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Peer Reviewed

Title: ACOG Committee Opinion No. 434: induced abortion and breast cancer risk.
Author: Committee on Gynecologic Practice
Source: Obstetrics and Gynecology. 2009 Jun;113(6):1417-8.
Abstract: The Relationship between induced abortion and the subsequent development of breast cancer has been the subject of a substantial amount of epidemiologic study. Early studies of the relationship between prior induced abortion and breast cancer risk were methodologically flawed. More rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.
Language: English
Keywords:
GLOBAL | CRITIQUE | RETROSPECTIVE STUDIES | PROSPECTIVE STUDIES | ABORTION | BREAST CANCER | RISK FACTORS | EPIDEMIOLOGY | BIAS | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Cancer | Neoplasms | Diseases | Health | Public Health | Error Sources | Measurement
Document Number: 341807 Notification

Title: Adherence and treatment response among HIV-1 infected adults receiving antiretroviral therapy in a rural government hospital in southwestern Uganda.
Author: Bajunirwe F; Arts EJ; Tisch DJ; King CH; Debanne SM
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Mar-Apr;8(2):139-147.
Abstract: Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving (n = 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n = 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] = 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | KAP SURVEYS | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | ADULTS | RURAL POPULATION | HIV INFECTIONS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | GOVERNMENT PROGRAMS | SEX FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | HIV | Programs | Organization and Administration
Document Number: 331336

Peer Reviewed

Title: Sensitivity of paediatric AIDS score vs. WHO case classification in Indian children--a retrospective study.
Author: Banerjee T; Pensi T; Banerjee D
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):91-6.
Abstract: This study was conducted at the Department of Paediatrics, Dr Ram Manohar Lohia Hospital, to test the statistical significance of existing World Health Organization (WHO) clinical case definition (CCD) for diagnosis of AIDS in areas where diagnostic resources are limited. A total of 360 cases between 18 months and 12 years of age satisfying WHO case definitions of AIDS were included in study group. Our study detected 16.66% (60) of HIV incidence in children visiting the paediatrics outpatient clinic. Twenty percent of cases manifested three major and two minor signs, which had sensitivity of 73.33%; specificity, 90.66% and positive predictive value (PPV), 61.11%. Stepwise logistic analysis identified weight loss, chronic fever >1 month and total lymphocyte count <1500 cells mm(-3) as important predictors. Eighty-six cases (23.89%) showed two major and two minor signs with sensitivity and specificity of 86.66 and 88.66%, respectively. Thus a CCD based on 13 clinical signs/symptoms was proposed for paediatric AIDS with better sensitivity and PPV than the WHO case definition but with almost similar specificity.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | AIDS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | STANDARDS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331192

4.
Peer Reviewed

Title: Loss to care and death before antiretroviral therapy in Durban, South Africa.
Author: Bassett IV; Wang B; Chetty S; Mazibuko M; Bearnot B; Giddy J; Lu Z; Losina E; Walensky RP; Freedberg KA
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):135-9.
Abstract: OBJECTIVE: To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Design: Retrospective cohort study. METHODS: We reviewed data from ART eligible adults (> or = 18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count < or = 200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. RESULTS: During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3-3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (< or = 100 cells/microL) and unemployment were independently associated with being lost. CONCLUSIONS: Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | PROGRAM ACCESSIBILITY | TIME FACTORS | MORTALITY | EMPLOYMENT STATUS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Program Evaluation | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors
Document Number: 341755

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

Peer Reviewed

Title: Peripheral neuropathy in HIV-positive patients at an antiretroviral clinic in Lilongwe, Malawi.
Author: Beadles WI; Jahn A; Weigel R; Clutterbuck D
Source: Tropical Doctor. 2009 Apr;39(2):78-80.
Abstract: Peripheral neuropathy (PN) is common in the setting of antiretroviral (ARV) programmes in resource-limited settings and poses significant challenges in assessment and management. A retrospective analysis was undertaken of prevalence and management of PN in a cohort of 3341 patients on highly active antiretroviral therapy. A first line ARV regimen containing stavudine (D4T) is used for clinically eligible patients. Amitriptyline is prescribed for symptom relief and in cases of persistent or escalating symptoms zidovudine (AZT) is substituted for D4T. Leg pain or numbness was reported in 1173 patients (35%). However, only 428 (13%) were given a diagnosis of PN, 228 (7%) were prescribed amitriptyline and 200 (6%) were switched to AZT. A recent pharmokinetic study in this population showed a high Cmax of D4T with the generic combination triomune (D4T 40 mg). This could account for the high prevalence of PN. The optimum time for switch to a non-D4T containing regimen is unknown.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | NEUROLOGIC EFFECTS | PREVALENCE | SIGNS AND SYMPTOMS | TOXICITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Measurement
Document Number: 341785

Title: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding.
Author: Benacerraf BR; Shipp TD; Bromley B
Source: Ultrasound In Obstetrics and Gynecology. 2009 Jun 29;34(1):110-115.
Abstract: OBJECTIVE: To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices. METHODS: Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones. RESULTS: Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms wasonly detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal. CONCLUSION: A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ULTRASONICS | IUD COMPLICATIONS | IUD MIGRATION | BLEEDING | PAIN | MYOMETRIUM | CERVIX | INSERTION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment
Document Number: 341864

Peer Reviewed

Title: Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use.
Author: Berenson AB; Rahman M
Source: American Journal of Obstetrics and Gynecology. 2009 Mar;200(3):329.e1-8.
Abstract: OBJECTIVE: The purpose of this study was to determine changes in bodyweight and composition that result from hormonal contraception. STUDY DESIGN: Dual-energy x-ray absorptiometry was performed at baseline and every 6 months for 3 years for 703 women (African American, 200; white, 247; Hispanic, 256) who were beginning the use of oral contraception (OC; n = 245), depot medroxyprogesterone acetate (DMPA; n = 240), or nonhormonal contraception (NH; n = 218). DMPA discontinuers were observed for up to 2 years to examine the reversibility of the observed changes. RESULTS: Over 36 months, DMPA users increased their weight (+5.1 kg), body fat (+4.1 kg), percent body fat (+3.4%), and central-to-peripheral fat ratio (+0.1) more than OC and NH users (P < .01). OC use did not cause weight gain. After DMPA discontinuation, NH users lost 0.42 kg in 6 months; OC users gained 0.43 kg in 6 months. CONCLUSION: Bodyweight and fat significantly increase with the use of DMPA. After discontinuation of DMPA, some decrease in bodyweight and fat occurs when NH is used.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | ORAL CONTRACEPTIVES | BODY WEIGHT | MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE USAGE | LIPIDS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330467

Title: Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review.
Author: Berghella V; Airoldi J; O'Neill AM; Einhorn K; Hoffman M
Source: BJOG. 2009 Aug;116(9):1151-7.
Abstract: BACKGROUND: Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied. OBJECTIVE: To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery. SEARCH STRATEGY: Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed. SELECTION CRITERIA: Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately. DATA COLLECTION AND ANALYSIS: Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture. MAIN RESULTS: The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy. CONCLUSIONS: Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | ABORTION | CESAREAN SECTION | UTERINE EFFECTS | RISK FACTORS | INCIDENCE | Developed Countries | North America | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Measurement
Document Number: 342794 Notification

10.

Title: Risk factors for deep vein thrombosis in women aged 18 to 50: a retrospective analysis.
Author: Binder B; Lackner HK; Salmhofer W; Hofmann-Wellenhof R
Source: Dermatologic Surgery. 2009 Mar;35(3):451-6.
Abstract: BACKGROUND: Deep vein thrombosis (DVT) occurs in one of every 1,000 individuals per year. Various inherited and acquired risk factors are known. We investigated the importance of oral contraceptives (OCs) as a risk factor in women of child-bearing age. OBJECTIVES: To evaluate the risk factors for DVT in a female patient collective. METHODS: We analyzed the records of 99 women aged 18 to 50 with DVT. We documented age, identifiable risk factor of DVT, location of the thrombus, use of OCs, and thrombophilia. RESULTS: 52.5% of patients suffering from DVT were aged between 40-50 years. Forty-six patients had an unprovoked DVT; the most common risk factor was immobilization in 41. Thrombophilia was found in 18 cases. Twenty-nine patients used OCs; no influence of OCs on any of the other risk factors was found. CONCLUSIONS: In our patient group, the most important risk factors were older age and immobilization. DVT is typically idiopathic and may be caused by subtle nondetectable thrombophilic disorders. The use of OCs was distributed in DVT patients just as in the general Austrian community and seems not to be a severe additional risk factor. Examining the whole lower extremity during ultrasonography is important so as not to overlook a DVT of the lower leg.
Language: English
Keywords:
AUSTRIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | PREGNANT WOMEN | THROMBOSIS | AGE FACTORS | RISK FACTORS | Developed Countries | Europe, Central | Europe | Studies | Research Methodology | Demographic Factors | Population | Population Characteristics | Thromboembolism | Embolism | Vascular Diseases | Diseases | Health
Document Number: 331221

11.
Peer Reviewed

Title: Antiretroviral adherence in rural Zambia: the first year of treatment availability.
Author: Birbeck GL; Chomba E; Kvalsund M; Bradbury R; Mang'ombe C; Malama K; Kaile T; Byers PA; Organek N
Author: RAAZ Study Team
Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):669-74.
Abstract: We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | RURAL POPULATION | PERSONS LIVING WITH HIV/AIDS | SPOUSE | SOCIAL NETWORKS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | CLINIC VISITS | PARTNER COMMUNICATION | KNOWLEDGE | SEX FACTORS | SPOUSAL SUPPORT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Friends and Relatives | HIV | Behavior | Service Statistics | Program Activities | Programs | Organization and Administration | Interpersonal Relations | Microeconomic Factors | Economic Factors
Document Number: 331277

12.

Peer Reviewed

Title: Sexual and marital trajectories and HIV infection among ever-married women in rural Malawi.
Author: Boileau C; Clark S; Bignami-Van Assche S; Poulin M; Reniers G; Watkins SC; Kohler HP; Heymann SJ
Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i27-i33.
Abstract: Objective: To explore how sexual and marital trajectories are associated with HIV infection among ever-married women in rural Malawi. Methods: Retrospective survey data and HIV biomarker data for 926 ever-married women interviewed in the Malawi Diffusion and Ideational Change Project were used. The associations between HIV infection and four key life course transitions considered individually (age at sexual debut, premarital sexual activity, entry into marriage and marital disruption by divorce or death) were examined. These transitions were then sequenced to construct trajectories that represent the variety of patterns in the data. The association between different trajectories and HIV prevalence was examined, controlling for potentially confounding factors such as age and region. Results: Although each life course transition taken in isolation may be associated with HIV infection, their combined effect appeared to be conditional on the sequence in which they occurred. Although early sexual debut, not marrying one's first sexual partner and having a disrupted marriage each increased the likelihood of HIV infection, their risk was not additive. Women who both delayed sexual debut and did not marry their first partner are, once married, more likely to experience marital disruption and to be HIV-positive. Women who marry their first partner but who have sex at a young age, however, are also at considerable risk. Conclusions: These findings identify the potential of a life course perspective for understanding why some women become infected with HIV and others do not, as well as the differentials in HIV prevalence that originate from the sequence of sexual and marital transitions in one's life. The analysis suggests, however, the need for further data collection to permit a better examination of the mechanisms that account for variations in life course trajectories and thus in lifetime probabilities of HIV infection.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | CLINICAL RESEARCH | EVER MARRIED | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREVALENCE | SEX BEHAVIOR | MARRIAGE PATTERNS | HIV INFECTIONS | FIRST INTERCOURSE | PREMARITAL SEX BEHAVIOR | DIVORCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Marital Status | Nuptiality | Demographic Factors | Population | Economic Development | Economic Factors | Population Characteristics | Measurement | Behavior | Marriage | Viral Diseases | Diseases
Document Number: 340104

13.
Peer Reviewed

Title: Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa.
Author: Bourne DE; Thompson M; Brody LL; Cotton M; Draper B; Laubscher R; Abdullah MF; Myers JE
Source: AIDS. 2009 Jan 2;23(1):101-6.
Abstract: OBJECTIVES: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. METHODS: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997-2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. RESULTS: Postneonatal mortality increased each year over the period 1997-2002. A peak in HIV-related deaths was observed, centred at 2-3 months of age, rising monotonically over time. CONCLUSION: We interpret the peak in mortality at 2-3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LINEAR REGRESSION | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | AIDS | CAUSES OF DEATH | CHILD MORTALITY | VITAL STATISTICS | MOTHER-TO-CHILD TRANSMISSION | DEATH RATE | AGE SPECIFIC DEATH RATE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Statistical Regression | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Population Statistics | Transmission | Infections
Document Number: 330334

14.

Peer Reviewed

Title: The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria.
Author: Chabikuli NO; Awi DD; Chukwujekwu O; Abubakar Z; Gwarzo U
Source: AIDS. 2009;23(Suppl 1):S97-S103.
Abstract: Objective: To measure changes in service utilization of a model integrating family planning with HIV counselling and testing (HCT), antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in the Nigerian public health facilities. Design: It is a retrospective survey of attendance and family planning commodity uptake in 71 health facilities in Nigeria that analyzes the preintegration and postintegration periods between March 2007 and January 2009. Methods: A prepost retrospective comparison of mean attendance at family planning clinics and couple-years of protection (CYP) compared 6 months preintegration with 9 months postintegration period. An analysis of service ratios was conducted, relating completed referrals at family planning clinics to service utilization at the referring HIV clinics. Results: Mean attendance at family planning clinics increased significantly from 67.6 in preintegration to 87.0 in postintegration. Themean CYP increased significantly from32.3 preintegration to 38.2 postintegration. Service ratio of referrals from each of the HIV clinics was low but increased in the postintegration period by 4, 34 and 42 per 1000 clients from HCT, ART and PMTCT clinics, respectively. Service ratios were higher in primary healthcare settings than in secondary or tertiary hospitals. Attendance by men at family planning clinics was significantly higher among clients referred from HIV clinics. Conclusion: Family planning-HIV integration using the referral model improved family planning service utilization by clients accessing HIV services, but further improvement is possible. Male utilization of family planning services also improved. The government of Nigeria should review the family planning user fee policy and scale up the integration in primary healthcare facilities.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | HIV/FP INTEGRATION | HEALTH SERVICES EVALUATION | HIV TESTING | COUNSELING | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | REFERRAL AND CONSULTATION | UTILIZATION OF HEALTH CARE | SERVICE STATISTICS | FAMILY PLANNING CLINIC ATTENDANCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Programs | Organization and Administration | Program Evaluation | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Disease Transmission Control | Prevention and Control | Diseases | HIV | HIV Infections | Viral Diseases | Family Planning Program Evaluation | Family Planning Programs | Family Planning
Document Number: 339927

15.

16.
Title: Impact of prior HAART use on clinical outcomes in a large Kenyan HIV treatment program.
Author: Chung MH; Drake AL; Richardson BA; Reddy A; Thiga J; Sakr SR; Kiarie JN; Yowakim P; John-Stewart GC
Source: Current HIV Research. 2009 Jul;7(4):441-6.
Abstract: BACKGROUND: HIV treatment programs in Africa typically approach all enrolling patients uniformly. Growing numbers of patients are antiretroviral experienced. Defining patients on the basis of antiretroviral experience may inform enrollment practices, particularly if medical outcomes differ. METHODS: Baseline and follow-up measures (CD4, weight change, and survival) were compared in a retrospective analysis between antiretroviral-naive (ARV-N) and antiretroviral experience (ARV-E) patients enrolled at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya and followed between January 2004 and August 2006. RESULTS: 1,307 ARV-N and 962 ARV-E patients receiving highly active antiretroviral therapy (HAART) were followed for median of 9 months (interquartile range: 4-16 months). Compared to ARV-N, ARV-E had substantially higher CD4 count (median cells/mm(3), 193 versus 95, P < 0.001) and weight (median kg, 62 versus 57, P < 0.001) at baseline, and lower rates of change in CD4 (-9.2 cells/mm(3)/month; 95% CI, -11.4 -7.0) and weight (-0.24 kg/month; 95% CI, -0.35 - -0.14) over 12 months. Mortality was significantly higher in ARV-N than ARV-E (P = 0.001). CONCLUSIONS: ARV-E patients form a growing group that differs significantly from ARV-N patients and requires a distinct approach from ARV-N clients. Systematic approaches to streamline care of ARV-E patients may allow focused attention on early ARV-N clients whose mortality risks are substantially higher.
Language: English
Keywords:
KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | LABORATORY PROCEDURES | PERSONS LIVING WITH HIV/AIDS | HIV | ANTIRETROVIRAL THERAPY | MORTALITY | TREATMENT | IMPACT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Communication
Document Number: 342728

17.

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 | Population Characteristics | Demographic Factors | Population | Child Development | Biology | Nutrition Disorders | Diseases | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors
Document Number: 330228

18.

Peer Reviewed

Title: Repeat abortion: facts and issues.
Author: Das S; Adegbenro A; Ray S; Amu O
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):93-5.
Abstract: BACKGROUND: The commonest reason for undertaking termination of pregnancy (TOP) in the UK is as defined by Clause 2 of the Abortion Act. There are no agreed criteria for defining 'recurrent abortion seekers'. We aimed to review the characteristics of women requesting termination of at least two consecutive pregnancies within 24 months of the first and to identify any factors for seeking repeat TOP. METHODS: The database of patients that attended our Fertility Control Services from 2001 to 2006 was evaluated. Demographic data, contraceptive use in the cycle of conception and reasons for request were assessed for possible associations with repeat TOP. RESULTS: The incidence was 2.3% as defined by our criteria. Financial circumstances was the commonest reason for seeking TOP (75%). The combined oral contraceptive pill and condom were the commonest forms of contraception in these patients before the first TOP (35% and 38%, respectively). Long-acting reversible contraception (LARC) was used by only 8% of women before their TOP. Although 58% accepted LARC following TOP, only 2% continued its use thereafter and 50% of women were not using any contraception at the time of the repeat TOP. CONCLUSION: This study suggests that social workers and perhaps psychologists should be part of the peri-abortion counselling team. Contraceptive counselling should emphasise the side effects of LARC to improve compliance. Follow-up to ensure compliance and involvement of partners in decision-making could help to reduce the incidence of repeat TOP.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | CONTRACEPTION TERMINATION | USER COMPLIANCE | EMERGENCY CONTRACEPTION | COUNSELING | PSYCHOLOGICAL FACTORS | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Contraception | Behavior | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 341653

19.

Title: Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.
Author: de Jonge A; van der Goes BY; Ravelli AC; Amelink-Verburg MP; Mol BW; Nijhuis JG; Bennebroek Gravenhorst J; Buitendijk SE
Source: BJOG. 2009 Aug;116(9):1177-84.
Abstract: OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321,307 (60.7%) intended to give birth at home, 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%), the intended place of birth was unknown. METHODS: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. MAIN OUTCOME MEASURES: Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit. RESULTS: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16). CONCLUSIONS: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
Language: English
Keywords:
NETHERLANDS | RESEARCH REPORT | COHORT ANALYSIS | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | PERINATAL MORTALITY | CHILDBIRTH | PREGNANCY OUTCOMES | RISK FACTORS | MATERNAL AGE | Europe, Western | Europe | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Mortality | Population Dynamics | Pregnancy | Reproduction | Parental Age | Age Factors
Document Number: 342276

20.

Peer Reviewed

Title: Youth, unemployment, and male gender predict mortality in AIDS patients started on HAART in Nigeria.
Author: DeSilva MB; Merry SP; Fischer PR; Rohrer JE; Isichei CO; Cha SS
Source: AIDS Care. 2009 Jan;21(1):70-7.
Abstract: This retrospective study identifies risk factors for mortality in a cohort of HIV-positive adult patients treated with highly active antiretroviral therapy (HAART) in Jos, Nigeria. We analyzed clinical data from a cohort of 1552 patients enrolled in a HIV/acquired immune deficiency syndrome treatment program and started on HAART between December 2004 and 30 April 2006. Death was our study endpoint. Patients were followed in the study until death, being lost to follow-up, or the end of data collection, 1 December 2006. Baseline patient characteristics were compared using Wilcoxon Rank Sum Test for continuous variables and Pearson Chi-Square test for categorical variables to determine if certain demographic factors were associated with more rapid progression to death. The Cox proportional hazard multivariate model analysis was used to find risk factors. As of 1 December 2006, a total of 104 cases progressed to death. In addition to the expected association of CD4 count less than 50 at initiation of therapy and active tuberculosis with mortality, the patient characteristics independently associated with a more rapid progression to death after initiation of HAART were male gender, age less than 30 years old, and unemployment or unknown occupation status. Future research is needed to identify the confounding variables that may be amenable to targeted interventions aimed at ameliorating these health disparities.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | YOUTH | MEN | PERSONS LIVING WITH HIV/AIDS | UNEMPLOYMENT | AIDS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | MORTALITY | DEATH | GENDER ISSUES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors | HIV | Population Dynamics | Sociocultural Factors
Document Number: 331211

21.
Peer�Reviewed

Title: Contraceptive counselling to teenagers at abortion visits--a qualitative content analysis.
Author: Falk G; Brynhildsen J; Ivarsson AB
Source: European Journal of Contraception and Reproductive Health Care. 2009 Oct;14(5):357-64.
Abstract: OBJECTIVE: Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager. METHODS: Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps. RESULTS: Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up. CONCLUSION: The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | RETROSPECTIVE STUDIES | QUALITATIVE EVALUATION | ADOLESCENTS, FEMALE | ABORTION | CONTRACEPTION FAILURE | POSTABORTION CARE | COUNSELING | RECORDS | CONTRACEPTIVE USAGE | Developed Countries | Europe, Northern | Europe | Studies | Research Methodology | Evaluation | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Contraception | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Information Processing | Information
Document Number: 343385 Notification

22.

Peer Reviewed

Title: Rates of serious infection after changes in regimens for medical abortion.
Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V
Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51.
Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation
Document Number: 342147 Notification

23.

Title: Cerebral venous sinus thrombosis associated with oral contraceptives: the case for neurosurgery.
Author: Galarza M; Gazzeri R
Source: Neurosurgical Focus. 2009 Nov;27(5):E5.
Abstract: Object The goal of this study was to provide data about neurosurgical management of cerebral venous sinus thrombosis in young women after use of oral contraceptives. Methods Between 1990 and 2007, the authors treated 15 women (age range 23-45 years) in whom neurosurgical management was used for overt thrombosis of cerebral sinus. All were healthy, with a history of use of oral contraceptives. Severe headache was the most common symptom, followed by motor focal deficits and comatose state. Deep infarcts were located in the thalamic and basal ganglia region in 11 cases. Seven women had associated intracerebral hemorrhage, and 3 had ventricular dilation. Angiographic MR imaging was done in 10 patients, and conventional angiography was done in 7. Genetic analysis of chromosomal abnormalities associated with stroke was done in 5 cases. Results The intracranial pressure (ICP) was monitored in all cases. Three patients underwent external ventricular drainage, and 1 had a decompressive craniotomy. All hadabsence of signal in the cerebral sinus rectus, with associated thrombosis of the transverse sinus in 7 cases. Angiograms were negative for additional vascular malformation. Medical treatment included sodium heparin and mannitol in 9 cases, and enoxaparin in the other 6 patients. Genetic analysis was positive for prothrombin mutation G20210A (factor II variant) in 2 cases. The mean follow-up duration of 53 months demonstrated no neurological deficit in 10 patients, hemiparesis in 3, and severe hemiparesis with aphasia in 1 case. One woman died 5 days after a decompressive craniotomy. Conclusions Cerebral venous sinus thrombosis secondary to oral contraception in young women, including lesions in critical and deep regions, can be treated medically with acceptable morbidity. In spite of this, a subgroup of patients needed basic neurosurgical management of the lesions, including surgical measures for controlling raised ICP.
Language: English
Keywords:
SPAIN | ITALY | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | THROMBOSIS | CEREBROVASCULAR EFFECTS | SIGNS AND SYMPTOMS | ORAL CONTRACEPTIVES, COMBINED | COMPLICATIONS | SURGERY | DRUGS | GENETICS | NEUROLOGIC EFFECTS | Developed Countries | Europe, Southwestern | Europe | Europe, Southern | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Thromboembolism | Embolism | Vascular Diseases | Diseases | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 343120

24.

Peer Reviewed

Title: Pregnancy outcome in women with an intrauterine contraceptive device.
Author: Ganer H; Levy A; Ohel I; Sheiner E
Source: American Journal of Obstetrics and Gynecology. 2009 Aug 27;
Abstract: OBJECTIVE: To investigate pregnancy outcome in patients who conceived with an intrauterine contraceptive device. STUDY DESIGN: A retrospective study comparing the pregnancy outcome of women with retained intrauterine device (n = 98), patients after intrauterine device removal in early pregnancy (n = 194), and pregnancies without an intrauterine device (n = 141,191) was performed. RESULTS: A significant linear association was documented among the 3 groups and adverse outcomes such as preterm delivery (18.4% in the retained intrauterine device, 14.4 % in removed intrauterine device, and 7.3% in the no-intrauterine device group; P < .001) and chorioamnionitis (7.1% in the retained intrauterine device, 4.1% in removed intrauterine device and 0.7% in the no-intrauterine device group; P < .001). The presence of retained or removed intrauterine device was found as an independent risk factor for both preterm delivery and chorioamnionitis in multivariable models. CONCLUSION: Women conceiving with an intrauterine device are at increased risk for adverse obstetric outcomes, whereas the risk is higher for pregnancies with retained intrauterine device compared with early intrauterine device removal.
Language: English
Keywords:
GLOBAL | ISRAEL | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | PREGNANT WOMEN | PREGNANCY OUTCOMES | IUD | PREGNANCY | LOW BIRTH WEIGHT | PREMATURE BIRTH | Developed Countries | Middle East | Studies | Research Methodology | Demographic Factors | Population | Population Characteristics | Reproduction | Contraceptive Methods | Contraception | Family Planning | Birth Weight | Body Weight | Physiology | Biology
Document Number: 342708

25.

Title: Choosing medical or surgical terminations of pregnancy in the first trimester: what is the difference?
Author: Goodyear-Smith F; Knowles A
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Apr;49(2):211-5.
Abstract: BACKGROUND: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. AIMS: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone-misoprostol interval from two to one day impacted on outcomes. METHODS: Retrospective audit of two consecutive years (December 2005-November 2006 and December 2006-November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. RESULTS: A total of 1495 terminations were performed in 2005-2006 and 1588 in 2006-2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. CONCLUSIONS: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | RETROSPECTIVE STUDIES | ABORTION | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | RU-486 | ADMINISTRATION AND DOSAGE | ANALGESIA | Oceania | Developed Countries | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342383 Notification

26.

Peer Reviewed

Title: Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis.
Author: Gordts S; Campo R; Puttemans P; Gordts S
Source: Fertility and Sterility. 2009 Oct;92(4):1198-202.
Abstract: OBJECTIVE: To evaluate pregnancy rates after tubal microsurgical anastomosis. DESIGN: Retrospective study. SETTING: Private tertiary care center. PATIENT(S): Two hundred sixty-one women undergoing tubal microsurgical anastomosis. INTERVENTION(S): Tubal anastomoses were performed by minilaparotomy using microsurgical principles and approximating proximal and distal tubal ends in a two-layer technique with 8-0 ethylon. MAIN OUTCOME MEASURE(S): Pregnancy outcome was analyzed for the technique of sterilization, location of anastomosis, tubal length, age, and semen parameters. RESULT(S): After exclusion of 89 patients lost to follow-up (34%) and 8 who did not attempt to conceive, 164 of the 261 patients were analyzed.The overall intrauterine pregnancy rate was 72.5%, with a miscarriage rate of 18% and a tubal pregnancy rate of 7.7%. Related to age, the cumulative intrauterine pregnancy rate was, respectively, 81%, 67%, 50%, and 12.5% for patients <36, 36-40, 40-43, and >43 years. Mean time to pregnancy was respectively 6.9, 6.2, and 12.7 months, respectively, for patients aged <36, 36-39, and 40-43 years According to the type of sterilization, intrauterine pregnancies occurred in 72% after ring sterilization, 78% after clip sterilization, 68% after coagulation, and 67% after Pomeroy sterilization. Intrauterine pregnancies and ectopic pregnancies, respectively, occurred in 80% and 3.4% in the isthmo-isthmic, 63% and 18% in the isthmo-ampullar, 75% and 8.3% in the isthmo-cornual, 100% and 0% in the ampullo-ampullar, and 60% and 0% in the ampullo-cornual anastomosis groups. Tubal length after anastomosis did not influence the pregnancy rate. In case of fertile sperm, the pregnancy rate was found to be 80%, and it decreased to 50% in case of subfertile semen. CONCLUSION(S): Our results clearly demonstrate the validity of tubal microsurgical anastomosis, establishing a quasinormalization of the fertility potential and offering the opportunity for a spontaneous conception.
Language: English
Keywords:
BELGIUM | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | TUBAL REANASTOMOSIS | MINILAPAROTOMY | PREGNANCY OUTCOMES | FERTILITY | STERILIZATION, SEXUAL | AGE FACTORS | SPERMATOZOA | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Sterilization Reversal | Reversible Sterilization | Family Planning | Female Sterilization | Pregnancy | Reproduction | Population Dynamics | Demographic Factors | Population | Population Characteristics | Germ Cells | Genitalia | Urogenital System | Physiology | Biology
Document Number: 343158

27.

Title: Contraception and screening for cervical and breast cancer in neuromuscular disease: A retrospective study of 50 patients monitored at a clinical reference centre.
Author: Goutard S; Baron C; Bouton C; Penisson-Besnier I; Fosse G; Aube-Nathier AC; Havet-Thomassin V; Dubas F; Richard I
Source: Annals of Physical and Rehabilitation Medicine. 2009 Aug 14;
Abstract: OBJECTIVE: To analyse contraceptive methods and the extent of screening for breast and cervical cancer in women with neuromuscular disease, compare these results with data and guidelines for the general population and determine the environmental and attitudinal barriers encountered. PATIENTS AND METHODS: A retrospective, descriptive study in a population of female neuromuscular disease patients (aged 20 to 74) monitored at a clinical reference centre. RESULTS: Complete datasets were available for 49 patients. Seventy percent used contraception (hormonal contraception in most cases). Sixty-eight percent had undergone screening for cervical cancer at some time in the previous 3 years and 100% of the patients over 50 had undergone a mammography. Architectural accessibility and practical problems were the most common barriers to care and were more frequently encountered by wheelchair-bound, ventilated patients. CONCLUSIONS: In general, the patients had good access to contraceptive care and cervical and breast cancer screening. However, specific measures may be useful for the most severely disabled patients.
Language: English
Keywords:
FRANCE | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | WOMEN | ORAL CONTRACEPTIVES | CONTRACEPTION | BREAST CANCER | CERVICAL CANCER | SCREENING | MUSCULAR EFFECTS | PROGRAM EVALUATION | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Contraceptive Methods | Family Planning | Cancer | Neoplasms | Diseases | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 342589

28.

Peer Reviewed

Title: Uterine artery embolization to treat hemorrhage following second-trimester abortion by dilatation and surgical evacuation.
Author: Haddad L; Delli-Bovi L
Source: Contraception. 2009 Jun;79(6):452-5.
Abstract: BACKGROUND: This study was conducted to review cases of second-trimester postabortal hemorrhage (PAH) occurring at a private women's health facility that were treated with uterine artery embolization (UAE). METHODS: A retrospective review was conducted on all second-trimester terminations performed at a private women's health facility between 1999 and 2006. Cases of PAH treated with UAE were reviewed in detail, reviewing progress, operative and discharge notes along with anesthesia records. RESULTS: Fifteen cases of PAH were identified among 3936 second-trimester terminations that were performed. Seven cases were identified in which UAE was used to treat PAH. Etiologies leading to hemorrhage varied in the seven cases as did the presence of coexisting factors such as infection and anatomic lesions. All cases were successfully treated by UAE, requiring no additional surgical intervention. CONCLUSION: Given the success of embolization, we offer this as an alternative to exploratory surgery and hysterectomy and as a first-line approach in cases of PAH after conservative management strategies have failed.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANCY, SECOND TRIMESTER | POSTABORTION | POSTABORTION CARE | BLEEDING | TREATMENT | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Medical Procedures | Medicine
Document Number: 342598

29.
Title: Paediatric antiretroviral therapy outcomes under HIV hospice care in South Africa.
Author: Harding R; Brits H; Penfold S
Source: International Journal of Palliative Nursing. 2009 Mar;15(3):142-5.
Abstract: AIM: This study aims to evaluate outcomes of children with advanced HIV disease who are initiated on antiretroviral therapy under multiprofessional specialist paediatric hospice care. DESIGN: A retrospective cohort file review methodology was undertaken in a specialist paediatric hospice in South Africa. METHODS: Antiretroviral therapy was initiated for children with a CD4% of less than 15% (for children under 6 years of age) or a CD4 count under 200 for children over 6 years of age. According to the World Health Organization Europe (2007) staging criteria, all children were stage 3/4 HIV disease. Multiprofessional staff provided daily tailored assessment and care. Each child was followed for 6 months. Data on mortality, CD4 count, CD4 percentage, body weight, and viral load were measured at initiation and a follow-up after 6 months. FINDINGS: Of the 37 children initiated on ART therapy, 31 I survived at 6 months. From a baseline of mean body weight 13.3 kg, there was an average of 3.2 kg increase (P < 0.001). Mean CD4 counts more than doubled (P < 0.001), with a mean increase of 467 cells per mm3 blood. Mean CD4 percentages increased from 13.6-19.4% (P < 0.001).Viral load decreased significantly from a median 271000 copies per mm3 blood to a median of 25 (imputed value for undetectable viral load) (P < 0.001). Twenty-three children had an undetectable viral load. CONCLUSION: For children with advanced HIV disease, who are least likely to access or respond to treatment, this study demonstrates a novel approach to managing care successfully.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COHORT ANALYSIS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | BODY WEIGHT | IMMUNOLOGIC FACTORS | MORTALITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Physiology | Biology | Immunity | Immune System | Population Dynamics
Document Number: 342153

30.

Peer�Reviewed

Title: Continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia.
Author: Harvey C; Seib C; Lucke J
Source: Contraception. 2009 Dec;80(6):527-32.
Abstract: BACKGROUND: This study examined demographic profile, continuation rates and reasons for removal among Implanon users accessing two family planning clinics in Queensland, Australia. STUDY DESIGN: A retrospective chart audit of 976 women who attended for implant insertion over a 3-year period between May 2001 and May 2004. RESULTS: Continuation rates showed that at 6 months after insertion, 94% of women continued, 74% continued at 1 year and 50% continued at 2 years. Metropolitan women were more likely than rural women to discontinue use because of dissatisfaction with bleeding patterns. Cox regression analysis showed that those attending the regional clinic experienced significantly shorter time to removal. CONCLUSIONS: Implanon continuation rates and reasons for removal differ between clinics in metropolitan and rural locations. A cooling-off period did not affect the likelihood of continuation with Implanon. Preinsertion counselling should emphasize potential changes in bleeding patterns.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | FAMILY PLANNING PROGRAMS | CONTRACEPTIVE IMPLANTS | CONTRACEPTION CONTINUATION | CONTRACEPTIVE REMOVAL | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENSTRUATION | Oceania | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Family Planning | Contraceptive Methods | Contraception | Contraceptive Usage | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents | Reproduction
Document Number: 343396


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