| 1. Peer Reviewed Title: Childcare cash benefits and fertility timing in Norway. Author: Aassve A; Lappegard T Source: European Journal of Population. 2009 Feb;25(1):67-88. Abstract: In 1998 a new cash benefit for parents with young children was introduced in Norway. Its purpose was to provide a cash payment to parents who either preferred to care for their children at home or to compensate those who were not offered external childcare provision. It has been argued that the new policy encouraged women to stay at home with their children, possibly reducing labour supply. The policy was consequently considered gender-biased, creating reduced incentives for women to participate in the labour market and therefore encouraging a more traditional division of labour of husbands and wives. Given this background of the policy we undertake an analysis in two parts. We ask first the question "who takes the cash benefit?" Second, by applying simple matching techniques, we ask the question "Do couples taking the benefit behave differently in terms of their fertility timing?" Using information from Norwegian registers we find that more traditional households (in a broad sense) are more likely to take the cash benefit. Those taking the benefit accelerate childbearing significantly, though the reasons why they do so varies by socio-economic groups. Language: English Keywords: NORWAY | RESEARCH REPORT | COUPLES | REPRODUCTIVE BEHAVIOR | FAMILY POLICY | FAMILY ALLOWANCES | CHILD CARE | TIME FACTORS | Developed Countries | Europe, Northern | Europe | Family Characteristics | Family and Household | Sociocultural Factors | Fertility | Population Dynamics | Demographic Factors | Population | Social Policy | Policy | Political Factors | Child Rearing | Behavior Document Number: 331296 |
2.  Peer Reviewed Title: Evaluation of mifepristone as a once a month contraceptive pill. Author: Agarwal M; Das V; Agarwal A; Pandey A; Srivastava D Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e27-9. Abstract: OBJECTIVE: The purpose of this study was to assess the efficacy and safety of mifepristone as a contraceptive pill. STUDY DESIGN: A prospective case-control study was conducted in a tertiary care center of North India. The study group (n = 86) was given 200-mg mifepristone tablets on the 16th day of the menstrual cycle. The control group (n = 92) received combined oral contraceptive (COC) as per protocol. Subjects were followed for drug compliance, satisfaction, side effects, and failure. RESULTS: Acceptability of mifepristone was significantly higher in educated population (P < .001), with fewer side effects (P = .001), good satisfaction (P < .001), and higher compliance rate (P = .05). The oral contraceptive pill group had higher adverse biochemical parameters. CONCLUSION: Mifepristone can be used as a monthly contraceptive pill effectively. Language: English Keywords: INDIA | RESEARCH REPORT | ORAL CONTRACEPTIVES | RU-486 | TIME FACTORS | ADMINISTRATION AND DOSAGE | Asia, Southern | Asia | Developing Countries | Contraceptive Methods | Contraception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341243 |
| 3. Peer Reviewed Title: Menstrual blood loss in women using the frameless FibroPlant LNG-IUS. Author: Andrade A; Wildemeersch D Source: Contraception. 2009 Feb;79(2):134-8. Abstract: BACKGROUND: This study was conducted to report on a menstrual blood loss (MBL) study and iron stores in women with and without heavy menstrual bleeding using the frameless FibroPlant levonorgestrel-releasing intrauterine system (LNG-IUS) for contraception. STUDY DESIGN: An open, prospective, noncomparative MBL study, using FibroPlant releasing 14 mcg of LNG/day for contraception. MBL was assessed by the quantitative alkaline hematin (QAH) technique. RESULTS: The MBL study was conducted in 40 heavy and normally menstruating Brazilian women seeking contraception. MBL was reduced from a mean baseline menstrual volume of 29.7 mL to a mean volume of 1.5 mL after 24 months, while ferritin values increased from a mean value of 31.1 ng/mL (at baseline) to a mean level of 72.5 ng/mL (after 24 months of use). Differences were highly significant (p<.0005). There were no significant differences between those who had normal menstrual bleeding and the heavy bleeders. The heavy bleeders had comparable MBL to thenormal bleeders 3 months after insertion, and by 24 months post-insertion, their ferritin levels were comparable to those of the normal bleeders. Amenorrhea occurred in 80% of women out of 40 after 24 months of use. No pregnancies were recorded. CONCLUSION: The LNG-IUS is effective in reducing MBL in normally menstruating women as well as in women with heavy menstrual bleeding. The authors agree with the recommendations by the UK National Institute for Clinical Effectiveness and the new Finnish guidelines for heavy menstrual bleeding that the LNG-IUS should be positioned as first-line treatment prior to endometrial ablation or hysterectomy. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | MENSTRUATION | SERUM IRON LEVEL | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | TIME FACTORS | AMENORRHEA | PREVALENCE | CONTRACEPTIVE EFFECTIVENESS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Reproduction | Hemic System | Physiology | Biology | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Population Dynamics | Demographic Factors | Population | Measurement Document Number: 331016 |
| 4. Peer Reviewed Title: Universal voluntary HIV testing and immediate antiretroviral therapy [letter] Author: Assefa Y; Lera M Source: Lancet. 2009 Mar 28;373(9669):1080; author reply 1080-1. Abstract: Reuben Granich and colleagues use mathematical models to show that annual screening of most adults for HIV, with immediate commencement of antiretroviral therapy for all infected, would strikingly reduce HIV incidence. The findings are very interesting. We would like to share our lessons from Ethiopia. Ethiopia had a millennium AIDS campaign with the objective of increasing the number of people tested for HIV through universal voluntary counselling and testing and providing antiretroviral treatment for eligible patients. We were able to increase the number of people tested in 1 year from 560 000 in 2005/06 to 4.6 million in 2007/08. The number of patients started on antiretroviral therapy per month increased from 3500 to more than 5700. Even though we accomplished a lot in terms of HIV testing and antiretroviral therapy provision, we had challenges during the rapid scale-up of these services. We learnt that mass testing is very resource-intensive and needs a strong health system, including adequate human resources and a continuous supply of commodities. As a result, our current guiding principle is "high yield" and "high impact" through targeted testing of most-at-risk populations: patients with tuberculosis or sexually transmitted diseases, and pregnant women. Universal voluntary HIV testing and antiretroviral therapy provision might be effective in reducing HIV transmission, but with the current health system constraints in many sub-Saharan African countries such as Ethiopia, it is really not feasible to practise it. We recommend "high yield" and "high impact" HIV testing with early initiation of antiretroviral therapy, and improved adherence and retention of patients in care and treatment. (full-text) Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | RESEARCH PROPOSAL | THEORETICAL MODELS | COST BENEFIT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | BEST PRACTICES | HIV PREVENTION | PUBLIC HEALTH | TIME FACTORS | COST EFFECTIVENESS | ETHICS | NOTIFICATION | Studies | Research Methodology | Quantitative Evaluation | Evaluation | HIV Infections | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Health | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Sociocultural Factors | Political Factors Document Number: 330977 |
| 6. 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 |
| 7. Title: Estimating HIV-1 incidence using the serologic testing algorithm for recent HIV infections at HIV counseling and testing centers in the city of Sao Paulo, Brazil. Author: Bassichetto KC; Bergamaschi DP; Veras MA; Sucupira MC; Mesquita F; Diaz RS Source: Brazilian Journal of Infectious Diseases. 2009 Feb;13(1):9-12. Abstract: The network of HIV counseling and testing centers in Sao Paulo, Brazil is a major source of data used to build epidemiological profiles of the client population. We examined HIV-1 incidence from November 2000 to April 2001, comparing epidemiological and socio-behavioral data of recently-infected individuals with those with long-standing infection. A less sensitive ELISA was employed to identify recent infection. The overall incidence of HIV-1 infection was 0.53/100/year (95% CI: 0.31-0.85/100/year): 0.77/100/year for males (95% CI: 0.42-1.27/100/year) and 0.22/100/ year (95% CI: 0.05-0.59/100/year) for females. Overall HIV-1 prevalence was 3.2% (95% CI: 2.8-3.7%), being 4.0% among males (95% CI: 3.3-4.7%) and 2.1% among females (95% CI: 1.6-2.8%). Recent infections accounted for 15% of the total (95% CI: 10.2-20.8%). Recent infection correlated with being younger and male (p = 0.019). Therefore, recent infection was more common among younger males and older females. Language: English Keywords: BRAZIL | RESEARCH REPORT | ESTIMATION TECHNIQUES | STATISTICAL STUDIES | CLIENTS | HIV TESTING | HIV INFECTIONS | INCIDENCE | LABORATORY PROCEDURES | EPIDEMIOLOGY | PREVALENCE | TIME FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Public Health | Population Dynamics | Demographic Factors | Population Document Number: 342655 |
| 8. Peer Reviewed Title: Contraceptive failure with Depo-Provera® [letter] Author: Bhathena R Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):130. Abstract: I have a concern regarding the recent case report where a 28-year-old woman was given a subsequent (second) injection of Depo-Provera® by a practice nurse when she attended after 13 weeks, and when no precautions were advised, nor documentation done. The patient subsequently again reported with a positive pregnancy test and opted for a termination of pregnancy. My personal feeling is that although by and large consultation times are often too short for practising doctors to cover all aspects of counselling at all times, when a patient is using a contraceptive method outside the terms of the product licence, to ensure that optimal service is offered and also in view of the remote possibility of litigation following failure of the method, it should be mandatory for the practising doctor to also get involved and appropriately counsel, and to adequately document such an episode. (full-text) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PHYSICIANS | NURSES AND NURSING | DEPO-PROVERA | CONTRACEPTION FAILURE | ABORTION | REFERRAL AND CONSULTATION | COUNSELING | TIME FACTORS | FAMILY PLANNING EDUCATION | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Health Personnel | Delivery of Health Care | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Usage | Fertility Control, Postconception | Program Activities | Programs | Organization and Administration | Clinic Activities | Population Dynamics | Demographic Factors | Population | Education Document Number: 330946 Notification |
| 9. Peer Reviewed Title: Cervical obstruction complicating second-trimester abortion: treatment with misoprostol. Author: Borgatta L; Sayegh R; Betstadt SJ; Stubblefield PG Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):548-50. Abstract: BACKGROUND: Cervical cone biopsy or loop electrosurgical excision procedures (LEEP) may lead to cervical scarring, agglutination, or stenosis. Leiomyomas may also obstruct the lower uterine segment such that instruments cannot be passed from the vagina to the gestation. CASE: Two women requested second trimester abortion. Both women had undergone cervical LEEP. In addition, one woman had a 10-cm leiomyoma, which seemed to be obstructing the lower segment. In both, the external cervical os was essentially obliterated. After administration of misoprostol, the cervix softened markedly in 18-24 hours. In both women, the cervix dilated readily and allowed dilation and evacuation of the uterus. CONCLUSION: Misoprostol resulted in the ability to evacuate the uterus vaginally, in a situation that might have otherwise resulted in hysterotomy. Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL EFFECTS | CERVICAL LACERATION | GROWTH | TIME FACTORS | Developed Countries | United States of America | North America | Americas | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Diseases | Child Development | Population Dynamics Document Number: 330357 Notification |
| 10. Peer Reviewed Title: Effect of sexual intercourse on the absorption of levonorgestrel after vaginal administration of 0.75 mg in Carraguard gel: a randomized, cross-over, pharmacokinetic study. Author: Brache V; Croxatto H; Kumar N; Sitruk-Ware R; Cochon L; Schiappacasse V; Sivin I; Munoz C; Maguire R; Faundes A Source: Contraception. 2009 Feb;79(2):150-4. Abstract: BACKGROUND: The Population Council studied a pre-coital contraceptive microbicide vaginal product containing levonorgestrel (LNG) as active component and Carraguard gel as a vehicle (Carra/LNG gel) for couples who engage in occasional unplanned intercourse. The objective of this study was to evaluate the effect of sexual intercourse after vaginal application of Carra/LNG gel on serum levels of LNG in women and to assess LNG absorption by the male partner. STUDY DESIGN: This was a randomized, cross-over, pharmacokinetic study including an abstinence arm and an arm in which couples engaged in sexual intercourse between 2 and 4 h after gel application. In each study arm, each woman received a single application of Carra/LNG gel (0.75 mg in 4 mL gel) followed by serial blood samples taken at 0, 1, 2, 4, 8, 24 and 48 h after gel application for LNG measurements. In the intercourse arm, LNG was measured in blood samples taken from the male partner before intercourse and at 4, 8 and 24 h after gel application in the female partner. RESULTS: Time concentration curves for serum LNG levels showed a mean C(max) of 7.8+/-5.5 and 8.3+/-5.7 nmol/L, a mean T(max) of 6.2+/-5.9 and 7.5+/-5.7, and comparable area under the curve for the intercourse and abstinence arm, respectively. Pharmacokinetic parameters presented large variability between subjects, but excellent reproducibility within each subject. LNG was undetectable in 10 out of 12 male partners. CONCLUSION: Sexual intercourse does not appear to interfere with vaginal absorption of LNG after application of a Carra/LNG gel. A vaginal pre-coital contraceptive gel is feasible. Language: English Keywords: DOMINICAN REPUBLIC | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | SEXUAL INTERCOURSE | PHYSIOLOGY | LEVONORGESTREL | VAGINAL GEL | MICROBICIDES | TIME FACTORS | CONTRACEPTIVE EFFECTIVENESS | EMERGENCY CONTRACEPTION | Developing Countries | Caribbean | Americas | Research Methodology | Economic Development | Economic Factors | Sex Behavior | Behavior | Reproduction | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Vaginal Spermicides | Contraceptive Methods | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population Document Number: 331015 |
| 11. Peer Reviewed Title: Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women. Author: Brown ER; Otieno P; Mbori-Ngacha DA; Farquhar C; Obimbo EM; Nduati R; Overbaugh J; John-Stewart GC Source: Journal of Infectious Diseases. 2009 May 1;199(9):1292-300. Abstract: BACKGROUND: There are limited data regarding the relative merits of biomarkers as predictors of mortality or time to initiation of antiretroviral therapy (ART). METHODS: We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human immunodeficiency virus type 1 (HIV-1) load, total lymphocyte count (TLC), body mass index (BMI), and hemoglobin measured at 32 weeks' gestation as predictors of mortality in a cohort of HIV-1-infected women in Nairobi, Kenya. Sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curve (AUC) were determined for each biomarker separately, as well as for the CD4 cell count and the HIV-1 load combined. RESULTS: Among 489 women with 10,150 person-months of follow-up, mortality rates at 1 and 2 years postpartum were 2.1% (95% confidence interval [CI], 0.7%-3.4%) and 5.5% (95% CI, 3.0%-8.0%), respectively. CD4 cell count and CD4% had the highest AUC value (>0.9). BMI, TLC, and hemoglobin were each associated with but poorly predictive of mortality (PPV, <7%). The HIV-1 load did not predict mortality beyond the CD4 cell count. CONCLUSIONS: The CD4 cell count and CD4% measured during pregnancy were both useful predictors of mortality among pregnant women. TLC, BMI, and hemoglobin had a limited predictive value, and the HIV-1 load did not predict mortality any better than did the CD4 cell count alone. Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | IMMUNOLOGIC FACTORS | BODY WEIGHT | HEMOGLOBIN LEVEL | RISK FACTORS | AIDS | MORTALITY | ANTIRETROVIRAL THERAPY | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Hemic System | Health | Population Dynamics | HIV Document Number: 342360 |
| 12. Title: Vasectomy reversal: a seven-year experience. Author: Busato WF Jr Source: Urologia Internationalis. 2009;82(2):170-4. Abstract: INTRODUCTION: Since the demand for vasectomy reversal is increasing and many populations in Brazil and other countries show distinct characteristics, this study was carried out as an effort to determine factors and characteristics associated with the success rate of reversal in a population in Southern Brazil. PATIENTS AND METHODS: We reviewed 29 cases of vasectomy reversal performed over a 7-year period using the single-layer technique under microscopic magnification. RESULTS: Mean patency, pregnancy, and birth rates were 75, 41.7 and 29%, respectively. The patency and pregnancy rates were 92.3 and 38.5%, respectively, for time intervals since vasectomy <10 years and 63.6 and 45.4%, respectively, for intervals >10 years. Patency and pregnancy rates were 87.5 and 50%, respectively, for patients who had their vasectomy performed by a urologist, and 50 and 25%, respectively, for those who had their vasectomy performed by a generalist surgeon (p < 0.05). CONCLUSIONS: High patency and pregnancy rates are associated with time intervals since vasectomy of <10 years and vasectomies performed by urologists. There was no significant difference in the anastomosis time between the first 12 procedures and the next 12 procedures. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | MEN | VASECTOMY | STERILIZATION REVERSAL | PREGNANCY RATE | BIRTH RATE | TIME FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Demographic Factors | Population | Male Sterilization | Sterilization, Sexual | Family Planning | Reversible Sterilization | Fertility Measurements | Fertility | Population Dynamics Document Number: 331231 |
| 13. Peer Reviewed Title: Improvement of the patient flow in a large urban clinic with high HIV seroprevalence in Kampala, Uganda. Author: Castelnuovo B; Babigumira J; Lamorde M; Muwanga A; Kambugu A; Colebunders R Source: International Journal of STD and AIDS. 2009 Feb;20(2):123-4. Abstract: Antiretroviral treatment roll-out programmes in Africa often have difficulties to cope with the increasing number of clients. Based on the findings of a survey carried out in 2005 that showed long waiting times, innovative organizational changes (nurse visits and pharmacy-only refill visits) were introduced in our clinic. In August 2007, the survey was repeated to evaluate the impact of these changes. During both surveys we used the same standardized questionnaire. In 2007, 400 patients visited the clinic on the study day compared to 250 in 2005. The median time spent at the clinic decreased from 157 minutes in 2005 (range 22-426) to 124 minutes (15-314). All the waiting times for different services decreased except the time between the visit to the triage nurse and the doctors' visit. A similar methodology could be used by other health services to evaluate and compare different models of care. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | SURVEYS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | CLINIC VISITS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | CAPACITY BUILDING | TIME FACTORS | ORGANIZATION AND ADMINISTRATION | WAITING AREAS AND QUEUES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Service Statistics | Program Activities | Programs | HIV | AIDS | Program Sustainability | Population Dynamics | Workplace | Employment | Macroeconomic Factors | Economic Factors Document Number: 331091 |
| 14. Peer Reviewed Title: A randomized trial to compare two dosing intervals of misoprostol following mifepristone administration in second trimester medical abortion. Author: Chai J; Tang OS; Hong QQ; Chen QF; Cheng LN; Ng E; Ho PC Source: Human Reproduction. 2009 Feb;24(2):320-4. Abstract: BACKGROUND: The conventional timing of misoprostol administration after mifepristone for second trimester medical abortion is 36-48 h, but simultaneous administration, which may make the regimen more convenient, has not been studied. The objective of this randomized comparison study is to compare two intervals of administration of misoprostol after pretreatment with mifepristone for second trimester medical abortion. METHODS: Eligible women with gestational age between 12 and 20 weeks were randomized to receive mifepristone 200 mg orally followed by 600 microg misoprostol vaginally either immediately or 36-38 h later, followed by 400 microg vaginal misoprostol every 3 h for a maximum of four doses. The primary outcome measure was the success rate at 24 h after the start of misoprostol treatment and the secondary outcome measures were the induction-to-abortion interval and the frequency of side effects. RESULTS: There was a significant difference in the success rate at 24 h (36-38 h: 100%; immediate: 91.5%). The median induction-to-abortion interval was significantly shorter in the 36-38 h regimen (4.9 h) compared with the immediate regimen (10 h). Side effects in terms of febrile episodes and chills/rigors were significantly higher in the immediate administration group. CONCLUSIONS: Simultaneous use of mifepristone and misoprostol for second trimester medical abortion is not as effective as the regimen using a 36-38 h dosing interval. Language: English Keywords: CHINA | HONG KONG | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | ABORTION | ADMINISTRATION AND DOSAGE | MISOPROSTOL | RU-486 | PREGNANCY, SECOND TRIMESTER | TIME FACTORS | SIDE EFFECTS | Asia, Eastern | Asia | Developing Countries | Developed Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Fertility Control, Postconception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Pregnancy | Reproduction | Population Dynamics Document Number: 331075 Notification |
| 15. Title: Timing and determinants of mother-to-child transmission of HIV in Nigeria. Author: Charurat M; Datong P; Matawal B; Ajene A; Blattner W; Abimiku A Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3; Abstract: OBJECTIVE: To characterize the timing and determinants of mother-to-child transmission (MTCT) of HIV among mothers receiving single-dose nevirapine to prevent MTCT in Nigeria. METHODS: Three hundred and seventy-one HIV-infected mothers and their infants were followed from birth, at 1 week, and at 1, 3, 6, and 12 months. Risks of in utero (IU), intrapartum (IP/EPP), and postnatal (PP) transmission were quantified using conditional Cox regressions. RESULTS: Maternal viral load was the only risk factor for IU transmission after controlling for known risk factors. Low birth weight, premature birth, mixed feeding, and maternal viral load were associated with IP/EPP transmission. Increased PP transmission was associated with low birth weight and mixed feeding. At 6 months, mixed-fed infants were more likely to acquire infection than formula-fed infants (hazard ratio=5.74; 95% CI, 1.26-26.2). CONCLUSION: Risk factors for IU transmission differed from those of IP and PP transmission. Reducing mixed feeding and low birth weight delivery among HIV-infected mothers can further decrease IP and PP transmission. Language: English Keywords: NIGERIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | MOTHERS | INFANT | PERSONS LIVING WITH HIV/AIDS | HIV TRANSMISSION | TIME FACTORS | MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | LOW BIRTH WEIGHT | RISK FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Transmission | Infections | HIV | Birth Weight | Body Weight | Physiology | Biology | Health Document Number: 341465 |
| 16. Title: Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial. Author: Chawdhary R; Rana A; Pradhan N Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):78-85. Abstract: AIM: To compare the efficacy of mifepristone and vaginal misoprostol with misoprostol alone for pregnancy termination up to 63 days. METHOD: This exploratory study was conducted in the Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal as a part of a thesis study for a period of one year from April 2005-2006. After confirming a pregnancy < or =63 days gestation by transvaginal ultrasound, an equal number of women (50) were randomized into (i) group A, women who received 200 mg oral mifepristone (RU 486) on day 1 and vaginal misoprostol 800 microg on day 3; and (ii) group B, women who received vaginal misoprostol (800 microg) on day 1 and 3 (total dose 1600 microg). The primary study outcome measure was complete abortion without surgical intervention making comparisons between these two groups in terms of complete abortion rate, need for manual vacuum aspiration for incomplete abortion and pregnancy continuation after reconfirming the diagnosis on transvaginal ultrasound, besides comparing the side effects/complications. RESULTS: Fewer side effects and a more complete abortion rate (94%) was observed in group A (mifepristone and vaginal misoprostol) in comparison to vaginal misoprostol alone (total dose 1600 microg) giving a complete abortion rate of 86% along with a significant hematocrit drop on follow-up day 10 (P = 0.03) besides having increased duration of bleeding (P = 0.017). CONCLUSION: Mifepristone oral (200 mg) followed by vaginal misoprostol (800 microg) on day 3 provides a better success rate (94%) with fewer complications than vaginal misoprostol 800 microg used on days 1 and 3 for medical abortion of pregnancies up to 63 days. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | RU-486 | MISOPROSTOL | ABORTION | VAGINA | ULTRASONICS | ADMINISTRATION AND DOSAGE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, FIRST TRIMESTER | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Genitalia, Female | Genitalia | Urogenital System | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Population Dynamics | Contraceptive Agents | Contraception | Pregnancy | Reproduction Document Number: 341125 |
| 17. Title: Recent oral contraceptive use and adverse birth outcomes. Author: Chen XK; Wen SW; Sun LM; Yang Q; Walker MC Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2009;144:40-43. Abstract: OBJECTIVE: To examine the possible association between oral contraceptive use and adverse birth outcomes. STUDY DESIGN: We conducted a population-based cohort study of pregnant women who used oral contraceptives within 3 months before their last menstrual period. Subjects were divided into three groups, according to the interval (0-30, 31-60, and 61-90 days) between the dispensing date and their last menstrual period. For each exposed subject, 4 subjects without exposure to oral contraceptives were individually matched by infant's year of birth and plurality and by mother's age and parity. RESULTS: Oral contraceptive use within 30 days prior to the last menstrual period was associated with increased risks of very low birth weight (OR: 3.24, 95% CI: 1.18, 8.92), low birth weight (OR: 1.93, 95% CI: 1.17, 3.20), and preterm birth (OR: 1.61, 95% CI: 1.01, 2.55); however, oral contraceptive use 31-90 days prior to the last menstrual period did not increase the risk of low birth weight or preterm birth.CONCLUSION: Our results indicate the use of oral contraceptives near the time of conception may be associated with an increased risk of low birth weight and preterm birth. Language: English Keywords: CANADA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | CLINICAL RESEARCH | INFANT | PREGNANT WOMEN | PREVALENCE | PREGNANCY OUTCOMES | ORAL CONTRACEPTIVES, SIDE EFFECTS | TIME FACTORS | LOW BIRTH WEIGHT | PREMATURE BIRTH | RISK FACTORS | North America, Northern | Americas | Developed Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Pregnancy | Reproduction | Contraceptive Safety | Safety | Public Health | Health | Population Dynamics | Birth Weight | Body Weight | Physiology | Biology Document Number: 330420 |
| 18. Peer Reviewed Title: One versus multiple packs for women starting oral contraceptive pills: a comparison of two distribution regimens. Author: Chin-Quee D; Otterness C; Wedderburn M; McDonald O; Janowitz B Source: Contraception. 2009 May;79(5):369-74. Abstract: BACKGROUND: Despite World Health Organization and International Planned Parenthood Federation recommendations to provide multiple pill cycles to new users, many programs in developing countries still give only one pill cycle to new acceptors. STUDY DESIGN: To compare provision of a single versus multiple packs of pills, new pill users in 20 matched public sector clinics in Jamaica were assigned to one of two pill regimens in which they received either one (then subsequently three) or four pill cycles at method initiation. The primary outcome was the proportion of women who used pills beyond 4 months. RESULTS: Among 655 women, those receiving one cycle of pills at initiation, followed by counseling and a three-pack resupply, were no more likely to be using pills after 4 months than women who received four packs at initiation (odds ratio=1.33; 95% confidence interval=0.88-2.0). In both pill regimen groups, returning late to the clinic for resupply was a problem. However, more women in the 1+3-pack regimen group returned late to study clinics to obtain their fifth cycle of pills than their counterparts in the 4-pack regimen group (53% vs. 28%). CONCLUSION: Our findings support the recommendation that pill users should be given more than one cycle to start, because an extra visit for resupply contributes to clinic and provider costs. Moreover, providing more pill cycles at initiation would decrease the likelihood that women experience a gap in pill use between cycles. Language: English Keywords: JAMAICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE SURVEYS | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | CONTRACEPTIVE DISTRIBUTION | PACKAGING | ORAL CONTRACEPTIVES | TIME FACTORS | COUNSELING | USER COMPLIANCE | CONTRACEPTIVE PREVALENCE | CONTRACEPTION CONTINUATION | Caribbean | Americas | Developing Countries | Family Planning Surveys | Family Planning | Studies | Research Methodology | Economic Development | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Marketing | Contraceptive Methods | Contraception | Population Dynamics | Demographic Factors | Population | Clinic Activities | Behavior | Contraceptive Usage Document Number: 330940 |
| 19. Peer Reviewed Title: Sustained immunological responses to highly active antiretroviral therapy at 36 months in a Ghanaian HIV cohort. Author: Collini P; Schwab U; Sarfo S; Obeng-Baah J; Norman B; Chadwick D; Bibby D; Bedu-Addo G Source: Clinical Infectious Diseases. 2009 Apr 1;48(7):988-91. Abstract: Two hundred thirty-seven Ghanaian human immunodeficiency virus-infected patients who were starting antiretroviral therapy underwent clinical and immunological monitoring for 3 years. Seventy-eight percent of patients had disease classified as World Health Organization stage III or IV. The mean increase in the CD4 cell count was 395 cells/mm(3), 13% of patients experienced immunological failure, and 8% of patients switched treatment to a second-line regimen. However, two-thirds of patients who experienced immunological failure did not switch treatment, and 31% of all patients were lost to follow-up. Language: English Keywords: GHANA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | LONGITUDINAL STUDIES | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | IMMUNITY, CELLULAR | TIME FACTORS | AIDS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Population Dynamics | Demographic Factors | Population Document Number: 330985 |
| 20. Title: Reliability of reported breastfeeding duration among reproductive-aged women from Mexico. Author: Cupul-Uicab LA; Gladen BC; Hernandez-Avila M; Longnecker MP Source: Maternal and Child Nutrition. 2009 Apr;5(2):125-37. Abstract: Breastfed children have lower risk of infectious diseases, post-neonatal mortality and chronic diseases later in life. Because epidemiologic studies usually rely on reported history of previous breastfeeding, data on the accuracy and precision of recalled histories allow improved interpretation of the epidemiologic findings. We evaluated the reliability of two reported breastfeeding durations in 567 reproductive-aged women from Mexico using information obtained from nearly identical sets of questions applied at different times after weaning. We compared differences between reports, and examined the intraclass correlation coefficient (ICC) for any and for exclusive breastfeeding (EBF). Logistic regression was used to evaluate the determinants of poor recall (difference between reports of >20%). The reliability of duration of any breastfeeding was high (ICC 0.94). Overall, differences between reports of duration were usually <1 month, and for 385/567, the difference was < or =0.5 months. Predictors of poorer recall were having > or =4 children, and time between reports of >2 months. The only predictor of better recall was greater age of the baby at weaning. The reliability of EBF duration was lower (ICC 0.49). In this population with a relatively long duration of breastfeeding, reliability of any breastfeeding duration was high. Age, education and previous breastfeeding were not important predictors of recall, in contrast to findings in earlier studies. Consistent with previous reports, however, parity and length of recall were associated with poorer recall of duration of any breastfeeding. Future studies that use reported breastfeeding duration may want to consider the effect of these variables on recall. Language: English Keywords: MEXICO | RESEARCH REPORT | SAMPLING STUDIES | MEASUREMENT | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | RELIABILITY | SOCIOECONOMIC STATUS | North America | Americas | Developing Countries | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors Document Number: 341786 |
| 21. Title: Mainstreaming early and exclusive breastfeeding for improving child survival. Author: Dadhich JP; Agarwal RK Source: Indian Pediatrics. 2009 Jan;46(1):11-7. Abstract: India is home to maximum number of under-five deaths and underweight children in the world. In 2006, for the first time, the number of children in the world dying before their fifth birthday fell below 10 million, to 9.7 million annually. South Asia's contribution to this figure was 3.1 million out of which 2.1 million deaths occurred in India i.e., 21 percent of the global burden of under five deaths. Most of these deaths occur during the neonatal period. A reduction in the number of deaths among the under-five children reflects the country's progress on the fourth Millennium Development Goal (MDG 4). About 55 million, or one-third of the world's underweight children under the age of five years, live in India. Malnutrition has been estimated to be an underlying cause of up to 50-60 percent of under five deaths. The number of young underweight children reflects the country's progress on the first Millennium Development Goal (MDG 1), which deals with eradication of extreme poverty and hunger. In India, the average annual rate of decline in malnutrition has been around 0.9% since 1990. Considerably accelerated progress is needed for India to meet its MDG target of halving the percentage of underweight children by 2015. Despite breastfeeding's numerous recognized advantages, early and exclusive breastfeeding rates in most states of the India are low. There are many gaps in policy and programs related to infant and young child feeding in India. The big challenge is how to mainstream IYCF counseling and support interventions to help women to succeed both in early and exclusive breastfeeding. The rationale for supporting a major program to protect, promote and support breastfeeding action, backed by a budgetary support, is compelling for our country. Child health and development policies should urgently address this major concern. Language: English Keywords: INDIA | RECOMMENDATIONS | HEALTH SURVEYS | MOTHERS | INFANT | BREASTFEEDING, EXCLUSIVE | CHILD SURVIVAL | MALNUTRITION | BODY WEIGHT | TIME FACTORS | POSTPARTUM PROGRAMS | LONGTERM EFFECTS | INTELLIGENCE | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | Asia, Southern | Asia | Developing Countries | Health | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Breastfeeding | Infant Nutrition | Nutrition | Survivorship | Length of Life | Mortality | Population Dynamics | Nutrition Disorders | Diseases | Physiology | Biology | Family Planning Programs | Family Planning | Personality | Psychological Factors | Behavior | HIV Infections | Viral Diseases | Disease Transmission Control | Prevention and Control Document Number: 331250 |
| 22. Peer Reviewed Title: Two-months-off, four-months-on antiretroviral regimen increases the risk of resistance, compared with continuous therapy: A randomized trial involving West African adults. Author: Danel C; Moh R; Chaix ML; Gabillard D; Gnokoro J; Diby CJ; Toni T; Dohoun L; Rouzioux C; Bissagnene E; Salamon R; Anglaret X Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):66-76. Abstract: A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antiretroviral treatment (hereafter, "C-ART") to an ART regimen of 2 months off and 4 months on therapy (hereafter, "2/4-ART"). We report the final analysis. A total of 435 adults who were receiving successful ART ((median CD4 cell count prior to ART, 272 cells/mm3; 88% were receiving a zidovudine-lamivudine-efavirenz regimen) were randomized to receive C-ART or 2/4-ART. The main primary end point was the percentage of patients with <350 CD4 cells/mm3 at 24 months. The sample size ensured 80% power to demonstrate noninferiority (noninferiority bound, -15%), assuming that 30% of the patients in the C-ART arm would have <350 CD4 cells/mm3. Other end points were mortality, morbidity, cost of care, genotypic resistance, adherence, and toxicity. The percentage of patients with <350 CD4 cells/mm3 at 24 months was 5.6% (6 of 107) in the C-ART arm and 14.6% (46 of 315) in the 2/4-ART arm (lower bound of the 95% CI for the difference, -14%). Cost was 18% higher in the C-ART arm, and resistance to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was 20% higher in the 2/4-ART arm. Other end points were nonconclusive. Although 2/4-ART met the predetermined criteria for noninferiority, the percentage of patients with <350 CD4 cells/mm3 in the C-ART arm was lower than anticipated, which makes the clinical significance of this noninferiority uncertain. In addition, 2/4-ART led to an unacceptable additional risk of selecting for drug-resistant virus. This new argument against episodic ART strategies is also a caveat against any unplanned ART interruptions in Africa, where most patients receive NNRTIs. Language: English Keywords: COTE D'IVOIRE | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | ADULTS | TIME FACTORS | ADMINISTRATION AND DOSAGE | RISK ASSESSMENT | DRUG RESISTANCE | ANTIRETROVIRAL DRUGS | IMMUNITY, CELLULAR | GENETICS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Immunity | Immune System | Physiology | Biology Document Number: 328597 |
| 23. Peer Reviewed Title: Modeling CD4+ cell count increase over a six-year period in HIV-1-infected patients on highly active antiretroviral therapy in Senegal. Author: De Beaudrap P; Etard JF; Diouf A; Ndiaye I; Gueye NF; Gueye PM; Sow PS; Mboup S; Ndoye I; Ecochard R; Eric D Author: ANRS 1215/90 Study Group Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):1047-53. Abstract: To assess the extents and determinants of long-term CD4 cell increases after initiation of antiretroviral therapy (ART), changes in CD4 cell counts were analyzed in a cohort of HIV-1-infected Senegalese using a mixed-effects model. After a median follow-up of 54 months, an average of 483 CD4 cells/mm3 (95% confidence interval [CI] = 331; 680) was reached. The average asymptote level was approximately 421 cells/mm3 (95% CI = 390; 454) in patients with < 200 cells/mm3 at baseline and approximately 500 cells/mm3 in patients with > 200 cells/mm3. The independent predictors of long-term CD4 cell reconstitution were the baseline CD4 cell count and the monthly average viral load over the entire follow-up. This good long-term immune reconstitution, optimal in subjects with low average viral loads and > 200 CD4 cells/mm3 at baseline, argues in favor of the earliest possible access to ART and underlines the importance of strict compliance with the treatment. Language: English Keywords: SENEGAL | RESEARCH REPORT | STATISTICAL STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | TIME FACTORS | HEMATOLOGIC TESTS | USER COMPLIANCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior Document Number: 341762 |
| 24. Title: Rapid progression of HIV infection in infancy. Author: Devi NP; Shenbagavalli R; Ramesh K; Rathinam SN; Swaminathan S Source: Indian Pediatrics. 2009 Jan;46(1):53-6. Abstract: Transmission of HIV from mother to child can occur in utero, during labor or after delivery via breast feeding. Data on the fate of babies born with HIV in India are scarce. We present details of 25 infants with perinatally acquired HIV infection (virologically confirmed) to highlight the observed high rate of morbidity and mortality within the first 18 months of life. Our findings of rapid disease progression among perinatally infected HIV positive children underline the importance of early diagnosis and treatment. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | INFANT | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | DEATH RATE | INFANT MORTALITY | AIDS | TIME FACTORS | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Transmission | Infections | Mortality | Population Dynamics Document Number: 331249 |
| 25. Title: Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality. Author: Dickinson JE; Doherty DA Source: Prenatal Diagnosis. 2009 May;29(5):520-4. Abstract: OBJECTIVE: Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality. METHODS: All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 6-hourly were extracted from the database and outcomes reviewed. RESULTS: This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30-39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration. CONCLUSIONS: Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | CONGENITAL ABNORMALITIES | ABORTION | MISOPROSTOL | TIME FACTORS | AGE FACTORS | NULLIPARITY | Oceania | Developed Countries | Neonatal Diseases and Abnormalities | Diseases | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Population Dynamics | Demographic Factors | Population | Population Characteristics | Parity | Fertility Measurements | Fertility Document Number: 342614 Notification |
| 26. Title: Risk factors for triple-negative breast cancer in women under the age of 45 years. Author: Dolle JM; Daling JR; White E; Brinton LA; Doody DR; Porter PL; Malone KE Source: Cancer Epidemiology, Biomarkers and Prevention. 2009 Apr;18(4):1157-66. Abstract: Little is known about the etiologic profile of triple-negative breast cancer (negative for estrogen receptor/progesterone receptor/human epidermal growth factor), a breast cancer subtype associated with high mortality and inadequate therapeutic options. We undertook this study to assess the risk for triple-negative breast cancer among women 45 years of age and younger in relation to demographic/lifestyle factors, reproductive history, and oral contraceptive use. Study participants were ascertained in two previous population-based, case-control studies. Eligible cases included all primary invasive breast cancers among women ages 20 to 45 years in the Seattle-Puget Sound area, diagnosed between January 1983 and December 1992, for whom complete data was obtained for estrogen receptor, progesterone receptor, and human epidermal growth factor status (n = 897; including n = 187 triple-negative breast cancer cases). Controls were age matched and ascertained via random digit dialing. Oral contraceptive use > or =1 year was associated with a 2.5-fold increased risk for triple-negative breast cancer (95% confidence interval, 1.4-4.3) and no significantly increased risk for non-triple-negative breast cancer (P(heterogeneity) = 0.008). Furthermore, the risk among oral contraceptive users conferred by longer oral contraceptive duration and by more recent use was significantly greater for triple-negative breast cancer than non-triple-negative breast cancer (P(heterogeneity) = 0.02 and 0.01, respectively). Among women < or =40 years, the relative risk for triple-negative breast cancer associated with oral contraceptive use > or =1 year was 4.2 (95% confidence interval, 1.9-9.3), whereas there was no significantly increased risk with oral contraceptive use for non-triple-negative breast cancer among women < or =40 years, nor for triple-negative breast cancer or non-triple-negative breast cancer among women 41 to 45 years of age. In conclusion, significant heterogeneity exists for the association of oral contraceptiveuse and breast cancer risk between triple-negative breast cancer and non-triple-negative breast cancer among young women, lending support to a distinct etiology. Language: English Keywords: UNITED STATES OF AMERICA | WASHINGTON | RESEARCH REPORT | CASE CONTROL STUDIES | BREAST CANCER | RISK FACTORS | ORAL CONTRACEPTIVES | TIME FACTORS | AGE FACTORS | Developed Countries | North America | Americas | Studies | Research Methodology | Cancer | Neoplasms | Diseases | Health | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Population Characteristics Document Number: 341655 |
| 27. Peer Reviewed Title: Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Author: Edelman AB; Carlson NE; Cherala G; Munar MY; Stouffer RL; Cameron JL; Stanczyk FZ; Jensen JT Source: Contraception. 2009 Aug;80(2):119-27. Abstract: BACKGROUND: This study was conducted to determine whether increased body mass index (BMI) affects oral contraceptive (OC) pharmacokinetics and suppression of hypothalamic-pituitary-ovarian (HPO) axis activity. STUDY DESIGN: Ovulatory reproductive-age women with normal weight (BMI <25 kg/m(2); n=10) and with obesity (BMI >30 kg/m(2); n=10) received OCs for two cycles (prospective cohort). Subjects were admitted for two 48-h inpatient stays at the beginning and end of the hormone-free interval. Ethinyl estradiol and levonorgestrel (LNG) levels were evaluated during both inpatient stays. Gonadotropin pulsatility (follicle-stimulating hormone and luteinizing hormone) was measured during the second inpatient stay. Estradiol (E(2)) and progesterone (P) were measured daily during inpatient stays and twice per week in Cycle 2. RESULTS: BMI was greater in the obese compared to the normal-BMI group [37.3 kg/m(2) (SD, 6.0) vs. 21.9 kg/m(2) (SD, 1.6); p<.05]. The LNG half-life was significantly longer in the obese group (52.1+/-29.4 vs. 25.6+/-9.3 h, p<.05), which correlated with a lower maximum LNG concentration on Cycle 2, Day 1 [1.9 ng/mL (SD, 0.5) vs. 2.5 ng/mL (SD, 0.7)] and a longer time to reach steady state (10 vs. 5 days) in obese women. There were no significant differences in volume of distribution between groups. LH pulse parameters did not differ statistically between groups but trended toward greater HPO activity in the obese group. Additionally, more obese (6/10 vs. 3/10 normal BMI, p>.05) women exhibited E(2) levels consistent with development of a dominant follicle and P levels consistent with ovulation (2/10 vs. 1/10) during Cycle 2. CONCLUSIONS: Compared to women with normal BMI, obese women exhibit differences in OC pharmacokinetics that are associated with greater HPO activity. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | OBESITY | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTION FAILURE | ETHINYL ESTRADIOL | LEVONORGESTREL | GONADOTROPINS, PITUITARY | LABORATORY PROCEDURES | TIME FACTORS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Body Weight | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Gonadotropins | Hormones | Endocrine System | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 342308 |
| 28. Peer Reviewed Title: Trends in infant nutrition in Saudi Arabia: compliance with WHO recommendations. Author: El Mouzan MI; Al Omar AA; Al Salloum AA; Al Herbish AS; Qurachi MM Source: Annals of Saudi Medicine. 2009 Jan-Feb;29(1):20-3. Abstract: BACKGROUND AND OBJECTIVE: The WHO recommends exclusive breastfeeding in the first 6 months of life. Our objective was to evaluate trends in infant nutrition in Saudi Arabia and the degree of compliance with WHO recommendations. SUBJECTS AND METHODS: A nationwide nutritional survey of a sample of Saudi households was selected by the multistage probability sampling procedure. A validated questionnaire was administered to mothers of children less than 3 years of age. RESULTS: Of 5339 children in the sample, 4889 received breast milk at birth indicating a prevalence of initiation of 91.6%. Initiation of breastfeeding was delayed beyond 6 hours after birth in 28.1% of the infants. Bottle feeding was introduced by 1 month of age to 2174/4260 (51.4%) and to 3831/4260 (90%) by 6 months of age. The majority of infants 3870/4787 (80.8%) were introduced to "solid foods" between 4 to 6 months of age and whole milk feedings were given to 40% of children younger than 12 months of age. CONCLUSIONS: The current practice of feeding of Saudi infants is very far from compliance with even the most conservative WHO recommendations of exclusive breastfeeding for 4 to 6 months. The high prevalence of breastfeeding initiation at birth indicates the willingness of Saudi mothers to breastfeed. However, early introduction of complementary feedings reduced the period of exclusive breastfeeding. Research in infant nutrition should be a public health priority to improve the rate of breastfeeding and to minimize other inappropriate practices. Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | NUTRITION SURVEYS | INFANT | HOUSEHOLDS | INFANT NUTRITION | WHO | STANDARDS | BREASTFEEDING, EXCLUSIVE | PREVALENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | AGE FACTORS | BREASTFEEDING | Middle East | Developing Countries | Nutrition | Health | Youth | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | UN | International Agencies | Organizations | Political Factors | |