The Pop Reporter®
– Events – Archives – Subscribe – Modify Profile – The Pop Reporter en Espaņol (Spanish)
Volume 7, Number 14
23 April 2007
Pop Reporter Tip: Contact an author! Receiving your Pop Reporter might be just the first step in any research project or educational program you are working on. If you read an interesting abstract or article in The Pop Reporter, but would like to have more information, why not use the e-mail address provided by the journal to contact the author? You could be starting a correspondence that will last a lifetime.
Guest Editorials (free with every subscription)
Developing a continuing-client strategy
Author: Deepa Ramchandran, INFO Project, Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health
dramchan@jhuccp.org
A family planning program that focuses on clients not only when they first choose a contraceptive method but also throughout their reproductive lives can offer better care than one that focuses on new clients alone (1, 2).
Among women using contraception, the majority of unintended pregnancies occur because of inconsistent or incorrect use of the method, or because the user discontinued one method without immediately switching to another effective one (3). Analysis of data from the Demographic and Health Surveys (DHS) reveal that, among women who became pregnant while using a contraceptive method, most were relying on periodic abstinence and withdrawal -- among the least effective methods -- followed by oral contraceptives and condoms -- methods that are user-dependent and that people often use inconsistently and incorrectly (4).
Family planning providers and programs can help continuing clients who want to avoid pregnancy by addressing their concerns about using contraception and providing encouragement and counseling for maintaining effective contraceptive use. Clients who stop using contraception even though they want to avoid pregnancy often need counseling to help them manage side effects or to choose another method that suits them better.
Programs can adopt a continuing-client strategy by realigning their activities to focus more on continuing clients, while continuing to focus on new users. Most family planning programs already offer substantial counseling and support for contraceptive use. But they could provide even better service by making appropriate changes in their clinic operations to strengthen their relationship with continuing clients. For example, programs can offer a continuous supply of a range of family planning methods, train providers to respond better to continuing clients, reorganize client flow to differentiate between new and continuing users, and maintain adequate records that help them serve clients over the course of their reproductive lives.
Understanding how family planning providers and program services can help individual clients make informed decisions about continued contraceptive use and then acting on this knowledge are the heart of a continuing-client strategy. The strategy can enable clients to avoid unintended pregnancy by removing obstacles to sustained use, improving quality of care, and focusing on their health care needs and reproductive intentions.
For more information, see Population Reports, "Developing a Continuing-Client Strategy." Full text of the report can be seen online at: http://www.populationreports.org/j55/. For printed copies of the report, send an e-mail to Orders@jhuccp.org or write to Orders Department, INFO Project, Johns Hopkins Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, MD 21202, USA. A web-based order form can be found at: http://www.jhuccp.org/orders/
For information on how to monitor and evaluate a continuing-client strategy, managers can refer to the INFO Reports issue, "Measuring Success of a Continuing-Client Strategy." This tool includes 24 indicators that can help managers gauge the progress of a continuing-client strategy and adjust program operations as needed. Full text of the report can be seen online at: http://www.infoforhealth.org/inforeports/.
See products related to "Developing a Continuing-Client Strategy" at www.infoforhealth.org.
References:
1. Best, K. Consultation on improving contraceptive continuation: Partnering to generate and apply knowledge for better results. Proceedings of the Consultation on Improving Contraceptive Continuation, Washington, D.C., Nov. 29-30, 2005. Family Health International and The ACQUIRE Project, EngenderHealth, (Available: http://www.acquireproject.org/fileadmin/user_upload/ACQUIRE/Contraceptive_Continuation_Proceedings_Nov_28-29_2005.pdf)
2. McGinn, T., Khan, E., and Asmatullah, D. Family planning continuation among Afghan refugees in Northwest Frontier Province, Pakistan. Peshawar, Pakistan, Reproductive Health Research Group, Aug. 2001. 38 p. (Available: http://www.rhrc.org/pdf/pakistan.pdf)
3. Trussell, J. and Vaughan, B. Contraceptive failure, method-related discontinuation and resumption of use: Results from the 1995 National Survey of Family Growth. Family Planning Perspectives 31(2): 64-72, 93. Mar./Apr. 1999.
4. MEASURE DHS PROJECT. DHS STATcompiler. Macro International Inc., May 9, 2006. (Available: http://www.statcompiler.com/)
FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH
Once-a-month contraceptive pills in China: A review of available evidence
(Abstract; subscription needed for full text; Asia)
Contraception . 2007 May;75(5):337-343.
Kejuan F | Meirik O | Yongang D | Yan C | Weijin Z
A review of evidence was conducted to assess the safety, effectiveness and continuation of once-a-month contraceptive pills. Papers were identified by electronic searches in Chinese and international databases and manual searches of Chinese journals and index of family planning literature. Data on pharmacokinetics, clinical performance and laboratory examinations were extracted from 17 papers of mixed quality on pills containing quinestrol 3 mg and norgestrel 12 mg (Quin-Ng) or levonorgestrel 6 mg (Quin-Lng) used by women in China. Quin-Lng pills gave steady-state serum levels of ethinylestradiol between 0.20-0.25 and 0.15 ng/mL. The 1-year perfect use pregnancy rate was 1.1 per 100 women-years. Nausea and increased leukorrhea were common; bleeding control was good. Hypertension developed in 5.8% of Quin-Ng pill users during the first year of use. For Quin-Ng and Quin-Lng once-a-month pills, 1 year continuation rates were 73.6 and 82.1 per 100, respectively. Lack of good quality data prevents confident assessment of the safety and efficacy of once-a-month pills. Short-term safety information indicates a high incidence of bothersome side effects and hypertension. The high monthly estrogen and progestogen doses raise questions about the safety of the once-a-month pills.
Possible reasons for an increase in the proportion of genital ulcers due to herpes simplex virus from a cohort of female bar workers in Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections . 2007 Apr;83(2):91-96.
Riedner G | Todd J | Rusizoka M | Mmbando D | Maboko L
The objectives were to determine trends in the prevalence and aetiological distribution of genital ulcer syndrome (GUS) in a cohort of female bar workers and to assess factors associated with these trends. An open cohort of 600 women at high risk of HIV and sexually transmitted infection (STI) was offered screening and treatment for STI at 3-month intervals. The prevalence of GUS and associated aetiological agents (Herpes simplex virus (HSV), Treponema pallidum and Haemophilus ducreyi) were monitored over 27 months through clinical examination, dry lesion swabbing and multiplex polymerase chain reaction. The effects of HIV status and other factors on the prevalence trends of STI were assessed. A total of 753 women were recruited into the cohort over 10 examination rounds. At recruitment, the seroprevalence was 67% for HIV and 89% for HSV type 2 (HSV-2). During follow-up, 57% of ulcers had unknown aetiology, 37% were due to genital herpes and 6% to bacterial aetiologies, which disappeared completely in later rounds. The absolute prevalence of genital herpes remained stable at around 2%. The proportion of GUS caused by HSV increased from 22% to 58%, whereas bacterial causes declined. These trends were observed in both HIV-negative and HIV-positive women. The changes observed in the frequency and proportional distribution of GUS aetiologies suggest that regular STI screening and treatment over an extended period can effectively reduce bacterial STI and should therefore be sustained. However, in populations with a high prevalence of HSV-2, there remains a considerable burden of genital herpes, which soon becomes the predominant cause of GUS. Given the observed associations between genital herpes and HIV transmission, high priority should be given to the evaluation of potential interventions to control HSV-2 either through a vaccine or through episodic or suppressive antiviral therapy and primary prevention.
Antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia
(Abstract; subscription needed for full text; Asia)
Sexually Transmitted Infections . 2007 Apr;83(2):133-135.
Vorobieva V | Firsova N | Ababkova T | Leniv I | Haldorsen BC
The objectives were to characterise comprehensively the antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia, and to investigate whether the recommended treatment guidelines are updated and effective. The susceptibility of N gonorrhoeae isolates, cultured during June-November 2004 mainly from consecutive patients with gonorrhoea (n = 76) in Arkhangelsk, to penicillin G, ampicillin, cefixime, ceftriaxone, ciprofloxacin, erythromycin, azithromycin, kanamycin, spectinomycin and tetracycline was analysed using Etest. Nitrocefin discs were used for b-lactamase detection. The levels of intermediate susceptibility and resistance to the different antibiotics were as follows: penicillin G 76%, ampicillin 71%, cefixime 0%, ceftriaxone 3%, ciprofloxacin 17%, erythromycin 54%, azithromycin 14%, kanamycin 49%, spectinomycin 0% and tetracycline 92%. Of the isolates 55 (72%) were determined as multiresistant-that is, they showed intermediate susceptibility or resistance to three or more classes of antibiotics. However, none of the isolates were b-lactamase producing. In Arkhangelsk, and presumably in many other areas of Russia, penicillins, ciprofloxacin, erythromycin, azithromycin, kanamycin and tetracycline should not be used in the treatment of gonorrhoea if the results of antibiotic susceptibility testing are not available. In Russia, optimised, standardised and quality-assured antibiotic susceptibility testing needs to be established in many laboratories. Subsequently, continuous local, regional and national surveillance of antibiotic susceptibility is crucial to detect the emergence of new resistance, monitor changing patterns of susceptibility and be able to update treatment recommendations on a regular basis.
Advance provision of emergency contraception for pregnancy prevention (full review)
(Abstract; subscription needed for full text; Global)
Cochrane Database of Systematic Reviews 18 Apr 2007 (Issue 2)
Polis CB | Schaffer K | Blanchard K | Glasier A | Harper CC | Grimes DA
Related News Article: Widespread use of morning-after pill 'fails to cut teenage pregnancy'
Cochrane Library Press Release, 18th April 2007
Women who have unprotected sexual intercourse or experience contraceptive failure can seek emergency contraception to reduce their chance of unintended pregnancy. Emergency contraception is a safe medication, and to be effective, must be taken within five days of unprotected intercourse. Several barriers can discourage use of emergency contraception, including an inability to obtain the medication fast enough. One proposed solution is to let women have a set of the tablets that they can keep for immediate use should it be needed.
"Providing emergency contraception before it is needed in case unprotected intercourse occurs gives women rapid access to the medication," says lead author Chelsea Polis, a PhD student at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, USA.
Polis headed up a team of Cochrane Researchers who set out to see whether this sort of advance provision of emergency contraception influenced pregnancy rates, occurrence of sexually transmitted diseases, sexual behaviour and the use of other contraceptives.
They identified eight randomised controlled trials that met their inclusion criteria, which involved a total of 6,389 people living in the USA, China and India.
Despite increased use (single and multiple) and faster use of emergency contraception, advance provision did not reduce pregnancy rates on a population level.
At the same time advance provision was not accompanied by increased rates of sexually transmitted infections or increased frequency of unprotected intercourse. In addition it did not lead to women changing their use of other contraceptives.
"Women should have education about, and easy access to, emergency contraception because it can decrease the chance of pregnancy. However, the interventions for advance provision tested so far have not reduced overall pregnancy rates," says Polis.
FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS
Philippines: Pulse Asia's March 2007 Ulat ng Bayan Survey, media release on family planning
(News Article; Asia)
13 Apr 2007
Pulse Asia Inc.
Uganda: New Health Show on UBC TV
(News Article; Sub-Saharan Africa)
17 Apr 2007
Birungi H, All Africa
MDs set to endorse HPV vaccinations
(News Article; North America)
16 Apr 2007
Kirkey S, CanWest News Service
Islamic Approach to Family Health in Egypt
(News Article; Sub-Saharan Africa)
15 Apr 2007
Kazaure M, Daily Trust
A birth control 'pill' for men?
(News Article; Central America and the Caribbean)
15 Apr 2007
Little-White H, Jamaica Gleaner
FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY
Philippines: RPEB-8 enjoins partner agencies to adopt PGMA's population policy directives
(News Article; Asia)
20 Apr 2007
Philippine Information Agency
HIV/AIDS RESEARCH
Children, AIDS and the politics of orphan care in Ethiopia: The extended family revisited
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Social Science and Medicine. 2007 May;64(10):2058-2069.
Abebe T | Aase A
The astounding rise in the number of orphans due to the HIV/AIDS epidemic has left many Ethiopian families and communities with enormous childcare problems. Available studies on the capacity and sustainability of the extended family system, which culturally performs the role of care for children in need, suggest two competing theories. The first is grounded in the social rupture thesis and assumes that the traditional system of orphan care is stretched by the impact of the epidemic, and is actually collapsing. By contrast, the second theory counter-suggests that the flexibility and strength of the informal childcare practise, if supported by appropriate interventions, can still support a large number of orphans. Based on a seven-month period of child-focused, qualitative research fieldwork in Ethiopia involving observations; indepth interviews with orphans (42), social workers (12) and heads of households (18); focus group discussions with orphans (8), elderly people and community leaders (6); and story-writing by children in school contexts, this article explores the trade-offs and social dynamics of orphan care within extended family structures in Ethiopia. It argues that there is a rural-urban divide in the capacity to cater for orphans that emanates from structural differences as well as the sociocultural and economic values associated with children. The care of orphans within extended family households is also characterised by multiple and reciprocal relationships in care-giving and care-receiving practices. By calling for a contextual understanding of the 'orphan burden', the paper concludes that interventions for orphans may consider care as a continuum in the light of four profiles of extended families, namely rupturing, transient, adaptive, and capable families.
Risk factors for treatment denial and loss to follow-up in an antiretroviral treatment cohort in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Tropical Medicine and International Health. 2007 May;12(5):687-694.
Karcher H | Omondi A | Odera J | Kunz A | Harms G
The objectives were to evaluate risk factors for treatment denial and loss to follow-up in an antiretroviral treatment (ART) cohort in a rural African setting in western Kenya. Sociodemographic and clinical data of patients enrolled in an ART cohort were collected within 18 months of an observational longitudinal study and analysed by logistic and Cox regression models. Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10-11.8; P = 0.035] and lower level of education (AOR 3.80, 95% CI 1.14-12.7; P = 0.03) were independently associated with treatment denial. The incidence of total loss of patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01-1.12; P = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15-29.5; P = 0.03) and incomplete adherence to treatment (AHR 1.05, 95% CI 1.03-1.07; P less than 0.001) were independent risk factors for death. Incomplete adherence also independently predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04-1.09; P less than 0.001). Pregnancy and lower level of education, higher age, advanced AIDS stage and impaired compliance to ART were identified as risk factors for treatment denial and death, respectively. Adequate counselling strategies for patients with these characteristics could help to improve adherence and outcome of treatment programmes in resource-limited settings.
Factors determining prenatal HIV testing for prevention of mother to child transmission in Dar Es Salaam, Tanzania
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Pediatrics International. 2007 Apr;49(2):286-292.
Kominami M | Kawata K | Ali M | Meena H | Ushijima H
The objectives of the study were (i) to evaluate the Prevention of Mother to Child Transmission (PMTCT) services in Temeke district, Tanzania and (ii) to identify factors for non-acceptance of HIV testing among pregnant mothers in the area. A structured questionnaire was used in face-to-face interviews at five health centers in the district. Univariate and multiple logistic regression analyses were used to assess the association of the refusal of human immunodeficiency virus (HIV) testing with risk factors. Two hundred and seventy-three (68.1%) of the participants had already had HIV testing, while 128 (31.9%) had not. Participants' general knowledge of HIV was high, but specific knowledge of mother to child transmission (MTCT) was relatively low. In the multiple logistic regression analysis, frequencies of antenatal clinic visits, awareness of MTCT and intensive family support were significantly and inversely associated with the refusal of HIV testing. Frequency of antenatal care visits, spreading information on HIV/acquired immune deficiency syndrome especially MTCT, and husbands' intensive support are significant factors for increase of HIV test acceptance among pregnant women in the study area.
HIV prevalence and poverty in Africa: Micro- and macro-econometric evidences applied to Burkina Faso
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Health Economics. 2007 May;26(3):483-504.
Lachaud JP
Based on the data of the Demographic and Health Survey, and of the Household Priority Survey, carried out in 2003, the present study, examining the factors of HIV prevalence in Burkina Faso, provides two conclusions. Firstly, the fight against poverty is not necessarily a means of reducing simultaneously and drastically HIV/AIDS prevalence, an assertion based on several elements of empirical analysis. First of all, the micro-econometric estimates of the probit models suggest a positive relationship between HIV prevalence in adult women and men, and living standards of individuals. Then, the macro-econometric approach reveals the existence of a positive (negative) relationship between, on the one hand, the level of regional HIV prevalence, and, on the other hand, the average monetary provincial standard of living (poverty) of households. At the same time, the relationship between HIV prevalence and poverty, apprehended at the regional level, is not linear. Secondly, and correlatively, the relationship between HIV prevalence and poverty is called into question. First of all, some structural factors may contribute to a distortion of the relationship between resources of households and the prevalence of HIV/AIDS. This may be due, on the one hand, to the persistence of cognitive and behavioural factors inherent in a traditional society, and in particular, to the fact that the social construction of female attributes and roles confers to men a statute of "decision-makers" with regard to sexual intercourse, while the persistence of secular beliefs contributes to minimizing the perception of HIV/AIDS in terms of risk, independently of standards of living. In addition, the enclavement of Burkina Faso required development of road and railway traffic with neighbouring countries, in particular Cote d'Ivoire. Therefore, it may be that the structural conditions of the process of development of Burkina Faso, concomitant with significant flows of the exchange of goods, services and labour with a country where the prevalence of the HIV is particularly high, constitute an element of an explanation of the positive relationship between the resources of households and HIV seroprevalence. Also, factors related to the economic situation probably contributed to reinforcing the opposite relationship between HIV seroprevalence and poverty, the macro-econometric analysis highlighting a direct relationship between the massive return of migrants of Cote d'Ivoire and the level of HIV prevalence in Burkina Faso.
Safety and efficacy of the HIV-1 integrase inhibitor raltegravir (MK-0518) in treatment-experienced patients with multidrug-resistant virus: A phase II randomised controlled trial
(Abstract; subscription needed for full text; Global)
Lancet. 2007 Apr 14;369(9569):1261-1269.
Grinsztejn B | Nguyen BY | Katlama C | Gatell JM | Lazzarin A
Raltegravir (MK-0518) is an HIV-1 integrase inhibitor with potent in-vitro activity against HIV-1 strains including those resistant to currently available antiretroviral drugs. The aim of this study was to assess the safety and efficacy of raltegravir when added to optimised background regimens in HIV-infected patients. HIV-infected patients with HIV-1 RNA viral load over 5000 copies per mL, CD4 cell counts over 50 cells per microL, and documented genotypic and phenotypic resistance to at least one nucleoside reverse transcriptase inhibitor, one non-nucleoside reverse transcriptase inhibitor, and one protease inhibitor were randomly assigned to receive raltegravir (200 mg, 400 mg, or 600 mg) or placebo orally twice daily in this multicentre, triple-blind, dose-ranging, randomised study. The primary endpoints were change in viral load from baseline at week 24 and safety. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, with the number NCT00105157. 179 patients were eligible for randomisation. 44 patients were randomly assigned to receive 200 mg raltegravir, 45 to receive 400 mg raltegravir, and 45 to receive 600 mg raltegravir; 45 patients were randomly assigned to receive placebo. One patient in the 200 mg group did not receive treatment and was therefore excluded from the analyses. For all groups, the median duration of previous antiretroviral therapy was 9.9 years (range 0.4-17.3 years) and the mean baseline viral load was 4.7 (SD 0.5) log10 copies per mL. Four patients discontinued due to adverse experiences, three (2%) of the 133 patients across all raltegravir groups and one (2%) of the 45 patients on placebo. 41 patients discontinued due to lack of efficacy: 14 (11%) of the 133 patients across all raltegravir groups and 27 (60%) of the 45 patients on placebo. At week 24, mean change in viral load from baseline was -1.80 (95% CI -2.10 to -1.50) log10 copies per mL in the 200 mg group, -1.87 (-2.16 to -1.58) log10 copies per mL in the 400 mg group, -1.84 (-2.10 to -1.58) log10 copies per mL in the 600 mg group, and -0.35 (-0.61 to -0.09) log10 copies per mL for the placebo group. Raltegravir at all doses showed a safety profile much the same as placebo; there were no dose-related toxicities. In patients with few remaining treatment options, raltegravir at all doses studied provided better viral suppression than placebo when added to an optimised background regimen. The safety profile of raltegravir is comparable with that of placebo at all doses studied.
HIV/AIDS NEWS
Namibia: HIV rates up - Report
(News Article; Sub-Saharan Africa)
18 Apr 2007
New Era
Africa: Treatment numbers growing, but universal access elusive
(News Article; Sub-Saharan Africa)
17 Apr 2007
PlusNews
Related Report: Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector 
(You need Adobe Acrobat Reader to access this document)
South Africa: New children's jab 'could save thousands'
(News Article; Sub-Saharan Africa)
19 April 2007
Business Day
CEPS auctions imported HIV drugs
(News Article; Sub-Saharan Africa)
17 April 2007
Joy Online
Red tape blocking medicine for Africa
(News Article; Sub-Saharan Africa)
18 April 2007
Globe and Mail
Cameroon announces free healthcare for nearly 50,000 HIV patients
(News Article; Sub-Saharan Africa)
19 April 2007
AFP
MATERNAL AND CHILD HEALTH RESEARCH
Hindmilk and weight gain in preterm very low-birthweight infants
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Pediatrics International. 2007 Apr;49(2):150-155.
Ogechi AA | William O | Fidelia BT
Feeding of own mother's milk to preterm very low-birthweight infants often results in suboptimal weight gain in these infants for whom energy requirements are high but in whom volume tolerance is limited. Therefore the purpose of the present paper was to investigate the effect of selective hindmilk feeding on the growth of preterm very low-birthweight babies. Preterm very low-birthweight babies admitted into the Special Care Baby Unit of the Jos University Teaching Hospital, Nigeria between April 2000 and July 2001 were randomized to hindmilk and composite breast milk feeding for 2 weeks. End-points were weight, occipitofrontal head circumference and length. For small-for-gestational-age babies, the infants fed on hindmilk gained weight at a mean rate of 12.92 plus or minus 10.95 g/kg per day as compared with a mean rate of 5.01 plus or minus 17.37 g/kg per day for their controls on composite milk ( P less than 0.0001). For appropriate-for-gestational-age babies, the mean rate of weight gain for the hindmilk group was 12.99 plus or minus 10.75 g/kg per day while that for their controls on composite milk was 8.29 plus or minus 20.56 g/kg per day ( P less than 0.01). There were no significant differences in the rates of increase in length and occipitofrontal head circumference between the groups. The lipid content of the hindmilk was 1.6-fold that of composite milk. Preterm very low-birthweight babies fed hindmilk had a higher rate of weight gain compared to those fed composite milk. It is recommended that the hindmilk fraction of expressed breast milk be predominantly used for the feeding of preterm very low-birthweight babies while in hospital to help shorten their duration of hospital stay.
Applying a framework for assessing the quality of maternal health services in urban India
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 May;64(10):2083-2095.
Hulton LA | Matthews Z | Stones RW
This paper presents findings from the application of a framework for assessing the quality of care of institutional maternity services in an urban slum in India. The framework divides quality into two parts: the quality of users' experience of care and the quality of the provision of care. Data from public and private hospitals were collected via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women in the immediate vicinity of the case study hospitals. Findings provide evidence that quality is far from optimal in both public and private facilities. Problems identified included a lack of essential drugs, women being left unsupported, evidence of physical and verbal abuse, and births occurring in hospitals without a health professional in attendance. The paper concludes that while many governments have explicit targets to increase institutional deliveries, many do not have explicit targets or even a commitment to assess and improve the quality of institutional services for childbirth.
Congenital anomalies in Iran: A cross-sectional study on 1574 cases in the North-West of country
(Abstract; subscription needed for full text; Middle East)
Child: Care, Health, and Development. 2007 May;33(3):257-261.
Dastgiri S | Imani S | Kalankesh L | Barzegar M | Heidarzadeh M
At least one congenital anomaly is present in between 1% and 6% of all infants throughout the world. The aim of this study was to document some epidemiological features of congenital anomalies in the North-West of Iran. The study cases (n = 1574) comprised all births registered/notified to three university-hospitals of Tabriz University of Medical Sciences, Iran, from 2000 to 2004. Total prevalence of congenital anomalies was 165.5 per 10 000 births [95% confidence interval (CI): 157-174]. Genito-urinary tract and kidney defects, anomalies of nervous system and limb anomalies accounted proportionally for more than 65% of anomalies in the region. The total prevalence of congenital anomalies in the study area increased from 104.6 per 10 000 births in 2000 (95% CI: 90-119) to 170.1 per 10,000 births in 2004 (95% CI: 152-189). It is concluded that the data from this cross-sectional study of congenital anomalies in the North-West of Iran may be used as the baseline information to establish a population-based registry of birth defects in the area for health care and research purposes.
Increasing rate of childhood tuberculosis in a region of east Croatia
(Abstract; subscription needed for full text; Europe)
Pediatrics International. 2007 Apr;49(2):183-189.
Aberle N | Bublic J | Feric M | Bukvic B | Simic A
The incidence of childhood tuberculosis as well as the number of children being in contact with persons having tuberculosis has increased in the region of Slavonski Brod during the past decade (1993-2003). The region is located in east Croatia along the border with Bosnia and close to the besieged and destroyed town of Vukovar. The region was heavily involved in recent military activities and migrations in Croatia and Bosnia (1991-1995). Before the war, the population was reasonably well situated, educated and provided with health services. Routine clinical and epidemiological methods for the diagnosis of tuberculosis were used. A total of 225 cases of tuberculosis were discovered among 271 suspected cases in a total number of 19 623 children below 18 years of age admitted during the last decade to the county hospital (1.38%). The number increased from three patients with tuberculosis in 1993 to 59 in 2003. Discharge diagnoses were: latent infection 40.1%, specific hilar lymphadenopathy 22.1%, primary lung tuberculosis 18.0%, postprimary tuberculosis 3.0%, and contact with infected person but otherwise normal findings 16.9%. The infection was usually (53.1%) acquired within the family, more often so in younger patients. Bacteriological cultures were positive in 19 of 117 patients with tuberculosis (16.4%). Antituberculosis drug treatment was carried out to completion in all children. Resistance was not encountered. The authors attribute high incidence of childhood tuberculosis in the region of Slavonski Brod, the second highest incidence in Croatia, to the sequellae of migrations during military activities in Croatia and Bosnia (1991-1995) and to the post-war recession.
MATERNAL AND CHILD HEALTH NEWS
A report for the ten year strategy for the reduction of vitamin and mineral deficiencies
(News Article; Global)
2007 Apr 15;
News-Medical.Net
Related Report: Vitamin and mineral deficiencies: A report for the ten year strategy for the reduction of vitamin and mineral deficiencies
(You need Adobe Acrobat Reader to access this document)
Essential medicines for children
(News Article; Global)
2007 Apr 16;
Bagozzi D, News-Medical.Net
Lesotho: New plan to reduce HIV infections in children
(News Article; Sub-Saharan Africa)
16 Apr 2007
PlusNews
MEN'S HEALTH RESEARCH
Prostate cancer risk among users of finasteride and alpha-blockers - A population based case-control study
(Abstract; subscription needed for full text; Europe)
European Journal of Cancer. 2007 Mar;43(4):775-781.
Murtola T | Tammela T | Maattanen L | Hakama M | Auvinen A
Related News Article: Prostate cancer risk among users of finasteride and alpha-blockers: A population based case control study
Finasteride has been reported to reduce prostate cancer risk in asymptomatic men. However, in clinical practice finasteride and alpha-blockers are used to treat benign prostatic hyperplasia (BPH). We evaluated prostate cancer risk among users of BPH pharmacotherapy at the population level. Comprehensive Finnish national registries provided information on 24723 prostate cancer cases and controls. Overall, prostate cancer risk was elevated among users of both drug categories compared to non-users (odds ratio, OR = 1.41; 95% confidence interval, CI 1.31-1.51 for finasteride and OR = 1.79; 95% CI 1.67-1.91 for alpha-blockers). However, the risk was lower among finasteride users when compared with alpha-blocker users (OR = 0.80; 95% CI 0.64-1.00). Regular finasteride users had the lowest risk. The increased risk is probably due to enhanced diagnostics of prostate cancer in men with BPH. Finasteride use does not decrease prostate cancer incidence compared with non-users. Nevertheless, the risk is lower when compared with alpha-blocker users.
An imaging biomarker of early treatment response in prostate cancer that has metastasized to the bone
(Abstract; subscription needed for full text; North America)
Cancer Research. 2007 Apr 15;67(8):3524-3528.
Lee KC | Sud S | Meyer CR | Moffat BA | Chenevert TL | Rehemtulla A | Pienta KJ | Ross BD
Related Press Release: New imaging method shows whether treatment for advanced prostate cancer is working
Related News Article: New imaging technique to measure the effectiveness of treatment for prostate cancer
Prostate cancer ranks as the most common lethal malignancy diagnosed and the second leading cause of cancer mortality in American men. Although high response rates are achieved using androgen blockade as first-line therapy, most men progress toward hormone-refractory prostate cancer. Systemic chemotherapies have been shown to improve clinical outcome in hormone refractory prostate cancer patients; however, they are not curative. Due to the high incidence of bone involvement in hormone-refractory prostate cancer, assessment of treatment response in metastatic prostate cancer to the bone remains a major clinical need. In this current study, we investigated the feasibility of using the functional diffusion map (fDM) as an imaging biomarker for assessing early treatment response in a preclinical model of metastatic prostate cancer. The fDM biomarker requires a pretreatment and midtreatment magnetic resonance imaging diffusion map, which is used to quantify spatially distinct therapeutic-induced changes in the Brownian motion (or diffusion) of water within tumor tissue. Because water within tumor cells is in a restricted environment relative to extracellular water, loss of cell membrane integrity and cellular density during therapy will be detected by fDM as an increase in diffusion. Regions of significantly increased diffusion values were detected early using fDM in docetaxel-treated versus untreated metastatic prostate bone tumors at 7 days post treatment initiation (P less than 0.05), indicating loss of tumor cell viability. Validation of fDM results was accomplished by histologic analysis of excised tissue. Results from this study show the capability of fDM as a biomarker for detection of bone cancer treatment efficacy, thus warranting clinical evaluation.
Human prostate epithelium lacks Wee1A-mediated DNA damage-induced checkpoint enforcement
(Abstract; subscription needed for full text; North America)
Proceedings of the National Academy of Sciences of the United States of America (PNAS). 2007 Apr;Online access April 12, 2007.
Kiviharju-af Hallstrom TM | Jaamaa S | Monkkonen M | Peltonen K | Andersson LC | Medema RH | Peehl DM | Laiho M
Related News Article: Study suggests reason for high incidence of cancer in the prostate
Cellular DNA damage triggers the DNA damage response pathway and leads to enforcement of cell cycle checkpoints, which are essential for the maintenance of genomic integrity and are activated in early stages of tumorigenesis. A special feature of prostate cancer is its high incidence and multifocality. To address the functionality of DNA damage checkpoints in the prostate, we analyzed the responses of human primary prostate epithelial cells (HPECs) and freshly isolated human prostate tissues to gamma-irradiation. We find that gamma-irradiation activates the ataxia telangiectasia mutated-associated DNA damage response pathway in the HPECs but that the clearance of phosphorylated histone H2AX (H2AX) foci is delayed. Surprisingly, gamma-irradiated HPECs were unable to enforce cell cycle checkpoint arrest and had sustained cyclin-dependent kinase 2 (Cdk2)-associated kinase activity because of a lack of inhibitory Cdk phosphorylation by Wee1A tyrosine kinase. We further show that HPECs express low levels of Wee1A and that ectopic Wee1A efficiently rescues the checkpoints. We recapitulate the absence of checkpoint responses in epithelium of ex vivo irradiated human prostate tissue despite robust induction of gammaH2AX. The findings show that prostate epithelium has a surprising inability to control checkpoint arrest, the lack of which may predispose to accrual of DNA lesions.
Complex urethral disruptions: In pursuit of a successful reconstruction
(Abstract; subscription needed for full text)
International Journal of Urology. 2007 Mar;14(3):198-202.
Pratap A | Gupta DK | Agrawal CS | Pandit RK | Adhikary S
We analyzed the methods and outcomes of urethroplasty in men with complex urethral disruptions. The medical records of 40 men with complex urethral disruptions were analyzed. Surgical methods were individualized according to stricture location, severity and length of the stricture, bladder neck characteristics and presence of complicating factors. Patientswere divided into four groups based on the above characteristics. End-to-end urethroplasty performed in six patients with short bulbar strictures (less than 3 cm) was successful in all. Elaborated perineal repair was performed in 10 patients with intermediate (3-6 cm) strictures with or without complicating factors. Elaborated perineal repair with urethral substitution was performed in nine patients with long segment stricture (greater than 6 cm). Abdominal transpubic repair was successfully applied to patients with rectourethral fistula or lacerated bladder neck. Success rate of anastomotic urethroplasty was 95% while over all success rate was 85%. Guidelines for urethral reconstruction of complex urethral disruptions are predicated on stricture length, location, bladder neck characteristics and associated complicating factors. End-to-end urethroplasty with stricture excision is highly reliable for short strictures for which previous operative repair have failed. Elaborated perineal repair is extremely versatile for intermediate and longer strictures with associated complicating factors. Abdominal transpubic urethroplasty is effective for patients with rectourethral fistula or lacerated bladder neck.
Enhanced external counterpulsation in patients with coronary artery disease-associated erectile dysfunction. Part I: Effects of risk factors
(Abstract; subscription needed for full text; North Africa)
The Journal of Sexual Medicine. 2007;Online access April 13, 2007.
El-Sakka A | Morsy A | Fagih B
Recently it has been demonstrated that enhanced external counterpulsation (EECP) could improve erectile dysfunction (ED) in patients with refractory ischemic heart disease (IHD). To assess the effect of risk factors on the efficacy and the satisfaction rate of EECP in patients with coronary artery disease (CAD)-associated ED. To assess the effect of risk factors on EECP efficacy and satisfaction rate, we compared the pre- and post-EECP responses to erectile function domain, Q3, and Q4 in patients with and without risk factors. Overall satisfaction and global efficacy question (GEQ) were also assessed. A total of 44 male consecutive patients with intractable angina caused by coronary insufficiency which cannot be controlled by conventional therapy were enrolled in this study. Patients were screened and followed up for ED using erectile function domain of the International Index for Erectile Function. A thorough sexual, medical, and psychosocial history was taken from all patients. All patients had severe diffuse triple vessels disease. They all had class III or IV angina. They were receiving the maximal antianginal pharmacotherapy. The mean age plus or minus SD was 57.1 plus or minus 5.6 years. Of the patients, 63.9% were below 60 years, and 86.4% were current or ex-smokers. There were significant differences between pre- and post-EECP regarding erectile function domain, Q3, and Q4. The sociodemographic variables were not significantly different among the studies groups and had not affected the GEQ or overall satisfaction. Overall satisfaction and GEQ were negatively influenced by smoking and presence of more than two risk factors. However, diabetes, hypertension, dyslipidemia, myocardial infraction, and obesity have not had such effects. The efficacy and satisfaction rate of EECP in patients with CAD-associated ED were negatively influenced by presence of risk factors; however, the global efficacy and the overall patients' satisfaction were encouraging.
Medical treatment of retrograde ejaculation in diabetic patients: A hope for spontaneous pregnancy
(Abstract; subscription needed for full text; North Africa)
Journal of Sexual Medicine. 2007;Online access April 13, 2007.
Arafa M | El Tabie O
Retrograde ejaculation (RE) is one of the complications of diabetes mellitus. Different therapeutic approaches are present, whether medical or surgical, with limited success rates. The aim of the present study is to evaluate different drug regimens for the medical treatment of RE in diabetic patients. Thirty-three diabetic patients with RE (23 complete and 10 partial) were included in the study. Patients were given three sequential courses of medical treatment: imipramine 25 mg twice/day, pseudoephidrine 120 mg twice/day, or combination of the two drugs. Establishment of antegrade ejaculate in cases with complete RE and improvement of semen quality in case of partial RE. In cases with complete RE, imipramine was successful in producing antegrade ejaculate in 10 patients (38.5%), while pseudoephedrine was successful in 11 patients (47.8%), and both drugs given together was successful in 16 patients (61.5%). In cases with partial RE, there was significant increase in the antegrade semen sample as regards semen volume, sperm count, total, and progressive motility with imipramine alone, pseudoephidrine alone, and both drugs. From the present study we can conclude that medical treatment for RE in diabetic patients is a promising method and should be the first line of treatment in these cases.
POPULATION RESEARCH
Explaining son preference in rural India: The independent role of structural versus individual factors
(Abstract; subscription needed for full text; Asia)
Population Research and Policy Review . 2007 Feb;26(1):1-29.
Pande RP | Astone NM
Much research has been done on demographic manifestations of son preference, particularly girls' excess mortality; however, there is less research that focuses on son preference itself. This paper analyzes the determinants of son preference in rural India. We separate the independent, relative effects of characteristics of individual women and their households, village opportunities for women and village development, and social norms. We look at both socioeconomic and sociocultural variables. Finally, we examine whether predictors of son preference differ by desired family size. Our data come from the National Family Health Survey (NFHS) India, 1992-1993. We use an ordered logit model, with dummy variables for state of residence. Our analysis shows that women's education, particularly at secondary and higher levels, is consistently and significantly associated with weaker son preference, regardless of desired family size. Once factors measuring social norms, such as marriage customs, caste and religion, are included, economic wealth and women's employment at household or village levels are not significant. Media access remains significant, suggesting an influence of "modernizing" ideas. Among social factors, caste and religion are associated with son preference but, once state of residence is controlled for, marriage patterns and cultivation patterns are insignificant. The strength and significance for son preference of many determinants differs by desired family size. Our results suggest that policy makers seeking to influence son preference need to identify and target different policy levers to women in different fertility and social contexts, rather than try an approach of one size that fits all.
The impact of infant and child death on subsequent fertility in Ethiopia
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Population Research and Policy Review . 2007 Feb;26(1):31-49.
Lindstrom DP | Kiros GE
This paper uses hazard regression models to assess the impact of experienced infant and child mortality on the risk of subsequent conceptions in Ethiopia. The purpose of this paper is to test for the presence of a fertility response to an infant or child death, net of the effects of truncated breastfeeding on fecundity. Using retrospective birth history data from a national survey in Ethiopia, we find a significantly higher risk of a conception in the months following the death of an index child, even after controlling for postpartum amenorrhoea and breastfeeding status. The fertility response is strongest after the death of the fourth or fifth child, which is when most women in Ethiopia are at or near their desired family size. However, we find no evidence of a fertility response to the death of a nonindex child. We attribute the higher risk of a conception following an index child's death to the intentional efforts of couples to reduce the waiting time to a next birth and thereby replace the deceased child. However, absent evidence of replacement fertility in response to the death of older nonindex children, we interpret the response to the death of an index child as an emotional response to child loss rather than a conscious strategy to meet a fertility target.
China's one-child policy and overweight children in the 1990s
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 May;64(10):2043-2057.
Yang J
The prevalence of overweight children in China has increased, and the one-child policy has been suggested as a cause. Drawing on longitudinal data from the China Health and Nutrition Survey, this paper investigates the relationship between the one-child policy and overweight among young children. The policy is measured directly as local variations and indirectly as sibship composition (i.e., number of siblings, birth order and birth interval). Results suggest that overweight among preschoolers and primary school children increased in the 1990s at a slower pace than that documented in previous studies in China, and the prevalence of overweight varies by age of children and urban residence. However, while there are substantially gross differences in overweight by policy variations and sibsize (i.e., number of siblings), single children and those in strict one-child policy communities do not differ from other children, after adjusting for household and community characteristics. Thus, the policy does not seem to bear an independent relationship to child overweight risk. Hence, this analysis provides little to support the public perception that the one-child policy is associated with the rising epidemic of child overweight in transitional China. Rather the risk associated with overweight include age of children, parental body mass index (BMI), level of maternal education, local socioeconomic development, urban residence and province/region.
POPULATION NEWS
Asia's falling fertility rates threaten baby bust
(News Article; Asia)
14 Apr 2007
Deen T , Inter Press Service News Agency
China's one-child policy reveals complexity, effectiveness
(News Article; Asia)
18 Apr 2007
Science Daily
Pakistan: Higher population growth, illiteracy posing potent threat to national integrity: Javed Ashraf Qazi
(News Article; Asia)
20 Apr 2007
Online News Pakistan
WOMEN'S HEALTH RESEARCH
Sexual function after radical hysterectomy for early-stage cervical cancer
(Abstract; subscription needed for full text; Asia)
Journal of Sexual Medicine. 2007;
Jongpipan J | Charoenkwan K
For early-stage cervical cancer, treatment with radical surgery appears effective with excellent survival. However, the treatment is associated with significant morbidities. Sexual dysfunction is the leading cause of symptom-induced distress after the treatments for early-stage cervical cancer. There has been no study that evaluates the effect of surgical treatments for cervical cancer on sexual function in the Eastern/Asian patients. The aim was to examine the effect of radical hysterectomy on postoperative sexual function in women with early-stage cervical cancer. The visual analog score on seven aspects of sexual function: overall satisfaction with sexual intercourse, sexual desire, vaginal lubrication, vaginal elasticity, orgasmic satisfaction, patient-perceived partner satisfaction, and associated anxiety. Thirty patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy at the Chiang Mai University Hospital were recruited. All of the patients were interviewed by questionnaire on sexual function at preoperative hospital admission and then at 3 and 6 months after surgery. Relevant clinical and pathologic data were also prospectively collected. The mean age of the patients was 45.3 plus or minus 6 years (range 28-59). Seven (23%) of the patients were postmenopausal. Almost all (97%) had FIGO stage IB1 disease. Fourteen (46.7%) patients had bilateral salpingo-oophorectomy, and one (3.3%) patient had unilateral salpingo-oophorectomy. Squamous-cell carcinoma and adenocarcinoma were diagnosed in 83% and 17%, respectively. At 3 and 6 months after operation, 63% and 93% of the patients had sexual intercourse, respectively. Considering the overall sexual satisfaction, the patient-rated visual analog score appeared comparable at preoperative and 6-month postoperative assessment (4.2 plus or minus 2.5 vs. 3.6 plus or minus 2.2, P greater than 0.05). Radical hysterectomy using the current technique has a minimal short-term impact on sexual function. A comparative study with long-term follow-up would provide clearer information on permanent effect of radical hysterectomy on sexual function.
Change and continuity: Childbirth and parenting across three generations of women in the United Arab Emirates
(Abstract; subscription needed for full text; Middle East)
Child: Care, Health and Development. 2007 May;33(3):266-274.
Green KE | Smith DE
The United Arab Emirates (UAE) is a country that has undergone remarkable physical, economic and social shifts in its short modern history. And while the economic and structural transformations of the society have been well documented and publicized, information about the changes and transformations of family processes is sparse. This study is one of the first steps towards documenting the changes in family processes, namely those related to childbirth and parenting, as described by three generations of Emirati women. Family triads of Grandmothers, Mothers and married Daughters (n = 216) were interviewed in local Arabic dialect by Emirati female research assistants. Data were analysed using chi square and Analysis of Variance. Generational differences were found between the Grandmothers, Mothers and Daughters in: number of births, maternal age at first birth, location and type of birth attendant, medication during labour and birth, father presence at birth, social support following birth, feeding and weaning of infant, and preventive infant health care. Changes were not found in the proximity to the mother of the infant during sleep. The age of first birth has risen for Emirati women and the birth rate may have dropped. Health care has also significantly improved. These results are discussed in relation to government initiatives and physical and social change within the UAE and the Middle East.
Immune concept of human papillomaviruses and related antigens in local cancer milieu of human cervical neoplasia
(Abstract; subscription needed for full text; Global)
Journal of Obstetrics and Gynaecology Research. 2007 Apr;33(2):103-113.
Sheu BC | Chang WC | Lin HH | Chow SN | Huang SC
It is presently the right time for clarifying human papillomavirus (HPV)-associated cellular immunity and clinical implications before global HPV vaccination programs begin. Infection with oncogenic HPV associates with the progression of cervical neoplasia. Both cellular and humoral immune responses are essential for the clearance of HPV-associated cervical lesions. There is increasing evidence that the immune system plays a pivotal role in determining the outcome of HPV infection. Viruses and associated neoplastic cells are proposed to have evolved mechanisms to avoid immune attack. T-cell-mediated immune responses against oncogenic HPV are believed to play a central role in cervical carcinogenesis. The presence of HPV-specific cytotoxic T lymphocytes (CTL) in a majority of human cervical cancer patients provides an approach for further study of their functional role in modulating this malignancy. Tumor-infiltrating lymphocytes (TIL) develop as manifestations of the recognition and defense against malignant cells by the host immune system. Cancer cells may overcome immune surveillance, either by downregulating the proliferation of HPV-specific CTL, or altering the effect or compositions of immune cells against HPV infections. TIL in the tumor microenvironment can be functionally inhibited and lose the ability of clonal proliferation as a result of depressed expression of IL-2Ra. The upregulation of inhibitory signaling relates to the modulation of the virus- and/or tumor-specific immune responses. Alteration of host genetic susceptibility may also lead to abnormal immune response as a general genomic instability resulting from virus persistence. Induction of HPV-specific immune responses is anticipated as an intimate point for the treatment of cervical neoplasia.
Lack of evidence for the involvement of rectal and oral trichomonads in the aetiology of vaginal trichomoniasis in Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Sexually Transmitted Infections. 2007 Apr;83(2):130-132.
Adu-Sarkodie Y | Opoku BK | Crucitti T | Weiss HA | Mabey D
The objective was to investigate the possible involvement of human trichomonads (Pentatrichomonas hominis and Trichomonas tenax) other than Trichomonas vaginalis in the aetiology of vaginal trichomoniasis. Vaginal swabs taken from women attending antenatal clinics were tested for Trichomonas vaginalis by traditional assays (wet-mount microscopy and InPouch culture) and nucleic acid amplification (polymerase chain reaction). These swabs were also tested for the presence of P hominis and T tenax by nucleic acid amplification. Oral and rectal swabs from these women were tested for T tenax and P hominis respectively. Data on sociodemographic characteristics, sexual and anogenital hygiene practices likely to seed P hominis and T tenax into the vagina were collected by a questionnaire. 93% (161) of the 173 samples in which T vaginalis was detected by wet preparation or culture was evaluable by PCR. Of this, T vaginalis was detected in 94% (152) by T vaginalis-specific PCR. Neither P hominis nor T tenax was detected in any of the vaginal swab samples. These included nine samples for which T vaginalis had been detected by wet preparation or culture, but were negative by T vaginalis nucleic acid amplification. P hominis and T tenax were not detected in any of the rectal and oral swabs, respectively. In this group of women, there was no evidence for the involvement of trichomonads other than T vaginalis in the aetiology of vaginal trichomoniasis.
WOMEN'S HEALTH NEWS
More efforts needed to reduce Fistula
(News Article; Sub-Saharan Africa)
14 Apr 2007
Tindwa P, Guardian
Uganda: Sabiny Need Radio and Girls' Schools to End FGM
(News Article; Sub-Saharan Africa)
16 Apr 2007
Kirunda K, The Monitor (Kampala)
Namibia: Dealing With Rape - We Need to Do Better
(News Article; Sub-Saharan Africa)
18 Apr 2007
Menges W, The Namibian (Windhoek)
YOUTH HEALTH RESEARCH
Isolated torsion of fallopian tube in a premenarcheal 12-year-old girl
(Abstract; subscription needed for full text; Global)
Journal of Obstetrics and Gynaecology Research. 2007 Apr;33(2):215-217.
Goktolga U | Ceyhan T | Ozturk H | Gungor S | Zeybek N
Isolated torsion of fallopian tubes should be considered even at premenarcheal ages in cases of acute pelvic pain, and prompt surgery can preserve the tube and thus fertility. It is an uncommon emergency event and a difficult condition to evaluate clinically. This report focuses on a 12-year-old premenarcheal girl who presented with acute pelvic pain of 2 days. Pelvic ultrasound showed an adnexal mass on the left side. Laparoscopy was performed and an isolated tubal torsion was discovered. The tube was necrotic and salpingectomy was performed. The appendix appeared to be hyperemic and erectile. Appendectomy was also performed to rule out appendicitis. It's our recommendation that in the differential diagnosis of acute lower abdominal pain of girls, isolated torsion of the fallopian tubes should be considered. Also, preservation of the tube and fertility should be possible with prompt surgical intervention.
YOUTH HEALTH NEWS
Uganda: Youth Living With HIV Prefer Negative Partners
(News Article; Sub-Saharan Africa)
17 Apr 2007
New Vision
Uganda: Keeping girls in school may cut incidence of teenage pregnancy
(News Article; Sub-Saharan Africa)
18 April 2007
The Monitor
India: Sex education to be introduced in schools: Union Minister
(News Article; Asia)
17 April 2007
United News of India
"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs/INFO Project. When you click on any link, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.
Problems and comments can be addressed to mdadamo@jhuccp.org.
Archives available at http://www.infoforhealth.org/popreporter/.
Subscribe at http://prds.infoforhealth.org/signup.php.
Modify your account at http://prds.infoforhealth.org/modify.php.
Forward this message to a friend who could benefit from INFO project activities!
The Pop Reporter--Delivering thought-provoking global health news to your desktop.
