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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

While AIDS seizes the headlines, other sexually transmitted diseases (STDs) create devastation of their own. In women STDs can lead to pelvic inflammatory disease, causing lifelong pain, infertility, and ectopic pregnancy, which can kill. Children are born with blinding eye infections. Men are left infertile. People die of advanced stages of syphilis. Furthermore, STDs multiply the transmissibility of HIV, the AIDS virus, as much as ninefold.
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PMID:Population reports. Controlling sexually transmitted diseases. 823 82

Currently, more than 50% of married women of childbearing age are using a form of contraception. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries increased from 31 to 381 million, in East Asia from 18 to 217 million, in Latin America from 4 to 44 million, in South Asia from 8 to 94 million, and in Africa from 2 to 18 million. WHO has recently estimated that over 500,000 women die each year from causes related to pregnancy and childbirth. With a worldwide estimate of 36-53 million induced abortions performed each year, between 125,000 and 170,000 women die each year because of unsafe abortions. According to data from the World Fertility Survey, short spacing between births raises the average chances of offspring dying in infancy by 60-70% and the chances of dying before the age of 5 years by about 50%. WHO's minimal estimate for yearly incidence of bacterial and viral STDs (excluding HIV infection) is 130 million. Most STDs have more serious sequelae in women than in men and lead to pelvic inflammatory disease (PID), permanent infertility, and the risk of ectopic pregnancy. African countries with high incidence of STDs have the lowest prevalences of contraceptive use. A recent examination of the WHO international data base of 22,908 IUD insertions and 51,399 woman-years of follow-up indicates that the occurrence of PID in IUD users is most strongly related to the insertion process and to background STD risk and suggests that PID is an infrequent occurrence after the insertion period. A WHO Scientific Working Group review confirmed the beneficial effects of oral contraceptives in reducing the risk of ovarian cancer, endometrial cancer, and biopsy-proven benign breast diseases. A WHO collaborative study in 5 centers in Kenya, Mexico, and Thailand provided assurance that women who used DMPA for a long time and who initiated use many years previously are not at increased risk of breast cancer.
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PMID:Contraception and women's health. 832 13

Chlamydia trachomatis genital infections are among the most common sexually transmitted diseases in the United States today. Although these organisms are obligate intracellular pathogens, they more closely resemble bacteria than viruses. C. trachomatis is responsible for considerable morbidity in women, causing urethritis, cervicitis, endometritis, and pelvic inflammatory disease. The latter complication is associated with a high incidence of infertility and ectopic pregnancy, even when the infection is asymptomatic. In young men, C. trachomatis is a common cause of urethritis and epididymitis. Diagnostic tests include tissue culture which has the greatest sensitivity and specificity but is difficult and costly, and various antigen assays which are useful in high-risk, high-prevalence populations. Treatment is effective with doxycycline or erythromycin, but success also depends on appropriate follow-up and empiric treatment of sexual partners. Control of C. trachomatis genital infections is crucial to the control of all sexually transmitted diseases including HIV infection.
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PMID:Chlamydia trachomatis genital infections. 837 72

There is an increased attention to preconception care and counseling (PCC) in the US. Midwives should include it into their practice. Even though the PCC concept is new, many midwives already know and/or practice its components, including risk assessment, health promotion, psychological and medical interventions, and follow-up. Opportunities for PCC are gynecology visits, postpartum visits, school-based programs, occupational health centers, and local health departments. Midwives can help women decide whether they are psychologically prepared for motherhood through group discussions and family-timing scenarios. They should refer women to substance abuse counseling and address physical abuse. A medical history and physical exam followed by an evaluation of any medical problems are also important. Preconception screening should include laboratory tests for hemoglobin or hematocrit, Rh factor, rubella titer, urine dipstick (protein and sugar), Pap smear, gonococcal culture, syphilis ...... and hepatitis B test. Midwives should offer women an illicit drug screen and an HIV serodiagnostic test. Additional tests recommended for some women include a tuberculosis screen, chlamydia culture or rapid screen, toxoplasmosis, herpes simplex, cytomegalovirus, varicella, hemoglobinopathies, Tay-Sachs, and karyotype. Factors which may affect sperm morphology are cigarette smoking, alcohol drinking, vitamins A and E, linoleic acid, and zinc. Other male factors which may affect pregnancy outcome are advanced age, sexually transmitted diseases, HIV, and exposure to drugs and chemicals. Midwives should determine the need to refer women for genetic counseling. They can help establish a positive environment for conception by conducting a nutritional history and counseling; promoting vitamin supplementation; by counseling about dangers of cigarette smoking, alcohol drinking, and drugs; and by keeping up to date on reproductive toxicology, environmental pollutants, and occupational hazards. Midwives should take a menstrual, contraceptive, and sexual history. Menstrual charting can help detect ovulation. Other issues needing to be addressed are infertility and choosing a care provider and birth place.
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PMID:Preconception care. An opportunity to maximize health in pregnancy. 841 Mar 47

Prior to the introduction of apartheid in South Africa in the 1940-50 period, the total fertility rate of Whites was 3.5 children per woman, compared with an average of 6.5 for the other racial groups. In the 1960s, family planning services were offered, and the state paid for the cost of contraceptives. In 1974, a national family planning program was initiated to provide clinical, counseling, and information services. Recently, policy has been adjusted by the national Population Development Program (PDP) which was established in 1984. PDP objectives are: 1) to stabilize the national population at 80 million people by the end of the next century by using family planning services; 2) to accelerate equal social and economic development of all population groups are increasing education, manpower training, the economic productivity of women, job creation, and adequate housing; 3) to achieve a national total fertility rate of 2.1 children per woman by the year 2010; 4) to promote basic good health among all population groups by stressing primary health care; and 5) to achieve orderly geographical distribution of the population in the rural areas. There are 3800 family planning clinics offering modern contraceptives services at 60,200 points. These services points include infertility treatment as well as education about reproductive health, HIV/AIDS, and other sexually transmitted diseases. The 1982, the Black Fertility Survey showed that among ever-married Blacks, 43.2% and 40.2% of contraceptive users aged 15-19 and 20-29, respectively, used injectable contraceptives. In 1987-90, oral contraceptive use was about the same for Black and Colored women but 20% of Colored women were sterilized vs. only about 4% of Black women. An assessment showed a decline in the national total fertility rate from 4.6 children per woman in 1986 to 4.2 in 1990. The African National Congress (ANC) is interested in integrating social and economic programs with women's development and family planning programs. ANC Policy Guidelines stress Sex Education and family planning as part of a future national health program and post-apartheid population policy.
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PMID:Population policy in South Africa. 847 22

WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year. STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection. HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs. PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache. STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections. Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission. HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus. Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection. Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections. Tourists are responsible for introducing HIV infection into many countries. Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries. Health resources are not keeping up with the spread of STDs and HIV. Governments should embark on health education campaigns to stem the spread of HIV. They should also integrate AIDS prevention with the control of other STDs.
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PMID:Sexually transmitted diseases in the age of AIDS. 847 83

In 1992, state legislatures considered more than 1300 measures dealing with abortion, family planning, sexuality education, infertility, maternal and infant health, sexually transmitted diseases, and AIDS. Fewer than 115 bills were approved, and 21 were later vetoed. 320 abortion bills (2/3 antiabortion measures) were introduced. There were 2 abortion referenda, 31 measures on women's right to abortion were introduced in 17 states, and 24 bills to prohibit most abortions were submitted in 10 states. 3 of the 63 parental involvement measures were approved. 41 counseling or waiting period bills were introduced in 24 states, but just one, in Kansas, was enacted. 16 bills to protect clinic employees, and patients from violence were introduced in 10 states, and 2 were enacted. 62 bills introduced in 26 states concerned family planning and contracepted issues, with many related to hormonal implants; one was enacted and one was vetoed. 73 bills on sexuality or health education were introduced; 5 were enacted, 1 was vetoed and 2 resolutions were adopted. 35 bills on teenage pregnancy prevention and care programs were proposed, with 2 enacted. 22 bills on school health services were proposed, with 1 enacted. 380 bills were introduced on early intervention for prenatal and infant care, prevention and treatment for pregnant women using alcohol and drugs, infertility insurance coverage, and family or medical leave for mothers. More than 40 were signed into law. Several of the 103 measures on prenatal care programs and insurance coverage dealt with Medicaid. Most of the 62 bills pertaining to the abuse of substances during pregnancy dealt with testing and treatment, the rest addressed criminal charges against the pregnant or postpartum women involved. 20 bills regarding infertility insurance benefits were introduced; none was enacted. 34 bills were enacted of the 455 introduced on issues related to STDs and AIDS. By the end of 1992, 33 states mandated some form of HIV or AIDS education in the public schools, 14 states encouraged it, and 3 had no policy.
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PMID:State legislation on reproductive health in 1992: what was proposed and enacted. 849 Dec 91

US fertility surveys were conducted during 1955-70 and were formally instituted under the National Survey of Family Growth (NSFG) during 1973-88. Telephone reinterviews were conducted in 1990. This paper reviews findings from about 50 studies based on the NSFG in 1988 and 1990 and identifies changes in survey data and methods. Findings pertain to variables on intercourse and union formation, conception and contraceptive use, gestation, and fertility-related issues. Policy issues are discussed that relate to adolescent pregnancy, adoption, use of family planning services, maternal-child health, and HIV and sexually transmitted disease prevention. Cycle 5, which is scheduled for the NSFG in 1995, will be redesigned to accommodate policy needs. Changes will include increased coverage of explanatory patterns, such as family background, and inclusion of event histories for cohabitation and marriage, sexual partnerships, work, education, and past living arrangements with parents and grandparents. Measurement will improve for fertility-related variables that may explain unintended pregnancy. Such measures will cover consistency of contraceptive use, characteristics of sexual partners, women's attitudes about their pregnancies, family planning and infertility services, and other health care use measures. The 1995 survey will make a qualitative shift to computer-assisted personal interviewing. Abortion reporting will be more complete, due, in part, to the use of audio-assisted computer interviewing. Data collection occurred during January-October 1995. Trends during 1988-90 include higher rates of cohabitation, and large racial differences in the proportions who never married. There were increases in premarital sex behavior and in births to unmarried women. Perception of economic opportunity was associated with a greater likelihood of contraceptive use at first intercourse. Female sterilization was the leading method among women aged 30-34 years. First year failure rates were higher among low income women. Infertility and teenage pregnancy remained stable. Unintended fertility, which was strongly related to low education and income, older age, and Black race, was very high at 57% of all pregnancies.
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PMID:Understanding U.S. fertility: continuity and change in the National Survey of Family Growth, 1988-1995. 882 9

In the US, when one of the two hospitals involved in a merger is a Catholic hospital, comprehensive reproductive health care tends to suffer. The Catholic Church forbids its hospitals from providing and making direct referrals for many reproductive health services (i.e., reversible contraception, infertility treatments, male and female sterilization, abortion, condoms for HIV prevention, and emergency contraception). These mergers are especially severe in small towns and rural areas. Several groups have formed to address this hidden crisis. In Troy, New York, a settlement was reached about 12 months after a law suit was filed against the conditions of a merger between a Catholic hospital and a nonsectarian hospital. After a long fight, the settlement essentially guaranteed that patients who are dependent on religious institutions obtain the contraceptive and sterilization services they need and want, but abortion services and referrals continued to be denied. The state of Montana considered the impact of a merger of a Catholic institution and a nonsectarian institution, yet continued availability of all reproductive health services was not guaranteed. The American Civil Liberties Union asked the Federal Trade Commission (FTC) to investigate the merger's impact on reproductive health care, since the merger created a monopoly on acute care in Great Falls. FTC took no action. Key factors to provision of reproductive health services other than abortion in cases of mergers between a Catholic hospital and a nonsectarian hospital include the type of association the two hospitals enter into, the local bishop's willingness to accept a creative solution, and the willingness of the state to consider the implications of such a merger and take steps to guarantee the continued availability of services. State reproductive health care advocacy groups (e.g., MergerWatch in New York) are increasing public awareness of the risks these mergers pose and helping residents ensure that reproductive health services remain available. Pressures to reduce costs will likely require Catholic hospitals to continue to merge with nonsectarian hospitals.
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PMID:Hospital mergers and reproductive health care. 895 20

Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.
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PMID:Current methods of laboratory diagnosis of Chlamydia trachomatis infections. 945 34


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