Search

The article focuses on a study examining the prevalence of urinary incontinence, urinary sensory symptoms, and dyspareunia and their associations among sexually active Chinese women between the ages of 15 and 34. It states that there was a linear increase of urinary incontinence prevalence with age, while dyspareunia was associated with primary level of education, an earlier sexual debut, and membership of a minority ethic community. It talked about the association of dyspareunia with urinary symptoms.

CONTEXT: A cultural preference for sons may be a factor driving recourse to abortion in India, as women carrying female fetuses may decide to terminate their pregnancies. To assess this hypothesis, more information on the incidence of abortion, and on maternal and social correlates of the procedure, is needed. METHODS: Birth order-specific abortion ratios were calculated using the birth histories of 90,303 ever-married women aged 15–49 who participated in India's 1998-1999 National Family Health Survey. For the first four births, the association between abortion and various maternal and social variables, including the sex of the respondent's last child, was assessed using logistic regression. RESULTS: The overall abortion ratio was 17.0 per 1,000 pregnancies. The ratio increased from 5.3 per 1,000 pregnancies for first-order births to 25.8 per 1,000 pregnancies for third-order births and then declined. The strongest predictor of abortion was maternal education: Women with at least a primary education were more likely than those with no education to have had an abortion (odds ratios, 1.9–6.7). Rural residence was associated with a reduced likelihood of abortion (0.6). There was no association between the sex of a woman's previous child and the odds that she subsequently had an abortion. CONCLUSION: At the national level, it is likely that unintended pregnancy, rather than the sex of the previous child, underlies demand for abortion in India. Rising educational attainment among women may lead to an increase in the demand for abortion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Chronic pelvic pain (CPP) is a common condition in women, and care experiences are distressing and unsatisfactory for many. Research suggests that elements of the initial hospital consultation influence clinical outcome. This study aimed to identify the dimensions through which initial consultations were subsequently recalled at follow-up. Method: A questionnaire study of 100 women, 6 months following a hospital gynaecology consultation for CPP, was conducted. Measures of pain and ratings of the medical consultation were completed at initial consultation and at follow-up. Results: Follow-up questionnaire items loaded to constructs of “affect”, “expectation”, and “cognition”, forming three subscales. Patients'' initial ratings of the consultation and scores on all three subscales measured at follow-up were correlated, remaining significant for both affect and expectation after controlling for current pain status. Conclusion: Doctor''s affect and the appropriateness of information to meet expectations are important influences on experiences of care and contribute to the long-term therapeutic element of the consultation. [Copyright &y& Elsevier]

Abstract: Objective: The interval between births is associated with child survival in the developing world. We aimed to investigate associations between use of depot-medroxyprogesterone acetate and other reversible contraception and short birth intervals in sub-Saharan Africa. Methods: Data from successive Demographic and Health Surveys undertaken in nine African countries were analyzed. Logistic regression was used to explain changes in the proportion of short birth intervals in four countries with relatively high use of reversible contraception. Findings: The overall odds ratio for the trend was 0.90 (95% CI 0.84 to 0.95) and this was unaffected by adjusting for the other variables. The odds of a short birth interval were reduced by exclusive breastfeeding (OR 0.67, 95% CI 0.58 to 0.78) and increased by use of injectable contraception (OR 1.23, 95% CI 1.11 to 1.38). Conclusion: The proportion of short birth intervals has changed little over the last decade in a context of very low use of the intrauterine device. Widespread adoption of injectable contraception is associated with greater odds of a short birth interval, thus not contributing favorable conditions for improved child health. [Copyright &y& Elsevier]

This study estimated birth order-specific miscarriage rates and characterized the influence of maternal age using the complete birth history of 90,303 ever-married women from the 1998–2000 Indian National Family Health Survey. Rates of miscarriage in India were low in association with early childbearing, whereas birth order as well as age substantially influenced miscarriage risk. [Copyright &y& Elsevier]

Presents an editorial about pelvic girdle pain in pregnancy. How such pain is common during pregnancy and can cause substantial distress and disruption of function; Lack of standard definitions for such pain; Importance of understanding the cause of the pain; Recommended treatment for this type of pain in the United Kingdom.

The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998–1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n=11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access. [Copyright &y& Elsevier]

: ObjectiveDeveloping country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries.: DesignQualitative study using semi-structured interviews.: SettingIndia and Yemen.: SampleForty-one doctors working in obstetrics, gynaecology, general practice and family planning services.: MethodsInterviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis.Main outcome measures: ResultsDoctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice.: ConclusionsPriorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge. [Copyright &y& Elsevier]

We aimed to document the demographic and clinical characteristics of women referred by primary care physicians for investigation of chronic pelvic pain to a university hospital gynecology outpatient clinic and to test the hypothesis that specific patient features and the quality of doctor/patient communication at the initial consultation would influence pain Out- comes. A clinical questionnaire, visual analog scales for pain, and instruments for hostility and the experience of the consultation were administered at the initial clinic attendance to 105 consecutive women. Follow-up pain scores were obtained 6 months later from 98 women. The mean hostility score was highly significantly elevated compared with normative data (p < 0.001). In a logistic regression model a favorable patient rating of the initial consultation was associated with complete recovery at follow-up and interacted significantly with whether or not exercise was impaired (p < 0.005). For those in whom symptoms persisted, significant factors found by multiple regression models to predict continuing pain levels were the initial level of pain, the number of functions of daily life impaired, endometriosis, and the doctor who carried out the initial consultation. Patient hostility scores and the doctor's level of experience or gender were not significantly associated with continuing pain. This study highlights the importance of good communication as a basis for successful treatment of a group of hostile patients and indicates the influence in individual doctors of subtle attitudinal and personality factors that modify patients' experience of the medical consultation. [ABSTRACT FROM AUTHOR]

Objective To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China. Methods We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China. The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002. Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables. Findings Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively. Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions. The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births. The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test. Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P < 0.001). Conclusion The upsurge in rates of births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure. [ABSTRACT FROM AUTHOR]

This study aimed to identify socio-cultural and reproductive health correlates of knowledge about AIDS among rural women using multivariate analysis of 1998-1999 National Family Health Survey (NFHS) data from two Indian states, Maharashtra and Tamil Nadu, where the urban HIV prevalence is relatively high. Analysis using multiple logistic regression was undertaken, modelling women's knowledge of AIDS, of whether the disease can be avoided, and of effective means of protection. Although 47% of all rural women in Maharashtra were aware of AIDS only about 28% knew that one can avoid it, and only about 16% possessed correct knowledge about its transmission. In Tamil Nadu, where overall 82% of rural women had awareness of AIDS, about 71% knew that one can avoid the disease but only about 31% possessed correct knowledge about its transmission. In both states, women from socially and economically backward groups had lower odds both of having awareness of AIDS and knowledge of ways to avoid getting the disease. Associations with socio-cultural and reproductive variables and the impact of contact with family planning services differed in the two states. The spread of the epidemic to rural areas presents a need actively to disseminate AIDS related knowledge for health protection rather than waiting for knowledge to follow the appearance of the disease in communities. Approaches to health promotion that do not consider differing contextual factors are unlikely to succeed. In particular, innovative strategies to disseminate knowledge among disadvantaged population groups are needed. [ABSTRACT FROM AUTHOR]