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This Bulletin examines the causes of subfecundity -- the diminished ability to reproduce -- and its effect today and in the past on the fertility, or actual reproductive performance, of individuals and, hence, populations. By definition, all real populations are subfecund since all experience some degree of involuntary biological factors affecting coitus, conception, or the ability to carry a conceptus to live birth which reduces their fecundity below the estimated biological population maximum of 15 children per woman. Affecting both men and women, these factors fall into 5 categories: genetic factors such as blood group incompatibilities and inherited sickle cell anemia or diabetes; psychopathology, including psychic stress and behavioral disorders (e.g., drug and alcohol abuse); infectious diseases such as gonorrhea, malaria, tuberculosis, and postabortion infection; malnutrrition, including the chronic undernutrition of the 3rd World and the overnutrition of developed societies; and hazards posed by increasing amounts of radiation and toxic chemicals in the environment. Reducing subfecundity requires improved living conditions, avoidance of or protection from known hazards, and adoption of medical advances which now can help 40 to 60% of subfecund couples. But even in the U.S. fertility would certainly rise among the 15% of couples now estimated to be involuntarily childless and the 10% who have fewer children than they want, and among disadvantaged groups, and teenagers.
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PMID:Frustrated fertility: a population paradox. 1233 56

A symposium held 3-5 May 1990 commemorated the anniversary of the "Network" by presentations on the health aspects of reproduction in Africa. Prof. Sambra Diarra of the Ivory Coast presented a paper on "Health of Reproduction in Africa, Bi-Dimensional Problems: Biomedical and Social." He stressed the need to emphasize both maternal (MM) and infant mortality (IM) in Africa, where MM rates are 640/100,000 and IMR are 130/1000, because they remain so high. Prof. Fadel Diadhiou of Senegal followed with a paper on "Operations Research on Women's Reproductive Health in Africa." The major themes were that problems in reproductive health have resulted because of the fragmentation between the ecosystem and development and the lack of research is due to the isolation of institutions that lack human and material resources. The 3rd presentation by Prof. Mouhamadou Fall of Senegal on "The Health of Children and the Perspectives for Senegal," focused on the increasing infant and child mortality rates in Senegal (238/1000 in 1981) due to the combination of factors caused by the mother-child syndrome. These are: 1) congenital malformations caused by incest, young or advanced age of mothers; 2) diseases of the mother that cause fetal mortality: diabetes, arterial hypertension, eclampsia; 3) lack of breastfeeding and illiteracy of mothers; 4) public health diseases such as measles, malaria, diarrhea; 5) streptococcic infections and their complications such as anemia and tuberculosis. The last presentation made by Prof. Eusebe Alihonou from Benin on the "Perspectives and Priorities of Reproductive Health in Africa," concluded that the research priorities in Africa should be on health systems that lower utilization rates of services and resources and on epidemiological studies that identify health problems and analyze the risk factors. The Symposium concluded that the research priorities should be: maternal morbidity and mortality; adolescents and reproduction and the morbidity and mortality of infants and children.
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PMID:[Network of researchers on the health aspects of reproduction]. 1234 30

Almost every birth in developed countries is attended by a trained person, but nearly half the births in developing countries get no such assistance. Nearly all pregnant women in developed countries receive prenatal care, but fewer than 6 in 10 receive it in the developing world. The updated World Health Organization (WHO) document Coverage of Maternity Care: A Tabulation of Available Information outlines the worldwide extent of trained attendance at birth, prenatal care, and delivery in a health institution. Currently in developing countries, 55% of births are attended by trained personnel, 37% take place in health institutions, and 59% of pregnant women receive prenatal care. In developed countries, the proportions are 99%, 95%, and 98%, respectively. In developing countries each year, almost 80 million babies are born at home and between 55 and 60 million infants are delivered with the help of only untrained traditional birth attendants or family members. Since 1989 the situation has improved in southeastern Asia and in southern, middle and northern Africa. But half a million women die from the complications of pregnancy each year and a further 15 million develop long-term disabilities, indicating that wider coverage of maternity care is crucial. More than 150 million women become pregnant each year, of these, at least 15% (23 million) develop serious complications that need skilled treatment. And 12.5 million pregnant women have diseases that are aggravated by pregnancy such as malaria, hepatitis, tuberculosis or diabetes. Every year 12.6 million children die before they reach their fifth birthday. About 3 million die in the first week of life, largely as a result of poorly managed pregnancies and/or deliveries. Some 3.6 million babies have moderate or severe birth asphyxia and 25 million have low birth weight of less than 2500 gm. WHO urges that all women receive appropriate prenatal care during pregnancy and delivery and in the first critical hours and days of life.
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PMID:Millions of women lack maternity care. 1234 93

This article reports a three-pronged attack developed by WHO against the AIDS epidemic. WHO will focus on three aspects of the epidemic, namely, care for the more than 30 million people currently living with HIV/AIDS, reduction in mother-to-child transmission, and access to HIV/AIDS-related drugs. Although treatment in developing countries has led to a dramatic fall in deaths due to AIDS, there are still many people in Africa who have no access to palliative medicines, let alone antiretroviral therapies or drugs for treating opportunistic infections. Together with the UN Joint Programme for HIV/AIDS and other partners, WHO is working to make HIV drugs more affordable by negotiating with the pharmaceutical industry on the cost of individual drugs and different approaches to drug pricing. Moreover, there are nine priority areas that WHO will focus on in 2002-2003: improving health systems; fighting malaria; HIV/AIDS and tuberculosis; curbing the tobacco epidemic; improving maternal health; campaigning for safe blood; preventing and improving treatment of mental disorders; working to reduce cancer, cardiovascular disease, diabetes, and chronic respiratory diseases; improving food safety; and investing in change in WHO.
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PMID:WHO outlines three-pronged attack against AIDS epidemic. 1234 44

Interleukin-12 (IL-12) is an important regulatory cytokine in infection and immunity. Administration of IL-12 may reduce complications of severe malaria in rodents. Polymorphisms in IL12B, the gene encoding the IL-12 p40 subunit, influence the secretion of IL-12 and susceptibility to Type 1 diabetes. We therefore investigated whether IL12B polymorphisms may affect the outcome of severe malaria. Homozygosity for a polymorphism in the IL12B promoter was associated with increased mortality in Tanzanian children having cerebral malaria but not in Kenyan children with severe malaria. Furthermore, homozygotes for the IL12B promotor polymorphism had decreased production of nitric oxide, which is in part regulated by IL-12 activity. These studies suggest that IL12B polymorphisms, via regulation of IL-12 production, may influence the outcome of malaria infection in at least one African population.
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PMID:A promoter polymorphism in the gene encoding interleukin-12 p40 (IL12B) is associated with mortality from cerebral malaria and with reduced nitric oxide production. 1242 23

Alfa-Galactosyl Ceramide was isolated from Ocean sponge which has antitumor effect against several tumors in in vivo animal model with no cytotoxicity. KRN7000(KRN) is the most potent alpha-Galactosyl Ceramide modified from the one isolated from Ocean sponge. KRN is also active against metastatic tumors through the activation ofanimal immune system. Research efforts in learning the mechanism of action, we found the important role of dendritic cells(DC) and NKT cells. NKT cells was first characterized in 1988 which is overlap some part with NK cells and T-Cells and majority is different from NK and T. KRN is active through the activation of DC and NKT in giving antigen specific immune stimulation in animal. This antigen specific stimulation is memorized by immune system and can reject second tumor challenge. KRN is not active in nude mice and NKT deficient animal. NKT cells level in blood is lower in patients with autoimmune disease, cancer, HIV positive or aplastic anemia. NKT rapidly releases IL-4 and IFN-gamma at high level when activated. NKT is CD1d and TCR restricted. NKT plays important role in autoimmune disease such as Type 1 Diabetes, Scleroderma and Systemic Lupus Erythematosus, infections such as Mycobacteria, Listeria and Malaria, GVHD control and tumor rejection. NKT acts as double edge sword, aggressive and suppressive ways. KRN can prevent the onset of Type 1 Diabetes, inhibit replication of hepatitis virus B in liver and suppress malaria replication in activating NKT cells. KRN can activate NKT through DC and activated NKT activates NK, T and macrophage. KRN also expands NKT cells and expanded NKT has full function. Although the exact role of DC and NKT is not clear, KRN clinical study results in conjunction with DC and NKT cell activation are expected.
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PMID:Role of NKT cells and alpha-galactosyl ceramide. 1243 Aug 64

The mean number of complement receptor 1 (CR1) molecules on erythrocytes differs between normal individuals within the range of 100-1000 molecules per cell. In some disease states such as systemic lupus erythematosus (SLE), acquired immune deficiency syndrome (AIDS), insulin-dependent diabetes mellitus and malaria, erythrocyte CR1 levels are reduced and CR1 function may be impaired. Current methods for determining erythrocyte CR1 levels by flow cytometry require the use of freshly drawn blood samples because CR1 is lost from erythrocytes during storage. In order to facilitate field studies of associations between erythrocyte CR1 levels and disease, we have developed and validated an assay to quantify CR1 on both healthy and diseased erythrocytes that have been fixed in 5% formaldehyde or frozen in glycerol. These methods enable blood samples to be collected in areas lacking the facilities for flow cytometry and stored for later accurate quantification of CR1. Such procedures will be of particular benefit for future investigations of erythrocyte CR1 expression level and malaria susceptibility.
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PMID:A simple method for accurate quantification of complement receptor 1 on erythrocytes preserved by fixing or freezing. 1244 29

A review of six patients requiring medical assessment prior to joining commercial mountaineering trips. Medical problems encountered include malaria risk with immunosuppression, renal transplant recipients climbing at altitude, coronary artery disease risk at altitude, cardiac pacemaker function at altitude, and diabetes with remote-area travel. Cases also illustrate personal and commercial risk assessment and potential international differences in legal duty of care. It is hoped that these cases will stimulate debate and thought regarding the preventive aspects of altitude-related medical problems. This can be achieved by education of the general mountaineering population in altitude- and expedition-related medical matters, combined with individual pretrip advice for patients.
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PMID:Six selected cases from a year's experience as advisory doctor to a commercial mountaineering expedition company. 1271 16

The major health problems in Africa are AIDS, tuberculosis, malaria, gastroenteritis and hypertension; hypertension affects about 20% of the adult population. Renal disease, especially glomerular disease, is more prevalent in Africa and seems to be of a more severe form than that found in Western countries. The most common mode of presentation is the nephrotic syndrome, with the age of onset at five to eight years. It is estimated that 2 to 3% of medical admissions in tropical countries are due to renal-related complaints, the majority being the glomerulonephritides. There are no reliable statistics for ESRD in all African countries. Statistics of the South African Dialysis and Transplant Registry (SADTR) reflect the patients selected for renal replacement therapy (RRT) and do not accurately reflect the etiology of chronic renal failure (CRF), where public sector state facilities will offer RRT only to patients who are eligible for a transplant. In 1994, glomerulonephritis was recorded as the cause of ESRD in 1771 (52.1%) and hypertension in 1549 (45.6%) of patients by the SADTR. In a six-year study of 3632 patients with ESRD, based on SADTR statistics, hypertension was reported to be the cause of ESRD in 4.3% of whites, 34.6% of blacks, 20.9% mixed race group and 13.8% of Indians. Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans, with hypertension accounting for 16% of all hospital admissions. In a ten-year study of 368 patients with chronic renal failure in Nigeria, the etiology of renal failure was undetermined in 62%. Of the remaining patients whose etiology was ascertained, hypertension accounted for 61%, diabetes mellitus for 11% and chronic glomerulonephritis for 5.9%. Patients with CRF constituted 10% of all medical admissions in this center. Chronic glomerulonephritis and hypertension are principal causes of CRF in tropical Africa and East Africa, together with diabetes mellitus and obstructive uropathy. The availability of dialysis and transplantation is quite variable in Africa: treatment rates in North Africa are 30 to 186.5 per million population (pmp) in countries with more established programs: Algeria 78.5; Egypt 129.3; Libya 30; Morocco 55.6; Tunisia 186.5 pmp. In South Africa, treatment rates of 99 pmp were reported; Dialysis and transplant programs in the rest of Africa are dependent on the availability of funding and donors. Services are still predominantly urban and therefore generally inaccessible to the poorer, less educated rural patient. There is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. The goal should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living donor and cadaver). Efforts should be made to optimize therapy of renal disease and renal failure globally and particularly in developing countries. Strategies should be developed to screen for and manage conditions such as hypertension and diabetes mellitus at the primary healthcare level in an effort to decrease the incidence of chronic renal failure. Increasingly, health is influenced by social and economic circumstances. Any improvements in health thus demand integrated, comprehensive action against all the determinants of ill health.
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PMID:End-stage renal disease in sub-Saharan and South Africa. 1286 89

In this cross-sectional study, 8,481 women aged 15-49 who had at least one pregnancy outcome were considered. This study aimed to examine the characteristics of Filipino women having had a pregnancy loss, and to test the association between domestic violence and pregnancy loss. To control for the confounding effect of the number of pregnancies, the sample was divided into seven groups classified by the number of pregnancies. The risk factors considered were demographic characters (age and partner's age, marital status, and place of residence), socioeconomic status (education and partner's education, having a paid helper at home, having a say in how income was spent), domestic violence (physical abuse and forced sex), sexual behavior of partner, whether the pregnancy was wanted, and disease history (tuberculosis, diabetes, hypertension, malaria, hepatitis, kidney disease, heart disease, anemia, goiter and other medical problems). The major risk factors were found to be physical abuse, region, faithfulness of partners, hypertension, hepatitis, kidney disease, anemia, and the other medical problems, respectively. The risk of pregnancy loss for the women suffering domestic violence was 1.59 (95% CI 1.28-1.97) times higher than for the women who did not. Women aged 15-19 years had a much higher risk of pregnancy loss than the other age groups (OR = 1.49, 95% CI 1.22-1.82). There were similar risk for women aged 20-24 years (OR = 1.08, 95% CI 0.94-1.25) and 35-39 years (OR = 1.05, 95% CI 0.92-1.19). No association emerged with marital status, socioeconomic status, forced sex, the number of partners, unwanted pregnancy, tuberculosis, diabetes, malaria, heart disease, and goiter. Although women's age, partner's age, residence, women's education, partner's education, and paid helper at home were significantly associated with pregnancy loss, they were likely to be confounders rather than risk factors.
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PMID:Pregnancy loss in the Philippines. 1297 77


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