandatory to respect the classical contraindications of oral contraception. Language: French Keywords: RESEARCH REPORT | CASE STUDIES | EPIDEMIOLOGY | WOMEN | MYOCARDIAL INFARCTION | ORAL CONTRACEPTIVES | TOBACCO USE | DIABETES | HYPERTENSION | VASCULAR DISEASES | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | RISK FACTORS | Studies | Research Methodology | Public Health | Health | Demographic Factors | Population | Heart Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Behavior | Contraceptive Safety | Safety | Biology Document Number: 329006 |
| 15. Title: Editorial summary of symposium on hypertensive disorders of pregnancy. Author: Druzin ML; Charles B; Johnson AL Source: Current Opinion in Obstetrics and Gynecology. 2008 Apr;20(2):91-95. Abstract: Hypertensive disorders of pregnancy, particularly the preeclampsia/eclampsia syndrome, remain the leading causes of worldwide pregnancy-related maternal and neonatal mortality and morbidity. This group of conditions are a 'riddle wrapped in a mystery inside an enigma' to quote Winston Churchill. We are fortunate to have contributions from leading clinical experts who have devoted many years of their professional careers attempting to solve this conundrum. Dr Jack Moodley has provided us with a perspective on clinical management in under-resourced countries. Referral to experts, aggressive treatment of hypertension and use of magnesium sulfate improves care. Dr Shennan focuses on the assessment of risk, close antenatal surveillance and timely delivery. Dr Uzan continues to champion the use of aspirin for prevention of preeclampsia, even though the evidence is contradictory. Dr Sibai addresses the lack of evidence for calcium, vitamin C and E in prevention of preeclampsia. Dr Von Dadelszen is developing a new paradigm for the classification of these disorders and emphasizes the importance of evidence-based intervention. Evidence suggests that treatment of severe hypertension, seizure prophylaxis with magnesium sulfate, and management by experienced healthcare professionals will improve maternal, fetal and neonatal outcomes. Well designed studies will lead to evidence-based improvement in caring for mothers and babies world-wide. (author's) Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | CRITIQUE | LITERATURE REVIEW | PREGNANT WOMEN | PREGNANCY | PREECLAMPSIA | ECLAMPSIA | HYPERTENSION | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Reproduction | Pregnancy Complications | Diseases | Vascular Diseases Document Number: 326661 |
| 16. Peer Reviewed Title: Accuracy of self-screening for contraindications to combined oral contraceptive use. Author: Grossman D; Fernandez L; Hopkins K; Amastae J; Garcia SG Source: Obstetrics and Gynecology. 2008 Sep;112(3):572-8. Abstract: OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged. Language: English Keywords: TEXAS | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | WOMEN | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | KNOWLEDGE | WHO | BLOOD PRESSURE | SELF CARE | SCREENING | HYPERTENSION | MIGRAINE | United States of America | North America | Americas | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Sociocultural Factors | UN | International Agencies | Organizations | Political Factors | Hemic System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Examinations and Diagnoses | Vascular Diseases | Diseases Document Number: 329053 |
| 17. Title: Calreticulin in human pregnancy and pre-eclampsia. Author: Gu VY; Wong MH; Stevenson JL; Crawford KE; Brennecke SP Source: Molecular Human Reproduction. 2008;14(5):309-315. Abstract: Pre-eclampsia is a disorder of human pregnancy that involves pregnancy-induced maternal hypertension and proteinuria. Evidence indicates that pre-eclampsia involves widespread activation of maternal endothelial cells. Calreticulin is a ubiquitously expressed, multi-functional protein that has been shown to have both pro- and anti-inflammatory effects on cultured endothelial cells in vitro and in whole animals. In order to clarify the role of this protein in normal human pregnancy and in pre-eclampsia, this study has measured expression of calreticulin in maternal blood and in placenta in patients with pre-eclampsia and in control pregnancies. There was a significant increase (approximately 5-fold) in calreticulin in plasma in term pregnant women compared with women who were not pregnant. There was no difference, however, in calreticulin in plasma from women who were sampled at first trimester, second trimester and at term. In addition, there was a significant increase (approximately 50%) in calreticulin in plasma from pre-eclamptic women compared to controls. Calreticulin mRNA and protein expression in placenta were not changed between pre-eclampsia and control pregnancies. These novel results indicate that calreticulin is increased in peripheral maternal blood early in pregnancy and remains elevated throughout normal gestation and that there is a further increase in calreticulin in pre-eclampsia. (author's) Language: English Keywords: AUSTRALIA | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANT WOMEN | PREECLAMPSIA | PREGNANCY | FETAL TISSUE | HYPERTENSION | Developed Countries | Oceania | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Reproduction | Fetal Membranes | Fetus | Vascular Diseases Document Number: 327241 |
| 18. Title: [Early determinants of blood pressure among adults of the 1982 birth cohort, Pelotas, Southern Brazil] Author: Horta BL; Gigante DP; Victora CG; Barros FC Source: Revista De Saude Publica. 2008 Dec;42 Suppl 2:86-92. Abstract: OBJECTIVE: To evaluate the effects of exposure occurring during pregnancy or the first years of life on blood pressure. METHODS: Cohort study on all children born in 1982 in maternity hospitals in the city of Pelotas, Southern Brazil. The mothers living in the urban area were interviewed and the children were followed up on different occasions. In 2004-5, all the individuals in the cohort were sought for monitoring. Their blood pressure was measured twice, at the start and end of the interview, using a digital wrist sphygmomanometer. Associations between blood pressure and the following variables were evaluated: skin color; maternal schooling level; family income at birth; change in income between birth and 23 years of age; birth weight; and duration of breastfeeding. Analysis of variance was used to compare the means and a generalized linear model was used in the adjusted analysis. RESULTS: Blood pressure measurements were obtained from 4,291 individuals: 2,208 males and 2,083 females. The mean systolic blood pressure was 117.5 +/- 15.0 mmHg and the mean diastolic was 73.6 +/- 11.5 mmHg. Among the men, systolic blood pressure was higher among those of black or brown skin color and among those who were never considered poor. Diastolic pressure was only associated with birth weight. Among the women, systolic blood pressure was greater among those of black or brown skin color whose mothers' schooling level was greater than or equal to 12 years or whose birth weight was less than 4,000 g. CONCLUSIONS: For both sexes, only skin color was associated with blood pressure. Breastfeeding did not have any long-term effect on blood pressure and the associations for birth weight and socioeconomic level were inconsistent. Language: EnglishPortuguese Keywords: BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | ADULTS | ETHNIC GROUPS | BLOOD PRESSURE | HYPERTENSION | SOCIOECONOMIC STATUS | BIRTH WEIGHT | BREASTFEEDING | INEQUALITIES | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Cultural Background | Hemic System | Physiology | Biology | Vascular Diseases | Diseases | Socioeconomic Factors | Economic Factors | Body Weight | Infant Nutrition | Nutrition | Health Document Number: 342192 |
| 19. Title: Saline contamination of drinking water in Bangladesh [letter] Author: Khan A; Mojumder SK; Kovats S; Vineis P Source: Lancet. 2008 Feb 2;371(9610):385. Abstract: Water-related crises are not a new problem in Bangladesh. The discovery of arsenic in drinking water was deemed "the largest mass poisoning of a population in history", threatening the lives of millions. Now Bangladesh is facing another environmental and health threat due to man-made and natural factors: increased salinity. Estimates indicate that Bangladesh has about 2.8 million hectares of land that is affected by salinity-ie, a third of the 9 million hectares of total national cultivated area, and about a fifth of the total area of Bangladesh. Saline intrusion from sea water owing to reduction of freshwater flow from upstream (partly owing to the establishment of the Farrakka Barrage on the Ganges near the border of Bangladesh) is expected to be aggravated by climate change and sea-level rises. It has already had adverse effects on crop productivity and grain production. Now it appears to be a threat to the well-being of communities who live in coastal areas of this low-lying nation. (excerpt) Language: English Keywords: BANGLADESH | PROGRESS REPORT | EVALUATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | WATER SUPPLY | ENVIRONMENTAL DEGRADATION | ENVIRONMENTAL POLLUTION | SOIL DEGRADATION | PREECLAMPSIA | HYPERTENSION | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Natural Resources | Environment | Pregnancy Complications | Diseases | Vascular Diseases Document Number: 324319 |
| 20. Title: The bradykinin-degrading aminopeptidase P is increased in women taking the oral contraceptive pill. Author: La Corte AL; Carter AM; Turner AJ; Grant PJ; Hooper NM Source: Journal of the Renin - Angiotensin-aldosterone System. 2008 Dec;9(4):221-5. Abstract: INTRODUCTION: The renin-angiotensin and kininogen-kinin hormonal systems are critically involved in regulating blood pressure and are candidates in contributing to oral contraceptive pill (OCP)-induced hypertension.Angiotensin-converting enzyme (ACE) and aminopeptidase P (AP-P) are key enzymes in these systems and are both involved in the degradation of the vasodilator bradykinin. METHODS: Circulating ACE and AP-P levels were measured by activity assay using selective fluorogenic peptide substrates in plasma samples from the Leeds Family Study. In addition, the effect of progesterone on the expression of AP-P and ACE was examined in cells. RESULTS: Women on the OCP had higher age-adjusted plasma AP-P (mean [95% confidence interval]) (0.27 [0.23-0.32] nmol/min/ml (n = 53)) compared with women not on the OCP (0.17 [0.16-0.19] nmol/min/ml (n = 133), p < 0.001) or males (0.19 [0.17-0.20] nmol/min/ml (n = 209), p<0.001).There were no differences in the age-adjusted plasma ACE levels among the three groups. In HepG2 cells, progesterone treatment increased the AP-P protein and mRNA expression, whereas no effect of progesterone treatment was observed for ACE. CONCLUSION: Increased AP-P may result in increased breakdown of bradykinin.These data suggest that progesterone-induced increases in AP-P may contribute to the development of OCP-induced hypertension in susceptible Women. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | WOMEN | PROGESTERONE | TREATMENT | HYPERTENSION | ORAL CONTRACEPTIVES | BLOOD PRESSURE | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vascular Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Hemic System Document Number: 329634 |
| 21. Peer Reviewed Title: China's health system performance. Author: Liu Y; Rao K; Wu J; Gakidou E Source: Lancet. 2008 Nov 29;372(9653):1914-23. Abstract: We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist. Language: English Keywords: CHINA | CRITIQUE | EVALUATION INDEXES | RURAL POPULATION | URBAN POPULATION | HEALTH STATUS INDEXES | QUALITY OF HEALTH CARE | EXPENDITURES | COMMUNICABLE DISEASE CONTROL | HYPERTENSION | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | INEQUALITIES | HUMAN GEOGRAPHY | ECONOMIC FACTORS | Asia, Eastern | Asia | Developing Countries | Quantitative Evaluation | Evaluation | Population Characteristics | Demographic Factors | Population | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Financial Activities | Health Services | Vascular Diseases | Diseases | Socioeconomic Factors | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 329368 |
| 22. Title: [Severe maternal morbidity at a local reference university hospital in Campinas, Sao Paulo, Brazil] Morbidade materna grave em um hospital universitario de referencia municipal em Author: Luz AG; Tiago DB; Silva JC; Amaral E Source: Revista Brasileira De Ginecologia E Obstetricia. 2008 Jun;30(6):281-6. Abstract: PURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity at the Hospital e Maternidade Celso Pierro, Campinas, Sao Paulo, between October 2005 and July 2006, identified from infirmary, admission and delivery unit logbooks. Pregnant and post-partum women with severe maternal morbidity were identified according to clinical criteria proposed by Waterstone. Later, cases with more severe morbidity, called extremely severe maternal morbidity, were reclassified using Mantel criteria, based on organic dysfunction and clinical management. RESULTS: there were 114 severe maternal morbidity cases among 2,207 birth deliveries, with a ratio of other severe morbidity and extremely severe morbidity near miss of 44.9 and 6.8 cases/1,000 live births, respectively. Mean gestational age at delivery was 35 weeks, and 87% came from the reference area for the maternity service. Hypertension (severe pre-eclampsia) represented 96% of other severe morbidity, while hemorrhage represented 60% of all extremely severe cases, followed by hypertension. The prevalence of extremely severe morbidity among the severe morbidity cases was not associated with marital status, schooling, maternal age, type of delivery, parity, gestational age at birth and home place. CONCLUSIONS: the other morbidities were 6.6 times more frequent than near miss, and it was not possible to differentiate both groups by epidemiological risk factors. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | PREVALENCE | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | MORBIDITY | HYPERTENSION | BLEEDING | RISK FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Vascular Diseases | Signs and Symptoms | Health Document Number: 341793 |
| 23. Title: Risk factors of cardiovascular disease among the oral contraceptive users in Kermanshah City of Iran [letter] Author: Malek-Khosravi S Source: JPMA. Journal of the Pakistan Medical Association. 2008 Aug;58(8):473-4. Abstract: This letter to the editor discusses risk factors associated with oral contraceptive use in Kermanshah City of Iran. It recommends a new generation oral contraceptive (OCP) with fewer side effects and attentiveness to the cardiovascular risk factors when prescribing OCPs. Language: English Keywords: IRAN | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | ORAL CONTRACEPTIVES, SIDE EFFECTS | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | RISK FACTORS | PROGESTERONE | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, LOW-DOSE | TIME FACTORS | AGE FACTORS | CARDIOVASCULAR EFFECTS | HYPERTENSION | Middle East | Developing Countries | Research Methodology | Economic Development | Economic Factors | Contraceptive Safety | Safety | Public Health | Health | Biology | Progestational Hormones | Hormones | Endocrine System | Physiology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Population Characteristics | Vascular Diseases | Diseases Document Number: 329155 |
| 24. Title: Use of ACE inhibitors and ARBs in hypertensive women of childbearing age. Author: Martin U; Foreman MA; Travis JC; Casson D; Coleman JJ Source: Journal of Clinical Pharmacy and therapeutics. 2008 Oct;33(5):507-11. Abstract: BACKGROUND AND OBJECTIVE: Treatment with angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) during pregnancy can cause severe foetal abnormalities. This study aimed to identify the proportion of women of childbearing age taking ACE inhibitors or ARBs on referral to a tertiary Hypertension Clinic. DESIGN: Retrospective cohort study. METHODS: A cohort of female patients aged 16-45 years was identified from approximately 1500 new referrals from January 2004 to October 2006, excluding those not taking antihypertensive medication. ACE inhibitors and ARBs were grouped together for the purposes of the study. Contraceptive status was established where possible. RESULTS: Forty seven of 101 (47%) women aged 16-45 years were taking an ACE inhibitor (35) an ARB (11) or both (1) of whom 26 (55%) were aged 16-40 years. In this younger group, eight were using no contraception and three were using barrier methods only. CONCLUSIONS: Many GPs continue to prescribe ACE inhibitors and ARBs to women of childbearing age. A quarter of women in the study were taking these agents and were 40 years or less; of these many were not using reliable contraception. These women are at risk of foetal malformation and poor perinatal outcomes if they become pregnant. The British Hypertension Guidelines may put younger women at risk if general practitioners are unaware of potential foetotoxic and teratogenic consequences of prescribing ACE inhibitors and ARBs to women of child bearing age. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | INFANT | HYPERTENSION | PREGNANCY | REPRODUCTIVE AGE | RISK FACTORS | STANDARDS | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Vascular Diseases | Diseases | Reproduction | Biology Document Number: 329583 |
| 25. Title: Can research accelerate progress toward millennium development goal 5 (maternal health) in Jamaica? Author: McCaw-Binns A Source: West Indian Medical Journal. 2008 Dec;57(6):549-54. Abstract: The Ministry of Health and the University of the West Indies have collaborated over 25 years to develop the evidence base to improve maternal health. The experience is reviewed as a model to accelerate Jamaica's progress toward achieving the Millennium Development Goals (MDGs). The process included measuring the disease burden due to maternal morbidity and mortality; developing and field testing interventions to manage the leading problems, national scale-up, monitoring and evaluation. This began with developing clinical guidelines to manage the hypertensive disorders of pregnancy while establishing high risk (referral) antenatal clinics, expansion and upgrading of referral facilities, and audits to identify barriers to quality healthcare, including establishing maternal mortality surveillance. As we succeed, research funds have become scarce, limiting support to postgraduate students, a reliable, cost effective resource pool capable of undertaking the research needed to provide the evidence base to influence public policy more widely. A locally financed resource pool is needed to support fellowships for graduate students to accelerate their training and availability to contribute to national development. The model from Thailand is put forward for consideration. The operations research model for maternal health can be transferred to other MDG objectives. As Jamaica pursues its goal of developed nation status, and international grant financing shrinks, local civil society will need to fill the vacancy and invest in the most abundant natural resource, young people. Language: English Keywords: JAMAICA | THAILAND | RESEARCH REPORT | OPERATIONS RESEARCH | GOALS | YOUTH | MATERNAL HEALTH | ANTENATAL CARE | HYPERTENSION | TRAINING ACTIVITIES | TESTING | INTERVENTIONS | RESEARCH AND DEVELOPMENT | Caribbean | Americas | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Program Evaluation | Programs | Organization and Administration | Planning | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Vascular Diseases | Diseases | Training Programs | Education | Measurement | Technology | Economic Factors Document Number: 342425 |
| 26. Peer Reviewed Title: Maternal deaths due to hypertensive disorders in pregnancy. Author: Moodley J Source: Best Practice and Research Clinical Obstetrics and Gynaecology. 2008;22(3):559-567. Abstract: Hypertensive disorders of pregnancy (HDP) are one of the most common direct causes of maternal mortality worldwide. Cerebral haemorrhage is the main final cause of hypertensive deaths and probably implies that doctors are reluctant to treat sustained high blood pressure effectively during pregnancy. Maternal deaths from HDP can probably be reduced markedly by: (1) promoting antenatal care and instituting a recall system for defaulters; (2) instituting regional centres and regional obstetricians to provide advice on, or care for, women with severe pre-eclampsia; (3) educating health professionals through continuing professional education and the use of clinical guidelines of management; and (4) informing the general public on complications associated with the pre-eclampsia/eclampsia syndrome. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | MATERNAL MORTALITY | PREGNANCY | HYPERTENSION | PREECLAMPSIA | CEREBROVASCULAR EFFECTS | BLEEDING | CAUSES OF DEATH | PREVENTION AND CONTROL | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Reproduction | Vascular Diseases | Diseases | Pregnancy Complications | Physiology | Biology | Signs and Symptoms Document Number: 326567 |
| 27. Peer Reviewed Title: Risk factors for high blood pressure among HIV patients in French Guiana [letter] Author: Nacher M; Basurko C; Vantilcke V; Dufour J; El Guedj M; Vaz T Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Aug 15;48(5):629-31. Abstract: French Guiana is the French overseas department where the human immunodeficiency virus (HIV) epidemic is most preoccupying. There are 38 new acquired immunodeficiency syndrome cases per 100,000 inhabitants per year and >1% of HIV-positive pregnant women. Approximately two thirds of the HIV patients are foreign citizens mostly from Haiti. The use of highly active antiretroviral therapy has led to remarkable gains in patient survival. However, HIV and the metabolic complications of highly active antiretroviral therapy seem to increase the risk of cardiovascular diseases, notably high blood pressure. To further improve survival, it is important to better understand these pathologies. The objective of the present study is to determine the risk factors for high blood pressure among patients followed in the hospital cohort of patients followed in the 3 hospitals of French Guiana. (author's) Language: English Keywords: FRENCH GUIANA | RESEARCH REPORT | COHORT ANALYSIS | RETROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | HYPERTENSION | RISK FACTORS | Developing Countries | South America, Northern | South America | Latin America | Americas | Research Methodology | Studies | Viral Diseases | Diseases | Vascular Diseases | Biology Document Number: 328265 |
| 28. Title: Thrombophilic mutations in pre-eclampsia and pregnancy-induced hypertension. Author: Omar SZ; Qvist R; Khaing SL; Muniandy S; Bhalla S Source: Journal of Obstetrics and Gynaecology Research. 2008 Apr;34(2):174-178. Abstract: The aim of the present study was to determine the existence or prevalence of thrombophilic markers such as Factor V Leiden, prothrombin G20210A, protein S, protein C, activated protein C and anti-thrombin in pre-eclampsia and pregnancy-induced hypertensive patients. Blood samples were collected from a total number of 124 women at the maternity unit, University of Malaya Medical Center. These included 49 patients with pre-eclampsia, 63 patients with pregnancy-induced hypertension and 12 normal pregnant women. DNA was extracted from the blood samples. Factor V Leiden (Taq I) and prothrombin G20210A (Hind III) genotyping was done on polymerase chain reaction-restriction fragment length polymorphism. Anti-thrombin activity and the concentrations of protein C, protein S and activated protein C were measured using the IL Coagulation System (Hemosil). Of the 124 subjects, one pre-eclampsia patient was homozygous for Factor V Leiden mutation but prothrombin G20210A mutation was not present in any of the subjects. The subject with Factor V Leiden mutation also had a low activated protein C resistance and a low protein S concentration. Factor V Leiden mutation is present in the Asian population and may very well serve as one of the genetic factors responsible for pre-eclampsia and other adverse pregnancy outcomes. (author's) Language: English Keywords: MALAYSIA | RESEARCH REPORT | PREGNANT WOMEN | PREECLAMPSIA | GENETICS | PROTEINS | LABORATORY PROCEDURES | HYPERTENSION | PREGNANCY OUTCOMES | Developing Countries | Asia, Southeastern | Asia | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Biology | Physiology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vascular Diseases | Pregnancy | Reproduction Document Number: 326138 |
| 29. Title: Hepatic vascular involvement related to pregnancy, oral contraceptives, and estrogen replacement therapy. Author: Perarnau JM; Bacq Y Source: Seminars In Liver Disease. 2008 Aug;28(3):315-27. Abstract: Both pregnancy and oral contraception (mainly when estrogen is included) may precipitate the development of Budd-Chiari syndrome in patients with underlying thrombophilia. By contrast, there is little evidence for such a role of pregnancy and oral contraception in women with portal vein thrombosis. In pregnant women, special modalities for anticoagulation are required, whereas the management of portal hypertension can be similar to that recommended in other diseases and settings. Hereditary hemorrhagic telangiectasia may deteriorate during pregnancy and improve after delivery. Hepatic sinusoidal dilatation and hepatic peliosis are classic complications of long-term use of oral contraceptives. The impact of pregnancy or oral contraceptives on the natural history on hemangioma and focal nodular hyperplasia appears to be limited. Preeclampsia, a liver disease unique to pregnancy, may be complicated by life-threatening liver vascular involvement, especially when the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome) is present. Language: English Keywords: FRANCE | UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | PREGNANCY | ESTROGENS | PREECLAMPSIA | HYPERTENSION | THROMBOSIS | LIVER DYSFUNCTION | Europe, Western | Europe | Developed Countries | North America | Americas | Demographic Factors | Population | Reproduction | Hormones | Endocrine System | Physiology | Biology | Pregnancy Complications | Diseases | Vascular Diseases | Thromboembolism | Embolism Document Number: 329647 |
| 30. Title: Controversies in contraception. Author: Pitts SA; Emans SJ Source: Current Opinion in Pediatrics. 2008;20:383-389. Abstract: New research is constantly being published regarding hormonal contraceptives and bone health, migraine headaches, thrombosis risk, hypertension, weight gain, and obesity, as well as emergency contraception. At times, these studies can be clarifying, but they can also raise new controversies and questions. It is important for providers to be aware of the emerging issues regarding contraceptive care for adolescent patients. Research suggests that Depo-Provera (depot medroxyprogesterone acetate; Pfizer, New York City, New York, USA) and, perhaps, low-dose oral contraceptive pills can have adverse effects on adolescent bone health, although the data demonstrating reversibility of bone loss after discontinuation of these contraceptives are reassuring. Additionally, estrogen-containing contraceptives pose risks for patients, including the onset of or exacerbation of migraine headaches, venous thromboembolism, and hypertension. Depo-Provera has been implicated in weight gain, especially in girls who are already overweight. Obesity may decrease the efficacy of some hormonal contraceptives. Finally, the mechanism of action of emergency contraception is still unknown, although studies continue to suggest that it has primarily preovulatory, not postovulatory, effects. Adolescent health providers need to be aware of the new research and controversies in contraceptive care in order to counsel and care for patients effectively. (author's) Language: English Keywords: GLOBAL | LITERATURE REVIEW | ADOLESCENTS | CONTRACEPTION | ADOLESCENT HEALTH | SKELETAL EFFECTS | MIGRAINE | THROMBOEMBOLISM | HYPERTENSION | BODY WEIGHT | OBESITY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | EMERGENCY CONTRACEPTION | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Family Planning | Health | Physiology | Biology | Vascular Diseases | Diseases | Embolism | Contraceptive Agents Document Number: 328122 |
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