Measurement of condom use as a risk factor for HIV infection

Correct and consistent condom use can prevent susceptible people from acquiring HIV infection. However, in many countries repeated cross-sectional studies reveal a trend of increasing prevalence of HIV infection alongside an increase in reported condom use. Changes in sexual behaviour that reduce the number of new HIV infections will not become apparent through changes in HIV prevalence until some time after the behaviour change takes place. Limitations in the data used to assess condom use may also explain the concurrent increases in condom use and HIV prevalence. One common indicator of condom use, the UNGASS indicator (condom use at last higher risk sex of those aged 15-24), has been chosen to illustrate how changes in the proportion of people who report using condoms do not always explain changes in the size of the group who had high risk behaviour. Indicators based on the proportion of the whole population who have sex without using a condom would be better measures of the size of the group at highest risk of HIV infection.     

Psychosexual behavior as a risk factor for cervix cancer]

Seventy-two patients with cervical cancer (n = 24), ovarian cancer (n = 24), or no disease (n = 24) were questioned about sexual activity and personal relationships. The interviews were conducted in a semistandardized fashion according to the Tübingen Sexual Therapy Scale. Patients with invasive cervical cancer did not have a larger number of sexual partners, an earlier age of first intercourse, greater sexual activity or less stable relationships than patients with ovarian cancer of healthy women. There was no statistical difference among the groups with regard to the relationships. However, patients with cervical cancer reported greater degrees of satisfaction with both sexuality and relationships.     

Heterosexual transmission of HIV infection]

The AIDS epidemic has spread rapidly in Africa among the urban impoverished where multiple sexual partners and sexually transmitted diseases are common. Over 80% of the 9 million Africans who will develop AIDS before the year 2000 will have been contaminated sexually. Poverty, multiple sexual partners in the framework of prostitution, and drug addiction are responsible for rapid spread of HIV infection in Southeast Asia, the West India, and Brazil. Drug addiction has played a major role in diffusion of HIV into the general population of Europe and the US. Prevalence rates are much higher in sexually transmitted disease centers in France and the US than among blood donors or pregnant women. Sexually transmitted diseases and heterosexual transmission have been studied in Africas since diagnostic tests became available. Several studies, the majority conducted among prostitutes in Nairobi or Kinshasa and their clients, allow establishment of a list of sexually transmitted diseases associated with increased risk of seroconversion. Genital ulcers within the past 6 months presented a relative risk of 2-4 depending on the series. Urethral or cervical gonorrhea has a lower relative risk of 1.2 in most studies. Absence of circumcision was also a risk factor. Studies were subsequently conducted in Europe on factors favoring sexual transmission. 513 heterosexual couples together for a minimum duration of 18 months and an average of 38 months were included in the Multicenter European Study conducted in 10 centers in 9 countries. The "index" subject was male in 400 cases and female in 113. At entry into the study, 73 of 400 males (18.2%) and 10 of 113 females (8.8%) had already infected their partners. Duration of union, frequency of intercourse, mode of transmission of the index subject, and oral contraceptive use had no effect on risk of transmission. Factors increasing risk of infection included the severity of immunosuppression of the index subject, whether judged by clinical classification of stage 4 vs. earlier stages, or by a level of CD4 lymphocytes of under 200 vs. over 200. The overall relative risk is 2.4 if there is a history of sexually transmitted disease in the past 5 years. Women are particularly vulnerable to the risk of sodomy, with a relative risk of 5.1 and an increase in there risk of transmission from 11.3 to 40%. Age over 45 is associated with an increase from 17 to 44% and a relative risk of 3.4 in women, probably because of greater fragility of the mucus in the postmenopausal period. For men, the relative risk of intercourse during menstruation is 9.6 and the rate increases from 3% to 20%. The greater risk of male to female transmission confirms impressions of earlier studies but should not be regarded as definitive. Condom use was shown to be effective in follow- up of discordant couples. 9 seroconversions occurred in an average follow-up of 12 months among 89 couples not using condoms, compared to 0 in 80 couples regularly using them.     

生殖活动与子宫内膜异位症发病的关系

通过对２０３例盆腔子宫内膜异位症（异位症）病例和４０６例随机抽样对照人群的流行病学调查，发现生殖活动可能减少异位症的发生。曾足月妊娠分娩１次即可使发病相对危险度（ＲＲ）下降为０．３４；两次以上者的ＲＲ值降至０．０８。妊娠次数对发病尤明显的保护作用。人工流产和口服避孕药与发病无明显的相关性。不孕患者发病的相对危险度明显增高，但二含之间的因果关系尚不明确。初孕年龄对异位症的发病未发现有何影响。     

Role of the placenta in perinatal transmission of HIV

The role of the placental tissue in the perinatal transmission of HIV is still far from being understood. Significant data regarding transplacental infection have been collected, but differences in technique have led to controversy. It appears clear that many Hofbauer cells are CD4+ and can become infected with HIV. Less certain but probable is infection of trophoblasts themselves. Whether infection is CD4 mediated or via cell-cell fusion is not established. Transplacental traffic of virus and cells remains a little-studied possibility. Further data are needed regarding the fascinating concept of the placenta as a modulator of infection.     

Smoking as a risk factor in the health of women.

It is estimated that more than 200 million women smoke worldwide. It is also estimated that if current smoking rates among men and women persist worldwide, by 2025, 9% of the world's deaths and disabilities will be related to tobacco use. Smoking is associated with an increased risk of cardiovascular disease, cancer (lung, cervix, pancreas, kidney, bladder, esophagus, pharynx), pulmonary disorders, cerebrovascular disease, and many other health risks. Smoking also adversely affects fertility and reproductive outcomes. Although a greater percentage of women smoke in developed than in developing countries, women in developing countries appear to be initiating smoking habits in increasing numbers. If current trends persist, the adverse effects of smoking on women's health clearly will continue to escalate.     

Sperm as infection-potentiating cofactors in HIV transmission

In this paper I will discuss the possible role of sperm as cofactors in the genital-mucosal transmission of HIV. The ideas involved arose from my laboratory's discovery that sperm bind to HLA-DR molecules expressed on somatic cells, and from our subsequent findings that lymphocytes are activated by these interactions. Sperm binding to HLA-DR mimics one of the two ligand binding characteristics of superantigens, which also bind to T-cell receptors in a V-beta-specific fashion. This property of sperm may be significant in HIV transmission because: (a) HLA-DR plays a central role in immune recognition and response; and (b) cell interactions involving HLA-DR are involved in HIV infection and disease development. After sexual contact, sperm elicit a transient leukocytic infiltration of the mammalian cervix (Thompson, L.A., Barratt, C.L., Bolton, A.E., Cooke, I.D., 1992. The leukocytic reaction of the human cervix. Am. J. Reprod. Immunol. 28, 85; Pandya, I.J., Cohen, J., 1985. The leukocytic reaction of the human uterine cervix to sperm. Fertil. Steril. 43, 417), and human cervical cells are bound and penetrated by sperm at this time (Sievers-Altermann, R., Engelbrecht, D.V., 1990. Entry of spermatozoa into the cervical mucosa and transmission of the AIDS virus. S. Afr. Med. J. 77, 319). At present, little is known about these in vivo events, but sperm-somatic cell interactions in vitro are also followed by sperm entry into the target cell cytoplasm and target cell activation. When the target cells are leukocytes, sperm interactions increase their susceptibility to HIV infection. If similar interactions occur in the cervicovaginal environment after sexual contact, they are likely to enhance the genital-mucosal transfer of HIV from semen.     

Transcervical embryo transfer as a risk factor for ectopic pregnancy.

OBJECTIVE: To evaluate the ease and timing of transcervical ET as risk factors for ectopic pregnancy (EP) after IVF. DESIGN: Retrospective study. SETTING: University-based IVF program in the United Kingdom. PATIENT(S): Eighteen consecutively seen patients with an EP after IVF and 314 patients with an intrauterine pregnancy after transcervical ET performed during the same period. INTERVENTION(S): Additional manipulation with a transfer catheter or the use of other instruments to assist transfer. Embryo transfer on day 2 or 3 after oocyte retrieval. MAIN OUTCOME MEASURE(S): Risk factors for EP (day 2 ET, difficult transfer overall and on days 2 and 3, history of tubal subfertility, and previous EP) presented as odds ratios with 95% confidence intervals. RESULT(S): The risk of EP was 2.26 (0.64-8.01) after day 2 ET, 3.91 (1.49-10.23) after difficult ET, 3.88 (1.34-11.24) after difficult ET on day 2, 2.7 (0.20-13.99) after difficult ET on day 3, 5.73 (1.99-16.62) when there was a history of tubal subfertility, and 5.41 (1.96-14.91) when there was a previous EP. CONCLUSION(S): A difficult ET significantly increases the risk of an EP. The risk is particularly high when the patient has a history of tubal damage or previous EP. The timing of ET is important only if the ET is difficult.     

Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy.

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiologic role of controlled ovarian hyperstimulation in a population with no previous history of ectopic pregnancy. Ovulation induction alone was associated with an increased risk of ectopic pregnancy (adjusted odds ratio = 3.98; 95% confidence interval 1.10-14.30). In contrast, ovulation induction for in vitro fertilization did not increase the risk further (adjusted odds ratio = 2.45; 95% confidence interval 0.54-11.13). These results suggest that hormonal factors may be involved in the development of ectopic pregnancy.     

Duration of ruptured membranes and extended labor are risk factors for HIV transmission.

OBJECTIVES: To determine the effects of duration of ruptured membranes (DRM) and duration of labor in HIV transmission. METHODS: A retrospective cohort study of 366 HIV-infected pregnant women and their infants analyzed the effects of these two variables; the cut-off point for transmission increase was estimated using a ROC curve. A multivariate analysis was performed with the most important risk factors according to the literature: maternal age, lymphocyte count, use of invasive procedures during gestation, antiretroviral treatment during pregnancy and labor, mode of delivery, newborn weight, DRM, labor duration, and the interaction of these last two factors. RESULTS: The cut-off points were estimated at 6 h for DRM and at 5 h for labor duration. A lymphocyte count below 500 cells/ml, use of invasive procedures, use of antiretroviral treatment during pregnancy and interaction between DRM, and labor duration remained significant in perinatal HIV transmission (P<0.05). CONCLUSIONS: An increased DRM increased perinatal HIV transmission when it was associated with prolonged labor.     

Obesity as a risk factor for endometrial cancer

The epidemiology and risk factors for endometrial cancer are reviewed, with current data. Obesity seems to be the main risk factor for this neoplasia, both because it is very common in the female population, and because the other risk factor (i.e. estrogen replacement therapy) has almost disappeared with the addition of progesterone therapy. The pathogenesis of obesity as risk factor, although it is not completely clear and unique, is examined.     

Obesity as a risk factor for premenstrual syndrome

Purpose: To determine the association between obesity and Premenstrual Syndrome (PMS).

Methods: A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18–44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index.

Results: The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI ??30) had nearly a three-fold increased risk for PMS than non-obese women OR?=?2.8 (95% CI?=?1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers.

Conclusion: This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.     

Obesity as a risk factor for premenstrual syndrome

PURPOSE: To determine the association between obesity and Premenstrual Syndrome (PMS). METHODS: A cross-sectional study was conducted using a random-digit dialing method. The sampling frame consisted of all possible area codes, exchanges, and 4-digit suffixes in Virginia. A total of 874 women between the ages of 18-44 residing in the state of Virginia between August 1 and September 15, 1994 were interviewed. Cases were defined as women who reported severe or extreme PMS symptom changes using the Shortened Premenstrual Assessment Form. The main exposure variable was obesity as measured by Body Mass Index. RESULTS: The prevalence of PMS in Virginia was 10.3 percent. Obese women (BMI > or = 30) had nearly a three-fold increased risk for PMS than non-obese women OR = 2.8 (95% CI = 1.1, 7.2). PMS was more prevalent among whites, younger women, and smokers. CONCLUSION: This data provided evidence that obesity is strongly associated with PMS. Since obesity is a modifiable risk factor, PMS management strategies should not only consider factors such as, high stress, and smoking but also obesity.     

Heterosexual transmission: A Growing Risk factor for HIV Spread

Summary: The risk of human immunodeficiency virus (HIV) spread by heterosexual contact is emerging as a risk factor for women in Sydney in the 1990's. As shown by this study, heterosexual exposure to the virus accounted for 40% of women in Western Sydney acquiring the disease between 1989–1991 inclusive, compared with O% in 1982–1985 inclusive. Further public awareness of this mode of transmission and information on safe sex practices is necessary to limit the spread of the AIDS virus.     

Studies on factor affecting mother-to-child HTLV-I transmission]

Epidemiological data indicate that breast feeding is the primary route of mother-to-child transmission of HTLV-I. However, serological studies show that 60 to 90% of infants who are fed breast milk from HTLV-I carriers avoid HTLV-I infection. To understand the mechanism of the virus transmission, the titer of HTLV-I antibodies and p40tax antibody and the copy number of the HTLV-I proviral DNA in peripheral lymphocytes in the HTLV-I carrier-mothers were surveyed. The seroprevalence of HTLV-I in the children born to carrier mothers was 6.1% in a normal breast feeding group, 7.7% in a group fed with freeze-thawed breast milk and none in a bottle-fed group. The difference between the seroconversion rate for the normal breast feeding group and others was statistically insignificant. Our studies also indicated that neither the titer of HTLV-I antibodies in carriers nor the duration of breast feeding was relevant to seroconversion in the children. The seroconversion rate in children was higher in p40tax antibody-positive mothers than in a seronegative group, but the difference was statistically insignificant. In conclusion, the copy number of the HTLV-I provirus in the lymphocytes of the carrier mothers was the most relevant factor in the seroconversion of infants who received breast milk from HTLV-I carriers.